August Pharmagram

Formulary Approvals:

Meloxicam (Mobic®) is a non-steroidal anti-inflammatory drug with slightly less GI side effects, less costly generic available, and once daily administration.

Thyrotropin (Thyrogen®) is used by Nuclear Medicine as an adjunctive diagnostic agent in the follow-up of patients with well-differentiated thyroid cancer.

Autosubstitution Reviewed:

Imipenem/Cilastin (Primaxin®) substitution to meropenem (Merrem®) was reviewed for possible reversal and for appropriateness of dose conversion. Based on effectiveness, safety, cost and workload, the P&T Committee decided to continue the same autosubstitution, with a slight adjustment to the conversion dose used for patients with reduced renal function.

Ondansetron (Zofran®) Dose Frequency for Adults Reduced:

A re-audit of ondansetron prescribing revealed improved, but continued inappropriate dose frequency orders. 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.

Based on this re-audit, the P&T Committee approved for the autosubstitution frequency to be extended from every 8 hours to 12 hours. The automatic stop time of 48 hours was removed. This substitution does not apply to chemo- or radiotherapy induced nausea and vomiting.

Change in Floor Stock Insulins

NovoLOG ® (insulin aspart) will replace NovoLIN 70/30 ® insulin as floor stock. Besides insulin aspart, regular insulin (NovoLIN-R), NPH insulin (NovoLIN-N), and insulin glargine (Lantus®) are the other floor stock insulins.