Calgary Long Term Care Formulary Pharmacy & Therapeutics February 2015 Highlights http://www.albertahealthservices.ca/4070.aspx 1
Contents February 2016... 3 Added Product(s)... 3 Not Listed, Delisted or Discontinued Drug Products Removed from Formulary... 3 Other Formulary Updates... 3 November 2015 (Archived)... 5 Added Product(s)... 5 Not Listed, Delisted or Discontinued Drug Products Removed from Formulary... 6 Other Formulary Updates... 7 July 2015 (Archived)... 8 Added Product(s)... 8 Not Listed, Delisted or Discontinued Drug Products Removed from Formulary Listing... 9 Other Formulary Changes... 10 June 2014 (Archived)... 11 Added Product(s)... 11 Other Formulary Updates... 12 2
February 2016 Added Product(s) Regular Formulary Listing The following drug product(s) were added to the Calgary Zone Long Term Care Formulary under regular benefits. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Description Strength Dosage Form Route of olanzapine 15 mg tablet oral Added (the 15 mg ODT tab is not listed) Not Listed, Delisted or Discontinued Drug Products Removed from Formulary The following drug products were removed or will not be added to the Calgary Zone Long Term Care Formulary. Product Description Strength Dosage Form Route of calcipotriol 50 mcg/g cream, lotion topical Removed discontinued by manufacturer dipyridamole 200 mg capsule oral strength not available, removed from Formulary (dipyridamole /ASA 200mg * 25mg is listed on Formulary) Other Formulary Updates Formulary Policies and Procedures FPP-11 Opioid Safety Review added 3
High Cost Drugs Fentanyl patch (HCD-08) updated Fentanyl patch (HCD-08) FORM updated Education Pain Management o Opioid Patch Handling updated (previously E06- Fentanyl Handling) o Opioid Tracking Tool new optional tool to facilitate opioid tracking and reviews 4
November 2015 (Archived) Added Product(s) Regular Formulary Listing The following drug product(s) were added to the Calgary Zone Long Term Care Formulary under regular benefits. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Description Strength Dosage Form Route of diclofenac diethylamine 2.32% gel topical added (subject to restricted criteria and automatic substitution) diltiazem 30 mg tablet oral added diltiazem 60 mg tablet oral added dimenhydrinate 25 mg suppository rectal added dimenhydrinate 50 mg suppository rectal added disopyramide 100 mg capsule oral added strengths listed on formulary are not available (subject to restricted criteria) erythromycin estolate 50 mg/ml liquid oral added liquid listed on formulary is not available morphine 5 mg suppository rectal added morphine 10 mg suppository rectal added morphine 20 mg suppository rectal added procainamide SR 250 mg tablet oral added strength listed on formulary is not available (subject to restricted criteria) quetiapine 200 mg tablet oral added terazosin 1 mg tablet oral added terazosin 2 mg tablet oral added terazosin 5 mg tablet oral added 5
Restricted Status The following additions and/or changes were made to Restricted Use Medications. Product Description Strength Dosage Form Route of Restricted Criteria diclofenac diethylamine 2.32% gel topical restricted to a maximum of twice a day application disopyramide 100 mg capsule oral restricted to cardiology or internal medicine procainamide SR 250 mg tablet oral restricted to cardiology or internal medicine Automatic Substitutions The following additions and/or changes were made to Automatic Substitution Listings Drug Ordered Automatic Substitution Doxazosin Prazosin Autosub to Prazosin removed. Doxazosin not added to formulary. Drug use subject to nonformulary approval Terazosin Prazosin Autosub to Prazosin removed. Terazosin 1 mg, 2 mg and 5 mg strengths added to formulary Diclofenac topical, single entity, including Voltaren Emulgel 1.16%, as ordered, any frequency Diclofenac diethylamine 2.32% (Voltaren Emulgel Extra Strength 2.32% subbed Any strength (compounded or commercial product will be auto-subbed to Voltaren Emulgel Extra Strength 2.32% up to a maximum of BID (e.g. Voltaren 1.16% QID would be substituted to Voltaren 2.32% BID. Voltaren 1.16% TID PRN would be substituted to Voltaren 2.32% BID PRN; Diclofenac 10% QD PRN would be substituted to Voltaren 2.32% QD PRN). Not Listed, Delisted or Discontinued Drug Products Removed from Formulary The following drug products were removed or will not be added to the Calgary Zone Long Term Care Formulary. Product Description Strength Dosage Form Route of 6
dexamethasone 4mg/mL injection injection strength not added to Formulary diclofenac diethylamine 1.16% gel topical Removed from formulary, may autosub to diclofenac ethylamine 2.32% gel up to a maximum of twice a day. disopyramide LA 150 mg capsule oral product not available disopyramide LA 250 mg capsule oral product not available doxazosin All strengths tablets oral not added to Formulary erythromycin 50 mg/ml liquid oral product not available stearate procainamide SR 500 mg tablet oral product not available sotalol 80 mg tablet oral strength not added to formulary terazosin 10 mg tablet oral strength not added to formulary Other Formulary Updates Pharmacy Service Providers Contact Information Long Term Care Providers -updated Formulary Policies and Procedures FPP-03 Transitional Medication Supply from Acute Care to Long Term Care updated 7
July 2015 (Archived) Added Product(s) Regular Formulary Listing The following drug product(s) were added to the Calgary Zone Long Term Care Formulary under regular benefits. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Description Strength Dosage Form Route of Administra tion acetaminophen 32 mg/ml Liquid Oral amantadine 10 mg/ml* liquid oral *corrected (previously listed as 50 mg/ml) amitriptyline 50 mg, 75 mg tablet oral amlodipine 2.5 mg tablet oral atenolol 25 mg tablet oral benztropine 1 mg tablet oral betamethasone 0.1% scalp lotion topical valerate bromocriptine 5 mg tablet oral carbamazepine 100 mg tablet oral cetirizine 20 mg tablet oral citalopram 10 mg tablet oral clonazepam 0.25 mg tablet oral clonidine 0.025 mg tablet oral codeine 5 mg/ml* liquid oral *corrected (previously listed as 30 mg/5ml) ethacrynic acid 25 mg tablet oral flupentixol decanoate 20 mg/ml injection furosemide 80 mg tablet oral gliclazide 60 mg Modified Release (MR) tablet oral hydromorphone 4.5 mg, 9 mg & 18 mg controlled release capsule oral 8
hydroxyzine 50 mg capsule oral loxapine 2.5 mg, 50 mg tablet oral loxapine 50 mg/ml* injection corrected (previously listed as 1 mg/ml) methylphenidate 5 mg tablet oral metoclopramide 5 mg tablet oral metoprolol 25 mg tablet oral mineral oil light liquid topical moclobemide 300 mg tablet oral olanzapine 5 mg/ml * injection *corrected (previously listed as 10mg/mL) oxybutynin 2.5 mg tablet oral perphenazine 4 mg, 8 mg tablet oral phenytoin 30 mg capsule oral prednisone 1 mg tablet oral primidone 125 mg tablet oral procyclidine 2.5 mg tablet oral propranolol 20 mg tablet oral quetiapine 300 mg tablet oral sterile water for injection injection zuclopenthixol 50 mg/ml injection Not Listed, Delisted or Discontinued Drug Products Removed from Formulary Listing The following drug products were removed or will not be added to the Calgary Zone Long Term Care Formulary. Product Strength Dosage Form Route of Description citalopram 30 mg tablet oral Do Not List citric acid 66.8 mg/ml * solution oral Do Not List sodium citrate (formerly Scholl s Solution) 100 mg/ml clonazepam 1 mg tablet oral Do Not List dexamethasone 2 mg tablet oral Do Not List dimenhydrinate 15 mg chewable oral Do Not List tablets dimenhydrinate 15 mg/5ml liquid oral Do Not List 9
ethacrynic acid 50 mg tablet oral not available metronidazole 500 mg capsule oral Do Not List olanzapine 15 mg ODT oral Do Not List quetiapine 150 mg tablet oral Do Not List salicylic acid any strength any formulation, topical Do Not List compounded or commercial venlafaxine 37.5 mg, 75 mg tablet oral Not available Other Formulary Updates Restricted Status The following drug product(s) were added to the Calgary Zone Long Term Care Formulary under Restricted Use Medications Product Strength Dosage Form Route of Description diazepam 5 mg/ml* injection *corrected (previously listed as 10 mg/ml 10
June 2014 (Archived) Added Product(s) Regular Formulary Listing The following drug product(s) were added to the Calgary Zone Long Term Care Formulary under regular benefits. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Description Dosage Form Route of Strength bupropion SR sustained release tablet oral 150 mg prednisolone acetate / ointment ophthalmic 0.2% * 10% sulfacetamide sodium simethicone tablets tablets oral 180 mg 5-ASA (mesalazine) all formulations oral All strengths 5-ASA (mesalazine) all formulations rectal All strengths sulfasalazine EC enteric coated tablet oral 500 mg naproxen EC enteric coated tablet oral 250 mg, 375 mg, 500 mg naproxen tablet oral 125 mg trolamine salicylate (triethanolamine) cream topical As commercially available Acetaminophen / codeine /caffeine tablet oral Acetaminophen * codeine 8 mg * caffeine 15 mg acetylcysteine inhalation solution oral inhalation 20% tolnaftate powder, powdered Topical spray, spray, cream As commercially available Restricted Status The following drug product(s) were added to the Calgary Zone Long Term Care Formulary under Restricted Use Medications Product Description Dosage Form Route of Strength Restriction Metoject (methotrexate) Prefilled syringes injection 10, 15, 20, 25 mg/ml Added to RS-41. Funding for commercially available prefilled syringes (Metoject) will be provided if the pharmacy does not have access to a biological safety hood or cabinet to prepare the syringes in-house. 11
Other Formulary Updates Restricted Use Medication The following documents in Restricted Use Medications were updated. Restricted Medication Document Phytonadione (vitamin K 1 ) RS-05 Methotrexate RS-41 Appendix 1 (Table) updated. Table now reflects Calgary Zone AMS guidelines which use an upper INR parameter of > 9.0 instead of 10 Updated to include additional criteria for Metoject prefilled syringes High Cost Drugs The following forms and/or documents in High Cost Drugs were updated. High Cost Drug clozapine (HCD-07) aripiprazole (HCD-25) Long Acting Injectable Atypical Antipsychotics (HCD-28) botulinum Toxin Type A (HCD-16B) Eligible for auto-renewal. See form for criteria. Eligible for auto-renewal. See form for criteria Minor wording changes, added field for Date of Admission Added field for baseline MAS score on renewal form New Established Automatic Substitution Listing Drug Ordered Frequency Automatic Substitution Frequency bupropion 150 mg as As ordered Bupropion SR 150 mg Same frequency Zyban tablet Automatic Substitution Listing Changes Drug Ordered bupropion SR 150 mg BID Automatic Substitution Bupropion XL 300 mg daily Autosub deleted. No longer applicable. Bupropion 150 mg SR is formulary 12