P H A R M A G R A M                   an educational memo from your Pharmacy and Therapeutics Committee

February, 2008

Pipeillinrac/Tazobactam (Zosyn®) Dose Auto-Substitution Eliminated:

The effectiveness of beta-lactam antibiotics can be improved when the drug is administered more frequently to prolong the time of the drug level being above the minimum inhibitory concentration. Therefore, the dose auto-substitution of piperacillin/tazobactam will be discontinued and doses such as 3.375gm every 6 hrs will not be changed to 4.5gm every 8 hrs.

Cefotetan (Cefotan®) is Back;
Substitution for Cefoxitin in Adults Approved:

Cefotetan, a second-generation cephalosporin with anaerobic coverage, is now being manufactured again. Because of the twice daily dosing, cefotetan has been placed back on the Formulary and will substituted for all cefoxitin (Mefoxin®) orders  in adult patients.

ValACYLOvir (ValTREX®) Added to the Formulary; Auto-Substitution to Acyclovir Revised:

ValACYCLOvir, an oral antiviral agent, has been added to the Formulary. This addition was made because the Pharmacy encountered difficulty substituting acyclovir for high doses of valACYCLOvir when used for certain indications (ex. CMV prophylaxis in transplant patients, treatment of herpes zoster, etc.). ValACYCLOvir orders on OB/GYN patients will be substituted to acyclovir 400mg TID, when appropriate.
IMPORTANT- SOUND-ALIKE/LOOK-ALIKE DRUGS:
ValACYCLOvir (ValTREX®) and ValGANciclovir (ValCYTE®)

Formulary Deletions:

The following drugs have been deleted from the Formulary:
Itraconazole IV (Sporonox ®), Ultralente insulin, interferon alfa-   2a (Roferon-A®) – discontinued by the manufacturer.
Opium and Belladonna Suppos – No current supplier/low use.
Phenol 80% - low use/high risk drug.
Meningococcal (unconjugated) Menomune® - Alternative meningococcal (conjugated) (Menactra®) available.

Autosubstitution for Generic (Modified) Cyclosporine Products:

(Modified) cyclosporine (Gengraf®) will be dispensed for patients who are taking a generic cyclosporine at home, but their home medication is unavailable.

Sound-Alike/Look-Alike Drugs (SALAD):

HYDROmorphone (Dilaudid®)        MorPHINE
HydrOXYzine (Atarax®)                HydrALAzine (Apresoline®)                       
NovoLIN R or NovoLIN N               NovoLOG
MetFORMIN (Glucophage®)          MetronidAZOLE (Flagyl®)
OxyCONtin (Controlled release)      OxycoDONE (immediate rel)
CeleBREX® (Celecoxib)                CeLEXA (Citalopram)
CloniDINE (Catapres®)                  KlonOPIN® (Clonazepam)
ToPAMAX® (Topiramate)              ToPROL XL (Metoprolol)
TraMADOL (Ultram®)                    TraZODONE (Desyrel®)
Heparin 10 units/ml                        Heparin 10,000 units/ml