INTERIM FORMULARY UPDATE

Transcription

1 INTERIM FORMULARY UPDATE The fllwing recmmendatins, made at the July 29, 2016 meeting f the Executive Frmulary Cmmittee, are apprved: Prduct(s) deleted frm the DADS/DSHS Drug Frmulary: Generic Name Brand Name Dsage frms t be deleted Dsage frms still available Aminphylline Injectin: 25 /ml Nne Suppsitry, rectal: 250 Tablet: 200 Salmeterl Serevent Aersl, inhalatin: 25 Pwder, inhalatin: 50 mcg mcg/dse Terbutaline Aersl, ral: 0.2 /actuatin Injectin: 1 /ml Tablet: 2.5, 5 Thephylline Capsule, timed release (12 Nne hur): 130, 260 Capsule, timed release (24 hur); 100, 200, Slutin, ral: 80 /15 ml, 150 /15 ml Tablet, immediate release (Sl-phyllin ): 100, 125, 200, 250, Tablet, timed release: Thelair SR (8-12 hur): 100, 200, 250,, 500 The-Dur (8-24 hur): 100, 200,, 450 Thephylline SR (12-24 hur): 100, 200, Uniphyl (24 hur): 400 Tablet, timed release (12 hur): 100, 200, Triamcinlne Aersl, ral, inhalatin: 100 mcg/metered spray Aersl, tpical: 0.2/2 secnd spray Cream, tpical: 0.025%, 0.1%, 0.5% Ltin, tpical: 0.25%, 0.1% Ointment, tpical: 0.25%, 0.1%, 0.5% Spray, intranasal: 55 mcg/actuatin [100 Brmpheniraminepseudephedrine Capsule: Brmpheniramine 12 pseudephedrine `20 Elixir: brmpheniramine 4 pseudephedrine 30 Liquid: brmpheniramine 12 pseudephedrine 1 per 5 ml Syrup: brmpheniramine 2 pseudephedrine 30 Tablet, sustained release: brmpheniramine 8 pseudephedrine 120 sprays/canister] Liquid: brmpheniramine 15 pseudephedrine 1 per 5 ml Tablet: brmpheniramine 4 pseudephedrine 60 Page 1

2 Generic Name Brand Name Dsage frms t be deleted Dsage frms still available Chlrpheniramine Capsule: 12 Tablet: 8, 12 Tablet, chewable: 2 Syrup: 2 /5 ml Tablet: 4 Tablet, timed release: 12 Tablet, timed release: 8 Diphenhydramine Tablet: 50 Capsule: 25, 50 Cream, tpical:2% Injectin: 50 /ml Liquid, ral: 12.5 /5 ml Phenylephrine Slutin, nasal, drps: 0.25%, 0.5% Pseudephedrine Tablet, timed release: 120 Tablet, extended release: 240 Triprlidinepseudephedrine Guaifenesin Capsule, extended release: Triprlidine 5 pseudephedrine 120 Syrup: Triprlidine 1.25 pseudephedrine 30 per 10 Caplet, sustained release: 600 Liquid, ral: 200 /5 ml Tablet: 100 Ltin: 1% Slutin, nasal, drps: 0.125% Slutin, nasal, spray: 0.25%,0.5%, 1% Slutin, phthalmic: 2.5%, 10% Liquid, ral: 15 /5 ml, 30 /5 ml Tablet, immediate release: 30, 60 Tablet, extended release: 120 Tablet: Triprlidine 2.5 pseudephedrine 60 Liquid, ral: 100 /5 ml Tablet: 200, 400 Tablet, sustained release: 600 Ptassium idide Slutin, ral: 100 /ml Slutin, ral: 1 g/ml Cetirizine Tablet, chew: 5, 10 Syrup: 1 /ml Tablet: 5, 10 Hydrxyzine Suspensin: 25 /5 ml Tablet: 100 Capsule: 25, 50, 100 Injectin, as hydrchlride: 25 /ml, 50 /ml Syrup, as hydrchlride: 10 /5 ml Tablet: 10, 25, 50 Other Recmmendatin(s)/additin(s)/revisins(s) t the tables listed in the DADS/DSHS Drug Frmulary Fr this Dermatlgical sectin the fllwing changes were recmmended: Acne Sectin Benzyl Perxide Delete: Bar: 5% Cream, tpical 10% Gel, tpical: 2.5% Ltin: 10% Pads: 9% Erythrmycin-Benzyl Perxide (Benzamycin ) Change listing t: Gel, tpical: Erythrmycin 3% - Benzyl Perxide 5% (with 20% alchl) Salicylic Acid Sulfur Delete: Bar Cream Gel Sulfacetamide Sdium Delete trade name Sebizn Delete Gel: 10% Tretinin Gel Page 2

3 Delete Gel frm the listing Delete: Gel, tpical: 0.01% Liquid, tpical: 0.05% Anesthetics, Lcal Benzcaine Delete Spray: 5% Ethyl Chlride Delete all sizes Lidcaine Delete: Gel, tpical: 2.5% Liquid, tpical: 2.5%, 4% Ointment, tpical: 2.5% Mve Liquid, viscus 2% t muth and thrat sectin Pramxine Delete trade name Trnthane Delete - Ointment, tpical: 1% Anti-Histamine Agents Delete bttle sizes frm the fllwing prducts: Calamine-Zinc Oxide-Glycerin Calamine-Pramxine Delete diphenhydramine ltin: 1% Anti-Infectives Antibitics Bacitracin-Plymyxin B Delete Pwder, tpical: Bacitracin 500 units Plymyxin B 10,000 units/g Plymyxin B-Nemycin Delete Cream: Plymyxin B 10,000 units Nemycin 3.5 Deletin remves Plymyxin B-Nemycin frm the frmulary as there are n prducts with this cmbinatin Anti-Infectives Antiviral Acyclvir Change cream listing frm 0.5% t 5% Ointment, tpical 5% [50 /g] delete all sizes Anti-Infectives Antifungals Delete all trade names listed in this sectin Cltrimazle Delete Ltin: 1% Micnazle Delete Ltin: 2% Anti-Infectives Antipsriatics Cal Tar Delete trade names Inil-T, Tegrin, Pentrax, Plytar Delete the fllwing prducts: Cream, tpical: 2% Liquid, tpical: 30% Shamp: 5% Slutin, tpical: 120 ml, 480 ml Add Shamp: 0.5% Selenium Sulfide Delete trade name Selsun Anti-Infectives Antisebrrheic Agents Cal Tar Delete trade names Inil-T, Tegrin, Pentrax, Plytar Delete the fllwing prducts: Cream, tpical: 2% Page 3

4 Liquid, tpical: 30% Shamp: 5% Slutin, tpical: 120 ml, 480 ml Add Shamp: 0.5% Salicylic Acid-Sulfur Delete the fllwing prducts: Bar Cream Gel Selenium Sulfide Delete trade name Selsun Sulfacetamide Sdium Delete trade name Sebizn Anti-Infectives Antiseptics & Germicides Chlrhexidine delete trade names Hibiclens, Bactshield Hexachlrphene delete trade name phishex Pvidne-Idine Delete all package sizes Delete Cleanser, tpical Change Slutin, prep t Surgical Scrub: 7.5% Burn Agents Bacitracin delete trade name Baciguent Crticsterids Betamethasne diprpinate Delete Gel: 0.05% Flucinnide Delete trade name Lidex Delete the fllwing prducts: Cream, tpical:1%, 2.5% Ltin, tpical: 1%, 2%, 2.5% Ointment, tpical: 1%, 2.5% Betamethasne valerate Delete Cream, tpical: 0.01% Triamcinlne Delete trade names Aristcrt, Kenacrt Desnide Delete trade name Lkara Hydrcrtisne Delete trade names Lanacrt, Crticaine Delete Ltin, tpical: 0.5% Diaper Rash Agents Fr the diaper rash sectin, n specific prducts will be listed. Any prduct used as a Diaper Rash prduct will be cnsidered Frmulary Emllients Emllient Gel delete trade name Clinac O.C. Emllient Ltin delete trade names Allercreme, Lac-Hydrin Keratlytics Salicylic Acid Delete individual listings f prducts Add statement: All available salicylic acid prducts as a single agent are cnsidered t be n frmulary. Urea Delete percentages ff the listing which makes all percentages n frmulary Delete Shamp Ointments & Ltin Bases Change sectin title t Ointments Page 4

5 Petrlatum, white Delete package size frm Ointment, tpical Rubs and Liniments Menthl Menthl is rarely fund as an single ingredient List menthl nly with n prducts listed Menthl-Methyl salicylate Delete the strength (30%) frm the Cream, tpical listing Add: Ointment, tpical Skin Cleansers Abrasive Cleanser Delete the Abrasive Cleanser sectin as many f these cntain salicylic acid which is listed separately Salicylic Acid-Sulfur Delete the prduct listings and add the fllwing statement: All cmmercially available frms are n frmulary. Scabicides & Pediculicides Permethrin Delete trade name Acticin Change Shamp t Cream Rinse Pyrethins 0.33%-Pipernyl Butxide 4% Delete Shamp: 0.3% Skin Prtectants Benzin, Cmpund Tincture Delete sizes frm the listing Change the als cntains t may als cntain Zinc Oxide Delete the percentages frm the intment and paste entries which makes all percentages n frmulary Tar-Cntaining Agents Cal tar Delete trade names Inil-T, Tegrin, Pentrax, Plytar Delete the fllwing prducts: Cream, tpical: 2% Liquid, tpical: 30% Shamp: 5% Slutin, tpical: 120 ml, 480 ml Add Shamp: 0.5% Wund Agents Cllagenase Delete the strengths frm the intment, tpical listing Trypsin-balsam Peru-Castr Oil Delete the fllwing trade names GranulDerm, Vaslex, Xenaderm Change listings t: Aersl Ointment Wund Cleanser Change trade name t Karringtn Clara-Klenz Miscellaneus Dermatlgicals Trypsin-balsam Peru-Castr Oil Delete the fllwing trade names GranulDerm, Vaslex, Xenaderm Change listings t: Aersl Ointment New Dsage Strengths t be added t the frmulary Page 5

6 Add 1% - hydrcrtisne, 1 % fam (Prctfam HC) Based n the Nvel Oral Anticagulant Review Add the fllwing Generic Name Brand Name Dsage Frm Classificatin Rivarxaban Xarelt Tablet: 10, 15, 20 Anticagulant Other recmmendatin: Mve terbutaline t the Geniturinary Sectin. Apprved: Ann Richrads, Pharm.D., BCPP Ann Richards, Pharm., D., BCPP Pharmacy Services Directr San Antni State Hspital Page 6