dru g formulary - Kern Health Systems

KFHC DRUG FORMULARY 27GENERIC BRAND FORMSNSAID – Acetic Acids, continued • SEE PREVIOUS PAGE G Sulindac Clinoril® 150mg, 200mg tabletRestriction: Restricted to pts. with RA. G Tolmetin Tolectin® 400mg capsule, 200mg, 600mg tabletRestriction: Restricted to pts. with RA.NSAID – COX-2 AgentsCelecoxib (Celebrex®) is allowed without prior authorization for patients over the age of 65 orwho are currently taking Warfarin (Coumadin®). Other indications require prior authorization.Only one daily is allowed – Celebrex® 100mg or 200mg. KHS requires that patients start at thelowest dose possible. Patients who fail a reasonable trial of two other Formulary NSAIDs will beconsidered for a COX-2 agent.Effectiveness: COX-2 medications are not more effective than other NSAIDs. NSAIDs cannotprovide an unlimited amount of the pain relief. While NSAIDs do provide pain relief and haveanti-inflammatory ability they do not alter the course of arthritis or prevent joint destruction.Safety: COX-2 medications are not risk free. Data does seem to reflect a lower incidence of GItoxicity but that may be diminished by concurrent aspirin therapy.Vioxx® had been allowed by the FDA to add to their product insert a statement of safety for GIproblems. Celebrex® was denied a similar request. Adding another NSAID such as aspirin toCOX-2 therapy will probably increase risk. (CLASS Study)COX-2 agents have renal liability as other NSAIDs. This risk may be less but there is somepotential for renal problems. These drugs can cause sodium and fluid retention like other NSAIDs.Cardiovascular safety with COX-2 drugs is being questioned.Cost of NSAIDs and COX-2 NSAIDs for a 30 days supplyOther NSAIDs as Ibuprofen, Meloxicam or Naprosyn $6Celebrex® 200mg QD $88Celecoxib Celebrex® 100mg, 200mg capsuleRestriction: Restricted to pts. > 65 yo or pts. on Warfarin. Limited to one dose daily. Pts. not at risk are required to failtwo other Formulary NSAIDs first. Other pts. and doses require prior authorization.NSAID – Other G Meclofenamate Meclomen® 50mg, 100mg capsule G Nabumetone Relafen® 500mg, 750mg tabletNSAID – Oxicam G Meloxicam Mobic® 7.5mg, 15mg tablet G Piroxicam Feldene® 10mg, 20mg capsule