Following is a P and T Committee update (from the May 27th meeting).  Starting date for specific programs is June 2 ^nd 2014, unless otherwise noted.  This information should soon be available in the formulary notebooks, the formulary website, and Formulary One-Source.  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.

eslicarbazepine (Aptiom) -  This drug is a new anti-epileptic agent that is thought to act through inhibition of voltage-gated sodium channels, and is approved for adjunctive therapy in the treatment of partial-onset seizures.  The dose is gradually titrated up to 800 – 1200 mg (once daily);  if CrCl < 50, the dose is reduced.  There are various adverse effects including dermatologic, hepatic and thyroid effects, hypersensitivity reactions, hyponatremia, and others.  This drug was approved for formulary status.

Antihistamine Liquid Update – cetirizine syrup is approved for pediatric use from 6 months and over;  however, loratadine syrup is approved only for children 2 years and over.  Since both are low cost generics, it was approved to change the liquid formulary interchange workhorse agent to cetirizine liquid.  This policy was also approved for adults.  Loratadine and cetirizine are very similar antihistamines, and the dosage conversion ratio is 1 mg:1 mg in pediatrics and adults. 

isosulfan blue (Lymphazurin) –  This drug is a blue dye used diagnostically in sentinel lymph node mapping procedures, with methylene blue being a less expensive alternative.  A new physician has requested to use Lymphazurin instead of methylene blue.  Literature and practice patterns at other institutions were presented in support of methylene blue use. This information will be discussed with the specific physician, and Lymphazurin use will be evaluated again at a future P and T Committee meeting.  

agalsidase beta (Fabrazyme) -  This agent is indicated to treat a rare disease called Fabry disease, which is an enzyme deficiency disease that leads to deposits of glycosphingolipids in vital tissues and resulting organ dysfunctions chronically. The drug is given by intravenous infusion every 2 weeks and can cause infusion related reactions and other ADRs. The cost for one dose is over 10 thousand dollars (depends on weight). The drug was approved for the specific patient requesting it at our site for use in the outpatient setting, with use of a protocol.

dextranomer-sodium hyaluronate (Solesta) – This is an injectable drug used to treat fecal incontinence in adults who have failed standard therapy.  It is administered in the outpatient setting, and at each treatment session, four 1 mL injections are given in the anal canal.  The treatment may be repeated in four weeks if necessary.   Each series of 4 injections cost about $6,000.  The drug was classified as non-formulary, not stocked, and this therapy should be deferred to the outpatient setting.

esomeprazole (Esomeprazole Strontium) – This is the strontium salt of of esomeprazole magnesium (Nexium), and is available in two strengths:  24.65 mg and 49.3 mg.  There is no advantage of this product over other PPIs.  It was classified as non-formulary, not stocked, with an automatic interchange to pantoprazole. 

bromocriptine (Cycloset) -  This is bromocriptine available as a 0.8 mg tablet used to treat type 2 diabetes.   The initial dose is 0.8 mg once daily, with maintenance doses ranging up to 4.8 mg daily.  Cycloset is much more expensive than generic bromocriptine 2.5 mg tablets.  Cycloset should be interchanged to the generic bromocriptine tablet in approximately equal dosage regimens (either 2.5 mg or 5 mg once daily)  The 0.8 mg dose is for initiation only, is unlikely to change blood glucose significantly in the hospital, and should be discontinued for inpatients with no replacement dose.  

avanafil (Stendra) – This is a Phosphodiesterase-5 inhibitor similar to Viagra, Levitra, and Cialis.  Therapy should be deferred to the outpatient setting.  It is classified as non-formulary, not stocked. 

Fleet Phosphosoda Enema (Pediatrics) – The Pediatric Subcommittee has approved conversion of the phosphosoda enema to the mineral oil enema.  There is a Fleet enema pediatric  product for both the phosphosoda and mineral oil enema in a 59 ml volume.  Date of conversion to be announced for pediatrics.