OSF Saint Francis Medical Center, Peoria, Illinois

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

June, 2002

Valganciclovir (Valcyte®), which is a pro-drug of ganciclovir (Cytovene®), is an antiviral agent used in the treatment of cytomegalovirus retinitis. Valganciclovir offers an alternative to oral and intravenous ganciclovir, with the advantage of once- or twice-daily oral administration. It appears to achieve ganciclovir levels comparable to those achieved with intravenous ganciclovir and the adverse effects are comparable to the parent drug.

Cilostazol (Pletal®) is a selective phosphodiesterase inhibitor used in the treatment of intermittent claudication. In doses of 100mg twice a day, cilostazol has shown moderate improvements in walking distance and may prove useful as an alternative to pentoxifylline (Trental®).

Advair® is a combination of fluticasone and salmeterol, which is administered twice daily as a dry powder inhaler, and is indicated for the long term maintenance therapy of asthma. The fluticasone portion is available in 100mcg, 250mcg and 500mcg strengths, and the salmeterol is fixed at 50mcg for the three fluticasone doses. Advantages include reduced cost with one inhaler and less frequent drug administrations compared to the use of separate drug inhalers.

Due to considerable processing time, the potential for lost medications and possible medication errors, the use of home medications will no longer include oral medications that are on the Hospital Formulary and are readily available within the Pharmacy.

As per Pharmacy and Therapeutics Committee approval, pharmacists will be able to substitute regular release oxybutynin for orders of oxybutynin XR. Since oxybutynin XR is available in 5mg, 10mg and 15mg dosage sizes, the same milligrams per day divided either twice or three times a day will be used.

DigiFab®, a generic version of Digibind®, will soon become available as current supplies of DigiBind® are exhausted. Digoxin Immune FAB is indicated for the treatment of patients with potentially life-threatening digoxin toxicity or overdose. Each vial of DigiFab® contains 40mg of purified digoxin-specific FAB, which will bind approximately 0.5mg of digoxin. Dosing of DigiFab® is the same as DigiBind, but will cost over $150 less per vial.

Insulin glargine is one of the newer insulin products to be approved and provides a sustained, basal level of insulin throughout the 24-hour dosing period from a single daily dose. According to the manufacturer, the best clinical response is when insulin glargine is administered at bedtime, rather than in the morning, and this is the time that was use in the clinical studies on this drug.