FOREWARD - WHO

FIJI ESSENTIAL MEDICINES FORMULARY -1-

FOREWARD

This edition arises out of the revision of the 1999 Fiji Essential Drug List (EDL) which has now been retitled as the Fiji Essential Medicines Formulary (2006).

It is a compilation of work consistently undertaken by the three Divisional Drug & Therapeutic Committees, the National Drug & Therapeutic Committee (NDTC) using Standard Treatment Guidelines and protocols.

The Essential Medicines Concept adopted by the World Health Organisation ensures that priority medicines such as Antiretroviral, diseases suffered by the majority of the population and the application of the Vital, Essential and Non Essential Analysis for procurement of cost effective medicine will facilitate the accessibility and affordability of these medicines to the citizens of Fiji.

Further, the Formulary includes relevant policies formulated by the NDTC, forms and procedures for reporting, Vital Drug list and an attempt to portray estimated cost of all medicines procured through our system.

The work by NDTC in compiling a listing of medicine which have been selected of the basis of quality, safety and effi cacy primarily and cost as secondarily for the Ministry of Health service providers and other stakeholders must be recommended.

Pharmaceutical services are integral component of clinical services and every effort be directed towards regular improvement in accessibility, availability and affodability of these safe and effi cacious medicines via best practice such as rational use of antibiotics as basis of benchmarking these services.

We should all aspire to achieve and providing the best for our patients and clients.

Lepani Waqatakirewa(Dr)CEO, Health

December 2006

FIJI ESSENTIAL MEDICINES FORMULARY-2-

ACKNOWLEDGEMENT

The National Drugs & Therapeutic Committee (NDTC) gratefully acknowledges the invaluable contribution to this edition of the following;

• Consultants at base hospitals• Chief Medical Offi cers in hospitals and Community Health• Divisional Drugs & Therapeutics Committees• Doctors, Medical Assistants, Nurse Practitioners, Pharmacist, Nurses, and Paramedical.

World Health OrganisationFiji School of MedicineNational NCD CommitteeNational Advisory Committee on AIDSProfessor Richard Fox of Melbourne

Ms Praveena Lata - for the electronic input of the formulary


DISCLAIMER

The authors do not warrant the accuracy of the information contained in the Fiji Essential Medicines Formulary and do not take responsibility for any death, loss, damage or injury caused by using the information in this Formulary.

While every effort has been made to ensure that this Formulary is correct and in accordance with current evidence based and clinical practices, the dynamic nature of medicines information requires that users exercise in all cases independent professional judgement and understand the individual clinical scenario when referring, prescribing or providing information from the Fiji Essential Medicines Formulary


MISSION STATEMENT

We commit ourselves to create health by providing cost-effective, effi cacious and safe essentials medicines within the National Drug Policy framework for the people of Fiji.

NATIONAL DRUGS & THERAPEUTICS COMMITTEE

Mrs. Rigieta Nadakuitavuki – Director Nursing & Health System Standards – Chairperson

Dr. Ganeshwar Rao – Consultant Medicine, CWMH – Vice Chairperson

Mr. Peter Zinck – Chief Pharmacist, Fiji Pharmaceutical Services Centre (FPSC) - Member

Professor Robert Moulds – Consultant Medicine/Pharmacologist – Fiji School of Medicine (FSM)

Mrs Vinita Ram – Principal Pharmacist – CEHS Clinical Representative

Dr. Frances Bingwor, Acting Chief Medical Offi cer – CEHS Community Health Representative

Dr. Omar Niazi – Consultant Medicine, Labasa MoH health facilities, NHS Clinical Representative

Mrs. Salome Baleivanualala – Actg Principal Pharmacy Offi cer, Labasa Hosp., NHS Clinical Rep

Dr. Isimeli Tukana – Acting Chief Medical Offi cer CH, WHS – CH Representative

Mrs. Reshmi Datt – Actg. Principal Pharmacy Offi cer – Lautoka Hospital – Clinical Rep.

Ms Vasiti Nawadra-Taylor, Fiji Pharmaceutical Services, Essential Medicines Programme - Secretary


INTRODUCTION

This Formulary is in line with the National Drug Policy 1994 in promoting Rational Use of Medicines by prescribing within the Formulary with reference to Standard Treatment Guidelines to reduce unwanted adverse events and wastage.

Since the formulary is undergoing constant change, the efforts of the National Drugs & Therapeutics Committee are directed towards the end, that it be constantly improved in order to provide the best clinical practices of patient care as economically as possible.

Please take time to read through each section of the Formulary and the Committee welcomes any constructive comments for continuous improvement of future publications.

Your comments can be directed to:

SecretaryNational Drug & Therapeutics CommitteeEssential Medicines ProgramFiji Pharmaceutical Services CentreP.O. Box 106SUVA


HOW TO USE THE FIJI ESSENTIAL MEDICINES FORMULARY

We have published this professional formulary handbook to improve patient care and contain costs in Ministry of Health service/providers institutions. We have worked very hard to assure the accuracy and quality of this communication.

The use of ‘drug(s)” and “medicine(s)” are inter-changeable in this publication.

Please take a few minutes to read the following instructions on how to use this reference book.

There are three basic sections in our formulary: • Section I, contains policy and procedures which are pertinent to the formulary

system. • Section II, contains the Medicines List and Pharmacological Listing of the

Essential Medicines. • Section III, is comprised of NDTC endorsed forms. Browse through it for a

moment to familiarize yourself with its content.

SECTION I

Provides the user with a reference on policies and procedures endorsed by the National Drugs and Therapeutics Committee.

SECTION II

• Abbreviations of Levels of distribution

Table A - has an alphabetized listing of all formulary medications by:• Generic name• Formulation• Strength • Level of distribution to MoH Facilities• Weighted Average Cost per Unit of Measure i.e. per dose, per vial etc.• Remarks

Table B is an alphabetical list of all formulary Transfusion Fluids by both generic and trade name in parenthesis with weighted average cost per unit of measure i.e. bag


Table C is an alphabetical list of all formulary Reproductive Health Commodities by both generic and trade name in parenthesis with weighted average cost per unit of measure i.e. each or ampoule or cycle

Table D is an alphabetical list of all formulary Immunological Preparations by both generic and trade name in parenthesis with weighted average cost per unit of measure i.e. vial

Table E – sorts all formulary listings into Pharmacological categories. Anaesthetics are followed by Analgesics, antipyretics & related agents, for example.

Table F – has the Vital Medicines List, sixty fi ve (65) have been considered Vital under the following fi ve (5) categories, that FPSC will endeavour to ensure 100% stock availability at all times.

i. Drugs used in life-threatening situationsii. No substitute available in the Fiji Essential Medicines Formularyiii. High demand – very commonly used vs. used by selective populationiv. Fatal consequence could result if not availablev. High risk of medico-legal liability if unavailable

Table G – Emergency Kit for Nursing Stations

SECTION III

Policy Forms and Adverse Drug Reaction Assessment Guideline


TABLE OF CONTENTS

Foreward .............................................................................................................1Acknowledgement ..............................................................................................2Disclaimer ...........................................................................................................3Mission Statement .............................................................................................4Introduction .........................................................................................................5How to Use the Fiji Essential Medicines Formulary ...........................................6

SECTION I . FORMULARY POLICIES & PROCEDURES 1) Defi nition & Description of the Formulary .......................................... 11 2) The National Drugs & Therapeutics Committee (NDTC) ....................11 3) Medicines usage in Ministry of Health Facilities .................................13

SECTION II. FORMULARY LISTING• Abbreviations of level of distributions ......................................................32• Table A - Alphabetic Listing of Formulary Drug Profi le ..........................33• Table B – Alphabetic Listing of Transfusion Fluids ..................................56• Table C – Alphabetic Listing of Reproductive Health Commodities ........57• Table D – Alphabetic Listing of Immunological Preparations ..................58• Table E - Formulary listings into Pharmacological categories. ..............61 Anaesthetics are followed by Analgesics, antipyretics & related agents, for example. • Table F – has the Vital Medicines List of which 65 have ........................78 been considered Vital under the following fi ve (5) categories:

vi. Drugs used in life-threatening situationvii. No substitute in the Fiji Essential Medicines Formularyviii. High demand – very commonly used vs. used by selective

populationix. Fatal consequence will result if not availablex. High risk of medico-legal liability

• Table G –Emergency Kit for Nursing Stations .........................................80

B. REFERENCE FOR DETAILED MEDICINE INFORMATION ..................81

C. GUIDE FOR CAUSALITY ASSESSMENT - ...........................................82 ADVERSE DRUG REACTIONS – Naranjo ADR probability Scale


SECTION III. POLICY FORMS

• Form 1 – Adverse Drug Reaction Reporting Form .................................83• Form 2 – Application of Drug to be included in the Fiji Essential Medicines Formulary Form ................................84• Form 3 – Request for Non-Formulary Drug Form ...................................85• Form 4 – Non-Formulary Drug request Purchases Flow Chart ..............86• Form 5 – Medication Incident Reporting Form ........................................87• Form 6 – Drug Quality Complaint Form .................................................88• Form 7 – Drug Reporting Quality Complaint Guidelines ........................89• Form 8 – Drug Recall Procedures – Initiated by Supplier ......................91• Form 9 – Drug Recall pro-forma – FPS Only ........................................92


SECTION I: FORMULARY POLICIES & PROCEDURES

1) Defi nition & Description of the Formulary

The formulary is a continually revised compilation of pharmaceutical information (plus important ancillary information) that refl ects the current clinical judgment of the clinical staff. These essential medicines have been selected by Clinicians through respective Divisional Drugs & Therapeutics Committee (DDTC) before fi nal endorsement by the National Drugs & Therapeutics Committee (NDTC).

2) The National Drugs & Therapeutics Committee (NDTC)

The National Drugs & Therapeutics Committee formulates, endorses, promotes and audits policies and protocols pertaining to the Essential Medicines Concept and the National Drug Policy. This committee is composed of medical offi cers, pharmacists, and other health professionals of whom two each have been appointed by each Divisional Drugs & Therapeutics Committee representing Clinical and Community Health Services. The Chairperson is the appointee of the Chief Executive Offi cer – Health. A senior Clinician from the Fiji School of Medicine is the appointee of the Dean. The Chief Pharmacist and Secretariat are representatives of the Pharmacy Profession and Fiji Pharmaceutical Services Centre.

The primary purposes of the Committee are (1) policy formulation (2) policy enforcement and (3) educational. It recommends the adoption of, or assists in the formulation of, policies regarding evaluation, selection and therapeutic use of medicines. Further, the Committee recommends or assists in the formulations of programs designed to meet the needs of the professional staff (physician, nurse, pharmacists and other health-care practitioners) for complete current knowledge of matters relating to medicines and their usage.

The functions of the Committee are:• To serve in an advisory capacity to clinicians, allied health care workers

and executive management on matters pertaining to use of medicines including investigational and donated medicines.;

• To develop a formulary of medicines accepted for use in MoH health facilities and provide for its constant revision. The selection of items to be included in the formulary is based on objective evaluation of their relative therapeutic merits, safety, and costs. The Committee strives to minimize duplication of the same basic medicine type, medicine entity, or medicine product;


• To ensure that Drug Use Evaluation activities are conducted and interventions carried out in order to decrease resistance to antimicrobials; promote rational prescribing habits; promote wise use of medicines by the public and minimize wastage;

• To establish programs and procedures that help ensure cost-effective medicine therapy;

• To initiate or direct drug use review/ drug use evaluation studies in public and private health facilities;

• To establish or plan suitable educational programs for all professional and clinical staff on matters related to medicine use;

• To participate in quality improvement activities related to the procurement, storage, distribution, administration, wise use and safe disposal of medicines;

• To review adverse drug reactions occurring in public health facilities and the private sector;

• To create health in the advocacy of the provision of drug and poisons information in promoting the prevention and better management of poisons;

• To ensure that proper inventory control practices in MoH facilities are practised and adequate inventory training for health care workers to decrease wastage and ensure that patients receive effi cacious and safe medicines.


3) MEDICINES USAGE in MINISTRY of HEALTH FACILITIES

INTRODUCTION

This formulary consolidates the requirements of the Pharmacy and Poisons Act (Cap 115) the Dangerous Drug Act (Cap 114), the National Drug Policy 1994, and Ministry of Health directives in relation to good practice in all aspects of medicines acquisition, prescribing, dispensing, distribution, administration and storage of medicines. All personnel involved in the complex process of medication management must observe the provision set out in this document.

1. DRUGS AND THERAPEUTICS COMMITTEE

All Divisional and Sub divisional MoH health facilities which have a pharmacy department must have a drugs and therapeutics committee.

1.1 The membership of the committee will comprise of the following as outlined below:

Divisional Drugs & Therapeutics Committee (DDTC) Manager Clinical Services (MCS) or nominated Consultant Principal Pharmacist or Drug Information Pharmacist – Secretary Consultant or representative – From each discipline Consultant Radiology or representative Consultant Pathology or representative Dental Representative Manager Nursing Services – MoH health facilities/Community Health General Manager Community Health or representative

Sub-divisional Drugs & Therapeutics Committee (SDTC) Sub-divisional Medical Offi cer – Chair Pharmacy Technician – Secretary One Medical Offi cer practicing in the Sub-divisional MoH health facilities Medical Offi cers from Health Centres within the Sub-division Nursing Representative Dental Representative Laboratory Representative Radiology Representative


1.2 The committee should meet six (6) times a year. Extraordinary meetings may be called by the Chairperson if any critical issues pertaining to drugs and therapeutics arise.

1.3 Minutes of the committee meetings will be referred to the National Drugs and Therapeutics Committee for information as soon as those meeting minutes have been confi rmed. Important issues should be highlighted with action points.

1.4 The Divisional Drugs and Therapeutics Committee will be responsible for defi ning therapeutic protocols at the local level, promoting, monitoring and rationalizing medication usage including the undertaking of medicines utilization review studies. The Committee will be responsible for the annual review of medicines requirements which will encompass requested additions to, and deletion from, the allocated medicines imprests or maximum stock levels for each health facility.

1.5 All drug therapy from the Essential Medicines Formulary for inpatient use is to be supplied free of charge by the MoH facilities in accordance with the National Drug Policy 1994. Non-formulary Medicines and Medicines for Paying Patients may be charged. All discharge medicines therapy from the Essential Medicines Formulary should be supplied free of charge by MoH health facilities in accordance with established policy. Medicines therapy for outpatient should be supplied in accordance with policies developed by the National Drug and Therapeutics Committee.

1.6 The Divisional Drugs and Therapeutics Committee should defi ne a system to monitor and report all medication incidents involving Doctors, Nurses, Pharmacist and allied Health Professionals. These reports must be reviewed thoroughly, and training introduced where necessary, and systems altered when necessary. Staff must be reassured that the objective of the system is the improvement of patient safety. All reports shall be confi dential.

1.7 If it is necessary for any medicines to be recalled this will be initiated by the Chief Pharmacist who will provide information to the General Managers Community Health, Managers Clinical Services and Principal Pharmacists. It will be the responsibility of GMCH/MCS to ensure that clinical staff are notifi ed within their institutions, and that any implicated medicines(s) is/are returned to the nearest Divisional MoH health facilities Pharmacy


Department or Fiji Pharmaceutical Services Centre as requested in the recall notifi cation. The Drug Recall Proforma (Form 9) will be fi lled by FPSC for notifi cation to clinicians and all Committee members informed and tabulated at the next NDTC meeting.

Any suspected problem or defect with medicines should be notifi ed by facsimile or telephone to the Principal Pharmacist – Essential Medicines Section (Telephone 3388 000 or Facsimile 3388003).


2.0 PRESCRIPTION OF MEDICINES

2.1 All prescription must clearly detail the following procedural and clinical requirements in the doctor’s handwriting in blue or black ink or biro.

• Name of Health Facility• the patient’s full name; address and NHN• age and weight for pediatric patients• generic medicines name• medicines strength• dosage regimen• quantity to be supplied or time period for treatment• registered prescriber’s signature, date and name printed or approved

rubber stamp with initials

2.2 Doses should be stated in mass units e.g. mg, microgram and not in number of tablets or ampoules, nor mL of mixture because the strength of the medication available may vary from time to time.

2.3 When writing a dose of less than one mass unit, a leading zero must be written before the decimal point e.g. 0.5mg. Failure to do this can result in ten times the desired dosage being administered.

2.4 Prescribing for MoH facilities inpatients must be charted on approved Ministry of Health Inpatient Drug Charts, Insulin Dosage Charts or Intravenous Fluids Charts with the name of the MoH facility specifi ed. These Charts must not be photocopied for dispensing or for administering of medicines. The use of Photocopies is prohibited. Treatment sheets must be regularly reviewed by the prescriber and at most every 7(seven) days.

2.4.1 The following details must be completed by the registered Prescriber: • Name of Health Facility• the patient’s full name; address and NHN• age and weight for pediatric patients• generic medicines name• medicines strength• dosage regimen• quantity to be supplied or time period for treatment• registered prescriber’s signature, date and name printed or approved rubber

stamp with initial. Each medicines order must be individually signed.


2.4.2 When a prescriber wishes to alter any of the above particulars, he/she must cease the original order and write a new order.

2.4.3 When a prescriber wishes to cease an order a line must be placed through the order, signed and dated by the prescriber. The original order must not be obliterated.

2.4.4 The patient’s discharge medication must be reviewed by the Prescriber as part of the patient’s general review prior to discharge from the MoH health facility. Any discharge medication should be prescribed separately to the inpatient order in the special section on the treatment sheet or alternately, a separate discharge prescription may be written.

2.4.5 To avoid errors in interpretation abbreviations must not be used. E.g. “Units” must be written in full and not abbreviated to “U”. “Microgram” must be written in full and not abbreviated to “mcg” or “ug”. “Six hourly” must be written in full and not abbreviated to “6/24.”

2.4.6 For liquid medications or other mass units, the strength should always be specifi ed and the dose stated in milligrams (or micrograms as the case may be), not millilitres (mls). This is especially important when prescribing pediatric medication

2.5 All prescriptions for MoH facilities outpatients and clinic patients must be clear and unambiguous as these prescriptions may be taken by patients to retail pharmacies for dispensing. The prescribers’s name must be clearly printed on the prescription, to enable contact to be made if necessary.

2.6 Prescriptions for outpatients are to be restricted to the policy defi ned by the National Drugs and Therapeutics Committee and a maximum quantity for one month’s treatment for special outpatient department prescriptions and maximum of one week’s treatment for general outpatient department prescriptions. Exceptions to this limit will be rare but may be defi ned by the National Medicines and Therapeutics Committee e.g. depending on adequate stock situation a maximum of four month’s therapy for patient’s who are better controlled with their diseases such as epilepsy, thyrotoxicosis, rheumatic heart fever prophylaxis and patients who are well controlled who live in remote areas.


2.7 Prescriptions for Special Outpatients Department patients who are intending to visit overseas will be supplied a maximum of three month’s supply, pending adequate stock situation.

2.8 Prescriptions for Special Outpatients Department presented at another health facility and where there is a stock problem will require the resident Medical Offi cer to review the patient again before medicines are dispensed.

2.9 Prescriptions for dangerous drugs for outpatienst are restricted to oral formulations which can be obtained from Divisional and Sub divisional MoH facilities only. Higher than usual dosage or a treatment period beyond four weeks requires approval from the Chief Executive Offi cer for Health. It is the Registered Medical Offi cer’s or Dentist’s responsibility to obtain this approval.

2.10 Prescriptions for parenteral dangerous drugs are restricted to inpatients only. Prescriptions for dangerous drugs must state exact administration schedules i.e. “prn” or “mdu” must be qualifi ed by a time schedule. E.g. “Pethidine 50mg IV every four hours when required for pain relief up to maximum of ten doses”.

2.11 Prescription of dangerous drugs for any patient cannot continue beyond four weeks without permission of the Chief Executive Offi cer for Health. Full patient details must be supplied including diagnosis, treatment program and prognosis.

2.12 In the interests of clarity and prevention of misinterpretation all prescription pads should be printed. All Ministry of Health prescribers must write prescriptions on the appropriate printed prescription pads for Schedule 4 and Schedule 8 medicines.

2.12.1 In the interests of safety, telephone orders are strongly discouraged. The acceptance of verbal order by telephone is restricted to the Nursing Supervisor or Senior Nurse. The Treatment Chart or Prescription must be written within 12 hours of the telephone order.

Should a nurse agree to accept a telephone order from a doctor in an emergency, she must record in ink on the treatment sheet the medicines, dosage, formulation and dosage regimen requested. This must be written in the “once only” section of the treatment chart.


2.12.2 The doctor must countersign the telephone order within 12 (twelve hours), and prescribe any continuing therapy.

2.12.3 No drug is to be prescribed or transcribed by nurses unless outlined in the NP protocol or the IMCI protocol for nurses or medical offi cer’s recommendation.

2.13 If it is necessary to alter prescribed medication (e.g. dosage, frequency) then the complete medication order must be rewritten.

2.14 Inventory and prescribing of medicines is restricted to the range of medicines specifi ed in the Health Facility’s categorization in the Fiji Essential Medicines Formulary. The purpose of the Essential Medicines Formulary is to ensure rational use of medicines using the NDTC Standard Treatment Guidelines. One example is the restriction of certain antibiotics to ensure treatment success and to prevent the emergence of resistant micro-organisms

2.15 Medicines outside this range may only be used in the health facility with the knowledge of the Chairperson of the Sub-divisional or Divisional Drugs and Therapeutics Committee. Non Formulary Medicines Request forms are available if a non-formulary medicine is requested for treating a particular patient. A report on the necessity of this action must be sent to the National Drugs and Therapeutic Committee so that annual review of these non-fomulary medicines can be done.

2.16 Parenteral therapy should not be prescribed for outpatients when oral therapy is the most satisfactory choice.


3. ADMINISTRATION OF MEDICINES

3.1 In all MoH facilities, no person may administer medication to a patient except on a written prescription from a doctor, dentist, medical assistant or nurse practitioner. It is accepted that a restricted range of medicines may be administered by a nurse in a nursing station according to the National Drugs & Therapeutics Committee approved protocols. See paragraph 2.12.3 above.

3.2.1 Medication must be administered to patients whilst referring to the prescriber’s instruction(s) on the drug treatment sheet.

3.2 2 The medication order must be rewritten for subsequent administration to a patient. This means that transcribing is not permitted.

3.2.3 All medication administered must be signed on the medicines treatment sheet by the registered clinician after administration.

3.3 Medication must be selected, administered and recorded by the same nurse, and must be counter-checked by a second nurse or doctor or dentist or registered pharmacist.

3.4 Medication must be administered to patients from the container supplied by the pharmacy department. Under no circumstances should nurses transfer medication from one container to another on the ward nor alter the label on any medicines container.

3.5 Ward Imprest and Dangerous Drug cupboards and trolleys are to be kept locked when not in use and the keys carried by the Sister-in-charge of the ward.

3.6 Patient’s own medication may not be routinely administered to them whilst they are inpatients. MoH facilities medication must be used except when the patient must be maintained on medication which is not available on the Essential Medicines Formulary.

3.7 Patients may self-administer medication only upon written order of the Medical Offi cer or Dental Offi cer. E.g. Metered Dose Inhalers


3.8 Patients must not take any medication (including herbal preparation or traditional medicines) whilst an inpatient unless approved by the medical offi cer.

3.9 Medicines must not be given from the ward to any patient to take home. A prescription must be written for dispensing in the MoH facilities pharmacy inpatients section. A registered Pharmacist may counsel discharged patients or carers in the ward.


4. Dangerous Drug Policy

4.1 A dangerous drugs register must be maintained by the sister in charge of the ward. Dangerous drugs must be kept locked in a dangerous drugs cupboard separate from other medicines. Administration of dangerous drugs must be checked by a second nurse and both nurses must sign the register. A book and stock balance must be undertaken at the beginning of every week and any problem, solved immediately. Both the Senior Matron/Matron and Pharmacist-in-charge must be notifi ed if any medicines or register is missing. Any remaining discrepancy which can not be solved at the time must be notifi ed to the Manager Clinical Services or Sub-divisional Medical Offi cer as appropriate.

4.2 The Sister-in-charge of the ward is responsible for the storage of all medicines on the ward. New issues of dangerous drugs must be checked by the sister on receipt, recorded in the register and immediately locked into the appropriate cupboard. The Sister-in-charge may delegate this responsibility to a senior nurse when she is absent from the ward.

4.3 No goods including money and documents shall be kept in the dangerous drugs cupboard.

4.3.1 The Dangerous drugs register must incorporate a record of all transactions involving dangerous drugs. The dangerous drugs register must be a bounded book with consecutively numbered pages. A separate page must be used for; each dangerous drug; each form of dangerous drug; each strength of dangerous drug.

4.3.2 The record in the register must include the following details for each transaction; date; name & address of person from whom medicines received or to whom supplied; quantity of medicines received or supplied; balance remaining; name of prescriber; signature of person making the entry; signature of person checking.

4.4. A person making an entry in the Dangerous Drugs Register must not make any false or misleading entry, and must not make any alterations, obliterations or cancellation (including crossing out or drawing a line through an entry). If a mistake is made it must be left as it is, marked with an asterisk, rewritten as appropriate, and a note explaining the error must be made in the margin or at the foot of the page, initialled and dated.


4.4.1 The Dangerous drugs Register entry must record the following details: • date; • time of day; • patients name; • National Health Number (NHN) • amount administered; • amount discarded (if part ampoule administered); • balance remaining; • signature of person(s) making the entry; • signature of person checking; • name of the prescriber.

4.5 If a Dangerous drugs Register is lost or stolen, the action specifi ed in 4.1 must be taken immediately.

4.6 The Sister In Charge must conduct monthly dangerous drugs stock take and checked by the Pharmacy technician or registered pharmacist. Any discrepancies triggers the action specifi ed in 4.1. A red ink or biro pen must be used.


5. PHARMACY MANAGEMENT OF MEDICINES

5.1 The Pharmacist-in-charge or Pharmacy Technician–in-Charge is responsible for the acquisition and supply of medication to MoH facilities patients in accordance with policies developed by the DDTC and NDTC.

5.2 The Pharmacist-in-charge or Pharmacy Technician–in-Charge is responsible for the provision of medicines information to MoH facilities staff, patients and members of public.

5.3 The Pharmacist-in-charge or Pharmacy Technician–in-Charge is responsible to the Chief Pharmacist, General Manager Hospital Services or Sub-divisional Medical Offi cer for the proper management of the pharmacy service.

5.4 The pharmacy is a restricted area and access is limited during opening hours to medical, nursing, allied health workers as authorized by the Pharmacist-in-charge or Pharmacy Technician in Charge. The outpatients pharmacy or dispensary is closed outside the normal working hours (except for Saturdays and public holidays from 8am to 12pm) with no access to any other personnel unless authorized by the Pharmacist-in-charge or in his/her absence the Sub-divisional Medical Offi cer. The Pharmacy personnel on-call will service wards via the inpatients section for replenishment of imprest stock or dispensing of newly charted medicines and Accident/Emergency Imprest.

5.5 Pharmacy locks must be of “dead-latch” type.

5.6 Reference resources available in the pharmacy must include recent editions of the following reference texts as a minimum “Martindale Extra Pharmacopoeia” and Australian Pharmaceutical Formulary or Australian Medicines Handbook or Prescription Proprietary Guide or similar.

5.7 All medicines for therapy entering the MoH facilities must be supplied through the pharmacy service so that actual MoH facilities requirements can be monitored.

5.8 All medicines for therapy supplied to discharged patients must be written on prescriptions and dispensed from the inpatients section of the MoH facilities pharmacy. The prescription should be written in the special discharge section of the treatment sheet. However, in special circumstances a special prescription may be used.


5.9 All medicines for therapy supplied to outpatients must be in accordance with policies as defi ned by the National Drugs & Therapeutic Committee.

5.10 All medication for patients must be packaged properly and labelled clearly with:

• patient’s name • Patient’s National health Number (NHN) • date of dispensing • generic name of medicine and strength • dosage schedule • total quantity dispensed • prescriber’s name

Label should be typewritten or computer generated.

5.11 Pharmaceuticals supplied from the Pharmacy department to wards and other departments should preferably be in manufactures’ original packs. Where repackaging is necessary, this must be carried out by pharmacy support staff under the direct supervision of a Pharmacist with clear labeling and an expiration date 3 months from the date of repackaging.

5.12 Supply of medicines for therapy to inpatients should be by imprest system monitored by Pharmacy Imprest staff. For individual patient dispensing or non-imprest issuance, the Pharmacy Inpatients staff shall dispense from the Inpatients Medication Chart.

5.13 As pharmacy staffi ng permits, a Pharmacist should visit the wards on a regular basis and review inpatients medicines treatment charts. Where appropriate, advice should be given to nurses and prescribers on:

• Administration of medicines; • Therapy of medicines; • The Pharmacology of medicines in use; • The choice of antibiotic based on laboratory sensitivity report and

rational usage criteria; • The reasons behind the Essential Medicines Formulary; • Medicines which require intensive monitoring e.g. gentamicin, digoxin,

theophylline and warfarin in the interest of safety and avoidance of toxicity;


• Any suspected adverse medicines reactions and report details of these to the Divisional Medicines and Therapeutics Committee. Adverse Drug Reactions (ADR) to medicines must be entered into the PATIS under the PMI section for allergies. The yellow ADR forms (form 1) should be available in all wards and units for reporting of any suspicious ADRs and forwarded to Secretary, National Drug & Therapeutics Committee, Essential Medicines Program, P.O. Box 106, SUVA.

These Ward based and community health pharmacy services are very important for the safe, appropriate, effective and economical use of medicines.

5.14 All medicines stocked in the storeroom must have stock cards and must be updated regularly. Monthly or quarterly stock balances must be conducted before monthly or quarterly orders are placed on FMIS order sheets or entering the Inventory Replenishment Report. Near expiration medicines or slow moving medicines must be re-distributed to the nearest divisional MoH health facilities and recorded on stock cards.

5.15 Regular and proper inventory control practices are practiced using FIRST EXPIRY, FIRST OUT (FEFO) concepts.

5.16 Expired medicines should never be used other than in very exceptional circumstances. If expired drugs are used then the patient or carer or family members must be informed and consent obtained before use. All expired medicines should be recorded and disposed of as per National Drug Policy.

5.17 Immunological preparations including vaccines must be stored in a refrigerator dedicated for that purpose e.g. Icelined. Vaccines must be place in the body of the domestic refrigerators and never packed in the door. Proper inventory control practices must be carried out regularly by practicing FEFO; updating of stock cards and Epicor entries; optimal storage and re-distribution of near expiring or slow moving commodities. Vaccine return forms must be fi lled completely and correctly for ordering from FPSC or nearest health facility.

5.18 Security of Family Planning Commodities must be ensured at all times. Proper inventory control practices must be carried out regularly by practicing FEFO; updating of stock cards and Epicor entries; optimal storage and re-distribution of near expiring or slow moving commodities. Family planning return forms must be fi lled completely and correctly for ordering from FPSC or nearest health facility.


6.0 OTHER ISSUES

6.1 Policy Regarding Medicine Samples

Distribution of medication samples by pharmaceutical company representatives in any of the MoH facilities is forbidden.

No sample medications shall be administrated to patients. In the event that a medicine is not available through normal channels, the Pharmacy Department must be contacted.

6.2 Policy regarding Drug Representatives

Ministry of Health care providers in public health service facilities shall not invite representatives from pharmaceutical companies or wholesalers to promote the use of any drug or clinical product unless approved by the NDTC Chairperson or his/her nominee.

6.3 Adding Medicines to the Formulary

Medicines are admitted to the formulary according to their non-propriety (generic) names. No medicine or preparation shall be admitted to the formulary unless its formula or composition is known and its therapeutic value has been established to the satisfaction of the National Drugs and Therapeutics Committee.

Any member of the Medical Staff may request the addition of a medicine to the formulary by submitting a request using the - Application for a New Drug to be included in the Fiji EMF Form (Form 2), along with supporting information, to the Secretary, Divisional Drugs & Therapeutics Committee (DDTC) for fi rst submission.

The Secretary of the DDTC will forward the request, along with supplemental information gathered by there Drug Information Service, to the NDTC. For each medicine, specifi c consideration is given to: • Pharmacologic classifi cation • Therapeutic indications • Dosage forms available • Bioavailablity and pharmacokinetics • Dosage range • Known side effects and toxicities • Special precautions required.


• Advantages of the medicine over similar agents • Disadvantage of the medicine compared to similar agents • Therapeutic comparisons with other medicines or treatments • Cost comparison with other medicines or treatments • Estimated usage rate per annum

The DDTC will then forward its fi ndings and submission to the NDTC for further literature search conducted by the National Poisons & Information Centre before a decision is made by the NDTC. The committee may invite the requesting party to attend this meeting and discuss the request.

6.4 Removing Medicines from the Formulary

Request for deletion of a medicine from the formulary shall be submitted in writing to the Chairperson, DDTC along with supplemental information gathered by the Offi cer and the Drug Information Service to the NDTC for action. The committee may invite the requesting party to attend this meeting and discuss the request.

The formulary is reviewed periodically in its entirely by the NDTC to assure that it contains only those medicines most useful for patient care.

6.5 Non-Formulary Drug Request

Request for purchase of a non-formulary medicine for (EMERGENCY PURPOSE ONLY) can be requested using the Request for Non-Formulary Drug Form (Form 3) and using the Non-Formulary Drug Request Purchases Flow Chart (Form 4) as a guide.

The form must be fi lled correctly and completely for ease of procurement. The fi lled form must be forwarded immediately to the Pharmacist In Charge and to the Secretary – NDTC, Fiji Pharmaceutical Services, Fax: 3388 003.

The estimated time of delivery of the non-formulary request is 72 hours and may vary for weekends and public holidays. The requestor is expected to present a feedback report to the NDTC on the effectiveness of the drug within 7 days of completion or suspension of therapy.

If the non-formulary drug is effective and has been requested at least three (3) times to the NDTC, then this can be considered for possible Formulary inclusion.


6.6 Donated Drugs

Any donated drugs from Non Governmental Organizations, Civil Societies, Religious Organizations, Foreign Governments & United Nations as aid for natural disaster consequences or outbreak and Overseas Teams must be within the Essential Medicines Formulary. The Ministry of Health has adopted the WHO Donated Guidelines following these four core principles: i. Maximum benefi t to the people of Fiji ii. Respect wishes and authority of the Ministry of Health iii. No double standards in quality, safety and effi cacy iv. Effective communication between donor/team coordinator and Pharmacy

Department/Fiji Pharmaceutical Services Centre

6.6.1 Selection of Drugs

All drug donations should be based on the Fiji Essential Medicines Formulary List and registered in Fiji.Should be relevant to the disease patterns of Fiji**If not on Formulary then approval should be sought from proper authority i.e. Chief Pharmacist and/or NDTC

6.6.2 Quality Assurance & Shelf –life

All donated drugs should be obtained from a supplier that has been approved by the Fiji Pharmaceutical Services and comply with the International Code of Good Manufacturing Practice (CGMP).

No drugs donated should be used for research purposes, nor recycled from previous patient use from the donated country (unless approved by authority) or should have been given to health professionals as free samples.

All donated drugs should have a remaining shelf-life of a minimum of 18 months upon arrival at designated MoH facility.


6.6.3 Presentation, packaging and labelling

All drug items should comply with the following:

• Labeling must be in the English language • Standard must be of British Pharmacopaeia (B.P) or United States

Pharmacopaeia (USP) or European Pharmacopaeia (EUP. P) or registered in approved countries as per Pre-qualifi cation requirements of the Regulatory Authority of FPSC.

• Generic name of drug • Strength • Dosage Form • Quantity of drug per primary container • Batch number • Expiry date • Name of manufacturer • Storage conditions • Have product leafl ets inserted (for reference)


6.6.4 Information and Management

Donor/coordinator/consultant should liaise with Chief Pharmacist or Principal Pharmacist at the Divisional MoH facilities at least four weeks before team or donation arrives in Fiji.

The initial correspondence should contain the following detailed information before approval of drug donations:

• The type and quantities of drug donated • Generic name of drug • Standard must be of British Pharmacopaeia (B.P)or USP or European

Pharmacopaeia or registered in approved countries as per Pre-qualifi cation requirements of the Regulatory Authority

• Strength and dosage form • Batch number • Expiry date • Manufacturer or wholesale supplier • The expected date of arrival and port of entry • Identity and contact address of donor

Costs of all freights and clearance (if not duty-free) should be met by the donor agencies or team.

The Warehouse Manager or Logistics Offi cer in the Divisional MoH health facilities will stock all donated drugs and document all transactions.

Any excesses from the visiting team will be discarded under the National Drug Policy 1994 or used appropriately by the consultant.


ABBREVIATIONS

The following abbreviations have been used in compiling the drug list:

HM - Hospital manufactured.Level 1 - Divisional hospital only.Level 2 - Divisional + Specialist hospital only.Level 3 - Divisional + Specialist + Sub divisional hospitals.Level 4 - Divisional + Specialist + Sub divisional hospitals + HealthCentres.Level 5 - Divisional + Specialist + Sub divisional hospitals + HealthCentres + Nursing Station.Level 5a - Nursing Station with medical offi cer’s authorizationRequest only - Those drugs which will only be purchased on request.Hub - Reproductive Health Clinic & Speciality Clinic for HIV/AIDS cases

Abbreviationsmg - milligramg - grammL - millilitreL - litrew/v - weight per volumev/v - volume per volumeMicrogram – To be written in fullUnits – To be written in fullInternational Units - To be written in full

Note: The number in superscipt following the drug name indicates the section under which the drug has been classifi ed in the Pharmacological Drug List.

For example, Amoxycillin6 . This means that Amoxycillin is included in the Pharmacological Drug List Section 6.


AAbacavir(ABC)29 tab 300mg Hub For HIV/AIDS Acetazolamide16.21 tab 250mg 3 0.05 Acetazolamide21 inj 500mg 1 20.19 Acetic Acid soln 6%, 500mL 3 - OT 6.01 For Surgical & Gynae Use Acetylcholine inj 20mg 1 29.12Chloride21 Acetylcysteine4 inj 2g/10mL 1 9.45 Antidote Paracetamol poisoning

Actinomycin-D8 inj 500mcg 1 Also known as Dactinomycin CYTOTOXIC CONSULTANT ONLYAciclovir Sodium6 inj 250mg 1 6.42 RESTRICTED ANTIMICROBIALAciclovir21 eye oint 30mg/g 1 38.55 Eye Department onlyAciclovir28 tab 200mg 1,hub Immunocompro- mised Patients & Opportunistic Infections For HIV/AIDS Adenosine12 inj 6mg/2mL 1 16.8Adrenaline3,12 inj 1mg/1mL 5a 0.6 Doctor’s order only at N/S Adriamycin8 inj 50mg (25mL) 1 50.87 Also known as Doxorubicin CYTOTOXIC CONSULTANT ONLY Alcohol (SVR) soln 96%/1L 1 6.07 Allopurinol2 tab 100mg 4 0.03 Alprostadil12 inj 500mcg 1 Also known as /mL (5mL) Prostaglandin E1 - Consultant Paediatrics only

DRUG NAME FORM STRENGTH LEVEL COST REMARKS

Table A - Alphabetic Listing of Formulary Drug Profi le


Aminophylline25 inj 250mg10mL 4 1 Amiodarone12 tab 100mg 1 0.48 Amiodarone12 inj 150mg/3mL 1 9.01 Amitriptylline24 tab 25mg 4 0.01 Amoxycillin6 cap 250mg 4 0.03 Amoxycillin6 cap 500mg 4 0.05Amoxycillin6 susp 125mg/ 5 0.78 5mL (100mL)Amoxycillin with tab 500mg/125mg 1 0.34 CONSULTANT Clavullinic Acid6 ONLY

Amphotericin B6 inj 50mg 1 26.79 RESTRICTED ANTIMICROBIAL

Amphotericin 21 eye oint 3% 1 CONSULTANT OPTHAMOLOGY

Ampicillin6 inj 500mg 3 0.79 IMCI Protocol at N/S

Arabinocide C8 inj 100mg/5mL 1 7.8 CYTOTOXIC - CONSULTANT ONLYL-Asparaginase8 inj 10,000iu 1 109.91 CYTOTOXIC - CONSULTANT ONLYAspirin2,7,17 tab 300mg 5 0.01Atenolol12 tab 50mg 4 0.01Atracurium20 inj 25mg/2.5mL 1 5.94Atropine inj 600mcg/1mL 3 2.1Sulphate1,4,17

Atropine Sulphate21 eye drops 1% 1 2.06Azathioprine8 tab 50mg 2 0.34 For autoimmune disorder

BBaclofen20 tab 10mg 2 0.05Beclomethasone25 inhaler 100mcg/dose 4 6.68Beclomethasone nasal 50mcg/dose - 1 For ENT Clinic diproprionate28 spray 200 doses OnlyBenzhexol9 tab 2mg 4 0.01



Benzoin tincture 5 2.48Compound28

Benztropine inj 1mg/mL 2 6.17 mesylate4,9 (2mL) Benztropine tab 2mg 2 0.16mesylate9

Benzyl Benzoate13 lotion 25% 5 1.03Betamethasone cream 0.1% 4 0.97(Valerate as salt)13

Betamethasone13 scalp 0.1% 2 5.42 Skin Clinic Only lotionBetamethasone- eye oint 0.1%/ 1 8.22 Eye Department Neomycin21 0.35% Only

Betamethasone- eye drops 0.1%/ 1 0.84 Eye Department Neomycin21 0.35% OnlyBisacodyl17 suppos 10mg 4 0.14Bisacodyl17 tab 5mg 4 0.01Bismuth in Idoform* paste (BIPP) B.P. 28 2 64.45 For ENT Clinic Only*Bismuth Subnitrate 250g, Iodoform 500g, Liquid paraffi n 250g Bleomycin Sulphate8 inj 15,000 IU 1 135.46 CYTOTOXIC - CONSULTANT ONLY

Bone Wax Oint 2.5g 1 3.94 CONSULTANT ONLY-CWMHBromocriptine9.18 tab 2.5mg 1 0.39Bupivacaine Plain1 inj 0.5% 1 1.2

Bupivacaine Heavy2 inj 0.5% 1 19.2

Bupivacaine with inj 0.5%/ 1 6.09Adrenaline1 1:200,000

Busulphan8 tab 5mg 1 0.48 CYTOTOXIC - CONSULTANT ONLY



CCalamine13 lotion 100mL 5 1.08Calcium Carbonate27 tab 500mg 3 0.07 For Chronic Renal Failure PatientsCalcium Chloride26 inj 10% 1 5.04Calciferol Strong26,27 tab 5000 Units 1 2.33Candid Ear Drop28 ear drop 1 For ENT Clinic OnlyCarbamazapine5 tab 200mg 3 0.03Carbimazole18 tab 5mg 3 0.02Cefaclor SR6 tab 375mg 1 0.49Ceftriaxone6 inj 250mg 1 1.06 RESTRICTED ANTIMICROBIAL CONSULTANT ONLYCeftriaxone6 inj 1g 1 2.47 RESTRICTED ANTIMICROBIAL CONSULTANT ONLYCephalothin Sodium6 inj 1g 1 8.21 RESTRICTED ANTIMICROBIAL CONSULTANT ONLYCharcoal Activated4 soln 4 21.81Chloral Hydrate20 oral soln 100mg/mL 1 31.87 For Paediatric (200mL) Use Only

Chorambucil8 tab 5mg 1 1.36 CYTOTOXIC - CONSULTANT ONLYChloramphenicol6 cap 250mg 4 0.03Chloramphenicol6 inj 1g 4 0.81 IM/IVChloramphenicol6 susp 125mg/5mL 4 2.61Chloramphenicol21 eye drop 0.50% 4 0.53Chloramphenicol21 eye oint 1% 4 0.4Chloramphenicol21 ear drop 5% 5 0.82Chlorhexidine soln 20% (4.5L) 1 113.35Gluconate15

Chlorhexidine cream 1% (500mL) 5 4.86Gluconate15



Chlorhexidine (HM)15 soln 1% 1Chlorhexidine in soln 0.50% 1SVM (HM)15

Chlorhexidine/ soln 1.5%/15% 5 4.58Cetrimide)15 (500mL)

Chlorhexidine/ aq. cream 1.5%/ 5 0.63Cetrimide)15 15% (50g)

Chloroquine tab 200mg 1 0.28Sulphate6 Chlorpromazine24 tab 50mg 3 0.02Chlorpromazine24 tab 100mg 3 0.02Chlorpromazine24 inj 50mg/2mL 4 0.26Ciprofl oxacin6 tab 500mg 1 0.09 RESTRICTED ANTIMICROBIAL CONSULTANT ONLYCiprofl oxacin6 inj 100mg/50mL 1 6.3 RESTRICTED ANTIMICROBIAL CONSULTANT ONLYCisplatin8 inj 10mg 1 8.49 CYTOTOXIC - CONSULTANT ONLY

Cisplatin8 inj 1mg/mL (50mL) 1 16.34 CYTOTOXIC - CONSULTANT ONLY

Cloxacillin Sodium6 inj 500mg 3 0.76 Alternative if Cloxacillin Inj is hard to procure, NDTC approved

Coal Tar oint 100g 2 2.48 For Skin Clinic Only

Codeine tab 30mg 3 0.09 DANGEROUS Phosphate2,17,25 DRUG



Colchicine2 tab 500 1 0.04 microgramCompound Powder 3 39.02Tragacanth Pulv BPCo-trimoxazole6* tab 480mg 4 0.02Co-trimoxazole6 susp 240mg/5mL 4 0.65

* For the treatment and prophylaxis of Pneumocystis carinii pneumonia and toxoplasmosis, treatment of norcadia infections, treatment of urinary tract infections and acute exacerbations of chronic bronchitis and treatment of acute otitis media in children where there is good reason to prefer, co-trimoxazole to a single antibiotic

Cyclophosphamide8 inj 200mg 1 2.56 CYTOTOXIC CONSULTANT ONLYCyclophosphamide8 inj 500mg 1 5.22 CONSULTANT ONLYCyclophosphamide8 inj 1g 1 36.81 CONSULTANT ONLYCyclophosphamide8 tab 50mg 1 0.25 CONSULTANT ONLY

DDacarbazine8 inj 200mg 56.77 CYTOTOXIC - CONSULTANT ONLY

Dapsone6 tab 50mg 2 0.24 TWOMEY HOSPITAL ONLY

Dapsone6 tab 100mg 2 TWOMEY HOSPITAL ONLY

Daunorubincin inj 20mg 1 25.64 CYTOTOXIC -Hydrochloride8 CONSULTANT ONLY

Desferrioxamine4 inj 500mg/5mL 1 12.3 For iron overloadDesmopressin inj 4mcg/mL (1mL) 1 PAEDIATRIC Acetate*18 CONSULTANT ONLY*For Neurogenic Diabetes Insipidus Patients



Dexamethasone3,8,18 tab 500microgram 1 0.1Dexamethasone3,8,18 tab 2mg 1 0.37Dexamethasone3,8,18 inj 4mg/1mL 3 0.28Didanosine (ddI)29 Chewable 250mg Hub For HIV/AIDS Tab Didanosine (ddI)29 Chewable 150mg Hub For HIV/AIDS Tab Diazepam1,24 tab 5mg 4 0.01Diazepam1,5,24 inj 10mg/2mL 5a 0.21 IMCI protocol/Doctor’s order only at N/S

Diethylcarbamazine6 tab 50mg 1 0.01 MDADigoxin12 elixir 50mcg/mL 4 8.03Digoxin PG12 tab 62.5mcg 4 0.03Digoxin12 tab 250mcg 4 0.06Digoxin12 inj 50mcg/2mL 4 2.4Dithranol13 oint 0.25% (100g) 2 For Skin Clinic OnlyDiphenoxylate/ tab 2.5mg/25mcg 4 0.02Atropine17

Dobutamine inj 250mg/ 1 7.48Hydrochloride12 20mL (20mL)Dopamine inj 200mg/5mL 3 6.75Hydrochloride12

Doxepin24 cap 25mg 2 0.02Doxycycline6 cap 100mg 5a 0.03 Refer to STI Protocol in Nursing StationDroperidol1,24 inj 10mg/2.5mL 1 4.7

EECG Electrodel14 gel 250mL 4 4.68Econazole13,22 cream 1% , 20g 4 1.03Econazole22 pessary 150mg/Pkt of 3 4 8.93Efavirenz (EFV)29 tab 50mg Hub For HIV/AIDSEfavirenz (EFV)29 tab 100mg Hub For HIV/AIDSEfavirenz (EFV)29 tab 200mg Hub For HIV/AIDSEfavirenz (EFV)29 tab 600mg Hub For HIV/AIDSEnalapril12 tab 5mg 4 0.02Ephedrine12 Inj 30mg/1mL 1 0.26



Ephedrine28 nasal drop 0.5%, 5mL 4 3.96Ergometrine/ inj 500mcg/5IU 3 2.55 RefrigerateOxytocin22

Erythromycin6 tab 250mg 4 0.17Erythromycin susp 125mg/5mL 3 1.87(Estolate as base)6 (100mL)

Erythromycin6 inj 1g 1 10.17 RESTRICTED ANTIMICROBIAL CONSULANT ONLYEthambutol6 tab 400mg 2 0.07Ethanolamine Oleate28 Inj 100mg/2mL 1

Ethinyloestradiol18 tab 50mcg 1 0.18Ethosuximide5 cap 250mg 2 0.31Ethyl Chloride1 spray 100mL 3 9.28

FFentanyl2 inj 100microgram/2mL 1 1.02 Dangerous DrugsFerrous Sulphate10 tab 200mg 5 0.01Ferrous Gluconate10 elixir 200mg/5mL 5 7.69 IMCI protocol at (100mL) N/S Flucloxacillin Sodium6 susp 125mg/5mL 5 6.94 IMCI protocol at (100mL) N/S

Flucloxacillin Sodium6 cap 250mg 4 0.09Flucloxacillin Sodium6 inj 500mg 3 Alternative to Cloxacillin Inj, if hard to sourceFlucloxacillin Sodium6 cap 500mg 4 0.17Fludrocortisone18 tab 100 microgram 1 0.08Fluorescein14 eye drops 2% (minims) 1 31.06 EYE DEPARTMENT ONLY

5-Fluorouracil Sodium8 inj 500mg 1 1.34 CYTOTOXIC - CONSULTANT ONLY



Fluphenazine inj 25mg/1mL 2 1.07Decanoate24

Folic Acid10 tab 5mg 5 0.01Folinic Acid4 inj 3mg/1mL 1 2.15 Also known as Leucovorin CONSULANT ONLY

Folinic Acid5 inj 100mg/10mL 1 45.64 Also known as Leucovorin CONSULANT ONLY

Fluconazole6 tab 200mg Hub/1 For HIV/AIDS opportunistic infections & Immunocompromised patients

Fluconazole6 inj 2mg/mL (100mL) 1 For HIV/AIDS opportunistic infections & Immunocompromised patients

Fluoxetine tab 20mg 2 St.Giles Only -Hydrochloride24 Depression cases only not responsive to TCAs

Flupenthixol inj 100mg/mL (0.5mL) 2 St.Giles Only -decanoate24 Depression & Pschizophrenic cases non oral dosage compliantFormalin BP Liq 1L 1 8.43Frusemide16 inj 20mg/2mL 4 0.36Frusemide16 tab 40mg 4 0.01Frusemide16 tab 500mg 1 0.16Fullers Earth4 Kit 1 12.5 For paraquat poisoning



GGentamicin21 eye drop 0.3% (10mL) 1 19.49 For Eye Department OnlyGentamicin28 ear drop 0.3% (10mL) 1 For ENT ClinicGentamicin6 inj 80mg/2mL 3 0.12Gentian Violet13 Paint 1% (10mL) 5 0.01Glibenclamide18 tab 5mg 4 0.01Glipizide18 tab 5mg 4 0.03Glucose BP Powder 275g 3 7.71Glutaraldehyde soln 2% 1 70.5(Stabilized)15

Glycerine BP Mixt 500mL 3 22.57Glyceryl Trinitrate12 tab 600mcg 4 0.08Glyceryl Trinitrate12 oint 2% 1Goserelin acetate implant 3.6mg 1 Urology Clinic - CONSULTANT ONLY Refer to protocolGriseofulvin6 tab 125mg 4 0.02Griseofulvin6 tab 500mg 4 0.06

HHaloperidol24 tab 1.5mg 4 0.04Haloperidol24 tab 5mg 4 0.03Haloperidol24 inj 50mg/mL 3 4.75Halothane1 Liq 250mL 1 51.49Hammamelis17 oint 30g 4 12.42Heparin Sodium10 inj 25000u/5mL 1 2.13Homatropine 21 eye drop 2% 1 12.66 For Eye Department OnlyHyaluronidase21 inj 1500iu 1 29.35Hydrallazine12 inj 20mg/1mL 4 9.94Hydrallazine12 tab 25mg 4 0.05Hydrochlorothiazide16 tab 25mg 4 0.01Hydrocortisone Sodium inj 100mg 4 0.64Succinate3,18

Hydrocortisone 13 cream 1% 5 0.71Hydrocortisone 18 tab 20mg 1 0.21Hydrogen Peroxide15 soln 6%/200mL 1 1.76 For Surgical Use Only



Hydroxychloroquine tab 200mg 2 0.42Hydroxycobalamin10 inj 1mg/2mL 4 0.63 Vitamin B12

Hydroxypropylmethl- inj 20mg/1mL 1 114 OCUCOAT® - For cellulose21 Eye Department Only

IIbuprofen2 tab 400mg 4 0.01Idinavir Sulphate (DV)29 cap 400mg Hub For HIV/AIDSImipramine 24 tab 25mg 2 0.09Insulin Neutral18 inj 1000u/10mL 4 17 RefrigerateInsulin Isophane18 inj 1000u/10mL 4 17.19 RefrigerateInsulin Isophane/Neutralmixed (Biphasic 70/30)18 inj 1000u/10mL 4 17.23 RefrigerateIndomethacin2 cap 25mg 4 0.01Indomethacin inj 1mg/mL (1mL) 1 For PDA (Sodium Trihydrate)3 - Consultant Paediatrics OnlyIpratropium Bromide25 soln 25% 1Iron Dextran10 inj 100mg/2mL 4 0.79 For Intra-muscular & Intravenous Routes

Isofl urane1 Liq 500mL 1 Use with specialised inhaler setsIsoniazid6 tab 100mg 2 0.02Isoprenaline12 inj 2mg/2mL 1 4.5Isosorbide Dinitrate12 tab 10mg 4 0.01Isosorbide Dinitrate12 inj 1mg/1mL (50mL) 4 15 Use special non - PVC administration sets - CCU & Consultant Only

JJelly Lubricant13 jelly 42g 5 2.44



KKetamine Hydrochloride1 inj 100mg5mL 1 2.93Ketoconazole6 tab 200mg 2 0.15 For Skin Clinic Only

LLabetalol hydrochloride12 inj 100mg/20mL 1 13.32 Consultant OnlyLactulose17 syrup 3.35g/500mL 1 6.45 For Hepatic EncephalopathyLevodopa/Benserazide tab 100mg/25mg 2 0.22Hydrochloride9

Levodopa/Benserazide tab 200mg/50mg 2 0.32Hydrochloride9

Lignocaine1,12 inj 1% 1 0.74 For IM and IV use

Lamivudine6 tab 150mg Hub/1 PEP Needle stick Injury & For HIV/AIDS

Lignocaine1 inj 2%/10mL 5 0.58 For IM and IV useLignocaine Heavy1 inj 5% 1 16.51Lignocaine with inj 2% 1:200,000 1 4.3Adrenaline1

Lignocaine with inj 2% 1:80,000 4 13.86 Adrenaline1

LignocaineTopical1 spray 10%/200mL 1 15.94LignocaineTopical1 soln 4%/200mL 1Lignocaine1 Oral Gel 2%/200mL 4 1.69Lignocaine/Prilocaine1 patch 2.5%/2.5% 1 138.93 PAEDIATRIC USE (Pkt of 25) ONLY

Lithium Carbonate24 tab 250mg 2 0.28Lopinavir/ritonavir tab 200mg/50mg Hub For HIV/AIDS(LPV/r)29



MMagnesium Sulphate26 inj 50% 3 1.85Magnesium Trisilicate17 mixt 200mL 5 0.99Magnesium Sulphate13 paste 50g 5 2.13Mebendazole6 chewable 100mg 5 0.01 IMCI protocol at tab N/S

Medium Chain Oil 500mL 1 37.27 Inpatients & Triglyceride26 Discharge Only

Medroxprogesterone18 tab 10mg 1 0.39 Use in secondary amennorhea only

Melphalan8 tab 5mg 1 1.64 CONSULTANT ONLY

Mercaptopurine8 tab 50mg 1 1.31 CONSULTANT ONLY

Methadone2 tab 5mg 1 0.16 DANGEROUS DRUGMetformin18 tab 500mg 4 0.02Methotrexate Sodium8 inj 50mg/2mL 1 4.6 CONSULTANT ONLY

Methotrexate Sodium8 tab 2.5mg 1 0.26 CONSULTANT ONLY

Methylated Spirit15 Soln 70% 5 (SVM)Methyldopa12 tab 250mg 4 0.06Methylene Blue inj 1% 1 10.71 For surgical use onlyMethyl Hydroxy- Powder 100g 3 6.2benzoate Pulv BPMethylprednisolone inj 1g 1 63.2 CONSULTANT acetate8 ONLYMetoclopramide inj 10mg/2mL 1 0.21Hydrochloride17

Metronidazole6 tab 200mg 4 0.01Metronidazole6 suppos 500mg 1 2.33 RESTRICTED ANTIMICROBIAL CONSULANT ONLY



Metronidazole6 inj 500mg/100mL 1 1.8 RESTRICTED ANTIMICROBIAL CONSULANT ONLY

Miconazole Nitrate22 vag cream 2% 1 5.32 For Gynae Clinic Only

Midazolam1 oral soln 2mg/mL 1 3.3 PAEDIATRIC USE (200mL) ONLY

Midazolam1 inj 10mg/2mL 1 3.3 PAEDIATRIC USE ONLY

Misoprostol22 tab 100microgram 1 0.44 CONSULTANT ONLY - O & G

Morphine Sulphate1,2 inj 10mg/1mL 4 0.47 Dangerous DrugsMorphine Sulphate2 oral soln 20mg/mL 3 Dangerous Drugs (30mL)Morphine Sulphate2 tab 10mg 3 0.25 Dangerous DrugsMorphine Sulphate SR2 tab 30mg 3 0.5 Dangerous Drugs

Multivitamin*27 coated 4 0.02 tablet

*Vitamin A - 2500 IU, Nicotinamide ( Vit B3) - 7.5mg, Thiamine(Vit B1) - 1mg, Ascorbic Acid - 15mg, Ribofl avin (Vit. B2) -0.5mg, Colecalciferol (Vit. D3) - 300 IU

Multivitamin*27 syrup 100ml 4 1.36

*Vitamin A – 2,500 IU, Vitamin D3 – 400IU, Vitamin B1 – 1mg,Vitamin B2 – 0.7mg, Vitamin B6 – 1mg, Vitamin C - 18mg, Nicotinamide – 5mg

NNaloxone4 inj 400microgram/1mL 3 1.51 Antidote- OpioidsNaphazoline HCl eye drops 1%/15mL 1 For Eye Department Only

Nelfi navir (NFV)29 cap 250mg Hub For HIV/AIDSNeomycin13 oint 1% 4 0.94



Neostigmine20 inj 2.5mg/1mL 1 0.65Nevirapine (NVP)29 tab 200mg Hub For HIV/AIDSNifedipine12 cap 10mg 4 0.01 Obstetric Use OnlyNifedipine MR12 tab 20mg 4 0.01Nitrofurantoin6 tab 100mg 3 0.05Norethisterone18 tab 5mg 3 0.03 For Gynae Clinic OnlyNystatin6 susp 100,000u/mL 4 1.84

OOral Rehydration crystal For 1L prep. 5 4.86 UNICEF Salt17,26 MODIFIED FORMULAOestrogen cream 42.5g 1 9.79Conjugated22

Olanzapine24 tab 10mg 2 0.12 For St. Giles ONLY

Ondansetron inj 8mg/4mL 1 Chemotherapy Hydrochloride17 induced nausea & vomiting - refer to protocol

Ondansetron tab 8mg 1 Chemotherapy Hydrochloride17 induced nausea & vomiting - refer to protocol

Oxybuprocaine21 eye drop 0.40% 1 1.55 For eye department onlyOxybutinin HCI20 tab 5mg 2 0.1

Oxytocin22 inj 10 IU/1mL 5 0.32 Refrigerate



PPancuronium inj 4mg/2mL 1 1.35Bromide20

Paracetamol2,7 tab 500mg 5 0.01Paracetamol2,7 suppos 125mg 3 0.08Paracetamol2,7 suppos 500mg 1 1.32Paracetamol2 mixt 120mg/5mL 5 0.58 (100mL)

Paraffi n BP17 liq 500mL 5Paclitexal*8 inj 100mg in 16.7mL 1 FOR CONSULTANT USE ONLY Refer to protocol*Advanced metastatic ovarian cancer after failure of prior therapy which includes a platinum

Penicillin Crystalline6 inj 1mega unit 4 0.53Penicillin Benzathine6 inj 2.4 megaunit 4 0.95Penicillin Procaine6 inj 4 mega unit 4 1.41Penicillin V6 tab 250mg 4 0.03Penicillin V6 syrup 125mg/5mL 4 2.12 (100mL)

Pethidine1,2 inj 50mg/1mL 4 0.41 Dangerous DrugsPethidine1,2 inj 100mg/2mL 5a 1.12 Dangerous DrugsPhenobarbitone inj 200mg/1mL 1 1.71Sodium24

Phenobarbitone 5,24 tab 15mg 4 0.02Phenobarbitone 5,24 tab 60mg 4 0.06Phenobarbitone syrup 100mg/5mL 1(HM) 5,24

Co-Phenyl Forte Topical 1 For ENT Clinic (Anaesthetic)12 Spray OnlyPhenylepherine 21 eye drop 10% 1 1.76Phenytoin 5 susp 30mg/5mL 4 17.47Phenytoin 5 Chewable 50mg 1 0.01 tabPhenytoin 5 cap 100mg 4 0.01Phenytoin Sodium 5 inj 250mg/5mL 3 4.01Pilocarpine21 eye drop 1% 3 4.2 For Eye Department Only



Pilocarpine21 eye drop 2% 3 6.2 For Eye Department Only

Pilocarpine21 eye drop 4% 3 9.32 For Eye Department Only

Piperacillin6 inj 2g 1 44.2 Restricted AntimicrobialPlastic Spray 13 spray 1

Polyantibiotic* 21 eye drop 1 2.12 For Eye Department Only*Polymyxin B Sulphate - 500IU, Neomycin Sulphate - 1700 IU or 2.5mg, Gramicidin - 25 microgram/mL, Thiomersal 0.001%

Polyantibiotic* 21 eye oint 1 4.92 For Eye*Polymyxin B Sulphate - 500IU, Neomycin Sulphate - 5mg, Department OnlyBacitracin zinc 400 Units/g. Sterile

Potassium tab 600mg 4 0.01Chloride S.R 16

Potassium Chloride 26 inj 7.46% w/v 2 0.73Potassium Chloride 26 mixt 1mmol/mL 1 20.7 Paediatrics Only (100mL)Potassium Citrate 26 mixt 20% 5 0.97Povidone Iodine soln 10% (500mL) 3 11 For SDH with Alcoholic 15 Operating Theater

Povidone Iodine soln 10% (500mL) 3 9.68Acqueous 15

Povidone Iodine soln 7.5% (500mL) 3 6.48 For SDH with Scrub 15 Operating Theater

Pralidoxime 4 inj 500mg/20mL 3 62.61 For anti- cholinesterase poisoning

Prednisolone with eye drop 10mg/ 1 18.34 For Eye Phenylepherine HCl21 1.2mg/mL Department Only



Prednisolone tab 1mg 1 0.03acetate 3,8,18

Prednisolone tab 5mg 4 0.01acetate 3,8,18

Prednisolone tab 20mg 1 0.11 CONSULTANT acetate18 USE ONLY Paediatrics

Prilocaine 1 inj 4%/2.2mL 1 0.71 For Dental Use OnlyPrimaquine 6 tab 7.5mg 1 0.09Primidone 5 tab 250mg 2 0.23 For St. Giles OnlyProbenecid 2 tab 500mg 4 0.12Procarbazine HCL 8 cap 50mg 1 2.17 CYTOTOXIC - CONSULTANT ONLYProchlorperazine HCl 17 tab 5mg 4 0.01Prochlorperazine HCl17 inj 12.5mg/1mL 4 0.72Promethazine 3,17,25 tab 10mg 4 0.01Promethazine 3,25 elixir 1mg/mL 3 0.82Promethazine 1,317,25 inj 50mg/2mL 4 0.36Propranolol 12 inj 1mg/1mL 1 0.93Propranolol 12 tab 10mg 4 0.01Propranolol 7,12 tab 40mg 4 0.01Propyl Hydroxy- Powder 100g 3 6.2benzoate Pulv BP

Propylene Glycol BP liq 1L 3 22.11Protamine Sulphate 4,10 inj 1% (5mL) 1 6.76 Heparin Antidote

Psoriasis 13 oint 100g 2 26.01 For Skin Clinic OnlyPyrantel Pamoate 6 Chewable 250mg 1 0.66 tab Pyrazinamide 6 tab 500mg 2 0.07Pyridostigmine 20 tab 60mg 1 0.38 For Mysthenia Gravis PatientsPyridoxine 27 tab 25mg 3 0.03Pyrimethamine/ tab 25mg/500mg 1 0.07Sulphadoxine 6



QQuinine inj 600mg/10mL 1 0.95Dihydrochloride 6

Quinine Sulphate 6 tab 200mg 1 0.16

RRanitidine tab 300mg 4 0.06(as Hydrochloride) 17

Ranitidine inj 50mg/2mL 1 0.53 CONSULTANT ONLY(as Hydrochloride)17

Rifampicin 6 oral susp 100mg/50mL 2 (60mL)Rifampicin 6 cap 150mg 2 0.07Rifampicin 6 cap 300mg 2 0.14Rifampicin / Isoniazide 6 cap 150mg/100mg 2 0.1Rifampicin / Isoniazide 6 cap 300mg/150mg 2 0.1Rotinavir ®29 cap 100mg Hub For HIV/AIDS

SSalbutamol 22,25 inj 500mcg/1mL 3 0.35 CONSULTANT ONLYSalbutamol 22,25 tab 4mg 4 0.01Salbutamol 25 inhaler 100mcg/dose 4 2.88Salbutamol - soln 0.5% (30mL) 4 2.01Respirator25

Salbutamol 25 elixir 2mg/5mL 4 0.61Saquinavir (SQV)29 caps-gel 200mg Hub For HIV/AIDS fi lled Silver Nitrate13 stick Pkt of 1 stick 4 1.62Silver Sulphadiazine13 cream 1% 3 11.23Simvastatin12 cap 10mg 1 CONSULTANT ONLY - Refer to protocol

Simvastatin12 cap 20mg 1 CONSULTANT ONLY - Refer to protocol



Soda Lime Granules 4.5kg 1 7.83Sodium Bicarbonate 26 inj 8.4% (10mL) 3 12.43Sodium Chloride 26 inj 0.9% (20mL) 3 0.29Sodium Chloride 26 inj 20% 1 0.23Sodium Chloride BP crystals 1kg 3 6.93Sodium Citrate BP crystals 1kg 3 12.88Sodium Hypochlorite soln 1%/1L 5 7.63 (HOSPITAL GRADE)

Sodium Hypochlorite soln 1%/5L 1 21.88 (HOSPITAL GRADE)

Sodium Polystyrene26 powder 15g/scoop 1 84.88 (Resonium A)Sulfonate ResinSodium Valproate 5 elixir 200mg/5mL 2 17.89 (500mL)Sodium Valproate 5 tab 200mg 4 0.05 (Enteric Coated)Spironolactone 16 tab 25mg 3 0.06

Stavudine (d4T) 29 tab 30mg Hub For HIV/AIDSStavudine (d4T) 29 tab 40mg Hub For HIV/AIDS

Streptokinase 12 inj 1.5 Milliunits 1 113.57 CONSULTANT ONLY - CCUStreptomycin Sulphate 6 inj 1g 2 0.78

Sulphasalazine 17 tab 500mg 2 0.14

Sulphathiazole / cream 3.42%/2.86%/ Sulphacetamide/ 3.7% sulphabenzamide 22 1 25.08 For O & G Use OnlySuxamethonium inj 100mg/2mL 1 0.77Chloride 20

Syrup BP soln 4L 3 6.52



TTalc Pulverized BP Powder 1kg 1 1.09 CONSULTANT ONLY

Tamoxifen Citrate 8 tab 20mg 1 0.14 CYTOTOXIC - CONSULTANT O + G ONLY

Tetracosactrin 14 inj 250mcg/1mL 1 13.65 CONSULTANT ONLYTetracycline 21 eye oint 1% (3.5g) 4 0.28Tetracycline 6 cap 250mg 3 0.02Theophylline 25 elixir 80mg/15mL 1 10.87Theophylline SR 25 tab 300mg 4 0.08Thiabendazole6 Chewable tab 250mg 4 0.23Thiamine HCI 27 tab 500mg 1 0.35Thiamine HCI 27 inj 100mg/2mL 1 1.92Thiopentone Sodium 1 inj 2.5g 1 36.16Thioridazine 24 tab 10mg 2 0.03Thioridazine 24 tab 100mg 2 0.08Thioridazine 24 tab 50mg 2 0.06Thyroxine 18 tab 50 microgram 3 0.02 Oroxine Brand ®Thyroxine 18 tab 100 microgram 3 0.02 Oroxine Brand ®

Timolol 21 eye drop 0.50% 1 1.24 For Eye Department Only

Timolol 21 eye drop 0.25% 1 0.76 For Eye Department OnlyTrifl uoperazine HCI 24 tab 1mg 2 0.05Trifl uoperazine HCI 24 tab 5mg 2 0.04Trimethoprim 6 tab 300mg 4 0.11Trimethoprim 6 susp 50mg/5mL 5 9.63 (100mL)Tropicamide 14,21 eye drop 1% 1 2.92 For Eye Department Only

Tropicamide 21 eye drops 0.5% (15mL) 1 21.75 For Eye Department Only



VVancomycin inj 500mg 1 9.16 RESTRICTEDHydrochloride6 ANTI MICROBIAL CONSULTANT ONLY

Vecuronium bromide 20 inj 10mg/1mL 1 17.78 (5mL)

Verapamil inj 2.5mg/1mL 3 3.7hydrochloride12 (2mL)

Verapamil tab 40mg 3 0.07hydrochloride12

Vinblastin Sulphate8 inj 1mg/mL 1 27.16 CYTOTOXIC - (10mL) CONSULTANT ONLY

Vincristine Sulphate 8 inj 1mg/1mL (1mL) 1 5.3 CYTOTOXIC - CONSULTANT ONLY

Vitamin A27 gel fi lled 50,000 IU 5 IMCI Protocol caps at N/S



Vitamin K (1)10,27 inj 1mg/mL 3 0.42

Vitamin K (1)10,27 inj 10mg/1mL 3 0.35



WWarfarin Sodium 10 tab 1mg 1 0.06 MAREVAN BRAND ®

Warfarin Sodium 10 tab 3mg 1 MAREVAN BRAND ®

Warfarin Sodium 10 tab 5mg 1 0.08 MAREVAN BRAND ®Wax Removal 28 ear drops 15mL 4 3.18(Carbamide Peroxide6.5%)

White Soft Parrafi n BP oint 1kg 1Whitfi elds13 oint 50g 5 1.55Whitfi elds (Strong)13 lotion 100mL 5 1.59

Water for Injection 26 inj 5mL 5 0.04 Polyvial Bottle

Water for Injection 26 inj 100mL 1 3.78 For Humidifi er Use Only - NICU

ZZidovudine (ZDV) 6 cap 100mg 1 0.35 For needle stick injury

Zidovudine (ZDV)29 cap 300mg Hub For HIV/AIDS

Zinc Oxide oint 5 1.71



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ITEM DIV MAT. SDH H/C N/S UNIT REMARKS HOS HOS COST Anti-D RHS * * * 66.75 Single DoseImmunoglobulin 250mcg/mL19

BCG Vaccine19 * * * * * 0.12 20 Doses

Cholera Vaccine19 “ONLY FOR SUVA, LTK, LABASA HEALTH CTR/OFFICE” Single Dose - Request Only

HBV Immunoglobulin * 82.96 Single Dose400units/mL19

Hepatitis B Vaccine * * * * * 0.72 Single Dose10mcg (Infant)19

Hepatitis B Vaccine * * 0.45 20mcg/mL (Adult)*19

*Staff vaccination co-ordinated by Divisional Infection Control Manager

Measels-Rubella19 * * * * * 0.84 10 Doses

Normal * N/AV Single Dose Human Gammaglobulin - Request Only16%/2mL19 BY CONSULTANT Oral Poliomyelitis * * * * * 0.13 10 Drops (Sabin) Vaccine19

PPD Human Tuberculin * * 3.67 10 Doses (Mantoux)14

100,000 units/mL

Tetanus Toxoid Absobed * * * * * 0.14 10 Doses Vaccine19

Typhoid Vaccine19 * * * * N/AV 3 Doses - Request Only

TABLE D - Alphabetic Listing of Immunological Preparations


ITEM DIV MAT. SDH H/C N/S UNIT REMARKS HOS HOS COST DPT- HB + Hib19 * * * * * 3.22 2 Doses (Pentavalent) Varicella Zoster * N/AV Single Dose Immunoglobulin19 - Request Only

Yellow Fever Vaccine19 # * 37.43 Single Dose

#Members of Public & staff from other Govt. Depts. to purchase from BPS.

All MCH Vaccine Orders to FPSC or any Health Facility must be accompanied by a fi lled Vaccine Return Form

TABLE D - Alphabetic Listing of Immunological Preparations


PHARMACOLOGICAL DRUG LIST INDEX

Section 1 Anaesthetics 2 Analgesics, antipyretics and related agent 3 Anti-allergics and drugs used in anaphylaxis 4 Antidotes and other substances used in poisoning 5 Antiepileptics 6 Anti-infectives 7 Antimigraine drugs 8 Antineoplastics and immunosuppressants 9 Antiparkinsonism drugs 10 Blood, drugs affecting 11 Blood products and substitute 12 Cardiovascular drugs 13 Dermatological preparations 14 Diagnostic agents 15 Disinfectants and antiseptics 16 Diuretics 17 Gastrointestinal drugs 18 Hormones, other endocrine drugs and Reproductive Health Commodities19 Immunological 20 Muscle relaxants, cholinegic agents and anticholinesterases 21 Opthamological preparations 22 Gynaecological and obstetric preparations 23 Dialysis, peritoneal 24 Psychotherapeutic agents 25 Respiratory agents 26 Preparations correcting water, electrolyte and acid-base balance 27 Vitamins and minerals 28 Ear, nose and oropharyngeal preparations 29 Anti-retrovirals (ARVs)


Table E - Formulary listings in Pharmacological Categories

PHARMACOLOGICAL DRUG LIST

SECTION 1 ANAESTHETICS

1.1 General Anaesthetics

Halothane solnIsoflurane liq 100mLKetamine inj 100mg/1mLThiopentone Sodium inj 2.5g

1.2 Local Anaesthetics

Bupivacaine Plain inj 0.50%Bupivacaine Heavy inj 0.50%Bupivacaine with Adrenaline inj 0.5%/1:200,000Ethyl Chloride sprayLignocaine Plain inj 1%(10mL)Lignocaine Heavy inj 5%(2mL)Lignocaine Plain inj 2%(20mL)Lignocaine with Adrenaline inj 2%1:200000Lignocaine with Adrenaline inj 2%1:80000Lignocaine Topical spray 10%Lignocaine jelly 2%Lignocaine/Prilocaine cream 2.5%/2.5%Prilocaine inj 4%(2.2mL)Co-Phenyl Forte topical spray

1.3 Pre-Operative Medicine

Atropine Sulphate inj 600mcg/1mLDiazepam tab 5mgDiazepam inj 10mg/2mLDroperidol inj 10mg/2.5mLMidazolam inj 10mg/2mLMorphine Sulphate inj 10mg/1mLPethidine inj 50mg/2mLPethidine inj 100mg/2mLPromethazine inj 50mg/2mL

SECTION 2 ANALGESTICS, ANTIPYRETICS AND RELATED AGENTS2.1 Non-Opioids

Allopurinol tab 100mgAspirin tab 300mgColchicine tab 500mcgIbuprofen tab 400mgIndomethacin cap 25mgParacetamol tab 500mgParacetamol elixir 120mg/5mL

DRUG NAME FORM STRENGTH



Paracetamol suppos 125mgParacetamol suppos 500mgProbenecid tab 500mg

2.2 Opioids

Codeine Phosphate tab 28mgFentanyl inj 100mcg/2mLMethadone tab 5mgMorphine Sulphate tab 10mgMorphine Sulphate SR tab 30mgMorphine Sulphate inj 10mg/1mLMorphine Sulphate mixture 20mg/mLPethidine inj 50mg/1mLPethidine inj 100mg/2mL

SECTION 3 ANTIALLERGICS AND DRUGS USED IN ANAPHYLAXIS

Adrenaline inj 1mg/1mLDexamethasone tab 500mcgDexamethasone tab 2mgDexamethasone inj 4mg/1mLHydrocortisone Sod. Succinate inj 100mgPrednisolone tab 1mgPrednisolone tab 5mgPrednisolone tab 20mgPromethazine tab 10mgPromethazine elixir 1mg/mLPromethazine inj 50mg/2mL

SECTION 4 ANTIDOTES AND OTHER SUBSTANCES USED IN POISONING

Acetylcysteine inj 2g/10mLAtropine Sulphate inj 600mcg/1mLBenztropine inj 2mg/2mLCharcoal Activated solnDesferrioxamine inj 500mgFolinic Acid inj 3mg/1mLFolinic Acid inj 100mg/10mLFullers Earth KitMethylene Blue inj 1%Nalaxone inj 400mcg/1mLPralidoxime inj 500mg/10mLProtamine Sulphate inj 1%




SECTION 5 ANTIEPILEPTICS

Carbamazepine tab 200mgDiazepam inj 10mg/2mLEthosuximide cap 250mgPhenobarbitone tab 15mgPhenobarbitone tab 60mgPhenobarbitone (HM) elixir 100mg/5mLPhenytoin susp 30mg/5mLPhenytoin chew. Tab 50mgPhenytoin cap 100mgPhenytoin Sodium inj 250mg/5mLPrimidone tab 250mgSodium Valproate elixir 200mg/5mLSodium Valproate tab 200mgSodium Valproate tab 200mgSECTION 6 ANTI-INFECTIVE DRUGS

6.1 Anthelmintics

6.1.1 Intestinal Anthelmintics

Mebendazole tab 100mgPyrantel Embonate tab 250mg

6.1.2 AntifilarialsDiethylcarbamazine tab 50mg

6.2 Antibacterials

6.2.1 Penicillins

Amoxycillin cap 250mgAmoxycillin cap 500mgAmoxycillin susp 125mg/5mLAmoxycillin/Clavulanic Acid tab 500mg/125mgAmpicillin inj 500mgCloxacillin inj 500mgFlucloxacillin inj 500mgFlucloxacillin susp 125mg/5mLFlucloxacillin cap 250mgFlucloxacillin cap 500mgPenicillin G inj 1mega unitPenicillin Benzathine inj 2.4 mega unitPenicillin Procaine inj 4mega unitPenicillin V tab 250mgPenicillin V syrup 125mg/5mLPiperacillin inj 1g




6.2.2 Other Antibacterial Drugs

Cefaclor SR tab 375mgCeftriaxone inj 250mgCeftriaxone inj 1gCephalothin Sodium inj 1gChloramphenicol cap 250mgChloramphenicol inj 1gChloramphenicol susp 125mg/5mLCiprofloxacin tab 500mgCiprofloxacin inj 100mg/50mLCo-trimoxazole tab 480mgCo-trimoxazole susp 240mg/5mLDoxycycline cap 100mgErthromycin tab 250mg/5mLErthromycin susp 125mg/5mLErthromycin inj 1g

ErythromycinErythromycinErythromycinGentamicin inj 80mg/2mLMetronidazole tab 200mgMetronidazole suppos 500mgMetronidazole inj 500mg/100mLNitrofurantoin tab 100mg/50mLTetracyline cap 250mgTrimethoprim tab 280mgTrimethoprim susp 50mg/5mLVancomycin inj 500mg

6.2.3 Antileprosy Drugs

Tetracycline

Dapsone tab 50mgDapsone tab 100mgRifampicin cap 150mgRifampicin cap 300mg

6.2.4 Antituberculosis Drugs

Ethambutol tab 400mgEthambutol/Isoniazid tab 100mg/100mgIsoniazid tab 100mgPyrazinamide tab 500mgRifampicin cap 150mgRifampicin cap 300mgRifampicin oral susp 100mg/5mLRifampicin/Isoniazid cap 150mg/100mgRifampicin/Isoniazid cap 300mg/150mgStreptomycin inj 1g




6.2.5 Antiviral Drugs

Aciclovir inj 250mgAciclovir tab 200mgLamivudine tab 150mgZidovudine cap 100mg

6.3 Antifungal Drugs

Amphotericin B inj 50mgFluconazole inj 200mg/mLFluconazole tab 200mgGriseofulvin tab 125mgGriseofulvin tab 500mgKetoconazole tab 200mgNystatin susp 100,000u/mL

6.4 Antiprotozal Drugs

6.4.1 Antiamoebic Drugs

Choroquine Sulphate tab 200mgMetronidazole tab 200mg

6.4.2 Antimalarial Drugs

a) Curative

Chloroquine Sulphate tab 200mgDoxycycline cap 100mgPrimaquine tab 7.5mgQuinine Dihydrochloride inj 600mg/10mL

b) Prophylaxis

Chloroquine Sulphate tab 200mg

6.4.3 Drugs for ToxoplamosisPrimethamine tab 25mgSulphadiazine tab 500mg

SECTION 7 ANTIMIGRAINE DRUGS

Aspirin tab 300mgMetoclopramide inj 10mg/2mLParacetamol tab 500mgParacetamol suppos 125mgParacetamol suppos 500mgParacetamol mixt 125mg/5mL

Units/mL




SECTION 8 ANTINEOPLASTIC & IMMUNOSUPPRESIVE DRUGS

8.1 Immunosuppressive drugs

Azathioprine tab 50mgCyclophosphamide tab 50mgDexamethasone tab 500mcgHydroxychloroquine tab 200mgMethylprednisolone inj 200mgPrednisolone tab 1mgPrednisolone tab 5mgPrednisolone tab 20mg

8.2 Antineoplastic drugs

Actinomycin D inj 500mcgAdriamycin inj 50mgArabinocide - C inj 100mgBleomycin inj 15,000IUBusulphan tab 5mgChlorambucil tab 5mgCisplatin inj 10mgCisplatin inj 50mgCyclophosphamide inj 200mgCyclophosphamide inj 500mgCyclophosphamide inj 1gCyclophosphamide cap 50mgDacarbazine inj 200mgDaunorubicin inj 20mg5-Fluorouracil inj 500mgGoserelin Acetate implant 3.6mgL-asparaginase inj 10,000iuMelphalan tab 5mgMercaptopurine tab 50mgMethotrexate inj 50mg/2mLMethotrexate tab 2.5mgPaclitexal inj 100mg/16.7mLProcarbazine cap 50mgVinblastine inj 10mgVincristine Sulphate inj 1mg

8.3 Hormones & Anti-hormones

Dexamethasone tab 500mcgDexamethasone tab 2mgDexamethasone inj 5mg/1mLEthinyloestradiol tab 50mcgPrednisolone tab 1mgPrednisolone tab 5mgPrednisolone tab 20mgTamoxifen tab 20mg

Acetate 1g




SECTION 9 ANTIPARKINSONISM DRUGS

Benzhexol tab 2mgBenztropine inj 2mg/2mLBenztropine tab 2mgBromocriptine tab 2.5mgLevodopa/Benserazide tab 200mg/50mgLevodopa/Benserazide tab 100mg/25mg

SECTION 10 BLOOD, DRUGS AFFECTING

10.1 Anti-anaemia Drugs

Ferrous Sulphate tab 200mgFerrous Gluconate elixir 200mg/5mLFolic Acid tab 5mgHydroxycobalamin inj 1mg/2mLIron Dextran - IM/IV inj 100mg/2mL

10.2 Anticoagulants and Antagonists

Heparin sodium inj 25000u/5mLProtamine Sulphate inj 1%Vitamin K1 inj 1mg/0.5mLVitamin K1 inj 10mg/1mLWarafarin Sodium tab 5mgWarfarin Sodium tab 3mgWarafarin Sodium tab 1mg

SECTION 11 BLOOD PRODUCTS AND BLOOD SUBSTITUES

Plasma volume expander 500mL

SECTION 12 CARDIVASCULAR DRUGS

12.1 Antianginal Drugs

Atenolol tab 50mgGlyceryl Trinitrate oint 2%Glyceryl Trinitrate S/L tab 600mcgIsosorbide Dinitrate tab 10mgIsosorbide Dinitrate inj 1mg/mLPropranolol inj 1mg/1mLPropranolol tab 40mgPropranolol tab 10mgVerapamil tab 40mgtab 40mg




12.2 Antiarrhythmic Drugs

Adenosine inj 6mg/2mLAmiodarone tab 100mgAmiodarone inj 150mg/3mLAtenolol tab 50mgLignocaine Plain inj 1% (10mL)Propranolol inj 1mg/1mLPropranolol tab 40mgPropranolol tab 10mgQuinidine Durules S.R. tab 250mgVerapamil inj 2.5mg/1mLVerapamil tab 40mg

12.3 Antihypertensive Drugs

Atenolol tab 50mgHydrochlorothiazide tab 25mgHydrallazine inj 20mg/1mLHydrallazine tab 25mgLebetalol inj 100mg/20mLMethyl Dopa tab 250mgNifedipine cap 10mgNifedipine MR tab 20mgPropranolol inj 1mg/1mLPropranolol tab 40mgPropranolol tab 10mg

12.4 Drugs used in heart Failure

Digoxin elixir 50mcg/mLDigoxin tab 62.5mcgDigoxin tab 250mcgDigoxin inj 500mcg/2mLEnalapril tab 5mgIsosorbide Dinitrate inj 1mg/mL

12.5 Drugs Used in Vascular Shock

Adrenaline inj 1mg/1mLDobutamine inj 250mg/20mLDopamine inj 200mg/5mLEphedrine inj 30mg/1mLIsoprenaline inj 2mg/2mL

12.6 Antithrombotic Drugs

Aspirin tab 300mgStreptokinase inj 1.5mU




12.7 Drugs used for Patent Ductus Arteriosus

Indomethacin (as Sodium Trihydrate) inj 1mgProstaglandin E1 (Alprostadil) inj 500mcg/mL

12.8 Local sclerosants

Ethanolamine Oleate inj 5%

12.9 Lipid lowering drugsSimvastatin cap 10mgSimvastatin cap 20mg

SECTION 13 DERMATOLOGICAL PREPARATIONS

13.1 Antifungal Agents

Econazole cream 1%Whitfields ointWhitfields lotion strong

13.2 Anti-infective Agents

Gentian Violet soln 1%Neomycin oint 1%Silver Sulphadiazine cream 1%

13.3 Anti-inflammatory and Anti-puritic Drugs

Betamethasone cream 0.10%Betamethasone lotion 0.10%Calamine lotionHydrocortisone cream 1%Zinc Oxide oint

13.4 Keratoplastic and Keratolytic Agents

Coal Tar ointDithranol oint 0.25%Psoriasis oint

13.5 Scabicides and Pediculocides

Benzyl Benzoate lotion 25%

13.6 Other Dermatological Preparations

Jelly LubricantMagnesium Sulphate pasteSilver nitrate sticks




SECTION 14 DIAGNOSTIC AGENTS

14.1 Ophthalmic Drugs

Fluorescein eye drops 2%Tropicamide eye drops 1%

14.2 Immunological Agents

PPD Human tuberculin (Mantoux) 100units/mL

14.3 Other AgentsECG Electrode Gel gelTetracosactrin inj 250mcg/1mL

SECTION 15 DISINFECTION AND ANTISEPTICS

Ethyl Alcohol (SVR) soln 96%Chlorhexidine Gluconate soln 20%Chlorhexidine Gluconate cream 1%Chlorhexidine (HM) soln 1%Chlorhexidine in SVM (HM) soln 0.50%Chlorhexidine - Cetrimide soln 1.5%/15%Chlorhexidine - Cetrimide aq. cream 1.5%/15%Glutaraldehyde (Stabilized) soln 2%Hydrogen peroxide soln 6%Methylated Spirit soln 70%Povidone Iodine alcoholic soln 10%Povidone Iodine aqueous soln 1%Povidone Iodine scrub soln 7.5%

SECTION 16 DIURETICS

Acetazolamide tab 250mgFrusemide inj 20mg/2mLFrusemide tab 40mgFrusemide tab 500mgHydrochlorothiazide tab 25mgMannitol soln 20%Spironolactone tab 25mg

SECTION 16 GASTROINTESTINAL DRUGS

17.1 Antacids and Other Related Drugs

Magnesium Trisilcate mixtRanitidine (as Hydrochloride) Coated tab 300mgRanitidine (as Hydrochloride) inj 50mg/2mL




17.2 Antiemetic Drugs

Metoclopramide inj 10mg/2mLOndanseteron inj 8mg/mL (4mL)Ondanseteron tab 4mgProchlorerazine tab 5mgProchlorerazine inj 12.5mg/mLPromethazine tab 10mg/2mLPromethazine inj 50mg/2mL

17.3 Anti-Haemorrhoidal Drugs

Hammamelis oint

17.4 Anti-Inflammatory Drugs

Sulphasalazine tab 500mg

17.5 Cathartic Drugs

Bisacodyl suppos 10mgBisacodyl tab 5mgParaffin liq

17.6 Anti-diarrhoeal Drugs

Codeine Phosphate tab 30mgDiphenoxylate/Atropine tab 2.5mg/25mcg

17.7 Drugs Used in Hepatic Encophalopathy

Lactulose syrup 3.35/5mL

SECTION 18 HORMONES, OTHER ENDOCRINE DRUGS AND CONTRACEPTIVES

18.1 Adrenal Hormones and Synthetic Substitutes

Bromocriptine tab 2.5mgDexamethasone tab 500mcgDexamethasone tab 2mgDexamethasone inj 4mg/1mLFludrocortisone tab 100mcgHydrocortisone Sod. Succinate inj 100mgPrednisolone tab 1mgPrednisolone tab 5mgPrednisolone tab 20mg




18.2 Contraceptives

Male Condoms - Pacific Design (PD) 52mmIUCD Copper T 380 IUCD

Depo-medroxyprogesterone Acetate 150mg Injection (DEPO-PROVERA - 3 monthly)

inj 150mg/mLMicrogynon 30 ED - Ethinyloestradiol /Levonorgestrel tab 30mcg/150mcgLevonogestrel (MICROLUT) 35 tabs tab 0.03mgLevonogestrel Tablet - (POSTINOR) Box of 2 pills 0.75mgLevonorgestrel (NORPLANT) Pkt of 6 Implants 36mg/rodNoristerat enanthate - 2 monthly (NORISTERAT) inj 200mg

18.3 Oestrogens

Ethinyloestradiol tab 50mcg

18.4 Insulin and Other antidiabetic Agents

Desmopressin inj 4mcg/mLGlibenclamide tab 5mgGlipizide tab 5mgInsulin Neutral inj 1000u/10mLInsulin Isophane inj 1000u/10mLInsulin Isophane/Neutralmixed (biphasic) 70/30 inj 1000u/10mLMetformin tab 500mg

18.6 ProgestogensMedroxyprogesterone Acetate tab 10mgNorethisterone tab 5mg

18.7 Thyroid and Anti-Thyroid Drugs

Carbimazole tab 5mgThyroxine tab 50 microgramThyroxine tab 100 microgram

SECTION 19 IMMUNOLOGICALS

19.1 Sera and Immunoglobulins

Anti-D RHD Immunoglobulin inj 250mcg/mLHBV Immunoglobulin inj 400units/mLNormal Human Immunoglobulin inj 16%/2mLVaricella Zoster Immunoglobulin inj

18.2 Reproductive Health CommoditiesDRUG NAME FORM STRENGTH



19.2 Vaccines

19.2.1 For Universal Immunisation

BCG (20 doses) injDPT-Hib-HBV (2 doses) injHepatitis B Vaccine (Infant) 10 mcg injHepatitis B Vaccine (Adult) 20mcg/mL injMeasles-Rubella (10 doses) injPoliomyelitis (Sabin) - 10 doses oral dropTetanus Toxoid Absorbed - 10 doses inj

19.2.2 For Specific Groups of Individuals

Cholera - Single Dose injTyphoid - Single Dose injYellow Fever - Single dose inj

SECTION 20 MUSCLE RELAXANTS, ANTI-CHOLINESTERASESAND CHOLINEGIC AGENTS

20.1 Muscle Relaxants - Peripherally Acting

Alcuronium inj 10mg/2mLAtracurium inj 25mg/2.5mLPancuronium Bromide inj 4mg/2mLSuxamethonium Chloride inj 100mg/2mLVecuronium inj 10mg/mL

20.2 Muscle Relaxants - Centrally ActingBaclofen tab 10mg

20.3 Cholinergic Agents

Neostigmine inj 2.5mg/1mLPyridostigmine tab 60mg

20.4 Drugs Used in Urinary Frequency

Oxybutinin HCI tab

SECTION 21 OPHTHALMOLOGICAL PREPARATIONS

21.1 Anti-Infectives

Acyclovir eye oint 30mg/gChloramphenicol eye drop 0.50%Chloramphenicol eye oint 1%Gentamicin eye drop 0.30%Polyantibiotic eye dropPolyantibiotic eye ointTetracycline eye oint 1%

Aciclovir




22.2 Anti-oxytocis

Salbutamol inj 1mg/1mLSalbutamol tab 4mg

21.2 Anti-Inflammatory Agents

Betamethasone-Neomycin eye oint 0.1%/0.5%Betamethasone-Neomycin eye drop 0.1%/0.5%Prednisolone Acetate/ eye drop 10mg-1.2mg/mLPhenylepherine HCI eye drop 10%

21.3 Local Anaesthetics

Oxybuprocaine (minims) eye drop 0.4%

21.4 Miotics and Anti-glaucoma Drugs

Acetazolamide tab 250mgAcetazolamide inj 500mgAcetylcholine Chloride inj 20mgPilocarpine eye drop 1%Pilocarpine eye drop 2%Pilocarpine eye drop 4%Timolol eye drop 0.25%Timolol eye drop 0.5%

21.5 Mydriatics

Atropine Sulphate eye drop 1%Homatropine eye drop 2%Phenylepherine eye drop 10%Tropicamide eye drop 1%

21.6 Other Ophthalmological Preparations

Hyaluronidase inj 1500iuHydroxpropylmethylcellulose inj 25mg/mLMydricaine No. 2 injNaphazoline HCl eye drop 1%/15mL

SECTION 22 GYNAECOLOGICAL AND OBSTETRIC PREPARATIONS

22.1 Oxytocis

Ergometrine/Oxytocin inj 500mcg/5iuOxytocin inj 10iu/1mLMisoprostol tab 100 microgram

(Minims®)




22.3 Gynaecological

Econazole pessary 150mgMiconazole Nitrate vag. Cream 2%Oestrogen Conjugated vag. CreamSulphathiazole/sulpha- cream 3.42%/2.86%cetamide/sulphabenzamide /3.7%

SECTION 23 DIALYSIS, PERITONEAL

Peritoneal Dialysis solution 1.5% 2 LitresPeritoneal Dialysis solution 4.25% 2 Litres

SECTION 24 PSYCHOTHERAPEUTIC DRUGS

Amitriptylline tab 25mgChlorpromazine tab 50mgChlorpromazine tab 100mgChlorpromazine inj 50mg/2mLDiazepam tab 5mgDiazepam inj 10mg/2mLDoxepin cap 25mgDroperidol inj 10mg/2mLFluoxetine Hydrochloride tab 20mgFlupenthixol inj 100mg/mLFluphenazine Decanoate inj 25mg/1mLHaloperidol tab 1.5mgHaloperidol tab 5mgHaloperidol inj 5mg/1mLImipramine tab 25mgLithium Carbonate tab 250mgOlanzapine tab 10mgThioridazine tab 10mgThioridazine tab 50mgThioridazine tab 100mgTrifluoperazine HCI tab 1mgTrifluoperazine HCI tab 5mg

SECTION 25 RESPIRATORY AGENTS

25.1 Anti-Asthmatic Drugs

Aminophylline inj 250mg/10mLBeclomethasone inhaler 100mcgIpratropium Bromide resp soln 25%Sallbutamol inj 1mg/1mLSallbutamol tab 4mgSallbutamol inhaler 100mcgSallbutamol resp soln 0.5%Sallbutamol elixir 2mg/5mLTheophylline elixir 80mg/15mLTheophylline SR tab 250mg




25.2 Antihistamines

Promethazine inj 50mg/2mLPromethazine tab 10mgPromethazine elixir 1mg/mL

SECTION 26 PREPARATIONS CORRECTING WATER, ELECTROLTYEAND ACID-BASE

26.1 Oral Preparations

Calciferol Strong tab 50000unitOral Rehydration Salts sachets UNICEF Modified Formula/1LPotassium Chloride mixt 5mmol/5mLPotassium Citrate mixt 20%Sodium Polystyrene sulphateResin (Resonium A) powder 15g/scoop/454g

26.2 Parenteral Preparations

Calcium Chloride inj 10%Dextrose 3.3% withsodium Chloride 0.3% inj 1 LitreDextrose 5% inj 1 LitreDextrose 10% inj 500mLDextrose 50% inj 500mLHartmans Solution 1 LitreMagnesium Sulphate inj 50%Plasma Volume Expander inj 500mLPotassium Chloride inj 7.46%Sodium Bicarbonate inj 8.4%Sodium Chloride 0.9% inj 10mLSodium Chloride 20% inj 20%Sodium Chloride 0.9% 1 LitreWater for Injection inj 5mLWater for Injection inj 100mL

26.3 Others

Medium Chain Triglyceride Oil

SECTION 27 VITAMINS AND MINERALS

Calcium Carbonate tab 500mgCalciferol Strong tab 50000unitHydroxycobalamin (Vitamin B12) inj 1mg/2mLMultivitamin tabMultivitamin syrup 100mLPyridoxine tab 25mgThiamine HCI tab 100mg

®

Oil




Thiamine HCI inj 100mg/2mLVitamin A gel filled caps 50,000 IUVitamin A gel filled caps 100,000 IUVitamin A gel filled caps 200,000 IUVitamin K (1) inj 10mg/1mLVitamin K (1) inj 1mg/0.5mL

SECTION 28 EAR, NOSE AND OROPHARYNGEAL PREPARATIONS

28.1 Ear Preparations

Candid ear dropsChloramphenicol ear drops 5%Gentamicin ear drops 0.3%Wax Removal ear drops

28.2 Nasal Preparations

Beclomethasone Nasal Spray 50mcg/doseBenzoin Tinct Compound inhalation

Candida®

Ephedrine nasal drop

28.3 Throat Preparations

Co-Phenyl Forte Topical Spray

SECTION 29 ANTI-RETROVIRALS (ARVs)

Section 29.1 Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI's)Efavirenz (EFV) tab 50mgEfavirenz (EFV) tab 100mgEfavirenz (EFV) tab 200mgEfavirenz (EFV) tab 600mgNevirapine (NVP) tab 200mg

Section 29.2 Protease Inhibitors PIs)Idinavir (DV) Sulphate caps 400mgNelfinavir (NFV) caps 250mgRitonavir - ( r ) caps 100mgLopinavir/ritonavir (LPV/r) tab 133.3mg/33.3mgSaquinavir (SQV) gel filled caps 200mg

Section 29.3 Nucleoside Reverse Transcriptase Inhibitors (NRTI's)Abacavir (ABC) tab 300mgDidanosine (ddI) Chewable Tab 25mgDidanosine (ddI) Chewable Tab 100mgLamivudine (3TC) tab 150mgStavudine (d4T) tab 30mgStavudine (d4T) tab 40mgZidovudine (ZDV) caps 300mg

®



Table F - Vital Medicines List (65)

Item Code Item Description Strength Dose Unit Cost32627 DPT-Hib-HBV 2 Dose Inj 6.2200008 Adrenaline 1mg/mL Inj 0.5900021 Atenolol 50mg/mL tab 0.0100023 Atropine 500mcg/mL Inj 2.0600027 Benzhexol 2mg tab 0.0100030 Benztropine 2mg/mL Inj 6.1700047 Enalapril 5mg tab 0.0200048 Carbamazepine 200mg tab 0.0300061 Chloramphenicol 1g Inj 0.78 Sod. Succinate00073 Cloxacillin* 500mg Inj 0.76

*NDTC has approved purchase of Flucloxacillin Inj 500mg if Cloxacillin Inj 500mg is hard to source

00091 Diazepam 5mg/mL Inj 0.2100095 Digoxin 250microgram tab 0.0600096 Digoxin 250mcg/mL Inj 2.400099 Dobutamine 250mg/20mL Inj 7.4700101 Dopamine 200mg/5mL Inj 6.7500132 Frusemide 20mg/2mL Inj 0.36 00133 Frusemide 40mg tab 0.01 00134 Frusemide 500mg tab 0.16 00138 Gentamicin 80mg/2mL Inj 0.12 00146 Haloperidol Inj 5mg/mL Inj 0.59 00151 Hydrallazine 20mg/mL Inj 9.94 00155 Hydrocortisone 100mg Inj 0.64 Sod. Succinate 00159 Insulin - Isophane 1000Units/10mL Inj 17.19 00160 Insulin - Soluble 1000Units/10mL Inj 17 00161 Insulin Mixtard 70/30 Inj 17.24 00177 Lignocaine Plain 2% Inj 0.84 00184 Magnesium Sulphate 2.47g/5mL Inj 1.85 00191 Metformin 500mg tab 0.02 00200 Metronidazole 500mg Inj 1.8 00202 Midazolam 5mg/mL Inj 3.3 00204 Morphine Sulphate 10mg/mL Inj 0.47 00208 Naloxone 400mcg/mL Inj 1.5100212 Neostigmine 2.5mg/mL Inj 0.6500221 Oxytocin 10IU/mL Inj 0.32


Item Code Item Description Strength Dose Unit Cost00222 Pancuronium bromide 2mg/mL Inj 1.3500228 Penicillin G 1 Mega Unit Inj 0.500236 Phenobarbitone 200mg/mL Inj 1.7100242 Phenytoin Sodium 100mg cap 0.0800243 Phenytoin Sodium 250mg/5mL Inj 4.0100251 Potassium Chloride 7.46%w/v Inj 0.7400261 Prednisolone/Prednisone 5mg tab 0.0100289 Salbutamol 0.50% Respirator 2.01 Solution00296 Sodium Valproate 40mg/mL Elixer 17.8900297 Sodium Valproate EC 200mg tab 0.0500303 Suxamethonium Chloride 50mg/mL Inj 0.7700308 Thiopentone Sodium 2.5g Inj 36.1700325 Verapamil 2.5mg/mL Inj 3.700329 Vitamin K 1mg/mL Inj 0.4200330 Warfarin (MAREVAN BRAND) 5mg tab 0.0800331 Warfarin (MAREVAN BRAND) 1mg tab 0.0600370 Streptokinase 1.5mU Inj 113.5700409 Nifedipine MR 20mg tab 0.0100425 Glipizide 5mg tab 0.0300511 Mannitol 20% (500mL) Inj (IV Fluid) 2.8101286 BCG 20 dose Inj 2.3701289 HBV Infant 10mcg (1 dose) Inj 0.7201290 HBV Adult 20mcg/dose Inj 4.56 (10 dose)01291 PPD Human Tuberculin 100,000units/mL Inj 36.78 (mantoux) 01292 HBV Immunoglobulin 300Units/mL Inj 82.9601293 Measels/Rubella 10 dose Inj 8.4401294 Polio Vaccine 10 dose PO 1.3101298 Tetanus Toxoid 10 dose Inj 1.4301819 Sodium Chloride 0.90% Inj (IV Fluid) 1.501881 Chloral Hydrate Syrup 100mg/mL Syrup 31.8732645 Warfarin (MAREVAN BRAND) 3mg tab

Table F - Vital Medicines List (65)


Table G - Nursing Station Emergency Kit

Item Strength Amount

1. Morphine injection 10mg/mL 2 ampoules

2. Pethidine injection 50mg/mL 2 ampoules

3. Promethazine injection 50mg/2mL 2 ampoules

4. Diazepam injection 10mg/2mL 2 ampoules

5. Prochlorperazine injection 12.5mg/mL 2 ampoules

6. Chlorpromazine injection 50mg/2mL 2 ampoules

7. Digoxin Injection 500microgram 3 ampoules

8. Frusemide injection 20mg/2mL 10 ampoules

9. Atropine Injection 600microgram/mL 2 ampoules

10. Hydrocortisone 100mg 10 vials Sodium Succinate Inj

11. Glyceryl Trinitrate S/L 600microgram 100 tablets

12. Salbutamol 1mg/mL 5 bottles Respirator Solution

13. Phenytoin injection 250mg/5mL 2 ampoules

14. Hydrallazine injection 20mg/mL 2 ampoules

15. Ampicillin injection 500mg 10 vials

16. Cloxacillin injection 500mg 10 vials

17. Gentamicin injection 80mg/2mL 4 ampoules

18. Chloramphenicol injection 500 mg 10 vials

19. Adrenaline injecttion 1mg/mL 10 vials

20. Oxytocin injection 10IU/mL 10 vials


B. REFERENCE FOR DETAILED MEDICINE INFORMATION

The following medicine reference works are compulsory for Pharmacy Departments:

• National Drug Policy 1994• Essential Medicines Formulary – current edition• Fiji Standard Treatment Guidelines – All updated and current editions -

NDTC• Medical Supplies Management Manual – Ministry of Health, FIJI, 1998• Australian Medicines Handbook – current edition• Australian Pharmaceutical Formulary – current edition• Martindale – current edition• British Pharmacopaeia – current edition• SHPA - Book of Injectables – current edition


Naranjo ADR Probability Scale

(Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse reactions. Clin Pharmacol Ther 1981;30(2):239-45.

Question Yes No Don’t Know Score

1. Are there previous conclusive reports on this reaction?

+1 0 0

2. Did the adverse reaction appear after the suspected drug was administered?

+2 -1 0

3. Did the adverse reaction improve when the drug was discontinued, or a specific antagonist was administered?

+1 0 0

4. Did the adverse reaction appear when the drug was re-administered?

+2 -1 0

5. Are there alternative causes (other than the drug) that could on their own have caused the reaction?

-1 +2 0

6. Did the reaction reappear when a placebo was given?

-1 +1 0

7. Was the drug detected in the blood (or other fluids) in concentrations known to be toxic?

+1 0 0

8. Was the reaction more severe when the dose was increased or less severe when the dose was decreased?

+1 0 0

9. Did the patient have a similar reaction to the same or similar drug in any previous reaction?

+1 0 0

10. Was the adverse event confirmed by any objective evidence?

+1 0 0

TOTAL

Score

<0 Unlikely

1-4 Possible

5-8 Probable

>9 Certain

C. GUIDE FOR CAUSALITY ASSESSMENT - ADVERSE DRUG REACTIONS


Outcome: Recovered Not recovered Unknown Fatal

Date of Death: / / Comments (e.g. relevant H2 allergies, previous exposure to this drug):

ESSENTIAL MEDICINES

(Note: Identities of Reporter, Patient and Institution will remain confi dential)Demographic DetailsPatient (Initials or National Health Number): __________________________________________

Age: _______ Sex: F M (Please circle

Wight: _______kg Height: ____ Race: ____

All Medicines in Use **Asterisk suspect medicine(s) include traditional medicines/supplements/OTCs.

ADVERSE DRUG REACTION REPORT

Please forward form as soon as Possible to: Secretary, National Drugs & Therapeutics Committee, FijiPharmaceuticl Service, P.O. Box 106, Suva or Facsimile: 338 8003

Reporting Person Name/Designation: ________________________________________________

Inssitution: _____________________________________________________________________

Signature: ______________________________ Date: ___________________________________

..............................................................................................................................................................

CAUSALITY ASSESSMENT: PLEASE CIRCLE (DTC USE ONLY

CERTAIN POSSIBLE PROBABLE UNLIKELY

DESCRIPTION OF ADVERSE DRUG REACTION

Date of unset: _______________

Trreatment of Reactions:

Medicine(s) Vaccine(s) Traditionalmedicines(s) OTC

Use Generic Names (Trade name in brackets)

DailyDosageAndRoute

DateRegun

DateStopped

Reason for use


APPLICATION FOR A NEW DRUG TO BE INCLUDED IN THE FIJI ESSENTIAL MEDICINES FORMULARY LIST (FORM 2)

Name of DRUG: _______________________________

Strength & Formulation of DRUG: ____________________________________

Indication of Use: ________________________________________________

ESSENTIAL MEDICINES

Other drugs on the EDL with similar indications and why this drug is preferred (Pleaseattach Literature review to support your claim)

Cost (per dose and per daily dosage regimen at recommended doses)

Estimated number of cases to be seen annually:______________________________

Drug(s) to be deleted from the EDL if the new drug is accepted: _________________

____________________________________________________________________

Other perceived non-medical benefits of introducing this drug: __________________

____________________________________________________________________

Name & Position of Requesting Officer: _____________________________________

Department: ___________________ Health Facility: ________________________

Date: ________________ Signature: ___________________________________

(Send completed form to Inpatients Pharmacist for notification to NDTC Secretary - Fiji Pharmaceutical Services, fax No: 3388003)…………………………………………………………………………………………………………….NDTC Response: Approved/Not Approved

If Approved, State: Quantity Purchased: ___________ Cost/unit: ___________ Total Cost: _________ Item Code: ____________________


REQUEST NON FORMULARY DRUG FORM (FORM 3)

(To be filled in by REQUESTING officer)

Name of DRUG: _______________________________

Strength & Formulation of DRUG: ____________________________________

Indication of Use: ________________________________________________

Duration of Therapy: ______________________________________________

Provide Justification for purchase of this DRUG: (Please attach Literature review, diagnostic results including microbiology report, second opinion from the microbiologist, pathologist, infection control specialist etc)

__________________________________________________________________________

ESSENTIAL MEDICINES

Name & Position of Requesting Officer: _____________________________________

Department: ___________________ Health Facility: ________________________

Date: ________________ Signature: ___________________________________

(Send completed form to Inpatients Pharmacist for notification to NDTC Secretary - Fiji Pharmaceutical Services, fax No: 3388003)…………………………………………………………………………………………………………….

NDTC Non-Formulary Response or FPS response (Essential Medicines)

Request No: _______ Approved/ Not-Approved

If Approved, State:

Quantity Purchased: ___________ Cost/unit: ___________ Total Cost: _________

Item Code: ____________________


Proposed Non Formulary Drug Request Purchases Flow Chart (EMERGENCY PURPOSE ONLY) – FORM 4

Feedbackto

requestoron options

YES

NO

NDTC Secretary to log request and create database for future reference for possible EDL inclusion

Requestor presents feedback to NDTC on the effectiveness of the drug within 7 days of completion orsuspension of therapy

Non-formulary drug received at FPS and issued to Inpatients Pharmacy Department for patient use

Procurement to place order with approved supplier from Schedule of Quotes Evaluation for non-formulary drug to be delivered within 48 hours of the order.

Approval by NDTC or FPS EMA or CP??

Complete “Non-Formulary Drug Request Form” with justification attachments to principalPharmacist for notification to NDTC Secretary

If ActionPlan – toNDTCChair

NO

Need identified for purchaseDiscussion/review by other

clinicians/specialist. Literature review & Diagnostic report

Finance is available for purchase?

YES

Call for Quotationswithin 24 hours

Schedule ofQuotes

Evaluation

YESNO

ESSENTIAL MEDICINES


MEDICATION INCIDENT REPORT FORM (FORM 5)

INSTITUTION: ___________________________ UNIT: _______________________

NATURE OF REPORT (Please tick and Provide Details) 1. ( ) DRUG QUALITY 2. ( ) DRUG PRESCRIBED INCORRECTLY

3. ( ) DRUG ADMINISTERED INCORRECTLY4. ( ) DRUG DISPENSED INCORRECTLY5. ( ) DRUG NOT GIVEN

6. ( ) UNABLE TO SUPPLY 7. ( ) COMPLAINT for PATIENT-STAFF 8. ( ) OTHER

INCIDENT DETAILS:

DRUG: Dose:________________________

Regimen:_____________________

Duration:____________________________________________________________________________________________

Patient Category: Inpatients ( ) Outpatients ( ) Discharge ( ) (Please tick)

State the problem:

Action Taken:

Please submit the completed form to the Principal Pharmacist of your nearest Divisional Hospital as soon as possible. Principal Pharmacist to forward report to Secretary, NDTC, Fiji Pharmaceutical Services, P.O. Box106, Suva or by facsimile 3388 003, one week before the next scheduled NDTC meeting.

Please state Strength & Formulation

E��ENTIA� MEDICINE�


ESSENTIAL MEDICINES

Name of reporting officer: __________________ Signature: ____________________

Unit: ____________ Health Facility: _________________________

Date: ______________________

(Please note: Return drug and completed form to Pharmacist/Pharmacy technician in Charge to beforwarded to FPS) ________________________________________________________________________________________________

To be filled in by local Pharmacist/Pharmacy Technician In Charge:

Product re-examined and tested if possible: YES NO

Comments on product quality:

Name: ________________________ Position: ___________________ Date: _____________

Signature: ________________________________

DRUG QUALITY COMPLAINT FORM (FORM 6)

(To be filled in by reporting officer)

Name of drug: _______________________________ Item No: _____________

Batch/Lot No: ________________________ Expiry date: ____________________

Brand: __________________________ Country manufactured: _______________

Registration No (if applicable): __________________________________________

Please state problem/s encountered with product:1.

2.


DRUG REPORTING/PRODUCT COMPLAINT GUIDELINES (FORM 7)

All product complaints/problems should be reported in all instances where there is concern relatingto the safety of a drug or it fails to meet expectations.

What is a drug quality complaint?

Complaint can be anything which creates a hazard or places you or your patient at risk, eg:

Compromised sterilityPhysical Structure Defects e.g. mouldy tablet; poor dissolution

Incomplete instructions Poor design

Packaging or labelling defectsSub-therapeutic Effects in comparison to time of onset of action and desired therapeutic effects

i. DO NOT THROW THE FAULTY DRUG OUT, unless it is contaminated or personnel are putat risk. Place item in a specimen bag, if applicable, including packaging and batch number if available.

ii. Contact the Chief Pharmacist or nominated person for your health facility.

iii. Complete the Drug/Medicines Complaint Report form and forward to the Chief Pharmacist.

What happens to your Report?

Forward the completed form and product to the nominated person in your Facility.

The report is placed on a Register with National Drugs & Theapeutics Committee and a copyforwarded to the Supplier.

Depending on the nature of the fault a recall of that drug may occur.

A replenishment stock will be distributed until replacements stocks are received.

The Supplier will be contacted regarding the problem.

A report will be sent back to the unit as soon as possible and widely circulated.

Drug Quality Complaints

It is the responsibility of the person initiating the complaint to categorise the complaint and instigate the appropriate procedure as laid out below.

In all instances the Chief Pharmacist is to be advised as soon as practicable, in order to ensure theappropriate response is taken, actioned and Pharmacist/Pharmacy Technician in Charge notified.

Wherever possible the product and packaging should be retained (except in instances of contamination or personal risk).

A Drug Quality Complaint Report is to be completed and the FPS Chief Pharmacist advised.

ESSENTIAL MEDICINES


Category 1 - MAY CAUSE ADVERSE EVENT

1. The Chief Pharmacist will confirm the category and raise the concern with the supplier.

2. The Chief Pharmacist will reply to the initiator advising the response taken and the reply from supplier.

CAUSE ADVERSE EVENT

1. All product should be presumed to be effected and treated in the same manner.

2. The Chief Pharmacist will confirm the category, and will notify the suppliers senior management and:

advise of complaint request information relating to product/batch advise supplier that all product, in known locations, must be removed from

premises within five (5) working days request lead time of replacement stock

3. The Chief Pharmacist will advise the nominated person of the complaint and isolate the stock product/batch.

4. The Chief Pharmacist will advise if stock is to be replaced by supplier or ordered from an alternate supplier.

5. If the product is a stock item, end-users will be notified by the Chief Pharmacist by memo issued with non-affected stock and will be followed up by inclusion in hospitals newsletters and email.

6. Complaint will be minuted in National Medical & Surgical Supplies Management Committee minutes.

Category 3 - HAS CAUSED ADVERSE EVENT

1. As per Category 2. Plus:

2. The Chief Pharmacist will ensure product in all areas of all health facilities effected is removed.

3. The Chief Pharmacist confirms notification of incident to Health Service Manager and Director of Health Systems Standards Ministry of Health.

4. For out of hours notification, contact phone no 3388000 ext 126 (leave message) or fax no 3388003 or email [email protected]

ESSENT�A� MED�C�N


ESSENTIAL MEDICINES

DRUG RECALL PROCEDURE (FORM 8) (Initiated by Chief Pharmacist)

1. Chief Pharmacist issues Product Recall notice.

2. Notice forwarded to Clinical Managers and the Risk Manager.

3. FPS Warehouse Manager identifi es and facilitates area/s of product use and isolates any affected stock.

4. Risk Manager notifi es Warehouse Manager who notifi es Chief Pharmacist regarding fi ndings. If appropriate, a memorandum may be issued, or copies of the recall notice placed on maxibins where stock is held.

5. Any affected stock is quarantined by Infection Control Offi cer/Stores Offi cer for forwarding to FPS and documentation completed.

6. Replacement stock must be supplied by the supplier before any stock is removed from sites. Replacement stock is arranged for distribution by Warehouse Manager to appropriate health facilities, in cooperation with the Stores Offi cer.

** In the event of recall the supplier must supply an alternative equivalent for a minimum period of four to six (4 to 6) months normal usage (FPS minimum stock level)

** If all stock held within the health service division is subject to the recall, the Chief Pharmacist is to liaise with the company for immediate replacement of stock. If this is not possible, an alternative supplier is sought.


ESSENTIAL MEDICINES

DRUG RECALL PRO FORMA (FORM 9)(Filled by FPS)

A recall has been initiated on the following:-

PRODUCT:

ITEM NUMBER:

BATCH/LOT:

SUPPLIER:

PHONE: _______________________ FAX:

REASON FOR RECALL:

METHOD RETURN:

REPLACEMENT STOCK RECEIVED:

COMMENTS:

QUALITY ASSURANCE ACTION:___________________________________________________________________________________

RESULTS OF QUALITY ASSURANCE TEST:

(RETURN REPORT TO Chief Pharmacist – for forwarding to Secretary NDTC)

Tabled at the next National Drug & Therapeutics Committee

Date / /

Meeting No: _____________

FOREWARD - WHO

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