Physician Update

INTEGRIS System Formulary Updates

Therapeutic Interchange Updates effective June 26, 2018

  • A new lidocaine patch  therapeutic interchange involving the interchange of 5% lidocaine patch (Lidoderm) with the more cost-effective 4% patch (Salonpas Lidocaine).
  • An update to the ophthalmic products therapeutic interchange provides use of brimonidine 0.2%/ brinzolamide1% solution (Simbrinza) as the preferred agent until dorzolamide’s marketplace return. 

Acute Care Formulary

  • The combination dry powder inhaler Trelegy Ellipta was added to the formulary. This inhalational combination agent contains the corticosteroid fluticasone furoate, the anticholinergic umeclidinium, and the long-acting beta2-adrenergic agonist vilanterol. 
  • Restrictions for Clevidipine (Cleviprex), an ultra-rapid acting calcium channel blocker infusion, were adjusted to allow use in intermediate care units as long as patients are on a stable infusion rate (no nurse-driven titration) or patients are being weaned and specific orders on how to do so are provided to the nurse by the prescriber. 
  • Oral combination products including estrogens and medroxyprogesterone (Prempro packs) as well as estrogens and methyltestosterone were removed from the acute care formulary due to lack of use.
  • Infusion location for the chemotherapy agent for refractory multiple myeloma daratumumab (Darsalex) was updated to allow the cycle 1 day 1 infusion to be given during an inpatient observation status visit due to high infusion reaction potential and long infusion duration. Remaining chemotherapy cycles for daratumumab will be given in the outpatient cancer center setting.  
  • The SGLT2 (sodium-glucose cotransporter 2) class of oral agents for type 1 diabetes are currently non-formulary in the acute care setting. After further review of safety risks including ketoacidosis (particularly perioperatively) and UTI increased risk, this class of agents will not be continued in the acute care setting even if a patient’s own supply is available. Patients will be managed by the inpatient hyperglycemia management protocol in the acute care setting. 


Julia Chiappe, Pharm.D., BCPS, drug information specialist, INTEGRIS Baptist Medical Center Inpatient Pharmacy

Armando Burchett-Zuniga, Pharm.D., drug information specialist, INTEGRIS Southwest Medical Center Inpatient Pharmacy