P H A R M A G R A M
...an educational memo from your Pharmacy and Therapeutics Committee
January, 2006
Formulary Additions and Denials:
Approvals:
Aripiprazole (Abilify®), a newer ‘atypical’ antipsychotic agent. Most common side effects include headache, agitation, anxiety, insomnia, somnolence, akathisia. lightheadedness, nausea, dyspepsia, constipation, vomiting, and weight gain.
Esomeprazole (Nexium®), a proton-pump inhibitor, will be replacing pantoprazole (Protonix®) on the Formulary. Equivalent oral and parenteral dosage forms and a significantly lower cost were reasons for the decision to add esomeprazole and institute an autosubstitution for pantoprazole which will become effective around January 17th.
Denials:
Extended-release, epidural morphine (Depodur®) was denied Formulary addition based on lack of evidence of superior efficacy over currently available drugs and significant cost.
Pramlinitide (Symlin®) and exenatide (Byetta®), two newer parenteral hypoglycemia drugs, were denied Formulary approval. Although effective for maintenance of normal blood glucose in out-patients, concerns about the risk of severe hypoglycemia in the acute care setting caused the P&T Committee to decide not to allow these two drugs to be used for hospitalized patients. Other means of glucose control (ex. sliding scale insulin) should be used in place of these drugs.
Formulary Deletions:
Clofazimine (Lamprene®) and riboflavin were voted to be deleted from the Formulary due to lack of use.
Dalteparin (Fragmin®), which was restricted to Orthopedics, has been replaced with fondaparinux (Arixtra®)
Chloraseptic® throat lozenge, which contains sugar, will be deleted from the Formulary and an autosubstitution
to Cepacol®, which is sugarless, was approved
Procedural Change and New Protocol:
The 48 hour automatic discontinuation for albumin has been removed as a process for controlling usage and replaced with an alternative process of medical service specific education.
A Pediatric Patient-Controlled Analgesia protocol and order set was approved by the P&T Committee for children aged 6 and older.
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 provide 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 the subsequent doses.
ADE (Adverse Drug Event) Hotline: 655-6805
Visit the Pharmacy Website for past issues of the PharmaGram: http://library.osfhealthcare.org/Pharmacists.asp