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Group Number

 

Student Names

 

Drug Class Being Reviewed

 

Recommendations to the Committee

[Include summary of findings, key issues, and conclusions, and 1 or 2 short paragraphs that explain the logic leading to your recommendations.]

Therefore, the following P&T action is recommended to approve the following medication(s) to the formulary:

Comparative Review

Fill in the chart below to document each agent’s ability to satisfy the listed criteria. After completing the chart, use the information to identify the most appropriate agent(s) for inclusion on the closed formulary.

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Criteria Atorvastatin Fluvastatin Lovastatin Pitavastatin Pravastatin Rosuvastatin Simvastatin

High-intensity dosing available

             

Moderate-intensity dosing available

             

Low-intensity dosing available

             

Maximum dose can achieve 60% reduction in LDL (either as monotherapy or in combination with ezetimibe)

             

Non-P450 3A4 metabolic pathway

             

Can be used safely with cyclosporine/tacrolimus

             

Can be used safely with protease inhibitors

             

Secondary prevention of ASCVD in stable CAD

             

Secondary prevention of ASCVD after early initiation during hospitalization for ACS

             

Secondary prevention of stroke/TIA in patients with recent TIA/stroke

             

Secondary prevention of ASCVD in patients with PAD without CHD

             

Primary prevention of ASCVD in patients with average baseline LDL>190

             

Primary prevention of ASCVD in patients with diabetes and average baseline LDL 70–189

             

Primary prevention of ASCVD in nondiabetic patients with average baseline LDL 70–189

             

Primary or secondary prevention of ASCVD in patients with CKD (with or without hemodialysis)

             

Primary or secondary prevention in elderly patients (>65 years old)

             

Hepatic impairment dosage adjustments

             

Renal impairment dosage adjustments

             

Therapeutic Substitution Chart

After selecting the appropriate agent(s) for inclusion on the closed formulary, fill out the chart below for pharmacists to use as a guide when automatically substituting a formulary agent for a nonformulary agent.

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...
NONFORMULARY AGENT/DOSE FORMULARY AGENT/DOSE TO SUBSTITUTE

Example: Atorvastatin 10mg

Pitavastatin 2mg

   
   
   
   
 

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