Calgary Long Term Care Formulary

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1 Page 1 of 10 Calgary Long Term Care Formulary Pharmacy & Therapeutics November 2018 Highlights

2 Page 2 of 10 Contents November Formulary Changes (Additions, Changes, Deletions)... 3 Other Formulary Updates... 3 June Formulary Changes (Additions, Changes, Deletions)... 4 Other Formulary Updates... 4 March Formulary Changes (Additions, Changes, Deletions)... 5 Other Formulary Updates... 6 November Formulary Changes (Additions, Changes)... 8 Other Formulary Updates... 8 June Formulary Changes (Additions, Changes)... 9 Other Formulary Updates... 9

3 Page 3 of 10 November 2018 Formulary Changes (Additions, Changes, Deletions) The following drug product(s) were added to the Calgary Zone Long Term Care Formulary. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Description Strength Dosage Route of Listing/Comments Form Administration pyridoxine (vitamin B6) 50 mg, 100 mg tablet oral Removed from Formulary (very low use/strength discontinued) losartan 25 mg, 50 mg, 100 mg, 150 mg tablet oral Added to Formulary and to Automatic Substitution List ACE Inhibitors and ARBs (ASL- 02) enoxaparin all strengths pre-filled syringes injection Added to Formulary as High Cost Drugs (HCD-06) dalteparin 3500 pre-filled injection Added to Formulary as High betamethasone dipropionate hydrocortisone 17- valerate unit/syringe syringe 0.05% cream, ointment & lotion 0.2% cream and topical topical Cost Drug (HCD-06) Added to Formulary and to Automatic Substitution List (ASL-01) Added to Formulary and to Automatic Substitution List (ASL-01) ointment clozapine 50 mg, 200 mg tablet oral Added to Formulary as High Cost Drug (HCD-06) Other Formulary Updates Formulary Policies and Procedures o Calgary Zone LTC Wardstock and Statbox lists (including Controlled Substances) were updated Formulary Medication Listing o Full Formulary Listing was updated See above table with changes

4 June 2018 Reminders: quetiapine 50 mg tablets are non-formulary ramipril 15 mg tablets are non-formulary Calgary Zone LTC Formulary Page 4 of 10 Automatic Substitution Lists o ASL-01 Automatic Substitution List Miscellaneous was updated o ASL-02 Automatic Substitution List -ACE Inhibitors and ARBS was updated Restricted Use Medications o Restricted Use Miscellaneous Drugs (RS-11) was updated Formulary Changes (Additions, Changes, Deletions) The following drug product(s) were added to the Calgary Zone Long Term Care Formulary. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Strength Dosage Form Route of Listing/Comments Description Administration atropine 1% drops ophthalmic Removed from Formulary (product discontinued) chlorhexidine compounded gel 0.12% - 1% gel oral Added chlorhexidine compounded gel to Formulary. glycopyrrolate compounded suspension Removed restrictions 0.5 mg/ml suspension oral Added glycopyrrolate oral compounded suspension (using powder) to Formulary metronidazole 1% gel, cream topical Formulary listing for topical gel or cream changed from 0.75% to 1% metronidazole 10% cream vaginal Formulary listing for vaginal gel changed from 0.75% to 10% mineral oil heavy liquid for topical/otic use Formulary listing changed from light to heavy Other Formulary Updates Formulary

5 Formulary Medication Listing list updated Restricted Status o RS-11 Misc. list updated to reflect chlorhexidine gel o RS-47 Metronidazole list updated Calgary Zone LTC Formulary Page 5 of 10 Automatic Substitution o ASL-01 updates Mineral oil, light (typically for otic use), will be auto-substituted to mineral oil, heavy. Mineral oil light is removed from Formulary Cerumenex will be auto-substituted to mineral oil, heavy. Nifedipine 5-10 mg will be auto-substituted to captopril mg when ordered for hypertensive crisis. Due to an intermittent manufacturer shortage of Lacri-lube, as an alternate substitution for when it is not available, Systane Lubricant eye ointment may be substituted. Automatic substitution for metronidazole topical cream or gel changed to 1% Automatic substitution for metronidazole vaginal cream changed to 10% March 2018 Formulary Changes (Additions, Changes, Deletions) The following drug product(s) were added to the Calgary Zone Long Term Care Formulary. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Description desmopressin acetate insulin detemir (Levemir) insulin glargine (Basaglar) Strength Dosage Form Route of Administration Listing/Comments 10 mcg/dose nasal spray inhaled (nasal) Strength updated in Formulary listing and RS-11 from 0.1mg/ml to 10mcg/dose. 100 unit/ml injectable subcutaneous Delisted from Formulary effective July 1, unit/ml injectable subcutaneous pre-filled pen Added to Formulary

6 insulin glargine (Lantus) insulin human biosynthetic regular (Novolin ge Toronto) insulin human biosynthetic isophane (Novolin ge NPH) insulin human biosynthetic regular / insulin human biosynthetic isophane (Novolin ge 30/70) 100 unit/ml injectable pre-filled pen subcutaneous 100 unit/ml injectable subcutaneous 100 unit/ml injectable subcutaneous 30 unit/ml * 70 unit/ml injectable subcutaneous Calgary Zone LTC Formulary Page 6 of 10 Moved from RS-44 to RS-11 RS-44 deleted. Transition period of 6 months (by Oct 1, 2018). Delisted from Formulary effective July 1, Autosubstitution will apply (ASL-01) midazolam 5 mg/ml injectable subcutaneous do not list eligible for nonformulary review morphine 2 mg/ml injectable subcutaneous Added to Formulary Restricted Misc. (RS-11). Other Formulary Updates Contact Information Long Term Care Providers list updated Formulary Formulary Medication Listing list updated Automatic Substitution o ASL-01 updates auto-substitution for Novolin ge Toronto, Novolin ge NPH and Novolin 30/70 Due to manufacturer shortage of amcinonide, betamethasone dipropionate 0.05% may be used as the auto-substitution for high potency corticosteroid creams/ointments or lotions in the interim.

7 Page 7 of 10 Clarification provided for auto-substitution PRN and daily use of diclofenac topical gels High Cost / Special Authorization o Influenza Antiviral Agents: Oseltamivir updated o Oseltamivir (SA-03) updated o Pregabalin (SA-28) updated o Direct Oral Anticoagulants (SA-29) new Restricted Use Medications o For all insulin products, the pre-filled disposable pens are considered the formulary listing. Insulin cartridges and vials are restricted to: a) a pre-filled pen is not available in the product line; or b) in situations where the LTC facility has approved the vial or cartridge as their site's preference through the site's P&T committee. o For all insulin products, resident-specific dispensing is preferred over supplying as wardstock. Any exceptions should be approved through the LTC facility's P&T committee. o RS-44 Basal Insulin (Glargine and Detemir) deleted. Lantus continues to be restricted and its restriction can now be found in RS-11 Miscellaneous. Basaglar is added to the formulary without restrictions. Levemir will be de-listed effective July 1, It will be eligible for non-formulary review. Antimicrobial Stewardship Under Resources link to Spectrum provided Education Under Other Topics of Interest Proton Pump Inhibitor Deprescribing and References. Thank you to AHS Drug Utilization and Stewardship for preparing this Drug and Therapeutics Backgrounder and for permission to share with the Calgary Zone LTC Formulary program. November 2017

8 Page 8 of 10 Formulary Changes (Additions, Changes) The following drug product(s) were added to the Calgary Zone Long Term Care Formulary. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Strength Dosage Form Route of Listing/Comments Description Administration Cholecalciferol units and Tablet/capsule Oral Formulary (vitamin D3) units Clodronate 400 mg Capsule Oral Formulary (restrictions removed) Alfacalcidol 0.25 mcg, 1 mcg Capsule Oral Formulary Tiotropium bromide (Spiriva Respimat) 2.5 mcg/dose Inhalation solution Inhaled (oral) Formulary Tiotropium bromide / olodaterol hydrochloride (Inspiolto Respimat) 2.5mcg/dose*2.5mcg/dose Inhalation solution Inhaled (oral) Formulary Other Formulary Updates Contact Information Long Term Care Providers list updated Antimicrobial Stewardship Antimicrobial Statements from P&T minor updates, including links and antibiogram summary AS-01: Antimicrobial Statements minor updates AS-02: Extended Use of Antimicrobials for Urinary Tract Infections minor updates AS-03: Antimicrobial Use in Conjunctivitis minor updates AS-04: Antibiogram Comparison: LTC vs. Community minor updates, including links and antibiogram Under Resources links updated

9 Page 9 of 10 June 2017 Formulary Changes (Additions, Changes) The following drug product(s) were added to the Calgary Zone Long Term Care Formulary. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Description Strength Dosage Form Route of Listing/Comments Administration Pregabalin 25 mg, 50 mg, 75 mg, 150 mg, 225 mg and 300 mg Capsule Oral Special Authorization See SA-28 Apixaban 2.5 mg & 5 mg Tablet Oral Dabigatran 75 mg, 110 mg Capsule Oral & 150 mg Rivaroxaban 10 mg, 15 mg & Tablet Oral 20 mg Special Authorization See SA-29-draft Other Formulary Updates Contact Information Long Term Care Providers list updated. Formulary Policies and Procedures Wardstock/Statbox Lists under Statbox optional: pantoprazole magnesium 40 mg added and rabeprazole 10 mg removed Automatic Substitution Automatic Substitution List-01 minor corrections. High Cost Drugs/Special Authorization Direct Oral Anticoagulants (DOACs) Apixaban, dabigatran and rivaroxaban (SA-29):

10 o o o o o Calgary Zone LTC Formulary Page 10 of 10 Listing under Special Authorization with criteria for funding. The DOAC form (draft version) will be made available through or by the pharmacy service providers The form is to be submitted only once following admission or prior to new starts provided funding criteria are met. If the clinical situation does not meet criteria, the applicant may submit a non-formulary request. Criteria for warfarin trial is included for atrial fibrillation funding. Additional criteria for funding includes review of drug selection, dose, risks and benefits, and alignment with resident s goals. Pregabalin (SA-28): o Listing under Special Authorization with criteria for funding. o The pregabalin form is to be submitted only once following admission or following new starts provided funding criteria are met. o Establishes gabapentin as Formulary First-Line agent/step therapy o Additional criteria for funding includes that non-pharmacological pain management strategies be in place and pregabalin be reviewed for ongoing effectiveness with regular medication reviews

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