FormWeb • P & T Update Memo September 2017

Huntsville Hospital

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Medications not yet evaluated by P&T are considered NON-FORMULARY . . . . . Always check 2 unique patient identifiers - NAME and DATE OF BIRTH - at every step! . . . . . Please be sure to document all clinical activities daily.

Huntsville Hospital

Approved Hospital Formulary

Suggestions or Corrections? Above and Beyond Nominations Formulary Request

P & T Update Memo September 2017

Following is a P and T Committee update (from the September 26^th meeting). Starting date for specific programs is 2 October 2017, unless otherwise noted. Please let me know if you have any questions or comments. Don’t forget to check the “New Drug Monitoring Spotlight” section of the website, which provides important monitoring information about newly approved drugs. Also, attached is the updated version of the “Not Stocked, Not Ordered” drug list with the new additions highlighted in red.

Below is the memo with links to the drug monographs, protocols, and formulary documents. Click to access the full P&T packet for this month, or here to access the P&T packet archive.

Drug or Drug Class	Formulary Decision	Comments
deutetrabenazine (Austedo)	Non-Formulary	Inpatients should use their own supply. Defer initiation until after discharge.
brodalumab (Siliq)	Non-Formulary	Inpatients may use own supply if a dose is due during hospitalization. This is a last-resort biological option for treatment of plaque psoriasis.
treprostinil (Tyvaso)	Non-Formulary	Requires utilization of a specialized inhalation system. For inpatients, the physician should be contacted to discuss another treprostinil dosage for or alternative agent.
aminolevulinic acid topical (Ameluz)	Non-Formulary	Procedure required for administration is normally performed in outpatient clinics.
raltegravir (Isentress HD) and (Isentress)	Isentress HD: Formulary Isentress: Non-Formulary Therapeutic Interchange Approved	Orders for Isentress 400 mg BID will be automatically interchanged to Isentress HD 1,200 mg Daily.
bezlotoxumab (Zinplava)	Formulary, Restricted to GI Physicians Recommend Therapeutic Interchange	For other prescribers/specialties, pharmacist should contact the prescriber and discuss using alternative therapy (i.e. change to IVIG 400 mg/kg x 1 dose).
Carbapenem Formulary Update	meropenem, doripenem, imipenem-cilastatin – Formulary, Restricted Therapeutic Interchange Discontinued ertapenem- Unrestricted	In effect October 16, 2017: The Committee finalized approval for the restriction of anti-pseudomonal carbapenems to infectious disease, critical care (i.e. pulmonology & trauma), ED, and pediatric specialists. For pediatrics, prescribers are limited to hospitalists, critical care MDs, and oncologists. Meropenem remains formulary workhorse for antipseudomonal carbapenems. For other prescribers, the automatic therapeutic interchange to an antibiotic regimen with similar spectrum of activity was discontinued. Pharmacists should contact the prescriber to discuss an alternative antibiotic regimen.
ampicillin Shortage - Interchange	Therapeutic interchange approved for 250 mg capsule and suspension.	Separate interchange guidelines approved for adults and pediatrics.
aminocaproic acid (Amicar) Shortage	Informational	tranexamic acid can be recommended for many situations where Amicar was traditionally used. Amicar Protocol for Spinal Surgery is under review.
tranexamic acid (Cyklokapron) Update	Reclassified as Formulary	Formulary restrictions discontinued for tranexamic acid, a similar antifibrinolytic drug to Amicar.
IVIG Order Set Update	Order Set Update Approved	Includes more dosage options and more rapid administration rates and titration.
famotidine (Pepcid) Renal Dose Adjustment Update	Renal Adjustment Update Approved	Dosing adjustments updated for creatinine clearance < 50 mL/min.
Tapering and Titration Guidelines Update	Updated Guidelines Approved	See Tapering and Titration Guidelines.

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