NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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2 Cardiovascular system

2.12 Lipid-regulating drugs

See the NHSGGC Guidelines for the Management of Cholesterol, available on the Clinical Guidelines Directory on StaffNet.

Preferred list
ATORVASTATIN (tablets)

Prescribing Notes:

For guidance on the management of cholesterol for primary and secondary prevention of coronary heart disease and stroke, see the NHSGGC Cholesterol Guidelines.

Excludes chewable tablets.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/60589.htm

SIMVASTATIN

Prescribing Notes:

  • The MHRA has issued updated advice on prescribing simvastatin based on information relating to the risk of myopathy and rhabdomyolysis. The changes include some additional medicines with which simvastatin is contraindicated and advice on a maximum recommended dose when simvastatin is taken with other medicines.
  • PostScript 71 offers further advice on how to manage patients prescribed simvastatin and these other interacting medicines
  • Caution in renal impairment (see BNF for details).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2870.htm

Total Formulary
ALIROCUMAB (injection)

Restrictions:

Restricted to use only on the advice of a lipid specialist in accordance with local protocol and implementation plan (in development) only in patients with:

  • heterozygous familial hypercholesterolaemia (HeFH) and LDL-C 5.0mmol/L as primary prevention of cardiovascular events
  • or patients with HeFH and LDL-C 3.5mmol/L as secondary prevention of cardiovascular event.

Prescribing Notes:

Use in other patient groups is subject to ongoing discussion.  All requests for this medicine are to come from lipid clinics.

EVOLOCUMAB (injection)

Restrictions:

Restricted to use only on the advice of a lipid specialist in accordance with local protocol and implementation plan (in development) only:

  • in patients with heterozygous familial hypercholesterolaemia (HeFH) and LDL-C ≥5.0 mmol/L for primary prevention of cardiovascular events 
  • in patients with HeFH and LDL-C ≥3.5 mmol/L for secondary prevention of cardiovascular events

Evolocumab is only Formulary when adminstered at a dose of 140mg every two weeks (i.e. excludes 420mg once monthly dosing).

Prescribing Notes:

Use in other patient groups is subject to ongoing discussion.   All requests for this medicine are to come from lipid clinics.

EZETIMIBE (tablets)

Restrictions:

Restricted to use in combination with a statin for secondary prevention of coronary heart disease and stroke where the goals of treatment are not met on the maximal tolerated dose of statin, in accordance with the NHSGGC Cholesterol Guidelines (March 2017) (Access to NHSGGC network required to open link).

Prescribing Notes:

Use of ezetimibe as monotherapy and for primary prevention remains non-Formulary.

Pravastatin

Restrictions: Restricted to use only in patients in whom drug interactions might pose a problem or for patients who are intolerant of simvastatin and atorvastatin

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2868.htm

ROSUVASTATIN

Restrictions:

Restricted to use only in patients who fail to reach target lipid levels in accordance with NHSGGC Lipid Lowering Guidelines or are intolerant of other statins. Doses of 40mg or higher should only be initiated by, or on the advice of a specialist. The use for primary prevention is not recommended by SMC and is non-Formulary.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/128042.htm