I was recently asked how to prescribe Isoptin SR (verapamil) 360mg po daily for an elderly patient. She has drug coverage with Ontario Drug Benefits; hence we should try to prescribe medications that are listed for coverage by the formulary.

The prescriber asked me how to prescribe for this patient. The ODB formulary only lists 180mg and 240mg strength for coverage. The 120mg strength is not covered.

For a dose of 360mg, she would have to take 240mg plus 120mg and the additional cost of 120mg would become difficult to afford.

Isoptin SR (or its generic) contains a sustained release formulation. Hence we typically do not suggest cutting the tablet as it destroys the special coating meant to release the medication in a slow-release manner.

However for Isoptin SR and the generic brand, the 240mg SR tablet is scored. Plus the product monograph indicates it can be cut in half, assuming it won’t destroy the special formulation.

Isoptin SR

I adviced the prescriber to write a prescription for the 240mg strength and ask patient to take 1 and 1/2 tablet for a dose of 360mg.  So I was happy the issue has been resolved.

However, I wonder why we make it so difficult for everyone.

Who on earth has the time to look up if this specific formulation can be cut in half?

Why can’t the Ontario Drug Benefits pay for the 120mg strength. As we continue to find ways to make prescribing more seamless, I wish the e-prescribing platform can be set up such that prescribers have the following information at their finger tips:

  • Medication Cost – so that both prescribers and patients are well informed the monthly cost of the medication before going to the pharmacy.
  • Whether it is covered by the patient’s plan. It would be nice the electronic medical record / prescribing module can only display medications that are listed on the patient’s drug plan formulary.
  • Clinical Tools – It would be nice if the prescribers can select what to treat and a list of possible treatment options plus doses are provided for guidance.

I wonder when this type of e-prescribing will become a reality. What’s your wish list for e-prescribing?

Thank you for reading my post.