Modernized Reference Drug Program Dihydropyridine Calcium Channel Blockers (CCBs)
Fully Covered (Reference Drugs) Partially Covered (Non-Reference Drugs) •• Amlodipine •• Felodipine •• Nifedipine extended release Information provided is not intended as a substitute for professional judgement.
Step 1 – Does your patient need to switch medications to retain PharmaCare coverage?
Is patient already taking the fully covered (reference) drug listed above?
NO YES No medication change Pharmacists To confirm Special Authority Is patient concerned about prescription costs and about getting Prescribers coverage for patient’s the most PharmaCare coverage possible? To confirm Special Authority current medication, call coverage for the patient’s the PharmaCare HelpDesk and select the YES NO No medication change current medication, call 1-866-905-4912 Self-Service Option
Does patient already have Special Authority coverage of their existing drug (i.e., is eligible for continued full coverage as explained in Section 4 of the Guide to the Modernized RDP)? Prescribers NO YES No medication change Submit a Special Authority Request Specialty Exemptions from Does the patient meet the criteria (below) for full coverage of a drug submitting Special Authority Pharmacists that will be only partially covered as of December 1, 2016? Requests: cardiologists, If the patient meets the cardiovascular and thoracic surgery, criteria, refer to prescriber Criteria for full coverage of a partially covered (non-reference) drug* internists specializing in cardiology, who can submit a Treatment failure on optimal doses or intolerance to amlodipine or nephrologists, paediatrics, Special Authority Request Complex patient requiring medication(s) for co-existing chronic condition(s)* paediatric cardiology. for coverage
NO YES
Step 2 – Making the switch
Consider the following precautions: Pharmacists ••If nifedipine is used to treat hypertension in pregnancy, these patients should not be switched to You may wish to contact the prescriber for another CCB. complex or frail patients such as: ••pregnant, lactating or pediatric patients ••patients with an acute or unstable cardiac condition, e.g.: ••Obtain a baseline BP measurement prior to therapeutic substitution OR ensure that the patient has had a recent BP measurement. • hospitalization in the past 6 months for cardiac reasons ••Patients can switch at the next fill of their prescription. Switch the patient to the fully covered CCB at a • cardiac medication has changed in the past 6 months therapeutically appropriate dose as shown below. • currently being seen by a cardiac specialist
Target Doses and Dose Adjustments 1-4 Hypertension Adjustments–Renal Adjustments–Hepatic •• Amlodipine ••Initial: 5 mg daily ••None ••Initial dose: 2.5 mg daily Drug Approximate Equivalent Dose 5 ••Usual: 5-10 mg daily •• Amlodipine 2.5 mg 5 mg 10 mg ••Max: 10 mg daily •• Felodipine 2.5 mg 5 mg 10 mg •• Felodipine ••Initial: 5 mg daily ••None ••Initial dose: 2.5 mg daily •• Nifedipine 20 mg 30 mg 60 mg-90 mg (2.5 mg daily for elderly) (extended release) ••Usual: 2.5-10 mg daily ••Max: 10 mg daily •• Nifedieine ••Initial: 20-30 mg daily ••None ••Caution: may need to extended release ••Usual: 30-60 mg daily reduce dose ••Max: 90 mg daily
Monitor blood pressure. Inform the patient of the changes made, of any self-monitoring required, and of plans for follow-up.
Prescribers Pharmacists Check patient progress at next Communicate therapeutic substitution information to the scheduled appointment. appropriate prescriber according to the requirements of PPP-58.
* If medical circumstances warrant, Special Authority may be granted Check patient progress at next pharmacy visit. for exceptional coverage on a case-by-case basis. REFERENCES: 1. CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2016 [updated 2011 Sep; cited 2016 Apr 25]. Calcium Channel Blockers [CPhA monograph] Available from www.e-therapeutics.ca. Also available in paper copy from the publisher. 2. CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2016 [updated 2015 Jul; cited 2016 Apr 25]. Amlodipine [Sivem product monograph] Available from www.e-therapeutics.ca. Also available in paper copy from the publisher. 3. CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2016 [updated 2015 Jan; cited 2016 Apr 25]. Adalat XL [product monograph] Available from www.e-therapeutics.ca. Also available in paper copy from the publisher. 4. CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2016 [updated 2015 Jan; cited 2016 Apr 25]. Plendil [product monograph] Available from www.e-therapeutics.ca. Also available in paper copy from the publisher. 5. Therapeutic Interchange Program and Prescription Interpretations at Vancouver Community of Care. Available at www.vhpharmsci.com/vhformulary/(2)%20VA%20Copy%20of%20BCHA%20Formulary%20THERAPEUTIC%20INTERCHANGE%20PROGRAM.pdf