New Hope Hospital

Drug Formulary

First Edition

Pharmacy and Therapeutics Committee

2020

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PHARMACY AND THERAPEUTICS COMMITTEE

Viviene Baldeo, M.D.

Chairperson

Raphael Barbas, M.D. Shaira Kate Biliran, M.D.

Nurses

Nureen Boligor, R.N.

Tiffany Myrrh Bulahan, R.N.

Secretariat

Abigail Jane Cabiladas, RPh

Krizia Caño, RPh

Brunette Eloise Cesa, RPh

Administrator

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 TABLE OF CONTENTS
Page(s)

PTC Members --------------------------------------------------------------------------- i

Gastrointestinal Drugs

Aluminum Hydroxide ------------------------------------------------------------------ 4

Calcium Carbonate ---------------------------------------------------------------------- 5

Cimetidine -------------------------------------------------------------------------------- 6

Dicycloverine ---------------------------------------------------------------------------- 8

Loperamide ------------------------------------------------------------------------------- 9

Metoclopramide -------------------------------------------------------------------------- 11

Nizatidine --------------------------------------------------------------------------------- 13

Omeprazole ------------------------------------------------------------------------------- 15

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Aluminium Hydroxide

Mixture or Gel: 320 mg/ml

Suspension: 360mg/5ml
Chewable table: 500mg

Drug Classification: Antacid

Indications: ulcer and non-ulcer dyspepsia; gastro-esophageal reflux,

hyperphosphatemia.

Precautions: uremia, congestive heart failure, renal failure,

edema, cirrhosis, low sodium diets, gastrointestinal hemorrhage, and
elderly.

Contraindications: hypophosphatemia, undiagnosed gastrointestinal or rectal bleeding;

appendicitis; porphyria.

Side effects: constipation, stomach cramps, fecal impaction, nausea, vomiting, and
discoloration of feces, hypophosphatemia, and hypomagnesemia.

Dose and Administration: Dyspepsia, gastro-esophageal reflux:

Adult: 5–10 ml suspension 4 times daily between meals and at bedtime, orally

Child: 6–12 years 5 ml up to three times daily, orally

Instructions: Do not take other medicines within 2–4 hours of aluminum hydroxide
preparations.

Storage: at room temperature, avoid freezing.

Drug Interactions: allopurinol, antibiotics (tetracycline, quinolones, some

cephalosporins), bisphosphonate derivatives, corticosteroids,
cyclosporine, iron salts, imidazole antifungals, isoniazid, phenytoin,
phenothiazines- absorption will be decreased; citric acid derivatives
may decrease absorption of aluminum hydroxide.

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Calcium Carbonate
Tablet: 350mg, 500mg, 700mg

Drug Classification: Antacid

Indications: used as an antacid, and treatment or prevention of calcium

deficiency or hyperphosphatemia.

Precautions: renal impairment; renal calculi; hypercalcemia; hypophosphatemia.

Contraindications: hypersensitivity, high calcium levels in the urine, kidney stones

(renal calculi), low phosphate levels, high calcium levels, suspected
digoxin toxicity.

Side effects: headache, hypophosphatemia, hypercalcemia, constipation,

laxative effect, acid rebound, nausea, vomiting, anorexia, abdominal pain,
xerostomia, and flatulence.

Dose and Administration:

Adult: Antacid: 1-2 tablets every 2 hours; maximum 7000 mg per 24 hours,
orally

Instructions: Do not take more or less of it or take it more often than prescribed by your
doctor. When using this medicine as a dietary supplement, take it with food
or following meals.

Storage: Store in a cool, dry area. Store material tightly sealed in properly labeled
containers. Protect from moisture.

Drug Interactions: thiazide diuretics, levothyroxine, digoxin, tetracycline,

atenolol, iron, quinolones, sodium fluoride, and verapamil.

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Cimetidine
Tablet: 200 mg, 300 mg, 400 mg (Rx), 600 mg(Rx), 800 mg (Rx)
Injection solution:150 mg/mL
Oral solution: 300 mg/5mL

Drug Classification: Histamine H2 Antagonist

Indications: Gastric ulcer, Duodenal ulcer, Gastroesophageal Reflux Disease (GERD),

Heartburn, Pathological Hypersecretory condition, Renal impairment

Precautions: liver disease, GI bleeding, Hemodialysis

Contraindications: Hypersensitivity to the active component, other acid reducers, or any

of the ingredients.

Side effects: Headache, dizziness, somnolence, diarrhea

Dose and Administrations:

Gastric ulcer:

Adult: 800 mg orally once a day at bedtime OR 300 mg orally 4

times a day (with meals and at bedtime)

Child: Use is not recommended unless the anticipated benefits outweigh

the potential risk.

Duodenal ulcer:

Adult: 800 mg orally once a day at bedtime

Child: <16 years: Use only if benefit outweighs risks

20-40 mg/kg/day IV/PO divided q6hr

Neonates: (<28 days old): 5-20 mg/kg/day IV/PO divided q8-12hr

Infants: 10-20 mg/kg/day IV/PO divided q6-12hr

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 GERD:

Adult: 800 mg orally 2 times a day OR 400 mg orally 4 times a day

Child: Use is not recommended unless the anticipated benefits outweigh

the potential risk.

Pathological Hypersecretory Conditions:

Adult: 300 mg PO q6hr with meals and HS

Child: Use is not recommended unless the anticipated benefits outweigh

the potential risk.

Heartburn:

Adult: 200 mg PO up to q12hr

Child: Use is not recommended unless the anticipated benefits outweigh

the potential risk.

Renal impairment :

Adult with CrCl<30 mL/min: 300 mg IV/IO q12hr

Instructions: Take this medication by mouth with or without food as directed by your
doctor. The dosage and length of treatment are based on your medical
condition and response to therapy.

Storage: Store in a tightly closed container at room temperature, away from moisture
and light.

Drug Interactions: Hydrocodone, Loperamide, Oxycodone, Caffeine, Ethanol, Nicotine

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Dicycloverine

Tablet: 10 mg

Drug Classification: Anticholinergic

Indications: GI spasms, irritable colon & spastic constipation.

Precautions: patients with history of liver or kidney disease, urinary retention, paralytic
ileus, thyroid deficiency, heart failure, abnormal heart rhythm, who are
taking other medications, children, elderly, and during pregnancy.

Contraindications: overactive thyroid gland, mental problems, myasthenia gravis, skeletal

muscle disorder, closed angle glaucoma, high blood pressure, coronary
artery disease, chronic lung disease, reflux esophagitis, stomach ulcer,
severe ulcerative colitis, decreased kidney function, enlarged prostate,
dysreflexia

Side effects: dry mouth, thirst, and dizziness, on rare occasions, fatigue, sedation, blurred
vision, rash, constipation, anorexia, nausea and vomiting, headache, and
dysuria

Dose and Administration:

Adult: 10mg tablet three to four times a day. Maximum of 40mg.

Instructions: May be taken with or without food.

Storage: Store below 25°C. Protect from direct sunlight. Protect from excessive heat

Drug Interactions: antacids, amantadine, class I antiarrhythmic agents, antihistamines,

antipsychotic agents , nitrates & nitrites, sympathomimetic agents,
TCAs, antiglaucoma agents

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Loperamide
Capsule: 2 mg
Tablet: 2 mg
Oral solution: 1 mg/5 mL, 1mg/7.5 mL
Oral suspension: 1 mg/7.5 mL
Tablet (chewable): 2 mg

Drug Classification: Antidiarrheal

Indications: Acute diarrhea, chronic diarrhea, short bowel syndrome, traveler’s diarrhea,
management of colostomies or ileostomies

Precautions: Hepatic dysfunction, patients with dysentery or constipation, nursing

women, history of allergy of the drug, black/tarry stool, blood/mucus in your
stool, HIV infection/AIDS, liver problems, stomach/intestinal infections, and
bowel disease.

Contraindications: Ileus (constipation), severe gastrointestinal infections (fever, blood in

the stool),pronounced fluid loss, children younger than six or infants
below 24 months of age, has hypersensitivity to the drug, abdominal
pain in the absence of diarrhea, patients with: acute ulcerative colitis,
bacterial enterocolitis, and pseudomembranous colitis.

Side effects: abdominal pain, nausea, vomiting, dry mouth, tiredness,

drowsiness, dizziness, constipation, and flatulence

Dose and Administration:

Acute Diarrhea

Adult: Oral: 4 mg(after the first loose stool), 2 mg (after each unformed
stool) Maximum dose: 16 mg per day

Child: Oral: 2-5 years, first day dose: 1 mg every 8 hours, divided doses;
1 mg after a loose stool, note: not to exceed 3 mg/day

Child: Oral: 6-8 years, first day dose: 2 mg every 12 hours; 2 mg after a
loose stool, note: not to exceed 6 mg/day

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 Chronic Diarrhea

Adult: Oral: 4 mg (after the first stool), 2 mg (after each unformed stool)
Maximum dose: 16 mg per day

Instructions: Never administer more than eight tablets/capsules a day. If symptoms

continue for more than 48 hours, re-evaluate. Discontinue loperamide as
soon as symptoms settle down. Most loperamide capsules and tablets are
best administered with a drink of water.

Storage: Store in a cool dry place away from direct heat and light, store in a closed
container at room temperature, keep out from freezing, do not keep outdated
medicine or medicine no longer needed.

Drug interactions: antifungal drugs (itraconazole and ketoconazole);

cholesterol drug (gemfibrozil); heart drug (quinidine);
antimalarial drug (quinine); HIV drug (ritonavir); drugs to treat acid
reflux including histamine type 2 receptor antagonists (H2RAs); and
antibiotics erythromycin; cimetidine, clarithromycin, gemfibrozil,
ranitidine, pramlintide, belladonna, scopolamine, glycopyrrolate,
oxybutynin, morphine.

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Metoclopramide
Tablet: 5mg, 10mg
Dispersible Tablet: 5mg, 10mg
Syrup: 5mg/5mL, 10mg/10mL
Injection solution: 5mg/mL

Drug Classification: Anti-emetic

Indications: Chemotherapy-Induced Nausea & Vomiting, Diabetic Gastroparesis, Small

Bowel Intubation/Radiologic Examination of Upper GI Tract,
Gastroesophageal Reflux Disease, Postoperative Nausea & Vomiting (Off-
label)

Precautions: convulsions (seizures), difficulty with breathing, fast heartbeat, high fever,
high or low blood pressure, increased sweating, loss of bladder control,
severe muscle stiffness, unusually pale skin, or tiredness.

Contraindications: Lurasidone, pheochromocytoma, high prolactin level, porphyria,

depression, parkinsonism, tardive dyskinesia, neuroleptic malignant
syndrome, high blood pressure, chronic heart failure, mechanical
intestinal obstruction, chronic kidney disease

Side effects: Diarrhea, drowsiness, headache, may cause hypotension (occurs with IV
infusion), hypersensitivity (occurs with IV Infusion), loss of strength or
energy, muscle pain or weakness, restlessness, unusual weak feeling

Dose and Administration:

Chemotherapy-Induced Nausea & Vomiting

Adult: 2 mg/kg IV (infused over at least 15 minutes) 30 minutes before

chemotherapy, then repeated 2 more times q2hr (after initial dose)

Child: 1-2 mg/kg IV (infused over at least 15 minutes) 30 minutes before

chemotherapy; repeat every 2-4hr; pretreatment with
diphenhydramine decreases risk of extrapyramidal adverse effects

Diabetic Gastroparesis

Adult: 10 mg IV/IM/oral every 6hrs, 30 minutes before meals and at

bedtime; use injectable dosing only if severe symptoms are present

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 Child: <6 years old: 0.1 mg/kg orally every 8hrs; not to exceed 0.1 mg/kg
≥6 years old: 0.5 mg/kg/day orally divided every 8hrs

Small Bowel Intubation/Radiologic Examination of Upper GI Tract

Adult: 10 mg IV over 1-2 minutes

Child: <6 years old: 0.1 mg/kg IV over 1-2 minutes

6-14 years old: 2.5-5 mg IV over 1-2 minutes
≥14 years old: 10 mg IV over 1-2 minutes

Gastroesophageal Reflux Disease

Adult: 10-15 mg orally every 6hrs, 30 minutes before meals and at

bedtime; not to exceed 80 mg/day

Child: Neonate: 0.15 mg/kg IV every 6hrs

Infant: 0.1 mg/kg IV/IM/orally every 6-8hrs, 30 minutes before
meals and at bedtime. Not to exceed 0.3-0.75 mg/kg/day

Postoperative Nausea & Vomiting (Off-label)

Adult: 10-20 mg IM administered near end of procedure; may be repeated

postoperatively every 4-6hrs, as needed

Child: 0.1-2 mg/kg IV every 6-8hrs, as needed

Instructions: Never use in larger amounts than recommended, or for longer than 12
weeks. Can be taken with or without food, swallow the tablets whole, with
a drink of water. For the liquid, use plastic syringe or medicine spoon.

Storage: Keep in a cool, dry place, away from direct sunlight. Store at room temperature.

Drug Interactions: cabergoline, citalopram, desvenlafaxine, dopamine, duloxetine,

escitalopram, fluoxetine, fluvoxamine, levodopa inhaled,
levomilnacipran, lisuride, methyldopa, milnacipran, paroxetine,
pramipexole, rivastigmine, ropinirole, safinamide, sertraline,
venlafaxine, vilazodone

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Nizatidine
Tablet: 75 mg
Capsule: 150mg, 300 mg
Oral solution: 15mg/mL

Drug Classification: Histamine H2 Antagonist

Indications: endoscopically diagnosed esophagitis, including erosive and ulcerative

esophagitis and associated heartburn due to GERD. Active benign gastric
ulcer.

Precautions: allergies to it; or to other H2 blockers such as Cimetidine, Famotidine,

Ranitidine.

Contraindications: patients with known hypersensitivity to the drug because cross

sensitivity in this class of compounds has been observed, H2-
receptor agonists, should not be administered to patients with a
history of hypersensitivity to other H2-receptor antagonists.

Side Effects: headache, dizziness, drowsiness, constipation, diarrhea, stomach pain,

runny nose, sneezing, coughing, sweating

Dose and Administration:

Erosive Esophagitis

Adult: 150 mg orally 2 times a day up to 12 weeks

Child: 12 years and older is 150 mg orally 2 times a day or maximum

dose of 300 mg/day up to 8 weeks.

Gastroesophageal Reflux Disease

Adult: 150 mg orally 2 times a day up to 12 weeks

Child: 12 years and older is 150 mg orally 2 times a day or maximum

dose of 300 mg/day up to 8 weeks.

Duodenal Ulcer

Adult: 300 mg orally once a day at bedtime or 150 mg orally 2 times a

day up to 8 weeks.

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 Gastric Ulcer

Adult: 300 mg orally once a day at bedtime or 150 mg orally 2 times a

day up to 12 weeks

Instruction: Nizatidine is to be taken by mouth. It is usually taken once daily at bedtime

or twice a day with or without food.

Storage: Store in a tightly closed container at room temperature between 59-86 degrees F
(15-30 degrees C) away from moisture and light.

Drug Interactions: atazanavir, bosutinib, dasatinib, digoxin, indinavir, itraconazole,

ketoconazole, mesalamine, neratinib, pazopanib, pexidartinib,
pimozide, ponatinib, risedronate, acalabrutinib, alendronate,
aripiprazole, avapritinib, axitinib, budesonide, carbonyl iron,
cefdinir, cefditoren, cefpodoxime, cefuroxime, crizotinib,
cyclosporine, dabrafenib, dexmethylphenidate, dofetilide, erlotinib,
ferric maltol, ferrous fumarate, ferrous gluconate, ferrous sulfate,
flibanserin, fosamprenavir, gefitinib, iron dextran complex, iron
sucrose, ivacaftor, lemborexant, lomitapide, metformin,
methylphenidate, , mycophenolate, nelfinavir, nilotinib,
polysaccharide iron, posaconazole, rilpivirine, saquinavir,
tazemetostat, tinidazole, varenicline, vismodegib

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Omeprazole
Capsule: 10mg, 20mg, 40mg
Oral suspension: 2.5 mg/5ml, 10 mg/15ml
Injection, (sodium): 250 mg, 500 mg, 1g in vial

Drug Classification: Proton-pump Inhibitor

Indications: indigestion, heartburn and acid reflux, prevention and treatment for stomach
ulcers and Zollinger-Ellison syndrome, eradication of Helicobacter pylori
associated with peptic ulcer disease, Gastric and duodenal ulcers, Gastro-
esophageal reflux disease, and NSAID-associated ulceration.

Precautions: history of allergy, during pregnancy and lactation, reduced body store or
risk factors for reduced vitamin B12 absorption, osteoporosis, hepatic
impairment and CYP2C19 ultrarapid metabolizers.

Contraindications: Concomitant use with nelfinavir.

Side effects: body aches or pain, chest pain, constipation, cough, diarrhea or loose stools,
difficulty with breathing, dizziness, ear congestion, heartburn, loss of voice,
muscle pain, nasal congestion, runny nose, sneezing, unusual drowsiness

Dose and Administration:

Eradication of H. pylori associated with peptic ulcer disease, Gastric and

duodenal ulcers, Gastro-esophageal reflux disease, NSAID-associated
ulceration:

Adult: IV: 40 mg once daily given via infusion over 20-30 minutes until
oral administration is possible.

Zollinger-Ellison syndrome

Adult: IV: Initially, 60 mg daily via infusion over 20-30 minutes, adjust
dose according to response. Daily doses >60 mg should be given in
2 divided doses

NSAID-associated ulceration:

Adult: Oral: 20 mg once daily for up to 8 weeks.

Maintenance: 20 mg once daily.

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 Eradication of H. pylori associated with peptic ulcer disease:

Adult: Oral: 20 mg bid for 1 week in combination with clarithromycin

and with either amoxicillin or metronidazole. Alternatively, 40mg
once daily for 1 week in combination with amoxicillin and
metronidazole.
Child: >4 years 15-30 kg: 10 m, twice daily.
31->40 kg: 20 mg, twice daily.
All doses are given in combination with amoxicillin and
clarithromycin for 1 week.

Peptic ulcer:
Adult: Oral: 20 mg or 40 mg once daily. Treatment duration: 4 weeks
(duodenal ulcer); 8 weeks (gastric ulcer). Maintenance: 10-20 mg
once daily, may increase up to 40 mg according to response.

Gastro-esophageal reflux disease:

Adult: Oral: 20 mg once daily for 4-8 weeks. For severe case: 40 mg once
daily for 8 weeks. Maintenance: 10 mg once daily, may increase to
20-40 mg once daily if necessary.
Child: ≥1 year weighing 10-20 kg: 10 mg once daily, increased to 20 mg
once daily if necessary.
≥2 years weighing >20 kg: 20 mg once daily, increased to 40 mg
once daily if necessary. Treatment duration: 4-8 weeks.

Zollinger-Ellison syndrome:

Adult: Oral: Initially, 60 mg daily, adjust as required. Usual dose: 20-120

mg daily. Dose >80 mg should be given in 2 divided doses.

Instructions: Usually taken once daily, unless directed by physician. Use the lowest dose
for the shortest amount of time appropriate to the condition being treated.
Administer on an empty stomach at least one hour before a meal. Do not
crush or chew tablets or capsules, swallow whole. Capsules can be opened
and the contents mixed with applesauce and swallowed immediately in
patients who have difficulty swallowing capsules. Do not heat, chew, or
store the applesauce for later.

Storage: Store below 25°C. Protect from light and moisture.

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Drug interactions: nelfinavir and atazanavir (decrease plasma concentrations).
Diuretics.Tacrolimus, methotrexate, itraconazole, ketoconazole,
posaconazole, erlotinib, diazepam, phenytoin, cilostazol, clopidogrel,
digoxin.

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