Formulary for Prescribing Podiatrists in Nova Scotia
In the practice of podiatry, the use of medication is a cornerstone of effective patient care. Good prescribing is not merely about selecting the right drug, it is a complex process that encompasses accurate diagnosis, patient-centred treatment planning, and the consideration of the broader health implications of medication use.
It is the College’s responsibility to ensure that the highest standards of patient care are maintained within the podiatry profession; part of this involves ensuring that medication is prescribed appropriately and safely.
It is imperative that podiatrists prescribe medications only in relation to ailments of the foot, which falls within the podiatry scope of practice. This is crucial for patient safety and aligns with the legal and ethical boundaries of the profession.
Podiatrists must adhere to the following guidelines when prescribing medications:
- Ensure that the medication is directly related to the treatment of ailments of the foot.
- Assess the patient thoroughly to confirm the diagnosis and need for medication.
- Prescribe medications with a clear understanding of their indications, contraindications, side effects, and potential interactions.
- Maintain accurate and up-to-date records of all prescriptions and patient consultations.
Formulary
Podiatrists may prescribe the following medications in Nova Scotia:
Schedule 1 – Substances Administered by Injection into the Foot
Betamethasone sodium phosphate beta-acetate
Dexamethasone sodium phosphate
Hydrocortisone sodium succinate
Methylprednisolone acetate
Triamcinolone acetonide
Denatured alcohol 4% (ethyl alcohol)
Bupivacaine
Lidocaine hydrochloride (with or without epinephrine)
Mepivacaine hydrochloride
B12- Cyanocobalamin
Schedule 2 – Drugs for Topical Use
Topical Antibacterial Agents – for the purpose of managing superficial bacterial infections of the foot:
Bacitracin
Framycetin sulfate
Fusidic acid
Gentamicin sulfate
Mupirocin
Silver sulfadiazine
Erythromycin
Bacitracin/neomycin sulphate
Neomycin sulphate/polymyxin B sulphate/bacitracin
Neomycin sulphate/polymyxin B sulphate/gramicidin
Topical Antifungal Agents – for the purpose of managing fungal and/or yeast infections of the skin and nails of the foot:
Ciclopirox olamine
Clotrimazole
Ketoconazole
Miconazole nitrate
Nystatin
Terbinafine HCl
Tolnaftate cream
Undecylenic acid
Efinaconazole
Clioquinol
Topical Antipruritic and Local Anesthetic Agents – for the purpose of decreasing or eliminating sensation in an area of skin of the foot to relieve inflammatory skin symptoms or prior to injection of superficial procedures:
Benzocaine
Lidocaine
Prilocaine
Topical Nonsteroidal Anti-inflammatory Agents — for the purpose of relieving inflammation and pain in structures of the foot:
Diclofenac
Ketoprofen
Piroxicam
Sulindac
Topical Corticosteroid Agents – for the purpose of treating inflammatory manifestations of corticosteroid responsive dermatoses in structures of the foot:
Amcinonide
Betamethasone diproprionate
Betamethasone valerate
Desoximetasone
Flumethasone/clioquinol
Fluocinonide
Halcinonide
Hydrocortisone
Hydrocortisone 17 valerate
Mometasone furoate
Triamcinolone acetonide
Topical Emollients, Keratolytic, and Miscellaneous Skin Agents — for the management of hyperkeratotic, inflammatory, and/or infectious skin conditions of the foot, adjunct treatment of fungal nails, and/or chemical destruction of miscellaneous skin and nail lesions:
Salicylic Acid (70% or less)
Urea (50% or less)
Ammonium lactate (12% or less)
Cantharidin (1% or less)
Silver Nitrate (95% or less)
5-Fluorouracil (5% or less)
Podophyllin (2% or less)
Lactic acid (16.7% or less)
Imiquimod (3.75% w/w)
Pimecrolimus (1% w/w)
Calcipotriol (50 mcg/g)
Collagenase
Schedule 3 – Drugs for Oral Use
Oral Penicillin Antibacterial Agents — for the purpose of managing susceptible bacterial infections of foot wounds (traumatic, post-op complications), cellulitis, lacerations/punctures, abscesses, and/or surgical prophylaxis:
Amoxicillin
Amoxicillin/Clavulanic acid
Cloxacillin
Oral First-Generation Cephalosporin Agents — for the purpose of managing susceptible bacterial infections of foot wounds (traumatic, post-op complications), cellulitis, lacerations/punctures, abscesses, and/or surgical prophylaxis:
Cefadroxil
Cephalexin
Oral Erythromycin and Macrolide Agents — for the purpose of managing susceptible bacterial infections of foot wounds (traumatic, post-op complications), cellulitis, lacerations/punctures, abscesses, and/or surgical prophylaxis:
Erythromycin
Azithromycin
Clarithromycin
Oral Quinolone Agents — for the purpose of managing susceptible bacterial infections of foot wounds (traumatic, post-op complications), cellulitis, lacerations/punctures, abscesses, and/or surgical prophylaxis:
Ciprofloxacin
Levofloxacin
Moxifloxacin
Oral Sulfonamide Agents — for the purpose of managing susceptible bacterial infections of foot wounds (traumatic, post-op complications), cellulitis, lacerations/punctures, abscesses, and/or surgical prophylaxis:
Sulfamethoxazole/trimethoprim
Oral Tetracycline Agents — for the purpose of managing susceptible bacterial infections of foot wounds (traumatic, post-op complications), cellulitis, lacerations/punctures, abscesses, and/or surgical prophylaxis:
Tetracycline
Doxycycline
Oral Lincomycins — for the purpose of managing susceptible bacterial infections of foot wounds (traumatic, post-op complications), cellulitis, lacerations/punctures, abscesses, and/or surgical prophylaxis:
Clindamycin
Oral Metronidazole — for the purpose of managing susceptible anaerobic bacterial infections of foot wounds (traumatic, post-op complications), cellulitis, lacerations/punctures, and abscesses:
Metronidazole
Oral Nonsteroidal Anti-Inflammatory Agents — for the purpose of relieving inflammatory conditions or pain of the foot:
Diclofenac potassium
Diclofenac sodium
Diflunisal
Ibuprofen
Indomethacin
Meloxicam
Ketorolac tromethamine (maximum daily dosage of 10 mg every 4-6 hours, as needed for pain, with the total dosage not to exceed 4 doses per day, or 40 mg in total per day, for a maximum duration of 5 days)
Naproxen
Naproxen sodium
Tiaprofenic acid
Celecoxib
Ketoprofen
Piroxicam
Sulindac
Oral Misoprostol — to be prescribed only in conjunction with Nonsteroidal Anti-inflammatory Agents for the purpose of preventing gastric bleeding, in the course of engaging in the practice of podiatry:
Misoprostol
Oral Azole Agents — for the purpose of managing fungal and/or yeast infections of the skin and nails of the foot:
Itraconazole
Fluconazole
Oral Allylamine Agents — for the purpose of managing fungal and/or yeast infections of the skin and nails of the foot:
Terbinafine
Oral First-Generation Antihistamines — for use in the management of nausea/vomiting, pruritis, urticaria, and/or allergic symptomatology, while engaging in the practice of podiatry:
Diphenhydramine
Promethazine
Hydroxyzine
Oral Second-Generation Antihistamines — for use in the management of pruritis, urticaria, and/or allergic symptomatology, while engaging in the practice of podiatry:
Cetirizine
Oral Histamine H2-Antagonists — to be prescribed only in conjunction with Nonsteroidal Anti-inflammatory Agents for the purpose of preventing gastric bleeding, while engaging in the practice of podiatry:
Cimetidine
Nizatidine
Acknowledgements
The development of this College document was informed by the College of Chiropodists of Ontario’s 2023 Drug Regulation for Podiatrists/DPMs in Ontario.