Thiazides and Related Diuretics

Preferred list (P)

INDAPAMIDE

  • Modified release preparation is non-formulary.

Total list (T)

BENDROFLUMETHIAZIDE

Loop Diuretics

Preferred list (P)

FUROSEMIDE

Total list (T)

BUMETANIDE

  • A treatment option in patients that do not respond to Furosemide.
  • 1mg BUMETANIDE is equivalent to 40mg FUROSEMIDE, although this should not be used for direct substitution at higher doses (Martindale, July 2021).

Sources:
Martindale: The Complete Drug Reference is available via MedicinesComplete.

Potassium-Sparing Diuretics and Aldosterone Antagonists

Preferred list (P)

SPIRONOLACTONE

Specialist initiation (S1)

EPLERENONE

  • Reserve use for:
    • Patients with left ventricular systolic dysfunction accompanied by evidence of heart failure, both manifesting within 3-14 days of myocardial infarction.
    • An addition to standard optimal therapy, to reduce the risk of cardiovascular mortality and morbidity in adult patients with NYHA class II (chronic) heart failure and left ventricular systolic dysfunction (LVEF ≤30%).

  • Dose: Initially 25 mg daily, then increased to 50 mg daily, within 4 weeks of initial treatment.

Prescribing Notes:

  • Potassium–sparing diuretics should be used with caution in renal impairment.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.