|Therapeutic Area||Formulary Choices||Cost for 28|
(unless otherwise stated)
|Rationale for decision / comments|
|Antithrombotic drugs, Antiplatelet drugs|
|Aspirin - suitable for self-care||75mg dispersible tablet: £0.73||Enteric coated aspirin is non-formulary as current evidence suggests it does not exert a demonstrably protective effect on the gastric mucosa and its effect in the secondary prevention of arterial thrombosis is unclear.
Offer pregnant women at increased risk of pre-eclampsia at the booking appointment a prescription of 75 mg to 150 mg of aspirin to take daily from 12 weeks until birth.
Offer aspirin (300 mg daily), unless contraindicated, to people who have had a suspected TIA, to be started immediately.
Offer secondary prevention, in addition to aspirin, as soon as possible after the diagnosis of TIA is confirmed.
Offer the following as soon as possible, but certainly within 24 hours, to everyone presenting with acute stroke who has had a diagnosis of intracerebral haemorrhage excluded by brain imaging:
• aspirin 300 mg orally if they do not have dysphagia or
• aspirin 300 mg rectally or by enteral tube if they do have dysphagia.
Continue aspirin daily 300 mg until 2 weeks after the onset of stroke symptoms, at which time start definitive long-term antithrombotic treatment. Start people on long-term treatment earlier if they are being discharged before 2 weeks.
Offer a proton pump inhibitor, in addition to aspirin, to anyone with acute ischaemic stroke for whom previous dyspepsia associated with aspirin is reported.
Offer an alternative antiplatelet agent to anyone with acute ischaemic stroke who is allergic to or genuinely intolerant of aspirin.
Ensure that people with disabling ischaemic stroke who are in atrial fibrillation are treated with aspirin 300 mg for the first 2 weeks before anticoagulation treatment is considered.
For people with prosthetic valves who have disabling cerebral infarction and who are at significant risk of haemorrhagic transformation, stop anticoagulation treatment for 1 week and substitute aspirin 300 mg.
Ensure that people with ischaemic stroke and symptomatic proximal deep vein thrombosis or pulmonary embolism receive anticoagulation treatment in preference to treatment with aspirin unless there are other contraindications to anticoagulation.
For secondary prevention, offer people who have had MI treatment with dual antiplatelet therapy (aspirin plus a second antiplatelet) unless they have a separate indication for anticoagulation.
Consider aspirin 75 mg daily for people with stable angina, taking into account the risk of bleeding and comorbidities.
For acute tension-type headache and migraine, take 1 to 3 (300mg) tablets with water, every 4 hours. Do not take more than 4 doses in any 24 hours.
Antiplatelets should not be prescribed routinely for the primary prevention of cardiovascular disease, however, they may be considered in people at high risk of stroke or myocardial infarction.
Do not offer aspirin monotherapy solely for stroke prevention to people with atrial fibrillation.
Do not offer antiplatelet therapy (aspirin or clopidogrel) to adults with type 2 diabetes without cardiovascular disease.
Because of the association with Reye's syndrome, preparations containing aspirin should not be offered to under 16s.
|300mg dispersible tablet: £1.23 (32)|
|NHS Somerset classify Aspirin enteric coated and modified release as Black (not recommended) as per Traffic light guidance.|
|Clopidogrel||75mg tablet: £1.36||Clopidogrel is recommended as an option to prevent occlusive vascular events (including TIA):
• for people who have had an ischaemic stroke or who have peripheral arterial disease or multivascular disease or
• for people who have had a myocardial infarction only if aspirin is contraindicated or not tolerated.
Treatment with clopidogrel to prevent occlusive vascular events should be started with the least costly licensed preparation.
|Dipyridamole||200mg modified-release capsule: £13.15 (60)||Modified-release dipyridamole in combination with aspirin is recommended as an option to prevent occlusive vascular events:
• for people who have had a transient ischaemic attack or
• for people who have had an ischaemic stroke only if clopidogrel is contraindicated or not tolerated.
Modified-release dipyridamole alone is recommended as an option to prevent occlusive vascular events:
• for people who have had an ischaemic stroke only if aspirin and clopidogrel are contraindicated or not tolerated or
• for people who have had a transient ischaemic attack only if aspirin is contraindicated or not tolerated.
|Prasugrel||5mg tablet: £37.60|
|10mg tablet: £7.50|
|Ticagrelor||60mg tablet: £54.60|
|90mg tablet: £54.60|
|90mg orodispersible tablet sugar free: £54.60|