Drug interactions involving cannabis may vary significantly in clinical relevance, given the wide variation in products, potencies, ratios of active components, doses, routes of administration and

March 2026

Updated IV monograph

updated dosing information on IM and SC

Current newsletter

Current Newsletter

Formulary addition request for tinzaparin in patients with renal dysfunction

Current newsletter

Updated monograph

Current newsletter

Updated April 1, 2026

New drug monograph

Current newsletter

VTE prophylaxis trials are not available in patients receiving rivaroxaban 2.

Stability studies should ideally be used to determine the BUD of compounded products; however, in a pharmacy setting this is often not feasible. The National Association of Pharmacy Regulatory Auth

Current newsletter

Drug interaction databases alert clinicians to an

CKD patients may be prescribed oral anticoagulants for prevention of stroke in atrial fibrillation (AF) or for ve

Thrombosis Canada recommends that the dose of LMWH in obese patients should b

updated April 2023

updated document - Nov 2021

Thrombosis Canada (2020) provides fixed dosing recommendations of LMWHs for patients with body

Adults with a history of shingles should receive the shingles vaccine as shingles may recur. Th

The addition of polyethylene glycol 3350 (PEG) to a liquid that has been thickened with a starch-based thickener results in a decrease in liqui

Gardasil 9 is the nonavalent human papilloma virus (HPV) vaccine currently marketed in Canada f

Osteoporosis guidelines from the Endocrine Society (2019) recommend that deno

1. Animal reproduction data suggest low risk for use of benzyl alcohol during pregnancy. One case report described adverse effects in the mother associated with use of benzyl alcohol as a preserva

updated March 2022

Stablity study from Sunnybrook Pharmacy presented at Professional Practice Conference 2022.

• For secretions towards the end of life, glycopyrrolate administered subcutaneously (SC) is the preferred option due to less adverse effects compared to available alternatives.
• Sc

• Antiresorptive treatments (i.e. bisphosphonates and denosumab) for osteoporosis carry a rare risk of osteonecrosis of the jaw (ONJ); risk is increased with major, invasive dental procedures

Dosage update to align with product monograph update

See the FAQ for a medication table. 

Your question answered in the attached FAQ with medication table. 

See the attached FAQ for details. 

See the attached FAQ for details.

Due to limited evidence on the use of DOACs in AKI, hospitalized patients with AKI previously on DOACs should be switched to an alternative agent, such as unfractionated or low-molecular weight hep

In a patient who is otherwise stable without increased bleeding risk or extensive clot, each day of LMWH therapy may be subtracted from the recommended apixaban loading dose duration. For example,

In summary, given the potential for serious toxicity, where possible, methotrexate should be 
avoided in patients receiving hemodialysis or peritoneal dialysis. See the FAQ for details. 

Administration of a levodopa-carbidopa rectal suspension that included citric acid added to a 50% glycerin vehicle demonstrated predictable absorption and efficacy. See the FAQ for sample formulati

The DAPA-CKD and EMPA-KIDNEY clinical trials demonstrated reduced progression of kidney disease or death from renal or cardiovascular causes with use of SGLT2i (

See the FAQ for details. 

Sunnybrook VTE Prophylaxis Policy - Aug 2023 update

Sunnybrook Recommendations for Anticoagulation in Renal Insufficiency - Aug 2023 update.

Includes VTE prophylaxis, VTE treatment, and atrial fibrillation.

See attached document for details.

See attached document for details.

Vismodegib Oral Suspension

Please see the attached monograh for the new adalimumab biosimilar product available in Canada, brand name Yuflyma.

IDSA has published an update to their Guidelines for Diabetes-Related Foot Infections.

The most notable changes include:

• A reduced treatment duration for antibiotics to

Please see the attached updated document. Changes from last IV monograph are highlighted in Yellow.

See the attached file.

Update: as of April 2024, finerenone is covered for adults with ODB (LU Code 700).

Please see the attached document for direction from CPhA regarding the semaglutide (Ozempic) shortage, which is anticipated to extend until 31-March-2024. 

Note that since this direction

Please see the attached re: intermittent shortages of Mounjaro (tirzepatide).

The landmark SELECT trial has recently been published on 11-Nov-2023 in NEJM. 

Background: Semaglutide has shown efficacy in reducing CV events for diabetic patients, and it was unknown

See attached for the recently released guidelines from the AHA for the diagnosis and treatment of atrial fibrillation.

Please see attached for the recent Canadian Cardiovascular Society focused update on the use of antiplatelets.

A review of the highlights of a drug new to Canada, tirzepatide (Mounjaro). 

A review of a drug new to Canada, tirzepatide (Mounjaro). 

A new COVID-19 vaccine, Nuvaxovid, is now available in Canada. It is advertised as "the only non-mRNA protein-based option."

Some advantages are that it can be stored unopened in a stand

NAPRA has posted an updated table regarding the scope of practice of pharmacists in each province and territory with Alberta and Quebec leading the pack. See the attached document for details!

A new real-world cohort study of 2 million patients has been conducted on the long-term efficacy of the herpes zoster/shingles vaccine Shingrix. 

The results showed that vaccine efficacy

A review article on aspirin-free antiplatelet strategies post-PCI for those without indications for oral anticoagulation. Please see the attached article for details.

The attached is an excellent review of DOACs for less common indications including catheter-associated DVTs, sinus vein thrombosis, splanchnic vein thrombosis, LV thrombus, and specific patient pop

The International Pharmaceutical Federation has recently released a comprehensive guideline for management of iron deficiency anemia, which includes specific patient populations such as pregnancy

Please see the attached FAQ about the risk of severe hypocalcemia with denosumab in patients with CKD.

Please see the attached systematic review and meta-analysis of observational trials which found that apixaban is both safer and more effective than rivaroxaban in non-valvular atrial fibrillation.

Please see the attached updated prep sheet for oral cyclophosphamide suspension. 

This prep sheet allows for all doses that are increments of 25mg to 1000mg to be prepared using tablets.

Please see the attached document for the updated Digibind monograph.

An encouraging article reviewing intake of antibiotics by humans and consumed animals, ultimately showing that reduced consumption results in reduced E coli resistance.

Further informatio

To the shock of absolutely no one who has ever tried them: Kayexalate tastes bad!

Other K binders such as SZC (Lokelma) and patiromer (Veltassa) are more palatable.

Please see t

A very useful treatment algorithm on the updated management of resistant hypertension can be found within the attached article, recently published in JAMA.

Due to a global surge in measles cases, the Topical Diclofenac for Prevention of Capecitabine-Associated Hand-Foot Syndrome

A recent double-blind, placebo-controlled RCT which found diclofenac was beneficial for the prevention of capecitabine-induced hand-foot syndrome. See the attached trial for details.

See the attached document on entecavir oral suspension.

Please see the attached helpful document for the appropriate use, choice, and monitoring of antipsychotics in patients with dementia. This document was put forward by the All Wales Medicines Strate

Compatibility of oxaliplatin and GMP leucovorin

Please see the attached document and click PTSD Guidelines Veterans Affairs 2023

Veteran's Affairs has updated their guidelines for the management of PTSD, published in Feb 2024. Please see the attached document for further details.

Please see the attached file for the new ASCO guidance on use of cannabinoids in cancer.

Prescribing and dispensing trends for ARATa at the SOCC

Venetoclax Prescribing Patterns at a Large Regional Cancer Centre

Conception and Impact of the Oral Anticancer Medication Clinical Co-op Program at the SOCC

Prescribing Patterns of BTK Inhibitors at  a Large Regional Cancer Centre

Capecitabine Prescribing Patterns at the Sunnybrook Odette Cancer Centre

A Retrospective Patinet Chart Review of Niraparib-Induced Toxicity

Oral Cyclophosphamide Use at a Large Tertiary Cancer Centre

CAM-ACT e-catalog

Impact of Vitamin C Supplementation on Oxidizing Cytotoxic Anti-Cancer Therapy (ACT)- A Systematic Review

BRAFI and MEKI prescribing and dispensing trends at the SOCC

Prescribing and Dispensing Trends for Olaparib and Niraparib at the SOCC

Lenalidomide and Pomalidomide Prescribing Trends at the OCC

Prescribing and Dispensing Trends for CDK4-6 Inhibitors at the SOCC

Changes in EGFR-Inhibitor Treatment Landscape Across a Decade

Systematic Review to Evaluate Impact of Melatonin Supplementation on Efficacy of Oxidizing Cytotoxic Anti-Cancer Therapy (ACT)

Workload Requirements for EAP Drug Applications and Impact on Pharmacy

Trends in Oral Anticancer Medication Prescribing at a Large Regional Cancer Centre in Toronto

Prescribing Trends for Traditional vs Modern OAMs

This article isn't new, but it is useful to keep in mind when treating patients with akathisia!

Amphotericin B Liposomal AmBisome - IV Drug Monograph - March 2024

Recently, Health Canada has approved the use of the Mirena IUD for 8 years, which is an extension from the previous 5 years. The Canadian product monograph has been updated.

This extensio

A new meta-analysis on CV outcomes with SGLT2is in non-diabetic patients has been published. They found significant CV benefits vs placebo. Due to a heterogenous patient population (e.g. CKD, reduc

Please see the attached document for further details.

Please see the attached document for further details.

Please see the attached document for further details.

Please see the attached document for references used in the FAQ on aspiration risk with GLP1-RAs

The product monograph for canagliflozin has recently been updated by Janssen. The major changes include:

• Recommendations to temporarily hold canagliflozin prior to surgery when po

Granulocyte Colony Stimulating Factor (G-CSF) Prescribing Patterns in Breast Cancer Patients Following the Introduction and Change in Funding Status of Biosimilar G-CSFs

Granulocyte Colony Stimulating Factor (G-CSF) Prescribing Patterns in Patients with Gastrointestinal Cancers Following the Introduction and Change in Funding Status of Biosimilars

Desmopressin DDAVP - IV Monograph - April 2024

A randomized, double-blinded, placebo-controlled trial of 156 patients with Parkinson's Disease given lixisenatide or placebo found that those given lixisenatide had less progression of motor d

A Taiwanese retrospective cohort trial of 12,331 users of SGLT2is, with an active comparator of GLP1-RAs (1468 participants), found that SLGT2is improve anemia parameters (e.g. Hb, HCT, RBCs, anemi

Eli Lilly has released information from the SURMOUNT-OSA trial which has found that tirzepatide (Zepound) reduces OSA severity by up to 67% in obese patients with OSA. See attached for further deta

Diabetes Canada has recently updated their guidelines on the treatment of hypoglycemia.

Relevant changes include:

- Grading system for hypoglycemia: switched from "mold, moderat

An updated look at the utility of Paxlovid now that vaccination is common and hospitalizations are low.

For those having dental procedures who are allergic to penicillins and require antibiotics, consider cefuroxime before clindamycin. 

2024 British Society for Rheumatology guideline on management of adult and juvenile onset Sjogren disease.

A summary sheet can be found Use of SGLT2 Inhibitors vs GLP-1RAs and Anemia in Patients With Diabetes and CKD - 2024

A cohort of ~14,000 patientswith T2DM and CKD were given either SGLT2is or GLP1-RAs. After 2.5 years of follow-up, those taking SGLT2is had a lower incidence of composite anemia outcomes, but witho

A recently published meta-analysis, "Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men" has renewed the debate

New guidance has been published on NICE for the management of familial and genetic risk as it pertains to ovarian cancer.

A new article was just published on the use of andexanet alfa in acute intracerebral hemorrhage, which found better control of hematoma expansion vs usual care, but at the cost of more thrombotic e

A nice summary from the ADA on their 2024 recommendations for treating diabetes,

A randomized trial of semaglutide 1mg subcut weekly vs placebo has just been published. 

The trial involved 3533 participants with T2DM and CKD (eGFR 50 to 75mL/min nad uACR 300 to 5000,

See attached document for details.

A systematic review and meta-analysis was recently published in JAMA, which found that prolonged B-lactam infusions are associated with reduced 90-day mortality vs intermittent infusions for adults

This review article discusses drug-drug interactions between gender?affirming hormone therapy and antiretrovirals for HIV.

A prospective cohort of 2500 patients with CKD has found that adhering to a plant-based diet was associated with a 20-25?creased risk of mortality over 12 years vs those who were not adherent. Int

In a post-hoc pre-specified subgroup analysis of the ELAN trial, which found no evidence of major treatment effect or safety concerns with early DOAC initiation in those with and without hemorrhagi

See attached for the most recent update to the CANMAT Clinical Practice Guidelines on Depression in Adults. 

A trial has recently been published on lorlatinib vs crizotinib for patients with advanced ALK-positive NSCLC. This mutation is found in ~5 to 7% of NSCLC patients, and is associated with a particu

This matched cohort study of ~42,000 patients found reductions in CV events after statins were started in those 75 years or older without an increase in adverse effects vs non-users. These results

This newly published article discusses various scenarios of methotrexate toxicity and their management.

A combined study of 2 RCTs was just published in NEJM on the use of tirzepatide (Mounjaro), a mixed GLP1/GIP receptor agonist, for obese patients with moderate to severe obstructive sleep apnea. On

In a post-hoc analysis of 2966 patients age 80 and older from the ENGAGE AF-TIMI 48 trial, those on reduced-dose edoxaban (i.e. 30mg once daily) had less major bleeding events (especially GI bleedi

Advice regarding the Cotazym shortage and how to manage patients with pancreatic insufficiency.

The UK has just published their national guidance on the treatment of measles, which is relevant given the increased number of cases in Canada this year.

An article discussing controversy over the current 12 month recommendations for DAPT post-ACS has recently been published. See attached for details.

FAQ - Insulin icodec (Awiliq)

Per this trial which assessed the use of corticosteroids for immune checkpoint inhibitor adverse effects in 6 trials of ~2000 patients found that higher corticosteroid peak doses were associated wi

A new network meta-analysis has just been published which reviews and compares drug therapy for hypertrophic cardiomyopathy, with particular benefit from mavacamten. See the attached study for furt

The ADALA trial has just been published, showing favorable results for low-dose DOAC post-LAA closure as compared to DAPT. Caution in generalizing these findings is required since the sample size w

Dupilumab has now established efficacy and safety data in atopic dermatitis up to 5 years of use.

In this retrospective cohort study, tirzepatide was found to have superior efficacy outcomes as compared to traditional GLP1RAs for patients with T2DM, including lower risk of all-cause mortality,

This retrospective cohort study of almost 200,000 women in England vaccinated for COVID within 12 months before pregnancy showed fewer adverse birth outcomes vs unvaccinated women. They also found

Epinephrine nasal spray (brand name Neffy) has just been approved in the USA as the first non-injectable alternative to traditional IM epinephrine (e.g. EpiPen) for allergic reactions. This could

In this 20 year study, the risk of severe cutaneous ADRs to antibiotics was found to be highest with sulfa antibiotics and cephalosporins. 

Semaglutide is gaining attention for impacts on addiction and compulsive disorders (e.g. cannabis use disorder). This study looked at the incidence of tobacco use disorders in patients taking a va

A great article recently published in BMJ that discusses what is known and unknown about the various mechanisms of actions of GLP1-RAs.

A new systematic review and meta-analysis has compared the safety and efficacy of 1 month of DAPT post-stenting vs longer durations and has found less major bleeding without more stent thrombosis.<

Health Canada has released a review article on cases of prolonged (3 or more days) and new-onset diabetic ketoacidosis (DKA) even after SGLT2 inhibitors have been held or stopped. While a definitiv

New ESC/EACTS guidelines have been released regarding the management of atrial fibrillation, with a focus on identification of underlying causes.

The ABYSS trial has recently been published in NEJM. It was a multi-center, open-label, randomized non-inferiority trial (all locations in France). 3698 patients with a history of MI (with LVEF 40%

Information on weight loss medications for children is sparse. This was a randomized controlled trial of liraglutide 3mg subcut once daily vs placebo. It followed 82 children aged 6 to 11 with obes

Performed at a number of sites including our very own Sunnybrook Health Sciences Centre, this randomized assessed the potential benefit of tranexamic acid for prevention of post-op bleeding for tho

This network meta-analysis has found that eletriptan, rizatriptan, sumatriptan, and zolmitriptan were most efficacious and better than other acute treatments, including newly marketed CGRP receptor

A new IV iron product, Ferinject, is now available in Canada. See the attached monograph or visit the following link for further details: https://pdf.hres.ca/dpd_pm/00076112.PDF

See the attached FAQ for details.

A new meta-analysis of 51 RCTs with almost 100,000 patients taking SGLT2is has just been published with the following findings vs placebo/active comparators:

- Short-term use (less than 1

A cohort study has just been found which has found that semaglutide is associated with a reduced risk of opioid overdose vs other active T2DM treatments (including other GLP1-RAs) in patients with

Tools for Practice has just released a review on use of vitamin D for prevention of fractures, and they found no benefit of vitamin D alone to prevent fractures regardless of dose, vitamin D statu

This newly published RCT in over 6000 patients demonstrated that DAPT (clopidogrel plus ASA) showed the most benefit in the first week post-stroke as compared to ASA monotherapy, with diminishing (

A preliminary analysis has been presented as an abstract at the most recent HFSA Annual Scientific Meeting, which has found that finerenone has cardiovascular benefits across the spectrum of ejecti

Preliminary results from this trial have recently been presented as an abstract at the annual HFSA Scientific Meeting. This was a prespecified subgroup analysis from the FINEARTS trial which looked

A review article discussing chronic spontaneous urticaria including its differential diagnosis and treatment.

PHO has published a helpful document discussing the differences and similarities of various respiratory viruses.

Tools for Practice (an organization that provides free evidence updates via email) has recently published a review showing duloxetine and mirtazapine have convincing evidence for reducing fibromyal

A new article by Tools for Practice has been published discussing the risks and benefits of testosterone supplementation for healthy men with low tesosterone levels. They found no meaningful impro

New guidelines have just been published by the AHA and ASA for the primary prevention of stroke. They emphasize the importance of physical activity, discuss new medications such as GLP1-RAs and PCS

Last month, the ACG published updated guidance surrounding the testing and treatment of H pylori. See attached for further details.

More preliminary research has just been published on the impact of semaglutide on dementia risk. This paper which conducted emulation target trials based on national database information has found

A review article has been published on cancer cachexia, citing olanzapine and short-term steroids as reasonable pharmacological treatment options.

The OPTIMAS trial has just been published. This open-label, blinded-endpoint, multicenter RCT looked at 321 patients with acute ischemic strokes due to atrial fibrillation. They were randomized to

A phase-2 trial of a CRISPR-based therapy, NTLA-2002, has demonstrated significant benefit in a small number of patients with hereditary angioedema in terms of reduction in angioedema episodes. Se

This review article discusses the recommendations, literature, and controversy surrounding the use of IV thrombolysis in acute ischemic stroke for those taking DOACs. See the attached document for

A randomized, double-blind, placebo-controlled trial of 407 obese patients with osteoarthritis given semaglutide has just been published. They found that over 68 weeks, there were significant reduc

New Canadian guidelines on the management of chronic insomnia have just been published. Please see the attached document for further details.

New guidance has been published regarding the presribing of opioids. Overall, these updated recommendations are less restrictive than previous guidelines. See the attached document for details.

Please see the attached FAQ for details.

Please see the attached FAQ for details.

This trial of over 12,000 patients in China with uncontrolled hypertension and type 2 diabetes randomized patients to BP targets of less than 120 mmHg systolic vs less than 140 mmHg systolic. The

The SUMMIT trial has found that tirzepatide reduces a composite of cardiovascular outcomes vs placebo for those with preserved ejection fraction heart failure, which was largely driven by a reduct

Please see the attached document for an excellent review regarding Candida auris recently published in the NEJM.

The BALANCE trial, led by Sunnybrook physicians Dr Nick Daneman and Dr Fob Fowler, is a landmark study assessing the optimal duration of antibiotics for patients with bacteremia. 

In thi

Tools for Practice, a free primary care resource, has published an evaluation of romosozumab for osteoporsis in post-menopausal women. They found that in a single RCT, romosozumab out-performed ale

A systematic review and meta-analysis has just been published in JAMA. It aimed to determine if alternative LDL-lowering strategies resulted in similar cardiovascular outcomes versus those on high-

New guidance has just been published as a collaboration between multiple relevant societies providing guidance on her of GLP1-RAs (e.g. semaglutide) in the perio-operative period. Previously, there

Please see the attached for an excellent evidence-based review of hyperkalemia management. 

As a practicing Nephrology pharmacist, one sticking point I disagree with in this article is t

A new review article has been published on the diagnosis and treatment of polycythemia vera. Please see the attached document for details.

Details

An open-label RCT of 179 Japanese cancer patients with low-risk PE has found that 18 months of rivaroxaban was superior to 6 months for recurrent VTE events without a statistically significant incr

Pfizer has recently released a communication that medroxyprogesterone acetate has been associated with a small increase in the risk of meningioma. As such, it recommends against use for non-oncolog

NICE has recently released new guidelines on the diagnosis and management of menopause. See the attached document for further details.

A new study has been published that has shown Paxlovid is associated with lower risks of hospitalization and long-COVID when given to outpatients. Please see the attached study for further details.

Health Canada has conducted a review concluding a possible link between statins and myasthenia gravis. This appears to be a class effect. See the attached communication for further details.

Just in time for the holidays! This recently published prospective cohort trial has found increased intake of dark chocolate (but not milk chocolate) is associated with a lower risk of developing

A recently published cohort study has added to the existing literature finding benefit of GLP1-RAs on alcohol intake and the rates of alcohol use disorder. While not yet fully understood, GLP1-RAs

New guidelines for the prevention of migraines have been published by the Canadian Headache Society. They provide an accompanying systematic review and meta-analysis. See the attached guideline for

A new systematic review and case series has found that abrupt discontinuation of cannabis increases the risk of first episode of psychosis. See the attached study for further details.

A new cohort trial has found a higher risk of stenting, amputations, and vascular surgery with SGLT2is vs DPP4is in patients with peripheral arterial disease. This is consistent with a recently pub

New Canadian guidelines have been published on the systemic treatment of HER2+ breast cancer. See the attached document for further details.

A review of new treatments for MASLD.

Lidocaine - IV Drug Monograph - December 2024

This database study (including centres from Ontario) has found that GLP1-RAs such as semaglutide do not increase the risk of thyroid cancer as has been previously seen in animal studies. The data

Updated dosing now matches the AMS app.

Minor updates.

A narrative review discussing the differences between semaglutide (Ozempic) and tirzepatide (Mounjaro).

A cohort study (with more patients and longer follow-up than a previous cohort study) has also found improved overall survival and significantly better health-related quality of life for those with

A Health Canada review did not find a link between GLP1-RA use (e.g. semaglutide) and suiciality or self-harm in Type 2 diabetes, though there was insufficient evidence to make firm conclusions inÂ

Please see the attached document for the newly-released ACS guidelines from AHA / ACC and others. 

A focused update to the clinical practice guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

A new review article on the treatment and prevention of left ventricular (LV) thrombus has been published. See the attached paper for details.

A new study has found that plant-based oils are associated with lower mortality, and dairy-based butter with higher risk of mortality. Patients may have questions about this article which has appea

This narrative review discusses the current safety and efficacy data for lecanemab for early Alzheimer's disease.

This retrospective cohort study of over 18,000 patients with kidney transplants and pre-existing diabetes has found that those receiving GLP1-RAs such as semaglutide had better graft survival and

This open-label RCT of 81 couples found that combined oral and topical antimicrobial therapy for male partners resulted in lower bacterial vaginosis recurrence rates vs standard care over 12 weeks.

This systematic reivew and meta-analysis found at-home LED devices are an effective option for management of acne. This may be especially useful for patients who are unable to tolerate or manage to

CANMAT has published new guidelines on the treatment of mood disorders in pregnancy. This includes a risk-benefit analysis of many medications. Please see the attached document for more details.

This article discusses the optimal dosing of lithium. This generally boils down to:

1) Levels of up to 1.2 mmol/L for acute mania.

2) Maintenance levels of 0.6 to 0.8 mmol/L as

This phase 3, randomized, open-label trial (PRESTIGE-AF) looked at DOACs for stroke prevention from a fib in those who have survived intracerebral hemorrhages. Not surprisingly, it found reduced st

This study did not find a benefit of ASA or Omega-3 fatty acid supplementation on age-related macular degeneration over ~7years. Please see the attached study for further details.

This retrospective cohort has found that GLP1-RAs are associated with a lower risk of multiple hematological cancers (e.g. myelodysplastic syndrome, myeloproliferative neoplasms) when compared to i

New guidance has been published by ASCO on the preservation of fertility in patients with cancer. Please see the attached document for further guidance.

This open-label RCT of patients with treatment-resistant depression has found that augmentation with quetiapine is superior to lithium, and likely most cost-effective. Please see the attached trial

This systematic review and meta-analysis found a very low baseline risk of suicide for both GLP1-RAs (0.044 per 100 patient-years) vs placebo (0.040 per 100-patient years), which was not statistic

A new meta-analysis of ~6800 patients with schizophrenia has been published with a focus on the trajectory of antipsychotic-induced sedation.

Ultimately this study found sedation peaks wi

See the attached FAQ for information on measles.

This evidence summary by Tools for Practice has found that large RCTs have not demonstrated increased risk of CV disease, fractures, C difficile infections, CKD, dementia, GI cancers, or pneumon

A new review article on the evidence for "Triple Therapy" (i.e. inclusion of an inhaled steroid) for COPD has been published by the Therapeutics Initiative. See the attached document for their find

The landmark DapaTAVI trial has recently been published in NEJM. This randomized controlled trial compared dapagliflozin to standard care in 1222 patients who were undergoing transcatheter aortic v

A new retrospective cohort study has shown that those who have received the shingles vaccine Zostavax have lower rates of dementia than those who have not (ARR 3.5%, NNT 29). How these findings ma

The SOUL trial was recently published in NEJM. This randomized, double-blind, controlled superiority trial found that in 9650 patients with diabetes and high risk of CV events, oral semaglutide up

The SMART-CHOICES3 trial has recently been published, which looked at 5506 patients who had completed the standard duration of DAPT post-PCI. They were then randomized in an open-label fashion to e

A new clinical practice guideline on the use of cannabinoids for non-cancer pain has been published by the American College of Physicians. They advise against use of inhaled cannabinoids, and give

In the attached document, the Therapeutics Initiative reviews thyroid function testing in those with primary hypothyroidism.

Please see the attached document for a clinical review of antiphospholipid antibody syndrome. 

Tools for Practice has published an evidence summary for use of tranexamic acid in epistaxis. Please see the attached file for details.

This study highlights that different CBGMs may have different BG results, emphasizing that this should be taken into account when CGM is used. Please see the attached study for more info.

Review of benralizumab and the ABRA trial.

A new study from Japan has found an association between SGLT2 inhibitors and falls, which is worsened when GLP1-RAs are added to SGLT2is. This risk is postulated to be due to a "decrease in skeleta

A new study from France published in JAMA has shown that pharmacists reduced ED visits and hospitalizations for those admitted to ED with medication-related adverse events. Please see the attached

This article reviews the evidence surrounding co-administration of incretin-based therapies such as GLP1-RAs and hormone replacement therapies. Please see the attached document for more information

The attached document from CPhA and CSHP reviews ways to best handle the recent discontinuation of acyclovir suspension.

This presentation by the Psychopharacology Institute reviews the management of lithium-induced renal side effects, including monitoring of levels to avoid supratherapeutic readings, and the importa

Updated May 2025

Should GLP1-RAs be used to treat binge eating disorder?

New guidelines are available for the treatment of hypertension in primary care. They recommend treating blood pressure that exceeds 140/90mmHg (or 130 to 139 if CV risk factors are present). Initia

A recent open-label trial of 751 patients with obesity (but not diabetes) has found that the maximally tolerated dose of tirzepatide (10mg or 15mg subcut weekly) was more effective than the maximal

Please see the attached helpful FAQ on Shingrix by MedSask.

Please see the attached updated guidelines for MASLD which have incorporated GLP1-RA data into their recommendations.

New guidelines have been published on the management of restless leg syndrome, emphasizing the importance of evaluating for medication-induced causes of RLS (e.g. antihistamines), and correcting ir

This multicenter, double-blind, RCT of 154 patients with MASH (with or without diabetes) has found that dapagliflozin had positive outcomes on fibrosis and MASH progression vs placebo. Please see t

A new meta-analysis of ranoomized controlled trials has found that when post-PCI DAPT is stepped down to monotherapy, that ticagrelor or clopidogrel had reduced rates of myocardial infarction and s

Therapeutics Initiative has released a summary on management of antidepressant withdrawal. Please see the attached document for more details.

Please see the attached FAQ for further details

CSHP PPC 2025

CSHP PPC 2025

CSHP PPC 2024

CSHP PPC 2024

CSHP PPC 2024

CSHP PPC 2024

Presented several years ago at a Canadian Oncology Conference evaluating the compatibility and stability of oxaliplatin and leucovorin (specifically a brand containing the excipient trometamol). So

New guidelines on the management of metabolic dysfunction–associated steatotic liver disease have been published by the American Diabetes Association, including new data on GLP1-RAs and SGLT2is.

The STRIDE trial is a recently published double-blind, RCT of 792 adult outpatients with PAD with intermittent claudication and T2DM who were given semaglutide 1mg subcut once weekly or placebo for

A new cohort study has been published based on a national registry of ~13,800 Norwegian women with early breast cancer who received chemotherapy and antiemetics. The rationale for this trial is tha

A retrospective cohort of ~72,000 patients has found that Septra has a higher risk of malformations including severe cardiac malformations and cleft palate when compared to beta-lactams (a control

This recent article reviews various interventions for managing the GI side effects of incretin-based medications such as GLP1-RAs. See the attached document for more details.

Please see the attached PDF for information on nicotine pouches.

A double-blind RCT in 72 patients with T1DM, obesity, and an automated insulin delivery system has shown that semaglutide (up to 1mg once weekly) improves the time spent within the target blood glu

These newly published guidelines conclude that there is no single best strategy for tapering benzodiazepines, but that medication reviews and pharmacist involvement are key. Please see the attached

This ketamine guide, put forth by the Psychopharmacology Institute, reviews ketamine's pharmacology, indications, dosing, and side effects. Please see the attached document for full details.

A new clinical practice guideline for T2DM, focusing on CV, renal, and weight loss outcomes, has been published in BMJ. They advise prescribing be stratified by the patient's overall risk level

The American Heart Association, in conjunction with multiple other organizations, have published updated guidance on management of hypertension. They now recommend earlier initiation of drug thera

New guidelines for the management of hepatitis B have been published by CASL and AMMI Canada. Please see the attached guidelines for full details.

New guidelines for the management of metastatic, castration-resistant prostate cancer have been published by CUA. There is also a summary document available on their website. Please see the attachm

The ACP has published new guidelines on the treatment of irritable bowel syndrome. Please see their attached guidance for more information.

A new double-blind, placebo-controlled trial of 120 IBS patients has found that enterosorbent silicolgel is effective in reducing the symptoms of IBS-diarrhea and IBS-mixed subtypes vs placebo over

Spironolactone 25mg and 100mg tablets are currently short, with earliest estimated availability of late 2025, and combination products with spironolactone are also short with earliest estimated ava

Spironolactone 25mg and 100mg tablets are currently short, with earliest estimated availability of late 2025, and combination products with spironolactone are also short with earliest estimated ava

TFP has published a summary on the evidence for once weekly insulin. They conclude that it is as effective as typical long-acting insulins in lowering HbA1c and hypoglycemia risk appears similar, b

Due to the association of obesity with metabolic hypogonadism, there has been interested in GLP1-RAs for possible treatment of this disorder.

This trial of 83 obese patients with metaboli

The Psychopharmacology Institute has published a presentation on the use of benzodiazepines for catatonia. Please see the attached document for more information.

This JAMA article reviews current treatments and their efficacy for ovarian cancer. Please see the attached document for full details.

Please see the attached document for full details.

Please see the attached document for an excellent review on the diagnosis and management of adrenal insufficiency in adults.

The below trial summary of the recently published DOTS trial is per the Sanford Antimicrobial Guide:

• Treatment of complicated S. aureus bacteremia (SAB) generally requi

Please see the attached meropenem IV monograph with updated dosing.

This evidence summary by Tools for Practice has found that while trials were older and small, they support benefit of propranolol over placebo for essential tremor, with improvement of ~2 on a 10 t

There has been controversy about beta-blocker use post-MI for those who do not develop reduced LVEF heart failure (i.e. LVEF less than 40%), since evidence for beta-blockers has largely been in the

The SOGC has released a position statement reiterating the safety of acetaminophen in pregnancy, including evidence that refutes erroneous claims that acetaminophen increases the risk of autism in

Ontario Health has updated their guidance on access to antiviral therapies for COVID in the community. Please see the attached document for full details.

This multicentre, double blind, randomised, placebo-controlled, phase 3 trial of 234 patients receiving capecitabine for breast cancer randomized patients to methylcobalamin 0.5mg po TID or placeb

A new database study has just been published that has found that GLP-1 receptor agonist initiation compared to DPP-4inhibitors initiation was associated with a reduced risk of Alzheimer's dise

Please see the attached for the latest ASCO advice on extravasation of antineoplastic drugs.

See the attached PDF for details.

Please see the attached FAQ for details.

A review article has recently been published, giving a comprehensive review of the risks and benefits of testosterone for hypogonadism in middle-aged and older men.

Improved parameters in

Tools for Practice has published a new review on the use of fezolinetant (brand name Veozah) for vasomotor symptoms of menopause, and have found that at 3 months, women reported feeling "much bett

Please see the attached tool from British Columbia which provides an easy-to-use chart for beta-lactam cross-reactivities.

This newly published systematic review in the BMJ has found that maternal exposure to acetaminophen does not increase the risk of autism spectrum disorder or ADHD in offspring. Please see the attac

In this evidence summary by Tools for Practice, nicotine-containing e-cigarettes were found to be more effective than traditional NRT for smoking cessation (18% vs 10% at 6 to 12 months), with simi

Previous observational evidence has demonstrated a lack of benefit and increased bleeding risk when adding ASA for stable coronary artery disease in those otherwise taking oral anticoagulants for o

Please see the attached ESC guidelines for management of dyslipidemia that were recently updated.

Please see the attached summary from Health Canada regarding the risk of serious hepatotoxicity with BTK inhibitors.

Please see the attached for Ontario Health guidance on the management of seasonal influenza.

TACSI is an open-label, randomized trial of 2201 patients looking at DAPT (ASA + ticagrelor) vs ASA monotherapy in patients having a CABG at the time of ACS. At 1 year, they found no differences in

The FDA has recently updated the boxed warning for hormone replacement therapy. Previously, these warnings included CV disease, breast cancer, stroke, and probable dementia, which have now all been

This recent study concluded that commonly prescribed medications do not appear to alter the efficacy of immune checkpoint inhibitors in stage IV NSCLC, and advises previous associations seen in lit

This prospective study of 72 patients with renal cell carcinoma has found that eGFR equations significantly overtimate renal function vs 24 hour creatinine clearance-derived GFR. Particularly when

Note the significant risk of hypophosphatemia which necessitates phosphate monitoring (not required with other IV irons). 

See the attached file for details.

The Inpatient Mental Health Pharmacist at Sunnybrook has created an extremely helpful document on clozapine. Please see the attached PDF for full details. 

The University of Waterloo has created a handy resource that gives an overview of otitis externa. Please see the attached document. 

This recent randomized, controlled, open-label non-inferiority study of 110 adults aimed to clarify the optimal duration of systemic corticosteroids in asthma exacerbations, with the hope that biom

This recently-updated meta-analysis on the role of GLP1-RAs such as semaglutide for diabetics with PAD has found that GLP1-RAs reduce major adverse cardiac events and all-cause mortality, but have

The Psychopharmacology Institute has published a nice summary on the treatment of dementia, focusing largely on the efficacy and side effects of cholinesterase inhibitors and memantine. Please see

The European Renal Association has recently published an overview of calciphylaxis including management, recognizing the lack of high-quality data to support various interventions. Please see their

Please see the attached PDF for details.

This review article, recently published in the BMJ in December 2025, gives an overview of the management of inflammatory bowel diseases as well as how to treat specific patient populations such as

This randomized, open-label, phase 3 trial assessed the efficacy and safety of epirubicin and cyclophosphamide followed by weekly paclitaxel with or without carboplatin as adjuvant therapy in 808 p

This recent systematic review and meta-analysis has found that while all SSRIs and SNRIs increase the risk of GI bleeding, the risk is highest with venlafaxine (OR 1.50, 95% CI 1.32–1.70), citalo

This updated systematic review has found that "comparable and high THC-to-CBD ratio cannabinoid products may result in small improvements in pain and increased common adverse events during short-te

This useful guide by the Psychopharmacology Institute, a service that is free with sign-up, gives some clinical pearls on the use of lamotrigine such as:

- Titrating slowly from 25mg dai

Critical Care Medications

Please see the attached document for updated guidance on pre- and post-exposure HIV prophylaxis in Canada.

Please see the attached FAQ for details on the recent issue that has come to light regarding amoxi-clav stability.

Sunnybrook has been conducting stability testing on repackaged oral drugs, particularly those known to have stability concerns. As part of that testing, amoxicillin-clavulanic acid tablets from low

The Dose is an excellent newsletter published by the Thames Family Health Team. Sign-up is free through their website at https://thamesvalleyfht.ca/the-dose/ . 

Topics from their most r

An excellent summary of vitamin supplementation in bariatric surgery patients receiving hemodialysis has been created by one of Sunnybrook's Pharmacy Residents, Erica Pietrangelo. Please see h

This retrospective cohort of 587 patients with metastatic cancer receiving immune checkpoint inhibitors looked at the association between vaccination and clinical outcomes, ultimately finding an as

Scopolamine transdermal patches have been discontinued in Canada. MedSask has published a helpful guide with therapeutic alternatives. Please see the attached document for full details.

Several insulin products (e.g. insulin determir) are being discontinued. MedSask has put together a helpful guide. Please see the attached document for full details.

The adverse effects from statins based on unblinded observational data are potentially over-stated. This meta-analysis of large, double-blinded RCTs of statins aimed to assess side effects using th

The attached presentation by the Psychopharmacology Institute has an excellent review of OCD management, including avoidance of citalopram / escitalopram (due to their more conservative dosing caps

Please see the attached document for details.

This excellent review from the Psychopharmacology Institute gives an overview of lithium-induced nephrotoxicity and its management.

Strategies to avoid this side effect include regular mo

The Psychopharmacology Institute has recently published a document discussing the adjustment of medications used to treat substance use disorders in those with renal dysfunction, including:

Please see the attached document for open-access resources regarding swallowing difficulties and enteral feeding tubes.

A recent retrospective cohort study has found an association between GLP1-RA use and chronic cough. While some of this potential risk has been proposed to be due to GERD, there may be other mechan

Please see the attached advice from CPhA on the current cyclophosphamide shortage.

The FDA has issued an alert regarding a rare but potentially life-threatening cutaneous hypersensitivity reaction found with both levetiracetam and clobazam.

Drug Reaction with Eosinophil

See attached for the most recent Canadian Clinical Practice Guidelines for the Management of Osteoporosis.

Please see the following link to access CPhA resources and tools on sexual and reproductive health.

This includes reviews of safety, efficacy, red flags, counselling points, a Choosing T

NACI has released a new update regarding COVID-19 vaccine doses for spring 2024.

In summary, those at high risk of severe illness can receive an additional dose of XBB.1.5 COVID-19 vaccin

Omega-3s are commonly taken by patients, but the increased risk of developing atrial fibrillation is often not communicated to them. This dose-dependent adverse effect affects up to 1 in 10 patient

Please see the attached updated guidance on the use of benzodiazepines in breastfeeding from the Specialist Pharmacy Service in the UK.

Lorazepam and oxazepam are the preferred choices if

Please see the attached for updates on the national pharmacare bill. 

Initial coverage for every Canadian with a health card will consist of diabetes medications (excluding Ozempic) and

Zolpidem and zopiclone are preferred as they have shorter half-lives than benzodiazepines and only pass into the milk in small quantities.

Prescribing Trends for Antiestrogens, Bicalutamide, and Cytotoxic OAMs

The Ontario College of Pharmacists is exploring legal options due to an overwhelming number of recent reports from pharmacists regarding corporate pressure to provide their services. 

A new trial has been published on the association with triptans and CV events, purportedly with improved methodology over previous trials. It assessed a cohort of more than 400,000 triptan users fo

Chronic phenytoin use can reduce folate levels, and folic acid supplements can reduce phenytoin levels. If folic acid is started or stopped for a patient established on phenytoin, phenytoin levels

A network meta-analysis has recently been published on the efficacy and safety of various DAPT durations post-PCI (1, 3, 6, and 12 months). They found that shorter durations of DAPT did not result