[Index]

4.5 RESTRICTED PRESCRIBING

The following drugs have restricted formulary status with use limited to specific physicians or for specific indications.
Refer to the Parenteral Drug Therapy Manual (PDTM) for restrictions of parenteral medication to specific nursing units.

Amino Acids                    -   restricted to designated TPN physicians

Aripiprazole                      -   restricted to diagnosis of schizophrenia or other psychosis PLUS treatment failure or
    intolerance to another antipsychotic agent

Azithromycin                    -   tablets restricted for treatment of Chlamydia infections, MAC prophylaxis, or ID consult

Bleomycin intralesional      -   restricted to radiology

Botulinum Toxin Type A     -   restricted to Physical Medicine & Rehabilitation Physicians, and Spinal Cord Program
     Physicians

Cardioplegia Solution         -   restricted to perfusion services

Clarithromycin                   -   non-XL tablets restricted to NG use

Clozapine                          -   restricted to authorization by CSAN or GENCAN Registration

Donepezil                          -   restricted to geriatricians, neurologists, psychiatrists, and those on this drug prior
     to admission

Epinephrine topical
nasal solution                    -   restricted to OR

Erythropoietin                    -   restricted to Jehovah’s Witness and surgery patients to reduce allogeneic blood exposure;
     Hematology consult required for perioperative use in non-Jehovah’s witness patients

Fludarabine                       -   restricted to Hematology

Fluticasone 250mcg           -   restricted to doses greater than 250mcg

Fondaparinux                    -   restricted to NSTEMI patients who have not had PCI, and to Hematology for patients with HIT

Galantamine                      -   Vancouver Acute: restricted to those on prior to admission; Vancouver Community: Restricted
      those enrolled in the ADTI program

Gentamicin cream              -   restricted to burn patients and in-patient PD patients

Insulin aspart                     -   restricted to prior to admission and endocrinology

Insulin glargine                   -   restricted to prior to admission and endocrinology

Lamivudine                        -   restricted to GI, SOT, Leukemia/BMT or patients on high dose chemotherapy for  Hepatitis
     B prophylaxis, or those on this drug prior to admission

Levetiracetam                    -   restricted to neurology

Methadone                        -   restricted to physicians authorized by HPB

Methadone tablets              -   restricted to PCU, POPS, Palliative Type patient

Morphine 50mg/mL
Oral Syrup                         -   restricted to Palliative Care Unit               

Mycophenolate                   -   restricted to SOT and BMT patients

Nifedipine XL                       -   restricted to obstetrics/gynecology

Oseltamivir                          -   Prophylactic use restricted to Medical Health Officer, Infection Control, or Infectious
       Diseases

Posaconazole                      -   restricted to the prophylaxis or treatment of invasive fungal infections in patients 13 years

                                              or older who can tolerate a full fat meal and as indicated below:
                                              1. Prophylaxis:
                                                 a. Neurtopenic patients, where neutropenia is present for 10 days or longer in Acute
                                                     Myeloid Leukemia or Myelodysplastic Syndrome receiving induction chemotherapy

                                                  b. Allogeneic stem cell transplant patients with steroid-refractory GVHD treated with

                                                       intensive immunosuppressive therapy

        2. Treatment of invasive fungal infections, including zygomycetes, in L/BMT patients for
      the following situations:
      a. intolerant or resistant to other appropriate antifungals (e.g. amphotericin B,
          voriconazole, itraconazole, micafungin) OR
      b. where oral step down therapy is appropriate and cost effective

Rabies Vaccine                      -   requires prior approval from Medical Health Officer

Rabies Immune Globulin          -   requires prior approval from Medical Health Officer

Rivastigmine                          -   Vancouver Acute: restricted to those on prior to admission; Vancouver Community:

                                                 Restricted those enrolled in the ADTI program

Rivaroxaban                           -   restricted to Orthopedics for prophylaxis of elective total hip or knee replacement

Sativex                                  -   restricted to Complex Pain, Palliative Care and those on prior to admission

Sincalide                                -   restricted to Radiology

Sirolimus                                -   restricted to islet cell transplant patients

Sodium Chloride 5%                -   restricted to hepatobiliary surgery for intra-operative
                       instillation into liver cysts

Tetracaine 4% gel                    -   restricted to Eye Care Centre and  Pediatric patients

Valganciclovir                          -   restricted to SOT and BMT patients

Varenicline                              -   restricted to those on prior to admission

Zanamivir                                 -   restricted to treatment and prophylaxis of oseltamivir resistant influenza as approved by
            the Medical Health Office or Infection Control

Ziprasidone                              -   restricted to diagnosis of schizophrenia or other psychosis PLUS treatment failure or
           intolerance to another antipsychotic agent