P H A R M A G R A M

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

February, 2006

Formulary Deletions, Denials, Autosubstitution:

Etidronate (Didronel®) – very rare usage and injection was discontinued by the manufacturer.

Pimozide (Orap®) – very rare usage

Praziquantel (Biltricide®) – very rare usage

Dextran-1 (Promit®) – discontinued by the manufacturer.

Theophylline IV – discontinued by the manufacturer. (Aminophylline IV is on the Formulary)

Rifaximin (Xifaxan®) – denied Formulary addition

Tobramycin inhaled solution (TOBI®) – denied Formulary addition. Injectable product is currently used.

Albuterol sustained-release tablets will be substituted with an equivalent dose of the regular-release tablets.

Pharmacist Review Required for Therapeutic Use of Dietary Products:

Table salt, meat tenderizer, molasses, and mayonnaise are dietary products that have been ‘prescribed’ for therapeutic uses within the hospital. The Pharmacy and Therapeutics Committee has authorized Pharmacy to review all of these requests in order to assure that they are being used safely. The prescriber will be contacted by the pharmacist for any questionable orders.

Patient Use of Investigational Drugs:

The P&T Committee has revised the hospital policy on investigational drugs to include information on study protocols not approved by the Peoria-area Investigational Review Board (IRB). In this situation, the ordering physician must ensure the study is approved by an IRB within the United States and the drug, product information, study protocol, IRB approval letter and patient’s informed consent are made available.

Dose Adjustments May Be Required When Changing Between Oral and IV:

Because of bioavailability issues and extensive metabolism of orally administered drugs, some doses of medications may require significant changes when alternating between IV and oral administration. Listed below are drugs and usual, single, (adult) doses recommended based on the route of administration.

.

DRUG ORAL DOSE IV DOSE

Enalapril (Vasotec®)                           5 - 40 mg                                 1.25 – 5 mg

Diltiazem (Cardizem®)                       30 – 90 mg                              20 mg

HYDROmorphone (Dilaudid®)           2 – 4 mg                                  0.4 – 0.8 mg

Labetalol (Normodyne®)                    100 – 400 mg                          0.25 – 0.5 mg/kg

Levothyroxine (Synthroid®)               100 mcg                                  50 mcg

Metoprolol (Lopressor®)                     50 – 100 mg                            5 – 20 mg

Morphine                                             5 – 30 mg                                2 – 10 mg

NiCARdipine (Cardene®)                   20 – 40 mg                              0.5 – 2.2 mg/hour

Propranolol (Inderal®)                        10 – 40 mg                              1 – 3 mg

Verapamil (Calan®)                            80 – 120 mg                            5 – 10 mg       

.   

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.osfhealthcare.org/druginfo.asp