P
H A R M A G R A M 
...an educational memo from your Pharmacy and Therapeutics
Committee
February, 2007
Formulary Addition
and Denial:
Varenicline (Chantix®), a
partial nicotine agonist, was approved to the Formulary as part of a smoking
cessation plan. The unique mechanism of
action provides an alternative to currently available Formulary products (i.e.
transdermal nicotine, nicotine gum and bupropion (Zyban®) and has demonstrated
at least equal efficacy to the bupropion drug therapy.
The chewable dosage form of
levadopa/carbidopa (Sinemet®), known by the trade name Parcopa®, was denied
Formulary addition based on potential usage and cost.
Nutritional News:
Updated and revised Total Parenteral Nutrition pre-printed order
forms and protocol, reflecting current practice, were approved. The Enteral
Feeding protocol was updated.
A protein tube feeding product, Beneprotein®, available in 6 gram unit
of use packets will replace the current protein product.
Peptamen AF® was added to the Formulary as a second-line alternative
enteral feeding for immune compromised patients with malabsorption
issues.
Caution:
Promethazine IV:
Although no serious adverse events have been reported with the use
of intravenously administered promethazine (Phenergan®) at Saint Francis
Medical Center, there are new warnings that have been issued as a result of
isolated reports of severe extravasation necessitating limb amputations being
documented. If administered intravenously, the following procedure is
recommended:
Ø
Administer through a running IV.
Ø
Use a large bore needle
Ø
Use a large vein; avoid hand and wrist veins
Ø
Dilute the dose with normal saline to 10ml
Ø
Have patients report any burning or pain with the injection
Keep in mind, promethazine may be administered intramuscularly, as
well as orally, and should be avoided in children less than 2 years old.
Correction:
The ‘risk of severe hypoglycemia’ provided in the December 2006
issue of the PharmaGram for banning
exenatide (Byetta®) was incorrect. Dosing and safety concerns with product administration
and the multiple dose syringes are the reasons for this ban.
Drug Information Service – 655-2382
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