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Disclaimer: This guide is offered as an easy reference to the prescription drugs that are supported by the National Prescription Drug Plan. It is by no means intended or to be construed as a directive to physicians to prescribe any of the drugs listed in the Formulary, nor does the National Insurance Board, by making available this guide, assume any responsibility for any treatment regimen or prescription drugs physicians prescribe for their patients with reference to the Formulary. The treatment and prescription process remains the sole purview of physicians in consultation with their patients.

2 NPDP Formulary | Health Professionals Edition

NATIONAL PRESCRIPTION DRUG PLAN FORMULARY

TABLE OF CONTENTS

Foreword ................................................................................. 3 Patient Registration Eligibility.................................................. 8 Completing Registration Forms .................................................. 9 Prescription Processing .......................................................... 10 Key Abbreviations .................................................................. 13 A r t h r i t i s .............................................................................. 16 A s th m a ............................................................................... 45 Benign Prostatic Hypertrophy (BPH) ..................................... 58 Breast Cancer .................................................................. 63 D iabe tes ............................................................................. 69 Ep i lepsy .............................................................................. 92 Glaucoma ......................................................................... 103 Hypercholesterolemia (High Cholesterol) ............................ 117 Hype r tens ion .................................................................. 124 Ischaemic D isease ....................................................... 153 Pros ta te Cancer ............................................................ 170 Psychiat r ic I l lness ........................................................ 177 Sickle Cell Anemia ............................................................... 201 Thyroid Diseases ................................................................. 204 ICD 9 Diagnosis Codes For NPDP Diseases ...................... 209

NPDP Formulary | Health Professionals Edition 3

Foreword This booklet is intended to be a valuable resource for healthcare professionals by providing essential information regarding the National Prescription Drug Plan (NPDP). It gives an introduction to NPDP, information on patient registration, the processing of prescriptions and a comprehensive listing of the benefits offered by the Plan. Another important purpose is to answer questions you or your patients may have regarding NPDP. National data indicate that in 2010, one in three Bahamians was suffering from a chronic disease. Such ailments are costly in terms of human suffering and the expense of treatment and care. The National Insurance Board of The Bahamas, through the NPDP, seeks to reduce the health and financial burden of chronic diseases by targeting the following non-communicable diseases: arthritis, asthma, benign prostate hypertrophy, breast cancer, diabetes, epilepsy, glaucoma, hypercholestremia, hypertension, ischaemic disease, prostate cancer, psychiatric illness, sickle cell disease and thyroid disease. One element of the NIB strategy focuses on prevention by funding well organized and well managed health promotion and wellness projects in the community. The second element of the strategy addresses the following:


• Reducing cost - by negotiating medication prices through

a public tender process • Increasing access- by utilizing private and public

pharmacies, and • Improving health - through increased access to

medications and wellness programmes.

The Formulary combines both clinical and cost effectiveness. The listing of prescription drugs contained herein was developed through wide and intense consultation with practicing physicians and pharmacists in the public and private sector, as well as thorough research into similar plans that exist in other countries. We recognize that you and your patients desire choices when it comes to selecting medication. The NPDP has taken this into consideration by making available options within most of the drug classes. We ask for your assistance in supporting the goal of the NPDP to provide cost-effective therapy by being mindful of cost and appropriate use in prescribing. Another area for choice allows patients to receive their prescription benefits at any participating public or private pharmacy. The drug information in this booklet covers the products and diseases in the NPDP and is not intended to serve as a comprehensive database. If you have any questions regarding information contained herein, please contact the NPDP pharmacists for further details. If you require additional copies of any NPDP form or publication, please contact the NPDP office at 356-2032, NIB Headquarters


502-1500, toll- free 242-300-0001 or fax 356-2026. You may also visit us online at www.nibdrugplan.com or www.nib-bahamas.com.

http://www.nibdrugplan.com/�

http://www.nib-bahamas.com/�


The National Insurance Board is grateful for your interest and support. We appreciate feedback and suggestions as to how this guide or any aspect of our services may be improved or expanded to serve you and your patients in a more efficient manner. Thank you and we look forward to providing exceptional service to you and your patients. Director The National Insurance Board


Formulary Committee Eugene Gray, MD, Chairman

Kevin Bowe, MD Brenna Turnquest, Pharm. D

Laura Pratt-Charlton, RPh Vivienne Lockhart, RPh Ilsa Grant-Taylor, MD Marcia Bassett, MD

Specialist Review Sub-Committee

Timothy Barrett, MD Conville Brown, MD Patrick Cargill, MD Dionne Dames, MD

John Lunn, MD Kevin Moss, MD

Vincent Nwosa, MD K.J.A. Rodgers, MD Adrian Sawyer, MD

Dean Tsertopoulos, MD Geoffrey Sweeting, MD

Theodore Turnquest, MD


Introducing The National Prescription Drug Plan In order to reduce the overall health expenditure burden, the National Insurance Board has devised the National Prescription Drug Plan as one of the benefits offered to its subscribers. It is hoped that by providing high quality, cost-effective medications and increased access, we can minimize the impact of chronic diseases in the Bahamas. Patient Registration Eligibility The National Prescription Drug Plan (NPDP) covers patients in the following categories:

• NIB Pensioners receiving: o Retirement Benefit or Grant o Old-Age Non Contributory Pension o Survivors Benefit/Assistance (age 60 & over) o Disablement Benefit assessed at 100%

• NIB Invalids receiving: o Invalidity Benefit o Invalidity Assistance

• Bahamian citizens age 65 and over • Children

o under 18 years o under 25 years (if full-time students)

• Indigent persons • Government employees/Civil Servants • Women receiving ante-natal and post-natal care

A person falling into one of the foregoing categories and


diagnosed with a covered chronic disease is eligible for NPDP, regardless of income, financial status, health insurance, or nationality. NOTE: Patients seeking to enroll and access the benefits of NPDP should possess a valid NIB number. Completing Registration Forms To register a patient for the NPDP, a licensed physician in The Bahamas needs to complete and sign Section 2 of the Patient Registration Form (DP-1). The ICD-9 code needs to be included in the diagnosis. Special Terms Regarding Diagnosis Certain diseases are considered to need specialist treatment. Diagnosis of these diseases, for the purposes of NPDP, is limited to the following certified medical specialists:

• Psychiatric Illnesses: diagnosis by a psychiatrist. • Breast Cancer: diagnosis by an oncologist or

surgeon. • Prostate Cancer: diagnosis by urologist or oncologist. • Glaucoma: diagnosis by an opthalmologist.

Completing the Registration Process Patients must take the completed form to the NPDP office to complete the registration process and receive their ACE Rx card. Once in receipt of their card, they may fill eligible prescriptions at any participating pharmacy.


Prescription Processing Pharmacies must be registered with the NPDP to be eligible to process prescriptions for members. Patients should present their eligible prescription along with their ACE Rx card. To begin processing a NPDP prescription, the pharmacist needs to swipe the ACE Rx card through the card reader and enter the prescription information into the EPOS System. This will submit the information for processing, which will verify the eligibility of the patient and prescription. Within five (5) seconds the claim will be processed, and an approval or denial will be returned through the EPOS System. If approved, the pharmacist should then finish filling the prescription, using formulary medications purchased through the approved distributors. The authorization code returned by the Processing Centre verifies the claim has been submitted to NPDP for processing and will be paid on the next weekly pay date. If denied, a rejection message will appear. If there are any questions regarding the denial, you may contact the NPDP office for clarification. For manual claims (those not processed via EPOS), the pharmacist should call the NPDP office at 356-2032 or after hours at 502-1504 to obtain an authorization number for the claim. This authorization number must be included on the Manual Claim Form submitted to the NPDP office. Manual claims will be paid on the next monthly paydate for manual


claims processing. How Is The Formulary Organized? This booklet provides a listing of the benefits provided by the National Prescription Drug Plan. Every effort has been made to ensure that the formulary can be easily read by busy practitioners. In this regard, the contents of this guide are presented in the following manner. The formulary is divided into fourteen (14) sections. Each section heading bears the name of one of the diseases targeted by the National Prescription Drug Plan. Each section contains a listing of a range of prescription medications used in the treatment of the specific disease addressed in that section and which are supported by the National Prescription Drug Plan. For each disease, there is a brief introduction giving relevant information you may need to know when registering a patient or prescribing medications. Section Contents Where available or appropriate, the following information is provided for each drug listed in the sections noted above:

• Pharmacological Class, e.g “analgesic’, ‘corticosteroids’, ‘non steroidal anti-inflammatory’ (NSAID), ‘Leukotriene pathway inhibitor‘, etc.

• Strength • Dosage (adult and pediatric) • Pregnancy Category • Indication


• Dosage Adjustments • Precautions • Contraindications • Warnings • Major Drug Interactions • Adverse Reactions (including a subsection listing

serious reactions) • Dosage Range • Formulary Labels/Preparations (indicating drug

strength, type e.g; tablet, capsule, liquid, etc.; quantity; price)

NOTE: Certain medications are designated as Specially Authorized Medications (SAM) either due to cost, toxicity or place in therapy. Some of these medications are restricted to certain prescribers and will automatically be accepted when prescribed by these specialists. For others a Specially Authorized Medication (SAM) form will need to be completed and submitted to the NPDP office. Documentation showing the patient has attempted alternative therapies and these were ineffective or caused adverse effects may be required.


Key Abbreviations Manufacturers and Local Distributors An index of the three-letter abbreviations following each formulary label product listing is provided below. Abbreviations represent The Bahamas based distributor/pharmaceutical manufacturer. Manufacturer/Local Distributor CODE Abbott .................................................................................. ABB Alcon ..................................................................................... ALC Apotex ................................................................................. APO Aurochern ............................................................................ AUR Astra-Zeneca ........................................................................ ZEN Bayer .................................................................................... BYA Boehringer-Ingleheim .......................................................... BOM Carlisle Labs…………………………………………………... . CAR Cipla ...................................................................................... CIP Commonwealth Drugs & Medical Supplies* ........................ CDM Ebewe ................................................................................... EBE Eli-Lilly .................................................................................... LIL Falcon ................................................................................... FAL Glaxo-Smith-Kline ................................................................ GSK Health 2000, Meditab ............................................................ HLT Janssen Cilag ....................................................................... JAN Labdhi ................................................................................... LBD Lowes Wholesale Drug Agencies* ........................................ LWD Martindale .............................................................................. MAT Medicamen ........................................................................... MCM Merck Sharpe Dohme ........................................................... MSD Nassau Agencies Ltd. 1995* ................................................. NAS


MDMS International* .......................................................... MDMS Novartis West Indies .............................................................. NOT Novo-Nordisk Pharmaceuticals.............................................. NOV Oden Pharmaceuticals ......................................................... ODN Pfizer ....................................................................................... PFI Pharmascience ...................................................................... PMS Ports International* ................................................................ PRT Remedica Ltd........................................................................ REM Sandoz (Novartis) ................................................................. SAN Sanofi-Aventis........................................................................ SAA Schein Pharmaceuticals ........................................................ SHE Servier ................................................................................... SER


Pregnancy Categories The pregnancy categories as used in the Drug Formulary are as follows: Category A Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). Category B Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. Category C Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Category D There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.


Category X Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.


ARTHRITIS

Arthritis as covered by the NPDP comprises of three disease states: Rheumatoid Arthritis (RA), Osteoarthritis (OA) and Gout. Medications from the following classes are available for the treatment of arthritis:

• Non-steroidal Anti-inflammatory Drugs (NSAIDs) • Cyclo-oxygenase 2 Inhibitors (COX-2 Inhibitors) • Proton Pump Inhibitors (PPI’s) • Disease Modifying Anti-Rheumatic Drugs (DMARD’s) • Corticosteroids • Anti-gout Agents • Non-classified Analgesic Products

There are two DMARD’s available in the Plan for the management of RA: Methotrexate and Hydroxychloroquine. These medications are designated as SAM (specially authorized medications) and, for the purposes of NPDP, can only be prescribed by a rheumatologist or internal medicine specialist. NSAIDs and COX-2 Inhibitors are available for the management of pain associated with arthritis. It is recommended that the lowest effective dose be used for the shortest possible duration in order to minimize the risk of adverse effects associated with these medications. Patients are only allowed 30 tablets of Etoricoxib monthly (15 tablets of Etoricoxib 120mg monthly). Patients who are at high risk of developing a peptic ulcer with NSAID therapy should be


prescribed a proton pump inhibitor concomitantly to reduce that risk. Proton pump inhibitors are designated as SAM and will only be covered in combination with an NSAID. Acetaminophen is available under the Plan. Although this is a nonprescription item, it must be written as a prescription in order to be covered for the treatment of arthritis. It is recommended as first line for pain management for patients with OA as it is less toxic than the other classes of drugs. Allopurinol and Colchicine are available for the treatment of gout. They may be prescribed in both treatment and prophylactic dosages. Prednisolone suspension is available as a SAM for patients aged twelve (12) and under or with prior-authorization from the Plan.

AN AL G ESI C A ND CO RT I CO ST ERO I D DR UG S

Acetaminophen

Class: Analgesic Strength: 500mg Dosage: Adult: 650-1000mg every 4 hours as needed (MAX

4gm/ day)


Pediatric: Age < 6: 10-15mg/kg/dose every 4-

6 hours (MAX 5 doses/day) Age 6-12: 325mg every 4-6 hours (MAX 2.6gm/day)

Pregnancy Category: A Contraindications: Hypersensitivity to acetaminophen Precautions: Acetaminophen induced liver disease; patients who drink more than 3 alcoholic beverages every day. Major Drug Interactions: None. Adverse Reactions: Common: Rash

SERIOUS: Stevens-Johnson syndrome, toxic epidermal necrolysis, gastrointestinal hemorrhage, hepatotoxicity, liver failure, nephrotoxicity, pneumontitis.

Formulary Labels/Preparations: Ceta 500mg tabs, pkg 100, $2.31 ($0.231/tablet), CDM/MCM

Prednisone/Prednisolone Class: Corticosteroid Strength: 5mg, 2mg/ml solution


Dosage: Adult:

Asthma (moderate and severe exacerbation): 40- 80mg/day in 1-2 divided doses until PEF reached 70% of predicted or personal best or 40-60mg in 1-2 divided doses for 3-10 days.

Asthma (long-term therapy): 7.5-60mg daily or every other day as needed.

Rheumatoid arthritis: 5-60mg daily.

Pediatric: Asthma (moderate and severe exacerbation):

Age <12: 1-2mg/kg divided twice daily (MAX 60mg/day) until PEF reached 70% of predicted or personal best; or 1-2mg/kg divided twice daily (MAX 60mg/day) for 3-10 days.

Age > 12: as adult dosing

Asthma (long-term therapy):

Age <12: 0.25-2mg/kg daily or every other day as needed. Age >12: as adult dosing

Rheumatoid arthritis: 5-60mg daily

Pregnancy Category: A


Dosage Adjustments: None Contraindications: Hypersensitivity to prednisone, systemic fungal infections. Precautions: Cirrhosis; diverticulitis; hypothyroidism; hypertension; measles, chickenpox and other infections; myasthenia gravis; ocular herpes simplex; osteoporosis; peptic ulcer; pregnancy; psychotic tendencies; renal insufficiency; smallpox vaccine and other immunizations; tuberculosis; ulcerative colitis; untreated systemic infections. Major Drug Interactions: LIVE ROTAVIRUS VACCINE (CONTRAINDICATED). Aldesleukin, asparaginase, bupropion, gatifloxacin, quetiapine. Adverse Reactions:

Common: hypertension, atrophic condition of skin, impaired skin healing, fluid retention, decreased body growth, hypernatremia, GI disorders, increased risk for infection, osteoporosis, depression, euphoria. SERIOUS: Cushing’s syndrome, hyperglycemia, Primary adrenocortical insufficiency, cataract, glaucoma, tuberculosis.

Formulary Labels/Preparations: Apo-Prednisone 5mg, pkg 100, $1.98 ($0.198/tablet), NAS/APO Prednisolone DS 2mg/ml, 125ml, $6.74 ($0.0562/ml), NAS/ CAR


NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

AND COX-2 INHIBITORS

Ibuprofen Class: NSAID Strength: 400mg, 600mg, 100mg/5ml Susp. Dosage: Adult: 1200-3200mg divided in 3-4 doses daily. Use

the lowest effective dose for the shortest possible duration.

Pediatric: 30-50mg/kg divided in 3-4 doses daily. Use the lowest effective dose for the shortest possible duration.

Pregnancy Category: C Dosage Adjustments: Recommended in renal impairment.


WARNINGS: NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may be increased in patients with cardiovascular disease or risk factors for cardiovascular disease. Ibuprofen is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery. NSAIDs can also cause an increased risk of serious gastrointestinal adverse events especially in the elderly, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Contraindications: Asthma, urticaria, or allergic-type reaction following aspirin or NSAID use; coronary artery bypass graft surgery; hypersensitivity to ibuprofen. Precautions: Cardiovascular disease, serious GI adverse events; aspirin triad; asthma; inhibition of platelet aggregation; cardiovascular thrombotic events, myocardial infarction, stroke and fatalities have been reported; changes in colour vision; chronic use; concomitant use of ACE inhibitors, thiazides, loop diurectics or oral corticosteroids; elderly; fluid retention or heart failure; hepatic reactions; hypertension; liver dysfunction; lupus erythematosus; poor general health; 3rd trimester pregnancy; advanced renal disease; skin reactions; smoking or alcohol use; blurred and/or diminished vision has been reported. Major Drug Interactions: CONTRAINDICATED: KETOROLAC, PENTOXIFYLLINE Aredeparin, betaglucan, certoparin, citalopram, clopidogrel, clovoxamine, dlateparin, danaparoid, desirudin, enoxaparin,


escitalopram, femoxetine, flesinoxan, fluoxetine, fluvoxamine, ginkgo, methotrexate, nadroparin, nefazodone, parnaparin, paroxetine, pemetrexed, reviparin, sertraline, tacrolimus, tinzaparin, zemeldine. Adverse Reactions:

Common: Rash, heartburn, nausea, vomiting, dizziness, headache. SERIOUS: Congestive heart failure, hypertensions, myocardial infarction, thrombotic tendency observations, erythema mulitforme, erythroderma, Stevens-Johnson syndrome, toxic epidermal necrolysis, GI hemorrhage, GI perforation, GI ulcer, inflammatory disorder of the digestive tract, melena, pancreatitis, agranulocytosis, aplastic anemia, hemolytic anemia, neutropenia, thrombocytopenia, fluminant hepatitis, hepatic necrosis, hepatitis, hepatotoxicity, jaundice, liver failure, vanishing bile duct syndrome, anaphylactoid reaction, immune hypersensitivity reaction, aspetic meningitis, cerebrovascular accident, amblyopia, hearing loss, depression, acute renal failure, hematuria, renal azotemia, Reye’s syndrome.

Formulary Labels/Preparations: Ibuprofen 400mg, pkg 100, $1.95 ($0.0195/tablet), LWD/HLT Ibuprofen 600mg, pkg 100, $2.97 ($0.0297/tablet), LWD/HLT Ibufen liquid, 100ml, $2.75, NAS/CAR


Diclofenac Sodium

Class: NSAID Strength: 50mg, 75mg SR, 100mg SR, 1% gel Dosage: Adult:

Osteoarthritis: 100-150mg divided in 2-3 doses daily (MAX 200mg/day). Use lowest effective dose for shortest possible duration; topical gel apply 4 times daily to affected extremity, MAX of 8 times total daily use (4 times to any one joint of lower extremity and 2 times to any one joint of upper extremity) Rheumatoid arthritis: 100-200mg divided in 3-4 doses daily (MAX 225mg/day). Use lowest effective dose for shortest possible duration.

Pediatric: Safety and efficacy have not been determined

Pregnancy Category: C Dosage Adjustments: Recommended in renal impairment


WARNINGS: NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may be increased in patients with cardiovascular disease or risk factors for cardiovascular disease. Diclofenac is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery. NSAIDs can also cause an increased risk of serious gastrointestinal adverse events especially in the elderly, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Contraindications: Asthma, urticaria, or allergic-type reaction following aspirin or NSAID use; coronary artery bypass graft surgery; hypersensitivity to diclofenac, aspirin or other NSAIDS. Precautions: Cardiovascular disease, serious GI adverse events; aspirin triad; asthma; chronic use; coagulation disorder; concomitant use of aspirin, methotrexate or cyclosporine; concomitant use of other topical products (with topical gel); elderly; fluid retention or heart failure; hepatic reactions; hypertension; liver dysfunction; late pregnancy; renal disease; skin reactions; smoking or alcohol use. Major Drug Interactions: CONTRAINDICATED: KETOROLAC, PENTOXIFYLLINE Aredeparin, betaglucan, certoparin, citalopram, clopidogrel, clovoxamine, dlateparin, danaparoid, desirudin, enoxaparin, escitalopram, femoxetine, flesinoxan, fluoxetine, fluvoxamine, ginkgo, methotrexate, nadroparin, nefazodone, parnaparin, paroxetine, pemetrexed, reviparin, sertraline, tacrolimus,


tinzaparin, zemeldine. Adverse Reactions:

Common: Application site reactions (topical gel); blood coagulation disorder. SERIOUS: Congestive heart failure, hypertension, myocardial infarction, thrombotic tendency, erythema multiforme, generalized exfoliative dermatitis; Stevens-Johnson syndrome, toxic epidermal necrolysis, GI hemorrhage, GI perforation, GI ulcer, Inflammatory disorder of digestive tract, melena, pancreatitis, agranulocytosis, aplastic anemia, hemolytic anemia, hepatic necrosis, liver failure, anaphylactoid reaction, cerebrovascular accident, meningitis, seizure, acute renal failure, papillary, necrosis, angioedema.

Formulary Labels/Preparations: Diclofenac Sodium 50mg, pkg 100, $1.18 ($0.0118/tablet), LWD/HLT Diclofenac Sodium 75SR, pkg 100, $0.63($0.0063/tablet); LWD/HLT Diclofenac 100mg SR, pkg 100, $1.92 ($0.0192/tablet); LWD/HLT Diclofenac Sodium Gel, $0.66, LWD/HLT

Naproxen Class: NSAID Strength: 500mg


Dosage: Adult: Gout: 250mg every 8 hours.

Osteoarthritis: 250-500mg twice daily (MAX 1500mg/day for up to 6 months). Use lowest effective dose for shortest possible duration.

Rheumatoid arthritis: 250-500mg twice daily (MAX 1500mg/day for up to 6 months). Use lowest effective dose for shortest possible duration.

Pediatric: 10mg/kg divided twice daily

Pregnancy Category: C (1st and 2nd trimesters); D (3rd trimester) Dosage Adjustments: Recommended in elderly, liver disease and renal impairment WARNINGS: NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may be increased in patients with cardiovascular disease or risk factors for cardiovascular disease. Naproxen is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery. NSAIDs can also cause an increased risk of serious gastrointestinal adverse events especially in the elderly, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Contraindications: Asthma, urticaria, or allergic-type reaction following aspirin or NSAID use; coronary artery


bypass graft surgery; hypersensitivity to naproxen. Precautions: Increased risk of serious cardiovascular events; increased risk of serious GI adverse events; asthma; late in pregnancy; dehydration; elderly; history of coagulation defects, GI ulceration, GI bleeding, GI perforation, liver disease, or renal disease; hypertension, fluid retention, or CHF; preexisting anemia. Major Drug Interactions:CONTRAINDICATED: KETOROLAC, PENTOXIFYLLINE. Aredeparin, aspirin, beclamide, beta glucan, caramiphen, carbamazepine, certoparin, chlormethiazole, citalopram, clopidogrel, clovoxamine, dalteparin, danaparoid, desirudin, diazepam, enoxaparin, escitalopram, felbamate, femoxetine, flesinoxan, fluoxetine, fluvoxamine, fosphenytoin, gabapentin, ginkgo, lacosamide, levetiracetam, mephenytoin, mephobarbital,methotrexate,nadroparin,nefazodone, oxcarbazepine,paraldehyde, prarmethadione, parnaparin, paroxetine, pemetrexed, phenacemide, Phenobarbital, phenytoin, piracetam, pregabalin, reviparin, rufinamide, sertraline, stiripentol, tacrolimus, tiagabine, tinzaparin, topiramate, trimethadione, valproic acid, vigabatrin, warfarin, zimeldine, zonisamide Adverse Reactions:

Common: Edema, pruritis, rash, abdominal pain, constipation, diarrhea, heartburn, indigestion, nausea, stomatitis, dizziness, headache, lightheadedness, somnolence, vertigo, tinnitus, dyspnea.


SERIOUS: Congestive heart failure, myocardial infarction, pulmonary edema, vasculitis, scaling eczema, Stevens-Johnson syndrome, toxic epidermal necrolysis, GI hemorrhage, GI perforation, inflammatory disorder of the digestive tract, pancreatitis, agranulocytosis, anemia, granulocytopenic disorder, thrombocytopenia, thrombotic tendency observations, hepatitis, increased liver function tests, jaundice, liver failure, anaphylactoid reaction, aseptic meningitis, cerbrovascular accident, seizure, interstitial nephritis, nephritic syndrome, papillary necrosis, renal failure, serum creatinine elevations.

Formulary Labels/Preparations: Apo-Naproxen 500mg, pkg 100, $7.90 ($0.079/tablet), NAL/APO

Meloxicam Class: NSAID Strength: 7.5mg Dosage: Adult: 7.5mg once daily (MAX 15mg once daily). Risks

and benefits should be discussed with patient prior to initiating therapy. Use lowest effective dose for the shortest possible duration

Pediatric: Age >2: 0.125mg/kg once daily (MAX 7.5mg)

Pregnancy Category: C (1st and 2nd trimesters); D (3rd


trimester) Dosage Adjustments: Do not use in severe renal impairment (CrCl <15ml/min) WARNINGS: NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may be increased in patients with cardiovascular disease or risk factors for cardiovascular disease. Meloxicam is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery. NSAIDs can also cause an increased risk of serious gastrointestinal adverse events, especially in the elderly, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Contraindications: Asthma, urticaria, or allergic-type reaction following aspirin or NSAID use; coronary artery bypass graft surgery; hypersensitivity to meloxicam Precautions: Cardiovascular disease, serious GI adverse events; aspirin triad; asthma; chronic use; coagulation disorder; concomitant use of aspirin; elderly; debilitated; do not use as corticosteroid substitute; dehydration; hepatic reactions; fluid retention or heart failure; hypertension, history of liver dysfunction; 3rd trimester of pregnancy; renal impairment; skin reactions; smoking or alcohol use. Major Drug Interactions:CONTRAINDICATED: KETOROLAC, PENTOXIFYLLINE. Aredeparin, certoparin, citalopram, clopidogrel, clovoxamine,


dalteparin, danaparoid, desirudin, enoxaparin, escitalopram, femoxetine, flesinoxan, fluoxetine, fluvoxamine, ginkgo, nadroparin, nefazodone, parnaparin, paroxetine, pemetrexed, reviparin, sertraline, tacrolimus, tinzaparin, zemeldine. Adverse Reactions:

Common: Edema, abdominal pain, constipation, diarrhea, flatulence, indigestion, nausea, vomiting, dizziness, headache, upper respiratory infection, fever. SERIOUS: Angina, congestive heart failure, hypertension, myocardial infarction, thrombosis, erythema multiforme, erythroderma, Stevens-Johnson syndrome, toxic epidermal necrolysis, GI hemorrhage, GI perforation, GI ulcer, inflammatory disorder of the digestive tract, anemia, decreased platelet aggregation, purpuric disorder, hepatitis, jaundice, liver failure, anaphylactoid reaction, immune hypersensitivity reaction, cerebrovascular accident, interstitial nephritis, renal failure, asthma, bronchospasm, dyspnea, angioedema.

Formulary Labels/Preparations: Apo-Meloxiam 7.5mg, pkg 100, $6.60 ($0.066/tablet), NAS/APO.

Etoricoxib Class: COX-2 Inhibitor


Strength: 60mg, 90mg and 120mg (120mg is restricted to a maximum of 15 tablets/30 days) Dosage: Adult:

Osteoarthritis: 60 mg daily

Rheumatoid Arthritis: 90mg daily Gouty Arthritis: 120 mg daily(maximum of 8 days)

Pediatric: Use is contraindicated in children under age 16

Risk and benefits should be discussed with the patient prior to initiating therapy. Use the lowest effective dose for the shortest possible duration. Pregnancy Category: D Dosage Adjustments: Recommended in hepatic impairment (Child-Pugh 5-6 maximum dose 60mg daily; Child-Pugh 7-9 maximum dose 60mg every OTHER day). Contraindicated in patients with CrCI <30ml/min.


WARNINGS: Etoricoxib should not be used in patients with ischaemic heart disease, peripheral arterial disease, or cerebrovascular disease. It should be used with caution in patients with significant risk factors for cardiovascular disease such as hypertension, hyperlipidemia, and diabetes mellitus. Etoricoxib is also contra-indicated in patients with inflammatory bowel disease, moderate to severe heart failure (NYHA class II to IV), and renal impairment associated with a creatinine clearance of less than 30 mL/minute. It should be avoided in patients with severe hepatic impairment. Etoricoxib can also cause an increased risk of serious gastrointestinal adverse events especially in the elderly, including bleeding, ulceration and perforation of the stomach or intestines, which can be fatal. Contraindications: Ischaemic heart disease, peripheral artery disease, cerebrovascular disease, inflammatory bowel disease, moderate to severe heart failure, renal impairment with CrCl <30ml/min; severe hepatic disease; ARCOXIA tablets contain lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine; patients with hypersensitivity to etoricoxib or components. Major Drug Interactions: Warfarin, Diuretics, ACE Inhibitors, Angiotensin II receptor antagonists, lithium. Adverse Reactions:

Common: edema, fluid retention, dizziness,


headache, hypertension, diarrhea, dyspepsia, nausea, epigastric discomfort, fatigue, flu-like symptoms, increase ALT/AST SERIOUS: Hypertension; gastrointestinal perforation, ulceration and bleeding; Renal impairment; Hepatic impairment

Formulary Labels/Preparations: Arcoxia 60mg, pkg 14, $6.27 ($0.4479/tablet), LWD/MSD Arcoxia 90mg, pkg 14, $8.62 ($0.6157/tablet), LWD/MSD Arcoxia 120mg, pkg 14, $10.98 ($0.7843/tablet), LWD/MSD

DMARDs (Disease-Modifying Anti-Rheumatic

Drugs)

Hydroxychloroquine *SAM* Class: Aminoquinolone Strength: 200mg Dosage: Adult:

Rheumatoid Arthritis: 400-600mg once daily for 4-12 weeks, then decrease to 200-400mg daily.


Pediatric: No safety and efficacy for juvenile rheumatoid arthritis.

Pregnancy Category: D Dosage Adjustments: None WARNINGS: Physicians should be knowledgeable about hydroxychloroquine prior to prescribing. Contraindications: Hypersensitivity to 4-amioquinoline compound; long term use in children; retinal or visual changes from prior 4-aminoquinoline compound use. Precautions: Concomitant therapy with drugs producing dermatitis; glucose-6-phosphate (G6P) deficiency; liver disease, alcoholism, or concurrent hepatotoxic drugs; long-term or high dose therapy; porphyria; psoriasis. Major Drug Interactions: CONTRAINDICATED: AUROTHIOGLUCOSE Digoxin, metoprolol Adverse Reactions:

Common: Pigmentation changes, nausea, vomiting, diarrhea, myopathy, headache, corneal disorder.

SERIOUS: Torsades de pointes, agranulocytosis, retinopathy, ototoxicity

Formulary Labels/Preparations: Apo-Hydroxyquine 200mg, pkg 100, $14.50 ($0.145/tablet),


NAS/APO.

Methotrexate *SAM* Class: Antimetabolite Strength: 2.5mg Dosage: Adult:

Rheumatoid Arthritis: 10-15mg once weekly, increase by 5mg/wk every 2-3 weeks (MAX 20-30mg/wk)

Pediatric: Polyarticular juvenile rheumatoid arthritis: 10mg/m2 once weekly, adjust to optimal response.

Pregnancy Category: X Dosage Adjustments: Recommended in moderate renal failure (CrCl 10-50ml/ml), hepatic impairment (bilirubin 3.1-5 or AST > 180). Dosage should be given after hemodialysis (but not peritoneal dialysis). Do not use if CrCl < 10ml/min or bilirubin >5.


WARNINGS: Only for life-threatening neoplastic disease or severe rheumatoid arthritis and psoriasis unresponsive to other therapies. Death, fetal death and/or congenital anomalies, lung disease, tumor lysis syndrome, fatal skin reactions, and Pneumocystis carinii pneumonia have been reported. Monitor for bone marrow, liver, lung, and kidney toxicities. Unexpectedly severe (sometimes fatal) bone marrow suppression, aplastic anemia, and gastrointestinal toxicity have been reported with concomitant administration of methotrexate (usually in high dosage) along with some nonsteroidal anti-inflammatory drugs (NSAIDs). Hepatotoxicity, fibrosis, and cirrhosis occur with prolonged use. Diarrhea and ulcerative stomatitis require interruption of therapy. Methotrexate elimination is reduced in patients with impaired renal functions, ascites, or pleural effusions. Increased risk of soft tissue necrosis and osteosarcoma with concomitant radiotherapy. Malignant lymphoma may occur. Contraindications: Pregnancy; breast feeding; known hypersensitivity to methotrexate; patients with alcoholism, alcoholic liver disease, chronic liver disease, blood dyscrasias or immunodeficiency syndromes. Precautions: Acute or chronic hepatotoxicity, GI toxicity, myelosuppression, nephrotoxicity, neurotoxicity, potentially fatal infections, pulmonary toxicity, severe/fatal skin reactions, severe renal or hepatic impairment, women of child-bearing potential. Major Drug Interactions: CONTRAINDICATED: LIVE


ROTAVIRUS VACCINE Alclofenac, amoxicillin, apzaone, asparaginase, aspirin, BCG vaccine (live), benoxaprofen, bentiromide, bismuth subsalicylate, carprofen, dantrolene, diclofenac, diflunisal, dipyrone, doxycycline, droxicam, etodolac, fenbufen, fenoprofen, flurbiprofen, ibuprofen, indomethacin, indoprofen, influenza vaccine (live), isoxicam, ketoprofen, ketorolac, leflunomide, measles virus vaccine (live), meclofenamate, mefenamic acid, mezlocillin, mumps vaccine (live), nabumetone, naproxen, nimesulide, omeprazole, oxaprozin,penicillins, phenylbutazone, phenytoin, piperacillin, pirazolac, piroxicam, pirprofen, poliovirus vaccine (live), pristinamycin, probenecid, proquazone, pyrimethamine, rubella virus vaccine (live), salsalate, smallpox vaccine, sulfamethizole, sulfamethoxazole, sulfapyridine, sulfisoxazole, sulindac, suprofen, tamoxifen, tenidap, tenoxicam, tiaprofenic acid, tolmetin, triamterene, trimethoprim, typhoid vaccine, varicella virus vaccine, warfarin, yellow fever vaccine, zomepirac. Adverse Reactions:

Common: Alopecia, photosensitivity, rash, diarrhea, loss of appetite, nausea, vomiting, stomatitis. SERIOUS: Skin ulcer, hyperuricemia, GI hemorrhage, inflammatory disease of the mucous membrane, myelosuppression, atrophy of liver, cirrhosis of liver, hepatic fibrosis, hepatic necrosis, increased LFT’s, liver failure, kidney disease, renal failure, lung disorders, interstitial pneumonia


Formulary Labels/Preparations: Methotrexate 2.5mg tabs, pkg 100, $12.60 ($0.1260), CDM/REM.

ANTI-GOUT AGENTS

Allopurinol Class: Xanthine Oxidase Inhibitor Strength: 100mg, 300mg Dosage: Adult: 100-600mg daily divided 1-3 times daily (MAX

800mg)

Pediatric: Hyperuricemia: Age <6: 150mg daily

Age 6-10: 300mg daily Pregnancy Category: C Dosage Adjustments: Recommended for CrCl< 20ml/min. Contraindications: Concomitant use of didanosine, hypersensitivity to allopurinol Precautions: Allergic reactions; liver disease; decreased renal function; poor urate clearance Major Drug Interactions: CONTRAINDICATED: DIDANOSINE Azathioprine, captopril, cyclophophamide, enalapril,


enalaprilat, mercaptopurine Adverse Reactions:

Common: Maculopapular eruption, pruritis

SERIOUS: Rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, agranulocytosis, aplastic anemia, eosinophilia, myelosuppression, thrombocytopenia, granulomatous hepatitis, hepatic necrosis, hepatotoxicity, immune hypersensitivity reaction, renal failure.

Formulary Labels/Preparations: Apo-Allopurinol 100mg, pkg 100, $2.70 ($0.027/tablet), NAS/APO Apo-Allopurinol 300mg, pkg 100, $4.74 ($0.474/tablet), NAS/APO

Colchicine Class: Anti-gout Strength: 0.6mg Dosage: Adult:

Treatment: 1.2mg at the first sign of flare, followed by 0.6mg 1 hour later; Prophylaxis: 0.6mg twice daily (MAX 1.2mg/day)

Pediatric: Age >16: Prophylaxis: 0.6mg once or twice daily (MAX 1.2


mg/day) Pregnancy Category: C Dosage Adjustments: Recommended in renal impairment, hepatic impairment, elderly, dialysis, concomitant CYP3A4 use, and concomitant P-gp inhibitors. Contraindications: Concomitant use of p-glycoprotein or strong CYP3A4 inhibitors in patients with hepatic or renal impairment Precautions: Blood dyscrasias; concomitant use of p-glycoprotein or strong CYP3A4 inhibitors in patients with normal hepatic or renal function; severe hepatic disease; neuromuscular toxicity and rhabdomyolysis; renal impairment Major Drug Interactions: CONTRAINDICATED: ATAZANAVIR, CLARITHROMYCIN, DRAUNAVIR, INDINAVIR, ITRACONAZOLE, KETOCONAZOLE, LOPINAVIR, NEFAZODONE, NELFINAVIR, RITONAVIR, SAQUINAVIR, TELITHROMYCIN, TIPRANAVIR Amprenavir, aprepitant, cyclosporine, diltiazem, erythromycin, fluconazole, fosamprenavir, gemfibrozil, interferon alfa-2a, lovastatin, provastatin, quinidine, ranolazine, reserpine, tacrolimus, verapamil Adverse Reactions:

Common: Diarrhea, nausea, vomiting SERIOUS: Myelosuppression, Neuromyopathy

Formulary Labels/Preparations:


Colchicine 0.6mg tabs, pkg 100, $64.58 ($0.6458/tab); CDM/ODN

ADJUNCT AGENTS

Omeprazole *SAM* Class: Proton-pump inhibitor Strength: 20mg Dosage: Adult:

GI Ulcer prevention in patients on NSAIDs at risk of developing GI Ulcer: 20-40mg daily

Pediatric: 5kg-10kg: 5mg daily;

10kg-20kg: 10mg daily; >20kg: 20mg daily

Dosage Adjustments: Recommended in Asians and hepatic impairment.

Pregnancy Category: C Contraindications: Hypersensitivity to omeprazole, esomeprazole or components Precautions: Bartter’s syndrome, hypocalcemia, hypokalemia, long term therapy, metabolic alkalosis, sodium restricted diets,


respiratory alkalosis Major Drug Interactions: Atazanavir, bendamustine, clopidogrel, clorazepate, dasatinib, delavirdine, erlotinib, indinavir, methotrexate, mycophenolate mofetil, nelfinavir Adverse Reactions:

COMMON: Abdominal pain, diarrhea, headache SERIOUS: Toxic epidermal necrolysis, clostridium difficile diarrhea, pancreatitis, hepatotoxicity, bone/hip fracture, rhabdomyolysis, interstitial nephritis

Formulary Labels/Preparations: Alocid Capsules, pkg 30, $2.64 ($0.088/tablet), NAS/CAR


ASTHMA Asthma is the only lung disorder covered by the Plan. Patients with other airways conditions, including COPD, are not covered. Medications from the following pharmalogical classes are available:

• Beta-2 Agonists • Corticosteroids • Leukotriene Receptor Antagonists • Adjunct Medical Supplies

Judicious prescribing should be used, as the cost of some medications is high and use is not indicated for all persons. Both inhaled corticosteroids for maintenance and oral cortico-steroids for treatment of exacerbations are available. Nebulizers and nebulized salbutamol are available as SAM’s. These may only be prescribed by an asthma specialist or pulmonologist. Nebulizer kits and masks are covered under the Plan as a SAM. To be paid for by the Plan, such supplies must be written for as a prescription and presented to a participating pharmacy. Peak flow meters and spacers are available to assist your patient with monitoring and controlling their disease. These are available free of charge under the Plan. Patients are limited to one per year. These must be written for as a prescription and presented to a participating pharmacy.


Prednisolone suspension is available as a SAM for patients aged twelve (12) or under or with prior-authorization from the Plan.

BETA2 ADRENERGIC AGONIST

Salbutamol Class: Beta2 adrenergic agonist Strength: 100mcg MDI, 0.4mg/ml syrup, 4mg tabs, 0.5% resp. solution *SAM* Dosage: Adult: MDI:

Acute exacerbation: 4-8 inhalations every 20min up to 4hr, then every 1-4 hours as needed.

Bronchospasm: 2 inhalations every 4-6 hours or 1 inhalation every 4 hours as needed.

Exercise-induced asthma prophylaxis: 2 inhalations 15-30 minutes prior to exercise.

Nebulized solution: Acute exacerbation: 2.5-5mg every 20min for 3 doses, then 2.5-10mg every 1-4 hours as needed, or 10-15mg/ hr by continuous nebulization.

Bronchospasm: 2.5mg (0.5ml diluted in 2.5ml NS)


over 5-15 minutes 3-4 times daily as needed.

Syrup/tablets: 2-4mg 3-4 times daily (MAX 32mg/day divided)

Pediatric Dosage: MDI: Acute exacerbation: 4-8 inhalations every 20min for 3 doses, then every 1-4 hours as needed; use mask for children >4.

Bronchospasm: Age>4: 2 inhalations every 4-6 hours or 1 inhalation every 4 hours as needed

Exercise-induced asthma prophylaxis: Age>4: 2 I

nhalations 15-30 minutes prior to exercise

Nebulized solution: Acute exacerbation: 0.15mg/kg (MINIMUM DOSE 2.5mg) every 20 minutes for 3 doses then 0.15-0.3mg/ kg (MAX 10mg) every 1-4 hours as needed OR 0.5mg/kg/hr by continuous nebulization.

Brochospasm: Age >2: 0.1-0.15mg/kg/dose (dilute with NS to total volume of 3ml) (MAX 2.5mg) 3-4 times daily as needed. Syrup/tablets:

Age 2-6: 0.1mg/kg 3 times daily (MAX 12mg/day divided).

Age: 6-12: 2mg 3-4 times daily (MAX 24mg/day divided)


Pregnancy Category: C Dosage Adjustments: Recommended in elderly and patients with sensitivity to beta-adrenergic stimulators. Contraindications:Hypersensitivity to salbutamol (albuterol), components or levalbuterol. Precautions: Concomitant use with anti-inflammatory agents, beta-adrenergic blockers, MAOI’s, digoxin, non-potassium sparing diuretics, short acting sympathomimetics; asthma deterioration; preexisting cardiovascular disorders, convulsive disorders, diabetes mellitus, hyperthyroidism, keotacidosis; death; hypersensitivity; hypokalemia; paradoxical bronchospasm. Major Drug Interactions: Beta blockers, atomoxetine, brofaromine, clorgyline, furazolidone, iproniazid, isocarboxazid, lazabemide, linezolid, moclobemide, nialamide, pargyline, phenelzine, procarbazine, rasagiline, selegiline, toloxatone, tranylcypromine. Adverse Reactions:

Common: Tachyarrhythmia, hypokalemia, nausea, pharyngitis, throat irritation, nervousness, headache, tremor, cough, rhinitis, upper respiratory infection, lower respiratory infection.

SERIOUS: Atrial fibrillation, myocardial infarction, pulmonary edema.


Formulary Labels/Preparations: Ventolin 100mcg MDI, $2.12, CDM:LWD:NAS/GSK Ventolin Respiratory Solution 0.5% 20ml, $2.57, CDM:LWD:NAS/GSK Ventolin Syrup (0.4mg/ml), 200ml, $2.50 ($0.0125/ml), CDM:LWD:NAS/GSK Apo-Salvent 4mg tabs, pkg 100, $2.62 ($0.0262/tab), NAS/APO

CORTICOSTEROIDS

Fluticasone Class: Corticosteroid, inhaled Strength: 50mcg, 125mcg Dosage: Adult:

Asthma (previous therapy with bronchodilators only) 100mcg twice daily; (Max 500mcg twice daily).

Asthma (previous therapy with inhaled corticosteroids) 100-250 mcg twice daily (MAX 500mcg twice daily)

Pediatric:

Age 4-11: 50mcg twice daily (MAX 100mcg twice daily)


Age >12: as adult dosing Pregnancy Category: C Dosage Adjustments: None Contraindications: hypersensitivity to fluticasone or other ingredients; severe allergy to milk proteins; status asthmaticus or acute asthma exacerbation Precautions: adrenal insufficiency; concomitant CYP3A4 inhibitors; fungal, bacterial, viral or parasitic infections; ocular herpes simplex; tuberculosis. Major Drug Interactions: Atazanavir, bupropion, clarithromycin, darunavir, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, tipranavir. Adverse Reactions:

Common: Pharyngeal candidiasis; epistaxis, pharyngitis.

SERIOUS: Secondary hypocortisolism, anaphylaxis, immune hypersensitivity reaction, glaucoma, pneumonia.

Formulary Labels/Preparations: Flohale 125mcg, $13.85, CDM/CIP. Flixotide 50mcg, $9.37 CDM:LWD:NAL/GSK

Prednisone/Prednisolone See monographs under arthritis.


LEUKOTRIENE PATHWAY INHIBITOR

Montelukast Class: Leukotriene pathway inhibitor Strength: 4mg, 5mg, 10mg Dosage: Adult: 10mg each evening

Pediatric: Age 12-23 months: 4mg each evening; Age 2-5 yr: 4mg each evening;

Age 6-14 yr: 5mg each evening; Age >14: 10mg each evening

Pregnancy Category: B Dosage Adjustments: None Contraindications: Hypersensitivity to montelukast or component Precautions: Neuropsychiatric events have occurred; not indicated for acute asthma attacks; use in aspirin-sensitive patients; not indicated as mono-therapy for exercise-induced asthma; do not abruptly substitute for corticosteroids; contains phenylalanine. Major Drug Interactions: None


Adverse Reactions:

Common: Headache

SERIOUS: Allergic granulomatosis angitis, Cholestatic hepatitis, aggressive behavior, altered behavior, suicidal thoughts

Formulary Labels/Preparations: Singulair 4mg, pkg 30, $34.50 ($1.15/tablet), LWD/MSD. Singulair 5mg, pkg 30, $34.50 ($1.15/tablet), LWD/MSD. Singulair 10mg, pkg 30, $18.15 ($0.605/tablet), LWD/MSD

COMBINATION PRODUCTS

Budesonide/Formoterol Class: Anti-inflammatory/Bronchodilator Combination Strength: 80mcg/4.5mcg; 160mcg/4.5mcg Dosage: Adult: 2 inhalations twice daily

Pediatric: Age >12: 2 inhalations twice daily Pregnancy Category: C


WARNINGS: Long-acting beta (2)-adrenergic agonists may increase the risk of asthma-related deaths. Therefore, when treating patients with asthma, budesonide/formoterol fumarate should only be used for patients not adequately controlled on other asthma-controller medications or whose disease severity clearly warrants initiation of treatment with two maintenance therapies. Contraindications: Hypersensitivity to budesonide, eformoterol or any component; primary treatment for status asthmaticus or acute episodes of asthma or COPD. Precautions: Increased risk of asthma-related death and serious asthma events; inadequate adrenal response; bone mineral density loss; cardiovascular disorders; concomitant short-acting beta2- agonist use; convulsive disorders; COPD; systemic corticosteroid use; diabetes mellitus and ketoacidosis; exceeding recommended dose; decreased growth in children; hypokalemia; untreated systemic infections; thryotoxicosis; tuberculosis. Major Drug Interactions: Beta-blockers; brofaromine, clorgyline, furazolidone, iproniazid, isocarboxazid, lazabemide, linezolid, moclobemide, nialamide, pargyline, phenelzine, procarbazine, rasagiline, selegiline, toloxatone, tranylcypromine. Adverse Reactions:

Common: oral candidiasis, stomach ache, vomiting, backache, headache, nasal congestion, nasopharyngitis, throat pain, upper respiratory


infection, influenza.

SERIOUS: Hypokalemia, cataract, glaucoma, asthma related death, paradoxical bronchospasm.

Formulary Labels/Preparations: Vannair 80/4.5 MDI, $31.94, NAS/ZEN. Vannair 160/4.5 MDI, $34.75, NAS/ZEN.

Salmeterol/Fluticasone Class: Long-Acting Bronchodilator/Corticosteroid Stength: 25 mcg/50mcg, 50mcg/100mcg, 50mcg/250mcg Dosage: Adult and children > 12:

Asthma (50mcg/100mcg - 50mcg/500mcg) inhaled twice daily.

Initiation of Maintenance for Moderate Persistent Asthma: 50mcg/100mcg inhaled twice daily. Review after 6-12 weeks, if asthma is controlled, consider discontinuation of salmeterol and maintaining patient on inhaled corticosteroid only.

COPD: (not covered under NPDP) 50mcg/250mcg – 50mcg/500mcg inhaled twice daily.

Pediatric: Age 4-12: Asthma: 100mcg/50mcg inhaled twice daily


No dosing recommendations available for children under the age of 4. Pregnancy Category: C WARNINGS: Long-acting beta 2 adrenergic agonists may increase the risk of asthma-related deaths. Salmeterol/Fluticasone should only be used in patients not adequately controlled on other asthma-controller medications or whose disease severity warrants therapy. Contraindications: Hypersensitivity to salmeterol, fluticasone or any component of the inhaler Precautions: Not for use in acute symptoms, patients should be advised to carry their relief medication with them at all times; therapy should not be stopped abruptly; pneumonia; use with caution in patients with pulmonary tuberculosis and/or thyrotoxicosis; cardiovascular effects may be seen, therefore should be used with caution in patients with cardiovascular disease; transient decreases in serum potassium may occur; glaucoma; may unmask underlying eosinophilic conditions; may increase glucose levels, therefore should be used with caution in patients with diabetes; combination with retonavir should be avoided; CYP3A4 inhibitors should be avoided. Major Drug Interactions: CYP3A4 inhibitors (ketoconazole, atazavir, ritonavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir); beta-blockers


Adverse Reactions: Common: oral candidiasis, nasal congestion, nasopharyngitis, throat pain, upper respiratory infection, influenza, muscle cramps

SERIOUS: hypersensitivity, cardiac arrhythmia, hyperglycemia

Formulary Labels/Preparations: Seretide Inhaler 25/50mcg MDI, $22.50, CDM:LWD:NAL/NOT Seretide Disk 50/100mcg MDI, $22.50, CDM:LWD:NAL/NOT Seretide Disk 50/250mgc MDI, $25.00, CDM:LWD:NAL/NOT

MISCELLANEOUS AGENTS

Sodium Chloride for Inhalation *SAM* Class: Isotonic Solution Strength: 0.9% Dosage: QS with Salbutamol respiratory solution to a total of 3ml. Pregnancy Category: C Dosage Adjustments: None Precautions: Must be used in combination with salbutamol


Adverse Effects: SEVERE: Respiratory distress Formulary Labels/Preparations: Sodium chloride for inhalation, 100x3ml, $15.00, LWD/Nephron.

MEDICAL SUPPLIES

Nebulizer Drive Nebulizer Kit, $29.95, PRT Drive Nebulizer Mask, Adult, $1.65, PRT Drive Nebulizer Mask, Child, $1.75, PRT

Peak Flow Meter Hudson Peak Flow Meter, $11.65, PRT

Spacer Hudson Spacer, Large, $17.63, PRT Hudson Spacer, Medium, $17.63, PRT Hudson Spacer, Child, $17.63, PRT Hudson Spacer, Infant, $17.63, PRT


BENIGN PROSTATIC HYPERTROPHY (BPH) The following classes of drugs are available under the Drug Plan for the management of Benign Prostatic Hypertrophy (BPH)

- 5-Alpha Reductase Inhibitor - Alpha 1-Adrenoreceptor Blockers

5-ALPHA REDUCTASE INHIBITORS

Dutasteride Class: 5-Alpha Reductase Inhibitor Indication: Benign Prostatic Hypertrophy (BPH) Dosage: 0.5mg once daily Pregnancy Category: X Precautions: Do not prescribe this medication to women. Advise patients not to donate blood during drug therapy or six months after stopping the medication. CONTRAINDICATIONS: Hypersensitivity to dutasteride or any other 5-alpha reductase inhibitors such as finasteride.


Adverse Reactions: Common: impotence, decreased libido, dizziness and breast disorders.

SERIOUS: None

Drug Interactions: Dutasteride is extensively metabolized by the CYP 3A4 isoenzymes. Use caution when prescribing dutasteride in combination with potent CYP 3A4 inhibitors such as ritonavir, ketoconazole, verapamil and diltiazem. Formulary Label/Preparation Avodart 0.5mg capsules, pkg30, $30.00($1.00/capsule); CDM:LWD:NAS/GSK

ALPHA-1 ADRENORECEPTOR BLOCKER

Terazosin Class: Alpha-1 adrenoreceptor blocker Indication: Benign Prostatic Hypertrophy and Hypertension. Dosage: BPH: 1mg at bedtime, thereafter, titrate upwards, if

needed over several weeks. Most patients require 10mg daily; if no response after 4-6 weeks of 10mg daily may increase to 20mg daily.

Hypertension: 1mg daily at bedtime; slowly increase


to achieved desired blood pressure, up to a maximum of 20mg daily.

Pregnancy Category: C Precautions: Can cause significant orthostatic hypotension, especially with the first dose; anticipate similar effects if therapy is interrupted for a few days, if dosage is rapidly increased or if another anti-hypertensive drug (particularly vasodilators) or PDE-5 inhibitors such as sildenafil are introduced. Discontinue therapy if symptoms of angina occur or worsen. Patients should be cautioned about performing hazardous task when starting new therapy or adjusting dosage upward. Prostate Cancer should be ruled out before staring therapy for BPH. CONTRAINDICATIONS: Hypersensitivity to terazosin or any component of the formulation. Adverse Reactions:

Common: Orthostatic hypotension, dizziness, impotence, decreased libido, somnolence and peripheral edema.

SERIOUS: Chest pain, abdominal pain, abdominal vision, allergic reactions, cardiac arrhythmias and anaphylaxis.

Drug Interactions: Amifostine, verapamil, diltiazem, rituximab, pentoxiphylline, prostacyclin analogs, methylphenidate, sildenafil, tadalafil and vardenafil.


Formulary Label/Preparations: Apo-terazosin 1mg, Pkg 100, $9.20 ($0.0920/tablet), NAL/APO Apo-terazosin 2mg, Pkg 100, $9.20 ($0.0920/tablet), NAL/APO Apo-terazosin 5mg, Pkg 100, $9.20 ($0.092/tablet), NAL/APO

Tamsulosin Class: Alpha-1 Adrenoreceptor Blocker Indication: Benign Prostatic Hypertrophy (BPH). Dosage: 0.4mg once daily 30 minutes after the same meal every day, dose may be increased after 2-4 weeks. Pregnancy Category: B Precautions: Not intended for use as an anti-hypertensive agent. May cause significant orthostatic hypotension and syncope, especially for the first dose; anticipate a similar effect if therapy is interrupted for a few days, if dosage is increased rapidly or if other anti-hypertensive drugs are introduced. CONTRAINDICATIONS: Hypersensitivity to tamsulosin or any component of the formulation. Adverse Reactions:

Common: Orthostatic hypotension, headaches,


dizziness, gum pain, toothache, nausea, cough and decreased libido.

SERIOUS: Syncope, angioedema, priapism, palpitations and skin desquamations.

Drug Interactions: Ritonavir, dasatinib, verapamil, diltiazem, sildenafil, tadalafil, vardenafil and felodipine. Formulary Label/Preparation: Tamsulosin 0.4mg tablets, pkg 10, $1.98 ($0.1980/tablet), LWD/HLT


BREAST CANCER

Breast cancer is restricted to diagnosis by an oncologist or surgeon. The medications available for breast cancer are SAM and can only be prescribed by a medical oncologist. Medications from the following pharmalogical classes are available: AROMATASE INHIBITORS: Anastrozole is the aromatase inhibitor currently on the formulary. It should be prescribed as a 28 day supply for ease of dispensing from the pharmacy. The patient will be allowed to refill the medication every 28 days. SERMs (Selective Estrogen Receptor Modulators): Tamoxifen, also known as tamoxifen citrate, is a hormonal therapy for breast cancer available under the Plan.


AROMATASE INHIBITOR

Anastrazole (SAM) Class: Antineoplastic agent; aromatase inhibitor Strength: 1mg Dosage: Breast cancer; adults oral: 1 mg once a day Pregnancy Category: D Indication: For adjuvant treatment of postmenopausal women with hormone receptor-positive early breast cancer; is indicated for the first-line treatment of postmenopausal women with hormone receptor-positive or hormone receptor unknown locally advanced or metastatic breast cancer; is indicated second-line treatment for the treatment of advanced breast cancer in postmenopausal women with disease progression following tamoxifen therapy. Precautions: Hazardous agent - Use appropriate precautions for handling and disposal. Caution in women with pre-existing ischemic heart disease, an increased incidence of ischemic cardiovascular events was observed in Arimidex. Use with caution in patients with hyperlipidemias; total cholesterol and LDL-cholesterol increase in patients receiving anastrozole; exclude pregnancy prior to initiating treatment; may be associated with reduction in bone mineral density; safety and efficacy in premenopausal women and children have not been established.


Contraindications: Hypersensitivity to anastrozole or any of its components; pregnancy; tamoxifen. Adverse Reactions:

Common: hot flashes, asthenia, arthritis, pain, arthralgia, pharyngitis, hypertension, depression, nausea and vomiting, rash, osteoporosis, fractures, back pain, insomnia, headache, bone pain, peripheral edema, increased cough, dyspnea, pharyngitis and lymphedema.

SERIOUS: Skin reactions such as lesions, ulcers, or blisters; allergic reactions with swelling of the face, lips, tongue, and/or throat; changes in blood tests of the liver function, including inflammation of the liver with symptoms that may include a general feeling of not being well, with or without jaundice, liver pain or liver swelling.

Major Drug Interactions: Estrogen-containing therapies should not be used with ARIMIDEX as they may diminish its pharmacological action; avoid black cohosh, hops, licorice, red clover, thyme, and dong quai. Formulary Labels/Preparations: Arimidex 1mg, pkg 28, $118.72 ($4.24/per tab), NAS/ZEN.


SERM

Tamoxifen (SAM) Class: Antineoplastic agent; SERM Strength: 20mg Indication: Palliative or adjunctive treatment of advanced breast cancer; reduce the incidence of breast cancer in women at high risk; reduce risk of invasive breast cancer in women with ductal carcinoma in situ; metastatic female and male breast cancer. Dosage: Adults:

Breast cancer: metastatic (males and females) or adjuvant therapy (females): 20-40mg/day; daily doses > 20mg should be given in divided doses (morning & evening);

Prevention (high risk females): 20 mg/day for 5 years. *Note: Indication not covered by Plan.

Pregnancy Category: D Precautions: For Women with Ductal Carcinoma in Situ (DCIS) and Women at High Risk for Breast Cancer: Serious and life-threatening events include uterine malignancies, stroke and pulmonary embolism.


Contraindications: in patients with known hypersensitivity to the drug or any of its ingredients; reduction in breast cancer incidence in high risk women and women with DCIS; in women who require concomitant coumarin-type anticoagulant therapy or in women with a history of deep vein thrombosis or pulmonary embolus. Adverse Reactions: Increased bone and tumor pain, flushing, hypertension, peripheral edema, mood changes, depression, skin changes, rash, hot flashes, fluid retention; altered menses, amenorrhea, nausea, weight loss, vaginal bleeding/discharge, weakness, arthritis, pharyngitis. Drug Interactions: Concomitant use with warfarin; increases the levels of: amidarone, paclitaxel, pioglitazone, repaglinide and rosiglitazone; fluconazole, nicardipine, NSAIDS, sulfonamides, tolbutamide; chlorpromazine, fluoxetine, paroxetine, miconazole, azole antifungals; quinidine, verapamil; rifamycin derivatives. Formulary Label/Preparation: APO-TAMOX 20 mg, pkg 100, $15.30 ($0.1530 per tab), NAS/APO.


ADJUNCT – PAIN RELEIVERS

NSAIDS/COX2 Inhibitors: see monographs under arthritis. Tricyclic Antidepressants: see monographs under psychiatric illness. Neuropathic Agents (Carbamazepine/Gabapentin): see monographs under epilepsy.


DIABETES Patients with Type I and Type II diabetes are eligible under the Plan. Medications to treat specific complications of diabetes (neuropathy and nephropathy) are also covered if the patient has a diagnosis of diabetes. Medications from the following pharmacological classes are available:

• Biguanides • Dipeptidylpeptialase type 4 (DDP-4) Inhibitors • Sulfonylureas • Insulin • Thiazolidinedione

Medications for the treatment of selected diabetic complications inclusive of, but not limited to:

• Nephropathy (Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors).

• Neuropathy (Tricyclic Antidepressants (TCA’s) and Anticonvulsants).

• Adjunct Medical Supplies Necessary to Improve Patient Care and Compliance

Any practitioner may prescribe from the approved list of drugs. However, judicious prescribing should be used, as the cost of some medications is high and use is not indicated in all persons. The Humulin® insulins are designated SAM. Prior authorization must be given by the NPDP before the prescription is filled. Patients must have documented


intolerance to the Novolin® brand insulin in order for the Humulin® to be covered. Glucometers, test strips, alcohol swabs, and insulin syringes are covered free under the Plan. These medical supplies must be written as a prescription and presented to a participating pharmacy in order for the patient to receive their supplies. Any patient with diabetes is allowed glucometers and test strips. There is a maximum of 2 boxes (100 test strips) per month. Sulphonylureas work by stimulating the pancreas to release insulin and are only effective when pancreatic beta-cell activity still present. Non-obese patients with type 2 diabetes are usually started on sulfonylureas. A common side effect is hypoglycemia. They may cause weight gain and should be used cautiously in obese patients. Biguanides, of which metformin is the only drug currently available, decrease hepatic glucose production, increase the insulin-receptor binding, and stimulate tissue uptake of glucose. It does not stimulate the pancreas to make or release more insulin. It does not cause hypoglycemia or weight gain therefore most patients with Type 2 diabetes are usually started on this class. The most common side effects are abdominal discomfort, diarrhea, nausea or vomiting, loss of appetite, and metallic taste. Thiazolidinediones (glitazones) work by increasing insulin sensitivity and decreasing insulin resistance in the periphery and liver. They should be prescribed in combination with metformin or a sulphonylurea.


Insulins are categorized as basal or bolus insulin based on the duration of action. Basal insulins include neutral protamine Hagedorn (NPH), or isophane insulin (Novolin N, Humulin N), ultralente (extended insulin zinc suspension), and the insulin analogue glargine (Lantus). Bolus or mealtime insulins include regular insulin (Novolin R, Humulin R) and the analogue forms aspart (NovoLog) and lispro (Humalog). Premixed formulations incorporate NPH and regular or rapid-acting analogues. Regular insulin must be injected 30 to 60 minutes before the meal to match postprandial glucose influx. NPH peaks 4 to 10 hours after injection. Premixed formulations of NPH and regular insulin provide a bimodal pattern of insulin activity for approximately 12 hours. Analogue insulins (i.e., glargine, aspart, and lispro) have one to three amino acids substituted in the human insulin protein, producing altered absorption rates and more reliable absorption profiles. Lispro and aspart are active within 15 minutes and peak in about one hour, mimicking normal mealtime insulin release. Glargine provides a peakless, continuous release over 24 hours that approximates a normal basal pattern. Dipeptidyl Peptidase 4 Inhibitors work by protecting the endogenous incretin hormones and enhancing their actions. Glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are incretin hormones released in response to meal intake to maintain glucose homeostasis. GLP-1 and GIP increase insulin synthesis and release from the pancreas. GLP-1 also lowers glucagon


secretion causing reduced hepatic glucose production. GLP-1 and GIP are metabolized rapidly by DPP-4 enzyme, resulting in loss of insulinotropic effects. DPP-4 Inhibitors thus inhibit the degradation of incretin hormones by DPP-4; thereby, enhancing the function of GLP-1 and GIP to increase insulin release and decrease glucagon levels.


DIPEPTIDYL PEPTIDASE 4 INHIBITORS

Sitagliptin Class: Antidiabetic, DPP-4 Inhibitor Indication: Type II Diabetes Dosage: Adult:

Single agent: 100mg once daily.

Combination with sulphonylurea: may require lower dosage of the sulphonylurea.

Combination with metformin: inadequately controlled on metformin monotherapy, initial: sitagliptin 50 mg plus current dose of metformin twice daily.

inadequately controlled on sitagliptin monotherapy, initial: sitagliptin 50 mg/metformin 500 mg twice daily

switching from sitagliptin co-administered with metformin, initial: same as current doses of sitagliptin and metformin

not currently treated with metformin, initial, sitagliptin 100 mg/metformin hydrochloride 1000 mg once daily.

Pediatric: Safety and efficacy not determined.


Dosage Adjustment: 25mg daily is recommended for patients with end-stage renal disease on dialysis. Pregnancy Category: B Precautions: hypersensitivity and allergic reactions, serious (eg. angioedema, anaphylaxis, Stevens-Johnson syndrome), acute pancreatitis, worsening renal function, moderate –severe renal impairment monitoring and dosage adjustment recommended. Adverse Reactions:

Common: hypoglycemia, headache,nasopharyngitis, upper respiratory infection

SERIOUS: Acute pancreatitis, anaphylaxis, angioedema, generalized exfoliative dermatitis, hypersensitivity reaction, rash, Stevens-Johnson syndrome, urticaria, rhabdomyolysis, acute renal failure

Drug Interactions: chlorpropamide, danazol, dextrothyroxine, digoxin, glimepiride, glipizide, glyburide, levothyroxine, liothyronine, thyroglobulin, thyroid, tolazamide, tolbutamide Formulary Label/Preparations: Januvia 50mg, pkg 28, $31.64 ($1.13 per tab) LWD/MSD Januvia 100mg, pkg 28, $31.64 ($1.13 per tab) LWD/MSD Janumet 50/1000mg, pkg 56, $33.88 ($0.605/tab) LWD/MSD Janumet 50/500mg, pkg 56, $34.80 (0.6214/tab) LWD/MSD

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SULPHONYLUREAS

Glibenclamide/Glyburide Class: Antidiabetic, sulphonylurea Indication: Management of Type II diabetes mellitus Dosage: Adult:

Initial: 2.5 - 5mg/day, administered with breakfast or the first main meal of the day. Maintenance: 1.25 -20mg daily, either as a single dose or in divided doses.


Dosage Adjustment: Needed in elderly, debilitated or malnourished patients: initial 1.25 - 2.5mg once daily. Pregnancy Category: B Precautions: Severe hypoglycemia; exacerbated by insufficient caloric intake; after severe prolonged exercise, when alcohol is ingested, or when more than one glucose lowering drug is used. Hypoglycemia is more likely in elderly patients, malnourished patients or in patients with impaired renal or hepatic function. Adverse Reactions: Vasculitis, headache, dizziness, allergic


reactions, disulfiram-like reaction, hypoglycemia, hyponatremia, nausea, epigastric fullness, heartburn, constipation, diarrhea, anorexia, nocturia. Drug Interactions: Adrenocorticoids, amphetamines, baclofen, furosemide, glucocorticoids, phenytoin, rifamycins, thiazide diuretics, thyroid hormones, triameterene: may increase blood glucose level. Anabolic steroids Formulary Label/Preparation: Glyburide 5mg, pkg 100, $0.079, ($0.01per tab) LWD/HLT

Gliclazide Class: Antidiabetic, sulphonylurea Indication: Management of Type II diabetes mellitus (noninsulin dependent) Dosage: Adult: sustained release tablet: 30-120mg once

daily; should be taken with a meal; contraindicated in severe renal/ hepatic impairment. Pediatric: Safety and efficacy not determined.

Pregnancy Category: C Precautions: Severe hypoglycemia; exacerbated by insufficient caloric intake; after severe prolonged exercise, when alcohol is ingested, or when more than one glucose lowering drug is used. Hypoglycemia is more likely in the


elderly patients, malnourished patients or in impaired renal or hepatic function. Adverse Reactions: Headache, nervousness, dizziness, allergic reactions, hypoglycemia, nausea, vomiting, gastritis and diarrhea. Drug Interactions: Increase effect/ toxicity: ACE inhibitors, H2 antagonists, antacids, oral sodium bicarbonate, salicylates, & sulfonimides may increase the hypoglycemic effect of gliclazide. Formulary Label/Preparation: Diamicron MR 30mg, pkg 30, $4.90, (0.163 per tab), LWD:NAL/SER Diamicron MR 60mg, pkg 30, $9.80, (0.3267 per tab), LWD:NAL/SER

Glimepiride Class: Antidiabetic; sulphonylurea Indication: Management of Type II diabetes mellitus as an adjunct to diet and exercise to lower blood glucose; may be used in combination with metformin or insulin. Dosage: Adult:

Initial: 1 to 2 mg P.O. once daily with first main meal or the day;

Maintenance: 1 to 4 mg P.O. once daily. After a dose of 2mg once daily, increase in increments of 2mg at 1


to 2 week intervals based on patient’s blood glucose response; maximum dose 8mg once daily.

Geriatric: Initial: 1mg/day.

Renal impairment: 1 mg/day with first meal.


Pregnancy Category: C Precautions: Severe hypoglycemia; exacerbated by insufficient caloric intake; after severe prolonged exercise, when alcohol is ingested, or when more than one glucose lowering drug is used. Hypoglycemia is more likely in the elderly patients, malnourished patients or in impaired renal or hepatic function. Contraindications: Known hypersensitivity to the drug or sulphonamides; diabetic ketoacidosis, with or without coma. Adverse Reactions: Dizziness, headache, blurred vision, abdominal pain, diarrhea, nausea, vomiting, aplastic anemia, thrombocytopenia, hypoclycemia, allergic skin reactions. Drug Interactions: Beta blocker may mask symptoms of hypoglycemia; hormonal contraceptives, nicotinic acid, corticosteroids, phenytoin, thiazide and other diuretics, thyroid products may increase risk of hyperglycemia. Insulin may increase risk of hypoglycemia; NSAIDS and other drugs that


are highly protein bound such as beta blockers, salicylates, sulphonamides-may potentiate hypoglycemic action. Alcohol use may alter glycemic control, may also cause disulfiram-like reaction. Formulary Labels/Preparations: Diaberyl 2mg, pkg 30, $3.12, ($0.104 per tab), CDS/REM. Diaberyl 4mg, pkg 30, $6.80, ($0.23 per tab), CDS/REM.

INSULIN

Insulin Glargine Class: Antidiabetic; pancreatic hormone Indication: Management/treatment of Type I diabetes mellitus & Type II diabetes mellitus in patients who need basal (long acting) insulin to control hyperglycemia. Dosage: Children and adults:

Type I Diabetes: Initial: 0.2-0.6 units/ kg/day subcutaneously once daily at the same time each day.

Type II Diabetes: Patients not already on insulin: 10 units once daily, adjust according to patient response (range: 2-100 units/day).

Pregnancy Category: C Precautions: Not intended for intravenous administration; must


not be diluted or mixed with any other insulin or solution. Insulin may cause sodium retention and edema, particularly if previously poor metabolic control is improved by intensified insulin therapy. Hypoglycemia reactions may be associated with the administration of insulin glargine. Contraindications: Patients hypersensitive to insulin glargine or the excipients. Adverse Reactions: Lipodystrophy may occur at the injection site and delay insulin absorption. Redness, pain, itching, hives, swelling, and inflammation of the injection site may also occur. Drug Interactions: The following may increase blood-glucose- lowering effect and susceptibility to hypoglycemia: oral antidiabetes products, ACE inhibitors, disopyridamole, fibrates, fluoxetine, MAO inhibitors, propoxyphene, salicylates, somatostatin analog, sulphonamide antibiotics. Corticosteroids, danazol, diuretics, sympathomimetic agents, isoniazid, thyroid hormones, oral contraceptives, protease inhibitors and atypical antipsychotic medications may reduce the blood-glucose lowering effect of insulin. Formulary Label/Preparation: Lantus 100 units/mL (10 mL) [vial], $36.05, LWD/SAN

Insulin Isophane Class: Antidiabetic, insulin


Indication: Management of Type 1 diabetes mellitus (insulin-dependent) and Type II diabetes mellitus (non–insulin-dependent) not properly controlled by diet, exercise, and weight reduction. Dosage: Children and Adults: Subcutaneous 0.5 to 1

units/kg/day. Adjust doses to achieve pre-meal and bedtime blood glucose levels of 80 to 140 mg/dL

Severe ketoacidosis or diabetic coma: subcutaneous 0.8 to 1.2 units/kg/day. Regular insulin is given IV or IM

Children younger than 5 yr of age: 100 to 200 mg/dL.

Pregnancy Category: B Precautions: Check blood sugar frequently and observe for signs of hypoglycemia and hyperglycemia. Periodically measure glycosylated hemoglobin (A 1c) to monitor long-term glycemic control. Check urine for ketones in patient at risk for ketoacidosis and observe for signs and symptoms of ketoacidosis (eg, drowsiness, frequent urination, fruit-like breath, thirst). Changes in purity, strength, brand, type, or species source of insulin may necessitate dosage adjustment. Hyperthyroidism may cause an increase in the renal Cl of insulin; hyperthyroidism may delay insulin turnover. Contraindications: Hypersensitivity to any ingredient of the product; during episodes of hypoglycemia.


Adverse Reactions: Cutaneous hypersensitivity, pain at injection site, hypoglycemia, lypodystrophy. Drug Interactions: ACE inhibitors, anabolic steroids, clofibrate, disopyramide, fibrates, fluoxetine, guanethidine, MAOIs, oral antidiabetics, propoxyphene, salicylates, sulfinpyrazone, sulfonamide antibiotics, tetracyclines may increase hypoglycemic effects of insulin. Alcohol, beta-blockers, clonidine, lithium salts- may increase or decrease the blood glucose-lowering effect of insulin. Atypical antipsychotics, corticosteroids, danazol, diazoxide, diltiazem, glucagon, isoniazid, oral contraceptives, phenothiazines, protease inhibitors, somatropin, sympathomimetics, thyroid hormone: may decrease hypoglycemic effects of insulin Formulary Labels/Preparations: Novolin N 100 units/ml; $7.50 per 10 ml [vial], CDS/NOV; Humulin NPH HI310 100 units/ml; $13.34 per 10 ml [vial], NAS/LIL; *SAM

Insulin Lispro *SAM Class: Antidiabetic; insulin Indication: Treatment of type 1 diabetes mellitus; type 2 diabetes mellitus to control hyperglycemia Dosage: Dosage regimens of insulin lispro will vary among patients and should be determined by the health care professional familiar with the patient’s metabolic needs, eating habits, and other lifestyle variables.


Pregnancy Category: B Precautions: Hypoglycemia is the most common adverse effect associated with insulins, including insulin lispro. As with all insulins, the timing of hypoglycemia may differ among various insulin formulations. Glucose monitoring is recommended for all patients with diabetes. Any change of insulin should be made cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type (e.g., regular, NPH, analog), species (animal, human), or method of manufacture (rDNA vs. animal-source insulin) may result in the need for a change in dosage. Hypoglycemia and hypokalemia are among the potential clinical adverse effects associated with the use of all insulins. Because of differences in the action of Humalog and other insulins, care should be taken in patients in whom such potential side effects might be clinically relevant (e.g., patients who are fasting, have autonomic neuropathy, or are using potassium-lowering drugs or patients taking drugs sensitive to serum potassium level). Contraindications: Humalog is contraindicated during episodes of hypoglycemia and in patients sensitive to Humalog or one of its excipients. Adverse Reactions: Allergic reactions; injection site reaction, lipodystrophy, pruritus, rash and hypoglycemia. Drug Interactions: Corticosteroids, isoniazid, certain lipid-lowering drugs (e.g., niacin), estrogens, oral contraceptives, phenothiazines, and thyroid replacement therapy.


Formulary Label/Preparation: Humalog 100 units/mL (10 ml) [vial], $32.81, NAS/LIL Humalog KwikPen 100 units/ml (3 ml x 5) $46.80, NAS/LIL *SAM

Insulin Regular Class: Antidiabetic; insulin Indication: Treatment of diabetic patients with marked insulin resistance (daily requirements more than 200 units), since a large dose may be administered subcutaneously in a reasonable volume. Dosage: Regular insulin is short-acting insulin and is generally injected subcutaneously 2-5 times daily within 30-60 minutes before a meal. Total daily insulin requirements: Initial dose: 0.5-0.8 unit/kg/day subcutaneously • Honeymoon phase: 0.2-0.5 unit/kg/day subcutaneously • Split dose therapy: 0.5-1.2 unit/kg/day subcutaneously • Insulin resistance: 0.7-2.5 units/kg/day subcutaneously

Pregnancy Category: B Precautions: Human insulin product differs from animal-source insulins because it is structurally identical to the insulin produced by the body’s pancreas and because of its unique


manufacturing process. Any change of insulin should be made cautiously and only under medical supervision. Changes in purity, strength, brand (manufacturer), type (regular, nph, lente, etc), species (beef, pork, beef-pork, human), and/or method of manufacture (rdna versus animal-source insulin) may result in the need for a change in dosage. This insulin preparation contains 100 units of insulin in each milliliter. Extreme caution must be observed in the measurement of dosage because inadvertent overdose may result in irreversible insulin shock. Serious consequences may result if it is used other than under constant medical supervision. Contraindications: Not for use during episodes of hypoglycemia. Adverse Reactions: Hypoglycemia (sweating, dizziness, palpitations, tremor, hunger, drowsiness, depressive mood, irritability, lightheadedness; more severe hypoglycemia-disorientation, seizures, unconsciousness, death); lipodystrophy, local allergy (erythema, local edema, pruritus at injection site); systemic allergy. Drug Interactions: Oral hypoglycemic taken concurrently can intensify hypoglycemia; albuterol, clonidine, reserpine, guanethidine, beta blockers Formulary Labels/Preparations: Novolin R 100 units/ml; $7.50 per 10 ml [vial], CDS/NOV; Humulin R 100 units/ml; $13.34 per 10 ml [vial], NAS/LIL; *SAM


Insulin Isophane/Regular Class: Antidiabetic; insulin Dosage: Individualized for each patient Pregnancy Category: B Indication: Treatment of Type I diabetes mellitus; Type II diabetes mellitus to control hyperglycemia. Precaution: Human insulin product differs from animal-source insulins because it is structurally identical to the insulin produced by the body’s pancreas and because of its unique manufacturing process. Any change of insulin should be made cautiously and only under medical supervision. Changes in purity, strength, brand (manufacturer), type (regular, nph, lente®, etc), species (beef, pork, beef-pork, human), and/or method of manufacture (rdna versus animal-source insulin) may result in the need for a change in dosage. Adverse Reactions: Hypoglycemia (sweating, dizziness, palpitations, tremor, hunger, drowsiness, depressive mood, irritability, lightheadedness; more severe hypoglycemia-disorientation, seizures, unconsciousness, death); lipodystrophy, local allergy (erythema, local edema, pruritus at injection site); systemic allergy. Formulary Labels/Preparations: Novolin 70/30 100 units/ml; $7.50 per 10 ml, CDS/NOV Humulin 70/30 100 units/ml; $13.34 per 10 ml, NAS/LIL *SAM


THIAZOLIDINEDIONE

Pioglitazone *SAM Class: Antidiabetic; thiazolidinedione Indication: As an adjunct to diet and exercise to improve glycemic control in adults with Type II diabetes mellitus. Dosage: Adults: Initial: 15 mg or 30mg once a day; may be

increased up to 45 mg once a day. Maximum dose: 45 mg once daily.


Dosage Adjustments: Recommended in congestive heart failure Class II. Contraindicated in Classes III and IV. Pregnancy Category: C Precautions: Thiazolidinediones can cause fluid retention when used alone or in combination with other antidiabetic agents, including insulin. Fluid retention may lead to or exacerbate heart failure. Patients should be observed for signs and symptoms of heart failure (including excessive, rapid weight gain, dyspnea, and/or edema). If these signs and symptoms develop, the heart failure should be managed according to current standards of care. Furthermore, discontinuation or dose reduction must be considered.


Contraindications: Class III or IV heart failure; active liver disease or jaundice; Type I diabetes; women pregnant or breastfeeding or patients with known hypersensitivity to this product or any of its components; not indicated for the treatment of diabetic ketoacidosis and should be used with caution in people with edema. Adverse Reactions: New or worsened heart failure, low blood sugar (hypoglycemia), swelling (edema), weight gain, ovulation, low red blood cell count (anemia), liver problems, swelling in the back of the eye, bone fractures upper respiratory tract infection, headache, sinus infection, muscle soreness, tooth problems, aggravated diabetes, sore throat. Drug Interactions: Oral contraceptives, fexofenadine, ketoconazol, gemfibrozil, atorvastatin, nifedipine, rifampin, montelukast Formulary Label/Preparation: Lapizone 15mg, pkg 30, $3.96, ($0.132 per tab) CDM/LBD. Lapizone 30mg, pkg 30, $5.61, ($0.187 per tab) CDM/LBD.

BIGUANIDE

Metformin Class: Antidiabetic agent; Biguanide Indication: Type II diabetes mellitus. Metformin may be used


concomitantly with a sulfonylurea or insulin to improve glycemic control. Dosage: Adults: Initial: 500 mg twice daily (with morning and

evening meals) or 850 mg once daily; increase dosage in increments of 500-850mg every 2 weeks. MAX 2550 mg.

Pediatric: Initial: 500 mg twice daily (with morning and evening meals); increases in daily dosage should be made in increments of 500mg at weekly intervals given in divided doses. MAX 2000mg.

Pregnancy Category: B Precautions: Lactic acidosis is a rare by serious metabolic complication that can occur due to metformin accumulation during treatment. When is does occur it is fatal in 50% of patients. Lactic acidosis is characterized by elevated blood lactate levels (> 5 mmol/L), decreased blood pH, electrolyte disturbances with an increased anion gap, and an increased lactate/pyruvate ratio. When metformin is implicated as the cause of lactic acidosis, metformin plasma levels > 5 μg/mL are generally found. In particular, treatment of the elderly should be accompanied by careful monitoring of renal function. Metformin treatment should not be initiated in patients ≥ 80 years of age unless measurement of creatinine clearance demonstrates that renal function is not reduced, as these patients are more susceptible to developing lactic acidosis. In addition, metformin should be promptly withheld in the presence of any condition associated with hypoxemia, dehydration, or sepsis. Because impaired hepatic function may significantly limit the ability to


clear lactate, metformin should generally be avoided in patients with clinical or laboratory evidence of hepatic disease. Patients should be cautioned against excessive alcohol intake, either acute or chronic, when taking metformin since alcohol potentiates the effects of metformin hydrochloride on lactate metabolism. Monitor renal function- metformin is mainly excreted by the kidney, and the risk of metformin accumulation and lactic acidosis increases with the degree of impairment or renal function. Contraindications: Renal disease or renal dysfunction (e.g., as suggested by serum creatinine levels ≥ 1.5 mg/dL [males], ≥ 1.4 mg/dL [females] or abnormal creatinine clearance) which may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction, and septicemia; known hypersensitivity to metformin hydrochloride; acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Adverse Reactions: Diarrhea, nausea, vomiting, flatulence, asthenia, indigestion, abdominal discomfort and headache. Drug Interactions: Increased effect: furosemide, cimetidine, amiloride, digoxin, morphine, procainamide, quiidine, quine, ranitidine, triamterene, trimethoprim, and vancomycin. Contrast agents may increase the risk of metformin-induced lactic acidosis; discontinue metformin prior to exposure and withhold for 48 hours. Decreased effect: diuretics, corticosteroids, phenothiazines, thyroid products, sympathomimetics, phenytoin, calcium channel blockers, oral contraceptives, nicotinic acid, and isoniazid.


Formulary Label/Preparation: Apo-Metformin 500mg, pkg 500, $14.28, (0.029/ tab),NAS/APO

DIABETIC ADJUNCT MEDICATIONS Nephropathy – Lisinopril, Perindopril, Telmisartan, Valsartan Neuropathy – Amitryptyline, Gabapentin, Carbamazepine

DIABETIC SUPPLIES

Alcohol Prep Pads Dynarex, pkg 200 per box $1.89, MDMS

Glucometer TrueBalance, 1, Free, CDM

Glucose Test Strips TrueBalance, pkg 50, $8.85, CDM

Insulin syringes w/Needles Nipro, 1cc, pkg 100 per box, $8.00 CDM Becton Dickinson Syringes 1/2 cc, pkg 100 per box, $13.85, LWD

Lancets Boca Medical, pkg 100 per box, $1.99, PRT


EPILEPSY

The following Classes of medications will be available under the Drug Plan for the management of Epilepsy.

• Hydantoins • Dibenzazepine Carbamates • Histone Deacetylase Inhibitors • Sulfamates

HYDANTOIN

Phenytoin Sodium Class: Hydantoin, Anticonvulsant Indication: Generalized tonic-clonic (grand mal), complex partial seizures; prevention of seizures following head trauma/ neurosurgery. Dosage: Adults: 100mg 3 times or 4 times a day. If seizure

control is established with divided doses of three 100mg capsules daily, once daily dosing with 300mg of extended release Phenytoin Sodium may be considered. Alternatively, the dosage may be increased up to 200mg 3 times a day if necessary.

Children: Age 6 months - 3 years: (8mg-10mg/kg/day every 8


hours) Age 4 years - 6 years: (7.5mg-9mg/kg/day every 8 hours) Age 7 years - 9 years: (7mg-8mg/kg/day every 8 hours) Age 10 years - 16 years: (6mg-7mg/kg/day every 8 hours)

CONTRAINDICATIONS: Hypersensitivity to phenytoin, other hydrations, or any component of the formulation; pregnancy. Precautions: Antiepileptics are associated with an increased risk of suicidal behavior/thoughts with use (regardless of the indication); patients should be monitored for signs/symptoms of depression, suicidal tendencies, and other unusual behavioral changes during therapy and instructed to inform their healthcare provider immediately if symptoms occur. Adverse Reactions:

Common: Gingival hyperplasia, gum tenderness, dizziness, drowsiness, nausea, vomiting, mood changes.

SERIOUS: hypotension, cardiac arrhythmias, thrombocytopenia, leucopenia, agranolucytosis, vascular collapse, coma.

Drug Interactions: allopurinol, amiodarone, verapamil, ketoconazole, fluconazole, omepreazole, carbamazepine, fluoxetine, valproic acid, warfarin.


Formulary Label/Preparations: Dilantin 100mg capsules, Pkg, 100, $17.92($0.1792/capsule), LWD:NAL/PFI Dilantin 25mg/ml Suspension, 125mls, $38.4($38.4/bottle), LWD:NLA/PFI

DIBENZAZEPINE CARBAMATE

Carbamazepine Class: Dibenzazepine Carbamate, Anti-convulsant Indication: Partial seizures with complex symptomatology generalized tonic-clonic seizures and mixed seizure patterns. Dosage: Adults: 400mg/day in two divided doses, usual dose

is 800mg-1200mg/day; some patients may require up to 1600mg/day to achieve adequate response.

Children: Age < 6years: 10-20mg/kg/day divided twice daily or 3 times a day, increase dose every week until optimal response and therapeutic levels are achieved, maximum recommended dose(35mg/kg/day);

Age 6 years - 12 years: 200mg/day in 2 divided doses, increase dose up to 100mg/day at weekly intervals using twice daily dosing regimen of extended release tablets, usual dose is 400mg-


800mg/day; maximum recommended dose is 1000mg/day; Age > 12 years: 400mg/day in 2 divided doses, increase dose by up to 200mg/day at weekly intervals using twice daily regimen of extended release tablets, usual dose is 800mg-1200mg/day

Pregnancy Category: D CONTRAINDICATIONS:Hypersensitivity to carbamazepine TCAs, or any component of the formulation; bone marrow suppression; with or within 14 days of MAO Inhibitor use; concurrent use of nefazodone. Precautions: Antiepileptic are associated with an increased risk of suicidal behavior/thoughts with use (regardless of the indication); patients should be monitored for signs/symptoms of depression, suicidal tendencies, and other unusual behavioral changes during therapy and instructed to inform their healthcare provider immediately if symptoms occur. Administer carbamazepine with caution to patients with history of cardiac damage, ECG abnormalities, hepatic or renal disease. Adverse Reactions:

Common: Abdominal pain, constipation, diarrhea, dyspepsia, gastric distress.

SERIOUS: AV block, Stevens-Johnson syndrome, myelosuppression (thrombocytopenia), TEN, cardiac arrhythmias, CHF, thromboembolism.


Drug Interactions: Nefazodone, MAO inhibitors, clomipramine, lithium, phenytoin, allopurinol, verapamil, fluconazole, ketoconazole, Grapefruit juice, clarithromycin, theophyline, valproic acid, warfarin. Formulary Label/Preparations: Lazepine 100mg tablets, pkg 100, $6.21 ($0.0621/tab), CDM/LBD Tegretol 200mg tablets, pkg 20, $7.98($0.399), LWD/NOV Tegretol CR 200mg tablets, pkg 30, $8.87($0.295), LWD/NOV Tegretol CR 400mg tablets, pkg 30, $11.44 ($0.381), LWD/NOV Tegretol 20mg/ml syrup, pkg 100ml, $5.33 ($0.0533/ml), LWD/NOV

Oxcarbamazepine Class: Dibenzazepine Carbamate. Indication: Monotherapy or adjunctive therapy in the treatment of partial seizures in adults and children greater than 4 years of age with epilepsy; adjunctive therapy in the treatment of partial seizures in children greater than 2 years of age with epilepsy. Dosage: Adults:

Adjunctive therapy: 300mg twice daily, dose may be increased by as much as 600mg/day at weekly intervals; recommended daily dose is 1200mg/day in 2 divided doses.


Conversion to monotherapy: 600mg/day in twice daily divided doses while simultaneously initiating the reduction of the dose of the concomitant antiepileptic drug. The concomitant dosage should be withdrawn over 3-6 weeks, while the maximum dose of oxcarbamazepine should be reached in about 2-4 weeks. Recommended daily dose is 2400mg/day.

Children: Adjunctive therapy: 8-10mg/kg/day do not exceed 600mg/day; give in 2 divided daily doses.

Conversion to monotherapy based on patient’s weight: Weight <20kg: 600mg-900mg/day Weight 25kg-30kg: 900mg-1200mg/day Weight 35kg-40kg: 900mg-1500mg Weight 45kg: 1200mg-1500mg/day Weight 50kg-55kg: 1200mg-1800mg/day Weight 60kg-65kg: 1200mg-2100mg/day Weight 75kg: 1500mg-2100mg

Pregnancy Category: C Precautions: Antiepileptic are associated with an increased risk of suicidal behavior/thoughts with use (regardless of the indication); patients should be monitored for signs/symptoms of depression, suicidal tendencies, and other unusual behavioral changes during therapy and instructed to inform their healthcare provider immediately if symptoms occur. Clinically significant hyponatremia can develop during the use of oxcarbamazepine.


CONTRAINDICATIONS: Hypersensitivity to oxcarbamazepine or any component of the formulation. Adverse Reactions:

Common: Dizziness, somnolence, headaches, nausea, vomiting, abdominal pain, fatigue, vertigo, diarrhea, constipation, constipation.

SERIOUS: Hyponatremia, hypotension, leg edema, ECG abnormalities.

Drug Interactions: Phenytoin, selegiline, hydrochlorothiazide, sorafenib, tadalafil, divalproex, valproic acid, Phenobarbital. Formulary Label/Preparations: Trileptal 300mg tablets, pkg 20, $11.86 ($0.593/tablet), LWD/NOV Trileptal Soln 60mg/ml, pkg 100ml, $9.97 (0.0997/ml), LWD/NOV

HISTONE DEACETYLASE INHIBITORS/VALPROIC ACIDS

Valproic Acid

Class: Histone Deacetylase Inhibitor, Anti-convulsant. Indications: Monotherapy and adjunctive therapy in the


treatment of patients with complex partial seizures; monotherapy and adjunctive therapy of simple and complex absence seizures; adjunctive therapy in patients with multiple seizure types that include absence seizures. Dosage: Adults and children: 15mg/kg/day may increase dose

by 5-10mg/kg/day at weekly intervals until therapeutic levels are achieved; maximum dose is 60mg/kg/day. Larger maintenance doses may be required in younger children; and give doses >250mg/day in divided doses.

Pregnancy Category: D BLACK BOXED WARNING: Hepatic failure resulting in fatalities has occurred in patients; children <2 years of age are at considerable risk. BLACK BOXED WARNING: May cause teratogenic effects such as neural tube defects. Use in women of childbearing potential requires that benefits of use in morther be weighed against the potential risk to the fetus, especially when used for conditions not associated with permanent injury or risk of death such as migraine. Precautions: May cause severe thrombocytopenia, inhibition of platelets aggregation, and bleeding. Tremors may indicate overdosage, use with caution in patients receiving other antiepileptic drugs. CONTRAINDICATIONS: Hypersensitivity to valproic acid, derivatives, or any component of the formulation; hepatic


disease or significant impairment; urea cycle disorders. Adverse Reactions:

Common: Headache, somnolence, dizziness, nausea, vomiting, abdominal pain, diarrhea.

SERIOUS: Thrombocytopenia, cardiac arrhythmias, agranulocytosis, anaphylaxis.

Drug Interactions: Risperidone, TCAs, chlorpromazine, carbamazepine, oxcarbamazepine, lorazepam, phenytoin, rifampin. Formulary Labels/Preparations: Depakene 250mg capsules, pkg 100, $25.62 ($0.2562/capsule), LWD/ABB Depakene 50mg/ml syrup, pkg 480mls, $23.34 ($0.0486/ml), LWD/ABB

Divalproex Sodium (Please refer to Valproic Acid for all relevant information) NOTE: Equivalent oral doses of divalproex sodium and valproic acid deliver the same quantities of valproate ion. Formulary Label/Preparation: Depakote 125mg sprinkles, pkg 100, $38.05 (0.3805/cap), LWD/ABB Depakote 250mg cap, pkg 100, $25.62 (0.2562/cap) LWD/ ABB Depakote 500mg, pkg 100, $43.25 (0.4325/cap) LWD/ABB


FRUCTOPYRANOSE SULFAMATE

Topiramate Class: Fructopyranose Sulfamate, Anticonvulsant. Indication: Monotherapy or adjunctive therapy for partial onset of seizures and primary generalized tonic-clonic seizures; adjunctive treatment of seizures associated with Lennox-Gastaut syndrome. Dosage: Adults: 25mg once or twice daily for one week; may

increase weekly by 25mg-50mg/day until adequate response; usual maintenance dose is 100mg-200mg twice daily. Maximum recommended daily dose is 800mg/day. However, doses > 400mg/day have no additional benefits and doses > 1600mg/day have not been studied.

Children: 1mg-3mg/kg/day once daily; may increase every 1-2 weeks in increments of 1mg-3mg/kg/day up to the recommended maximum of 5mg-9mg/kg/day in 2 divided doses.

Pregnancy Category: C Precautions: Antiepileptics are associated with an increased risk of suicidal behavior/thoughts with use (regardless of the indication); patients should be monitored for signs/symptoms of depression, suicidal tendencies, and other unusual


behavioral changes during therapy and instructed to inform their healthcare provider immediately if symptoms occur. Use with caution in patients with hepatic, respiratory or renal impairment. Avoid abrupt withdrawal of topiramate therapy; it should be withdrawn/tapered slowly to minimize the potential of increased seizure frequency. Adverse Reactions:

Common: Somnolence, dizziness, fatigue, anorexia, nausea, nervousness.

SERIOUS: Chest pain, AV blocks, myelosuppression, hypotension, hepatic failure, Stevens-Johnson syndrome, suicidal behavior.

Drug Interactions: Divalproex, lithium, Phenytoin, valproic acid, thiazide diuretics, mefloquine. Formulary Label/Preparations: Topamax 25mg capsules, pkg 20, $6.89($0.3445/capsule), NAL/JAN Topamax 100mg capsules, pkg 20, $20.02 ($1.0010/capsule), NAL/JAN


GLAUCOMA The diagnosis of glaucoma is restricted to an opthamologist. Medications for the treatment of glaucoma are available from the following pharmalogical classes:

• Alpha-adrenergic Agonists • Beta-adrenergic Blockers • Carbonic Anhydrase Inhibitors • Cholinergic Agents • Prostaglandin Analogs • Combination Products

Alpha Agonists decrease production of fluid and increase drainage. Side effects can include burning or stinging upon instillation of the eye drop, fatigue, headache, drowsiness, dry mouth and dry nose. Beta Blockers decrease production of intraocular fluid. Side effects can include low blood pressure, reduced pulse rate, and fatigue. Beta blockers can also cause a shortness of breath in people who have a history of asthma or other respiratory disorders. Additionally, beta blockers can change cardiac activity by decreasing the amount of blood the heart pumps out, which may reduce the pulse rate and/or slow down the heart’s response rate during exercise. Rare side effects include reduced libido and depression Carbonic Anhydrase Inhibitors decrease production of intraocular fluid. Side effects of the oral medication can include tingling or loss of strength of the hands and feet, upset stomach, mental fuzziness, memory problems, depression,


kidney stones, and frequent urination. Side effects of the opthalmic include stinging, burning and other eye discomfort. Cholinergics (Miotics) increase drainage of intraocular fluid by decreasing pupil size thereby increasing the flow of intraocular fluid from the eye. Prostaglandin Analogs increase drainage of intraocular fluid. Side effects: a gradual change in eye color, stinging, blurred vision, eye redness, itching, and burning.

ALPHA-ANTIADRENERGIC BLOCKERS

Brimonidine Tartrate Class: Adrenergic; antiglaucoma Indication: Open angle glaucoma, and ocular hypertension Dosage: 1 drop in the affected eye (s) 3 times daily, approximately 8 hours apart Pregnancy Category: B Precautions: Use in hypotension, circulation disorders, or depression, liver or kidney problems. Contraindications: Hypersensitivty to adrenergic eyedrops, concomitent MAOI use.


Adverse Reactions: Macular edema and eye irritation, allergic reaction, bleeding of the eye, inflamed or infected eye or eyelid, sensitivity to light. Drug Interactions: Use of other adrenergics or with drugs that lower intraocular pressure can cause an additive effect; MAOIs, anti hypertensives (beta blockers, digoxin, glyceryl trinitrate, isosorbide dinitrate) TCAs, barbiturates, medicines that cause drowsiness or tiredness (zolpidem), narcotic painkillers, and alcohol. Formulary Label/Preparation: Apo-Brimonidine 0.2%, $7.50 per 5 ml, NAL/APO

BETA BLOCKERS

Betaxolol Class: Beta blocker, beta 1 selective Indication: Ocular hypertension and chronic open-angle glaucoma. Dosage: 1 to 2 drops in eyes twice a day. Precautions: Use caution in patients with severe bradycardia. Pregnancy Category: C (1st trimester), D (2nd & 3rd trimesters)


Contraindications: In patients with hypersensitivity to the drug, severe bradycardia, greater than first-degree heart block, cardiogenic shock, or uncontrolled heart failure. Adverse Reactions: Insomnia, depressive neurosis, eye stinging or instillation causing brief discomfort, photophobia, erythema, ititching, keratitis, occasional tearing, dizziness, headache Drug Interactions: may increase the systemic effect of oral beta blockers; enhances the hypotensive & bradycardiac effect of resperine & cathecholamine-depleting agents; enhances the lowering of IOP with pilocarpine, epinephrine, and carbonic anhydrase inhibitors; Formulary Label/Preparation: Betopic S 5mg/5ml (0.5%); $3.26 per (5 ml), LWD/FAL

Timolol Class: Beta blocker; anti-glaucoma Indication: For treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma. Dosage: 0.5%- One drop to the conjunctiva twice a day. Pregnancy Category: C Precautions: Severe respiratory reactions and cardiac reactions, including death due to bronchospasm in patients with


asthma, and, rarely, death in association with cardiac failure, have been reported following systemic or ophthalmic administration of timolol. Contraindications: Bronchial asthma; a history of bronchial asthma; severe chronic obstructive pulmonary disease, sinus bradycardia; second or third degree atrioventricular block; overt cardiac failure, cardiogenic shock; or hypersensitivity to any component of this product. Adverse Reactions: Burning and stinging upon use; headache, fatigue, chest pain, bradycardia, arrhythmia, hypotension, hypertension, cerebral vascular accident, cardiac failure, worsening of angina pectoris, palpitation, dizziness, depression. Drug Interactions: Mydriasis resulting from concomitant therapy with timolol and epinephrine; beta- adrenergic blockers taken orally with timolol can have an additive effect of beta-blockade, systemically and on intraocular pressure. Coadministration of timolol and oral or IV calcium antagonists can cause possible atrioventricular conduction disturbances, left ventricular failure, and hypotension. Use care in patients with impaired cardiac function. Coadministration with reserpine can cause additive effects when used together with timolol causing hypotension, bradycardia resulting in vertigo or postural hypotension. Formulary Label/Preparation: Timolol 0.5 %, $1.46 per 5 ml, LWD/MAT


CARBONIC ANHYDRASE INHIBITORS

Acetazolamide Class: Carbonic anhydrase inhibitor; anti-glaucoma Indications: Chronic simple (open-angle) glaucoma, secondary glaucoma, and preoperatively in acute angle-closure glaucoma where delay of surgery is desired in order to lower intraocular pressure; for adjunctive treatment of: edema due to congestive heart failure; drug-induced edema; centrencephalic epilepsies (petit mal, unlocalized seizures). Dosage: 250 mg to 1000 mg every 24 hours, divided 2- 4 times daily. Pregnancy Category: C Precautions: Increased dose may increase the incidence of drowsiness and/or paresthesia and often results in a decrease in diuresis. Under certain circumstances, however large doses in conjunction with other diuretics may improve diuresis in complete refractory failure. Adverse Reactions: Paresthesias, hearing dysfunction or tinnitus, loss of appetite, taste alteration and gastrointestinal disturbances such as nausea, vomiting and diarrhea; polyuria, and occasional instances of drowsiness and confusion. Metabolic acidosis and electrolyte imbalance may occur. Transient myopia has been


reported. Other: urticaria, melena, hematuria, glycosuria, hepatic insufficiency, flaccid paralysis, photosensitivity and convulsions. Drug Interactions: Cyclosporine; primidone; diflunisal; aspirin, choline salicylate, magnesium salicylate, and salicylates; decreased lithium levels. Formulary Label/Preparation: Apo-Acetazolamide 250mg, pkg 500, $15.84, ($0.032/tab), NAS/APO

Dorzolamide Class: Carbonic anhydrase inhibitor; anti-glaucoma Indication: Ocular hypertension or open angle glaucoma. Dosage: One drop in the conjunctivial sac of affected eye three times a day. Pregnancy Category: C Precautions: Renal and hepatic dysfunction. Contraindications: Sensitivity to any of the components or the preparation. Adverse Reactions: Asthenia, headache, fatigue, ocular burning, stinging, discomfort, superficial punctuate keratitis; ocular allergic reactions; blurred vision; lacrimation, dryness, redness, eye pain, eye lid crusting, bitter taste, nausea.


Drug Interactions: CONTRAINDICATED: ORAL CARBONIC ANHYDRASE INHIBITORS. Formulary Label/Preparation: Trusopt 2%, $8.63 per 5 ml, LWD/ MSD

CHOLINERGIC AGONIST

Pilocarpine Class: Cholinergic agonist, miotic Indication: For chronic open-angle glaucoma; before, or instead of, emergency surgery in acute narrow-angle glaucoma. Dosage: One or two drops in the lower conjunctival sac every 4 to 12 hours. Pregnancy Category: C Precautions: Acute cardiac failure, bronchial asthma, peptic ulcer, hyperthyroidism, GI spasm, urinary obstruction, and Parkinson’s disease. Contraindications: Hypersensitivity to drug or when cholinergic effects such as constriction are undesirable (as in acute iritis, some form of secondary glaucoma, pupilary block glaucoma, acute inflammatory disease of


the anterior chamber). Adverse Reactions: Hypertension, tachycardia, periorbital or supraorbital headache, transient stinging and burning, keratitis, lens opacity, retinal detachment, lacrimation, changes in visual field, brow pain Drug Interactions: Epinephrine derivatives and timolol: pilocarpine can enhance reductions in intraocular pressure. Monitor patient closely Formulary Labels/Preparations: Pilocarpine 2%, 10ml, $2.37; LWD/MAT Pilocarpine 4%, 10ml, $2.87; LWD/MAT

PROSTAGLANDIN ANALOGS

Travoprost Class: Prostaglandin analogue; anti- glaucoma Indication: For the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension who are intolerant of other intraocular pressure lowering medications or insufficiently responsive to another intraocular pressure lowering medication. Dosage: One drop in the affected eye(s) once daily in the evening


Pregnancy Category: C Precautions: Changes to pigmented tissues of the iris and periorbital tissue (eyelid) and increased pigmentation and growth of eyelashes. These changes may be permanent. Adverse Reactions: Ocular hyperemia, visual acuity decreases, eye discomfort, foreign body sensation, pain, pruritus. Drug Interactions: No known drug interactions. Formulary Labels/Preparations: Travatan BAK Free 0.004%, pkg 3ml, $10.49, LWD/ALC

Latanoprost *SAM Class: Prostaglandin analog; Indication: Treatment of intraocular pressure (IOP) in patients with ocular hypertension or open angle glaucoma who are intolerant of other (IOP)-lowering medications or insufficiently responsive to another IOP-lowering medication. Dosage: One drop in the conjunctival sac of the affected eyes once daily in the evening. Pregnancy Category: C Precautions: Renal or hepatic dysfunction, active ocular inflammation (iritis, uveitis), risk for macular edema.


Contraindications: Hypersensitivity to the drug and, benzalkonium chloride or other ingredients. Adverse Reactions: Chest pain, angina, blurred vision, stinging, itching, conjunctival hyperemia, foreign body sensation, dry eye, excessive tearing, increased pigmentation of the iris, eye pain or discharge, edema, herpes simplex keratitis. Drug Interactions: Precipitation occurs when eye drops containing thimerosal are mixed with latanoprost; if both drugs are used together, administer at least five minutes apart. Topical betaadrenergic blocking agents, topical dipivefrin, topical epinephrine, an oral carbonic anhydrase inhibitor, or topical carbonic anhydrase inhibitor; IOP-lowering effects of these drugs may be additive and separate administration times by five minutes. Formulary Label/Preparation: Xalatan 0.005%, $32.83 per 2.5 ml, LWD:NAL/PFI

COMBINATION PRODUCTS

Brinzolamide/Timolol Class: Carbonic anhydrase inhibitor/beta blocker combination Indication: Open-angle glaucoma or ocular hypertension. Dosage: One drop in the affected eye (s) twice daily


Pregnancy Category: C Precautions: Severe cardiac disease, diabetes, impairment of alertness and physical coordination in the elderly may occur, eye discomfort and contact lens discoloration. Contraindications: Hypersensitivity to the active substances, or to any of the excipients, bronchial asthma, a history of bronchial asthma, or severe chronic obstructive pulmonary disease, sinus bradycardia, second or third degree atrioventricular block, overt cardiac failure, or cardiogenic shock, severe allergic rhinitis and bronchial hyperreactivity; hypersensitivity to other beta-blockers, hyperchloraemic acidosis, severe renal impairment, hypersensitivity to sulphonamides. Adverse Reactions:

Common: dysgeusia, blurred vision, eye pain, eye irritation, foreign body sensation in eyes.

SERIOUS: Corneal erosion, hypotension, chronic obstructive pulmonary disease.

Drug Interactions: Ketoconazole, itraconazole, clotrimazole, ritonavir, troleandomycin, oral calcium channel blockers, guanethidine or beta-blocking agents, antiarrhythmics, digitalis glycosides or parasympathomimetics. Formulary Label/Preparation: Azarga 1%/0.5%, $9.90 per 5ml, LWD/ALC


Travoprost/Timolol

Class: Prostaglandin analog/ beta-blocker combination Indication: Open angle glaucoma or ocular hypertension Dosage: One drop in the affected eye(s) once daily in the morning Pregnancy Category: C Precaution: Patients may slowly develop increased brown pigmentation of the iris which is permanent, patients with active intraocular inflammation (iritis/uveitis), macular edema, including cystoid macular edema, contact lenses, choroidal detachment, thyrotoxicosis, muscle weakness, cerebrovascular insufficiency, driving or using machinery. Contraindications:

Drug Interactions: Beta-blockers, calcium channel blockers,

hypersensitivity to this drug or to any ingredient in the formulation, bronchial asthma orhistory of bronchial asthma, severe chronic obstructive pulmonary disease, sinus bradycardia, second or third degree atrioventricular block, overt cardiac failure, cardiogenic shock. Adverse Reaction:

Common: Change in color of the iris, eye irritation, eye and eyelid pruritis, feeling of foreign body in eye, blurred vision, post-nasal drip, thirst.


catecholamine depleting medications, digitalis products, quinidine, clonidine, CNS depressants, tricyclic antidepressants, epinephrine. Formulary Label/Preparation: DuoTrav 0.004%/0.5%, $12.36 per 5ml, LWD/ALC


HYPERCHOLESTEROLEMIA (High Cholesterol)

Medications from the following pharmacological classes are available:

• HMG-CoA Reductase Inhibitors • Selective Cholesterol Absoprtion Inhibitors

Ezetimibe is available under the Plan, however as it is not indicated in all persons, responsible prescribing habits are encouraged. NOTE: Patients diagnosed with hypercholesterolemia should be encouraged to make lifestyle modifications with regard to diet and exercise throughout the course of their disease.

HMG CoA REDUCTASE INHIBITORS

Simvastatin Class: HMG CoA Reductase Inhibitor Strength: 20mg, 40 mg Dosage: Adult:

Initial: 40mg, 5-40mg once daily. MAX 80mg in divided doses.

Pediatric: Age 10-17 (girls should be postmenarchal) 10-40mg once daily. MAX 40mg.


Dosage Adjustments: Recommended in severe renal impairment; concomitant clyclosporine, danazol, gemfibrozil, amiodarone, verapamil, diltiazem; Chinese patients on concomitant niacin. Pregnancy Category: X Contraindications: Active liver disease; unexplained persistent elevations in serum transaminases, concomitant HIV protease inhibitors, clarithromycin, erythromycin, itraconazole, ketoconazole, nefazodone, or telithromycin; hypersensitivity to simvastatin or component; pregnancy or lacation. Precautions: Amyotrophic lateral sclerosis; elderly; concomitant use with gemfibrozil, cyclosporine, danazol, amiodarone, verapamil or diltiazem; creatinine kinase > 10 X upper limit; grapefruit juice; heavy alcohol use, higher doses increase risk of myopathy, transaminases >3X upper limit; uncontrolled hypothyroidism; major surgery; myopathy and rhabdomyolysis; renal impairment. Major Drug Interactions: CONTRAINDICATED: ATAZANAVIR, DARUNAVIR, FOSAMPRENAVIR, ITRACONAZOLE, LOPINAVIR, MIBEFRADIL, RITONAVIR, SAQUINAVIR, TIPRANAVIR Acenocoumarol, amiodarone, amprenavir, bezafibrate, ciprofibrate, ciprofloxacin, clarithromycin, clofibrate, cyclosporine, dalfopristin, danazol, delavirdine, erythromycin, everolimus, fenofibrate, fluconazole, fusidic acid, gemfibrozil, indinavir, ketoconazole, nefazodoe, nelfinavir, niacin,


quinupristin, risperidone, tadalafil, telithromycin, verapamil, warfarin. Adverse Reactions:

Common: Constipation, GI irritation, headache, upper respiratory infection.

SERIOUS: Hepatotoxicity, compartment syndrome of lower leg, muscle disorder, rhabdomyolysis, tendon rupture.

Formulary Label/Preparation: Simvastatin 20mg, pkg 30, $1.84 ($0.0613/tablet), LWD/HLT Simvastatin 40 mg, pkg 30, $3.10 ($0.1033/tablet), LWD/HLT

Atorvastatin Class: HMG CoA Reductase Inhibitor Strength: 10mg, 20mg, 40 mg Dosage: Adult: 10-80mg once daily

Pediatric: Ages 10-17: 10-20mg once daily. MAX 20mg.

Dosage Adjustments: Recommended with concomitant cyclosporine, clarithromycin, ritonavir and saquinavir, ritonavir and lopinavir, elderly and hepatic impairment Contraindications: Hypersensitivity to atorvastatin or any


component of the product, active liver disease, pregnancy or lactation, and unexplained persistent serum transaminase elevation Precautions: Preexisting amyotropic lateral sclerosis, concomitant therapy with azole antifungals, cyclosporine, clarithromycin, erythromycin, fibric acid derivaties, lopinavir/ritonavir, niacin, ritonavir/saquinavir; conditions predisposing to renal failure due to rhabdomyolysis; creatine kinase >10X upper limit; heavy alcohol use; liver disease; myopathy and rhabdomyolysis may occur; recent stroke or TIA. Pregnancy Category: X Major Drug Interactions: Atazanavir, bezafibrate, ciprofibrate, clarithromycin, clofibrate, dalfopristin, diltiazem, erythromycin, fenofibrate, fluconazole, fusidic acid, gemfibrozil, itraconazole, ketoconazole, mibefradil, nefazodone, niacin, quinupristin, rituximab, telithromycin, tipranavir, troleandomycin, verapamil. Adverse Reactions:

Common: Abdominal pain, constipation, flatulence, indigestion, increased liver enzymes, headache. SERIOUS: Rhabdomyolysis, tendon rupture.

Formulary Label/Preparation: Apo-Atorvastatin 10mg, pkg 90, $6.60 (0.0753/tablet), NAL/APO Apo-Atorvastatin 20 mg, pkg 90, $11.86 (0.1318/tablet),


NAL/APO Apo-Atorvastatin 40 mg, pkg 90, $19.80 (0.221/tablet), NAL/APO

Rosuvastatin *SAM* Class: HMG CoA Reductase Inhibitor Strength: 10 mg, 20mg, 40 mg Dosage: Adult: 5-40mg once daily, MAX 40mg

Pediatric: Age 10-17: 5-20mg once daily, MAX 20mg

Dosage Adjustments: Recommended in Asian patients; concomitant cyclosporin, gemfibrozil, lopinavir/ritonavir, atazanavir/ritonavir; CrCl <30ml/min. Contraindications: Hypersensitivity to rosuvastatin or any component, patients with active liver disease or unexplained persistent transaminase elevation, pregnancy or breast feeding. Precautions: Preexisting amyotrophic lateral sclerosis, Asian patients, concomitant use with cyclosporine, fibrates, niacin, gemfibrozil, ketoconazole, spironolactone, cimetidine; conditions predisposing to renal failure secondary to rhabdomyolysis, therapy with warfarin, transaminases > 3X upper limit, heavy alcohol use, history of liver disease, predisposition to myopathy, renal impairment, unexplained


persistent proteinuria. Pregnancy Category: X Major Drug Interactions: Atazanavir, cyclosporin, fenofibrate, fasamprenavir, gemfibrozil, indinavir, lopinavir, niacin. Adverse Reactions:

Common: Abdominal pain, constipation, nausea, arthralgia, myalgia, asthenia, headache, urinary tract infection, pharyngitis, influenza-like illness.

SERIOUS: Liver enzymes abnormalities, muscle disorders, rhabdomyolysis, tendon rupture.

Formulary Label/Preparation: Crestor 10mg, pkg 30, $20.16 ($0.672/tablet), NAS/ZEN Crestor 20mg, pkg 28, $30.48 ($1.089/tablet), NAS/ZEN Crestor 40mg, pkg 28, $30.48 ($1.089/tablet), NAS/ZEN

CHOLESTEROL ABSORPTION INHIBITOR

Ezetimibe Class: Cholesterol Absorption Inhibitor Strength: 10mg Dosage: Adult: 10mg once daily.


Pediatric: Age > 10 years: 10mg once daily.

Dosage Adjustments: Do not use in moderate to severe hepatic disease. Contraindications: Concomitant use with a statin in pregnancy or lactation, patients with active liver disease, or unexplained persistent elevations in hepatic transaminases; hypersensitivity to ezetimibe or any component. Precautions: Concomitant use with fibrates other than fenofibrate, moderate to severe hepatic impairment, myopathy and rhabdomyolysis may occur. Pregnancy Category: C Major Drug Interactions: Clofibrate, gemfibrozil, niacin Adverse Reactions:

Common: Diarrhea, arthralgia, myalgia, nasopharngitis, sinusitis, upper respiratory infection.

SERIOUS: Hepatitis, anaphylaxis, rhabdomyolysis.

Formulary Label/Preparation: Ezetrol 10mg, pkg 20, $17.28 ($0.864/tab), LWD/MSD Vytorin 10/20mg, pkg 14, $12.87 ($0.9192/tab), LWD/MSD Vytorin 10/40mg, pkg 14, $12.87 ($0.9192/tab), LWD/MSD


HYPERTENSION

Medications from the following pharmacological classes are available:

• ACE Inhibitors • Alpha -1 agonist • Angiotensin Receptor Blockers (ARB’s) • Beta Blockers • Calcium-Channel Blockers • Diuretics • Miscellaneous Medications Necessary for the

Management of the Disease Perindopril (and perindopril combination products) are designated as SAM. Patients must have a documented intolerance or inadequate response to another approved ACE inhibitor prior to being granted approval for this medication. The authorization form must be submitted to the NPDP office. Suspensions are available for certain products and are designated as SAM. Patients must be twelve (12) years of age or younge or have obtained prior authorization from the NPDP. Physicians are encouraged to exercise responsible prescribing for the use of maximum doses before adding or switching a patient to a new medication. Also, as not all patients are indicated for all medications, judicious use of higher cost medications is encouraged.


DIURETICS

Hydrochlorothiazide

Class: Thiazide diuretic Strength: 25mg Dosage: Adult:

Hypertension: 12.5-100mg divided 1-2 times daily.

Edema: 25-100mg divided 1-2 times daily.

Pediatric: Hypertension: 1-2mg/kg divided 1-2 times daily;

Infants less than 6 months old: may increase to 3mg/kg divided 2 times daily); Infants up to age 2: MAX dose 37.5mg daily; Children age 2-12: MAX dose 100mg daily.

Dosage Adjustments: Recommended in elderly, renal impairment. Not recommended if CrCl <15-25ml/min. Contraindications: Anuria, hypersensitivity to hydrochlorothiazide or sulfonamides


Precautions: Concomitant lithium, diabetes mellitus, electrolyte imbalance, elderly, hyperuricemia or gout, hypotension, liver disease, concomitant digoxin, renal disease, history of allergies or asthma, systemic lupus erythematosus. Pregnancy Category: B Major Drug Interactions: CONTRAINDICATED: DOFETILIDE Acetyldigoxin, arsenic trioxide, deslanoside, digitalis, digitoxin, digoxin, droperidol, flecainide, ketanserin, levemethadyl, lithium, metildigoxin, ouabain, proscillaridin, sotalol Adverse Reactions:

Common: Hypotension, vasculitis, photosensitivity, phototoxicity, electrolyte imbalances, hyperglycemia hyperuricemia, constipation, diarrhea, loss of appetite, nausea, vomiting, spasticity, dizziness, headache, paresthesia, blurred vision, xanthopsia, restlessness, impotence SERIOUS: Cardiac dysrhythmia, scaling eczema, Stevens-Johnson syndrome, toxic epidermal necrolysis, pancreatitis, hematopoiesis disorder, hepatotoxicity, systemic lupus erythematosus, angle-closure glaucoma, pulmonary edema.

Formulary Label/Preparation: Apo-Hydro 25mg, pkg 1000, $3.78 ($0.0038/tablet), NAS/APO


Furosemide Class: Loop diuretic Strength: 40mg, 10mg/ml Suspension *SAM* Dosage: Adult:

Hypertension: 40mg twice daily;

Edema: 20-80mg daily (max 600mg/day)

Pediatric: Edema: 1-2mg/kg 1-3 times daily. MAX 6mg/kg/day

Dosage Adjustments: Recommended in renal impairment, liver disease. WARNING: If given in excessive amounts, can lead to profound diuresis with water and electrolyte depletion. Careful medical supervision required. Contraindications: Anuria, hypersensitivity to furosemide Precautions: Profound diuresis, allergy to sulfonamides, blood dyscrasias, increased blood glucose, concomitant use of aminoglycosides, concomitant use of ethacrynic acid, elderly, preexisiting electrolyte depletion, electrolyte imbalances, preexisiting hepatic cirrhosis, ascites and coma; hepatic damage, hyperuricemia, hypokalemia, ototoxicity, renal damage, preexisting severe progressive renal disease, preexisiting systemic lupus erythematosus.


Pregnancy Category: C Major Drug Interactions: Amikacin, arsenic trioxide, bepridil, digitoxin, dofetilide, droperidol, ethacrynic acid, gentamicin, kanamycin, ketanserin, levomethadyl, lithium, metolazone, neomycin, netilimicin, sotalol, streptomycin, tobramycin. Adverse Reactions:

Common: Hyperuricemia, hypomagnesemia, loss of appetite, spasm of bladder.

SERIOUS: Orthostatic hypotension, erythema multiforme, Stevens-Johnson syndrome, pancreatitis, agranulocytosis, aplastic anemia, thrombocytopenia.

Formulary labels/Preparations: Apo-Furosemide 40mg, pkg 1000, $17.15 ($0.0172/tablet), NAS/APO; Furosemide Liquid 10mg/ml, 120ml, $21.00 ($0.175/ml), CDM/ROX

Indapamide Class: Thiazide-like diuretic Strength: 1.5mg Dosage: Adult:

Hypertension: 1.25-5mg once daily;

Edema: 2.5-5mg once daily.


Pediatric: Safety and efficacy are not determined.

Dosage Adjustments: Recommended in hepatic dysfunction. Contraindications: Anuria, hypersensitivity to indapamide or other sulfonamide-derived drugs. Precautions: Cardiac arrhythmias, concomitant cardiac glycosides, severe cirrhosis, diabetes mellitus, edema, brisk diuresis, elderly females, fluid and electrolyte imbalance, impaired hepatic function, risk of hypokalemia, progressive liver disease, parathyroid function testing, post-sympathectomy, predisposition to electrolyte imbalance, renal disease, salt-restricted diet, systemic lupus erythematosus, vomiting. Pregnancy Category: B Major Drug Interactions: Acetyldigoxin, arsenic trioxide, deslanoside, digitalis digitoxin, digoxin, dofetilide, droperidol, ketanserin, levomethadyl, lithium, metildigoxin, sotalol. Adverse Reactions:

Common: Orthostatic hypotension, vasculitis, flushing, hives, pruritus, rash, hyperuricemia, hypochloremia, hypokalemia, hyponatremia, dizziness, fatigue, headache, paresthesia.

SERIOUS: Cardiac dysrhythmia, Stevens-Johnson syndrome, Toxic epidermal necrolysis.


Formulary Label/Preparation: Natrilix SR 1.5mg, pkg 30, $5.46 ($0.182/tablet) LWD:NAS/SER

CALCIUM CHANNEL BLOCKERS

Amlodipine Class: Calcium Channel Blocker, Dihydropyridine Strength: 5mg, 10mg Dosage: Adult: 5-10mg daily

Pediatric: Ages 6-17: 2.5-5mg daily Safety and efficacy not determined for children under 6.

Dosage Adjustments: Recommended in liver disease, elderly, frail or persons on concomitant antihypertensive therapy to start at 2.5mg daily. Contraindications: Hypersensitivity to amlodipine Precautions: Liver disease, aortic stenosis, obstructive coronary artery disease Pregnancy Category: C Major Drug Interactions: Amiodarone, Atazanavir, Dantrolene,


Droperidol, Fentanyl Adverse Reactions:

Common: Palpitations, peripheral edema, flushing, dizziness, headache, fatigue

SERIOUS: Angina, cardiac dysrhythmia, myocardial infarction, angioedema

Formulary Labels/Preparations: Amlodipine 5mg, pkg 100, $2.37 ($0.0237/tablet), LWD/HLT Amlodipine 10mg, pkg100, $2.78 ($0.0278/tablet), LWD/HLT Felodipine Class: Calcium Channel Blocker, Dihydropyridine Strength: 5mg, 10mg Dosage: Adult:

Hypertension: 2.5-10mg daily;

Angina: 2.5-5mg twice daily;

Congestive heart failure: 5mg 1-2 times daily

Pediatric: 0.1-0.6mg/kg divided 1-2 times daily Dosage Adjustments: Recommended in liver disease and elderly.


Contraindications: Hypersensitivity to felodipine or other calcium channel blockers Precautions: Aortic stenosis; CHF; exacerbation of angina; hypotension; liver impairment; persistent, progressive dermatologic reactions. Pregnancy Category: C Major Drug Interactions: Amiodarone, atazanavir, cyclosporine, dantrolene, droperidol, fentanyl, mibefradil. Adverse Effects:

Common: Peripheral edema, flushing, drug-induced gingival hyperplasia, dizziness, headache.

SERIOUS: Angina, hypotension, myocardial infarction, tachyarrhythmia.

Formulary Labels/Preparations: Felotensil 5mg, pkg 30, $4.22 ($0.1407/tablet), CDM/AUR Felotensil 10mg, pkg 30, $6.34 ($0.2113/tablet), CDM/AUR

Nifedipine LA Class: Calcium Channel Blocker, Dihydropyridine Strength: 30mg, 60mg Dosage: Adult:

Hypertension: 30-60mg once daily on an empty stomach. MAX 90mg daily.


Angina: 30-60mg daily on an empty stomach. MAX 120mg daily.

Pediatric: Safety and efficacy not determined. Dosage Adjustments: None. Contraindications: cardiogenic shock, concomitant use of strong CYP3A4 inducers (i.e. rifampin), hypersensitivity to nifedipine Precautions: Angina, aortic stenosis, beta blocker withdrawal, cirrhosis, avoid grapefruit juice, hypotension, obstructive coronary artery disease, fentanyl anesthesia. Pregnancy Category: C Major Drug Interactions: CONTRAINDICATED: CARBAMAZEPINE, PHENOBARBITAL, PHENYTOIN, RIFABUTIN, RIFAMPIN. Amiodarone, atazanavir, clarithromycin, dantrolene, fentanyl, mibefradil Adverse Reactions:

Common: Palpitations, peripheral edema, flushing, constipation, gingival hyperplasia, heartburn, nausea, dizziness, headache

SERIOUS: Angina, myocardial infarction


Formulary Labels/Preparations: Adalat 30mg, pkg 30, $12.50 ($0.417/tablet), NAS/BYA Adalat 60mg, pkg 30, $21.96 ($0.732/tablet), NAS/BYA

BETA BLOCKERS

Atenolol Class: Beta-blocker Strength: 50mg, 100mg Dosage: Adult:

Hypertension: 50-100mg daily

Angina pectoris (chronic): 50mg-200mg daily.

Pediatric: 0.5-1mg/kg/day in 1-2 divided doses. Max 2mg/kg/day up to 100mg daily in 1-2 divided doses.

Dosage Adjustments: Recommended in hemodialysis, renal impairment with CrCl <35ml/min, elderly and bronchospastic disease.


WARNINGS: Abrupt discontinuation can cause exacerbations in angina and may lead to myocardial infarction and ventricular arrhythmia. Discontinuation should be planned and patients carefully observed and advised to limit physical activity. If the angina worsens or cardiac insufficiency develops, atenolol should be restarted before patient is weaned again. Contraindications: Cardiogenic shock, hypersensitivity to atenolol, overt cardiac failure, second and third degree AV block, severe sinus bradycardia. Precautions: Anesthesia/surgery, avoid abrupt withdrawal, bronchospastic disease, congestive heart failure, diabetes mellitus, hyperthyroidism/thyrotoxicosis, patients on clonidine, peripheral vascular disease, pregnancy, renal impairment. Pregnancy Category: D Major Drug Interactions: Albuterol, Amiodarone, Arformoterol, Bambuterol, Bitolterol, Broxaterol, Clenbuterol, CLonidine, Colterol, Diltiazem, Dronedarone, Fenoldopam, Fenoterol, Fentanyl, Formoterol, Hexoprenaline, Isoetharine, Levalbuterol, Metaproterenol, Pirbuterol, Procaterol, Reproterol, Rimiterol, Ritodrine, Salbutamol, Salmeterol, Terbutaline, Tretoquinol, Tulobuterol, Verapamil Adverse Reactions:

Common: Bradyarrhythmia, cold extremities, hypotension, diarrhea, nausea, dizziness, fatigue, insomnia, depression

SERIOUS: Lupus erythematosus


Formulary Labels/Preparations: Atenolol 50mg, pkg 140, $1.45 ($0.0104 tablet), LWD/HLT Atenolol 100mg, pkg 140, $2.25 ($0.016/tablet), LWD/HLT

Metoprolol Class: Beta-blocker Strength: 50mg, 100mg Dosage: Adult:

Hypertension: 50-450mg divided daily.

Angina: 100-400mg divided daily.

Pediatric: 1-2mg/kg/day divided in 2 daily doses. MAX 6mg/kg/ day (200mg/day) in 2 divided doses.

Dosage Adjustments: Recommended in hepatic dysfunction WARNINGS: Abrupt discontinuation can cause exacerbations in angina and may lead to myocardial infarction and ventricular arrhythmia. The dosage should be gradually reduced over 1-2 weeks and the patient should be carefully monitored. If angina worsens or cardiac insufficiency develops, metoprolol should be restarted before patient is weaned again. Patients should be warned against interruption or discontinuation of therapy without a physician’s advice. Contraindications: Sinus bradycardia, cardiac failure, cardiogenic shock, heart block, hypersensitivity to metoprolol or other beta blockers, severe peripheral


arterial circulatory disorders, sick-sinus syndrome, systolic blood pressure < 100mmHg. Precautions: Abrupt withdrawal, history of bronchospastic disease, cardiac failure, withdrawal of concomitant clonidine, diabetes mellitus, hypotension, surgery/anesthesia, pheochromocytoma, thyrotoxicosis, hepatic dysfunction. Pregnancy Category: C Major Drug Interactions: Albuterol, amiodarone, arformoterol, bambuterol, bitolterol, broxaterol, clenbuterol, clonidine, colterol, diltiazem, dronedarone, fenoldopam, fenoterol, fentanyl, formoterol, hexoprenaline, isotharine, levalbuterol, lidocaine, metaproterenol, pirbuterol, procaterol, reproterol, rimiterol, ritodrine, salbuterol, salmeterol, terbutaline, tretoquinol, tulobuterol, venlafaxine, verapamil. Adverse Reactions:

Common: bradyarrhythmia, heart block, heart failure, hypotension, pruritus, rash, constipation, diarrhea, indigestion, nausea, dizziness, fatigue, headache, depression, dyspnea, wheezing

SERIOUS: bronchospasm

Formulary Label/Preparation: Apo-Metoprolol 50mg, pkg 100, $2.62 (0.0262/tab), NAL/APO Apo-Metoprolol 100mg, pkg 100, $3.15 (0.0315/tab), NAL/APO


Carvedilol Class: Alpha/Beta-blocker, anti-anginal Indication: Angina pectoris, hypertension, heart failure Dosage: Adult:

Angina pectoris, chronic: 25-50 mg twice daily

Heart failure: initial, 3.125 mg twice daily for 2 weeks; dose may be doubled every 2 wks to highest dose tolerated; max dose, patients weighing less than 85 kg, 25 mg twice daily; max dose, patients weighing more than 85 kg, 50 mg twice daily

Hypertension: initial, 6.25 mg ORALLY twice daily; dose may be doubled every 1-2 wks; maximum dose, 25 mg ORALLY twice daily

Impaired left ventricular function - Myocardial infarction: initial, 6.25 mg twice daily; dose may be increase after 3-10 days to 12.5 mg twice daily, then again to target/max dose of 25 mg twice daily.

Pediatric: Safety and efficacy not determined. Pregnancy Category: C Precautions: Abrupt withdrawal, history of bronchospastic disease, cardiac failure, withdrawal of concomitant clonidine, diabetes mellitus, hypotension, surgery/anesthesia, pheochromocytoma, thyrotoxicosis, hepatic dysfunction.


CONTRAINDICATIONS: second- or third-degree atrioventricular block, severe bradycardia, bronchial asthma or related bronchospastic condition, cardiogenic shock, decompensated heart failure requiring IV inotropic therapy, severe hepatic impairment, hypersensitivity (eg, Stevens-Johnson syndrome, anaphylactic reaction, angioedema) to carvedilol or any component of the product , sick sinus syndrome Adverse Reactions:

Common: bradyarrhythmia, hypotension, peripheral edema, abnormal weight gain, hyperglycemia, diarrhea, dizziness, erectile dysfunction, fatigue

SERIOUS: atrioventricular block, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, aplastic anemia, intraoperative floppy iris syndrome, asthma with status asthmaticus

MAJOR Drug Interactions: Albuterol, amiodarone, arformoterol, bambuterol, bitolterol, broxaterol, clenbuterol, clonidine, colterol, diltiazem, dronedarone, fenoldopam, fenoterol, fentanyl, formoterol, hexoprenaline, isotharine, levalbuterol, lidocaine, metaproterenol, pirbuterol, procaterol, reproterol, rimiterol, ritodrine, salbuterol, salmeterol, terbutaline, tretoquinol, tulobuterol, venlafaxine, verapamil. Formulary Label/Preparation: Carvedilol 6.25mg, pkg 100, $5.15 ($0.0515 per tab), CDM/PMS


Carvedilol 12.5mg, pkg 100, $6.47 ($0.0647 per tab), CDM/PMS Carvedilol 25mg, pkg 100, $9.90 ($0.099 per tab), CDM/PMS

ACE INHIBITORS

Captopril Class: ACE-inhibitor Strength: 50mg tablets Dosage: Adult:

Hypertension: 25-150mg 2-3 times daily. Max 450mg/day.

Diabetic nephropathy: 25mg 3 times daily;

Left ventricular cardiac dysfunction: titrate to target dose 50mg 3 times daily

Pediatric: Safety and efficacy have not be determined

Dosage Adjustments: Recommended in renal impairment WARNINGS: ACE-inhibitors can cause injury or death to a fetus when used during the second and third trimesters. Stop therapy as soon as possible when pregnancy is detected. Contraindications: History of angioedema,


hypersensitivity to captopril or other ACE-inhibitor. Precautions: Pregnancy, cough, head and neck angioedema, hemodialysis with high flux membrane, hepatic dysfunction, hyperkalemia, hypotension, insect venom allergy, hymenoptera venom inmmunotherapy, intestinal angioedema, neutropenia, proteinuria, renal insufficiency (CrCl<30ml/min), aortic or renal artery stenosis, sugery/anesthesia. Pregnancy Categories: C (1st trimester), D (2nd and 3rd trimesters) Major Drug Interactions: Allopurinol, Amiloride, Azathioprine, Canrenoate, Eplerenone, Interferon Alfa-2a, Potassium, Spironolactone, Triamterene. Adverse Reactions:

Common: Edema, hypotension, rash, gynecomastia, hyperkalemia, altered taste sense, proteinuria, cough.

SERIOUS: Angioedema (more frequent in Black patients), intestinal angioedema, agranulocytosis, neutropenia.

Formulary Labels/Preparations: Captopril 50mg, pkg 100, $4.01 ($0.0401/tablet), LWD/HLT

Enalapril Class: ACE-inhibitor


Strength: 10mg, 20mg Dosage: Adult:

Hypertension: 5mg daily to start then increase to 10-40mg in 1 or 2 divided doses

Nondiabetic nephropathy: 5-20mg once daily

Pediatric: From 4 days: 0.1-0.5mg/kg in 1-2 divided doses, MAX 0.94mg/kg daily.

6-16 years: 0.08mg/kg daily up to 0.58mg/kg, MAX 40mg daily

Dosage Adjustments: Recommended in renal impairment (CrCl</= 30ml/min; SCr >/= 3mg/dL), hyponatremia WARNINGS: ACE-inhibitors can cause injury or death to a fetus when used during the second and third trimesters. Stop therapy as soon as possible when pregnancy is detected. Contraindications: Angioedema (hereditary or idiopathic), angioedema related to prior ACE inhibitor therapy, hypersensitivity to enalapril or enalaprilat. Precautions: Pregnancy, hemodialysis with high flux membrane, lipid apheresis with dextran sulfate membranes, head and neck angioedema, intestinal angioedema, aortic stenosis/hypertrophic cardiomyopathy, cerebrovascular disease, congestive heart failure, concomitant high dose diuretic therapy, hepatic failure, hyperkalemia, hyponatremia,


insect venom allergy, hymenoptera venom immunotherapy, ischemic heart disease, renal dialysis, renal impairment, surgery/anesthesia, severe volume and/or salt depletion. Pregnancy Category: C (1st trimester), D (2nd and 3rd trimesters) Major Drug Interactions: Allopurinol, Amiloride, Azathioprine, Canrenoate, Eplerenone, Interferon Alfa-2a, Potassium, Spironolactone, Triamterene. Adverse Reactions:

Common: Hypotension, rash, hyperkalemia, nausea and vomiting, asthenia, dizziness, cough.

SERIOUS: Syncope, intestinal angioedema, liver failure, angioedema.

Formulary Labels/Preparations: Apo-Enalapril 10mg, pkg 100, $6.52 ($0.0652/tablet), NAL/APO Apo-Enalapril 20mg, pkg 100, $10.46 ($0.1046/tablet), NAL/APO

Lisinopril Class: ACE-inhibitor Strength: 10mg, 20mg. Dosage: Adult:


Hypertension: 10-40mg once daily. MAX 80mg/day.

Heart failure: 5-20mg once daily. MAX 40mg/day.

Pediatric: Age 6-16: 0.07mg/kg (5mg) - 0.61mg/kg/day (MAX 40mg/day).

Age < 6 or CrCl < 30ml/min/1.73m2: Safety and efficacy not determined.

Dosage Adjustments: Recommended in renal impairment (CrCl </=30ml/min), CHF with hyponatremia and/or renal impairment, Acute myocardial infarction with low systolic BP. Pregnancy Category: C (1st trimester), D (2nd and 3rd trimesters) WARNINGS: ACE-inhibitors can cause injury or death to a fetus when used during the second and third trimesters. Stop therapy as soon as possible when pregnancy is detected. Contraindications: History of ACE inhibitor induced angioedema, hereditary or idiopathic angioedema, hypersensitivity to lisinopril Precautions: Pregnancy, angioedema of head and neck (increased in Black patients), history of angioedema unrelated to ACE inhibitor therapy, aortic stenosis, apheresis, hypertrophic cardiomyopathy, cerebrovascular disease, collagen vascular disease, concomitant use of potassium-sparing diuretics, severe congestive heart failure, diabetes mellitus with renal impairment, hemodialysis with high flux membrane, hepatic


impairment, hymenopteria densensitization, insect venom allergy, intestinal angioedema, ischemic heart disease, acute myocardial infarction, renal impairment, risk of hperkalemia, renal stenosis, surgery, anesthesia. Major Drug Interactions: Amiloride, azathioprine, canrenoate, eplerenone, potassium, spironolactone, tramterene. Adverse Reactions:

Common: Hypotension, rash, hyperkalemia, nausea, vomiting, dizziness, headache, cough.

SERIOUS: Intestinal angioedema, immune hypersensitivity reaction, kidney disease, angioedma (more frequent in Blacks)

Formulary Labels/Preparations: Apo-Lisinopril 10mg, pkg 100, $6.40 ($0.064/tablet), NAS/APO

Perindopril *SAM* Class: ACE-inhibitor Strength: 5mg, 10mg. Combinations: Perindopril/Amlodipine (5mg/5mg; 5mg/10mg; 10mg/5mg; 10mg/10mg); Perindopril/ Indapamide (2.5mg/ 0.625mg; 5mg/1.25mg; 10mg/2.5mg) Dosage: Adult:

Hypertension: 5-10mg divided 1-2 times daily. MAX


20mg/day. Pediatric: Safety and efficacy not determined.

Dosage Adjustments: Recommended in renal impairment (CrCl 30- 80ml/min), elderly. WARNINGS: ACE-inhibitors can cause injury or death to a fetus when used during the second and third trimesters. Stop therapy as soon as possible when pregnancy is detected. Contraindications: History of ACE inhibitor induced angioedema, hypersensitivity to perindopril or other ACE inhibitors Precautions: Pregnancy, lipid apheresis with dextran sulfate membranes, hemodialysis with high flux membranes, head and neck angioedema, cerebrovascular disease, history of CHF, prolonged diuretic therapy, insect venom allergy, hymenoptera venom immunotherapy, history of ischemic heart disease, intestinal angioedema, renal artery stenosis, diabetes and renal disease with concomitant potassium supplementation, renal dialysis, collagen vascular disease with renal impairment, surgery/anesthesia, volume and/or salt depletion. Pregnancy Category: D Major Drug Interactions: Amiloride, azathioprine, canrenoate, eplerenone, potassium, spironolactone, triamterene Adverse Reactions:

Common: hypotension, hyperkalemia, nausea,


dizziness, coughs. SERIOUS: Intestinal angioedema, liver failure,

angioedema (more frequent in Blacks). Formulary Labels/Preparations: Coversyl 5mg, pkg 30, $13.46 ($0.449/tablet), LWD:NAS/SER Coversyl 10mg, pkg 30, $18.85 ($0.628/tablet), LWD: NAS/SER Coveram 5/5 (perindopril/amlodipine), pkg 30, $21.45 ($0.715/ tablet), LWD:NAS/SER Coveram 10/10 (perindopril/amlodipine), pkg 30, $21.45 ($0.715/tablet), LWD:NAS/SER Coveram 5/10 (perindopril/amlodipine), pkg 30, $21.45 ($0.715/ tablet), LWD:NAS/SER Coveram 10/5 (perindopril/amlodipine), pkg 30, $21.45 ($0.715/tablet), LWD:NAS/SER Preterax 2.5(perindopril/indapamide 2.5mg/0.625mg), pkg 30, $16.90 ($0.5633/tablet), LWD:NAS/SER Preterax 5(perindopril/indapamide 5mg/1.25mg), pkg 30, $19.50 ($0.65/tablet), LWD:NAS/SER Preterax 10(perindopril/indapamide 10mg/2.5mg) pkg 30, $23.40 (0.78/tablet), LWD:NAS/SER

ANGIOTENSIN II RECEPTOR ANTAGONISTS

Telmisartan Class: Angiotensin II receptor antagonist.


Strength: 80mg. Combinations: Telmisartan/HCTZ Dosage: Adult:

Hypertension: 20-80mg once daily. Pediatric: Safety and efficacy not determined.

Dosage Adjustments: Recommended in hepatic impairment and dialysis patients with volume depletion. WARNINGS: Drugs that act directly on the renin-angiotensin system can cause injury or death to the developing fetus when used during the second and third trimesters. Stop therapy as soon as pregnancy is detected. Precautions: Pregnancy, concomitant ramipril, severe congestive heart failure ,dialysis, hepatic dysfunction, biliary obstructive disorder, hyperkalemia, renal artery stenosis, preexisting renal impairment, volume and/or salt depletion Pregnancy Category: C (1st trimester), D (2nd and 3rd trimesters) Major Drug Interactions: Ramipril Adverse Reactions:

Common: Cough, Upper respiratory infection

SERIOUS: Rhabdomyolysis Formulary Labels/Preparations:


Micardis 80mg, pkg 28, $20.50 ($0.732/tablet), NAS/BOM. Micardis Plus 80mg/12.5mg (telmisartan 80mg/HCTZ 12.5mg), pkg 28, $20.50 ($0.732/tablet), NAS/BOM.

Valsartan Class: Angiotensin II receptor antagonist Dosage: Adult:

Hypertension: 80-320mg once daily.

Heart failure: 40-160mg twice daily. MAX 320mg/day.

Pediatric: Age 6-16: 1.3-2.7mg/kg once daily. MAX 160mg/day.

Dosage Adjustments: None. WARNINGS: Drugs that act directly on the renin-angiotensin system can cause injury or death to the developing fetus when used during the second and third trimesters. Stop therapy as soon as pregnancy is detected. Contraindications: Hypersensitivity to valsartan or any component of the product. Precautions: Pregnancy, severe heart failure, post-myocardial infarction, hepatic impairment, biliary obstructive disorder, renal artery stenosis, volume and/or salt depletion.


Pregnancy Category: D Major Drug Interactions: Lithium Adverse Reactions:

Common: hypotension, dizziness, headache, increased BUN, increased SCr, cough, fatigue

SERIOUS: Acute renal failure, angioedema Formulary Labels/Preparations: Diovan 80mg, pkg 14, $11.63 ($0.8307/tablet) CDM:LWD: NAS/NOT Diovan 160mg, pkg 14, $11.63 ($0.8307/tablet) CDM:LWD: NAS/NOT Diovan 320 mg, pkg 14, $1.63 ($0.8307/tablet) CDM:LWD: NAS/NOT Co-Diovan 80/12.5mg (Valsartan/HCTZ), pkg 14, $11.63 ($0.8307/ tablet), CDM:LWD:NAS/NOT Co-Diovan 160/12.5mg (Valsartan/HCTZ), pkg 14, $11.63 ($0.8307/ tablet), CDM:LWD:NAS/NOT Co-Diovan 160/25mg (Valsartan/HCTZ), pkg 14, $11.63 ($0.797/ tablet), CDM:LWD:NAS/NOT

MISCELLANEOUS

Potassium Chloride Class: Electrolyte


Strength: 600mg Dosage: Adult: 600mg once daily.

Pediatric: 2-5 mEq/kg/day in divided doses.

Dosage Adjustments: None. Contraindications: Anticholinergic agents; patients with esophageal compression; hyperkalemia. Precautions: Acidosis or alkalosis; adrenal insufficiency; burn patients; concomitant use of ACE inhibitors or potassium sparing diuretics; dehydration; GI ulcerative or stenotic lesions; metabolic acidosis; impaired potassium excretion mechanism; chronic renal failure; extensive tissue breakdown Pregnancy Category: C Major Drug Interactions: CONTRAINDICATED: AMANTADINE, ATROPINE, BELLADONNA, BELLADONNA ALKALOIDS, BENZTROPINE, BIPERIDEN, CLIDINIUM, DICYCLOMINE, EPLERENONE, GLYCOPYRROLATE, HYOSCYAMINE, METHOSCOPALAMINE, OXYBUTYNIN, PROCYCLIDINE, SCOPALAMINE, SOLIFENACIN, TOLTERODINE, TRIHEXYPHENIDYL. Alacepril, amiloride, benazepril, canrenoate, captopril, delapril,enalaprilat, enalapril, fosinopril, imidapril, indomethacin, lisinopril, moexipril, pentopril, perindopril, quinapril, ramipril, spirapril, sprinolactone, temocapril, trandolapril, triamterene, zofenopril


Adverse Reactions: Common: diarrhea, flatulence, nausea,vomiting

Serious: Cardiac arrest, abnormal EKG, hyperkalemia, abdominal pain, GI ulcer.

Formulary Labels/Preparations: Apo-K 600mg, pkg 100, $7.22 ($0.0722/tablet); NAS/APO.


ISCHAEMIC DISEASE Ischaemic disease encompasses the diagnoses of ischaemic heart disease, history of ischaemic stroke or transient ischaemic attack and patients with peripheral ischaemic events (both of arterial and vascular nature). Patients may be prescribed medications from the following pharmacological classes:

• ACE Inhibitors • Anticoagulants • Anti-platelet Aggregation Agents • ARB’s • Calcium Channel Blockers • Beta Blockers • Digitalis Preparations • Diuretics • Flavanoid Vasoprotectors • Lipid lowering agents • Methylxanthine • Nitrates • Miscellaneous Medications • Xanthine derivatives

Aspirin 81mg and 325mg is covered under the Plan. In order to receive it, the patient must have a prescription for these agents to present to a participating pharmacy. Clopidogrel and ivabradine are available as SAM and prescribing is restricted to a cardiologist. Perindopril and combination products are available as a SAM.


Patients must obtain prior authorization from the NPDP based on documented failure or intolerance to alternative formulary ACE Inhibitors.

ANTICOAGULANTS

Warfarin Class: Coumarin Anticoagulant Indications: atrial fibrillation - thromboembolic disorder, myocardial reinfarction; prophylaxis, prosthetic cardiac valve component embolism and prophylaxis, pulmonary embolism and prophylaxis, prophylaxis post myocardial infarction, venous thromboembolism and prophylaxis, anticoagulant therapy, genotype-guided, antiphospholipid syndrome, cancer: thromboembolic disorder prophylaxis, recurrent cerebrovascular accident prophylaxis, coronary arteriosclerosis, impaired left ventricular function, percutaneous transluminal coronary angioplasty. Dosage: Standard dose 2-5mg adjusted based on INR Pregnancy Category: X Precautions: anemia, bleeding, major or potentially fatal, may occur, especially in the first month of therapy, cerebrovascular disease, CYP2C9 and VKORC1 genetic variation, duration of therapy, elderly (age 65 and older), history of gastrointestinal bleeding, high intensity of anticoagulation (INR greater than 4.0), history of highly variable INRs, hypertension, renal


impairment, trauma, diabetes mellitus, diarrhea, eye surgery, hepatic disease or impairment, indwelling catheter use, infectious diseases or disturbances of intestinal flora, such as sprue or antibiotic therapy, necrosis and/or gangrene of skin and other tissues has been reported, polycythemia vera, poor nutritional state, pregnant women with mechanical heart valves who are at high risk of thrombo-embolism, protein C or protein S deficiency, hereditary or acquired, steatorrhea, thrombocytopenia, heparin-induced, thrombocytopenia with thrombosis syndrome, heparin-induced, vasculitis, vitamin K deficiency, vitamin K intake increased, hereditary warfarin resistance CONTRAINDICATIONS: anesthesia, major regional or lumbar block, cerebral aneurysms, cerebral, bacterial endocarditis, blood dyscrasias, CNS hemorrhage, eclampsia, preeclampsia, threatened abortion, gastrointestinal, genitourinary, or respiratory tract ulcerations or overt bleeding , hemorrhagic tendencies, hypersensitivity to warfarin or any component of the product, malignant hypertension , pericarditis and pericardial effusion, pregnancy, except in pregnant women with mechanical heart valves, who are at high risk of thromboembolism, spinal puncture and other procedures with potential for uncontrollable bleeding, surgery of central nervous system or eye, recent or potential, traumatic surgery resulting in large open surface, recent or potential, unsupervised and potentially noncompliant patients Adverse Reactions:


Common: bleeding SERIOUS: cholesterol embolus syndrome, hemorrhage, hypersensitivity reaction, intraocular hemorrhage, tissue necrosis

Drug Interactions: Warfarin has a large list of Drug Interactions. If you are concerned about a drug interaction, please contact the Drug Plan office for further information. Formulary Label/Preparation:

ANTI-PLATELET AGGREGATION AGENTS

Coumadin 1mg, pkg 100, $46.08 ($0.4608/tab), LWD/BMS Coumadin 2mg, pkg 100, $48.95 ($0.4895/tab), LWD/BMS Coumadin 5mg, pkg 100, $39.22 ($0.3922/tab), LWD/BMS

Aspirin EC Class: Nonsteroidal Anti-inflammatory Strength: 81mg, 325mg Dosage: Adult: 81-325mg once daily (dosages for other

disease states available).

Pediatric: Not available for this disease state.

Dosage Adjustments: None.


Contraindications: Hypersensitivity to NSAIDS; children and teenagers with chickenpox or flu symptoms; syndrome of asthma, rhinitis and nasal polyps. Precautions: Bleeding disorders, alcohol use, 3rd trimester pregnancy, peptic ulcer disease, renal failure, severe hepatic insufficiency Pregnancy Category: D Drug Interactions: CONTRAINDICATED: KETORALAC Acenocoumarol, anisindione, beta glucan, cliostazol, citalopram, desirudin, desvenlafaxine, dicumarol, duloxetine, epitifibatide, escitalopram, fluoxetine, fluvoxamine, ginkgo, heparin, ketoprofen, methotrexate, milnaciptran, naproxen, nefazodone, paroxetine, phenindione, phenprocoumon, reteplase, sertraline, ticlopidine, varicella virus vaccine, velafaxine, warfarin Adverse Reactions:

SERIOUS: GI ulcer, bleeding, tinnitus, bronchospasm, angioedema, Reye’s syndrome.

Formulary Labels/Preparations: Aspirin EC 81mg, pkg 100, $1.12 ($0.0112/tablet), LWD/HLT Entrophen 325mg, pkg 100, $4.20, ($0.042 per tab), CDM/PMS

Clopidogrel *SAM* Class: ADP-Induced aggregation inhibitor


Strength: 75mg Dosage: Adult: 75mg once daily Pediatric: Safety and efficacy notdetermined Dosage Adjustments: None WARNINGS: Clopidogrel hydrogen sulfate effectiveness is dependent on its activation to an active metabolite by CYP2C19. In patients who are CYP2C19 poor metabolizers, clopidogrel at recommended doses forms less of that metabolite and has a smaller effect on platelet function. Compared with normal metabolizers, poor CYP2C19 metabolizers with acute coronary syndrome or undergoing percutaneous coronary intervention treated with clopidogrel at recommended doses exhibit higher cardiovascular event rates. Tests are available to identify a patient’s CYP2C19 genotype; these tests can help determine therapeutic strategy. Consider alternative treatment or treatment strategies in CYP2C19 poor metabolizers. Contraindications: Active bleeding; hypersensitivity to clopidogrel or any component. Precautions: CYP2C19 poor metabolizers; concomitant NSAID, warfarin, aspirin, CYP2C19 inhibitors; premature discontinuation of therapy; surgery; thrombotic thromboycytopenia purpura; Transbronchial lung biopsy. Pregnancy Category: B


Major Drug Interactions: Aceclofenac, acemetacin, acenocoumarol, alclfenac, alteplase, anistreplase, apazone, ardeparin, argatroban, benoxaprofen, bivalirudin, bromfenac, bufexamac, carprofen, certoparin, cilostazol, cimetidine, citalopram, clometacin, clonixin, dalteparin, danaparoid, desirudin, desvenlafaxine, dexketoprofen, dexlansopraxole, diclofenac, diflunisal, dipyrone, drotrecogin alfa, doxicam, duloxetine, enoxaparin, enoxaparin, escitalopram, esomeprazole, etodolac, etofenamate, etravirine, felfbamate, felbinac, fenbufen, fenoprofen, fentiazac, floctafenine, fluconazole, flufenamic acid, fluoxetine, flurbiprofen, fluvoxamine, fondaparinux, heparin, ibuprofen, isoxicam, ketoconazole, ketoprofen, ketorolac, lansoprazole, lepirudin, lornoxicam, meclofenamate, mefinamic acid, meloxicam, milnacipran, nabemetone, nadroparin, naproxen, nefazodone, nifluic acid, nimesulide, omeprazole, oxaprozin, oxyphenbutazone, pantoprazole, parnaparin, paroxetine, phenidione, phenprocoumon, phenylbutazone, pirazolac, piroxicam, priprofen, propyphenazone, proquazone, protein C, rabeprazole, reteplase, reviparin, sertraline, streptokinase, sulindac, suprofen, tenecteplase, tenidap, tenoxicam, tiaprfenic acid, ticlopidine, tinzaparin, tolmetin, urokinase, venlafaxine, voriconazole, warfarin, zomepirac Adverse Reactions:

Common: Chest pain, hypertension, pruritis, purpuric disorder, rash, hyperchloesterolemia, abdominal pain, constipation, diarrhea, gastritis, indigestion, epistaxis, purpura, arthralgia, backache, headache.

SERIOUS: Acute myocardial infarction, rebound effect, atrial fibrillation, congestive heart failure, coronary artery stent thrombosis, erythema


multiforme, Stevens-Johnson syndrome, gastrointestinal hemorrhage, gastrointestinal ulcer, agranulocytosis, pancytopenia, thrombotic thrombocytopenia purpura, hepatitis, hepatotoxicity, abnormal liver tests, anaphylaxis, epidrual hematoma, intracranial hemorrhage, intraocular hemorrhage, abnormal renal function, acute renal failure, noncardiogenic pulmonary edema

Formulary Label: Apo-Clopidogrel 75mg, pkg 30, $15.80 ($0.5267/tab), NAL/APO

DIGITALIS PREPARATIONS

Digoxin Class: Cardiac glycoside Strength: 0.125mg, 0.25mg, 50mcg/ml elixir *SAM* Dosage: Adult : 0.125-0.5mg once daily.

Pediatric: Age > 2: 10mcg/kg/day (solution).

Age 2-5: 10-15mcg/kg once daily.

Age 5-10: 7-10 mcg/kg once daily.

Age > 10: 3-5 mcg/kg once daily (tablet).


Dosage Adjustments: Recommended in age> 70 and renal impairment. Contraindications: Hypersensitivity to digoxin or other digitalis preparations; ventricular fibrillation. Precautions: Incomplete AV block; beri beri heart disease; electrical cardioversion; electrolyte imbalance; hypermetabolic or hyperdynamic states; hypothyroidism; idiopathic hypertrophic subaortic stenosis; acute myocardial infarction; myocarditis, preserved left ventricular systolic function, renal impairment; sinus node disease; Wolff-Parkinson-White syndrome. Pregnancy Category: C Major Drug Interactions: Alprazolam, amiodarone, bemetizide, bendroflumethiazide, benzthiazide, buthiazide, calcium, chan su, chlorothiazide, chlorthalidone, clarithromycin, clopamide, conivaptan, cyclopenthiazide, demeclocycline, diphenoxylate, doxycycline, dronedarone, erythromycin, hydrochlorothiazide, hydroflumethiazide, indapamide, indomethacin, itraconazole, kyushin, lily of the valley, methyclothiazide, metolazone, minocycline, oleander, oxytetracycline, pheasant’s eye, polythiazide, prpafenone, propantheline, quercetin, quinethazone, quinidine, quinine, ritonavir, saquinavir, spironolaction, squill, St. John’s wort, succinylcholine, tetracycline, trichlormethiazide, verapamil, xipamide Adverse Reactions:

Common: Diarrhea, Loss of appetite, nausea,


vomiting, headache, visual disturbance

SERIOUS: Cardiac dysrhythmia Formulary Labels/Preparations: Civlor 0.125mg, pkg 28, $2.05 ($0.0732/tablet), CDM/MCM Civlor 0.25mg, pkg 20, $2.90 ($0.1036/tablet), CDM/MCM Digoxin 50mcg/ml Elixir, 60ml, $45.80 ($0.7633/ml), CDM/ROX

FLAVONOID VASOPROTECTOR

Diosmin/Heperidin Class: Flavonoid vasoprotector Indication: Venous insufficiency, acute and chronic hemorrhoids Dosage: Venous insufficiency: 2 tablets twice daily with food

Acute hemorrhoid attack: 3 tablets twice daily for 4 days, then decrease to 2 tablets twice daily for 3 days, then 2 tablets daily

Chronic hemorrhoids: 2 tablets daily with food

Pregnancy Category: C Precautions: None


CONTRAINDICATIONS: hypersensitivity to product or components, pregnancy or nursing Adverse Reactions:

Common: Nausea

SERIOUS: None Drug Interactions: fluoruracil, orlistat, calcitriol, capecitabine, warfarin

Formulary Label/Preparation: Daflon 500 tabs, pkg 30, $8.70 ($0.29/tab), LWD:NAL/SER

METHYLXANTHINE

Pentoxyfylline Class: Methylxanthine Indication: Intermittent claudication with chronic occlusive arterial disease Dosage: 400mg three times daily with food. Pregnancy Category: C Precautions: May cause hypotension, angina or arrhythmia in patients with cerebrovascular or coronary artery disease,


patients on warfarin or with recent hemorrhage should be checked for bleeding. CONTRAINDICATIONS: Recent Cerebral or Retinal Hemorrhage, Hypersensitivity to product or components or other methylxanthines (theophylline, caffeine) Adverse Reactions:

Common: dyspepsia, nausea, vomiting

SERIOUS: angina, Drug Interactions: warfarin

Formulary Label/Preparation: Pentoxyfylline 400mg, pkg 100, $9.90 (0.099/tab), LWD/HLT

NITRATES

Isosorbide Dinitrate Class: Nitrate Strength: 10mg. Dosage: Adult: 10-40mg 2-3 times daily (with a nitrate free

interval of 14 hours daily). Pediatric: Safety and efficacy not determined.


Dosage Adjustments: Recommended in elderly and hemodialysis Contraindications: Hypersensitivity to organic nitrates Precautions: Acute myocardial infarction, alcohol use, severe anemia, cerebral hemorrhage, head trauma, concurrent sildenafil, gastric hypermotility, hyperthyroidism, hypertrophic cardiomyopathy, hypotension, increased intracranial pressure, increased intraocular pressure, pregnancy and lactation. Pregnancy Category: C Major Drug Interactions: CONTRAINDICATED: SILDENAFIL, TADALAFIL, VARDENAFIL. Adverse Reactions:

Common: hypotension, lightheadedness, tachyarrhthmia, dizziness, headache.

SERIOUS: Rebound hypertension, syncope, unstable angina, methemoglobinemia.

Formulary Labels: Apo-ISDN 10mg, pkg 100, $2.16 ($0.0216/ tablet), NAS/APO

Nitroglycerin Class: Nitrate Strength: 0.6mg SL tabs.


Dosage: Adult: 1 tablet sublingually at first sign of attack;

repeat every 5 minutes as needed for a total of 3 tablets in 15 minutes, if no relief, seek medical attention.

Pediatric: Safety and efficacy not determined

Contraindications: Severe anemia; concurrent use of phosphodiesterase inhibitors; early myocardial infarction; hypersensitivity to organic nitrates; increased intracranial pressure; symptomatic hypotension Precautions: Hypertrophic cardiomyopathy; volume-depletion hypotension; increased intraocular pressure; acute myocardial infarction or CHF; cerebral hemorrhage or head trauma; concurrent use of alcohol, CNS depressants, or antihypertensives; hyperthyroidism Pregnancy Category: C Major Drug Interactions: CONTRAINDICATED: SILDENAFIL, TADALAFIL, VARDENAFIL. Alteplase, heparin Adverse Effects:

Common: Hypotension, tachyarrhthmia, rash, xerostomia, asthenia, dizziness, headache, lightheadedness, vision disorder

SERIOUS: Rebound hypertension, syncope, unstable angina, scaling eczema, coagulation disorder,


methemoglobinemia, thrombocytopenia Formulary Labels: Nitrostat 0.6 mg, pkg 100, $12.34 LWD:NAS/PFI

MISCELLANEOUS

Trimetazidine HCl

Class: Antianginal Strength: 35mg Dosage: Adult: 20mg three times daily; 35mg twice daily

Pediatric: Safety and efficacy not determined

Dosage Adjustments: None Contraindications: Hypersensitivity to trimetazidine Precautions: Renal or hepatic insufficiency, unstable angina, hypertension Pregnancy Category: C Major Drug Interactions: No known drug interactions. Adverse Reactions:

Common: Gastric burning


Formulary Labels: Vastarel MR, pkg 30, $7.02 (0.234/tab) NAS/SER

Ivabradine *SAM* Class: Sinus node inhibitor Strength: 5mg Dosage: Adult: 5-7.5mg twice daily

Pediatric: Safety and efficacy not determined Dosage Adjustments: Recommended in elderly Contraindications: Congenital QT prolongation; severe hypotension; severe hepatic impairment Precautions: Use in patients with HR< 60bpm, cardiogenic shock, severe conduction defects, acute myocardial infarction, unstable angina; heart failure; atrial fibrillation or other arrhythmias interfering with sinus node function; severe renal impairment; retinitis pigmentosa; grapefruit juice. Pregnancy Category: D Major Drug Interactions: Drugs that prolong QT interval;ketoconazole; itraconazole; clarithromycin; erythromycin; nelfinavir; ritonavir, nefazodone; diltiazem, verapamil; fluconazole; rifampin, phenytoin; St. John’s wort.


Adverse Reactions: Common: luminous pheomena in the visual field; blurred vision; nausea; constipation; diarrhea; headache; dizziness; dyspnea; muscle camps; hyperuricemia; eosinophilia.

SERIOUS: Bradycardia, arrhythmias, increased SCr

Formulary Labels/Preparations: Procoralan 5mg, pkg 28, $33.15 $1.18/tablet), LWD:NAS/SER

OTHER MEDICATIONS FOR ISCHAEMIC HEART DISEASE

Calcium Channel Blockers - Amloldipine, Amloldipine/ Perindopril, Felodipine, (see more information under hypertension). Beta Blockers - Atenolol (see more information under hypertension). Lipid Lowering Agents - Atorvastatin, Rosuvastatin, Simvastatin (see more information under hypercholesterolemia).


PROSTATE CANCER Diagnosis of prostate cancer is restricted to urologists and oncologists. Medications from the following pharmacological classes are available for the treatment of prostate cancer:

• Antiandrogens • Leutenizing Hormone Releasing Hormone

agonist • Miscellaneous Medications Necessary for the

Management of the Disease Leuprolide is available as a 3-month injection. The patient is only eligible to receive this injection every 90 days. The cost of administration of the injection is the responsibility of the patient and is not covered by the Plan. Medications for the treatment of prostate cancer are SAM and can only be prescribed by a medical oncologist.

ANTIANDROGEN

Bicalutamide *SAM* Class: Antiandrogen Strength: 50mg


Dosage: Adult: 50mg once daily in combination with a LHRH agonist

Pediatric: N/A

Pregnancy Category: X Dosage Adjustments: None Contraindications: Hypersensitivity to bicalutamide or any component; women. Precautions: Diabetes; hepatotoxicity. Major Drug Interactions: acenocoumarol, dicumarol, phenprocoumon Adverse Effects:

Common: peripheral edema; hot sweats; abdominal pain; constipation; diarrhea; nausea; infectious disease; backache; pelvic pain; asthenia; hematuria; nocturia; dyspnea; pain

SERIOUS: Congestive heart failure; myocardial infarctions; hepatitis; hepatotoxicity; liver failure.

Formulary Labels/Preparations: Biclutamide 50mg, pkg 28, $73.72 ($2.6329/tablet), CDM/PMS


LEUTENIZING HORMONE RELEASING HORMONE AGONIST

Goserelin *SAM*

Class: LHRH agonist Dosage: Adult: 10.8mg deep SQ every 3 months

Pediatric Dosage: N/A Pregnancy Category: X Dosage Adjustments: none Contraindications: Pregnancy; hypersensitivity to goserelin or any component. Precautions: Decreased bone mineral density; cardiovascular disease; hypercalcemia; hyperglycemia; hypersensitivity with anaphylaxis; tumor flare. Major Drug Interactions: None Adverse Effects:

Common: peripheral edema, acne, seborrhea, sweating; atrophy of breast; headache; depression; erectile dysfunction; flushing; reduced libido; sexual dysfunction; vaginitis; pain


SERIOUS:Congestive heart failure; diabetes mellitus; pituitary apoplexy; pituitary tumor; tumor flare; anaphylaxis; immune hypersensitivity reaction; cerbrovascular accident; renal impairment; chronic obstructive pulmonary disease.

Formulary Labels/Preparations: Zoladex 10.8mg syringe, pkg 1; $492.75; NAS/ZEN

MISCELLANEOUS

Ketoconazole *SAM* Class: Azole antifungal Strength: 200mg Dosage: Adult: Prostate Cancer: 400mg Q 8h

Pediatric: N/A

Pregnancy Category: C Dosage Adjustments: Recommended in liver disease.


WARNINGS: When used orally, ketoconazole has been associated with hepatic toxicity, including some fatalities. Patients receiving this drug should be informed by the physician of the risk and should be closely monitored. Coadministration of ketoconazole with terfenadine, astemizole, and cisapride is contraindicated due to the inhibition of metabolism of these drugs by ketoconazole. Coadministration of these drugs with ketoconazole may result in serious cardiovascular events, including death, ventricular tachycardia, ventricular fibrillation, torsades de pointes, and prolongation of the QT interval. Contraindications: Concomitant use with astemizole, cisapride oral triazolam or terfenadine; hypersensitivity to ketoconazole Precautions: Achlorhydria; anaphylaxis; concomitant use with antacids, hepatotoxic drugs, isoniazid, rifamin, nevirapine, and midazolam; hepatotoxicity; suppression of adrenal corticosteroid secretion and/or serum testosterone levels. Major Drug Interactions: CONTRAINDICATED: ALFUZOSIN, ALPRAZOLAM, ASTEMIZOLE, CISAPRIDE, COLCHICINE, CONIVAPTAN, DIHyDROERGOTAMINE, DOFETILIDE, DRONEDARONE, EPLERENONE, ERGOLOID MESyLATES, ERGONOVINE, ERGOTAMINE, METHLERGONOVINE, METHySERGIDE, PIMOZIDE, RANOLAZINE, SILODOSIN, TERFENADIE, TOLVAPTAN, TRIAZOLAM Amiodarone, aprepitant, atrovastatin, bretylium, cerivastatin, clopidogrel, dasatinib, docetaxel, erythromycin, etravirine, everolimus, fentanyl, fluticasone, ibutilide, iloperidone, irinitecan, ixabepilone, lapatinib, levomethadyl, lovastatin,


mefloquine, midazolam, nilotinib, oxycodone,pazopanib, romidepsin, salmeterol, simvastatin, sirolimus, sotalol, sunitinib, tadalafil, tamsulosin, temsirolimus, topotecan Adverse Reactions:

Common: Nausea, vomiting

SERIOUS: Hepatotoxicity, anaphylaxis, hypersensitivity reaction.

Formulary Labels/Preparations: Apo-Ketoconazole 200mg, pkg 100, $18.30 ($0.183/tablet), NAS/APO.

Hydrocortisone *SAM* Class: Corticosteroid Strength: 10mg Dosage: Adult: Prostate Cancer: Optimal dosing not defined,

used in combination with ketoconazole. Pregnancy Category: A Dosage Adjustments: None Contraindications: Hypersensitivity to hydrocortisone or components; live or live attenuated vaccines; systemic fungal infections


Precautions: Cirrhosis, diverticulitis; fluid disturbances; hypothyroidism; measles, chickenpox and other infections; myasthenia gravis; ocular herpes simplex; osteoporosis; peptic ulcer; pregnancy; psychotic tendencies; smallpox vaccine and other immunizations; tuberculosis; ulcerative colitis; untreated systemic infections. Major Drug Interactions: CONTRAINDICATED: LIVE ROTAVIRUS VACCINE Aldesleukin, bupropion, quetiapine Adverse Effects:

Common: Atrophic condition of skin; Impaired finding of skin healing; decreased body growth; disorder of GI tract; increased infection risk; osteoporosis; depression; euphoria

SERIOUS: Adrenal insufficiency; Cushing’s syndrome; Fluid and/or electrolyte imbalances; adrenalcortical insufficiency; HPA; hyperglycemia; cataract; glaucoma; tuberculosis.

Formulary Labels/Preparations: Cortef 10mg, pkg 100, $22.00 ($0.22/tab), LWD/PFI


PSYCHIATRIC ILLNESS The conditions of Depression (Major) and Psychosis/Schizophrenia have been combined and expanded to be inclusive of all psychiatric disorders. Diagnosis should be made by a psychiatrist; however treatment with antidepressants is not restricted. Treatment with antipsychotics is restricted to psychiatrists or persons working in collaboration with a psychiatrist. Medications from the following pharmacological classes are available:

• Selective Serotonin Reuptake Inhibitors (SSRI’s) • Tricyclic Antidepressants (TCA’s)

Selective Serotonin Reuptake Inhibitors (SSRIs): These medications block the reuptake of serotonin, a neurotransmitter found in the brain that affects anger, aggression, mood, vomiting and a variety of other activities. Increase in serotonin can lead to serotonin syndrome which may be life threatening, it typically occurs as a result of a drug interaction or overdose of medications that increase serotonin levels. Patients experience cognitive, autonomic, and somatic effects. Treatment consists of discontinuing the causative agent(s) and administration of a serotonin antagonist. Tricyclic Antidepressants: (TCAs): inhibit the reabsorption (reuptake) of serotonin and norepinephrine by brain cells. To a lesser extent, TCAs also inhibit reabsorption of dopamine. These antidepressants also block other cell receptors, which accounts for many of their side effects.


General Note: Precautions/Warning: Suicidality and Antidepressant drugs: Antidepressants increase the risk of suicidal thinking and behavior in children and adolescents with major depressive disorders and other depressive conditions; monitor all patients closely; not recommended for children <12 years; may worsen psychosis in some patients or precipitate a shift to mania or hypomania in patients with bipolar disorder. The possibility of suicide attempt is inherent in major depression and may persist until remission occurs. Use caution in high risk patients. Patients presenting with depressive symptoms should be screened for bipolar disorder.

TRICYCLIC ANTIDEPRESSANTS

Amitriptyline Class: Tricyclic antidepressants Indications: Depression; anorexia or bulimia related to depression; adjunctive treatment of neuropathic pain. Dosage: Adult:

Outpatient initial: 75 mg to 100 mg per day in divided doses or 50 to 150 mg at bedtime.

Inpatient: 100 to 300 mg. For pain management (neuropathy): 10-25 mg/day; may increase to 100 mg/day as tolerated.


Geriatric or adolescent patients: 10mg t.i.d. and 20 mg at bedtime.

Precautions: (See general note). Amitriptyline is not FDA approved for bipolar depression. Pregnancy Category: D Contraindications: Hypersensitivity to amitriptyline or any component of the formulation (cross-sensitivity with other tricyclics may occur); use of MAO inhibitors within the past 14 days; acute recovery phase following myocardial infarction; concurrent use of cisapride. Adverse Reactions: Myocardial infarction; stroke; nonspecific ECG changes and changes in AV conduction; heart block; arrhythmias; hypotension, particularly orthostatic hypotension; syncope; hypertension; tachycardia; palpitation; Coma; seizures; hallucinations; delusions; disorientation; ataxia; tremors; peripheral neuropathy; numbness, tingling, and paresthesias of the extremities; insomnia; nightmares; drowsiness; dizziness; weakness; fatigue; headache; alopecia; edema; weight gain or loss; urinary frequency. Drug Interactions: Increased effect/toxicity: alcohol, amphetamines, other CNS depressants, carbamazepine, chlorpropamide, warfarin; MAO inbibitors, SSRIs-fluoxetine, sertraline, and paroxetine, miconazole,: cholorpromazine; cimetidine; disulfiram; or heart rhythm medications such as flecainide propafenone, or quinidine; diltiazem, valproate, verapamil; lithium (increase risk of neurotoxicity) thyroid


medication; barbiturates and; grapefruit juice, kava kava & gotu kola decreased effect: clonidine, guanethidine, bethanidine & St. John’s wort. Formulary Labels/Preparations: Apo-Amitriptyline 25 mg, pkg 100, $2.45 ($0.0245/tab) NAS/APO Apo-Amitriptyline 50mg, pkg 100 $3.50 ($0.035 /tab)NAS/APO

SELECTIVE SEROTONIN REUPTAKE INHIBITORS

Fluoxetine

Class: Antidepressant; SSRI Indications: Acute and maintenance treatment of Major Depressive Disorder in adult patients and in pediatric patients aged 8 to 18 years. Treatment of moderate to severe bulimia, OCD, PMDD, panic disorder. Dosage: Adult: Initial: 20 to 80 mg/day (Doses above 20

mg/day may be administered on a once-a-day (morning) or BID schedule (i.e., morning and noon) and should not exceed a maximum dose of 80 mg/day.

Pediatric: Age: 8-18 yrs: Depression: 10 or 20 mg/day.


Lower weight children can start from 10mg/day. After 1 week at 10 mg/day, the dose should be increased to 20 mg/day if needed.

Geriatic: Initial: 10mg/day, with increases of 10 and 20mg every several weeks as tolerated; should not be taken at night unless patient experience sedation.

Pregnancy Category: C Precautions: (See General Note) Contraindications: MAOIs, pimozide, thioridazine & olanzapine Adverse Reactions:

Common: Headache, asthenia, fly syndrome, vasodilation, nausea, diarrhea, anorexia, dry mouth, insomnia, nervousness, anxiety, somnolence, dizziness

SERIOUS: Prolonged QT interval, hyponatremia, bleeding, seizure, worsening depression, mania, suicide, suicidal thoughts, serotonin syndrome.

Drug Interactions: Monoamine Oxidase Inhibitors (MAOI), CNS Acting Drugs, Serotonergic Drugs (triptans, linezolid, lithium, tramadol, or St. John’s Wort); tryptophan, Pimozide, thioridazine, antiarrhythmics, antipsychotics drugs with a narrow therapeutic index represent the greatest concern (e.g., flecainide, propafenone, vinblastine, and TCAs); benzodiazapines, anticonvulsants; drugs tightly bound to plasma proteins


(coumadin, digitoxin). Formulary Labels/Preparations: Apo-Fluoxetine 20mg, pkg 100, $11.80, (0.118/cap), NAS/ APO

Paroxetine Class: Antidepressant; SSRI Dosage: Adult: Initial: 20 mg/day single daily dose with or

without food, usually in the morning, increase if needed by 10mg/ day increments at intervals of at least 1 week; maximum dose: 50mg/day.

Geriatric: Initial: 10mg/day; increase if needed by 10mg/day increments at intervals of at least one week; maximum dose: 40 mg/day

Pediatric: Safety and efficacy not established.

Pregnancy Category: D Indication: Treatment of major depressive disorder (MDD); treatment of panic disorder; OCD; social anxiety; generalized anxiety disorder (GAD); post-traumatic stress disorder; premenstrual dysphoric disorder (PMDD). Precautions: (See general note)


Contraindications: Hypersensitivity to paroxetine or any of its components; use with or within 14 days of MAOIs; concurrent use with thioridazine or pimozide. Adverse Reactions:

Common: Diaphoresis, constipation, diarrhea, flatulence, decreased appetitie, nausea, xerostomia, arthralgia, asthenia, dizziness, insomnia, somnolence, terror, blurred vision, anxiety, nervousness, abnormal ejaculation, erectile dysfuntion, orgasm incapacity, yawning.

SERIOUS: Abnormal bleeding, toxic epidermal necrosis, hyponatremia, acute hepatitis, seizure, worsening depression, hypomania, mania, suicide, suicidal thoughts, serotonin syndrome.

Major Drug Interactions: CONTRAINDICATED: LINEZOLID, METOCLOPRAMIDE, NIALAMIDE, PROCARBAZINE, SELEGELINE, THIORIDAZINE NSAIDS, Clopidogrel, Dalteparin, Dextromethorphan, Dipyridamole, Heparin, St. John’s Wort, Sumatriptan, Trazodone, Warfarin, Zolmitriptan Formulary Labels/Preparations: Paroxetine 10mg, pkg 30, $4.36 (0.1453/ cap), CDS/PMS Paroten 20mg, pkg 30, $6.60 (0.22/ cap), CDS/PMS


Treatment of psychosis is restricted to psychiatrists only. Medications from the following pharmacological classes are available:

• Anti-cholinergics • Phenothiazines • Typical Antipsychotics • Atypical Antipsychotics

ANTICHOLINERGICS

Benzhexol HCl (Trihexypheidyl) *SAM*

Class: Anticholinergic Strength: 2mg, 5mg Dosage: Adult: 5- 15mg divided 3-4 times daily

Pediatric: Safety and efficacy are not determined Dosage Adjustments: None Contraindications: Narrow angle glaucoma, hypersensitivity to trihexyphenidyl, age < 3, tardive dyskinesias. Precautions: Administration in hot weather, to alcoholics, those with CNS disease, or manual labourers in hot environments; cardiac, liver or kidney disorders; elderly males; elderly;


glaucoma; hypertension; tardive dyskinesias; neuroleptic malignant syndrome may occur upon discontinuation; obstructive disease of GI and GU tracts Pregnancy Category: D Major Drug Interactions: CONTRAINDICATED: POTASSIUM CHLORIDE Adverse Reactions:

Common: dryness of mouth, nausea, dizziness, nervousness, blurred vision

SERIOUS: Angle-closure glaucoma, disorientation, increased intraocular pressure, paralytic ileus, hallucinations, confusion, aggressive behavior

Formulary Labels/Preparations: Apo-Trihex 2mg, pkg 100, $3.35 ($0.335/tablet); NAS/APO Apo-Trihex 5mg, pkg 100, $3.60 ($0.036/tablet); NAS/APO

Benztropine *SAM* Class: Anticholinergic Strength: 2mg Dosage: Adult : 1-4 mg once or twice daily

Pediatric: Age >3: 1-2mg daily


Dosage Adjustments: None Contraindications: Hypersensitivity to benztropine or component; age < 3 Precautions: Pediatric patients; heat prostration; avoid driving or hazardous activities; mental disorders; obstructive uropathy; prostatic hypertrophy; glaucoma; tachycardia; tardive dyskinesia. Pregnancy Category: B Major Drug Interactions: CONTRAINDICATED: POTASSIUM CHLORIDE Adverse Reactions:

Common: Tachyarrhythmia, constipation, nausea, xerostomia, blurred vision, urinary retention.

SERIOUS: Heat stroke, hyperpyrexia, paralytic ileus, confusion, increased intraocular pressure, psychosis.

Formulary Labels/Preparations: Benztropine 2mg, pkg 100, $4.62 ($0.0462/tablet); CDM/PMS


PHENOTHIAZINES

Chlorpromazine *SAM* Class: Phenothiazine Antipsychotic Strength: 25mg, 50mg, 100mg. Dosage: Adult: Schizophrenia/Psychosis: 30-200mg/day

divided 1-4 times daily, usual dose 400-600mg/day; some patient may require 1-2 gm/day.

Pediatric: Schizophrenia/Psychosis: Age >6 months: 0.5-1mg/kg/dose every 4-6 hours; Older children may require doses of 200mg or greater.

Dosage Adjustments: Recommended in geriatrics adn hepatic impairment Contraindications: Hypersensitivity to chlorpromazine, phenothiazines; myelosuppression, coma, sever CNS depression Precautions: Elderly patients with dementia-related psychosis: avoid abrupt withdrawal; cardiovascular disease; chronic respiratory disorders; concomitant guanethidine or CNS depressants; epilepsy; glaucoma; neuroleptic malignant syndrome, liver or renal disaese; pregnancy; breast cancer;


Reye’s Syndrome Pregnancy Category: C Major Drug Interactions: CONTRAINDICATED: CISAPRIDE, METOCLOPRAMIDE, THIORIDAZINE Amiodarone, Amphetamine, Aresenic Trioxide, Bretylium, CHloral Hydrate, Clarithromycin, Dolasetron, Droperidol, Erythromycin, Fentanyl, Fluconazole, Fluoxetine, Haloperidol, Halothane, Isoflurane, Levofloxacine, Lithium, Methadone, Morphine, Moxifloxacin, Octreotide, Pentamadine, Procainamide, Procarbazine, Prochlorperazine, Propafenone, Quetiapine, Quinidine, Risperidone, Tramadol, Trifluoperazine, Trimethoprim, Vasopressin, Zolpidem Adverse Effects:

Common: Hypotension, Orthostatic Hypotension, Descreased sweating, photosensitivity, constipation, xerostomia, akathesia, dizziness, tardive dyskinesias, dystonia, extraparamidal disease, Parkinsonianism, somnolence, blurred vision, epithelial keratopathy, retinitis pigmentosa, nasal congestion

SERIOUS: Prolonged QT interval, Torsades de Pointes, obstipation, paralytic ileus, agranulocytosis, leukopenia, thrombocytopenia, cholestatic jaundice, systemic lupus erythematosus, ineffective thermoregulation, heat stroke, hyperthermia, neuroleptic malignant syndrome, seizure, priapism

Formulary Labels/Preparations: Chlorpromazine 25mg, pkg 28, $4.93 ($0.1761/tab), CDM


Chlorpromazine 50mg, pkg 28, $2.54 ($0.0907/tab), CDM Chlorpromazine 100mg, pkg 28, $2.44 ($0.0871/tab), CDM

Thioridazine *SAM* Class: Phenothiazine Antipsychotic Strengths: 25mg, 100mg Dosage: Adult: 50-100mg three times daily. MAX 800mg/day

in 2-4 divided doses.

Pediatric: Age >2: 0.5mg/kg/day in divided doses. MAX 3mg/kg/ day.

Dosage Adjustments: Recommended in debilitated or geriatric patients and in liver disease. WARNINGS: Has been shown to prolong the QTc interval in a dose related manner, and drugs with this potential have been associated with torsades de pointes-type arrhythmias and sudden death. Due to its potential for significant, possibly life-threatening, proarrhythmic effects, thioridazine should be reserved for use in the treatment of schizophrenic patients who fail to show an acceptable response to other courses of treatment. Contraindications: Abnormal K+ levels; CNS depression, coma or drug-induced depression; concomitant use of drugs that cause QTc-interval prolongation or inhibit thioridazine metabolism or clearance; history of cardiac


arrhythmia or QTc-interval prolongation; hypersensitivity to thioridazine, QTc-interval > 450 milliseconds; reduced CYP2D6 enzyme activity; severe hypertensive or hypotensive heart disease. Precautions: Elderly patients with dementia-related psychosis; history of breast cancer; history of myasthenia gravis, history of neuroleptic malignant syndrome or tardive dykinesia; leucopenia or agranulocytosis; patients participating in activities requiring mental alertness; seizure disorders. Pregnancy Category: C Major Drug Interactions: CONTRAINDICATED: ACECAINIDE, ACETYLCHOLINE, AJMALINE, AMIODARONE, AMISULPRIDE, AMITRIPTYLINE, AMOXAPINE, APRINDINE, ARSENIC TRIOXIDE, ASTEMIZOLE, AZIMILIDE, BEPRIDIL, BRETYLIUM, CHLORAL HYDRATE, CHLOROQINE, CHLORPROMAZINE, CISAPRIDE, CLARITHROMYCIN, DEIPRAMINE, DIBENZEPIN, DIETHYLPROPION, DISOPYRAMIDE, DOFETILIDE, DOLASETRON, DOXEPIN, DRONEDARONE, DROPERIDOL, DULOXETINE, ENCAINIDE, ENFLURANE, ERYTHROMYCIN, FLECAINIDE, FLUCONAZOLE, FLUOXETINE, FLUVOXAMINE, FOSCARNET, GATIFLOXACIN, GEMIFLOXACIN, GREPAFLOXACIN, HALOFANTRINE, HALOPERIDOL, HALOTHANE, HYDROQUINIDINE, IBUTILIDE, IMIPRAMINE, IOPAMIDOL, ISOFLURANE, ISRADIPINE, KETANSERIN, LEVOFLOXACIN, LEVOMETHADYL, LIDOFLAZINE, LORCAINIDE, LUBELUZOLE, MEFLOQINE, METHADONE, METOCLOPRAMIDE, MOXIFLOXACIN, NORTRIPLYLINE, OCTREOTIDE, ONDANSETRON, PALIPERIDONE,


PAROXETINE, PAZOPANIB, PENTAMIDINE, PIMOZIDE, PINDOLOL, PIRMENOL, PRAJMALINE, PROBUCOL, PROCAINAMIDE, PROCATEROL, PROCHLORPERAZINE, PROPAFENONE, PROPRANOLOL, PROTRIPTYLINE, QUETIAPINE, QUINIDINE, RANOLAZINE, ROXITHROMYCIN, SEMATILIDE, SERTINDOLE, SOTALOL, SPARFLOXACIN, SPIRAMYCIN, SULFAMETHOXAZOLE, SULTOPRIDE, SUNITINIB, TEDISAMIL, TELAVANCIN, TELITHROMYCIN, TERFENADINE, TRIFLUOPERAZINE, TRIMEHTOPRIM, TRIMIPRAMINE, VASOPRESSING, ZIPRASIDONE, ZOLMITRIPTAN, ZOTEPINE. Asenpaine, darifenacin, fentanyl, hydromorphone, iloperidone, lapatinib, levorphanol, lithium lumefantrine, metrizamide, morphine, oxycodone, procarbazine, tapentadol, tetrabenazine, tramadol, zolpidem Adverse Reactions:

Common: Hypotension, orthostatic hypotension, diminished sweating, photosensitivity, constipation, xerostomia, akathisia, dizziness, tardive dystonia, dystonia, extrapyramidal disease, Parkinsonianism, somnolence, tardive dyskinesia, blurred vision, epithelial keratopathy, retinitis pigmentosa, urinary retention, nasal congestion.

SERIOUS: Prolonged QT interval, sudden cardiac death, Torsades de pointes, obstipation, paralytic ileus, agranulocytosis, disorder of hematopoietic structure, leucopenia, thrombocytopenia, cholestatic jaundice, drug-induced lupus erythematosus, ineffective thermoregulation, heatstroke or hypothermia, neuroleptic malignant syndrome,


seizure, priapism, death. Formulary Labels/Preparations: Thioridazine 25mg, pkg 100, $17.10 (0.171/tab), LWD/MUT Thioridazine 100mg, pkg 100, $28.18 (0.2818/tab), LWD/MUT

Trifluoperazine *SAM* Class: Phenothizine Antipsychotic Strength: 2mg, 5mg, 10mg. Dosage: Adult : 2-5mg twice daily, usual effective dose 15-

20mg/ day. MAX 40mg/day.

Pediatric: Age 6-12: 1mg 1-2 times daily. MAX 15mg/day.

Dosage Adjustments: Recommended in debilitated or elderly patients and in liver disease. Contraindications: Blood dyscrasias, bone marrow depression, coma, large doses of CNS depressants, hypersensitivity to trifluoperazine or other phenothiazines, pre-existing liver damage. Precautions: Elderly patients with dementia-related psychosis; cardiovascular disorders; concomitant lithium therapy; glaucoma or retinopathy; anginal pain; neuroleptic malignant syndrome; sodium bisulfite allergy.


Pregnancy Category: C Major Drug Interactions: CONTRAINIDATED: BEPRIDIL, CISAPRIDE, GREPAFLOXACIN, MESORIDAZINE, METOCLOPRAMIDE, PIMOZIDE, SPARFLOXACIN, TERFENADINE, THIORIDAZINE, VENLAFAXINE, ZIPRASIDONE. Ajmaline, amisulpride, amitriptyline, amoxapine, aprindine, arsenictrioxide, astemiszole, chloral hydrate, chloroquine, chlorpromazine, clarithromycin, desipramine, dibenzepin, disopyramide, dolasetron, doxepin, droperidol, encainide, enflurane, erythromycin, fentanyl, flecainide, fluconazzole, fluoxetine, foscarnet, gatifloxacin, gemifloxacin, halofantrine, haloperidol, halothane, hydromorphone, hydroquinidine, imipramine, isuflurane, isradipine, levofloxacin, levomethadyl, levorphanol, lidoflazine, lithium, lorcainide, mefloquine, methadone, metrizamide, morphine, moxifloxacin, nortriptyline, octreotide, oxycodone, paliperidone, pentamidine, pirmenol, prajmaline, probucol, procainamide, procarbazine, prochlorperazine, quetiapine, quinidine, risperidone, sertindole, spiramycin, sulfamethoxazole, sultropride, tapentadol, telithromycin, tramadol, trimethoprim, trimipramine, vasopressin, zolmitriptan, zotepine Adverse Reactions:

Common: hypotension, orthostatic hypotension, diminished sweating, photosensitivity, constipation, xerostomia, akathisia, dizziness, tardive dyskinesias, dystonia, extrapyramidal symtoms, Parkinsonianism, somnolence, tardive dykinesia, blurred vision, epithelial keratopathy, retinitis pigmentosa, urinary retention,


nasal congestion

SERIOUS: Prolonged QT interval, Torsades de pointes, obstipation, paralytic ileus, agranulocytosis, disorder of hematopoietic structure, leucopenia, thrombocytopenia, cholestatic jaundice, drug-induced lupus erythematosus, ineffective thermoregulation, heatstroke, hypothermia, neuroleptic malignant syndrome, seizure, priapis, death.

Formulary Labels/Preparations: Apo-trifluoperazine 2mg, pkg 100, $3.22 ($0.0322/tablet), NAS/APO Apo-trifluoperazine 5mg, pkg 100, $3.62 ($0.0362/tablet), NAS/APO Apo-trifluoperazine 10mg, pkg 100, $4.50 ($0.045/tablet), NAS/APO

TYPICAL ANTIPSYCHOTICS

Haloperidol *SAM* Class: Dopamine Antagonist Strength: 2mg, 5mg, 10mg. Dosage: Adult : 0.5-5mg 2-3 times daily.

Pediatric: Age 3-12 (weight 15-40kg): 0.05mg/kg/day


divided 2-3 times daily. MAX 0.15mg/kg/day. Age > 12: 0.5-5mg 2-3 times daily

Dosage Adjustments: Recommended in debilitated and elderly patients. WARNINGS: Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. Although the causes of death in clinical trials were varied, most of the deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. Observational studies suggest that antipsychotic drugs may increase mortality. It is unclear from these studies to what extent the mortality findings may be attributed to the antipsychotic drug as opposed to patient characteristics. Haloperidol is not approved for the treatment of patients with dementia-related psychosis. Contraindications: Comatose state; hypersensitivity to haloperidol; Parkinson’s disease; severe toxic central nervous system depression Precautions: Elderly; allergies or history of allergic reactionsto drugs; brochopneumonia; underlying cardiac abnormalities; severe preexisting cardiovascular disorders; concomitant lithium, anticoagulants, anticholinergics, anticonvulsants and drugs known to prolong QT interval; EEG abnormalities; electrolyte imbalance; hypothyroidism; high dose and long duration of use increases risk of tardive dyskinesia; family history of long QT syndrome; neuroleptic


malignant syndrome; history of QT prolongation; rapid mood fluctuations when used in bipolar disorders; history of seizure disorder; tardive dyskinesia; thyrotoxicosis Pregnancy Category: C Major Drug Interactions: CONTRAINDICATED: BEPRIDIL, CISAPRIDE, LEVOMETHADYL, MESOIDAZINE, METOCLOPRAMIDE, PIMOZIDE, SPARFLOXACIN, TERFENADINE, THIORIDAZINE, ZIPRASIDONE. Acecainide, ajmaline, amiodarone, amisulpride, amitriptyline, amoxpine, aprindine, arsenic trioxide, asenapine, astemizole, azimilide, bretylium, chloral hydrate, chloroquine, chlorpromazine, clarithromycin, dalfopristin, desipramine, dibenzepin, disopyramide, dofetilide, dolasetron, doxepin, droperidol, encainide, enflurane, erythromycin, flecainide, fluconazole, fluoxetine, foscarnet, gemifloxacin, halofantrine, halothane, hydromorphone, hydroquinidine, ibutilide, imipramine, isoflurane, isradipine, levofloxacin, lidoflazine, lithium, lorcainide, mefloquine, nortriptyline, octreotie, pazopanib, pentamidine, pirmenol, prajmaline, procuol, procainamide, prochlorperazine, propafenone, propranolol, protriptyline, quetipine, quinupristin, risperidone, sematilide, sertindole, sotalol, spiramycin, sulfamethoxazole, sultopride, tedisamil, telavancin, telithromycin, tetrabenazine, tramadol, trifluoperazine, trimethoprim, trimipramine, vasopressin, venlafaxine, zolmitriptan, zotepine. Adverse Reactions:

Common: hypotension, constipation, xerostomia, akathisia, dystonia, extrapyramidal disease, somnolence, blurred vision.


SERIOUS: Prolong QT interval, sudden cardiac death, torsades de pointes, paralytic ileus, agranulocytosis, neuroleptic malignant syndrome, seizure, tardive dyskinesia, priapism, death.

Formulary Labels/Preparations: Haloxen 5mg, pkg 100, $2.62 (0.0262/tab), CDM/REM Haloxen 10mg, pkg 100, $3.85 (0.0385/tab), CDM/REM

ATYPICAL ANTIPSYCHOTICS

Risperidone *SAM* Class: Antipsychotic Strength: 1mg, 2mg, 3mg. Dosage: Adult: 1-3mg twice daily. Maximal effect between 4-

8mg daily. MAX 16mg/day.

Pediatric: Autism, irritability: Wt < 20kg: 0.25mg once or twice daily.

Wt > 20kg: 0.5mg once or twice daily.

Bipolar: Age >10: 0.5-2.5mg divided once or twice daily.

Schizophrenia:


Age >13: 0.5-3mg divided once or twice daily. Dosage Adjustments: Recommended in combination with CYP3A4 inducers or CYP2D6 inhibitors; debilitated patients; elderly; hepatic impairment; patients at risk for hypotension; and severe renal impairment. WARNINGS: Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. Although the causes of death in clinical trials were varied, most of the deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. Observational studies suggest that antipsychotic drugs may increase mortality. It is unclear from the observational studies to what extent these mortality findings may be attributed to the antipsychotic drug as opposed to patient characteristics. Risperidone is not approved for the treatment of patients with dementia-related psychosis. Contraindications: Hypersensitivity to risperidone, paliperidone, or any component. Precautions: Elderly patients with dementia-related psychosis; agranulocytosis, leucopenia and neutropenia; predisposition to hypotension; cerebrovascular events; irregular body temperature regulation; diabetes mellitus; risk of tardivedyskinesia (particularly in elderly women and prolonged use); esophageal dysmotility and aspiration; severe hepatic impairment; hyperglycemia; hyperprolactinemia; neuroleptic malignant syndrome; Parkinson’s disease or dementia with Lewy bodies; priapism, severe renal impairment; history of


seizure disorder; suicide risk. Pregnancy Category: C Major Drug Interactions: CONTRAINDICATED: BEPRIDIL, CISAPRIDE, LEVOMETHADYL, MESORIDAZINE, METOCLOPRAMIDE, PIMOZIDE, TERFENADINE, THIORIDAZINE. Acecainide, ajmaline, amiodarone, amisulpride, amitriptyline, amoxapine, aprindine, arsenic trioxide, asenapine, astemizole, azimilide, bretylium, chloral hydrate, chloroquine, chlorpromazine,clarithromycin, desipramine, dibenzepin,disopyramide, dofetilide, dolasetron, doxepin, droperidol, encainide, enflurane, erythromycin, flecainide, fluconazole, fosarnet, gemifloxacin, ginkgo biloba, halofantrine, haloperidol, halothane, hydromorphone, hydroquinidine, ibutilide, imipramine, isoflurane, isradipine, lidoflazine, linezolid, lithium, loracainide, mefloquine, nortriptyline, octreotide, pentamidine, pirmenol, prajmaline, probucol, procainamide, prochlorperazine, propafenonce, protriptyline, quetiapine, sematilide, sertindole, simvastatin, sotalol, spiramycin, sulfamethoxazole, sultopride, tedisamil, telithromycin, tetrabenazine, tramadol, trifluoperazine, trimethoprim, trimipramine, vasopressin, zolmitriptan, zotepine Adverse Reactions:

Common: Peripheral edema; tachycardia; rash; hyperprolactinemia; weight gain; abdominal pain; constipation; diarrhea; excessive salivation; increased appetite; indigestion; nausea; vomiting; xerostomia; pain in extremities; akathisia; dizziness; extrapyramidal disease; headache; insomnia;


Parkinsonism; somnolence; tremor; abnormal vision; anxiety; fatigue; urinary incontinence; cough; rhinitis; upper respiratory infection; fever; generalized pain.

SERIOUS: Sudden cardiac death; syncope; diabetic ketoacidosis; hypothermia; pancreatitis; agranulocytosis; leucopenia; neutropenia; purpura; thrombocytopenia; thrombotic thrombocytopenia purpura; tadive dyskinesia; priapism; death; neuroleptic malignant syndrome.

Formulary Labels/Preparations: Apo-Risperidone 1mg, pkg 100, $7.90 ($0.0079/tablet), NAS/APO. Apo-Risperidone 2mg, pkg 100, $9.20 ($0.092/tablet), NAS/APO. Apo-Risperidone 3mg, pkg 100, $10.48 ($1.048/tablet), NAS/APO.


SICKLE CELL ANEMIA Hydroxyurea is the only medication available under the Drug Plan for the management of Sickle Cell Disease (SCD). Patients are also eligible to receive NSAIDs and COX-2 Inhibitors as indicated under arthritis as needed for pain management.

Hydroxyurea Class: Anti-metabolite, anti-neoplastic Indications: Sickle Cell Disease, Chronic Myeloid Leukemia, Squamous Cell Head and Neck Cancer in combination with radiation therapy, Malignant Melanoma, Metastatic Ovarian Cancer Dosage: All doses should be calculated based on ideal or actual body weight, whichever is less.

Adults: Sickle Cell Anemia: Initial 15mg/kg/day if blood counts are within an acceptable range. May increase by 5mg/kg every 12 weeks until the maximum dose of 35mg/kg/day is achieved or the dose that does not produce toxic effects.

Chronic myeloid leukemia, Resistant: Continuous


therapy, 20 to 30 mg/kg given as a single daily dose.

Head and neck cancer, Squamous cell, in combination with radiation therapy: concomitant therapy with irradiation, 80 mg/kg as a single dose every third day; begin at least 7 days prior to irradiation, and continue throughout radiation therapy and indefinitely thereafter.

Malignant melanoma: intermittent therapy, 80 mg/kg as a single dose every 3 days. Continuous therapy, 20 to 30 mg/kg as a single daily dose.

Ovarian carcinoma, Recurrent, metastatic, or inoperable: intermittent therapy, 80 mg/kg as a single dose every 3 days. Continuous therapy, 20-30 mg/kg as a single daily dose.

Children: Sickle Cell Anemia: 20mg/kg/day increase by 5mg/kg every 2-6 months to a maximum dose of 30mg/kg/day.

Dosage Adjustments: Recommended for CrCl < 60ml/min. Dosing in dialysis should be 7.5mg/kg following dialysis. Pregnancy Category: D Precautions: Hazardous agent. Use appropriate precautions for handling and disposal to decrease risk of exposure. Wear


gloves when and wash hands. Use with cautions in patients with a prior history of chemotherapy or radiation therapy. Correct severe anemia before initiating treatment. WARNING: Should be administered under the supervision of a physician experienced in the treatment of sickle cell disease or in cancer chemotherapy. CONTRAINDICATIONS: Hypersensitivity to hydroxyurea or any component of the formulation and in severe bone marrow suppression. Adverse Reactions:

COMMON: Anemia, constipation, dizziness, diarrhea and headaches.

SERIOUS: Chills, disorientation, skin cancer, secondary leukemia, hepatoxicity and myelosuppression.

Drug Interactions: didanosine, natalizumab, stavudine, live vaccines, tacrolimus, trastuzumab and pimecrolimus. Formulary Label/Preparations: Apo-Hydroxyurea 500mg capsules, Pkg 100, $9.24 ($0.0924/capsule), NAL/APO


THYROID DISEASES Thyroid disease as covered under the National Prescription Drug Plan consists of hyperthyroidism and hypothyroidism. Methimazole is the only medication available under the Drug Plan for the management of hyperthyroidism. Levothyroxine is available for the treatment of hypothyroidism.

ANTI-THYROID AGENTS

Methimazole Class: Anti-thyroid agent Indication: Hyperthyroidism Dosage: Adults:

Initial: 15mg/day in three divided doses for mild hyperthyroidism; 30-40mg/day in three divided doses for moderately severe hyperthyroidism, 60mg/day in three divided doses for severe hyperthyroidism.

Maintenance dose: 5-15mg/day, which may be given as a single daily dose.

Children: Initial: 0.4mg/kg/day in three divided doses.

Maintenance dose: 0.2mg/kg/day in three divided


doses. Pregnancy Category: D Precautions: Anti-thyroid agents have been associated with significant bone marrow suppression. Use with extreme caution in patients receiving other drugs known to cause severe myelosuppression. CONTRAINDICATIONS: Hypersensitivity to methimazole or any component of the formulation, breast feeding. Adverse Reactions:

Common: Constipation, epigastric distress, diarrhea, nausea, vomiting, drowsiness, fever, headaches and skin rash.

SERIOUS: Goiter, hypoglycemic coma, agranulocytosis, aplastic anemia, leucopenia, thrombocytopenia and hepatic necrosis.

Drug Interactions: Warfarin and sodium iodide. Formulary Label/Preparation: Methimazole 5mg, pkg 30, $5.64 (0.188/tab); CDM/SGP Methimazole 10mg, pkg 30, $11.80 (0.3933/tab);CDM/SGP


THYROID HORMONE (SYNTHETIC)

Levothyroxine Sodium Class: Thyroid hormone/agent Indication: Hypothyroidism Dosage: Adults:

Mild to Moderate hypothyroidism: 1.7mg/kg/day; < 200mcg/day. Titrate dose every 6 weeks.

Severe Hypothyroidism: 12.5mcg-25mcg/day, adjust doses by 25mcg every 2-4 weeks as appropriate

Neonates: Age 3-6months: 8mcg -10mcg/kg/day or 25mcg-50mcg/day

Age 6months-12months: 6mcg-8mcg/kg/day or 50mcg-75mcg/day

Children: Age 1year -5 years: 5mcg-6mcg/kg/day or 75mcg-100mcg/day

Age 6years -12 years: 4mcg-5mcg/kg/day or 100mcg-125mcg/day


Age > 12 years: 2mcg-3mcg/kg/day or > 150mcg/day

All doses should be adjusted based on clinical response and laboratory parameters. Pregnancy Category: A Precautions: Use with caution and reduce dosage in patients with angina pectoris or other CVD; decrease initial dose. Use cautiously in the elderly since they may be more likely to have compromised CV functions. WARNING: Thyroid hormones are ineffective and potentially toxic when used for the treatment of obesity or for weight reduction, especially in euthyroid patients. High doses may produce serious or even life-threatening toxic effects particularly when used with some anorectic drugs (e.g. sympathomimetic amines) CONTRAINDICATIONS: Hypersensitivity to levothyroxine sodium or any component of the formulation, acute MI, thyrotoxicosis of any etiology and uncorrected adrenal insufficiency. Adverse Reactions:

Common: Menstrual cycle irregularities, vomiting, diarrhea, abdominal cramps, weight loss, and headaches.

SERIOUS: Arrhythmias, cardiac arrest, heart


failure and MI. Drug Interactions: Warfarin, theophylline, carbamazepine, estrogen derivatives, iron salts, calcium salts, phenytoin, orlistat, raloxifene, rifampin, sucralfate and sevelamer. Formulary Label/Preparations: Synthroid 0.05mg, pkg 90, $45.93($0.51303/tablet), NAL/ABB Synthroid 0.075mg, pkg 90, $50.61($0.5623/tablet), NAL/ABB Synthroid 0.1mg, pkg, 90, $59.48 ($0.6609/tablet), NAL/ABB


ICD-9 Diagnosis Codes For NPDP Diseases


Diagnosis Codes for Arthritis

Code Description

714.0 Rheumatoid arthritis (excludes juvenile arthritis)

Requires *5th digit sub-classification as noted in brackets: (e.g. 715.01) 0 - site unspecified 1 - shoulder region 2 - upper arm 3 - forearm 4 - hand 5 - pelvic region and thigh 6 - lower leg 7 - ankle and foot 8 - other specified sites 9 - multiple sites

714.1 Felty’s syndrome (rheumatoid arthritis w/ splenoadenomegaly & leukopenia)

714.2 Other rheumatoid arthritis with visceral of systemic involvement (rheumatoid carditis)

714.3 Juvenile chronic polyarthritis

714.30 Polyarticular juvenile rheumatoid arthritis, chronic or unspecified (Still’s disease)

714.31 Polyarticular juvenile rheumatoid arthritis, acute

714.32 Pauciarticular juvenile rheumatoid arthritis

714.33 Monoarticular juvenile rheumatoid arthritis

714.4 Chronic post-rheumatic arthropathy

714.8 Other specified inflammatory polyarthopathies

714.81 Rheumatoid lung (Caplan’s syndrome)

715 Osteoarthrosis and allied disorders

*715.0 (0,4,9)

Osteoarthrosis, generalized (Degenerative joint disease, involving multiple joints)

*715.1 (0-8)

Osteoarthrosis, localized, primary (Localized osteoarthropathy, idiopathic)


Code Description *715.2 (0-8)

Osteoarthrosis, localized, secondary (Coxae malum senilis)

*715.3 (0-8)

Osteoarthrosis, localized, not specified whether primary or secondary

*715.8 (0,9)

Osteoarthosis involving, or with mention of more than one site, but not specified as generalized

*715.9 (0-8)

Osteoarthosis, unspecified whether generalized or localized

*716.2 (0-9) Allergic arthritis

*716.3 (0-9)

Climacteric arthritis (Menopausal arthritis)

*716.5 (0-9)

Unspecified polyarthropathy or polyarthritis

*716.6 (0-8) Unspecified monoarthritis

*716.8 (0-9) Other specified arthropathy

*716.9 (0-9)

Arthropathy, unspecified (acute, chronic,subacute)

274 Gout

274.0 Gouty arthropathy

274.00 Gouty arthropathy, unspecified

274.01 Acute gouty arthropathy

274.1 Gouty nephropathy

274.10 Gout nephropathy, unspecified

274.11 Uric acid nephrolithiasis

274.9 Gout, unspecified


Diagnosis Codes for Asthma

Code Description

493 Asthma (excludes wheezing) Requires *5th digit subclassification as noted in brackets: (e.g. 493.00) 0 - unspecified 1 - with status asthmaticus 2 - with (acute) exacerbation

*493.0 (0-2) Extrinsic asthma

*493.1 (0-2) Intrinsic asthma

*493.2 (0-2) Chronic obstructive asthma

493.8 Other forms of asthma

493.81 Exercise induced bronchospasm

493.82 Cough variant asthma

*493.9 (0-2) Asthma, unspecified


Diagnosis Codes for Benign Prostate Hypertrophy (BPH)

Code Description

600 Hypertrophy (benign) of prostate

600.00 Hypertrophy (benign) of prostate without urinary obstruction and other lower tract symptoms (LUTS)

600.01 Hypertrophy (benign) of prostate with urinary obstruction and other lower tract symptoms (LUTS)

600.1 Nodular prostate

600.10 Nodular prostate without urinary obstruction

600.11 Nodular prostate with urinary obstruction

600.2 Benign localized hyperplasia of prostate

600.20 Benign localized hyperplasia of prostate without urinary obstruction and other lower urinary tract symptoms (LUTS)

600.21 Benign localized hyperplasia of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS)

600.3 Cyst of prostate

600.9 Hyperplasia of prostate, unspecified

600.90 Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary tract symptoms

600.91 Hyperplasia of prostate, unspecified, with urinary obstruction and other lower urinary tract symptoms


Diagnosis Codes for Cancer - (Breast & Prostate)

Breast Cancer:

Code Description

174 Malignant neoplasm of female breast (excludes skin of breast)

174.0 • Nipple and areola

174.1 • Central portion

174.2 • Upper-inner quadrant

174.3 • Lower-inner quadrant

174.4 • Upper-outer quadrant

174.5 • Lower-outer quadrant

174.6 • Axillary tail

174.8 Other specified sites of female breast

174.9 Breast (female), unspecified

175 Malignant neoplasm of male breast (excludes skin of breast)

175.0 • Nipple and areola

175.9 • Other specified sites of male breast

233 Carcinoma in situ of breast and genitourinary system

233.0 Carcinoma in situ of breast

239.3 Neoplasm of breast

198.8 Other specified sites (secondary malignant)


198.81 • Breast

Prostate Cancer:

Code Description

185 Malignant neoplasm of prostate

198.82 Secondary malignant neoplasm of genital organ (includes prostate)

222.2 Benign neoplasm of prostate

233 Carcinoma in situ of breast and genitourinary system (Breast)

233.4 Carcinoma in situ of prostate

236.5 Neoplasm of uncertain behavior of genitourinary organs (Prostate)


Diagnosis Codes for Diabetes

Code Description

*249 Secondary diabetes mellitus

Requires *4th or *5th digit subclassification as noted in brackets: (e.g. 250.1 or 250.01) 1 - type 1 (juvenile type), not stated as uncontrolled 2 - type 2 or unspecified type, uncontrolled 3 - type 1 (juvenile type), uncontrolled

*249.0 (0-1)

Secondary diabetes mellitus without mention of complication

*249.1 (0-1)

Secondary diabetes mellitus with ketoacidosis

*249.2 (0-1)

Secondary diabetes mellitus with hyperosmolarity

*249.3 (0-1)

Secondary diabetes mellitus with other coma (excludes hyperosmolar coma)

*249.4 (0-1)

Secondary diabetes mellitus with renal manifestations

*249.5 (0-1)

Secondary diabetes mellitus with opthalmic manifestations

*249.6 (0-1)

Secondary diabetes mellitus with neurological manifestations

*249.7 (0-1)

Secondary diabetes mellitus with peripheral circulatory disorders

*249.8 (0-1)

Secondary diabetes mellitus with other specified manifestations

*249.9 (0-1)

Secondary diabetes mellitus with unspecified complication

*250 Diabetes mellitus

*250.0 Diabetes mellitus without mention of complication

*250.1 Diabetes with ketoacidosis


Code Description (0-3)

*250.2 (0-3) Diabetes with hyperosmolarity

*250.3 (0-3)

Diabetes with other coma (excludes diabetes with hyperosmolarity coma)

*250.4 (0-3) Diabetes with renal manifestations

*250.5 (0-3)

Diabetes with ophthalmic manifestations

*250.6 (0-3)

Diabetes with neurological manifestations

*250.7 (0-3)

Diabetes with peripheral circulatory disorders

*250.8 (0-3)

Diabetes with other specified manifestations

*250.9 (0-3)

Diabetes with unspecified complication

251 Other disorders of pancreatic internal secretion

251.0 Hypoglycemic coma

251.1 Other specified hypoglycemia: Hyperinsulinism; Hyperplasia of pancreatic islet beta cells NOS

251.2 Hypoglycemia, unspecified

251.3 Postsurgical hypoinsulinemia

251.4 Abnormality of secretion of glucagon

251.5 Abnormality of secretion of gastrin

251.8 Other specified disorders of pancreatic internal secretion


Code Description

251.9 Unspecified disorder of pancreatic internal secretion

253.5 Diabetes insipidus

271.4 Renal glycosuria (renal diabetes)


Diagnosis Codes for Epilepsy

Code Description

345 Epilepsy and recurrent seizures Requires * 4th or *5th digit subclassification as noted in brackets: (e.g. 345.1, 345.11) 0 – without mention of intractable epilepsy 1 - with intractable epilepsy

*345.0 (0,1)

Generalized non-convulsive epilepsy

*345.1 (0,1) Generalized convulsive epilepsy

*345.2 (0,1) Petit mal status

*345.3 (0,1) Grand mal status

*345.4 (0,1)

Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures

*345.5 (0,1)

Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures

*345.6 (0,1) Infantile spasms

*345.7 (0,1) Epilepsia partialis continua

*345.8 (0,1)

Other forms of epilepsy and recurrent seizures

*345.9 (0,1) Epilepsy, unspecified

780.3 Convulsions


Code Description

780.31 Febrile convulsions (simple), unspecified

780.32 Complex febrile convulsions

780.33 Post traumatic seizures

780.39

Other convulsions (Fits NOS, Recurrent convulsions NOS, Seizures NOS, Convulsive disorder NOS)


Diagnosis Codes for Glaucoma

Code Description

365 Glaucoma (excludes absolute glaucoma)

365.0 Borderline glaucoma (glaucoma suspect)

365.00 Pre-glaucoma, unspecified

365.01 Open angle with borderline findings

365.02 Anatomical narrow angle

365.03 Steroid responders

365.04 Ocular hypertension

365.1 Open angle glaucoma

365.10 Open angle glaucoma, unspecified

365.11 Primary open angle glaucoma

365.12 Low tension glaucoma

365.13 Pigmentary glaucoma

365.14 Glaucoma of childhood

365.15 Residual stage of open angle glaucoma

365.2 Primary angle-closure glaucoma

365.20 Primary angle-closure glaucoma, unspecified

365.21 Intermittent angle-closure glaucoma

365.22 Acute angle-closure glaucoma

365.23 Chronic angle-closure glaucoma


Code Description

365.24 Residual stage of angle-closure glaucoma

365.3 Corticosteroid-induced glaucoma

365.31 • Glaucomatous stage

365.32 • Residual stage

365.4 Glaucoma associated with congenital anomalies, dystrophies, and systemic syndromes

365.41 Glaucoma associated with chamber angle anomalies

365.42 Glaucoma associated with anomalies of iris

365.43 Glaucoma associated with other anterior segment anomalies

(250.00) Glaucoma associated with systemic syndromes (diabetes) 365.44

365.5 Glaucoma associated with disorders of the lens

365.51 Phacolytic glaucoma

365.52 Pseudo-exfoliation glaucoma

365.59 Glaucoma associated with other lens disorders

365.6 Glaucoma associated with other ocular disorders

365.60 Glaucoma associated with unspecified ocular disorders

365.61 Glaucoma associated with pupillary block

365.62 Glaucoma associated with ocular inflammation

365.63 Glaucoma associated vascular disorders

365.64 Glaucoma associated with tumors or cysts


Code Description

365.65 Glaucoma associated with ocular trauma

365.7 Glaucoma stage

365.70 Glaucoma stage, unspecified

365.71 Mild stage glaucoma

365.72 Moderate stage glaucoma

365.73 Severe stage glaucoma

365.74 Indeterminate stage glaucoma

365.8 Other specified forms of glaucoma

365.81 Hypersecretion of glaucoma

365.82 Glaucoma with increased episcleral venous pressure

365.83 Aqueous misdirection (malignant glaucoma)

365.89 Other specified glaucoma

365.9 Unspecified glaucoma


Diagnosis Codes for Hypercholesterolemia

Code Description

272 Disorders of lipid metabolism

272.0 Pure hypercholesterolemia

272.1 Pure hyperglyeridemia

272.2 Mixed hyperlipidemia

272.3 Hyperchylomicronemia

272.4 Other and unspecified hyperlipidemia

272.5 Lipoprotein deficiencies

272.6 Lipodystrophy

272.7 Lipidoses

272.8 Other disorders of lipoid metabolism

272.9 Unspecified disorder of lipoid metabolism


Diagnosis Codes for Hypertension

Code Description

401 Essential hypertension Requires *4th or *5th digit sub-classification as noted in brackets: (e.g. 404.2, 404.91) 0 - without heart failure and with chronic kidney disease stage 1 thru 4 or specified 1 - with heart failure and with chronic kidney disease stage 1 thru 4 or specified

401.0 • Malignant (Severe high

arterial BP possibly resulting in necrosis)

401.1 • Benign (Mildly elevated arterial blood pressure)

402 Hypertensive heart disease

402.0 • Malignant

402.00 >> without heart failure

402.01 >> with heart failure

402.1 • Benign



402.9 Unspecified hypertension (Cardiomegaly, cardiopathy, CV disease, heart disease failure)



*403 Hypertensive chronic kidney disease

*403.0 (0,1) Malignant chronic kidney disease


Code Description *403.1 (0,1) Benign chronic kidney disease

*403.9 (0,1)

Unspecified chronic kidney disease

*404 (0-3)

Hypertensive heart and chronic kidney disease

*404.0 (0-3) • Malignant

*404.1 (0-3) • Benign

*404.9 (0-3) • Unspecified

405 Secondary hypertension (High arterial BP due to primary diseases eg. Renal disorders)

405.0 Malignant secondary hypertension

405.01 • Renovascular

405.09 • Other

405.1 Benign secondary hypertension


405.19 • Other

405.9 Unspecified secondary hypertension


405.99 • Other


Diagnosis Codes for Ischaemic Disease

Code Description

*410 Acute myocardial infarction *Requires 5th digit classification as noted in brackets: (e.g. 410.02, 410.61)* 0 – episode of care unspecified 1 – initial episode of care 2 – subsequent episode of care

*410.0 • Of anterolateral wall

*410.1 • Of other anterior wall

*410.2 • Of inferolateral wall

*410.3 • Of inferoposterior wall

*410.4 • Of other inferior wall (diagphragmatic wall NOS)

*410.5 • Of other lateral wall (apical-

lateral; basal lateral; high lateral; posterolateral)

*410.6 True posterior wall infarction

*410.7 Subendocardial infarction

*410.8 Of other specified sites (atrium, papillary muscle, septum alone)

*410.9 Unspecified site (acute myocardial infarction NOS, coronary occlusion NOS, myocardial infarction NOS)

411 Other acute and subacute forms of ischemic heart disease

411.0 Postmyocardial infarction syndrome

411.1

Intermediate coronary syndrome (impending infarction, pre-infarction angina, pre-infarction syndrome, unstable angina)


Code Description

411.81 Acute coronary occlusion without myocardial infarction

411.89 Other (coronary insufficiency (acute)); subendocardial ischaemia

412 Old myocardial infarction

413 Angina pectoris

413.0 Angina decubitus (nocturnal angina)

413.1 Prinzmetal angina (variant angina pectoris)

413.9

Other and unspecified angina pectoris (angina syndrome, status anginosus, stenocardia, syncope anginosa)

414 Other forms of chronic ischemic heart disease

414.0 Coronary atherosclerosis

414.00 Of unspecified type of vessel, native or graft

414.01 Of native coronary artery

414.02 Of autologous vein bypass graft

414.03 Of nonautologous biological bypass graft

414.04 Of artery bypass graft

414.05 Of unspecified type of bypass graft

414.06 Of native coronary artery of transplanted heart

414.07 Of bypass graft (artery) (vein) of transplanted heart


Code Description

414.1 Aneurysm and dissection of heart

414.10 Aneurysm of heart (wall)

414.11 Aneurysm of coronary vessels

414.12 Dissection of coronary artery

414.19 Other aneurysm of heart

414.2 Chronic total occlusion of coronary artery

414.3 Coronary atherosclerosis due to lipid rich plaque

414.8 Other specified forms of chronic ischemic heart disease

414.9 Chronic ischemic heart disease, unspecified

415 Acute pulmonary heart disease

415.0 Acute cor pulmonale

415.1 Pulmonary embolism and infarction

415.11 Iatrogenic pulmonary embolism and infarction

415.12 Septic pulmonary embolism

415.13 Saddle embolus of pulmonary artery

416 Chronic pulmonary heart disease

416.0 Primary pulmonary hypertension

416.1 Kyphoscoliotic heart disease

416.2 Chronic pulmonary embolism


Code Description

416.8 Other chronic pulmonary heart disease

416.9 Chronic pulmonary heart disease, unspecified

417 Other diseases of pulmonary circulation

417.0 Arteriovenous fistula of pulmonary vessels

417.1 Aneurysm of pulmonary artery

417.8 Other specified diseases of pulmonary circulation

417.9 Unspecified disease of pulmonary circulation

427 Cardiac disrhythmias

427.0 Paroxysmal supraventricular tachycardia

427.1 Paroxysmal ventricular tachycardia

427.2 Paroxysmal tachycardia, unspecified

427.3 Atrial fibrillation and flutter

427.31 Atrial fibrillation

427.32 Atrial flutter

427.4 Ventricular fibrillation and flutter

427.41 Ventricular fibrillation

427.42 Ventricular flutter

427.5 Cardiac arrest

427.6 Premature beats


Code Description

427.60 Premature beats, unspecified

427.61 Supraventricula premature beats

427.69 Other (Ventricular premature beats, contractions or systoles)

427.8 Other specified cardiac dysrhythmias

427.81 Sinoatrial node dysfunction

427.89 Other (Rhythm disorder: coronary sinus, ectopic or nodal; wandering (atrial) pacemaker)

427.9 Cardiac dysrhythmia, unspecified

428 Heart failure

428.0 Congestive heart failure, unspecified

428.1 Left heart failure

428.2 Systolic heart failure

428.20 • Unspecified

428.21 • Acute

428.22 • Chronic

428.23 • Acute on chronic

428.3 Diastolic heart failure


428.31 • Acute

428.32 • Chronic


Code Description


428.4 Combined systolic and diastolic heart failure


428.41 • Acute

428.42 • Chronic


428.9 Heart failure, unspecified

429 Ill-defined descriptions and complications of heart disease

429.0 Myocarditis, unspecified

429.1 Myocardial degeneration

429.2 Cardiovascular disease, unspecified

429.3 Cardiomegaly

429.4 Functional disturbances following cardiac surgery

429.5 Rupture of chordae tendineae

429.6 Rupture of papillary muscle

429.7 Certain sequelae of myocardial infarction, not elsewhere classified

429.71 Acquired cardiac septal defect

429.79 Other (Mural thrombus (atrial) (ventricular) acquired following myocardial infarction)


Code Description

429.8 Other ill-defined heart diseases

429.81 Other disorders of papillary muscle

429.82 Hyperkinetic heart disease

429.83 Takotsubo syndrome

429.89 Other (Carditis)

429.9 Heart disease, unspecified

*433 Occlusion and stenosis precerebral arteries

*Requires 4th or 5th digit classification as noted in brackets: (eg. 433.31, 433.00, etc.) 0 – without mention of cerebral infarction 1 – with cerebral infarction

*433.0 Basilar artery

*433.1 Carotid artery

*433.2 Vertebral artery

*433.3 Multiple and bilateral

*433.8 Other specified precerebral artery

*433.9 Unspecified precerebral artery

*434 Occlusion of cerebral arteries

*434.0 Cerebral thrombosis

*434.1 Cerebral embolism

*434.9 Cerebral artery occlusion, unspecified

435 Transient cerebral ischemia

435.0 Basilar artery syndrome


Code Description

435.1 Vertebral artery syndrome

435.2 Subclavian steal syndrome

435.3 Vertebrobasilar artery syndrome

435.8 Other specified transient cerebral ischemias

435.9 Unspecified transient cerebral ischemia

437 Cerebral atherosclerosis

437.1 Other generalized ischemic cerebrovascular disease

440 Atherosclerosis

440.0 • Of aorta

440.1 • Of renal artery

440.2 • Of native arteries of the extremities

440.20 Atherosclerosis of the extremities, unspecified

440.21 Atherosclerosis of the

extremities with intermittent claudication

440.22 Atherosclerosis of the extremities with rest pain

440.23 Atherosclerosis of the extremities with ulceration

440.24 Atherosclerosis of the extremities with gangrene

440.29 Other


Code Description

440.3 Of bypass graft of the extremities

440.30 • Of unspecified graft

440.31 • Of autologous vein bypass graft

440.32 • Of nonautologous vein bypass graft

440.4 Chronis total occlusion of artery of the extremities

440.8 Of other specified arteries

440.9 Generalized and unspecified atherosclerosis

443 Other peripheral vascular disease

443.0 Raynaud’s syndrome

443.9 Peripheral vascular disease, unspecified

444 Arterial embolism and thrombosis

444.0 • Of abdominal aorta

440.09 Other arterial embolism

and thrombosis of abdominal aorta

444.1 • Of thoracic aorta

444.2 • Of arteries of the extremities

444.21 Upper extremity

444.22 Lower extremity

444.8 • Of other specified artery

444.81 Iliac artery


Code Description

444.89 Other

445 Atheroembolism

445.0 • Of extremities

445.01 Upper extremity

445.02 Lower extremity

445.8 • Of other sites

445.81 Kidney

445.89 Other site

785.51 Cardiogenic shock

786.5 Chest pain, unspecified

786.52 Precordial pain

786.59 Other chest pain (exhibiting discomfort, pressure and tightness)


Diagnosis Codes for Psychiatric Illness

Code Description

290 Dementias 290.0 Senile dementia, uncomplicated 290.1 Presenile dementia 290.10 Presenile dementia, unspecified 290.11 Presenile dementia with delirium

290.12 Presenile dementia with delusional features

290.13 Presenile dementia with delusional or depressive features

290.2 Senile dementia with delusional or depressive features

290.20 Senile dementia with delusional features

290.21 Senile dementia with depressive features

290.3 Senile dementia with delirium 290.4 Vascular dementia 290.40 Vascular dementia, uncomplicated 290.41 Vascular dementia, with delirium 290.42 Vascular dementia, with delusions

290.43 Vascular dementia, with depressed mood

290.8 Other specified senile psychotic condition


Code Description

290.9 Unspecified senile psychotic condition

293 Transient mental disorders due to condition classified elsewhere

293.0 Delirium due to conditions classified elsewhere

293.1 Subacute delirium

293.8 Other specified transient mental disorders due to conditions classified elsewhere

293.81 Psychotic disorder with delusions in conditions classified elsewhere

293.82 Psychotic disorder with hallucinations in conditions classified elsewhere

293.83 Mood disorder in conditions classified elsewhere

293.84 Anxiety disorder in conditions classified elsewhere

293.89 • Other

293.9 Unspecified transient mental disorder in conditions classified elsewhere

294 Persistent mental disorders due to conditions classified elsewhere

294.2 Dementia, unspecified

294.20 Dementia, unspecified, without behavioral disturbance

294.21 Dementia, unspecified, with behavioral disturbance

294.8

Other persistent mental disorders due to conditions classified elsewhere (Amnestic disorder NOS, Dementia NOS, Epileptic psychosis NOS, Mixed


Code Description paranoid and affective organic psychotic states)

294.9

Unspecified persistent mental disorder mental disorders due to conditions classified elsewhere (Cognitive disorder NOS)

*295 (0-5) Schizophrenia disorders

*Requires 4th or 5th digit classification as noted in brackets: (295.04, 295.65, etc.) 0 – unspecified 1 – subchronic 2 – chronic 3 – chronic with acute exacerbation 4 – chronic with acute exacerbation 5 – in remission

*295.0 (0-5) • Simple type

*295.1 (0-5) • Disorganized type

295.2 (0-5) • Catatonic type

*295.3 (0-5) • Paranoid type

*295.5 (0-5) • Latent schizophrenia

*295.6 (0-5) • Residual type

*295.7 (0-5) • Schizoaffective disorder

*295.8 (0-5)

• Other specified types of schizophrenia (acute, atypical or cenesthopathic schizophrenia)


Code Description

*296 Episodic mood disorders *Requires 4th or 5th digit classification as noted in brackets: (296.36, 296.61) 0 – unspecified 1 – mild 2 – moderate 3 – severe, without mention of psychotic behavior 4 – severe, specified as with psychotic behavior 5 – in partial or unspecified remission 6 – in full remission

*296.0 (0-6)

Bipolar 1 disorder, single manic episode

*296.1 (0-6) Manic disorder, recurrent episode

*296.2 (0-6)

Major depressive disorder, single episode

*296.3 (0-6)

Major depressive disorder, recurrent episode

*296.4 (0-6)

Bipolar 1 disorder, most recent episode (or current) manic

*296.5 (0-6)

Bipolar 1 disorder, most recent episode (or current) depressed

*296.6 (0-6)

Bipolar 1 disorder, most recent episode (or current) mixed

296.7 Bipolar 1 disorder, most recent episode (or current) unspecified

296.8 Other and unspecified bipolar disorders

296.80 • Bipolar disorder, unspecified

296.81 • Atypical manic disorder


Code Description

296.82 • Atypical depressive order

296.89 • Other

296.9 Other and unspecified episodic mood disorder

296.90 • Unspecified episodic mood disorder

296.99 • Other specified mood disorder

297 Delusional disorders

297.0 Paranoid state, simple

297.1 Delusional disorder

297.2 Paraphrenia

297.3 Shared psychotic disorder

297.8 Other specified paranoid states

297.9 Unspecified paranoid state

298 Other nonorganic psychoses (emotional stress or environmental factors as major part of etiology)

298.0 Depressive type psychosis

298.1 Excitative type psychosis

298.2 Reactive confusion

298.3 Acute paranoid reaction

298.4 Psychogenic paranoid psychosis

298.8 Other and unspecified reactive psychosis


Code Description

298.9 Unspecified psychosis

*299.0 (0,1) Autistic disorder

*Requires 5th digit classification as noted in brackets: (e.g. 299.01, etc) 0 – current or active state 1 – residual state

*299.8 (0,1)

Other specified pervasive developmental disorders

*299.9 (0,1)

Unspecified pervasive developmental disorder

300 Anxiety, dissociative and somatoform disorders

300.0 • Anxiety states

300.00 Anxiety state, unspecified

300.01 Panic disorder without agoraphobia

300.02 Generalized anxiety disorder

300.09 Other

300.1 Dissociative, conversion and factitious disorders

300.10 Hysteria, unspecified

300.11 Conversion disorder

300.12 Dissociative amnesia

300.13 Dissociative fugue

300.14 Dissociative identity disorder

300.15 Dissociative disorder with predominantly psychological signs and symptoms


Code Description

300.16 Factitious disorder with predominantly psychological signs and symptoms

300.19 Other and unspecified factitious illness

300.2 Phobic disorders

300.2 Phobia, unspecified

300.21 Agoraphobia with panic disorder

300.22 Agoraphobia without mention of panic attacks

300.23 Social phobia

300.29 Other isolated or specified phobias

300.3 Obsessive-compulsive disorders

300.4 Dysthymic disorder

300.5 Neurasthenia

300.6 Depersonalization disorder

300.7 Hypochondriasis

300.8 Somatoform disorders

300.81 • Somatization disorder

300.82 • Undifferentiated somatoform disorders

300.89 • Other somatoform disorders

300.9 Unspecified nonpsychotic mental disorder

301 Paranoid personality disorders


Code Description

301.1 Affective personality disorder


301.11 Chronic hypomanic personality disorder

301.12 Chronic depressive personality disorder

301.13 Cyclothymic disorder

301.2 Schizoid personality disorder


301.21 Introvert personality

301.22 Schizotypal personality disorder

301.3 Explosive personality disorder

301.5 Histrionic personality disorder


301.51 Chronic factitious illness with physical symptoms

301.59 Other histrionic personality disorder

301.6 Dependent personality disorder

301.7 Antisocial personality disorder

301.8 Other personality disorders

301.81 Narcissistic personality disorder

301.82 Avoidant personality disorder


Code Description

301.83 Borderline personality disorder 301.84 Passive-aggressive personality

301.89 • Other

301.9 Unspecified personality disorder

*303 Alcohol dependence syndrome *Requires 4th or 5th digit classification as noted in brackets: (e.g. 303.2, 303.01) 0 – unspecified 1 – continuous 2 – episodic 3 – in remission

*303.0 (0-3) Acute alcoholic intoxication

*303.9 (0-3)

Other and specified alcohol dependence

*304 Drug dependence *304.0 (0-3) Opoid type dependence

*304.1 (0-3)

Sedative, hypnotic or anxiolytic dependence

*304.2 (0-3) Cocaine dependence

*304.3 (0-3) Cannabis dependence

*304.4 (0-3)

Amphetamine and other psychostimulant dependence

*304.5 (0-3) Hallucinogen dependence

*304.6 (0-3) Other specified drug dependence

*304.7 (0-3)

Combination of opoid type drug with any other


Code Description *304.8 (0-3)

Combinations of drug dependence excluding opoid type drug

*304.9 (0-3) Unspecified drug dependence

*305 (0-3) Nondependent abuse of drugs

*305.0 (0-3) Alcohol abuse

305.1 Tobacco use disorder *305.2 (0-3) Cannabis abuse

*305.3 (0-3) Hallucinogen abuse

*305.4 (0-3) Sedative, hypnotic or anxiolytic abuse

*305.6 (0-3) Cocaine abuse

*305.7 (0-3)

Amphetamine or related acting sympathomimetic abuse

*305.8 (0-3) Antidepressant type abuse

*305.9 (0-3)

Other, mixed, or unspecified drug abuse

*306 (0-3)

Physiological malfunction arising from mental factors

306.0 • Musculoskeletal (psychogenic paralysis; psychogenic torticollis)

306.1 • Respiratory (air hunger;

hiccough, cough, hyperventilation, etc.)

306.2 • Cardiovascular (cardiac neurosis;

neurocirculatory asthenia; psychogenic cardiovascular


Code Description disorder)

306.3 • Skin (psychogenic pruritus)

306.4 • Gastrointestinal (aerophagy;

cyclical vomiting; nervous gastritis, etc.)

306.5 • Genitourinary

306.50 Psychogenic genitourinary malfunction, unspecified

306.51 Psychogenic vaginismus

306.52 Psychogenic dysmenorrhea 306.53 Psychogenic dysuria 306.6 • Endocrine

306.7 • Organs of special sense

306.8 • Other specified psychophysiological malfunction

306.9 • Unspecified psychophysiological malfunction

307.5 Other and unspecified disorders of eating

307.50 Eating disorder, unspecified

307.51 Bulimia nervosa

307.52 Pica

307.53 Rumination disorder

307.54 Psychogenic vomiting

307.59 Other


Code Description

307.6 Enuresis

307.7 Encopresis

307.9 Other and unspecified symptoms or syndromes not elsewhere classified

308 Acute reaction to stress

308.0 Predominant disturbance of emotions

308.1 Predominant disturbance of consciousness

308.2 Predominant psychomotor disturbance

308.3 Other acute reactions to stress 308.4 Mixed disorders as reactions to stress 308.9 Unspecified acute reaction to stress

309 Adjustment reaction

309.0 Adjustment disorder with depressed mood

309.1 Prolonged depressive reaction

309.2 With predominant disturbance of other emotions

309.21 Separation anxiety disorder

309.22 Emancipation disorder of adolescence and early adult life

309.23 Specific academic or work inhibition

309.24 Adjustment disorder with anxiety

309.28 Adjustment disorder with mixed anxiety and depressed mood


Code Description

309.29 • Other

309.3 Adjustment disorder with disturbance of conduct

309.4 Adjustment disorder with mixed disturbance of emotions

309.8 Other specified adjustment reactions

309.81 Post-traumatic stress disorder

309.82 Adjustment reaction with physical symptoms

309.83 Adjustment reaction with withdrawal

309.9 Unspecified adjustment reaction

310 Specific non-psychotic mental disorders due to brain damage

310.0 Frontal lobe syndrome

310.1 Personality change due to conditions classified elsewhere

310.2 Post-concussion syndrome

310.8 Other specific non-psychotic mental disorders following organic brain damage

310.81 • Pseudobulbar affect

310.89 • Other specified non-psychotic mental disorders

310.9 Unspecified non-psychotic mental disorder following organic brain damage

311 Depressive disorder, not elsewhere classified


Code Description

*312 Disturbance of conduct, not elsewhere classified

*Requires 4th or 5th digit classification as noted in brackets: (e.g. 312.23, 312.01, etc) 0 – unspecified 1 – mild 2 – moderate 3 - severe

*312.0 (0-3)

Under-socialized conduct disorder, aggressive type

*312.1 (0-3)

Under-socialized conduct disorder, unaggressive type

*312.2 (0-3) Socialized conduct disorder

312.3 Disorders of impulse control, not elsewhere classified

312.30 Impulse control disorder, unspecified

312.31 Pathological gambling

312.32 Kleptomania

312.33 Pyromania

312.34 Intermittent explosive disorder

312.35 Isolated explosive disorder

312.39 • Other

312.4 Mixed disturbance of conduct and emotions

312.8 Other specified disturbances of conduct, not elsewhere classified

312.81 Conduct disorder, childhood onset type

312.82 Conduct disorder, adolescent onset type

312.89 Other conduct disorder


Code Description

312.9 Unspecified disturbance of conduct 314 Hyperkinetic syndrome childhood

314.0 Attention deficit disorder 314.00 • Without mention of hyperactivity 314.01 • With hyperactivity 314.1 Hyperkinesis with development delay 314.2 Hyperkinetic conduct disorder

314.8 Other specified manifestations of hyperkinetic syndrome

314.9 Unspecified hyperkinetic syndrome


Diagnosis Codes for Sickle Cell Anemia

Code Description

282.6 Sickle-cell disease

282.6 Sickle-cell disease, unspecified

282.61 Hb-SS disease without crisis

282.62 Hb-SS disease with crisis

282.63 Sickle-cell/Hb-C disease without crisis

282.64 Sickle-cell/Hb-C disease with crisis

282.68 Other sickle-cell disease without crisis

282.69 Other sickle-cell disease with crisis


Diagnosis Codes for Thyroid Disease

Code Description

240 Simple and unspecified goiter

240.0 Goiter, specified as simple

240.9 Goiter, unspecified

241 Nontoxic nodular goiter

241.0 Nontoxic uninodular goiter

241.1 Nontoxic multinodular goiter

241.9 Unspecified nontoxic with or without goiter

*242 Thyrotoxicosis with or without goiter

242.0 (0,1) Toxic diffuse goiter *242.1 (0,1) Toxic uninodular goiter

*242.2 (0,1) Toxic multinodular goiter

*242.3 (0,1) Toxic nodular goiter, unspecified

*242.4 (0,1) Thyrotoxicosis from ectopic thyroid nodule

*242.8 (0,1) Thyrotoxicosis of other specified origin

*242.9 (0,1) Thyrotoxicosis without mention of goiter or other cause

243 Congenital hypothyroidism

244 Acquired hypothyroidism

244.0 Postsurgical hypothyroidism


Code Description

244.1 Other postablative hypothyroidism

244.2 Iodine hypothyroidism

244.3 Other iatrogenic hypothyroidism

244.8 Other specified acquired hypothyroidism

244.9 Unspecified hypothyroidism

245 Thyroiditis

245.0 Acute thyroiditis

245.1 Subacute thyroiditis

245.2 Chronic lymphocytic thyroiditis

245.3 Chronic fibrous thyroiditis

245.4 Latrogenic thyroiditis

245.8 Other and unspecified chronic thyroiditis

245.9 Thyroiditis, unspecified

246 Other disorders of thyroid

246.0 Disorders of thyrocalcitonin secretion

246.1 Dyshormonogenic goiter

246.2 Cyst of thyroid

246.3 Hemorrhage and infarction of thyroid

246.8 Other specified disorders of thyroid


NATIONAL PRESCRIPTION DRUG PLAN FORMULARY

INDEX Acetaminophen ............................................................................ 18 Acetazolamide ........................................................................... 108 Alcohol Prep Pads ....................................................................... 91 Allopurinol .................................................................................... 40 Amitriptyline ............................................................................... 178 Amlodipine ................................................................................. 130 Anastrazole (SAM) ...................................................................... 64 Aspirin EC ................................................................................... 156 Atenolol ...................................................................................... 134 Atorvastatin ................................................................................ 119 Benzhexol HCl ........................................................................... 184 Benztropine *SAM* ................................................................... 185 Betaxolol .................................................................................... 105 Bicalutamide *SAM* .................................................................... 170 Brimonidine Tartrate ................................................................... 104 Brinzolamide/Timolol................................................................... 113 Budesonide/Formoterol ............................................................... 52 Captopril..................................................................................... 140 Carbamazepine ........................................................................... 94 Carvedilol .................................................................................. 138 Chlorpromazine *SAM* .............................................................. 187 Clopidogrel *SAM* ..................................................................... 157 Colchicine .................................................................................... 41 Diagnosis Codes for Arthritis ..................................................... 210 Diagnosis Codes for Asthma ..................................................... 212 Diagnosis Codes for Benign Prostate Hypertrophy .................... 213 Diagnosis Codes for Cancer - (Breast & Prostate) ..................... 214 Diagnosis Codes for Diabetes ................................................... 216


Diagnosis Codes for Epilepsy .................................................... 219 Diagnosis Codes for Glaucoma ................................................. 221 Diagnosis Codes for Hypercholesterolemia ............................... 224 Diagnosis Codes for Hypertension ............................................ 225 Diagnosis Codes for Ischaemic Disease.................................... 227 Diagnosis Codes for Psychiatric Illness ..................................... 237 Diagnosis Codes for Sickle Cell Anemia .................................... 252 Diagnosis Codes for Thyroid Disease ........................................ 253 Diclofenac sodium ........................................................................ 25 Digoxin ....................................................................................... 160 Diosmin/Heperidin ..................................................................... 162 Divalproex Sodium .................................................................... 100 Dorzolamide .............................................................................. 109 Dutasteride .................................................................................. 58 Enalapril ..................................................................................... 141 Etoricoxib ..................................................................................... 32 Ezetimibe ................................................................................... 122 Felodipine ................................................................................... 131 Fluoxetine .................................................................................. 180 Fluticasone ................................................................................... 49 Furosemide ................................................................................ 127 Glibenclamide/Glyburide.............................................................. 75 Gliclazide ...................................................................................... 76 Glimepiride ................................................................................... 77 Glucometer .................................................................................. 91 Glucose Test Strips ..................................................................... 91 Goserelin *SAM* ........................................................................ 172 Haloperidol *SAM* ..................................................................... 194 Hydrochlorothiazide ................................................................... 125 Hydrocortisone *SAM* ............................................................... 175


Hydroxychloroquine *SAM ........................................................... 35 Hydroxyurea .............................................................................. 201 Ibuprofen ..................................................................................... 22 Indapamide ................................................................................ 128 Insulin Glargine ............................................................................. 79 Insulin Isophane ............................................................................ 80 Insulin Isophane/Regular ................................................................ 86 Insulin Lispro *SAM ....................................................................... 82 Insulin Regular .............................................................................. 84 Insulin syringes w/Needles .......................................................... 91 Isosorbide Dinitrate ..................................................................... 164 Ivabradine *SAM* ...................................................................... 168 Ketoconazole *SAM* ................................................................. 173 Lancets ........................................................................................ 91 Latanoprost *SAM ..................................................................... 112 Levothyroxine Sodium ............................................................... 206 Lisinopril ..................................................................................... 143 Meloxicam ................................................................................... 30 Metformin ..................................................................................... 88 Methimazole .............................................................................. 204 Methotrexate *SAM* .................................................................... 37 Metoprolol .................................................................................. 136 Montelukast ................................................................................. 51 Naproxen ..................................................................................... 27 Nebulizer ...................................................................................... 57 Nifedipine LA .............................................................................. 132 Nitroglycerin ............................................................................... 165 Omeprazole *SAM* ..................................................................... 43 Oxcarbamazepine ....................................................................... 96 Paroxetine .................................................................................. 182


Peak Flow Meter ......................................................................... 57 Pentoxyfylline ............................................................................ 163 Perindopril *SAM* ...................................................................... 145 Phenytoin Sodium ....................................................................... 92 Pilocarpine ................................................................................. 110 Pioglitazone *SAM ....................................................................... 87 Potassium Chloride ..................................................................... 150 Prednisone/Prednisolone .............................................................. 19 Risperidone *SAM* .................................................................... 197 Rosuvastatin *SAM* ................................................................... 121 Salbutamol .................................................................................... 46 Salmeterol/Fluticasone ................................................................ 54 Simvastatin................................................................................. 117 Sitagliptin ..................................................................................... 73 Sodium Chloride for Inhalation *SAM* ......................................... 56 Spacer.......................................................................................... 57 Tamoxifen (SAM) ......................................................................... 66 Tamsulosin .................................................................................. 61 Telmisartan ................................................................................ 147 Terazosin ..................................................................................... 59 Thioridazine *SAM*..................................................................... 189 Timolol ..................................................................................... 106 Topiramate ................................................................................ 101 Travoprost ................................................................................. 111 Travoprost/Timolol...................................................................... 115 Trifluoperazine *SAM* ............................................................... 192 Trimetazidine HCl ....................................................................... 167 Valproic Acid ............................................................................... 98 Valsartan ................................................................................... 149 Warfarin ..................................................................................... 154

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