Additions
to Web Site (Date added)
Please call Marshall Pierce at 804/764/6307 and leave a
message if you see anything that
needs to be changed or updated.
Arixtra 12/06,
Dosing Chart
explanation,
Therapeutic Dosing Chart Based on
Dosing Weight and Creatinine Clearance,
Therapeutic Dosing Based
on Levels,
Prophylaxis Dosing Chart Based on Dosing Weight,
Prophylaxis Dosing Chart Base on Levels,
Fondaparinux Pharmacokinetic Monitoring Form, &
Arixtra Dosing Calculator and Data Fitting For Mid Point Levels
Arixtra levels may now be ordered. The reference lab
runs the assay M-F, turn around time may be several days. When
ordering include a reminder to send a manual form since the test can
not be ordered in SMS. The specimen required is to be drawn in a Blue
top-citrated plasma collection tube. 7/07
Vancomycin Pharmacokinetic Dosing: Analysis of Patient Data &
Optimization of Kinetic Parameters Changes to
program were installed 7/3/07.
Gadolinium Contrast Agents FDA
warnings and articles
Infasurf Dosing (6/07)
Ceftriaxone Safety
Warning for Neonates (Letter
from company,
PI
5/07)
Cetriaxone should not be administered concurrently
with calcium-containing solutions or products in newborns because of
the risk of precipitation. Calcium containing solutions or products
must not be administered within 48 hours of the last administration of ceftriaxone.
ASHP clarification
P&T/MEC allow Chemotherapy,
monoclonal antibodies, and IVIG orders to be rounded up or down by 5% to
the nearest vial size(s) to minimize wastage.
Epoetin/Darbepoetin (7/07)
CMS has determined that there is sufficient evidence
to conclude that erythropoiesis stimulating agent (ESA) treatment is
not reasonable and necessary for beneficiaries with certain
clinical conditions, either because of a deleterious effect of the ESA
on their underlying disease or because the underlying disease increases
their risk of adverse effects related to ESA use. These conditions
include:
- any anemia in
cancer or cancer treatment patients due to folate deficiency, B-12
deficiency, iron deficiency, hemolysis, bleeding, or bone marrow
fibrosis;
- the anemia
associated with the treatment of acute and chronic myelogenous
leukemias (CML, AML), or erythroid cancers;
- the anemia of
cancer not related to cancer treatment;
- any anemia
associated only with radiotherapy;
- prophylactic use
to prevent chemotherapy-induced anemia;
- prophylactic use
to reduce tumor hypoxia;
- patients with
erythropoietin-type resistance due to neutralizing antibodies; and
- anemia due to
cancer treatment if patients have uncontrolled hypertension.
CMS have also determined that ESA treatment for the
anemia secondary to myelosuppressive anticancer chemotherapy in solid
tumors, multiple myeloma, lymphoma and lymphocytic leukemia is only
reasonable and necessary under the following specified conditions:
- The hemoglobin level immediately prior to
initiation or maintenance of ESA treatment is < 10 g/dL (or the
hematocrit is < 30%).
- The starting dose for ESA treatment is the
recommended FDA label starting dose, no more than 150 U/kg/three
times weekly for epoetin and 2.25 mcg/kg/weekly for darbepoetin
alpha. Equivalent doses may be given over other approved time
periods.
- Maintenance of ESA therapy is the starting dose if
the hemoglobin level remains below 10 g/dL (or hematocrit is < 30%) 4
weeks after initiation of therapy and the rise in hemoglobin is >
1g/dL (hematocrit > 3%).
- For patients whose hemoglobin rises <1 g/dl (hematocrit
rise <3%) compared to pretreatment baseline over 4 weeks of treatment
and whose hemoglobin level remains <10 g/dL after the 4 weeks of
treatment (or the hematocrit is <30%), the recommended FDA label
starting dose may be increased once by 25%. Continued use of the drug
is not reasonable and necessary if the hemoglobin rises <1 g/dl (hematocrit
rise <3 %) compared to pretreatment baseline by 8 weeks of treatment.
- Continued administration of the drug is not
reasonable and necessary if there is a rapid rise in hemoglobin > 1
g/dl (hematocrit > 3%) over 2 weeks of treatment unless the
hemoglobin remains below or subsequently falls to < 10 g/dL (or the
hematocrit is < 30%). Continuation and reinstitution of ESA therapy
must include a dose reduction of 25% from the previously administered
dose.
- ESA treatment duration for each course of
chemotherapy includes the 8 weeks following the final dose of
myelosuppressive chemotherapy in a chemotherapy regimen.
The Following are awaiting MEC approval
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