13-061 Code Vt. R. 13-140-061-X

Current through August, 2024

Section 13 140 061 - NATUROPATHIC PHYSICIAN FORMULARY RULES

Section I PURPOSE, AUTHORITY, AND PROHIBITION

1. Purpose

This is a formulary of prescription drugs that may be used by naturopathic physicians in a manner that is consistent with their scope of practice.

2. Authority

In accordance with 26 VSA § 4125(c), this formulary has been established by the Commissioner of Health with the advice of the advisor appointees described at 26 VSA § 4126.

3. Prohibition

A person licensed under 26 VSA Chapter 81 (Naturopathic Physicians) shall not prescribe, dispense, or administer any controlled substances except those natural medicines authorized by these rules. "Natural medicines" are substances present in or produced by nature, not artificial or man-made.

Licensed naturopathic physicians may only order, prescribe, dispense and administer certain medications of mineral, animal and botanical origin which are:

1. "Natural" according to the following definition: -present in or produced by nature, not artificial or man made. (Source - American Heritage Dictionary)

2. Not substances prohibited by other Vermont or federal law.

3. Appropriate within a general naturopathic practice, that is primary care in focus, recognizing that naturopathic physicians are also specialists in natural medicines and often serve in an adjunctory capacity for other chronic illness.

4. Prescribed in doses that are non-poisonous accepted therapeutic dosages. This is defined as a dose which by its actions does not impair function or destroy human life, and is consistent with the naturopathic principle - "First Do No Harm."

5. The substance being prescribed is clinically effective for the condition that the patient is seeking health care for. This will require the naturopathic physician to assess if the natural substance, or substances being used in a particular treatment protocol are working for that patient within a safe and reasonable amount of time for that condition. This assessment needs to be made within the context of naturopathic medical philosophy, the conventional standard of care as defined by such groups as the Vermont Program for Quality, and the patient's choice as long as adequate information and education is provided.

Section II PRESCRIPTION DRUGS THAT MAY BE USED BY NATUROPATHIC PHYSICIANS

1. Drugs That May be Prescribed

The following products may be prescribed by naturopathic Physicians: Routes of administration are usual routes.

PO = By Mouth

IM = Intra Muscular

IV = Intra Venous

SQ = Subcutaneous

Topical = Applied To Skin

1. Amino Acids and Amino Acid Combinations: (Usually PO) Alanine, Arginine, Aspartic Acid, Cystine, Glutamic Acid, Glycine, Histidine, Hydroxyproline, Isoleucine, Leucine, Levocarnitine, Lysine, Methionine, N-acetyl cysteine, Phenylalanine, Proline, Serine, Threonine, Tryptophan, Valine

2. Antimicrobials - naturally derived - (PO,IM, Topical)

a. Erythomycin

b. Penicillins - Amoxycillin, Ampicillin, Penicillin G, Penicillin VK

c. Tetracycline

d. Anti-fungal agents - Nystatin

3. Barrier Contraceptives

4. Botanical Extracts and their derivatives -

Botanical Medicines as exemplified in traditional botanical and herbal pharmocopea may be utilized by naturopathic physicians, following the above guidelines. The botanicals listed below represent substances that are currently available by prescription only, or they are botanicals that have both prescriptive and non-prescriptive dosage forms available.

Substance	Conditions Used For	Specific Dose	Route ofAdministration
Belladonna	clears & prevents local congestion, early stages of fever	Belladonna -0.03% atropinel-10 drops/atropine	PO
Carnivora	immune stimulation stimulates lymphocyte production	1 cc/d	IM or IV
Codeine	refractory cough	10mg/tsp1-2 tsp q 4 hr not to exceed 8-10 tsp/d	PO
Colchicine	gout other experimental disc disease-non surgical tx	acute: 1 mg/12 hr/maintainance:.5-1.5	PO or IV
Ephedra	also pseudoephedra bronchial dilator increases metabolic rate	standardized 10% extract125-250mg	PO
Ergotamine Tartate	vascular migraine	1 mg/tab/total dose/attack not to exceed 6mg	PO
Glycerhiza Usually OTC specific Rx	anti-inflammatory anti-viral/anti-bacterial	20cc/day	PO, IV
Hyocyamus Scopalamine Hyocyamine SO4	anti-spasmodic, coughs, cystitis, sedative	.125-.5mg TID/2-5 drops tincture	PO
Nicotine (patch)	smoking cessation	7-21 mg/d serial	Transdermal
Physostigmine	in small doses, stimulates smooth muscle/severe atony of bladder	1-3 grain (pwd)/3-10 drops (tincture)phys	PO Occasional IM
Pilocarpine	diaphoretic fevers acute skin rxn's stimulates body secretions	pilocarpine HC11/12-1/6 grain 5-60 drops fluid	PO
Podophyllum	cholagogue/hydrogogue alterative topical - for Dr's use not Rx	1/10 to 10 drops 5-15 grain (pwd)10mg-	Topical
Salix-Salicylates	anti-inflammatory analgesic arthritis	200-300mg/d in divided doses BID-TIP	PO Topical
Sarapin	pain syndromes cephalgia, sciatica	2-10ml for injection trigger points	IM
Viscum Album	anti-hypertensive	1-2ml TIDpwd 10-25g	PO
Iscador Iscucin	immune stimulant increases natural killer cells increases CD4 activity	1 cc/d	IV or SQ
Yohimbe HCI	male erectile dysfunction/ mood regulator	each tab 5.4mg 1/2 or 1 TID	PO

Substance	Length of	# of	Comments
	Treatment	Refills
Belladonna	small doses short	none	in non-
	period of time		opthalmic
	1 week		dosage forms
Carnivora	6wk - 3mo	potentially
		could be
		repeated
Codeine	7 days	none	single
			prescriptions
			for refractory
			cough only
Colchicine	can be used long-	many	i.v. can greatly
	term 4-6 tx		increase
			therapeutic
			effectiveness
Ephedra	can be used long-	many
	term high
	tendency to
	tolerance
Ergotamine	short- term no	may be
Tartate	more than 10mg	repeated
	per week
Glycerhiza	8-16 weeks	refill	2.0%
Usually OTC		depends	glycerrhizin
specific Rx		on	0.1%
		response	cysteine 2.0%
Hyocyamus	7-10 days	none
Scopalamine
Hyocyamine
SO4
Nicotine	4-12 wk	may be
(patch)	variable	repeated
Physostig-	4-7 days	none	in non-
mine			opthalmic
			dosage forms
Pilocarpine	4-7 days	none	in non-
			opthalmic
			dosage forms
Podophyl-	4-12 weeks	unlikely
lum		need for
		repeat
Salix-	long -term use	with
Salicylates	possible unlikely	caution
	in naturopathic	side
	practice	effects
Sarapin	variable with 5-7	1-5 tx
	days or more
	between
Viscum	long -term	many
Album
Iscador	month to years	many
Iscucin
Yohimbe	usual not more	depends
HCI	than 10 weeks	on patient
		response

5. Electrolytes - (IV)

Saline, Sodium Bicarbonate, Dextrose injection, Dextrose and Saline, Lactated Ringer's Solution, Ringer's Solution

6. Expectorants and Mucolytics - (PO)

Guaiacol, Iodinated Glycerol

7. Enzyme preparations - (PO, Topical)

Amylase, Chymotrypsin, Lipase, Pancreatin, including Pancrelipase, Papain, Protease, Typsin

8. Homeopathic preparations - all prescription and non-prescription remedies that are manufactured according to the pharmaceutical guidelines set forth in the H.P.U.S. (PO, SQ)

9. Hormones - (PO, IM, Topical)

a. Adrenal - e.g., adrenal extract, cortisol, DHEA, pregnenolone

b. Gonadal - for hormone replacement purposes, does not include oral contraceptive pills or anabolic steriods

1. Estrogens - conjugated estrogens, estradiol, ethinyl estradiol, etriol, estrogens, esterified, estrone, estropipate, quinestrol

2. Progesterone

3. Testosterone

c. Thymus

d. Thyroid - preparation as defined in the USP

e. Melatonin

10. Liver Preparations - (PO, IM)

11. Minerals - (PO/Topical/IM/IV) for example: calcium compounds, calcium folinate, fluoride compounds, iodine (including potassium iodine, niacinmide hydroiodide), iron compounds, magnesium compound, potassium compounds, silver nitrate, trace mineral compounds (chromium, selenium, molybdenum, banadium, boron)

12. Miscellaneous - (PO, SQ, IM, IV, Topical)

a. Digestive aids - betaine and glutamic hydrochloric acid (non RX)

b. Biological agents - urea

c. Bile salts and Acids - Chenodiol, Cholic Acid, Chenodeoxycholic acid, Dehycrocholic acid, Ox Bile, Ursodeoxycholic acid, Ursodiol

d. DMSO, Hyaluronidase, Grain Alcohol

e. Epinephrine - (SQ)

f. Glutathione, Reduced Glutathione - (IV or PO)

g. Oxygen

13. Vaccines/Toxoids - to be used consistent with Vermont Health Department Recommendations - (IM, PO)

14. Vitamins - All prescriptions and non-prescription vitamin preparations and their deratives - (PO/IM/IV, Topical)

Vitamin A, Betacarotene and Derivatives

Thiamin (Vitamine B1)

Riboflavin (Vitamine B2)

Niacin (Vitamine B3)

Pantothenic Acid including dexpanthenol (Vitamine B5)

Pyridoxine (Vitamine B6)

Cyanocobalamin or hydroxycobalamin (Vitamine B12), including intrinsic factor

Folic Acid

Biotin

Ascorbic Acid (Vitamin C)

Vitamin D (including calcitrol, calcifediol, ergocalciferol)

Vitamin E

Vitamin K (including menadiol)

15. Topical Medicines

a. Debridement/escharotic agents - Urea Cream 40%

b. Miscellaneous topical agents - Cantharidin, Capsaicin, DMSO, Selenium Sulfide 2.5%, Retin A, Hydrocortisone 1%, mineral salts such as copper sulfate to be used for iontophoresis

c. Topical antibiotics - Silver sulfadiazine cream, colloidal silver preparations

d. Scabicides and Pediculosides - Lindane, Permethrin or whichever agent is the current recommended treatment for these infections

2. Drugs That May be Used But Not Prescribed

The following products may be purchased or otherwise obtained by naturopathic physicians in any dosage form for appropriate use, but may not be prescribed:

A. Diagnostic Agents

Cobalt (57Co)

Corticotropin

Glucola

Lactulose/Mannitol Solution

Pentagastrin

Zylose

B. In Vivo Diagnostic Biologicals

Tuberculin Tests

Diptheria Toxin

Coccidioidin

Histoplasmin

Candida and Trichophyton Extracts

Mumps skin test antigen

Skin test antigens, multiple

C. Topical Medicines

Podophyllum Resin 25%

Podofilox 0.5% Solution

Topical anethetics and local anasthetics as described in the USP.

Section III Term of Rules

This formulary will be reviewed and revised on an annual basis.

13-061 Code Vt. R. 13-140-061-X

Effective Date: July 7, 1998 (Secretary of State Rule Log #98-41)
AMENDED: March 24, 2000 (Secretary of State Rule Log #00-15)

Statutory Authority: 26 V.S.A. § 4125(c)