A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

GENERIC NAME 
Daptomycin Daptomycin is restricted to microbiology proven gram-positive skin and skin structure infections resistant to vancomycin and linezolid or that have failed vancomycin/linezolid therapy, or for patients who are allergic or intolerant to vancomycin and linezolid. Infectious disease consultation is recommended.
Darbepoetin Autosubstitute with epoetin for inpatients

        An automatic substitution of epoetin using a conversion of 100 units/kg/week of epoetin for 0.45 mcg/kg/week of darbepoetin is recommend. Patients receiving darbepoetin every other week will be given weekly epoetin. Patients receiving darbepoetin every week will receive epoetin two to three times a week.

        The dosage equivalence chart in the package insert of darbepoetin (Aranesp) underestimates the potency of epoetin. Equivalent doses in studies were 1 mcg/kg/week darbepoetin = 200 units/kg/week of epoetin or 0.45 mcg/kg/week of darbepoetin = 100 units/kg/week of epoetin.

  

Dosage Equivalence

Darbepoetin mcg/week

25

40

60

100

200

Darbepoetin Cost

$88

$141

$211

$352

$704

Epoetin units/week

6,000

8,000-9,000

12,000-14,000

20,000

40,000

Epoetin Dosing Schedules

 

6,000 units 1 x/wk

3,000 units 2 x/wk

 

8,000 units 1 x/wk

4,000 units 2 x/wk

3,000 units 3 x/wk

14,000 unit 1 x/wk

6,000 units 2 x/wk

4,000 units 3 x/wk

20,000 units 1 x/wk

10,000 units 2 x/wk

7,000 units 3 x/wk

40,000 units 1 x/wk

20,000 units 2 x/wk

14,000 units 3 x/wk

Epoetin Cost

$52

$83-93

$124-143

$203

$406

Epoetin / Darbepoetin OPIC Monitoring Form 6/06

FDA Warning Against Use of Erythropoiesis Stimulating Agents in Anemia in Cancer Patients Not Receiving Chemotherapy

Desloratadine Autosubstitute with loratadine

Loratadine (Claritin) and Claritin D 12 hour (5 mg with 120 of pseudoephedrine) are the P&T recommended formulary non-sedating antihistamines with automatic substitution for desloratadine (Clarinex) fexofenadine (Allegra 30, 60, 180 mg), Allegra D (60 mg fexofenadine with 120 mg pseudoephedrine), Allegra D 24 Hour (180 mg fexofenadine and 240 mg pseudoephedrine), cetirizine (Zyrtec), and Semprex D (8 mg acrivastine with 60 mg pseudoephedrine). They will be stocked in the following dosage forms: Claritin 10 mg, Clartin D 12 hour, and as the syrup 1 mg/ml for pediatric patients.

 P&T/MEC APPROVED 11/2000, updated 3/21/07

 

Non Formulary Medication Ordered

P&T/MEC Approved Auto Substitution

Allegra 30 mg every day, 6-11 years old with renal dysfunction

Claritin 10 mg every other day

Allegra 30 mg BID, 6-11 years old

Claritin 10 mg every day

Allegra 60 mg every day, 12 years and older with renal dysfunction

Claritin 10 mg every other day

Allegra 60 mg BID, 12 years and older

Claritin 10 mg every day

Allegra 180 mg every day, 12 years and older

Claritin 10 mg every day

Allegra D one every 12 hours, 12 years and older

Claritin D one every 12 hours

Allegra D 24H every day

Claritin D one every 12 hours

 

 

Clarinex 5 mg every other day, 12 years and older: Clcr < 30 ml/min or liver impairment

Claritin 10 mg every other day

Clarinex 5 mg every day, 12 years and older

Claritin 10 mg every day

 

 

Zyrtec 2.5 mg every day, 6 months to < 2 years

Maximum dose: 2.5 mg every 12 hours

Do not substitute for patients < 2 years

Zyrtec 2.5 mg every day, 2-5 years old

Maximum 2.5 mg every 12 hours or 5 mg once daily

Claritin 5 mg every day

Zyrtec 5 mg every day, 6-11 years old: clcr < 31 ml/min, on hemodialysis or hepatically impaired

Claritin 10 mg every other day

Zyrtec 5Ė10 mg every day, 6-11 years old

Claritin 10 mg every day

Zyrtec 5 mg every day, 12 years and older: clcr < 31 ml/min, on hemodialysis or hepatically impaired

Claritin 10 mg every other day

Zyrtec 5-10 mg every day, 12 years and older

Claritin 10 mg every day

*Note Claritin dosage in renal impairment, clcr < 30 ml/min, or hepatic failure: 2-5 years old 5 mg every other day, 6 years and older 10 mg every other day.

Detemir Detemir is Non-formulary (P&T Review)
  • Patients using detemir at home will be asked to continue their own supply when possible.
  • Dosage conversion is unit for unit for Lantus and NPH (same total daily dose)
  • Physicians will be asked to use NPH twice daily or Lantus daily for patients being initiated on Detemir as
    • Detemirís duration of action is dose dependent, doses less than 0.4 units/kg do not allow for once daily dosing (see graphic below).  Determination of the proper once daily dose requires that the patient be started on twice daily dosing with dosage titration to an effective dose. The total daily dose can then be converted to once daily. The dose response curve for once daily dosing is not flat and is not comparable to glargine, which may cause higher rates of hypoglycemia (see graphic below).
      • There is only one published study comparing detemir to glargine [Pieber 2005 Diabetologia 2005;48(suppl1):A92]

       

      Plank  J, Diabetes Care 2005;28(5):1107-1112

       

Cost Comparison for Levemir , Lantus, NPH

 

Levemir

Lantus

NPH

Concentration

100 U/ml

100 U/ml

100 U/ml

Vial size

10 ml

10 ml

10 ml

Cost per vial

$48.79

$59.91

$10.98

Dexmedetomidine Dexmedetomidine P&T Review

Dexmedetomidine Standard Drip Rate Chart and Double Concentrate for patients > 100 kg who require high doses. Pharmacy will send the appropriate drip rate chart along with the medication when a patient is started on dexmedetomidine.

        Dexmedetomidine (Precedexģ) is recommended for provisional formulary addition, restricted to the following:

o       Cardiac surgery patients

o       Patients not tolerating propofol AND benzodiazepines

        Dexmedetomidineís formulary status will be re-evaluated after 6 months. Outcomes for cardiac surgery patientís receiving dexmedetomidine and propofol will be compared for the following:

o       LOS

o       ICU/CCU Length of Stay

o       Time to Extubation  

o       Mortality

o       Total Hospital Cost

o       Overall systemic infectious complications

o       % of patients receiving a single IV sedative agent (dexmedetomidine,  propofol, benzodiazepine)

o       Bradycardia

o       Hypotension

o       Hypertension

o       Sedation scores

 

 

Dexmedetomidine Overview

        Does not demonstrate clinically significant advantages over propofol.

        Studies have failed to demonstrate significant differences in time to extubation, ICU length of stay, level of sedation, or mortality.

        Opioid requirements are decrease but not eliminated by dexmedetomidine

        Alpha 2 adrenergic agonists (clonidine, dexmedetomidine) have been show to in a meta analysis to decrease perioperative cardiovascular complications with oral clonidine being studies most often, 15/23 studies.

        Precedex is indicated for up to 24 hours of use in intubated patients in ICU and may be used after extubation.

        Precedex is not indicated in pediatric patients.

        Precedex does not come premixed from the manufacturer.

        The loading dose must be administered slowly over 10 minutes by setting the IV pump at a rate 30 times faster than the maintenance infusion which may lead to dosage and administration errors.

        Side effect profile is mainly cardiovascular and hemodynamic (bradycardia, hypertension, hypotension).

        The cost is 3.5 times higher than high dose Primary Propofol with secondary opioid in cardiac surgery. A conservative total cost increase for an equivalent number of patients from 2006 is $37,171 for MRMC (1168 vials of propofol) and $39,367 for SMH (1237 vials of propofol) for cardiac surgery.

 

Dezocin Autosubstitute with nalbuphine mg for mg

Dezocine is non formulary. The formulary alternative, Nubain, has a wider range of indications (L&D, post MI), is less expensive, and has a superior pharmacokinetic profile (longer half life and quicker onset). Nubain may also be given subcutaneously in contrast to dezocine.

 

Dosage Equivalences & Pharmacokinetics

 

 

 

 

Onset (min)

 

 

Time to

Peak (min)

 

 

 

Duration (hr)

 

 

 

T1/2 Hours

Dose (mg) Equivalent

To 10 mg  Morphine

 

Relative

Antagonist

Activity

Buprenorphine

(Buprenex)

IM 0.3 mg q6h

IV 0.3 mg q6h

 

15

 

60

 

6

 

2-3

 

0.3

 

 

Equal to

Naloxone

 

 

 

 

 

 

 

Butorphenol

(Stadol)

IM1-4 mg q3-4h

IV1-2 mg q3-4h

 

 

<10

Rapid

 

 

30-60

 

 

3-4

 

 

2.5-4

 

 

2-3

 

30x Pentazocine

1/40 Naloxone

 

 

 

 

 

 

 

Dezocine

(Dalgan)

IM5-20 mg q3-6 h

IV2.5-10mg  q2-4h

Not Subcutaneous

 

 

<  30

<  15

 

 

30-150

 

 

2-4

 

 

 

2.4

(Dose Dependent > 10 mg)

 

 

10

 

 

Greater than Pentazocine

 

 

 

 

 

 

 

Nalbuphine

( Nubain )

IM 10 q3-6h

IV  10 q3-6h

SC 10 q3-6h

 

 

< 15

    2-3

 

 

60

30

 

 

3-6

 

 

5

 

 

10

 

 

10X Pentazocine

1/120 Naloxone

 

 

 

 

 

 

 

Pentazocine

(Talwin)

IM 30-60 mg q3-4h

IV 30 mg q3-4h

Oral

 

 

15-20

2-3

15-30

 

 

15-60

nd

60-180

 

 

3

 

 

2-3

 

 

30

 

 

 

Weak

Dialysis The follow adobe files may be found on the the http://www.nephrologypharmacy.com/ web site

Dialysis of Drugs Text 2006

Peritoneal Dialysis Text 2006

Dofetilide Dofetilide P&T Review

Physician Ordering Form (will add when I get copy of form)

Package Insert

Drugs that cause QT interval Prolongation may be found at www.torsades.org

Dolasetron Autosubstitute with Zofran

Dolasetron (Anzemet) was removed from formulary as it may cause ECG (PR and QTc prolongation, QRS widening), which usually reverses in 6 hours but may last up to 24 hours

 

Doxercalciferol Preferred vitamin D analog  for use in secondary hyperparathyroidism

Pharmacy will autosubstitute oral Hectorol for injectable Hectorol, injectable Zemplar, and oral Zemplar at an equivalent dose in patients who can take oral medications.  If the patient is unable to take oral use injectable Hectorol.

Dosage Equivalence (mcg)

Calcijex (calcitriol) Injection

Zemplar (paricalcitol) Injection

Zemplar (paricalcitol)

Oral

Hectorol (doxercalciferol) Injection

Hectorol Oral

(doxercalciferol)

0.2

0.7

1

0.3

0.5

0.4

1.4

2

0.6

1.5

0.75

2.5

4

1

2.5

1.5

5

8

2

5

2.25

7.5

10

3

7.5

3

10

14

4

10

3.75

12.5

18

5

12.5

4.5

15

20

6

15

5.25

17.5

24

7

17.5

6

20

28

8

20

Reference: K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease

1 mcg of doxercalciferol inj. is approximately equivalent to 2.5 mcg of paricalcitol inj. or 0.75 mcg calcitriol inj.

Paricalcitol oral 72% bioavailable, doxercalciferol oral 42% bioavailable

 

Drip Rate Charts, Adult Standard
Drip Rate Calculator, Adult Standard
DROPERIDOL  
Drotrecogin Preprinted Physician Order Form
DVT Prophylaxis BSR Approved Protocol  
   
   

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