P H A R M A G R A M
OSF Saint Francis Medical Center, Peoria, Illinois
...an educational memo from your Pharmacy and Therapeutics Committee
June, 2001
Parenteral Dexamethasone, Methylprednisolone and Betamethasone in Short Supply:
Discontinuation of product lines, production problems and shortages of raw materials continue to plague the pharmaceutical industry, resulting in critical drug shortages to pharmacies nationwide. Here at St. Francis Medical Center, if no new supplies arrive, it is estimated that we will exhaust our parenteral inventory of methylprednisolone (Solu Medrol), dexamethasone (Decadron) and betamethasone (Celestone) in about 2 to 4 months. The manufacturers and the FDA are anticipating these shortages to be ongoing for the next 12 months. We are encouraging the use of oral formulations, which are not in short supply, whenever clinically possible. If necessary, an autosubstitution procedure may be necessary between these two injectable corticosteroids in order to balance the inventory.
IV Pantoprazole (Protonix) added to Formulary:
The first parenteral proton-pump inhibitor, pantoprazole, has been added to the Formulary. The oral formulation of this drug was recently approved as the preferred proton pump inhibitor for adult patients. Given as a once-a-day, 40mg dose infused over 15-30 minutes, intravenous pantoprazole is FDA approved as an alternative to oral therapy in the treatment of erosive esophagitis and limited to 7 to 10 days treatment duration. Because of the possibility of micro-precipitates forming during the preparation, an in-line 1.2 micron filter must be used when administering this drug to patients. This drug is compatible with 5% Dextrose, Normal Saline and Lactated Ringers.
Neurology drugs added to the Formulary:
Because of their unique therapeutics, several newer anti-epileptic drugs were recently added to the Formulary. Drugs approved were levetiracetam (Kepra), oxcarbazepine (Trileptal), tiagabine (Gabitrol), and zonisamide (Zonegran). Modafinil (Provigil), which was recently FDA approved as an orphan drug in the treatment of narcolepsy, was also approved for the Formulary.
Other Formulary Additions and Autosubstitutions Approved:
Two drugs that were added to the Formulary from the May P&T Committee were tamsulosin (Flomax) and bisoprolol/hydrochlorthiazide combination (Ziac). Pharmacy authorization to substitute ibuprofen (Motrin) for nabumetone (Relafen) and Anusol ointment or suppositories for Preparation H ointment or suppositories were approved.
Enoxaparin Drug Orders Using Milligram per Body Weight:
When ordering enoxaparin (Lovenox), prescribers are encouraged to write out the total dose rather than a milligram/Kilogram amount, unless the patient’s weight appears on the Physician Order Sheet along with the order. Occasionally, inaccurate current patient weights appear in the computer data base which may result in an incorrect enoxaparin dose being calculated. Writing out the actual desired dose provides a better system for doubling checking an order and a more accurate medical record of the dose prescribed.
Report Adverse Drug Events on the ADE Hotline – 655-6805