OSF Saint Francis Medical Center, Peoria, Illinois

...an educational memo from your Pharmacy and Therapeutics Committee

August, 2001

Based on data reviewed from a randomized, controlled, clinical trial comparing propofol to other sedative agents (ex. lorazepam, chloral hydrate, fentanyl, ketamine, morphine, or phenobarbital), the FDA and the drug manufacturer have issued a warning against the use of propofol for sedation in pediatric ICU patients. The study was comprised of 327 pediatric patients and resulted in a 2-3 fold greater incidence of death among children randomized to propofol during the trial or 28 days after the study period.

Ginko, St. John’s Wort, Chromagen and Saw Palmetto are examples of herbal or nutritional products that many people use on a daily basis. Since none of these products are on the OSF Formulary of approved drugs, patients will sometimes bring these medications in from home and request to continue to take them while in the hospital. Prescribers should be aware of the possibility of significant drug interactions or adverse drug events, There are increasing numbers of reports of risks involved with taking the herbal supplements. Also, it is sometimes not understood that these products are not regulated by the FDA and that products may differ in potency and possibly contain contaminants.

Although taking these products while in the hospital is discouraged, a physician may continue home medications if he/she determines that a patient’s health may be put at risk if therapy is withheld. It is important that all healthcare providers be aware of all drugs that a patient is taking. Home medications not stocked by the Pharmacy, which are to be used in the hospital, must be sent to the Pharmacy for identification, re-labeling and entry into the patient’s Medication Administration Record. Physicians are encouraged to submit formal requests for Formulary additions, including herbal or nutritional supplements, to the Pharmacy and Therapeutics Committee.

Injectable drug shortages of chlorothiazide (Diuril), beclomethasone (Celestone), isoproterenol (Isuprel) and hyaluronidase (Wydase) have been lessened slightly with recent limited shipments of these drugs.

Influenza vaccine for 2001-2002 is expected to be in short supply. It is advised to delay vaccinating people not at high risk until November. Shortage of tetanus toxoid is expected to last into next year. Routine tetanus toxoid vaccinations for Illinois school children may be skipped for this coming school year. Parenteral phenobarbital, dexamethasone (Decadron) and methylprednisolone (Solu-Medrol) are in short supply. Whenever clinically feasible, consider administering the drug orally or per naso-gastric tube or using an alternative agent.

Novartis Pharmaceuticals, the sole manufacturer of tolazoline will discontinue making this product effective July 2002.

The ‘adult’ formulation of oral sodium chloride solution of 1 Gram/30mls, has been eliminated and is now standardized to the same concentration used for pediatric patients (2.5 milliequivalents/ml or 1Gram per 6.8 mls.)