Recently there may have been some confusing information about how to report Adverse Drug Events (ADE). Despite what you may have heard, the ADE Hotline at 655-6805 is still available and is the most convenient and easiest way to report any medication side effect. Physicians, nurses and any other St. Francis Hospital healthcare personnel are encouraged to report all known or suspected ADEs using the ADE Hotline.

Because of the morbidity and mortality associated with immediate-release nifedipine, this drug has been restricted for use in the treatment of procedure-related coronary vasospasm, and is available only in the Operating Room, Coronary Catheterization Lab and the Cardiovascular Intensive Care Unit. For pharmacy orders for immediate-release nifedipine 10mg orally three times a day, the Pharmacy and Therapeutics Committee has authorized the pharmacist to substitute extended-release nifedipine 30mg once a day. A Therapeutic Equivalent Substitution order will be completed for the Patient Record to indicate the change.

Clonidine, administered sublingually or orally, or intravenous labetolol have been used as alternatives for immediate-release nifedipine to reduce acutely elevated blood pressures.

The Pharmacy and Therapeutics Committee approved the recently available oseltamivir oral suspension to the Formulary. Oseltamivir 75mg capsules were added to the Formulary last year. This drug is also now approved for influenza treatment in children who are 1 year of age or older. The new formulation will allow for easy administration to this group of patients and to adults unable to swallow capsules. Dosing of oseltamivir for the treatment of influenza is based on weight; with patients weighing more than 40 kilograms dosed at the maximum 75mg twice a day for 5 days. Average wholesale price (AWP) of a 75ml bottle is about $60, which will provide enough drug for the 5 day treatment course. The AWP for the 75mg capsule is about $6 per dose.

Since oseltamivir can be used in children and is now available in a liquid dosage form, the Pharmacy and Therapeutics Committee voted to delete the oral inhaler, zanamivir, which has similar indications, from the Formulary.

Hyaluronidase is part of the hospital protocol for treating certain types of drug extravasation that can cause extensive tissue damage from infiltration of caustic intravenous drugs. Because of a drug shortage over the past few months, we have had to restrict the usage to the potentially severe episodes of drug infiltrations. Wyeth, the sole manufacturer of this drug, has now decided to discontinue manufacturing this product. Currently the FDA and Wyeth are trying to work out a solution to this latest supply problem