MEDICATION INCLUSION /REPLACEMENT FORM

In addition to the criteria for selection of drugs, guidelines for considerations for proposing medication replacement or inclusion on Essential Medicines List (EML)/ Formulary include:

1. Medicine being considered:

Name (generic)
Strength(s)
Form(s)
Therapeutic class

2. Comparative efficacy and therapeutic management:

· Pharmaco-dynamic profile
· Pharmaco-kinetic profile

3. Safety profile:

· Pregnancy
· Lactation
· Possible interactions
· Geriatrics
· Paediatrics
· ADR profile

4. Availability:

· In-country
· Registration status in Ghana

5. Cost estimations:

· Cost per normal adult dose
· Cost per day for normal adult
· Route of administration
· Storage (normal, special)

Summary of justification:

(State in not more than 2 A4 sheets justification for the gap to be filled or the medicine to be replaced. State the place in therapy of the recommended medicine, as well as the comparative advantages and disadvantages of the medicine with regards to the therapeutic area of concern).

When complete, forward information to the Expert Committee on Standard Treatment Guidelines (STG) & Essential Medicines List (EML) through the National Drug Information Resource Center (NDIRC).