Discussion
The Committee was presented with a request to add lansoprazole oral disintegrating
tablet (Prevacid Solu-Tab) to the formulary for Pediatrics. Lansoprazole is
currently the only proton pump inhibitor with extensive pediatric dosing guidelines.
Pediatric dosage forms of granules and extemporaneously prepared solutions have
been less than desirable. The oral disintegrating tablet can be dissolved in
a fixed amount of water and provides for aliquot small doses. However, the carbohydrate
content of the oral disintegrating tablet is quite high due to the excipients
to make the product palatable. Omeprazole suspension will still be available
for ketogenic diet patients only.
The Committee approved the addition of lansoprazole oral disintegrating tablets
(Prevacid Solu-Tab) for Pediatrics only. This restriction will be added to the
pediatric POE dictionary. Omeprazole suspension will be restricted to ketogenic
diet patients only. Esomeprazole will continue to be available for all appropriate
patients.
The discussion continued regarding the possible conversion to one exclusive proton pump inhibitors for all patient populations to streamline the Formulary. It is generally agreed upon that all proton pump inhibitors are equally efficacious.
Discussion
The Committee was presented with the request to add azacitidine injection (Vidaza)
to the Formulary. Azacitidine is an effective treatment for patients with myelodysplastic
syndrome (MDS). It has been approved for use for all MDS subtypes. In clinical
trials, azacitidine treatment results in significantly higher response rates,
improved quality of life, reduced risk of leukemic transformation and improved
survival compared with supportive care. The Committee approved the azacitidine-subcutaneous
protocol submission with no suggested revisions.
The Committee approved the addition
of azacitidine injection (Vidaza) to the Formulary with the following restriction:
myelodysplastic syndrome (MDS) use only. This restriction will be added to the
POE dictionary with a chemo restriction.
Discussion
The Committee was presented with the request to add cetirizine liquid (Zyrtec)
to the Formulary for pediatric use. Cetirizine has been shown to be effective
in relieving symptoms associated with seasonal allergic rhinitis, perennial
allergic rhinitis (year-round allergies), and chronic urticaria in children
as young as 6 months of age. We currently carry fexofenadine (Allegra), which
has no package insert dosing for patients less than 6 years of age and is not
available in a pediatric formulation. There have been numerous requests for
medications for patients under 6 years of age. The Committee discussed the feasibility
of one exclusive non-sedating antihistamine on formulary for all age groups.
Loratadine appears to be the only drug with the next broadest dosing and packaging
for pediatrics and adults. The side effect profile of loratadine is favorable
in comparison to other non-sedating antihistamines, particularly in adults.
Loratadine has dosing information to 2 years of age. The Committee asked the
Pharmacy to pursue this option but will approve the addition of cetirizine in
the interim.
The Committee approved cetirizine liquid (Zyrtec) with the following restriction: Pediatric (<6 years) use only.
Discussion
The Committee was presented with a request to add diphtheria and tetanus toxoids
and acellular pertussis adsorbed, hepatitis B (Recomb) and inactivated poliovirus
vaccine combined (Pediarix). Pediatricians currently obtain the product from
the state free of charge, under the mandated vaccination programs. Without having
the product on Formulary, test codes and administration fees cannot be billed
properly. The state supply product will be added to the Formulary inventory.
The Committee approved the addition of diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B (recomb) and inactivated poliovirus vaccine (Pediarix).
Discussion
A proposal was presented to have ampicillin/sulbactam, cefepime, ceftazidime,
and levofloxacin (IV) available for first doses in the Emergency Department
without requiring Infectious Disease (ID) approval. Members of the ID Division
have agreed to allow the ED to have the above-listed "first doses"
of medications without ID approval. This change will allow patients with pneumonia
and acute life threatening infections to receive their antibiotics in a more
timely fashion.
The Committee approved the ED First
Dose proposal.
Discussion
The Committee was presented with the Pharmacy Suggested Dose Instructions in
the Provider Order Entry ordering system for celecoxib (Celebrex): "The
Drug Therapy Committee recommends that the use of COX-2 agents is not recommended
over other NSAIDs unless the patient is at high risk of gastric ulceration based
on Aramis Rating. COX-2 agents should be used with caution and introduced at
the lowest dose to achieve efficacy and shortest possible duration and should
be avoided in patients with pre-existing renal, cardiovascular or thromboembolic
disease. Use in patients with concomitant low-dose aspirin may negate GI benefit
as well as the cardio-protective effects of aspirin."
The Committee approved these instructions with no revisions and agreed that all COX 2 inhibitors should have these warnings.
Discussion
The Committee was presented with the Pharmacy Suggested Dose Instructions in
the Provider Order Entry ordering system for eplerenone (Inspra): "Eplerenone
is restricted to those patients who have a documented intolerance to spironolactone
therapy. Questions should be referred to the Unit Pharmacist."
The Committee approved these instructions with no revisions.
Discussion
The Committee was presented with the Pharmacy Suggested Dose Instructions in
the Provider Order Entry Ordering system for nesiritide injection. "The
use of this drug is restricted to patients who are on the Heart Transplant List
and have failed standard therapy. Use requires approval by an attending physician
in the Heart Failure Group."
The Committee approved these instructions
with no revisions.