P H A R M A G R A M    

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

 January, 2005

Levofloxacin (Levaquin ®) to Replace Gatifloxacin (Tequin®):

Based on evidence of a slight, but significant, increase in hypoglycemic events and the reduction in cost savings with gatifloxacin, the Pharmacy and Therapeutics Committee has decided to return to levofloxacin as the fluoroquinolone of choice. On Tuesday, January 4th, all current and future orders for gatifloxacin will be autosubstituted to an equivalent dose of levofloxacin. This formulary change will not change the non-Formulary status of ciprofloxacin (Cipro®).  

Revised Adult Patient-Controlled Analgesia (PCA) and Adult Epidural Orders:

Fentanyl, morphine and hydromorphone (Dilaudid®) adult PCA pre-printed orders have been consolidated onto one physician order form. Also revised has been the Adult Epidural pre-printed orders. The new form has the available premixed solutions using 250ml bags and provides a check box for bolus doses if desired. Both of these forms are now available at the SFMC Intranet site: http://hospital-standards.sfmc.intranet.osfnet.org/ .

Formulary Additions, Deletions, Denials and Autosubstitutions:

The following Drug Formulary changes were approved by the Pharmacy and Therapeutics Committee: 

Ø      Atazanavir (Reyataz®), was added for use in combination therapy for HIV treatment. Adverse effects have included diarrhea, nausea, vomiting, hyperbilirubinemia, scleral icterus, and jaundice.

Ø      Diclofenac (Voltaren®) ophthalmic solution was added because of less burning and stinging with administration and reduced cost compared to the current Formulary agent (ketorolac).

Ø      DELETIONS: Ketorolac ophthalmic solution (Acular®) and Zalcitabine (Hivid®)

Ø      Morphine extended-release (Avinza®) denied approval due to concerns for appropriateness for in-patient setting and risk of adverse events.

Ø      Emtricitabine (Emtriva®), delavirdine (Rescriptor®), and enfuvirtide (Fuzeon®) denied approval based on efficacy and low potential use in treating HIV.

Ø      Zaleplon (Sonata®) was denied approval since zolpidem (Ambien®), an equally effective and significantly less-costly hypnotic, is currently available on the Formulary. The Committee approved an autosubstitution for zaleplon 10 or 20mg doses to zolpidem 5 or 10mg, respectively.

Ø      Trimethobenzamide (Tigan®) oral capsules are only available from the manufacturer as 300mg. All orders for the 250mg dose will be autosubstituted to 300mg, maintaining the same frequency ordered.  

Incomplete HOLD Orders:

As per policy, when an order is received to ‘Hold X drug,’ it is interpreted to discontinue that medication until new orders are received. However confusion can come about when there is an order to ‘Hold the next dose’ or to ‘Change the next dose’ of a daily drug. Please consider providing clarification with these hold orders (ex. ‘…resume previous dose on XX date’ OR ‘…check with MD for subsequent doses’), to make it clear as to how to proceed with all of the subsequent doses.   

ADE (Adverse Drug Event) Hotline: 655-6805

Drug Information Service – 655-2382 (Mon-Fri; 8am – 4pm)

 

Visit the Pharmacy Website for past issues of the PharmaGram: http://library.osfsaintfrancis.org/druginfo.asp