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
July, 2002
Enoxaparin (Lovenox®) Now Preferred Over Dalteparin (Fragmin®) due to Manufacturer’s New Pricing- Autosubstitution Approved:
Reacting to a recent significant cost reduction, the Pharmacy and Therapeutics Committee has decided to, once again, have enoxaparin as the preferred low molecular weight heparin. As part of this decision, all orders for prophylactic doses of dalteparin will be automatically substituted by the pharmacists to once daily 40mg of enoxaparin.
Things to Consider When Prescribing Enoxaparin (Lovenox®):
DVT prophylactic doses of 40mg once a day is preferred for medical, general surgery, and stroke patients. Patients at high risk or undergoing total knee surgery may require enoxaparin 30mg every 12 hours.
minimal information on dosing and pharmacokinetics in obese (greater than 150 KG) patients*
no reliable dosage information for patients with renal dysfunction*
prophylactic use: usual dose is 40mg SC once daily
DVT therapy: see www.tagpeoria.org for orders. Avoid only writing 1 mg/kg, include total dose.
round doses to the nearest 10mg (pre-filled syringes are 30, 40, 60, 80, 100mg)
*Consider using unfractionated heparin, which can be monitored with PTT in these patients.
Formulary Additions:
Brimonidine (Alphagan®), an ophthalmic solution with alpha-adrenergic agonist activity and indicated for the treatment of open-angle glaucoma or ocular hypertension.
Tenofovir (Viread®), a reverse transcriptase inhibitor used to treat HIV infections. Due to the anticipated low usage of this particular agent, it may not be immediately available from the inpatient pharmacy.
Bosentan (Tracleer®), an oral endothelin receptor antagonist indicated for treatment of pulmonary arterial hypertension and a potential alternative for epoprostenolol (Flolan®). Ordering of this product is patient specific and the manufacturer must be contacted prior to prescribing.
Isotretinoin (Accutane®) Being Considered for Non-Formulary Status:
Consideration is being made for removing isotretinoin from the Formulary due to new FDA requirements and restrictions to prescribing, potential confusion with another trans-retinoic acid product tretinoin (Vesanoid®) and the low usage within the hospital. The P&T Committee invites open comments about this issue until August 2, 2002.
Raloxifene (Evista ®) Not Added to the Formulary:
Continuation of raloxifene, which is currently indicated for the treatment or prevention of osteoporosis in postmenopausal women, is not viewed as being clinically necessary during an acute hospitalization. The use of raloxifene has been associated with thromboembolic events if it is not held several days prior to surgery and/or during immobility. The P&T Committee voted to deny formulary status for raloxifene based on this information.
Metoprolol, Enalaprilat and Lidocaine Intravenous Products Made Non-Overrideable
To ensure that a pharmacist reviews all drug orders for prescribing accuracy, intravenous metoprolol, enalaprilat and lidocaine will now be non-overrideable in the SureMed machines. Lidocaine for emergency use will still be immediately available on the emergency code carts.
Report Adverse Drug Events on the ADE Hotline – 655-6805