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Canadian Pharmacists Association
Canadian Pharmacists Association
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About

About the Canadian Pharmacists Association
The Canadian Pharmacists Association (CPhA) is the national voluntary organization of pharmacists committed to advancing the health and well-being of Canadians through excellence in pharmacist care. CPhA is the trusted source of education, information, tools and resources to support safe and effective medication use and optimal drug therapy outcomes for pharmacists, physicians, nurses and other health care practitioners. CPhA is responsible for developing partnerships with key stakeholders and other health care providers to improve the availability and quality of drug and therapeutic information at a national level, while addressing the challenges of providing optimal drug therapy to Canadians.

About RxTx and Improved Search
RxTx is the new name for CPhA’s e-Therapeutics+ and e-Therapeutics+ Complete products, providing health care providers a robust, intuitive solution to quickly investigate drug and/or therapeutic information. All previous clinical content is still available; however, regardless of the subscription model, users will experience the same powerful functionality needed to efficiently receive the desired drug or therapeutic information. Subscription models can include the full suite of CPhA products (CPS, CTC, CTMA, CPMA, Clin-Info tool, Lexi Drug Interaction and Product Identification tool) or can just include the specific content of drug and therapeutic modules you want.

In 2013, CPhA undertook a significant product analysis and concluded that in order to continue to meet our clients’ needs; a full redesign of the current offerings was required. After extensive development and quality assurance, a new interface was released to the general public in 2015. The new interface provides users with faster access to the same great content with an improved, streamlined and integrated search. It also features:

  • New navigation and term suggestions that make searching faster
  • More comprehensive full document searches across all drug and therapeutic content
  • Plus many more new features to help users find what they need quicker and easier

About Therapeutic Content (Tx)

The therapeutic information found in CPhA’s Compendium of Therapeutic Choices (CTC) and Compendium for Minor Ailments (CTMA) is provided through various channels (print, CPS and RxTx online and RxTx mobile). It has been developed by an editorial team of outstanding physicians and pharmacists from across Canada who have combined their experience and expertise to develop a condition-oriented model that reflects common and accepted practices using an evidence-based approach. This authoritative source of information offers comparative and evaluative information on treatment options for more than 250 common medical conditions, easy-to-use decision algorithms and tables of drug choices. Based on the best available medical evidence and acclaimed by healthcare professionals worldwide, CPhA’s CPS and RxTx is Canada’s leading source of drug therapy information.

Editorial Process
Each therapeutic topic from CTC and CTMA is written by an expert author and is based on the best available evidence. CPhA employs a rigorous review process to ensure that the information is accurate and unbiased. Content is extensively reviewed and validated by skilled CPhA clinical editors and by external reviewers who are recognized experts (physicians and pharmacists) in their particular clinical area. 

CPhA asks authors and reviewers to disclose any potential conflicts of interest. CPhA does not accept funding from pharmaceutical manufacturers for any content that we develop. 

Description and Limitations of Information
Although based on the best available evidence, CTC  also contains selected information representing the opinions and experience of individual authors. The authors, editors and publisher have tried to ensure the accuracy of the information at the time it is made available on the website. Users of this site's drug and therapeutic information should be aware that the text may contain information, statements and dosages for drugs different from those approved by the Therapeutic Products Directorate, Health Canada. Users are advised that the information presented on this site is not intended to be all inclusive. Consequently, healthcare professionals are encouraged to seek additional and confirmatory information to meet their practice requirements and standards as well as the information needs of the patient.

Time Stamped
The date of revision appears at the beginning of each topic and represents the date the topic last underwent complete review or a portion of the content was changed. 

Appendices
The Appendices address drug use during breastfeeding; drug use during pregnancy; nutritional supplements; and dosage adjustment in renal impairment. In the tables, the icon () appears after the drug name if dosage adjustment should be considered. General appendices (Nonprescription Therapy in Pregnancy and Breastfeeding, Complementary and Alternative Therapies, Information for the Traveler, Medical Devices and Aids to Daily Living, and Home Testing) follow the therapeutic topics in CTMA.

Suggested Reading
A Suggested Reading list accompanies each chapter to supplement clinical information provided.

References
Chapters and appendices are referenced and based on the best available evidence; the Reference list follows the Suggested Readings, and both are linked to their PubMed listing or directly to the source.

Users of CPS and RxTx requiring more detailed information on pediatric therapy should consult specialized resources. 

About the Compendium of Therapeutic Choices (CTC)
All topics are presented in a similar concise style under the headings of Goals of Therapy, Investigations, Therapeutic Choices (both Pharmacologic and Nonpharmacologic) and Therapeutic Tips. Pregnancy and breastfeeding sections accompany about 80 topics. Algorithms and Tables of Pharmacologic Choices including basic drug information facilitate quick referencing of a topic. From the table of drug choices, the appropriate CPhA monograph or manufacturer's product monograph may be accessed in CPS. The References are listed and accessible electronically within the text. A short list of Suggested Readings leads the user to additional recommended literature. 

Drug Therapy
Drug therapy is discussed using generic drug names. Brand name inclusion in the chapters is not intended as an endorsement of a product. Many Canadian brand names are listed in the drug tables. These are not all inclusive and are not listed in any order of preference. Within drug tables, classes and drugs are presented in alphabetical order, unless otherwise stated.

Relative Cost
The true cost of a specific therapy involves a number of elements including the manufacturer’s list price, the mark-up and the dispensing fee, the length of drug therapy and costs related to drug administration. Prices used to determine cost of therapy in this book represent the acquisition cost in Ottawa, Ontario, Canada at the time of writing. Drug costs in the tables do not include any mark-up or dispensing fees. Unless otherwise stated, costs are presented comparatively with the use of the $ symbol. For most conditions, calculations were made with the cost of the lowest priced product at the usual dosage for a given period. The treatment period selected for most chronic conditions is 30 days. However, treatment periods vary, and the legend accompanying each table should be consulted.

Grading Evidence
The Strength of Recommendation Taxonomy (SORT) system has been applied to selected statements within the text of therapeutic topics.1 SORT is a patient-oriented approach (as opposed to a disease-oriented approach) to grading evidence in medical literature. The system provides healthcare professionals with a clear recommendation that is strong (A), moderate (B) or weak (C) in its support of a particular intervention.

SORT1 Code

 

Definition

         A

Based on consistent AND good-quality patient-oriented evidence
 

         B

Based on inconsistent OR limited-quality patient-oriented evidence

 

         C

Based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series for studies of diagnosis, treatment, prevention or screening

           

 

  1. Ebell MH, Siwek J, Weiss BD et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician 2004;69:549-57. Available from: http://www.aafp.org/afp/2004/0201/p548.html.

Where appropriate, links are provided to CPS drug monographs related to Therapeutic Topic content. Product monographs with full prescribing information are supplied by manufacturers, while CPhA monographs are compiled by CPhA staff.

About the Compendium of Therapeutics for Minor Ailments (CTMA)
The therapeutic information provided in the Compendium of Therapeutics for Minor Ailments (CTMA)  provides 95 chapters and 6 appendices, on topics related to conditions that may be managed, initially and/or adjunctively, with nonprescription products. Links to content from its counter partner Compendium of Products for Minor Ailments (CPMA), are included throughout. Therapeutic chapters follow a consistent outline, including Pathophysiology, Patient Assessment, Goals of Therapy, Nonpharmacologic Therapy, Pharmacologic Therapy (with emphasis on nonprescription products) and Monitoring of Therapy. Prevention and pregnancy/breastfeeding are also addressed when appropriate. Illustrations, algorithms and photos complement the text.

Nonprescription Products
Nonprescription pharmacologic therapy is presented in table format. Products are usually addressed by generic name, and linked where possible to CPhA monographs in the CPS. To locate a particular product by brand name, users should search within Compendium of Products for Minor Ailments.

Natural Products and Herbals
Natural products and herbals are included in the discussion of nonprescription therapy if appropriate. In addition, the Complementary and Alternative Medicine appendix provides general information.

Patient Information
Patient information on self-care conditions (titled What You Need to Know) follow each therapeutic chapter and are intended to be printed for patients. Additional sources of patient-oriented information are provided as Resource Tips.

About Drug Information (Rx)

About the Compendium of Pharmaceuticals and Specialties (CPS)
The CPS contains information on proprietary and nonproprietary products intended for human use. The editorial staff of CPhA format monographs that have been submitted by the manufacturer for inclusion in CPS. The inclusion of a manufacturer’s product monograph in CPS does not imply that the editors or the CPhA Editorial Advisory Committee accept, endorse or recommend these preparations as being clinically superior to similar products of any other manufacturer.

Great care has been taken to ensure the accuracy and completeness of the information contained in CPS. However, the editors and publisher are not responsible for errors or any consequences arising from the use of the information published herein.

CPS users are advised that the information provided in the CPS is not exhaustive. Other sources may contain additional necessary information for safe use of drug products.

Product Monographs
CPS provides product monographs prepared by pharmaceutical manufacturers and approved by the Therapeutic Products Directorate (TPD), Health Canada. Included are  products and medical devices with a drug component that are available for use in Canada. Product information as published in CPS is a direct equivalent of the prescribing information contained  in Parts I and III of the Health Canada-approved monograph. References to Part II (Scientific Information) have been omitted since this section is not published in CPS. Monographs appear in varying formats, reflecting changes to Health Canada’s standard monograph template that periodically occur. Editorial changes are limited to those required for consistency of style, clarity and presentation.

Monographs approved by TPD for products containing the same therapeutic ingredient(s) may differ in their indications, contraindications, warnings, precautions, adverse effects, dosing regimens and constituents. CPS users are encouraged to consult the specific product monograph to ensure accurate information.

Product monographs contain listings of nonmedicinal ingredients. A statement may appear in the “Supplied” of “Dosage Forms, Composition and Packaging” sections indicating the presence or absence of a specific nonmedicinal ingredient in the product.  Lack of inclusion of an ingredient in this section is not conclusive evidence that it is not currently contained in the product. CPS users are urged to consult the product monograph of the specific product (see Clin-Info, Ingredients of Concern in Pharmaceuticals and Packaging section for further discussion on this topic). Contacting the manufacturer is recommended, to ensure direct confirmation of the most current ingredient information.

Some monographs contain boxed text indicating that the product has been approved under the Notice of Compliance with Conditions (NOC/c) policy of Health Canada. NOC/c is a form of market approval granted to a product on the basis of promising evidence of clinical effectiveness following review of the submission by Health Canada. Products approved under this policy are intended for the treatment, prevention or diagnosis of a serious, life-threatening or severely debilitating illness. They have demonstrated promising benefit, are of high quality and possess an acceptable safety profile based on a benefit/risk assessment. In addition, they either respond to a serious unmet medical need in Canada or have demonstrated a significant improvement in the benefit/risk profile over existing therapies. Health Canada has provided access to this product on the condition that sponsors carry out additional clinical trials to verify the anticipated benefit within an agreed-upon time frame.

We request that manufacturers submit the most recent version of the product monograph for publication in the CPS.With the availability of CPS online, we are able to publish the most recent version of the monograph on a regular basis. The Date of Preparation and the Date of Revision (if applicable) are included for new or recently revised monographs.

Information for the Patient
Information for the patient is provided for health care professionals to use in keeping their patients informed. Information for the Patient monographs are part of the Product Monographs as defined by Health Canada, but they are intended to be used separately as information for the patient. They contain information, in lay language, that is required by the patient for safe and effective use of the drug. Health care professionals may wish to supplement the advice given within these sections on an individual basis, as necessary. 

Although the Canadian Pharmacists Association maintains copyright on this information we grant permission to print and distribute individual files for the purpose of providing information to patients. 

CPhA Monographs
CPhA monographs bearing the CPhA logo are developed by the editorial staff of the Canadian Pharmacists Association. CPhA monographs are an important source of prescribing information that may not otherwise appear in the CPS. They are based on the best available evidence and reviewed by expert physicians and pharmacists. Readers should be aware that the text may contain information different from that found in Health Canada-approved Product Monographs. The term “Uses Without Health Canada Approval” refers to indications not approved by Health Canada. The term “Use or Purpose” replaces “Indications” for natural health products as defined by Health Canada Natural Health Product database entry.

Health Canada Advisories
Health Canada provides timely information on issues that concern the health of Canadians and posts recalls, advisories, and safety alerts (Advisories). CPhA assigns these links to Advisories on CPS and RxTx. Advisories posted on CPS and RxTx are provided for convenience only; CPhA does not warrant their accuracy or completeness nor does it warrant that all Advisories are posted on CPS and RxTx. CPS and RxTx are not a comprehensive, up-to-date source of Advisories, and the prescribing or dispensing professional should check with Health Canada to determine whether a particular medication is the subject of an Advisory. In the case of drug interaction Advisories, CPhA does not post the Advisory on the pages of all medications implicated by an Advisory, but only to the pages of medications that Health Canada makes the subject of the Advisory. CPhA retains the Advisories in CPS and RxTx for a period of 5 years. To access the full spectrum of Health Canada Recalls and Alerts, users can select the “Recent Advisory, Warnings and Recalls” tab under the “Advisories” Main Menu, which will launch the Health Canada website.

Clin-Info
The Clin-Info tools and topics can be found under the “Rx: Drugs” menu. Clin-Info provides quick reference clinical information and practice tools for healthcare professionals. This information is not intended to present a comprehensive review; the reader is therefore encouraged to seek additional and confirmatory information.

About the Compendium of Products for Minor Ailments (CPMA)
The Compendium of Products for Minor Ailments (CPMA) is compiled and produced by the Canadian Pharmacists Association (CPhA) for the benefit of all health professionals. This exclusive collection of information about nonprescription products including: drugs and natural health products, home tests medical aids and medical devices is an essential companion to CTMA in which therapies are discussed using generic drug names. Nonprescription pharmacologic therapy is presented in table format. Products are categorized by use and are usually addressed by generic name and linked where possible to CPhA monographs in the CPS.

Clients can use the tables to select a product to meet specific consumer health needs and to determine the availability and content of most nonprescription drug products available in Canada. The tables are designed for quick consultation in the practice setting. The classification of products is in accordance with labeling standards.

CPhA does not accept funding from pharmaceutical manufacturers for any content that we develop. The inclusion of individual products does not imply that the editors accept, endorse or recommend these preparations as being clinically superior to similar products of any other firm.

Drug therapy is constantly changing; consequently, it is the responsibility of the health care professional to seek additional and confirmatory information; to evaluate its appropriateness as it relates to the actual clinical situation; and to consider new developments.

About Lexi-Interact TM
The Canadian Pharmacists Association has entered into a partnership with Wolters Kluwer to offer RxTx users access to the Lexi-InteractTM module. Lexi-InteractTM is a trusted solution which provides a complete drug and herbal interaction analysis program capable of assessing potential drug-drug, drug-allergy interactions, and duplicate therapy interactions.

About Resources

  • Within the Resources main menu, users will find information on:
  • What's New within CPS and RxTx
  • Specific monograph updates
  • Directories for pharmaceutical manufacturers participating in CPS and RxTx, Poison Control Centres, as well as a listing of various health organizations
  • Glossaries for medical and microorganism abbreviations