OSF Saint Francis Medical Center, Peoria, Illinois

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

November, 2002

The only manufacturer of hyaluronidase (Wydase®) discontinued production several months ago. Because this product plays an important role in the treatment of certain types of extravasations, the Pharmacy will now prepare and currently has in stock, hyaluronidase 150 units/ml for injection. The approved use for this hyaluronidase product will be limited to the treatment of extravasations involving selected chemotherapeutic agents, calcium chloride, calcium gluconate, dextrose (10% or greater), parenteral nutrition (TPN,PPN), phenytoin (Dilantin®), potassium (bolus or infusion), sodium bicarbonate, mannitol, acyclovir (Zovirax®), chloramphenicol, gentamicin, nafcillin, penicillin, vancomycin and aminophylline. Please refer to the Drug Administration Policy for administration procedures.

The following pharmaceuticals were added to the hospital Formulary:

Nateglinide (Starlix®) – is a novel nonsulfonylurea oral antidiabetic agent indicated for treatment of patients with Type 2 diabetes. Nateglinide is rapidly absorbed and is administered 1 to 30 minutes before meals and may be used in combination with metformin.

Alemtuzumab (Campath®) – is indicated for the treatment of B-cell chronic lymphocytic leukemia in-patients who have been treated with alkylating agents and who have failed fludarabine therapy. This item will not normally be stocked in the Pharmacy until requested for use.

Voriconazole (Vfend®) – is indicated for the treatment of invasive aspergillosis and other serious fungal infections which are refractory to other therapies. Voriconazole is available in parenteral and oral tablet formulations. The intravenous administration is contraindicated in patients with creatinine clearances of 50 ml/min or less. There are many drug/drug interactions to be considered, including ones involving the P450 liver enzyme system. Voriconazole is more costly than fluconazole (Diflucan®), but offers a significant cost advantage over amphotericin B lipid complex (Abelcet®). All orders for voriconazole will have a concurrent utilization review by Infectious Disease and Pharmacy Services.

Like alendronate (Fosamax®), risedronate must be taken with 6-8 ounces of water and the patient should remain in an upright position for at least 30 minutes after the dose to reduce the risk for esophagitis, esophageal erosion or ulcers. Since most hospitalized patients cannot comply with this administration procedure and missing doses of this medication during hospitalization is unlikely to cause harm, risedronate was not added to the Formulary and all prescribing and dispensing, including the use of the home medication, is prohibited. Calcitonin (Miacalcin) may be considered as an alternative to risedronate and alendronate if clinically necessary.

Based on the lack of clinical trials showing an advantage of torsemide over the approved Formulary loop diuretics (furosemide (Lasix® and bumetanide (Bumex®) and the significant cost, the P&T Committee denied adding torsemide to the Formulary.

A pharmacy-compounded oral liquid formulation for pantoprazole is now available and will be used in place of omeprazole oral suspension in adult patients unable to take the oral tablets.