Hospital Formulary

Formulary
“It is a continually revised compilation of
pharmaceuticals (plus important
ancillary/supporting information) that reflect
the current clinical judgement of the medical
staff.”

Formulary should be complete, concise and easy

to use.
• The drugs on the formulary are listed after a careful
evaluation, judgement and selection from among
numerous available drug products.

The selection of drugs made on the basis of

 patient acceptability
 efficacy
 safety
 drug price.
 Formulary system

• “It is a method whereby the medical staff of an

institution, working through the PTC evaluate,
judges and selects from among the numerous
available drug entities and drug products those
that are considered most useful in patient care.”

 Only those so selected are routinely available from the

pharmacy. The formulary system is thus an important
tool for assuring the quality of drug use and controlling
its cost.
 Benefits of Formulary system
1) Therapeutic.
The most efficient products are listed and available.

2) Economic.
By volume purchasing and reducing inventory
duplication.

3) Educational.
Many formularies contain various prescribing
tips and additional drug information of educational values

• Other benefits include close expiry monitoring and improve

relationship.
 Demerits of Formulary system
 Deprives the physician’s freedom to
prescribe and obtain brands of their
preference

 Allows for the purchase of inferior quality

drugs (particularly, in institution where there
is no staff pharmacist).
 Objectives of Formulary

To provide the hospital staff with the information on:

 The drugs approved for use by the PTC

 Basic therapeutics of each approved item

 Hospital policies and procedures governing use of drugs

 Special aspects such as drug dosing rules and hospital

approved abbreviations.
 Example
Dosing Modifications for cefixime (adult)

• Acute Bronchitis
400 mg/day PO in single daily dose or divided q12hr

• Renal impairment

• CrCl >60 mL/min: Dosage adjustment not necessary

• CrCl 21-60 mL/min: 260 mg/day PO

• CrCl <20 mL/min: 200 mg/day PO

 Example

• Acute Bronchitis

• <6 months: Safety and efficacy not established

• 6 months-12 years, ≤50 kg: 8 mg/kg/day PO in

single daily dose or divided q12hr; not to exceed
400 mg/day 

• >12 years: 400 mg/day PO in single daily dose or

divided q12hr
 Formulary vs Drug list
• Formulary:
usually consist of a listing of therapeutic agents by their
generic names followed by information on strength, dosage
form, dosage/posology, toxicology, use and recommended
quantity to be dispensed.

• Drug list:
usually consisting of a listing of therapeutic agent by their
generic names followed by data on strength and dosage
form (there may or may not be any additional information)
 Guiding principles to develop formulary

The following principles will serve as a guide to

physicians, pharmacists, nurses and administrators in
hospital and other facilities utilizing the formulary
system:
1) The medical staff shall appoint a multi-disciplinary PTC
and outline its purpose, organization, function and
scope
2) The formulary system shall be sponsored by the
medical staff based upon the recommendations of PTC.
The medical staff should adjust the principles of the
system to the need of the particular institution
 Guiding principles--
3) The medical staff shall adopt written policies and
procedures governing the formulary system as
developed by the PTC. These policies and
procedure shall provide guidance in the
evaluation, selection, procurement, storage,
distribution, safe use and other matters relating
to drugs and shall be published in the institution’s
formulary or other media available to all
members of the medical staff
 Guiding principles--
4) Drug should be include in the formulary by their
non-proprietary names, prescribers should be
strongly encouraged to prescribe drugs by their
non-proprietary names
5) The PTC must set forth policies and procedures
governing the dispensing of generic equivalents
(drug product identical in their active
components)and therapeutic equivalent (drug
products differing in their basic drug entity but
having similar pharmacologic and therapeutic
activities)
 Guiding principles---
6) The institution shall ensure that its medical and
nursing staff are informed about the existence of
formulary system, the procedure governing its
operation and any changes in those procedures.
Copies of the formulary must be readily available
and accessible at all times

7) Provision shall be made for the evaluation and

use of drugs not included in the formulary, by
the medical staff
 Guiding principles---

8) The pharmacist shall be responsible for

specifications as to the quality, quantity and
source of supply of all drugs, chemicals,
biologicals and pharmaceutical preparations used
in the diagnosis and treatment of patients.
 Format and appearance
• The format is extremely important since it will
determine the practicality of daily use of
formulary as well as the publishing cost. (The
physical appearance and structure of the
formulary has a great influence on its use)
• Although expensive artwork and materials are
unnecessary, the formulary should be visually
pleasing, easily readable and professional in
appearance.
• The need for proper grammar, punctuation,
correct spelling and neatness is important
 Format and appearance--
• There is no single format or arrangement which all formularies
must follow, however, a typical formulary must have the following
composition:
1. Title page
2. Names and titles of the members of the PTC
3. Table of contents
4. Information on hospital policies and procedures concerning drugs
4.1. The PTC of XYZ hospital
4.2. objectives and operation of the formulary system
4.3. Hospital regulations and procedures for prescribing and
dispensing drugs
4.4. Hospital pharmacy services and procedures
4.5. How to use the formulary
 Format and appearance---
5. Product accepted for use at XYZ hospital
5.1. Items added and deleted since the previous
edition
5.2. Generic-brand name cross reference list
5.3. pharmacologic index with relative cost code
5.4. Description of formulary drug products by
pharmacologic class
6. Appendix
6.1. Rules for calculating pediatric doses
6.2. Nomogram for estimating body surface area
6.3. Schedule for standard drug administration time
 Format and appearance----
Presentation of formulary deals with format and
appearance. Several techniques can be used to
improve the appearance and ease of use of the
formulary. Among these are:
• Using a different color paper for each section of the
formulary
• Using an edge index
• Making the formulary pocket size (approx: 4”x7”)
• Printing the generic name heading of each drug entry
in boldface type or using some other method for
making it stand out from the rest of the entry
 Preparation of formulary
• The preparation of hospital formulary is the prime
responsibility of PTC
• PTC freely evaluate drugs for, to be admitted to, or
rejected from, hospital formulary.
• After decision of the inclusion of drugs in formulary,
a pharmacist undertake the production aspects of
preparation.
• The PTC selects the type of hospital formulary that
best suits the need among the various types such as
a hospital owned formulary, simple drug list or
catalogue, or a purchased formulary service
 Preparation of formulary--
• Regular updating of formulary requires
evaluation, approval or rejection of drugs from
the hospital formulary. It is the duty of
pharmacy committee to develop a drug
evaluation process and form for this purpose
• The development of comprehensive data base
is essential for evaluating drugs proposed for
admission to hospital formulary. A thorough
review of pharmaceutical and medical literature
is necessary when accumulating these data
 Keeping formulary up-to date
• Generally, the formulary will need to be revised
annually
• Addition and deletion to the formulary, changes in drug
products, removal of drug from marketplace and
changes in hospital policies and procedures all will
necessitate periodic revision of the formulary
• There should be a system for including between
revision changes in the current edition of the formulary
• This can be done by attaching formulary supplement
sheets to the inside back covers of the formulary books
 Formulary: drug inclusion and withdrawal
criteria
Inclusion criteria:
• Having an official status (i.e included in any of
pharmacopeia, national formulary or their
supplements
• Having known composition
• Has proven clinical value ( based on experience of
local general and speciality staff with it)
• Manufacturer having a proven integrity and
reputation
 Formulary: drug inclusion and withdrawl
criteria--
• Withdrawal criteria:
• The manufacture ceases its production
• Withdrawn of the product license by drug
authorities
• Evidence of severe adverse effects
• The drug has not been prescribed for a long
period of time
 Contraceptives
• A device or drug serving to prevent pregnancy.
• contraceptive method 
- birth control by the use of :
devices (such as condom) or
drugs or
surgery
 Contraceptives--
• the deliberate use of artificial methods or other
techniques to prevent pregnancy as a
consequence of sexual intercourse. The major
forms of artificial contraception are: barrier
methods, of which the commonest is the condom
or sheath; the contraceptive pill, which contains
synthetic sex hormones which prevent ovulation
in the female; intrauterine devices, such as the
coil, which prevent the fertilized ovum from
implanting in the uterus; and male or female
sterilization
 Hormone-based contraceptives
5 types
1) Oral contraceptives (pills)
2) Vaginal ring
3) Transdermal patch
4) Injected hormones
5) Hormonal IUDs
 Mechanism of hormonal contraceptives:

• Suppress ovulation
• Suppress follicular development
• Alter cervical mucous making sperm
penetration more difficult
• Alters endometrium making implantation less
likely
 Mechanism--
• Gonadotropin releasing hormone (GnRH)
triggers release of gonadotropins FSH & LH
• FSH & LH trigger ovulation
• Estrogen & progesterone in hormonal
contraceptives inhibit LH, FSH, and GnRH
secretion, preventing ovulation
• Progesterone also:
-thickens cervical mucus to prevent
Passage of sperm into the uterus
-changes uterine lining to inhibit implantation
 Oral contraceptives (OCs)
• Women who should not take OCs:
– history of blood clots, strokes,
heart/circulation problems, jaundice, breast or
uterine cancer, liver disease
• Women considered risky for taking OCs:
– Women who smoke, have migraines,
depression, high b.p., epilepsy, diabetes,
asthma,
• Side effects of OCs:
– Weight gain, decreased sexual interest,
headaches, mood changes, nausea, bleeding
between periods
 Summary
• Formulary and formulary system
• Benefits and demerits
• Objectives of formulary
• Formulary vs. drug list
• Guiding principles to develop formulary
• Format and appearance
• Preparation of formulary
• Keeping formulary up-to date
• Drug inclusion and withdrawal criteria
• contraceptives