Background The analysis of Non-formulary drugs (NFD) most frequently prescribed is important in managing a hospital's formulary.

Purpose Determine the most frequently prescribed and dispensed NFD in a 376 bed community hospital.

Materials and methods The hospital's NFD policy demands physicians to submit a request form, which must be validated by a pharmacist prior to its dispensation. A retrospective descriptive study was conducted with information collected from NFD applications received between January and June 2009.

Results A total of 1504 applications were received, and 296 different NFD were dispensed. The 5 most frequently prescribed NFD accounted for 25% of applications. Many other medications were ordered only once or twice. The most dispensed drugs were levetirazetam (5.6%), trazodone (5.3%) and escitalopram (5.3%). Different strengths or dosage forms of formulary products represented 11.4% of applications. Eight percent of NFD had a formulary alternative through the hospital's Therapeutic Interchange Program (approved by the Pharmacy and Therapeutic Committee, PTC), but were not accepted by physicians. Drugs related to the nervous system were the most prescribed (56.4%), mainly psycoanaleptics (23.6%). Cardiovascular drugs supposed a 14,4%. The Internal Medicine Department held 31.7% of the applications, while the Psychiatry Department prescribed more number of NFD per patient. The most common cause of NFD prescription was ‘no alternative available in the hospital’s formulary' and ‘outpatient’s medication'. The majority of NFD requested were already in stock and accounted the acquisition cost of NFD for 0,95% of total drug spending in this period.

Conclusions More than half of the NFD prescribed were related to the nervous system, followed by cardiovascular ones. Most of medications were rarely needed, while a low number of drugs caused the majority of the prescriptions. A significant percentage of NFD were different forms of formulary products and drugs with a formulary therapeutic alternative.