Following is a P and T Committee update (from the February 24^th meeting). Starting date for specific programs is 2 March 2015, 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. 

riociguat (Adempas) – This is a new oral drug approved to treat pulmonary arterial hypertension (PAH) and dosed 0.5 – 2.5 mg tid. It is category X pregnancy rating and has a restrictive REMS involving physician certification to prescribe, female patient registration, female compliance with contraceptive requirements, pharmacy certification, and pharmacist dispensing only for certified physicians.  This drug costs about $300 / day.   It was classified as non-formulary,  not stocked, and initiation should be deferred to the outpatient setting.  For hospital use, the patient should use their own drug supply. 

crofelemer (Fulyzaq) – This drug is an anti-diarrheal indicated for the symptomatic relief of non-infectious diarrhea in adults with HIV / AIDS on anti-retroviral therapy. The normal dose is 125 mg orally bid, and the cost is about $10 / day.  This drug acts pharmacologically in the GI tract and is not systemically absorbed.  Rare inpatient use is expected.  It was classified as a non-formulary, not stocked agent.  If needed, the patient should use their own supply, and initiation should be started in the outpatient setting.

Xartemis XR - This is a combination of oxyCODONE 7.5 mg and acetaminophen 325 mg extended release, dosed 2 tablets q 12 hrs, for pain control requiring opiates. It was classified as a non-formulary drug, not stocked,  and should be interchanged to Percocet 7.5 mg /acetaminophen 325 mg dosed as 1 tablet q 6 hrs.

Hysingla ER - This is HYDROcodone alone in an extended release tablet, dosed one tablet q 24 hrs, for patients requiring opiates for chronic pain control. It is formulated in an abuse-deterrent dosage form, is available in 7 different strengths, and costs from $6 to $32 / day depending on dosage.  This agent is similar to Zohydro ER, which just recently came out in an abuse-deterrent dosage form.  Hysingla ER was classified as non-formulary, not stocked, and should be interchanged to a nearly equivalent dose of morphine sulfate extended release tablets.

idelalisib (Zydelig) – This new oral drug is approved to treat relapsed CLL, relapsed follicular B-cell non-Hodgkin’s Lymphoma, and relapsed small lymphocytic lymphoma, and is dosed 100 – 150 mg bid. Several diseases, conditions, and drug interactions  prompt a dose reduction or discontinuation, and there is a black box warning involving several adverse effects.  The cost is about $240/day.  Rare inpatient use is expected.  It was classified as non-formulary, not stocked, initiation should be deferred to the outpatient setting, the patient should use their own supply in the hospital.

Natesto Gel - This is a testosterone gel that is applied to the nasal membranes, and an applicator system is used to transfer the gel from the container to the nasal wall. The dose is 11 mg (1 accuation to each nostril) tid, for a total of 33 mg /day.  The pump is a 10-day supply.  Natesto gel was classified as non-formulary, not stocked, with an interchange to Androgel 50 mg unit-dose packet applied topically once daily. 

Vogelxo – This is a new testosterone topical gel that is available in unit dose packets, a tube, and a pump dispenser. The recommended dose is 50 – 100 mg once daily.  It was classified as non-formulary, not stocked, with interchange of all 3 dosage forms to Androgel packets, with dosage on a 1 mg:1 mg conversion ratio. 

Invokamet - This is a combination of metFORMIN and canagliflozin, is available in 4 different strengths, and is dosed once daily. Both drugs are on the formulary separately.  Invokamet was classified as non-formulary, not stocked, and the individual drugs should be dispensed in its place in the same daily dose, with canagliflozin and metformin ER being dosed once daily.

Vancomycin in Hemodialysis MUE – The main objective of this project was to standardize the dosing and monitoring of vancomycin in hemodialysis (HD) patients. This prospective pilot involved comparing baseline data (n=20) compared to post-intervention (with protocol use, n = 8 ) data.   The following measurements increased with protocol use:  appropriate maintenance doses, vancomycin dosing adjustments post-level, total number of levels, and number of patients with at least one level.  Based on the results, plans are to adopt the pilot guidelines for dosing and monitoring of vancomycin in HD patients at the hospital.

Vesicant Drug Extravasation – Update – There is a national shortage of phentolamine injection, and the only manufacturer has discontinued producing the product, with no other supplier anticipated in the near future. Therefore, it was approved to change the extravasation order set antidote from phentolamine 5 mg to terbutaline 1 mg subcutaneously around the periphery of the involved area.   There is no repeat dose included for terbutaline, as there was with phenolamine if needed.

ADR Report – There were 86 ADRs reported in Nov / Dec, with vancomycin and levofloxacin involved with 19 of these reports.  Six of the reactions were classified as preventable, with warfarin and narcotics accounting for four cases.  Causes of 4 of the preventable ADRs were documented allergy/reaction, and excessive dosing.