Calgary Zone LTC Formulary Autosubstitution List

Transcription

1 Calgary Zone LTC Formulary Autosubstitution List PURPOSE ASL-01 In order to simplify drug therapy, orders for one medication may be automatically substituted using a different, but therapeutically equivalent medication. These substitutions are approved by the Calgary Zone LTC Pharmacy and Therapeutics Committee. The rationale for autosubstitutions may vary by drug product, but the typical motivating factors for any given product may be (in no particular order): - Ease of medication regimen - Decreasing number and variability of available medication (i.e. decreasing overall items of drug inventory to reduce workload on pharmacy and nursing staff) - Cost of therapy - Clinical effect must be non-inferior to original, ordered therapy Note: Autosubstitutions are considered mandatory in all circumstances unless there is clear rationale for use of an alternate agent. Any exemption from autosubstitutions requires application under the NF process and may or may not be approved by AHS (with the exception of the initial grace period upon admission or re-admission to a Long-Term Care facility). acetaminophen ER (Tylenol Arthritis 650 mg bid or q12h acetaminophen immediate 325 mg qid Pain ) 650 mg tid or q8h release 500 mg qid 1300 mg bid or q12h 650 mg qid 1300 mg tid or q8h 1000mg qid acyclovir (Zovirax ) 5 times a day valacyclovir (Valtrex ) Refer to renal dosing guidelines alendronate (Fosamax ) any strength risedronate (Actonel ) 35 mg weekly ampicillin (Penbritin ) mg qid amoxicillin (Amoxil ) mg tid bimatoprost (Lumigan RC ) 0.01% latanoprost (Xalatan ) 0.005% calcium 1000 mg (elemental) daily calcium 500 mg (elemental) bid calcium carbonate (Tums Ultra, Tums 400 mg or 200 mg Tums Extra Strength (or 300 mg elemental Regular Strength) elemental calcium LCA) calcium Cascara as supplied Senokot 8.6 mg ciclopirox (Loprox ) Cream/Lotion 1% clotrimazole (Canesten ) cream/solution 1%

2 clarithromycin (Biaxin ) mg bid azithromycin (Zithromax ) unless meets Restricted Status (RS 30) criteria 500 mg then 250mg daily on day 1 daily X 4 days Or daily x 3 days Or 500 mg clioquinol/flumetasone (Locacorten Vioform ) Cream/Ointment as supplied betamethasone/nystatin cream (1:1) 0.1%/ unit cefaclor (Ceclor ) mg tid cefuroxime (Ceftin ) mg bid Cerumenex any formulation mineral Oil (heavy) as supplied Combivent Nebulizer Sol n as supplied salbutamol (Ventolin )/ ipratropium (Atrovent ) single agent MDIs unless meets Restricted Status (RS 21) criteria 100mcg cyanocobalamin (vitamin B12) any oral 1-500mcg cyanocobalamin (vitamin 500mcg tablet formulation B12) oral form, regular release cyanocobalamin (vitamin B12) any oral formulation 501mcg and above dosing cyanocobalamin (vitamin B12) oral form, regular release 1000mcg tablet diclofenac topical, single entity any strength other than 2.32% (compounded or - commercial product) scheduled diclofenac diethylamine gel (Voltaren Emulgel ). 2.32% maximum BID (if orginally ordered as daily, may continue with daily) diclofenac topical, single entity any strength other than 2.32% (compounded or commercial product) - PRN diclofenac diethylamine gel (Voltaren Emulgel ). 2.32% darifenacin (Enablex ) 7.5mg PO dose solifenacin (Vesicare ) 5mg PO dose dextromethorphan cough suppressant, single entity, sustained-release (e.g.delsym ) q12h (scheduled or 30mg/5mL PRN) erythromycin EC (Eryc ) 333 mg q8h erythromycin base (E- Mycin, Erythromid ) maximum BID PRN (if originally ordered as daily PRN, may continue with daily PRN) dextromethorphan formulary cough suppressant, regular release, single entity ( e.g. Balminil DM), 15mg/5mL q6h (scheduled or PRN) 250mg q6h

3 etidronate (Didronel, Didrocal ) any strength risedronate (Actonel ) 35 mg weekly famciclovir TID (for herpes 500 mg zoster) valacyclovir 1000 mg TID x 7 days (primary herpes simplex) 250mg TID 1000 mg BID x 7 days (recurrence herpes simplex) 250mg TID 1000 mg daily x 3 days (suppression of herpes simplex) 250mg BID 500 mg daily (primary episode mucocutaneous herpes simplex) 500mg BID 1000 mg BID x 7 days (recurrent mucocutaneous herpes simplex) 1500 mg daily 2000 mg BID x 1 day famotidine (Pepcid ) 20 mg ranitidine (Zantac ) 150 mg fenofibrate, microcoated (Lipidil Supra) 100 mg once daily fenofibrate, micronized (Lipidil Micro) 134 mg (2 x 67 mg caps) once daily fenofibrate (Lipidil, Apo-Fenofibrate 100 mg TID fenofibrate, micronized (Lipidil Micro) 200 mg once daily fenofibrate, microcoated (Lipidil Supra) 160 mg once daily fenofibrate, nanocrystals (Lipidil EZ) 145 mg once daily gentamicin ophthalmic drops or 0.30% tobramycin ophthalmic drops 0.10% ointment or ointment heme iron polypeptide 11 mg ferrous gluconate 300 mg insulin human biosynthetic regular (Novolin ge Toronto) 100 unit/ml insulin human biosynthetic isophane (Novolin ge NPH) 100 unit/ml insulin human biosynthetic regular (Humulin R) 100 unit/ml same dose, same frequence insulin human biosynthetic isophane (Humulin N) 100 unit/ml same dose, same frequence

4 insulin human biosynthetic insulin human biosynthetic regular / insulin human biosynthetic isophane (Novolin ge 30/70) 30 unit/ml * 70 unit/ml regular / insulin human biosynthetic isophane (Humulin 30/70) 30 unit/ml * 70 unit/ml same dose, same frequence ipratropium (Atrovent ) Nebulizer 0.25 mg ipratropium bromide Inhaler 2 puffs Solution 0.5 mg unless meets Restricted 4 puffs ketoconazole (Nizoral ) 2% clotrimazole (Canesten ) 1% lactobacillus (Bacid ) as supplied saccharomyces (Florastor ) as supplied equivalent dose nitrofurantoin macrocrystals/ 100 mg bid nitrofurantoin regular tablets 50 mg qid monohydrate (MacroBID ) (AA Pharma) magnesium hydroxide (Milk milk of magnesia/paraffin (Magnolax ) as supplied of Magnesia ) as supplied miconazole (Monistat ) 2% clotrimazole (Canesten ) 1% mupirocin (Bactroban ) as supplied Polysporin as supplied metronidazole topical gel for Rosacea: once daily 0.75% metronidazole topical gel 1% for other indications: metronidazole topical cream 0.75% metronidazole topical cream 1% metronidazole vaginal gel 0.75% metronidazole vaginal cream 10% mineral oil light mineral oil heavy same dose, same frequence nifedipine (Adalat ) nifedipine (Adalat ) 5 mg 10 mg nonsteroidal anti-inflammatory eye drops, non-formulary e.g. ketorolac, nepafenac as supplied nystatin (Mycostatin, Nilstat ) vaginal tabs for hypertensive crisis captopril (Capoten ) 12.5 mg for hypertensive crisis captopril (Capoten ) 25 mg diclofenac (Voltaren Ophtha ) 0.1% 0.1% clotrimazole (Canesten ) 200 mg vaginal tablets May be given sublingually. Auto-substitution does not apply to other indications. For other indications, nifedipine immediate release is nonformulary May be given sublingually. Auto-substitution does not apply to other indications. For other indications, nifedipine immediate release is nonformulary

5 ophthalmic lubricant eye drops (any non-formulary lubricant eye drop) as supplied carboxymethylcellulose, purite preservative (Refreshtype LCA) as supplied ophthalmic lubricant eye drops, preservative-free minims (any nonformulary, preservative-free lubricant eye drop) as supplied ophthalmic lubricant ointment (any non-formulary eye lubricant ointment/gel) as supplied carboxymethylcellulose, preservative-free minims (Celluvisc-type LCA) as supplied petrolatum / mineral oil (Lacri-Lube ) 3.5 gm. If MCS, may substitute with Systane Lubricant Eye Ointment 3.5 gm as supplied oxycodone (OxyNEO ) oxycodone CR (generic LCA) same strength oxycodone CR (generic LCA) oxycodone/naloxone (Targin ) 5mg/2.5mg 5mg penicillin G 500,000 unit penicillin V (PVF-K) 500,000 unit phenytoin (Dilantin Suspension) phenytoin (Dilantin ) tab/cap same dose salbutamol (Ventolin ) nebulizer Solution 2.5 mg salbutamol (Ventolin ) Inhaler; unless meets Restricted Status (RS 21) criteria 2 puffs

6 terbinafine (Lamisil ) Cream 1% clotrimazole (Canesten ) unless meets Restricted Status (RS-17) criteria 1% tolterodine LA (Detrol ) 2 mg solifenacin (Vesicare ) 5 mg travoprost (Travatan Z ) 0.004% latanoprost (Xalatan ) 0.005% 84:00 - Skin and Mucous Membrane Agents Low potency corticosteroid cream/ointment/lotion Topical Corticosteroid Low Potency examples : Hydrocortisone 1% cream/ointment/lotion Aclomethasone diproprionate cream, ointment % Desonide cream, ointment % Fluocinolone acetonide cream, ointment, solution % Hydrocortisone cream, lotion, ointment, solution, - 0.5% - 2.5% Hydrocortisone acetate cream, ointment - 0.5% -1% Medium potency corticosteroid cream/ointment/lotion Betamethasone valerate 0.1% formulary product in Medium Potency Corticosteroid Examples: Betamethasone valerate cream, ointment, lotion %- 0.1% Clocortolone pivalate cream - 0.1% Desoximetasone cream % Fluocinolone acetonide cream, ointment % Fluticasone proprionate cream % Fluticasone proprionate ointment % Hydrocortisone valerate cream, ointment - 0.2% Mometasone furoate cream, ointment, lotion - 0.1% Triamcinolone acetonide cream, ointment, lotion % - 0.1% High potency corticosteroid cream/ointment/lotion High Potency Corticosteroid examples: betamethasone diproprionate cream, ointment, lotion % -0.1% Desoximetasone cream, ointment % Desoximetasone gel % fluocinolone acetonide cream - 0.2% Fluocinonide cream, gel, ointment, solution % Halcinonide cream, ointment, solution - 0.1% Triamcinolone acetonide cream, ointment - 0.5% Very high potency corticosteroid cream/ointment/lotion Very high Potency Corticosteroid examples: halobetasol propionate 0.05% (Ultravate ), betamethasone dipropionate Glycol Base 0.05% (Diprolene ) Amcinonide cream/ointment/lotion 0.1% (if MCS, alternatively use betamethasone dipropionate 0.05%) clobetasol 17-propionate (Dermovate )

7 52:00 - Eye, Ear, Nose, and Throat (EENT) Preparations Initial/Acute Adult Dose (Rhinitis) Initial/Acute Adult Dose (Allergic Rhinitis)* budesonide (Rhinocort Turbuhaler) 100 mcg/actuation 2 actuations (200 mcg) in each nostril once daily [total daily dose: 400 mcg/day] ** budesonide aqueous (Rhinocort Aqua) 64 mcg/ 2 s (128 mcg) into or 1 (64 mcg) into each nostril twice daily [total daily dose: 256 mcg/day] budesonide aqueous (Rhinocort Aqua) 100 mcg/ 2 s (200 mcg) into or 1 (100 mcg) into each nostril twice daily [total daily dose: 400 mcg/day] fluticasone propionate (Flonase) 50 mcg/ 2 s (100mcg) into or 1 (50 mcg) in each nostril BID [total daily dose: 200 mcg/day] mometasone furoate (Nasonex) 50 mcg/ 2 s (100mcg) into [total daily dose: 200 mcg/day] triamcinolone acetonide aqueous nasal (Nasacort Aq) 55mcg/ 2 s (110 mcg) into [total daily dose: 220 mcg/day]

8 *Dose equivalents based on initial dosing for rhinitis-type indications. For maintenance dosing, titrate down to minimum effective dose. Consult CphA Monograph -Corticosteroids: Eye, Ear, Nose -for more detailed dosing guidelines