Approved Hospital Formulary
Add Formweb to your mobile device
Approved Hospital Formulary
03/26/20 jm Re: Antiviral Therapy for COVID-19 for ADULTS - Information for the Verifying Pharmacist
March 27, 2020
From: "Justin Muklewicz" <justin.muklewicz@hhsys.org>
To: "Pharmacists" <grp_allpharm@hhsys.org>
Cc: "Jonathan Edwards" <jonathan.edwards@hhsys.org>
Sent: Thursday, March 26, 2020 3:48:09 PM
Subject: Re: Antiviral Therapy for COVID-19 for ADULTS - Information for the Verifying Pharmacist
Attention,
Thank you all for your help as we work on this together. AMT Spectralink: x50286
Important Updates to COVID-19 Treatment Pathway for ADULTS (3/26/2020)
Please see below 3 updates for pharmacists regarding COVID-19 therapy for ADULTS. The folder for the pathway can be found here. Steps in red are required.
- EKG Monitoring with Hydroxychloroquine: Per P&T approval on 3/24/2020, pharmacy is authorized to order EKG's to monitor for potential QTc prolongation in patients that receive hydroxychloroquine. The verifying pharmacist is required to order two EKG's upon order verification and place an open daily intervention in order to follow-up on the QTc. Instructions for ordering EKG's can be found here. The pharmacist should notify the ordering prescriber if any QTc interval is > 500 msec or based on a significant increase per pharmacist's discretion.
- First EKG: 3 hours after the second hydroxychloroquine 400 mg q12h loading dose on day 2 of therapy
- Second EKG: 3 hours after the morning hydroxychloroquine 200 mg q12h maintenance dose on day 3 of therapy
- Azithromycin: azithromycin was added to the COVID-19 treatment pathway as an optional add-on therapy to hydroxychloroquine based on risk-benefit analysis. The major risk of combining these two medications is additive QT prolongation and the clinical benefit of combining these two medications remains to be determined, although one study of 6 patients suggested increased viral eradication.
- Automatic stop dates (approval per P&T on 3/24/2020):
- Pharmacists are required to place stop dates on azithromycin for a total of 5 days of therapy (azithromycin 500 mg for 1 dose, then 250 mg q24h for 4 doses) when the indication is COVID-19
- For azithromycin orders for the indication of COPD exacerbation in non-critically ill patients, the verifying pharmacist should place a stop date of 5 days
- Pharmacists are strongly encouraged to aggressively perform IV to PO conversions for azithromycin per protocol in order to conserve therapy.
- Remdesivir: As of 3/24/2020, the Compassionate Use Application for Remdesivir is in the process of changing to an expanded access program. Currently, the program is limited to severely ill patients that are pregnant or less than 18 years of age. Prescribers are encouraged to continuously monitor the website for any changes to the program.
Stay tuned for more updates! We will be updating the above folder routinely as new literature is published.