Download Dihydropyridine Calcium Channel Blockers (CCBs)

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
Is patient concerned about prescription costs and about getting
the most PharmaCare coverage possible?
YES
NO
No medication change
Pharmacists
Prescribers
To confirm Special Authority
coverage for the patient’s
current medication, call
1-866-905-4912
To confirm Special Authority
coverage for patient’s
current medication, call
the PharmaCare HelpDesk
and select the
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
Does the patient meet the criteria (below) for full coverage of a drug
that will be only partially covered as of December 1, 2016?
Criteria for full coverage of a partially covered (non-reference) drug*
Treatment failure on optimal doses or intolerance to amlodipine or
Complex patient requiring medication(s) for co-existing chronic condition(s)*
NO
Submit a
Special Authority Request
Specialty Exemptions from
submitting Special Authority
Requests: cardiologists,
cardiovascular and thoracic surgery,
internists specializing in cardiology,
nephrologists, paediatrics,
paediatric cardiology.
Pharmacists
If the patient meets the
criteria, refer to prescriber
who can submit a
Special Authority Request
for coverage
YES
Step 2 – Making the switch
Consider the following precautions:
•• If nifedipine is used to treat hypertension in pregnancy, these patients should not be switched to
another CCB.
•• Obtain a baseline BP measurement prior to therapeutic substitution OR ensure that the patient has had a
recent BP measurement.
•• Patients can switch at the next fill of their prescription. Switch the patient to the fully covered CCB at a
therapeutically appropriate dose as shown below.
Pharmacists
You may wish to contact the prescriber for
complex or frail patients such as:
•• pregnant, lactating or pediatric patients
•• patients with an acute or unstable cardiac condition, e.g.:
• hospitalization in the past 6 months for cardiac reasons
• cardiac medication has changed in the past 6 months
• currently being seen by a cardiac specialist
Target Doses and Dose Adjustments 1-4
Hypertension
•• Amlodipine
•• Felodipine
•• Nifedieine
extended release
Adjustments–Renal
Adjustments–Hepatic
•• Initial: 5 mg daily
•• Usual: 5-10 mg daily
•• Max: 10 mg daily
•• None
•• Initial dose: 2.5 mg daily
•• Initial: 5 mg daily
(2.5 mg daily for elderly)
•• Usual: 2.5-10 mg daily
•• Max: 10 mg daily
•• Initial: 20-30 mg daily
•• Usual: 30-60 mg daily
•• Max: 90 mg daily
•• None
•• Initial dose: 2.5 mg daily
•• None
•• Caution: may need to
reduce dose
Drug
Approximate Equivalent Dose 5
•• Amlodipine
2.5 mg
5 mg
10 mg
•• Felodipine
•• Nifedipine
(extended release)
2.5 mg
20 mg
5 mg
30 mg
10 mg
60 mg-90 mg
Monitor blood pressure. Inform the patient of the changes made, of any self-monitoring required, and of plans for follow-up.
* If medical circumstances warrant, Special Authority may be granted
for exceptional coverage on a case-by-case basis.
Prescribers
Pharmacists
Check patient progress at next
scheduled appointment.
Communicate therapeutic substitution information to the
appropriate prescriber according to the requirements of PPP-58.
Check patient progress at next pharmacy visit.
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