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
April, 2003
Different Formulations of Amoxicillin/Clavulanic Acid Cause Confusion:
The patent for Augmentin ®, which is a combination of amoxicillin and clavulanic acid, has expired and is currently available as the generic drug. In the meantime, the original manufacturer has started offering Augmentin XR ® extended-release tablets and Augmentin ES ® liquid suspension, which are patent protected. Both of these products contains more amoxicillin per dosage form and have some unique indications for use than does the generic product. It is important for the prescriber to be clear as to which amoxicillin/clavulanic acid product is being ordered. A partial list of products is provided below.
Formulations Content (mg) Comments
Amoxicillin Clavulanic Acid
Amoxicillin/Clavulanic Acid 500 125 per tablet
Amoxicillin/Clavulanic Acid 875 125 per tablet - Most commonly used for adults.
Augmentin XR® (Non- 1000 62.9 per tablet - Usual dose: 2 tabs BID. Useful against penicillin-resistant Pneumococcus.
Amoxicillin/Clavulanic Acid 400 57 per 5ml - For adults unable to take tablets.
Augmentin ES® 600 42.9 per 5ml - For children: 90mg/KG/DAY
Parenteral Prochlorperazine (Compazine®) Still Unavailable:
The parenteral form of prochlorperazine has been unavailable for the past 2 years. However, prochlorperazine tablets, liquid and suppositories can still be prescribed. Other alternative antiemetics include trimethobenzamide (Tigan®), promethazine (Phenergan®), metoclopramide (Reglan®), thiethylperazine (Torecan®) and ondansetron (Zofran®).
Kaopectate® Now Contains Salicylates; Salicylate-Free Generic on Formulary:
Kaopectate®, which now contains bismuth subsalicylate, may cause some healthcare problems by increasing the risk of Reye’s Syndrome in children, allergic reactions in patients sensitive to aspirin, or drug interactions. Kaolin-Pectin, which is the generic version, contains attapulgite and is salicylate-free. The P&T Committee has authorized using the generic product as an autosubstitution for Kaopectate®.
Be Alert for New Drug Combinations Containing Metformin (Glucophage®):
Three new combination products containing metformin are being marketed. It is important that healthcare providers are aware of these products since metformin can increase the risk of lactic acidosis in patients with renal impairment or about to undergo radiologic tests involving contrast materials. The combination products are Avandamet® (metformin/rosiglitasone), Metaglip® (metformin/glipizide) and Glucovance® (metformin/glyburide). Although these products are non-Formulary, the individual drugs are on the hospital Formulary.
Respigam® and Zometa® Non-Formulary:
Since palivizumab (Synagis®) became available, the use of RSV immune globulin (Respigam®) has been abandoned and therefore deleted from the Formulary. The P&T Committee voted not to add zoledronic acid (Zometa®), a bisphosphonic acid, to the Formulary and to allow for an autosubstitution to pamidronate (Aredia®).