Approved Hospital Formulary
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Approved Hospital Formulary
P & T Update Memo March 2018
Following is a P and T Committee update (from the March 27th meeting). Starting date for specific programs is 2 April 2018, 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 |
| delafloxacin (Baxdela) | Non-Formulary | Antimicrobial activity is similar to other respiratory fluoroquinolones with the addition of MRSA coverage. Prescribers will be contacted to discuss alternative therapies. |
| zoster vaccine recombinant, adjuvanted (Shingrix) | Formulary, Restricted | The Advisory Committee on Immunization Practices (ACIP) recognizes Shingrix as the preferred vaccine for the prevention of shingles. Shingrix use is restricted to outpatient use (i.e. Employee Health, hospital associated clinics, and outpatient medical department). Implementation date to be announced. |
| zoster vaccine live (Zostavax) | Reclassified as Non-Formulary | Shingrix is recommended for adults who previously received the Zostavax vaccine. Implementation date to be announced as Shingrix is procured and distributed. |
| dolutegravir-rilpivirine (Juluca) |
Non-Formulary Automatic Interchange Approved |
Individual components will be dispensed separately. |
| insulin aspart (Fiasp) |
Non-Formulary Automatic Interchange Approved |
Pen formulation. Interchange to insulin lispro injections at a 1:1 unit ratio. |
| exenatide (Bydureon BCise) extended-release | Non-Formulary | A month-supply pen formulation. |
| betrixaban (Bevyxxa) |
Non-Formulary Therapeutic Interchange Approved |
Interchange to prophylactic enoxaparin regimens with renal adjustments as necessary. |
| Odactra Allergen Extracts | Non-Formulary | Inpatients may use own supply. |
| Oral Contraceptive/Hormone Replacement Update | Formulary Products Restricted to Non-Contraceptive Indications | Oral contraceptives will not be dispensed by Huntsville Hospital Pharmacy for contraceptive purposes for inpatients. Patients should continue to use their home supply. Selected combinations of hormones in varying levels of potency were approved for use in non-contraceptive indications. |
| sugammadex (Bridion) Update | Information supplied on MUE results and pharmacoeconomics - Remains Formulary, Restricted | Efforts are being made to reduce the market share of sugammadex use to ~15% in relation to the neostigmine/atropine combination for reversal of paralytics in the surgical setting. |
| Rapid Response Order Set | Order Set Approved | Multidisciplinary order set includes actions in several urgent situations, and includes CPR, airway, oxygen, drugs, antidotes, IV fluids, and monitoring as applicable. The order set will be activated for use once it clears all committees. |
| IVIG Dosing Utilizing Ideal/Adjusted Body Weight | Automatic Dosage Adjustments Approved | For adult inpatients only, the IVIG order set was updated to use either ideal body weight or adjusted body weight depending on the patient’s weight. This dosing is supported by the literature and should result in cost reductions. Outpatient dosing will be evaluated in the future. |
| acetaminophen Total Dose with Multimodal Analgesia | Policy Update Approved | In patients prescribed multiple acetaminophen containing products with an order for scheduled acetaminophen, the pharmacist may adjust the dose or discontinue the acetaminophen (non-combination product) if the total acetaminophen dose exceeds or is likely to exceed the recommended total daily dose limit for that specific patient. A note should be left on the chart informing the MD of dose changes. |
| Chemotherapy Prescribing, Verification, and Dose Rounding Policy | Policy Updates Approved | This policy covers general points and applies to multidisciplinary personnel. |
| Use of Prefilled Saline Flushes for Drug Reconstitution – Risk Assessment | Determined to be Low Risk | During the shortage of IVPB and sterile water/saline for injection vials (10 and 20 mL), the risk of the using of pre-filled saline flushes for drug reconstitution was outweighed by the benefits of being able to reconstitute and administer important drugs (i.e. IV antibiotics) via the IV push route. This risks associated with practice can be mitigated by education and diligent follow-up until the shortage resolves. |