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BNSSG Adult Joint Formulary

2.5 Heart Failure

Last edited: 16-04-2024

First line drugs Second line drugs Specialist drugs Secondary care drugs


See BNSSG Primary Care Heart Failure Treatment Guidance, Practical Guidance on how to use Heart Failure medications, Traffic Light: How to monitor renal function and potassium rises in stable heart failure patients - guidelines available here

Angiotensin Receptor Neprilysin Inhibitor

Sacubitril / Valsartan (Entresto) (TLS Amber 1 month) (SCP Click here)


Aldosterone Antagonists

Specific indications:

Spironolactone (TLS Blue)

  • Heart Failure
  • Hypertension (Step 4)
  • Oedema in liver cirrhosis
  • Conn's Syndrome

Eplerenone (TLS Amber Specialist Recommended) 

  • In 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 dysfunction (LEVF ≤30%)


Sodium Glucose Co-transporter 2 Inhibitors

See Endocrine System Guidelines page for the 'Advice on the use of SGLT-2 inhibitors in Type 2 Diabetes, Heart Failure and Chronic Kidney Disease' aide memoire

Dapagliflozin (TLS Amber Specialist Recommended)

Empagliflozin (TLS Amber Specialist Recommended)


Phosphodiesterase Type-3 Inhibitors

Enoximone (TLS Red)

Milrinone (TLS Red)



Vericiguat (TLS Red)

  • For the treatment of symptomatic chronic heart failure with reduced ejection fraction who are stabilised after a recent decompensation event requiring IV therapy. This treatment is reserved for patients who are on optimised standard therapy with a recent decompensation who have exhausted all other options under the care of the secondary care cardiology team


2.5.2 Cardiomyopathy

Obstructive Hypertrophic Cardiomyopathy

Mavacamten (TLS Red)

  • TA913 Mavacamten for treating symptomatic obstructive hypertrophic cardiomyopathy


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