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CPS at a Glance CPS is color-coded to help you find the information you need quickly and easily. For more information, see How to Use CPS on the next page. Therapeutic Guide Brand and Generic Name Index Clin-Info L4 G2 Therapeutic Guide • Brand and Generic Name Index acetaminophen / chlorpheniramine maleate / phenylephrine HCl. Benylin Cold and Sinus Plus; Dimetapp Nighttime Cold Extra Strength; Dristan; Dristan Extra Strength; Tylenol Allergy Extra Strength (Multi-Symptom Relief); Tylenol Sinus Extra Strength Nighttime. acetaminophen / chlorpheniramine maleate / pseudoephedrine HCl. Sinutab Sinus and Allergy; Tylenol Sinus Pain and Congestion Nighttime Extra Strength. acetaminophen / chlorzoxazone. Acetazone Forte. acetaminophen / chlorzoxazone / codeine phosphate. Acetazone Forte C8. acetaminophen / codeine phosphate. ratio-Emtec-30; ratio-Lenoltec No. 4; Triatec-30; Tylenol with Codeine No. 4 ; Tylenol with Codeine Elixir . acetaminophen / codeine phosphate / doxylamine succinate. Mersyndol with Codeine. acetaminophen / codeine phosphate / methocarbamol. Methoxacet-C⅛; Robaxacet-8. acetaminophen / dextromethorphan HBr. Tylenol Cough. acetaminophen / dextromethorphan HBr / diphenhydramine HCl. Tylenol Children’s Cold & Cough Nighttime. acetaminophen / dextromethorphan HBr / doxylamine succinate. Vicks NyQuil Liquicaps; Vicks NyQuil Liquid. Actifed Plus Extra Strength (McNeil Consumer Healthcare). acetaminophen / pseudoephedrine HCl / triprolidine HCl. Actinac (Hoechst Marion Roussel). allantoin / butoxyethylnicotinate / chloramphenicol / hydrocortisone acetate / precipitated sulfur. Discontinued 2000. Activase rt-PA (Acute Ischemic Stroke) (Roche). alteplase. Acetaminophen Overdose acetylcysteine Acne Vulgaris Androgen Receptor Antagonists spironolactone Antibiotics Activase rt-PA (Acute Myocardial Infarction) (Roche). alteplase. activated attapulgite. see attapulgite, activated. activated charcoal. see charcoal, activated. activated dimethicone. see simethicone. activated polymethylsiloxane. see simethicone. Active Calcium Chewable (USANA Health Sciences). calcium / magnesium / silicon / vitamin D. Active Calcium Plus (USANA Health Sciences). calcium / magnesium / silicon / vitamin D. Activelle (Novo Nordisk). estradiol / norethindrone acetate. Activelle LD (Novo Nordisk). estradiol / norethindrone acetate. Actonel (Procter & Gamble Pharmaceuticals). risedronate sodium hemi-pentahydrate. Folate Antagonists trimethoprim Macrolides erythromycin erythromycin estolate Tetracyclines doxycycline hyclate minocycline hydrochloride tetracycline hydrochloride Sulfonamide Combinations sulfamethoxazole/trimethoprim Antibiotics, Topical acetaminophen / dextromethorphan HBr / doxylamine succinate / phenylephrine HCl. Tylenol Cold & Flu Nighttime Liquid. Actonel Plus Calcium (Procter & Gamble Pharmaceuticals). calcium carbonate / risedronate sodium hemi-pentahydrate. acetaminophen / dextromethorphan HBr / guaifenesin / pseudoephedrine HCl. Balminil Cough & Flu; Benylin 1 All-in-One Cold and Flu; Benylin DM-D-E-A Cold and Sinus Rapid Gels. Actos (Lilly). pioglitazone HCl. acetaminophen / dextromethorphan HBr / phenylephrine HCl. Tylenol Cold & Flu Daytime Liquid; Tylenol Cold Extra Strength Daytime; Tylenol Cold Regular Strength Daytime; Tylenol Flu Extra Strength Daytime; Vicks DayQuil Liquicaps; Vicks DayQuil Liquid. Acular LS (Allergan). ketorolac tromethamine. Corticosteroids, Topical acyclovir. Mylan-Acyclovir; Nu-Acyclovir; ratio-Acyclovir; Zovirax Cream; Zovirax Ointment; Zovirax Oral. Hormones Acular (Allergan). ketorolac tromethamine. acetaminophen / dextromethorphan HBr / pseudoephedrine HCl. Robitussin Total Cough Cold and Flu; Sudafed Cold & Cough Extra Strength. acyclovir sodium. Acyclovir Sodium Injectable; Acyclovir Sodium Injection. acetaminophen / diphenhydramine HCl / phenylephrine HCl. Benylin All-in-One Cold and Flu Night PE. Acyclovir Sodium Injection (Hospira). acyclovir sodium. acetaminophen / diphenhydramine HCl / pseudoephedrine HCl. Benadryl Allergy/Sinus/Headache; Benadryl Total/Allergy/Regular Strength; Benadryl Total/Allergy/Extra Strength; Sinutab Nightime. Acyclovir Sodium Injectable (CPhA Monograph). acyclovir sodium. Adacel (sanofi pasteur). tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine adsorbed. Adalat PA 10 (Bayer). nifedipine. Discontinued 2001. acetaminophen / doxylamine succinate / phenylephrine HCl. Vicks NyQuil Sinus LiquiCaps. Adalat PA 20 (Bayer). nifedipine. Discontinued 2001. acetaminophen / methocarbamol. Methoxacet; Methoxacet Extra Strength; Midol Night-Time; Robaxacet; Robaxacet Extra Strength. Adalat XL (Bayer). nifedipine. acetaminophen / oxycodone HCl. Endocet; Percocet; Percocet-Demi; PMS-Oxycodone-Acetaminophen; ratio-Oxycocet. adalimumab. Humira. acetaminophen / pamabrom / pyrilamine maleate. Midol PMS Complete; Pamprin Extra Strength Multi-Symptom; Pamprin Extra Strength PMS; Tylenol Menstrual Extra Strength. acetaminophen / phenylephrine HCl. Benylin Cold and Sinus; Tylenol Sinus Extra Strength Daytime; Tylenol Sinus Regular Strength Daytime; Vicks DayQuil Sinus LiquiCaps. acetaminophen / pseudoephedrine HCl. Dimetapp Daytime Cold Extra Strength; Dristan N.D.; Dristan N.D. Extra Strength; Sinutab Sinus Non Drowsy; Sudafed Head Cold and Sinus Extra Strength; Tylenol Children’s Decongestant; Tylenol Sinus Pain and Congestion Daytime Extra Strength. acetaminophen / pseudoephedrine HCl / triprolidine HCl. Actifed Plus Extra Strength. acetaminophen / tramadol HCl. Tramacet. acetazolamide. Carbonic Anhydrase Inhibitors: Systemic. Acetazone Forte (Rougier Pharma). acetaminophen / chlorzoxazone. Acetazone Forte C8 (Rougier Pharma). acetaminophen / chlorzoxazone / codeine phosphate. Acetoxyl (Valeo Pharma). benzoyl peroxide. acetylcholine chloride / electrolytes. Miochol-E. acetylcysteine. Acetylcysteine Solution (Sandoz Standard); Mucomyst. Acetylcysteine Solution (Sandoz Standard) (Sandoz). acetylcysteine. Peroxides, Topical isotretinoin Adalat XL Plus (Bayer). ASA / nifedipine. Retinoids and Analogues, Topical adapalene. Differin; Differin XP. Adasept b.p.5 Acne Gel (Odan). benzoyl peroxide. Adasept Shampoo (Odan). alkyl alcohol sulfate / betaine amphoteric / coconut alkanolamide. Adasept Skin Cleanser (Odan). triclosan. Sulphur Preparations, Topical Various Topical Preparations adefovir dipivoxil. Hepsera. benzoyl peroxide/clindamycin erythromycin/tretinoin glycolic acid povidone-iodine salicylic acid triclosan ADEKs (Axcan Pharma). multiple vitamins / zinc oxide. Adenocard (Astellas). adenosine. Adenoscan Liquid IV Infusion (Fujisawa). adenosine. adenosine. Adenocard. Acromegaly Adrenalin (ERFA Canada). epinephrine HCl. Dopamine Agonists adrenaline. see epinephrine. bromocriptine Adriamycin PFS (Pfizer). doxorubicin HCl. Growth Hormone Receptor Antagonists Adrucil (Pfizer). fluorouracil. Discontinued 2003. pegvisomant Advagraf (Astellas). tacrolimus. Somatostatin Analogues Advair (GlaxoSmithKline). fluticasone propionate / salmeterol xinafoate. octreotide Actinic Keratosis Advair Diskus (GlaxoSmithKline). fluticasone propionate / salmeterol xinafoate. Advate (Baxter). antihemophilic factor (recombinant) plasma/albumin free method (rAHF-PFM). Advantage 24 (WellSpring). nonoxynol-9. Discontinued 2004. Immune Response Modifiers, Topical imiquimod Advicor (Oryx). lovastatin / niacin. Advil (Wyeth Consumer Healthcare). ibuprofen. Advil Cold & Sinus (Wyeth Consumer Healthcare). ibuprofen / pseudoephedrine HCl. Act-HIB (sanofi pasteur). Haemophilus b conjugate vaccine (tetanus protein-conjugate). Advil Cold & Sinus Daytime (Wyeth Consumer Healthcare). ibuprofen / pseudoephedrine HCl. Actifed (McNeil Consumer Healthcare). pseudoephedrine HCl / triprolidine HCl. adapalene isotretinoin tazarotene tretinoin sulphur Adderall XR (Shire). mixed salts amphetamine. Acne-Aid Soap (Stiefel). nonmedicated soap. ActiCal Plus (Usana). calcium citrate / cholecalciferol / magnesium / silicon. Discontinued 2002. Antiandrogen/Estrogen Combinations cyproterone acetate/ethinyl estradiol Progestogen/Estrogen Combinations, Monophasic drospirenone/ethinyl estradiol Progestogen/Estrogen Combinations, Triphasic levonorgestrel/ethinyl estradiol norgestimate/ethinyl estradiol benzoyl peroxide acetylsalicylic acid. see ASA. acitretin. Soriatane. methylprednisolone Retinoids, Oral Acid Concentrate (Baxter). acetic acid / calcium chloride / dextrose / magnesium chloride / potassium chloride / sodium chloride. Aclasta (Novartis Pharmaceuticals). zoledronic acid. Lincosamides clindamycin Macrolides erythromycin Acute Coronary Syndromes Alcohol Withdrawal acetylsalicylic acid (ASA) clopidogrel prasugrel ticlopidine phenytoin Antiplatelet Agents Laboratory Reference Intervals: SI and Traditional Units Barbiturates Calcium Channel Blockers phenobarbital Benzodiazepines Table 1: chlordiazepoxide diazepam lorazepam Allergies see also Conjunctivitis, Allergic; Gastrointestinal Allergy; Rhinitis, Allergic Factor Xa Inhibitors, Indirect grass tyrosine adsorbate, modified ragweed tyrosine adsorbate tree tyrosine adsorbate, modified abciximab eptifibatide tirofiban Antihistamines, Ophthalmic emedastine levocabastine hydrochloride Heparins, Unfractionated Antihistamines, Oral heparin sodium Alkylamines brompheniramine maleate chlorpheniramine maleate Ethanolamines diphenhydramine Phenothiazines promethazine trimeprazine Piperazines cetirizine hydroxyzine Piperidines cyproheptadine desloratadine fexofenadine loratadine Nitrates isosorbide dinitrate isosorbide-5-mononitrate nitroglycerin Renin-Angiotensin System Agents Angiotensin Converting Enzyme (ACE) Inhibitors captopril cilazapril enalapril fosinopril lisinopril quinapril ramipril Thrombolytics alteplase (rt-PA) reteplase streptokinase tenecteplase 10 16.67 0.5543 16.67 total 2–18 µmol/L 0.1–1 mg/dL 17.1 conjugated 0–4 µmol/L 0–0.2 mg/dL 17.1 2.2–2.58 mmol/L 8.8–10.3 mg/dL 0.2495 female <50 years 2.2–2.5 mmol/L 8.8–10 mg/dL 0.2495 female >50 years 2.2–2.56 mmol/L 8.8–10.2 mg/dL 0.2495 all populations 2.2–2.56 mmol/L 4.4–5.1 mEq/L 0.5 1–1.15 mmol/L 2–2.3 mEq/L 0.5 Calcium, ionized (serum) Mailing Address: Montreal Order Desk: Tel: 1-800-567-2226 (all area codes) 514-832-7333 (Montreal) Fax: 514-832-7251 1-800-513-7337 Chloride (serum) 22–28 mmol/L 22–28 mEq/L 1 95–105 mmol/L 95–105 mEq/L 1 Nfld: Provincial Medical Supplies 51 Pippy Pl PO Box 13427 St John’s NL A1B 4B7 Tel: 709-754-3033 1-800-563-8755 Fax: 709-754-3014 Edmonton: 16607–116th Ave Edmonton AB T5M 3V1 Tel: 780-451-4297 Fax: 780-455-7275 Montreal: 5685 Cypihot Rd Saint-Laurent QC H4S 1R3 Tel: 514-832-7000 Fax: 514-337-1986 Vancouver: 7403 Progress Way Delta BC V4G 1E7 Tel: 604-940-4148 Fax: 604-940-4102 Cholesterol (serum) low risk populations <5.2 mmol/L <200 mg/dL 0.02586 moderate and high risk populations <4.2 mmol/L <162 mg/dL 0.02586 0800 h 110–520 nmol/L 1600 h 50–410 nmol/L 2400 h 4–19 µg/dL 2–15 µg/dL Abbott Nutrition International Plant 198 Pearl St E Brockville ON K6V 1R4 Tel: 613-341-6000 Fax: 613-341-6056 27.59 27.59 27.59 ketotifen olopatadine Cortisol (urine) 30–300 nmol/day 10–110 µg/24 h 2.759 Diagnostic Reagents: Glucocorticoids betamethasone sodium phosphate betamethasone valerate cortisone acetate dexamethasone dexamethasone sodium phosphate hydrocortisone hydrocortisone sodium succinate methylprednisolone methylprednisolone acetate methylprednisolone sodium succinate prednisolone prednisolone sodium phosphate triamcinolone triamcinolone acetonide triamcinolone diacetate Mineralocorticoids fludrocortisone acetate beclomethasone dipropionate budesonide flunisolide fluticasone propionate mometasone furoate monohydrate triamcinolone acetonide Creatinine (serum) 50–110 µmol/L 0.6–1.2 mg/dL 88.4 Creatinine clearance 1.24–2.08 mL/s 75–125 mL/min 0.01667 C-Reactive Protein 0.68–82 mg/L 6.8–820 µg/dL 100 dexamethasone sodium phosphate fluorometholone fluorometholone acetate prednisolone acetate prednisolone sodium phosphate rimexolone Ethanol (plasma) Diagnostic Reagents Diagnostic Division 7115 Millcreek Dr Mississauga ON L5N 3R3 Tel: 905-858-2450 1-800-387-8378 Fax: 905-858-2462 Corticosteroids, Nasal <140 nmol/L Delta (5)-aminolevulinic acid (urine) Corticosteroids, Ophthalmic legal limit (driving)d toxic Folate, as folic acid, pteroylglutamic acid (serum) Gammaglutamyltransferase (GGT) 8–53 µmol/day 1–7 mg/24 h 7.626 <10.86 mmol/L <50 mg/dL 0.2171 >22 mmol/L Ferritin (serum) Fibrinogen (plasma) (serum)b <5 µg/dL >100 mg/dL 18–300 ng/mL 1 150–350 mg/dL 0.01 4–22 nmol/L 2–10 ng/mL 2.266 0–500 nkat/L 0–30 U/L 16.67 Tel: 1-800-268-4276 AndroGel Creon 5 Minimicrospheres Creon 10 Minimicrospheres Creon 25 Minimicrospheres Dicetel Influvac Luvox Marinol Serc Teveten Teveten Plus Narcotic Distribution Centers: Abraxis BioScience Canada inc Head Office: 30 Eglinton Ave W Suite 500 Mississauga ON L5R 3E7 Tel: 1-877-779-7480 Fax: 1-877-779-7482 (cont’d) Copyright © 2011 Canadian Pharmacists Association. All rights reserved. Head Office: 3100 Steeles Avenue East Suite 605 Markham ON L3R 8T3 Tel: 905-489-1957 Fax: 905-489-1973 Email: [email protected] Website: http://accord-healthcare.com/ Bicalutamide Tablets Letrozole Tablets USP Pioglitazone Hydrochloride Tablets Actavis Canadian Office: Tribute Pharma Canada Inc. 57 Martin Street Milton ON L9T 2R1 Tel: 905-876-1118 Fax: 905-876-4675 Website: www.tributepharma.com Customer Service: Tel: 1-888-333-4401 Medical Information: Tel: 1-866-391-4503 Bezalip SR Soriatane Actelion Pharmaceuticals Canada Inc. Head Office: 2550 Daniel Johnson Blvd Suite 701 Laval QC H7T 2L1 Tel: 450-681-1664 1-866-531-4885 Fax: 450-681-9545 Website: www.actelion.com Medical Information: Tel: 1-866-531-4885 Order Desk: Tel: 1-877-717-8382 Fax: 1-800-786-1967 Tracleer Zavesca Adrem Inc. Head Office: 2000 Ellesmere Rd Unit 16 Scarborough ON M1H 2W4 Tel: 416-438-6727 Fax: 416-438-3463 Email: [email protected] Wake Ups Afexa Life Sciences Inc. Corporate Office: 9604–20th Avenue Edmonton AB T6N 1G1 Tel: 1-888-843-7239 Website: www.afexa.com COLD-FX Compendium of Pharmaceuticals and Specialties (CPS), 2011 Compendium of Pharmaceuticals and Specialties (CPS), 2011 Compendium of Pharmaceuticals and Specialties (CPS), 2010 A listing of diseases and conditions with the generic names of drugs used to treat them. For brand names, consult the Brand and Generic Name Index. Accord Healthcare Inc. Abraxane Copyright © 2010 Canadian Pharmacists Association. All rights reserved. Names in bold face/not underlined: Availability information provided in the Monograph section. Names in regular face: Product is available in Canada but the monograph does not appear in CPS. An alphabetical, cross-referenced index of brand and generic names of products available in Canada including references to CPhA Monographs. Also integrated into this section are products discontinued between 2000 and 2013. Medical Information: UPS Logistics/Lynden Logistics 10 Corinne Court Vaughan ON L4K 4T7 Tel: 905-879-0114 1-800-268-4937 Fax: 905-879-0123 0.2171 18–300 µg/L 1.5–3.5 g/L Abbott Products Inc. Head Office: 60 Columbia Way Suite 207 Markham ON L3R 0C9 Tel: 905-944-2480 Fax: 905-944-2481 Plant: Cortisol (serum) Antihistamines and Mast Cell Stabilizers, Ophthalmic Adrenocortical Insufficiency Corticosteroids, Systemic Biaxin Biaxin BID Biaxin XL Calcijex Depakene Epival Humira Hytrin Isoflurane, USP Isoptin SR Kadian Kaletra Lupron/Lupron Depot 3.75 mg/7.5 mg Lupron Depot 3.75 mg/11.25 mg Lupron/Lupron Depot 7.5 mg/22.5 mg/30 mg Mavik Nimbex Norvir Norvir SEC Rythmol Sevorane AF Survanta Synagis Synthroid Tarka Ultiva Distribution Centres: (bicarbonate + CO2) (blood, plasma, serum) Provincial Medical Supplies 51 Pippy Pl PO Box 13427 St John’s NL A1B 4B7 Tel: 709-754-3033 1-800-563-8755 Fax: 709-754-3014 PO Box 6150 Stn Centre-Ville Montreal QC H3C 3K6 Carbon dioxide Advil Cold and Sinus Nighttime (Wyeth Consumer Healthcare). chlorpheniramine maleate / ibuprofen / pseudoephedrine HCl. Copyright © 2010 Canadian Pharmacists Association. All rights reserved. 16.67 10–85 µg/dL 0–35 U/L male levocabastine hydrochloride Heparins, Low Molecular Weight Conversion Factora 4–6 g/dL 30–120 U/L 0–585 nkat/L Calcium (serum) Antihistamines, Nasal dalteparin enoxaparin Traditional Reference 0–35 U/L 40–60 g/L 500–2000 nkat/L 5–50 µmol/L Aspartate aminotransferase (AST) (serum)b Bilirubin (serum) Allergenic Extracts fondaparinux sodium SI Reference 0–585 nkat/L Alkaline phosphatase (serum)c Ammonia, as ammonium ion (NH4+) (plasma) Albumin (serum) acamprosate calcium Opioid Antagonists UPS Logistics/Lynden Logistics 4441–76th Ave SE West Building Calgary AB T2C 2G8 Tel: 403-279-2700 Fax: 403-236-9104 Head Office: 8401 Trans-Canada Hwy Saint-Laurent QC H4S 1Z1 Tel: 514-832-7000 1-800-361-7852 (Canada) Fax: 514-832-7800 Reference Intervals Alanine aminotransferase (ALT) (serum)b Gamma Aminobutyric Acid (GABA) Agonists/Glutamate Antagonists naltrexone hydrochloride Glycoprotein IIb/IIIa Inhibitors Abbott Laboratories, Limited Adult Laboratory Intervals Laboratory Test Alcoholism • Y11 Directory III—Pharmaceutical Manufacturers/Distributors Date of Revision: August 2010 Table 1 provides a summary of selected adult clinical laboratory reference intervals. For serum drug concentration levels and conversion factors see the Serum Drug Concentration Monitoring section in Clin-Info. This information is not intended to present a comprehensive review; the reader is therefore encouraged to seek additional and confirmatory information. Reference intervals will vary depending on the analytical methods used and the population studied. Each laboratory establishes its own reference intervals. haloperidol Dihydropyridines amlodipine Nondihydropyridines diltiazem verapamil Directory M.J. McQueen, MB, ChB, PhD, FCACB, FRCPC Antipsychotics Nonselective without Intrinsic Sympathomimetic Activity (ISA) nadolol propranolol timolol Selective with ISA acebutolol Selective without ISA atenolol metoprolol Compendium of Pharmaceuticals and Specialties (CPS), 2010 Names in italics: Generic drug names, active ingredient or category. Names in bold face/underlined: Prescribing information provided in the Monograph section. • P5 Antiepileptics Beta-adrenergic Blocking Agents Directory • Clin-Info Copyright © 2011 Canadian Pharmacists Association. All rights reserved. Contact information for: • Pharmaceutical Manufacturers (includes product listings) • Poison Control Centres Valuable clinical information and practice tools to assist healthcare professionals in using drugs safely and effectively. CPhA Monographs Product Monographs CPhA Monographs are presented alphabetically by generic name or drug class name within the monograph section. Titles of the monographs are shaded in grey to distinguish them from manufacturers’ product monographs. CPhA Monographs are written by the editorial staff of CPhA, are based on the best available evidence and are reviewed by expert physicians and pharmacists. CPhA monographs are an important source of prescribing information that may not otherwise appear in CPS. The CPhA Monograph Index is located in the Front Pages of CPS following the Table of Contents. Product Monographs: Pharmaceutical product monographs and availability listings appear in alphabetical order by brand name. The product monographs are voluntarily submitted for publication by the pharmaceutical manufacturers. All monographs have been approved by the Therapeutic Products Directorate, Health Canada. Information for the Patient: Only available by subscription at www.pharmacists.ca/cps. Drug Updates: A summary table of drug updates is updated every 2 weeks. Available at www.pharmacists.ca/cpsupdates. Also available by subscription at www.pharmacists.ca/cps. Product Identification Appendices 2008 Appendices.qxd Full-color reproductions of products selected by manufacturers whose monographs appear in the Product Monograph section. This is an essential tool for accurate identification of pharmaceutical products. A P P E N D I C E S 12/11/2007 12:03 PM Glossaries 2008 Appendices.qxd Page 10 12/12/2007 8:42 AM Page 11 • Gl11 A10 • Glossary of Medical Abbreviated Terms APPENDIX 4B Canada Vigilance The form should be printed and faxed toll free to: 1 866 678-6789 or mailed as per instructions below. Report of suspected adverse reaction due to health products* marketed in Canada Health Products and Food Branch Direction générale des produits de santé et des aliments PROTECTED B** La version française de ce document est disponible à: http://www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/pdf/medeff/ar-ei_form_f.pdf C. Suspected Health Product(s) (See "How to report" section) A. Patient Information (See " Confidentiality" section) 1. Identifier 3. Sex Male 2. Age at time of reaction Female 4. Height 5. Weight _______ feet or _______ cm _______ lbs or _______ kgs B. Adverse Reaction 1. Outcome attributed to adverse reaction (check all that apply) Death___________ (yyyy/mm/dd) Life-threatening Hospitalization Hospitalization - prolonged 2. Date of reaction YYYY MM DD (when completed) Disability Congenital malformation Required intervention to prevent damage/permanent impairment Other : ________________ 3. Date of this report YYYY MM DD 4. Describe reaction or problem 1. Name (give labeled strength & manufacturer, if known) #1 __________________________________________________________________ #2 __________________________________________________________________ 2. Dose, frequency & route used 3. Therapy dates (if unknown, give duration) #1 # 1 From (yyyy/mm/dd) - To (yyyy/mm/dd) #2 #2 4. Indication for use of suspected health 5. Reaction abated after use stopped or dose reduced product #1 #1 #2 #2 Yes Yes No Doesn't apply No Doesn't apply 6. Lot # (if known) 7. Exp. date (if known) 8. Reaction reappeared after reintroduction #1 # 1 (yyyy/mm/dd) #2 #1 Yes No Doesn't apply #2 Yes No Doesn't apply #2 9. Concomitant health products (name, dose, frequency and route used), and therapy dates (yyyy/mm/dd) (exclude treatment of reaction) 5. Relevant tests / laboratory data (including dates (yyyy/mm/dd)) 10. Treatment of adverse reaction (medications and / or other therapy), include dates (yyyy/mm/dd) D. Reporter Information (See " Confidentiality" section) 6. Other relevant history, including pre-existing medical conditions (e.g. allergies, pregnancy, smoking and alcohol use, hepatic / renal dysfunction) 1. Name, address & phone number 2. Health professional? 3. Occupation 4. Also reported to manufacturer? Yes No Yes No Submission of a report does not constitute an admission that medical personnel or the product caused or contributed to the adverse reaction. * Use this form to report suspected adverse reactions to pharmaceuticals, biologics (including fractionated blood products, as well as therapeutic and diagnostic vaccines), natural health products or radiopharmaceuticals. ** As per the Treasury Board of Canada Secretariat Government Security Policy. HC/SC 4016 (10/07) Reproduced with permission from Report of suspected adverse reaction due to drug products marketed in Canada, Health Canada, 2002. © Minister of Public Works and Government Services Canada, 2005. Copyright © 2008 Canadian Pharmacists Association. All rights reserved. Compendium of Pharmaceuticals and Specialties (CPS), 2008 Health Canada drug regulatory and monitoring programs’ reporting and request forms are found in the Appendices. ACE ACTH ADH AHA AIDS ALT ANC APTT ASA AST AUC AV b.i.d. BID BMI BMR BP BSA BSP BUN oC 14C C CHF CK cm CNS COMT COPD CPK CPR CP CSD CSF CT CVA D&C DIC dL DNA DSA ECG ECT EEG EENT ERCP ESR ET FD&C FSH g GFR GGT GI G-6-PD GVHD h Hb hCG HDPE HIV HMG-CoA hs HS 131l I.M. or i.m. IM INR IOP IU IUD I.V. or i.v. IV J kg L lb LE LGL angiotensin converting enzyme adrenocorticotropic hormone antidiuretic hormone American Heart Association acquired immunodeficiency syndrome alanine transferase (SGPT) absolute neutrophil count activated partial thromboplastin time acetylsalicylic acid aspartate transferase (SGOT) area under the concentration curve atrioventricular twice daily twice daily body mass index basal metabolic rate British Pharmacopoeia; blood pressure body surface area bromsulphalein blood urea nitrogen degrees Celsius radioactive carbon isotope of atomic weight 14 controlled drug congestive heart failure creatine kinase centimetre central nervous system catechol-o-methyltransferase chronic obstructive pulmonary disease creatine phosphokinase cardiopulmonary resuscitation centipoise Canadian Standard Drug cerebrospinal fluid computed tomography cerebrovascular accident designation applied to dyes permitted for use in drugs and cosmetics disseminated intravascular coagulation decilitre deoxyribonucleic acid digital subtraction angiography electrocardiogram electroconvulsive therapy electroencephalogram ear, eye, nose and throat endoscopic retrograde cholangiopancreatography erythrocyte sedimentation rate endotracheal designation applied to dyes permitted for use in foods, drugs and cosmetics follicle-stimulating hormone gram glomerular filtration rate gamma-glutamyl transpeptidase, (-glutamyltransferase gastrointestinal glucose-6-phosphate dehydrogenase graft-versus-host disease hours hemoglobin human chorionic gonadotropin high density polyethylene human immunodeficiency virus hydroxy-methyl-glutaryl coenzyme A bedtime bedtime radioactive iodine isotope of atomic weight 131 intramuscular intramuscular international normalized ratio intraocular pressure international unit intrauterine contraceptive device intravenous intravenous joule kilogram litre pound lupus erythematosus Lown-Ganong-Levine Compendium of Pharmaceuticals and Specialties (CPS), 2008 LH g L m mol M MAO MAOI mEq mg MI min mIU MJ mL mmHg mmol mOsm MRI ms MS N NF nkat NMS NPN NSAID NST OHSS oz PABA PBI PBP pg PG pH pmol po PO ppm P P PRA prn PRN PSVT PT PTCA q.i.d. QID ® RAI r-hFSH RIA RNI s SA S.C. or s.c. SC SD SGOT SLE SGPT SMA SSPE SSRI T t.i.d. TID TM TSH TT ULN USP v/v WBC WHO WPW w/v w/w luteinizing hormone micron microgram microlitre micrometer micromole molar monoamine oxidase monoamine oxidase inhibitor milliequivalent milligram myocardial infarction minim; minute milli international unit megajoule millilitre millimetre(s) of mercury millimole milliosmole magnetic resonance imaging millisecond multiple sclerosis narcotic National Formulary nanokatal neuroleptic malignant syndrome nonprotein nitrogen nonsteroidal anti-inflammatory drug nonstress test ovarian hyperstimulation syndrome ounce para-aminobenzoic acid protein bound iodine penicillin binding protein picogram (10-12) prostaglandin the logarithm, on the base 10, of the reciprocal of the hydrogenion concentration picomole (10-12) orally orally parts per million prescription required rectally plasma renin activity when needed when needed paroxysmal supraventricular tachycardia prothrombin time percutaneous transluminal coronary angioplasty 4 times daily 4 times daily registered trademark radioactive iodine recombinant human follicle-stimulating hormone radioimmunoassay recommended nutrient intake second sinoatrial subcutaneous subcutaneous standard deviation serum glutamic oxaloacetic transaminase (AST) systemic lupus erythematosus serum glutamic pyruvic transaminase (ALT) sequential multiple analysis subacute sclerosing panencephalitis selective serotonin reuptake inhibitor target controlled substances 3 times daily 3 times daily trademark thyroid stimulating hormone thrombin time upper limit of normal United States Pharmacopeia volume in volume white blood cell World Health Organization Wolff-Parkinson-White weight in volume weight in weight Copyright © 2008 Canadian Pharmacists Association. All rights reserved. G L O S S A R I E S Glossaries for: • Medical Abbreviations • Microorganism Abbreviations • Risk Factors for Drug Use During Pregnancy The Glossaries are located after the Appendices. See also How to Use Guides at the start of most sections. Electronic Products: For new and revised content received by the publisher after the print deadline, subscribe to CPS e-Suite at www.pharmacists.ca/cps or contact us by email at [email protected] or by telephone at 1-800-917-9489 ext. 501.