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
February, 2002
Kaletra ® and Bivalrudin (Angiomax®) added to the Hospital Formulary:
Kaletra ® is a combination of lopinavir, a new protease inhibitor, and ritonavir (Norvir®) and is approved for the treatment of patients with HIV infection. The normal recommended dose is 400mg lopinavir/100mg ritonavir (3 capsules or 5 mls of the liquid formulation) twice a day. Numerous, potential drug-drug interactions are possible since ritonavir is known to interfere with the P-450 enzyme system. Both the capsules and liquid product need to be stored in the refrigerator.
Bivalrudin, is a direct thrombin inhibitor, which was recently approved by the FDA and is indicated for patients with unstable angina who are undergoing coronary angioplasty. Studies have not conclusively shown this drug to be better than unfractionated heparin. Bivalrudin was approved for use in the Cath Lab in treating patients with a history of heparin-induced thrombocytopenia or other heparin sensitivities.
Avoid Adding Flavoring Agents to Colyte® and Miralax®:
Colyte ® and Miralax® are cathartics that contain polyethylene glycol as the primary ingredient, that acts as an osmotic agent. When a sweetened flavoring agent is added to these products, colonic bacteria can produce hydrogen and methane gas as a byproduct of the carbohydrate metabolism. Bloating, irritability and, in extreme cases, bowel rupture have been reported when this combination was used.
Droperidol (Inapsine®) Deleted off the Formulary:
Because of recent FDA warnings and fatal arrhythmic events associated with the use of droperidol, the Pharmacy and Therapeutics Committee voted to remove this product from the Formulary.
Considerations When Ordering and Choosing Enoxaparin (Lovenox®):
Some things to consider before ordering enoxaparin include:
minimal information on dosing and pharmacokinetics in obese patients*
no reliable dosage information for patients with renal dysfunction*
order the desired dose, avoid ordering 1 mg/kg
round doses to the nearest 10mg (pre-filled syringes are 30, 40, 60, 80, 100mg)
DVT prophylactic doses of 40mg once a day is preferred for medical, general surgery, and stroke patients.
*Consider using heparin which can be monitored with PTT in these patients.
OSF Saint Francis Medical Center Formulary Available on the Web:
The latest edition of the Hospital Formulary is now available on the Web. Improvements are still being made, but you can get at the Formulary by going to the OSF web site at www.osfhealthcare.org, under the Library and Resource section, click on ‘Pharmacist’ and then click on ‘Formulary.’
Report Adverse Drug Events on the ADE Hotline – 655-6805