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
October, 2003
Ondansetron (Zofran®)-FDA Approved Dosing Not Reflected in Prescribing Practices:
It is not unusual to see ondansetron ordered as ‘every 4 to 6 hours PRN.’ Over the past year the increased use of this drug along with this way of prescribing for non-chemotherapy related nausea and vomiting is projected to cost the hospital about $800,000 for fiscal year 2003. Current literature does not support greater efficacy above 8 mg within a 24 hour period. The FDA approved prescribing of ondansetron for post-operative nausea and vomiting as stated in the product package insert is reprinted here for your consideration.
Prevention of Postoperative Nausea and Vomiting: The recommended I.V. dosage
of ZOFRAN ® for adults is 4 mg undiluted administered intravenously in not less
than 30 seconds, preferably over 2 to 5 minutes, immediately before induction
of anesthesia, or postoperatively if the patient experiences nausea and/or
vomiting occurring shortly after surgery. Alternatively, 4 mg undiluted may be
administered intramuscularly as a single injection for adults. While
recommended as a fixed dose for patients weighing more than 40 kg, few patients
above 80 kg have been studied. In patients who do not achieve adequate control
of postoperative nausea and vomiting following a single, prophylactic,
preinduction, I.V. dose of ondansetron 4 mg, administration of a second I.V.
dose of 4 mg ondansetron postoperatively does not provide additional control of
nausea and vomiting.
Formulary Additions:
The following drugs were added to the Formulary:
Tolterodine LA (Detrol LA) is a long-acting muscarinic receptor antagonist used for an overactive bladder
in treating urinary urgency, frequency and urge incontinence.
Divalproex ER (Depakote ER) is approved for the prophylactic treatment of migraine headaches.
Prescribers are reminded to add the suffix ‘ER” when ordering this drug to avoid confusion with
regular-release divalproex which is commonly used for seizure control.
Bicalutamide (Casodex®) is approved for the treatment of advanced prostate cancer in combination with
lutenizing-releasing hormone analogue therapy. The once-daily-dosing was viewed as an advantage
of this product over flutamide (Eulexin®).
Autosubstitution of Oral Erythromycin to Ethyl Succinate Approved for Adults:
In order to reduce the duplication of oral erythromycin products on the Formulary, the Pharmacy and Therapeutics Committee approved the autosubstitution of all oral forms of erythromycin to the ethyl succinate salt form. Erythromycin estolate will remain available for children with pertussis infections. Approval of this erythromycin autosubstitution for pediatrics is pending approval from Children’s Hospital.
Topical Ethyl Chloride Spray Deleted from the Formulary:
Due to environmental concerns, the topical refrigerant, ethyl chloride spray, was removed from the Formulary. Fluori-Methane ® spray is still available on Formulary.
Parenteral Erythromycin Shortage:
A nationwide shortage of parenteral erythromycin is anticipated to last through October 2003. An alternative parenteral macrolide antibiotic is azithromycin (Zithromax ®).
Avoid Unsafe Prescription Writing Habits:
1. Abbreviation of medication name – Write out the name 2. “U” for units – Write out “units”
3.”µg” for micrograms – Use “mcg” or micrograms 4. Q.D. – Use daily or q24hrs
5. Q.O.D. – Write out every other day or use q48hrs 6. .5 (no leading zero) – Should be 0.5
7. 5.0 (trailing zero) – Should be 5 8. SC or SQ – Use “subq” or subcutaneous
9. ‘cc” – Use mls 10. AU, AS, AD – Write out ‘both ears,’ ‘left ear,’ ‘right ear
11. <, >, ≤, ≥ - Write out “less than,” greater than,’ ‘less than or equal to,’ ‘greater than or equal to’