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Hospice of North Iowa
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I.
Preferred Drug List (Revised January 2013)
John M. Swegle, PharmD, BCPS
john-swegle@uiowa.edu
Key Points to remember:
The items selected in each category are in no particular order.
eg. Letter A is not preferred before letter B; and so forth.
The symptoms covered in the PDL are the most common
seen in our patient population.
The “restricted use” items are those items that we feel could
be reserved as 2nd/3rd line options, unless the other agents
have already been unsuccessfully tried or there are
contraindications for their use.
This PDL is to be used as a tool and is not a formulary. The
PCP’s have no restrictions on prescribing the medication they
feel is appropriate in each unique situation.
“restricted use”  used only after other preferred agents
have been tried, or have rationale for using over the preferred
agents
Medications deemed high-risk/high-alert will be identified
with a “*”
Pain
a. Nociceptive (visceral and somatic)
i. Mild pain: non-opioids
1. Acetaminophen (Tylenol®)
2. NSAIDS
a. Ibuprofen (Motrin®,
Advil)
b. Naproxen (Naprosyn)
c. Choline magnesium
trisalicylate (Trilisate)
d. Celecoxib (Celebrex)/ restricted use
ii. Mild to moderate pain
1. Opioid/non-opioid combinations
a. *Hydrocodone/APAP
(Norco, Lortab)
b. *Oxycodone/APAP
(Percocet)
iii. Moderate to severe pain:
1. Immediate release
a. *Morphine sulfate
(various)
b. *Oxycodone
(roxicodone, OxyIR)
c. *Hydromorphone
(Dilaudid)
2. Sustained release
a. *Morphine (MS Contin)
b. *Oxycodone
(Oxycontin)
c. *Fentanyl Transdermal
System (Duragesic)
Preferred Drug List – Hospice of North Iowa (January 2013)
J. Swegle, PharmD, BCPS
Other
a.
*Methadone - For
initiation/titration, it is
recommended to have
HNI medical directors
involved in the use of
this agent
b.
II.
III.
Bone pain
i. Corticosteroids
1. Dexamethasone (Decadron)
2. Prednisone (Deltasone)
ii. NSAIDS
1. Refer to nociceptive pain
c. Neuropathic pain
i. Tricyclic antidepressants (first line for nonstabbing pain)
1. *Nortriptyline (Pamelor)
2. *Desipramine (Norpramin)
ii. Anticonvulsants (first line for stabbing
pain)
1. Gabapentin (Neurontin)
2. Carbamazepine (Tegretol)
iii. Baclofen
Anxiety/Agitation
a. Benzodiazepines
i. *Lorazepam (Ativan)
ii. *Diazepam (Valium)
iii. *Alprazolam (Xanax)
b. Phenothiazines
i. *Chlorpromazine (Thorazine)
c. Butyrophenones
i. *Haloperidol (Haldol)
d. Atypical antipsychotics
i. *Risperidone (Risperdal)
ii. *Quetiapine (Seroquel)
Nausea/Vomiting
a. Gastric stasis (n/v within 2 hrs of eating)
i. Prokinetic agents
1. Metoclopramide (Reglan)
b. CTZ agents (constant n/v)
i. Phenothiazines
1. Prochlorperazine (Compazine )
ii. Butyrophenones
1. Haloperidol (Haldol)
iii. Others
1. Metoclopramide (Reglan)
c. Vestibular agents (movement induced n/v)
i. *Diazepam (Valium)
ii. Antihistamines
1. Meclizine (Antivert)
2. Promethazine (Phenergan)
iii. Anticholinergics (anitmuscurinics)
1. Scopolamine (Transderm-Scop)
1
d.
e.
f.
IV.
V.
VI.
VII.
Cerebral cortex agents (anxiety induced n/v)
i. Benzodiazepines
§
1. *Lorazepam (Ativan)
2. *Alprazolam (Xanax)
3. *Diazepam (Valium)
§
available in topical gel
Combinations* (severe n/v)
i. *ABH supp (ativan 2mg, benadryl 12.5mg,
haldol 2mg)§
ii. *RBD supp (reglan 10mg, benadryl 25mg,
dexamethasone 4mg)
§
available in topical PLO gel
Other
i. Ondansetron (Zofran)
1. Limit use to those with serotonininduced nausea (radiation, highly
emetogenic chemotherapy)
GI Irritation
a. Antacids
i. Maalox
ii. Mylanta
iii. Calcium carbonate (Tums)
b. H2 Antagonists
i. Famotidine (Pepcid)
c. Proton Pump Inhibitors
i. Omeprazole (Prilosec OTC)
ii. Lansoprazole (Prevacid)
iii. Esomeprazole (Nexium) – restricted use
Depression
a. SSRI’s
i. Sertraline (Zoloft)
ii. Citalopram (Celexa)
iii. Paroxetine
b. Tricyclic antidepressants
i. Nortriptyline
c. Miscellaneous
i. Mirtazapine (Remeron)
ii. Bupropion (Wellbutrin)
iii. Venlafaxine (Effexor)
d. Psychostimulants*
i. Methylphenidate (Ritalin) - limit use and
duration
Insomnia
a. Sedative/hypnotics*
i. Lorazepam (Ativan)
ii. Temazepam (Restoril)
iii. Zolpidem (Ambien)
b. Antidepressants
i. Trazodone (Desyrel)
Constipation
Preferred Drug List – Hospice of North Iowa (January 2013)
J. Swegle, PharmD, BCPS
a.
b.
c.
d.
Stimulant laxatives
i. Sennosides (Senokot-S)
ii. Bisacodyl (Dulcolax)
iii. Enema (Fleets®)
Stool softeners
i. Docusate (Colace)
Saline laxatives
i. MOM
ii. Magnesium citrate
Osmotic laxatives
i. PEG (Miralax)
ii. Sorbitol 70%
VIII.
Diarrhea/Gas
a. Antidiarrheal agents
i. Loperamide (Immodium)
ii. Diphenoxylate/atropine (Lomotil)*
iii. APAP w/codeine*
b. Antiflatulants
i. Simethicone (Mylicon)
IX.
Seizures
a. Antiepileptic agents*
i. Phenytoin (Dilantin)
ii. Valproic acid derivatives (Depakote)
iii. Levetiracetam (Keppra)
b. Benzodiazepines*
i. Lorazepam (Ativan)
ii. Diazepam (Valium)
X.
Fluid overload (edema, heart failure)
a. Thiazide/thiazide-like diuretics
i. §Metolazone (Zaroxolyn)
§
may use in combination with
loop
b. Loop diuretics
i. Furosemide (Lasix)
ii. Torsemide (Demadex) - use as alternative
for oral furosemide failure
c. Potassium sparing diuretics
i. Spironolactone (Aldactone)
XI.
Blood coagulation
a. Anticoagulants*
i. Warfarin sodium (Coumadin)
ii. Enoxaparin (Lovenox)
iii. Heparin
b. Anti-platelet
i. Aspirin
ii. Clopidogrel (Plavix)
XII.
Infection
a. Antibiotics
i. -lactam antibiotics
1. Amoxicillin
2
b.
c.
2. Cephalexin (Keflex)
ii. Macrolides
1. Azithromycin (Zithromax)
iii. Fluoroquinolones – restricted use
1. Levofloxacin (Levaquin)
2. Ciprofloxacin (Cipro)
iv. Miscellaneous
1. Metronidazole (Flagyl)
2. Sulfamethoxazole/trimethoprim
(Bactrim)
3. Doxycycline
Antivirals
i. Acyclovir (Zovirax)
Anitfungals
i. Nystatin (Mycostatin)
ii. Clotrimazole (Mycelex troches)
iii. Fluconazole (Diflucan)
XIII.
Skeletal muscle spasms
a. Benzodiazepines*
i. Diazepam (Valium)
b. “Skeletal muscle relaxants”
i. Cyclobenzaprine (Flexeril)
ii. Metaxalone (Skelaxin)
c. Miscellaneous
i. Nortriptyline (Pamelor)
ii. Amitriptyline (Elavil)
XIV.
Hiccups
a. Chlorpromazine (Thorazine)
b. Baclofen (Lioresal)
XV.
Pruritis
a. Antihistamine
i. Diphenhydramine (Benadryl)
ii. Hydroxyzine (Atarax, Vistaril)
iii. Cetirizine (Zyrtec)
b. H2 antagonists
i. Famotidine (Pepcid)
c. Antidepressant
i. Doxepin (Sinequan, Zonalon)
d. Corticosteroids
i. Prednisone
XVI.
XVII.
Mucositis/Stomatitis
a. Cryotherapy (ice chips, popsicles, cold liquids)
b. Viscous lidocaine
c. “Stomatitis cocktail”:
Benadryl elixir 30 ml +
Maalox suspension 30 ml +
Viscous Lidocaine 2% 30 ml
b.
i. Oxybutynin (Ditropan immediate-release)
ii. Tolterodine (Detrol LA)
Urinary burning sensation
i. Phenazopyridine (Pyridium)
XVIII. Anorexia
a. Prednisone (Deltasone)
b. Dexamethasone (Decadron)
c. Amitriptyline (Elavil)
d. Mirtazapine (Remeron)
e. Megestrol acetate (Megace®) – Restricted use;
liquid preferred
XIX.
Upper respiratory symptoms
a. (cough, congestion)
i. Antitussives*
1. Dextromethorphan/guaifenesin
(Robitussin DM)
2. Hydrocodone/guaifenesin
(Codiclear)
3. Morphine (Roxanol)
ii. Expectorants
1. Guaifenesin (Humibid LA,
Mucinex)
2. Fluids
b. Bronchospasms
i. -agonists
1. Albuterol (Ventolin)
ii. Anticholinergics
1. Ipratropium bromide (Atrovent)

use Combivent if on
both
iii. Corticosteroids – oral therapy more
effective in terminal care
1. Prednisone (Deltasone)
2. Dexamethasone (Decadron)
XX.
Copious secretions
a. Anticholinergics
i. Atropine
1. Eye drops given orally
2. Injection for acute control
ii. Scopolamine (Transderm Scop) – best to
limit use due to delayed onset of effect
iii. Glycopyrrolate (Robinul)
XXI.
Dyspnea
a. Identify and treat the cause (if possible)
b. Morphine (Roxanol)*
c. Lorazepam (Ativan)*
d. Non-pharmacologic
Bladder issues
a. Bladder spasms
Preferred Drug List – Hospice of North Iowa (January 2013)
J. Swegle, PharmD, BCPS
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