REMEDY : BNSSG referral pathways & Joint Formulary

Home > Formulary : Paediatric > Paediatric Chapters > 2. Cardiovascular system >

BNSSG Paediatric Joint Formulary

2.4 Blood pressure conditions

Last edited: 30-05-2024

First line drugs Second line drugs Specialist drugs Secondary care drugs

2.4.1 Hypertension

Secondary Care to maintain responsibility for monitoring amber specialist initiated drugs in the cardiovascular section of the Paediatric formulary. A clear management plan detailed in the clinic letter is required to support primary care prescribing. GP Practices should ensure a plan is in place before taking over prescribing responsibility

Angiotensin Converting Enzyme (ACE) Inhibitors

Enalapril (TLS Amber specialist initiated)

Lisinopril (TLS Amber specialist initiated)

Captopril (TLS Amber specialist initiated)


Angiotensin-II Receptor Antagonists

Indicated for those intolerant to ACE inhibitors

See the MHRA guidance for recommendations on use during pregnancy.

Losartan (TLS Amber specialist initiated)

  • Also used for Marfan's disease & Loey Dietz disease

Irbesartan (TLS Amber specialist initiated)


Antihypertensives (Centrally acting)

Clonidine (TLS Red)


Beta-adrenoceptor Blocking Drugs

Propranolol (TLS Amber specialist initiated)

Carvedilol (TLS Amber specialist initiated)

Metoprolol (TLS Amber specialist initiated) 

  • Used in genotype specific long QT syndrome

Nadolol (TLS Amber specialist initiated)

Atenolol (TLS Amber specialist initiated)

Esmolol (intravenous) (TLS Red)

Specific indications:

Labetalol (intravenous) (TLS Red)

  • For severe cardiac left ventricular systolic dysfunction and dilated cardiomyopathy. See local guideline


Calcium-channel Blockers

Amlodipine (TLS Amber specialist initiated) 

Diltiazem  immediate and modified-release (TLS Amber specialist initiated)

  • Prescribe modified release preparations by brand

Nifedipine capsules non modified-release (TLS Amber specialist initiated)

  • Raynaud's Phenomenon / ITU /Renal

Verapamil immediate and modified-release (TLS Amber specialist initiated)


Peripheral Vasodilators

Hydralazine (TLS Red)


Thiazides and Related Diuretics 

Chlorothiazide (TLS Amber Specialist Recommended)

Bendroflumethiazide 2.5mg tablets (TLS Amber Specialist Initiated)

Specific Indications:

Metolazone (unlicensed) (TLS Red)

  • For use in combination with a loop diuretic


2.4.3 Hypertensive crises

Diazoxide (TLS Red)

Sodium nitroprusside (TLS Red)

  • There may be delays in obtaining unlicensed product


2.4.4 Pulmonary hypertension

As per NHS England Clinical Commissioning Policy: National policy for targeted therapies for pulmonary hypertension in adults. A11/P/b and amendment to National Policy to include functional class II. NHSCB A11/P/a


Endothelin Receptor Antagonists

Bosentan (oral) (TLS Red)


Phosphodiesterase type-5

Sildenafil (oral) (TLS Red)

Tadalafil (oral) (TLS Red)


Prostaglandins (Cardiovascular)

Epoprostenol (intravenous) (TLS Red)



Tolazoline (TLS Red)

  • NICU for pulmonary vasospasm


2.4.5 Hypotension and shock

Sympathomimetics (vasoconstrictor)

Adrenaline (epinephrine) 1 in 1000 (1mg/mL) (TLS Green)

Adrenaline (epinephrine) 1 in 10,000 (100micrograms/mL) only in secondary care (TLS Red)

Noradrenaline (norepinephrine) (TLS Green)

Ephedrine (TLS Red)

Phenylephrine (TLS Red)

Specific indication:

Ephedrine hydrochloride (tablets) (unlicensed indication) (TLS Red)

  • For use post spinal cord injuries