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Following is a P and T Committee update (from the May 26th meeting). Starting date for specific programs is 1 June 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.
|
Drug or Drug Class |
Formulary Decision |
Comments |
| avibactam-cefTAZidime (Avycaz) | Non-formulary, not stocked. | Cost is $900/day. If ordered, contact MD for other options, refer to AMT. |
| isavuconazonium (Cresemba) | Formulary status, restricted to ID for use in immunocompromised patients for treatment of invasive fungal infection due to aspergillosis and mucormycosis or patients that have failed or cannot tolerate other possible agents. | Both IV and PO forms available, loading dose recommended, automatic IV to PO conversion per criteria by pharmacists. |
| posaconazole (Noxafil) | Removed from inpatient and hospital outpatient formulary, includes IV, suspension, and tablet. | This drug is similar to isavuconazole, which was just added to formulary. No automatic interchange for posaconazole, contact MD for alternatives. |
| Non-formulary, not stocked, dispense individual agents separately. | Both drugs are on formulary. | |
| atazanavir-cobicistat (Evotaz) | Non-formulary, not stocked, dispense individual agents separately. | Both drugs are on formulary. |
| siltuximab (Sylvant) | Non-formulary, not stocked. | IV infusion for rare disease, defer to outpatient use. |
| epoprostenol (Veletri) | Formulary status, restricted to use by several MD specialties, this is same drug as Flolan and will replace it. | Continuous IV infusion – rarely used for pulmonary hypertension. Offers preparation and stability advantages over Flolan. |
| epoprostenol (Flolan) | Non-formulary, not stocked. | Interchange to Veletri at same dose. |
| droxidopa (Northera) | Non-formulary, not stocked. | Rare use, expensive, normally provided directly to patient through specialty pharmacy, patient must use own supply, defer initiation to outpatient setting |
| theophylline (Uniphyl) | Non-formulary, not stocked. | Deleted from formulary due to no use. Interchange to Theo-24. |
| pegfilgrastim (Neulasta) | Formulary status, restricted to outpatient use. | Professional education on use of injector needed prior to use. |
| esomeprazole (NexIUM) | Formulary status, restricted to pediatrics. | Dose based on age/weight nomogram, other PPI liquids converted to this product for peds. Start date TBA. |
| DAPtomycin (Cubicin) | Formulary status changed from unrestricted to restricted to ID use for several specific criteria. | Inform non-ID physician that prescribing is limited to ID physician only, and select another alternative drug. AMT to provide follow-up. |
| alvimopan (Entereg) | Remains formulary status, restricted to EASE REMS and protocol use. | MUE showed some benefit in outcomes compared with 2009 controls, however a major weakness of results is practice standards have changed since 2009 so cannot realistically determine benefits of drug alone. |
| acetaminophen (Ofirmev) | Remains formulary status, restricted to colo-rectal surgery per protocol, and for critical care/oncology fever where alternatives are not an option. | MUE showed no difference between use of post op narcotics alone vs. narcotics plus Ofirmev for amount of opiates taken, pain scores, and ADR occurrences over 4 days post-op. |
| cefTRIAXone (Rocephin) | Remains formulary status, pediatric ER dosing standardization approved. | Weight based dosing protocol using 500 mg, 1 g or 2 g doses. Start date TBA. |
|
Prophylactic Antimicrobial Dosing and Readministration Timing Guidelines |
Guidelines for adult dosing of 15 antibiotics were approved, vancomycin and gentamicin doses are wt-based, (applies pre-op and intra-op). |
Vancomycin and gentamicin dose capped at 1,750 mg and 400 mg respectively. Start date TBA. |