The Joint Pharmacy and Therapeutics Committee came into being in the fall of 2000 as a result of the efforts of physicians, pharmacists and hospital administration from both St. Luke's and Mercy. The purpose of the committee is to synchronize the formularies at our two hospitals. Our goals are to use evidence-based medicine, to be cost effective, and to communicate helpful drug information to physicians. We hope to pool the efforts of our pharmacists, physicians, and support staff to help the committee make good decisions. We will do our best to separate pharmaceutical marketing influences from our decision making process. This is a very large job. Your suggestions and input would be welcomed.
The "P & T News" will be the vehicle to communicate formulary decisions to the medical staff.
Decisions regarding specific drug requests and review of drug classes will be briefly summarized. Physicians requesting formulary changes may be asked to present their request in person to the committee. Additionally, the committee may request specialists to attend the committee meeting where a drug or drug class particularly involved in their practice will be reviewed. The committee intends to make sound decisions using the best information available including the valued input from our medical staff colleagues.
Thanks for your support,
Whelan Koontz, M.D. (Mercy) and Ralph Beckett, M.D. (St. Luke's), Co-chairmen
September, 2000
Description: Integrelin® is a Glycoprotein IIb/IIIa Inhibitor in the class with two current formulary drugs: Reopro® and Aggrastat®. This class of drugs inhibits platelet aggregation and is used for acute coronary syndrome (ACS) and during percutaneous coronary intervention (PCI).
Decision: Do not add Integrelin® to the formulary.
Rationale: There is no convincing literature at this time to indicate superiority of Integrelin® over Aggrastat®.
Description: Protonix® is a Proton Pump Inhibitor in the class with two current formulary drugs: Prilosec® and Prevacid®. This class of drugs suppresses gastric acid secretion and is used in treating GERD.
Decision: Add Protonix®, retain Prevacid® for tube feeding use only, and delete Prilosec® on the formulary. Inpatient requests for non-formulary PPIs will be automatically converted to Protonix® 40 mg with a note sent to the physician.
Rationale: Protonix® is a new agent that is therapeutically comparable to other PPIs but less expensive. Prevacid® is being retained for use with tube feedings. There is no convincing data to suggest the Priolosec® is superior to the other PPIs for acute treatment of acid peptic diseases.
October, 2000
Description: TNKase® is a thrombolytic agent in the class with three current formulary drugs: streptokinase, Activase®, and Retavase®. Two other thrombolytic agents are listed on the formulary, but are not stocked: urokinase and Eminase®. This class of drugs is used to clear vessel occlusions.
Decision: Do not add TNKase® to the formulary; delete urokinase and Eminase® from the formulary.
Rationale: The low utilization of thrombolytics in Cedar Rapids does not justify four formulary agents. Scientific evidence does not show TNKase® to be superior to Activase® or Retavase®. There is no data on combination therapy or other indications with TNKase®. Limiting the number of thrombolytic agents/protocols reduces the potential for errors.
Description: Tikosyn® is an oral class III antiarrhythmic in the class with two current formulary drugs: sotalol and amiodarone. This class of drugs is used to chemically convert and maintain normal cardiac rhythms. Tikosyn® is specifically indicated for conversion of atrial fibrillation and maintenance of normal sinus rhythm.
Decision: Add Tikosyn® to the formulary. Tikosyn® can only be prescribed by a physician who is certified by Pfizer as having completed appropriate training. The drug can only be initiated on a hospitalized patient who must be monitored for side effects for 3 days. Thereafter, Tikosyn® must be obtained through mail-order on an outpatient basis. The complex inpatient ordering process will require a clearly defined protocol and significant education of physicians, pharmacists, nurses, and patients to assure patient safety. There must also be education presented to community physicians should one of their patients be placed on Tikosyn®.
Rationale: Tikosyn® is indicated specifically for conversion of atrial fibrillation and subsequent maintenance of normal sinus rhythm. It has a very short half-life when compared to amiodarone and has a different adverse reaction profile. Each of the class III antiarrhythmics on formulary has a place in the treatment of cardiac arrhythmias that is unique.
Upcoming reviews:
H2 Blockers
Statins