Calgary Zone Long-Term Care Pharmacy and Therapeutics ...

1 Calgary Zone Long-Term Care Pharmacy and Therapeutics CommitteeLast Revised Oct 27, 2021 AHFS Class Generic NameBrand Name & Synonyms (LCA to be dispensed when available)1 StrengthRoute of Administration Relevant Formulary Links Relevant Formulary Links 2 Formulary Considerations (and applicable Health Canada Advisories)Status4:00 ANTIHISTAMINE DRUGSH ealth Canada Advisories - Search Page4:04 First Generation Antihistamines cyproheptadinePeriactin4 mg tab, 2mg/5mL liquidOralFdiphenhydramine Benadryl25, 50 mg cap, mg/5mL liquidoralFdiphenhydramine Benadryl50 mg/mLInjection F4:08 Second Generation AntihistaminescetirizineReactine10 mg, 20 mg tabsoralFloratadineClaritin10 mg taboralF8.

2 00 ANTI-INFECTIVES 8 AminoglycosidesgentamicinGaramycin40 mg/mL injection FtobramycinNebcin40 mg/mL injection FPage 1 of 24 Calgary Zone Long-Term Care Pharmacy and Therapeutics CommitteeLast Revised Oct 27, 2021 AHFS Class Generic NameBrand Name & Synonyms (LCA to be dispensed when available)1 StrengthRoute of Administration Relevant Formulary Links Relevant Formulary Links 2 Formulary Considerations (and applicable Health Canada Advisories)Status8 CephalosporinscefazolinAncef500 mg / vial, 1 g / vialinjectionFcephalexinKeflex250 mg & 500 mg tabs, 250 mg/5mL liquidoral FcefaclorCeclornon-formulary (therapeutic substitution to cefuroxime)ASL-01NF-ASLcefiximeSuprax400 mg tab, 100 mg /5mL liquidoral Fcefuroxime axetilCeftin250 mg, 500 mg taboral g, 1 g & 2 g injectionF8 Macrolidesazithromycin Zithromax 250 mg, 500 mg & 600 mg caporalRS-30 RSclarithromycinBiaxin250 mg, 500 mg tabs (therapeutic substitution to azithromycin unless meets RS-30)

3 OralRS-30 ASL-01 RSerythromycin baseE-mycin250 mg oralASL-01 Ferythromycin EC Eryc333 mg cap (non-Formulary -therapeutic substitution to erythromycin base)oralASL-01NF-ASL8 PenicillinsamoxicillinAmoxil250 mg & 500 mg caps, 250 mg/5mL liquidoralFamoxicillin/clavulanateClavul in250mg*125mg, 500mg*125mg, 875*125mg tabs, 250mg*125 mg/5mL, 500mg*125 mg/5mL liquidsoralFampicillinLCAnon-formulary (oral forms auto to amoxicillin)oralASL-01NF-ASLampicillinLC A500 mg/vialinjectionFcloxacillinLCA250 mg & 500 mg caps, 125 mg/5mL liquidoralFcloxacillinLCA500 mg, 1 g vialsinjectionFpenicillin G sodiumLCA1 million units/vial, 10 million units/vialinjectionFpenicillin V potassiumLCA300 mg (500,000 units)

4 Tab, 125 mg/mL liquidoralF8 QuinolonesciprofloxacinCipro250 mg, 500 mg tabsoralRS-02 RSlevofloxacinLevaquin250 mg, 500 mg tabsoralRS-02 RSnorfloxacinNoroxin400 mg taboralRS-02RS8 SulfonamidessulfasalazineSalozopyrin, SSZ500 mg tab, 500 mg EC taboralFsulfamethoxazole / trimethoprimBactrim, Septra400mg*80mg, 800mg*160mg tabs, 40mg*8mg/mL liquidoralF8 TetracyclinesdoxycyclineVibramycin100 mg tab/caporalFtetracyclineLCA250 mg, 125 mg/5mL liquidoralFPage 2 of 24 Calgary Zone Long-Term Care Pharmacy and Therapeutics CommitteeLast Revised Oct 27, 2021 AHFS Class Generic NameBrand Name & Synonyms (LCA to be dispensed when available)1 StrengthRoute of Administration Relevant Formulary Links Relevant Formulary Links 2 Formulary Considerations (and applicable Health Canada Advisories)Status8 MiscellaneousclindamycinDalacin C150 mg & 300 mg caps, 75 mg/5mLoralFclindamycinDalacin C150 mg/mLinjection FvancomycinVanocin125 mg & 250 mg capsoralHCD-22 SAvancomycinVanocin500 mg/vialinjection HCD-22 Formulary for oral compounding when used for C-difficile infection under HCD-22 criteria.

5 All other use is considered non-formularySA8:14 AntifungalsfluconazoleDiflucan50 mg, 100 mg , & 150 mg taboralRS-23 RSnystatinNilstat, Mycostatin100,000 units/mL liquidoral RS-23 RSterbinafineLamisil250 mg taboralHCD-26 Lamisi 1%HCD for treatment of onychomycosis only if affecting functioning or painSA8:16 AntimycobacterialsisoniazidIsotamine100 mg taboralLTC ExemptionTuberculosis ProgramFor TB indications see links. All other indications are NFRS rifampin Rifadin150 mg, 300 mg cap oralLTC ExemptionTuberculosis ProgramFor TB indications see links. All other indications are NFRS8:18 AntiviralsacyclovirZoviraxnon-formulary therapeutic substitution to valacyclovirASL-01topical use is also non-formularyNF-ASLamantadineSymmetrel 100 mg cap, 10 mg/mL liquidoralHCD-03amantadineFormulary for movement disorders SAfamciclovirFamvirnon-formulary, therapeutic substitution to valacyclovirASL-01NF-ASLoseltamivirTamif lu30 mg & 75 mg capsules, 6 mg/mL liquidoralHCD-03 SAvalacyclovirValtrex500 mg taboralASL-01preferred formulary antiviral agent F8.

6 30 AntiprotozoalshydroxychloroquinePlaqueni l200 mg taboralFquinine sulfateLCA200 mg & 300 mg capsoralFmetronidazoleLCA 500 mg capsule topical*RS-47*Restricted for topical use. For oral use, select 250 mg tabletRSmetronidazoleFlagyl LCA250 mg taboralF8:36 Urinary Anti-infectivesfosfomycinMonurol LCA3 g satchetoralHCD-24 Single dose regimen is HCD; other dose regimens are NFSA methanamine mandelate Mandelamine500 mg taboralFnitrofurantoin LCA50 mg & 100 mg tabletsoralRS-32 Fnitrofurantoin macrocrystals/ monohydrate MacroBID (use LCA) 100 mg capsuleoralRS-32therapeutic subtitution suspended during COVID-19 FtrimethoprimProloprim100 mg taboralFPage 3 of 24 Calgary Zone Long-Term Care Pharmacy and Therapeutics CommitteeLast Revised Oct 27, 2021 AHFS Class Generic NameBrand Name & Synonyms (LCA to be dispensed when available)

7 1 StrengthRoute of Administration Relevant Formulary Links Relevant Formulary Links 2 Formulary Considerations (and applicable Health Canada Advisories)Status10:00 mg and 10 mg mL prefilled syringe10 mL prefilled syringe15 mL prefilled syringe20 mL prefilled syringe25 mg/1 mL prefilled syringe*All prefilled LCA Brand10 mg/ML and 25mg/mL vialsinjectionRS-41 LCA is Pfizer brand. LTC facility to supply sterile safety needle (20G to 27G, 1" to 1 ")RS12:00 CHOLINERGIC DRUGS12 Parasympathomemetic (Cholinergic) Agentsbethanechol chloride Duvoid, Urecholine10 mg & 25 mg tabsoralFdonepezilAricept5 mg & 10 mg tabs, 1 mg/mL liquidoralHCD-09 SAgalantamine ERReminyl8 mg, 16 mg & 24 mg capsoralHCD-09 SApyridostigmineMestinon60 mg tab, 180mg SR mg, 3 mg, mg & 6mg caps, 2 mg/mL hour, hour patchtopical HCD-09further restricted to clients with documented intolerance with oral product SA12 Antimuscarinic/Antispasmodic Agentsatropine sulfate mg/mL.

8 Mg/mL mg/mL may be stocked in StatboxFbelladonna / ergotamine tartrate / phenobarbitalBellergal * *40mg taboralFdicyclomineBentylol LCA10 mg and 20 mg mg/mL (2 mL size)injectionRS-11restricted to care of the imminently dying and dispensed resident-specific (not stock) mg/mL oral compounded susporaluse glycopyrrolate powder for compoundingFipratropium bromideAtrovent20 mcg/dose MDIinhaled Fipratropium bromideAtrovent125 mcg/mL & 250 mcg/mL inh solution (nebules)inhaled (nebulized)RS-21 ASL-01therapeutic substitution to MDI unless meets restrictions for nebule useRSipratropium nasal sprayinhaled (nasal) strength is NFRS ipratropium bromide / salbutamolCombivent, Teva-Combo *1mg/mL inh solution (nebules)inhaled (nebulized)

9 RS-21 ASL-01therapeutic substitution to individual ingredient MDI unless meets restrictions for nebule useRSipratropium bromide / salbutamolCombivent Respimat 20 mcg*100mcg/dose inh solutionssoft mist inhaler temporary listing during shortage of single ingredient MDIs and COVID-19 Fscopolamine mg patchtransdermalFscopolamine mg/mLinjectionFtiotropium bromideSpiriva18 mcg inh capinhaledFtiotropium bromideSpiriva mcg/dose inhalation solutioninhaledFtiotropium bromide / olodaterol hydrochlorideInspiolto mcg/dose* inhalation solutioninhaledFPage 4 of 24 Calgary Zone Long-Term Care Pharmacy and Therapeutics CommitteeLast Revised Oct 27, 2021 AHFS Class Generic NameBrand Name & Synonyms (LCA to be dispensed when available)1 StrengthRoute of Administration Relevant Formulary Links Relevant Formulary Links 2 Formulary Considerations (and applicable Health Canada Advisories)Status12.

10 12 Sympathomimetic (Adrenergic) Agentsbudesonide/ formoterol fumarate dihydratedry powder inhalerSymbicort100mcg/dose*6mcg/dose200 mcg/dose*6mcg/doseinhaledRS-29 RSepinephrineAdrenalin1 mg/mL (ampule/vial)injection Fformoterol fumarate Foradil12 mcg/dose inhalation capsuleinhaledFformoterol fumarateOxeze6mcg/dose12mcg/doseinhaledF formoterol fumarate dihydrate/ mometasone furoatemetered dose inhalerZenhale5 mcg/dose*100mcg/dose &5mcg/dose*200mcg/dose mg & 5 mg tabsoralFpseudoephedineSudafed30 mg & 60 mg tabsoralFsalbutamol Ventolin100 mcg MDIinhaledFsalbutamol Ventolin Diskus 200 mcg/dose DPIinhaledtemporary listing during shortage of MDIs and COVID-19 Fsalbutamol mg/mL nebules1 mg/mL nebules2 mg/mL nebules5mg/mL nebulesinhaled (nebulized)