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Following is a P and T Committee update (from the May 23rd meeting). Starting date for specific programs is 29 May 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 |
| insulin inhaled (Afrezza) | Non-Formulary Therapeutic Interchange Approved |
Convert to insulin lispro subcutaneous injection at a 1:1 unit ratio at the same ordered interval. |
| cholera vaccine, live (Vaxchora) | Non-Formulary | Vaccination should be deferred until after discharge. |
| obiltoxaximab (Anthim) | Formulary, Restricted Not Routinely Stocked |
Restricted to confirmed B. anthracis exposure or necessary prophylaxis per CDC criteria. |
| morphine (Arymo ER) | Non-Formulary Therapeutic Interchange Approved |
Interchange to MS Contin BID or TID based on patient specific dosing on a 1:1 mg ratio at the same dosing interval. |
| oxyCODONE-naltrexone (Troxyca XR) | Non-Formulary Therapeutic Interchange Approved |
Interchange to oxycodone ER (without naltrexone) at an equivalent total daily dose. |
| HYDROcodone (Vantrela XR) | Non-Formulary Therapeutic Interchange Approved |
Interchange to MS Contin BID or TID at an equivalent total daily dose. |
| oxyMORphone (Opana) Interchange Update | Remains Non-Formulary Therapeutic Interchange Updated |
Updated interchange to oxycodone ER or IR. Previously interchanged to morphine ER and IR. |
|
|
Non-Formulary | Defer initiation until after discharge. Patient’s may use their home supply. |
| dapagliflozin-sAXagliptin (Qtern) | Non-Formulary Interchange Approved |
Dispense each component separately. |
| aspirin-omeprazole (Yosprala) | Non-Formulary Therapeutic Interchange Approved |
Dispense as aspirin EC and pantoprazole at an equivalent dose. Omeprazole would be dispensed if specified as no substitution. |
| bupivacaine liposome (Exparel) Update | Approved Physicians Clarified | Updated for Dr. Golzarian to use as pilot use. |
| Acute Agitation Order Set Pilot | Pilot Approved for General Medicine/Surgery Units (Non-ICU Only) |
Pilot planned on a few medical units, and additional committee review; implementation date to be announced. |
|
|
New Protocol Approved |
Addresses administration in outpatient medical department. Implementation pending additional committee review and DocuShare posting process. |
| Tube Feed Formulary Update |
Pulmocare – Non-Formulary
|
Oxepa and Pulmocare were removed from formulary due to lack of evidence supporting specialized formulations. Vital HP is a 1 kcal/mL formulation with high protein that may be beneficial in patients with alternative calorie sources (i.e. propofol). |
| Tube Feed Residuals Policy Update | Hold Tube Feeds if Residuals > 500 mL | >250 mL hold requirement no longer in effect. ASPEN guidelines have been updated to no longer check TF residuals or hold TFs at any residual levels. Future plans include reevaluation and possible removal of routine residuals checks for patients on enteral nutrition at HH. |