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Milton Keynes Formulary
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.02.03  Expand sub section  Potassium-sparing diuretics and aldosterone antagonists
Amiloride hydrochloride
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Formulary
Green
  • Tablets 5mg
  • Oral solution - sugar free 5mg/5mL  
 
   
02.02.03  Expand sub section  Aldosterone antagonists
Eplerenone
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Formulary
Amber 2

Tablets 25mg, 50mg

Notes:

  • For use with standard therapy, to reduce risk of cardiovascular mortality and morbidity in stable patients with LVD (LVEF ≤40%) and clinical evidence of heart failure after recent MI or in patients with LVD (LVEF ≤30%) and chronic heart failure (NYHA II).
  • Therapy should be started within 3-14 days of event.
  • Eplerenone may be useful when patients have symptomatic gynaecomastia.
  • Plasma potassium levels should be checked before eplerenone is started, during the first week of treatment, and a month after starting. It is expected that treatment will be commenced within PHNT. GPs will then be asked to review potassium levels after one month of treatment and adjust the dose according to the table below:

 

Serum Potassium (mmol/L)

Action

Dose adjustment

< 5

Increase

25mg alternate days to 25mg OD

25mg OD to 50mg OD

 5.0 – 5.4

Maintain

No dose adjustment

5.5 – 5.9

Decrease

50mg OD to 25mg OD

25mg OD to 25mg alternate days

25mg alternate days to withhold

≥ 6.0

Withhold

N/A

 

  • Serum potassium should be assessed as needed periodically thereafter.
  • Elderly patients, diabetics, those with mild renal failure or mild to moderate hepatic failure should be monitored more frequently to ensure that normal potassium levels are maintained.
 
Link  NICE NG106: Chronic heart failure
   
Spironolactone
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Formulary
Green
  • Tablets 25mg, 50mg, 100mg
  • Oral Suspension 5mg/5mL, 10mg/5mL, 25mg/5mL, 50mg/5mL and 100mg/5mL

Notes:

  • Routine co-prescribing of potassium sparing diuretics in combination with thiazide or loop diuretics should be avoided except in patients where hypokalaemia has been demonstrated or in patients not taking an ACE inhibitor who are at risk from hypokalaemia, e.g. those with severe CHD and arrhythmias and those taking digoxin.
  • In severe heart failure, spironolactone added to other treatments in a low dose (e.g. 25mg daily) can reduce mortality and morbidity. Careful monitoring for hyperkalaemia and hypovolaemia is required especially for people taking other diuretics and/or ACE inhibitors.
  • Spironolactone has been shown to be carcinogenic in rodents. As a result the CSM has restricted its license to its use in oedema and ascites in cirrhosis of the liver, malignant ascites, congested cardiac failure, nephrotic syndrome and primary hyperaldosteronism.
 
Link  MHRA Drug Safety Update (Dec 2016)
   
 ....
 Non Formulary Items
Triamterene  (Dytac®)

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Routine prescribing within licensed indication  

Amber 1

Specialist recommendation followed by GP initiation and continuation  

Amber 2

Specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation   

Amber 3

Specialist initiation and stabilisation followed by GP continuation  

Amber SCG

Specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline  

Red

Hospital or specialist prescribing only  

Red Red

These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.  

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