National Formulary

The VA National Formulary generated controversy, which motivated congressional scrutiny and a directive to the VA to commission this report reviewing the experience with the National Formulary and formulary system. This Institute of Medicine committee was pleased to assist the Congress with this review, in part because the committee saw in the VHA example an opportunity to understand and anticipate problems that all publicly funded programs are likely to encounter in this new age of pharmaceuticals. The Congress asked the committee to review the restrictiveness of the National Formulary, its impact on the costs and quality of care in the VHA, and how it compared to formularies and drug management practices in the private sector and in other public programs, especially Medicaid. Detailed in the pages that follow, the committee's findings and conclusions on these questions are, the committee believes, highly instructive, though not always in the ways that we anticipated.

Neonatal Formulary provides comprehensive guidance on the safe use of the drugs prescribed during pregnancy and commonly given to babies during labour and delivery, as well as during lactation and the first year of life. Treating the journey from pregnancy to parenthood as a continuous event, the new edition contains updated information on how the drugs affect both mother and baby. The first part of the book focuses on drug storage, drug licensing, and drug prescribing. In addition, it explains to why the metabolism of drugs differs in premature and sick infants, and why the practice of extrapolating doses from adult studies is unsafe. Patient safety, excipients, and therapies that affect drugs are also covered. Part 2 consists of monographs for over 250 drugs that may find use in the neonatal unit, and possibly outside it. Each monograph is divided into sections covering use, pharmacology, treatment, drug interactions or other administration, information, supply and administration, and references. The monographs are evidence-based and include links to the Cochrane Database of Systematic Reviews, and national guidelines. The third part presents information on additional drugs, and groups of drugs, that are often taken by mothers during pregnancy, labour, or during breast feeding. The drugs discussed in this section all affect the foetus or infant. Containing far more detail than is available in the British National Formulary for Children, and with additional online material featuring updates related to specific drugs and dosing, Neonatal Formulary is an essential guide for neonatologists, neonatal nurses, hospital pharmacists, obstetric staff, advanced nurse practitioners and for all health care professionals caring for pregnant women and their infants in the first year of life.