Authors


Steve N. Georas, MD

Latest:

The treatment of acute severe asthma in the adult: an overview

Asthma is a chronic inflammatory disease of the airways affecting 5%–7% of the US and European populations. It accounts for nearly 400,000 hospitalizations and 5,000 deaths per year. Acute asthma comprises those asthmatics with severe symptoms, despite attempts at appropriate control. Typically these patients will present to a local emergency department for evaluation and treatment. This review examines the pharmaceutical treatment options made available to these patients in emergency settings, including their risks, benefits, side effects and overall effectiveness. (Formulary 2003;38:537–543.)


Joshua M.F. Rubenfeld, MD

Latest:

The treatment of acute severe asthma in the adult: an overview

Asthma is a chronic inflammatory disease of the airways affecting 5%–7% of the US and European populations. It accounts for nearly 400,000 hospitalizations and 5,000 deaths per year. Acute asthma comprises those asthmatics with severe symptoms, despite attempts at appropriate control. Typically these patients will present to a local emergency department for evaluation and treatment. This review examines the pharmaceutical treatment options made available to these patients in emergency settings, including their risks, benefits, side effects and overall effectiveness. (Formulary 2003;38:537–543.)


Brett Feret, Pharm D

Latest:

Lumiracoxib A COX-2 inhibitor for the treatment of arthritis and acute pain

Lumiracoxib (Prexige, Novartis) appears to be the next COX-2 specific inhibitor that will be marketed in the United States. Currently, lumiracoxib is being studied for the treatment of osteoarthritis, rheumatoid arthritis, and acute pain. Lumiracoxib has been shown in vitro to be more selective for the COX-2 isoenzyme compared to rofecoxib and celecoxib, but clinical head-to-head studies between these agents are lacking. Small controlled trials, presented in abstract form, have shown lumiracoxib to have comparable efficacy to diclofenac and celecoxib in osteoarthritis. It has an adverse effect profile similar to other COX-2 inhibitors and superior to traditional NSAIDs concerning gastrointestinal safety, but cardiovascular and renal safety data are still not available. While existing clinical data on lumiracoxib are minimal and only published in abstract form, research is ongoing, including comparing lumiracoxib to ibuprofen and naproxen in the largest arthritis trial undertaken to date. When the results of this study are published, lumiracoxib?s efficacy and safety profile will be better understood. (Formulary 2003;38:528?536.)


Moses SS Chow, PharmD, FCP, FCCP

Latest:

Panic Disorder: A pharmacological armamentarium

Panic disorder is the most common anxiety disorder in the primary-care setting. It is characterized by episodes of acute, unexpected, and unprovoked anxiety and is often associated with depression and/or agoraphobia. Symptoms may become so pervasive that many life situations may be avoided. Management of panic disorder includes cognitive behavioral therapy, patient education, and pharmacotherapy. This article focuses on the rationale of drug therapy, methods of management, and other clinical considerations such as side effects. In addition, newer formulations are available that may subsequently change how patients are managed. Selective serotonin reuptake inhibitors (SSRIs) are considered first-line therapy, with tricyclic antidepressants (TCAs) as a possible alternative if the patient fails to respond. These agents are also useful in the management of comorbid depression. Benzodiazepines offer more rapid anxiolysis and may be used in combination with an SSRI for bridging. Although monoamine oxidase inhibitors (MAOIs) have been studied, they do not have a significant role in the pharmacological management of panic disorder. (Formulary 2003;38:431?38.)


Johnathan Holt, MD

Latest:

Panic Disorder: A pharmacological armamentarium

Panic disorder is the most common anxiety disorder in the primary-care setting. It is characterized by episodes of acute, unexpected, and unprovoked anxiety and is often associated with depression and/or agoraphobia. Symptoms may become so pervasive that many life situations may be avoided. Management of panic disorder includes cognitive behavioral therapy, patient education, and pharmacotherapy. This article focuses on the rationale of drug therapy, methods of management, and other clinical considerations such as side effects. In addition, newer formulations are available that may subsequently change how patients are managed. Selective serotonin reuptake inhibitors (SSRIs) are considered first-line therapy, with tricyclic antidepressants (TCAs) as a possible alternative if the patient fails to respond. These agents are also useful in the management of comorbid depression. Benzodiazepines offer more rapid anxiolysis and may be used in combination with an SSRI for bridging. Although monoamine oxidase inhibitors (MAOIs) have been studied, they do not have a significant role in the pharmacological management of panic disorder. (Formulary 2003;38:431?38.)


Cheryl Chow, PharmD

Latest:

Panic Disorder: A pharmacological armamentarium

Panic disorder is the most common anxiety disorder in the primary-care setting. It is characterized by episodes of acute, unexpected, and unprovoked anxiety and is often associated with depression and/or agoraphobia. Symptoms may become so pervasive that many life situations may be avoided. Management of panic disorder includes cognitive behavioral therapy, patient education, and pharmacotherapy. This article focuses on the rationale of drug therapy, methods of management, and other clinical considerations such as side effects. In addition, newer formulations are available that may subsequently change how patients are managed. Selective serotonin reuptake inhibitors (SSRIs) are considered first-line therapy, with tricyclic antidepressants (TCAs) as a possible alternative if the patient fails to respond. These agents are also useful in the management of comorbid depression. Benzodiazepines offer more rapid anxiolysis and may be used in combination with an SSRI for bridging. Although monoamine oxidase inhibitors (MAOIs) have been studied, they do not have a significant role in the pharmacological management of panic disorder. (Formulary 2003;38:431?38.)


Mary Kwok, PharmD

Latest:

Panic Disorder: A pharmacological armamentarium

Panic disorder is the most common anxiety disorder in the primary-care setting. It is characterized by episodes of acute, unexpected, and unprovoked anxiety and is often associated with depression and/or agoraphobia. Symptoms may become so pervasive that many life situations may be avoided. Management of panic disorder includes cognitive behavioral therapy, patient education, and pharmacotherapy. This article focuses on the rationale of drug therapy, methods of management, and other clinical considerations such as side effects. In addition, newer formulations are available that may subsequently change how patients are managed. Selective serotonin reuptake inhibitors (SSRIs) are considered first-line therapy, with tricyclic antidepressants (TCAs) as a possible alternative if the patient fails to respond. These agents are also useful in the management of comorbid depression. Benzodiazepines offer more rapid anxiolysis and may be used in combination with an SSRI for bridging. Although monoamine oxidase inhibitors (MAOIs) have been studied, they do not have a significant role in the pharmacological management of panic disorder. (Formulary 2003;38:431?38.)


Robert J. Cersosimo, PharmD, BCOP

Latest:

Palonosetron: A novel 5-HT3 receptor antagonist for chemotherapy-associated nausea and vomiting

Nausea and vomiting are among the serious complications of chemotherapy and can be associated with medical and psychological complications. Palonosetron (Aloxi, MGI Pharma/Helsinn) is a new agent in the class of serotonin type 3 (5-HT3) receptor antagonists that have become a standard of care for the prevention of chemotherapy-induced nausea and vomiting. Palonosetron has a much longer half-life (~40 h) than typical 5-HT3 receptor antagonists and potentially improved efficacy in the prevention of delayed nausea and vomiting associated with moderately and highly emetogenic chemotherapy. Clinical trials of palonosetron in patients with cancer demonstrate its efficacy in the control of acute nausea and vomiting and its superiority to 2 agents in this class, dolasetron and ondansetron, in the control of delayed nausea and vomiting. Palonosetron is well-tolerated, with an adverse effect profile similar to other 5-HT3 antagonists. Its efficacy in the prevention of both acute and delayed nausea and vomiting makes palonosetron an attractive option for patients receiving chemotherapy. Further studies need to be conducted to determine the role of palonosetron among its competitors. (Formulary 2003;38:414?430.)


Margarita V. DiVall, PharmD, BCPS

Latest:

Palonosetron: A novel 5-HT3 receptor antagonist for chemotherapy-associated nausea and vomiting

Nausea and vomiting are among the serious complications of chemotherapy and can be associated with medical and psychological complications. Palonosetron (Aloxi, MGI Pharma/Helsinn) is a new agent in the class of serotonin type 3 (5-HT3) receptor antagonists that have become a standard of care for the prevention of chemotherapy-induced nausea and vomiting. Palonosetron has a much longer half-life (~40 h) than typical 5-HT3 receptor antagonists and potentially improved efficacy in the prevention of delayed nausea and vomiting associated with moderately and highly emetogenic chemotherapy. Clinical trials of palonosetron in patients with cancer demonstrate its efficacy in the control of acute nausea and vomiting and its superiority to 2 agents in this class, dolasetron and ondansetron, in the control of delayed nausea and vomiting. Palonosetron is well-tolerated, with an adverse effect profile similar to other 5-HT3 antagonists. Its efficacy in the prevention of both acute and delayed nausea and vomiting makes palonosetron an attractive option for patients receiving chemotherapy. Further studies need to be conducted to determine the role of palonosetron among its competitors. (Formulary 2003;38:414?430.)


Paul N. Urick, RPh

Latest:

Making the move: Bringing pharmacy benefit management in-house

Controlling the rate of growth in prescription drug expenses continues to be a challenge. The cost of offering healthcare insurance benefits, including prescription drug benefit programs, has increased to a rate of nearly 20% in 2003. Costs are expected to rise by double digits over the next 5 years. This daunting trend has influenced HMOs and other benefit providers to consider moving pharmacy benefit management in-house to cut costs.


Christine Blank

Latest:

Study: Shorter hospital stays with Xarelto

US hospitals using rivaroxaban (Xarelto, Janssen Pharmaceuticals) instead of warfarin (Coumadin, Bristol-Myers Squibb) to treat patients diagnosed with a venous thromboembolism (VTE) may save nearly $2,000 per patient and shorten a patient’s hospital stay by approximately 1.5 days, according to a new study.


Craig Coleman, PharmD

Latest:

Enfuvirtide: The first fusion inhibitor for the treatment of patients with HIV-1 infection (PDF)

Enfuvirtide (Fuzeon, Roche/Trimeris) is the first member of a unique class of antiretrovirals known as the fusion inhibitors to gain FDA approval for the treatment of human immunodeficiency virus type-1 (HIV-1) infection. Enfuvirtide is indicated for use in combination with other antiretroviral agents in the treatment of HIV-1 infection in treatment-experienced patients with evidence of HIV-1 replication despite ongoing antiretroviral therapy. Phase 3 trials demonstrated that adding enfuvirtide 90 mg twice daily to an optimized background regimen chosen with genotypic and phenotypic resistance testing improved the surrogate end points of HIV ribonucleic acid (RNA) levels, CD4 cell counts, and the proportion of patients reaching clinically undetectable HIV RNA levels (<400 and <50 copies/mL) through 24 weeks. Enfuvirtide?s efficacy in treatment-experienced patients when added to an optimized background regimen makes it a promising choice for salvage therapy. Further studies will be required to support enfuvirtide?s use in treatment-naïve patients.



Jill Wechsler

Latest:

Medicare Part D plans control drug spending

The Medicare Part D prescription drug program has emerged as the poster child for how private plans can control costs while providing quality care. Even critics of health insurers acknowledge that the drug benefit has been a success.


C. Michael White, PharmD

Latest:

Eslicarbazepine: A novel antiepileptic agent designed for improved efficacy and safety

Eslicarbazepine acetate (eslicarbazepine, or ESL) is a new antiepileptic agent awaiting FDA approval.


Brett Feret, PharmD

Latest:

Fampridine-SR: A potassium-channel blocker for the improvement of walking ability in patients with MS

Fampridine-SR is a sustained-release oral medication that is pending FDA approval for the symptomatic treatment of multiple sclerosis (MS).


Elizabeth Udeh, PharmD

Latest:

Management of epoetin alpha use in the intensive care unit: a drug use evaluation

This study evaluates the appropriateness and cost implications of using epoetin alpha for transfusion reduction in Hartford Hospital's (Hartford, Conn) intensive care units (ICUs), with the goal of implementing a protocol for use in this setting. We conducted a literature review to determine the efficacy, safety, and clinical outcomes of epoetin alpha for transfusion reduction in the ICU. We also evaluated the safety and supply of red blood cell (RBC) transfusions and the cost considerations of epoetin alpha. The literature review demonstrated that epoetin alpha can reduce blood transfusions in the ICU setting but its use provided no difference in mortality or any other clinical outcome. Our epoetin alpha expenditure for transfusion reduction was $112,067 annually to theoretically save $14,349 in blood transfusion costs. The pharmacy and therapeutics (P&T) committee subsequently recommended that epoetin alpha not be used for transfusion reduction in the ICUs and requested that a drug use evaluation (DUE) be performed to monitor compliance, adverse effects, and cost avoidance. One year after implementation of the epoetin alpha DUE program, the compliance rate was >90%, there were no reported adverse events with blood transfusions or problems with blood supply, and a cost avoidance of $104,562 was realized. (Formulary. 2006;41:442?449.)


Monica C. Goldman, PharmD

Latest:

Management of epoetin alpha use in the intensive care unit: a drug use evaluation

This study evaluates the appropriateness and cost implications of using epoetin alpha for transfusion reduction in Hartford Hospital's (Hartford, Conn) intensive care units (ICUs), with the goal of implementing a protocol for use in this setting. We conducted a literature review to determine the efficacy, safety, and clinical outcomes of epoetin alpha for transfusion reduction in the ICU. We also evaluated the safety and supply of red blood cell (RBC) transfusions and the cost considerations of epoetin alpha. The literature review demonstrated that epoetin alpha can reduce blood transfusions in the ICU setting but its use provided no difference in mortality or any other clinical outcome. Our epoetin alpha expenditure for transfusion reduction was $112,067 annually to theoretically save $14,349 in blood transfusion costs. The pharmacy and therapeutics (P&T) committee subsequently recommended that epoetin alpha not be used for transfusion reduction in the ICUs and requested that a drug use evaluation (DUE) be performed to monitor compliance, adverse effects, and cost avoidance. One year after implementation of the epoetin alpha DUE program, the compliance rate was >90%, there were no reported adverse events with blood transfusions or problems with blood supply, and a cost avoidance of $104,562 was realized. (Formulary. 2006;41:442?449.)


Mari Edlin

Latest:

The Academy of Managed Care Pharmacy's 24th Annual Meeting and Showcase: Management of MS medications to improve adherence rates

A panel at AMCP's annual meeting discussed the need to improve MS medication adherence.


C. Mich?l White, PharmD

Latest:

Rimonabant: A novel CB1 receptor antagonist for the treatment of obesity

Obesity is on the rise in the United States, with 60.5% of the adult population overweight and 23.9% obese as of 2005. Up to 10% of an industrialized country's healthcare budget often can be spent on obesity and associated comorbidities.


Sachin A. Shah, PharmD

Latest:

Rimonabant: A novel CB1 receptor antagonist for the treatment of obesity

Obesity is on the rise in the United States, with 60.5% of the adult population overweight and 23.9% obese as of 2005. Up to 10% of an industrialized country's healthcare budget often can be spent on obesity and associated comorbidities.


Abimbola Farinde, PharmD, MS, FASCP, FACA

Latest:

Drugs in Perspective: Dalvance

Dalvance (dalbavancin) is the first and only intravenous antibiotic was approved on May 2014 to treat ABSSSIs with a 2-dose regimen of 1,000 mg once week and later on a 500 mg that is given over a 30-minute time span


Gina Lumbard Harper, PharmD, BCPS

Latest:

BLOG: Optimize antibiotic stewardship

Now is the time to dedicate resources in the inpatient and outpatient world to optimize antimicrobial stewardship.


Ying Yin Chen, PharmD

Latest:

Emerging therapies for treating type 2 diabetes

Type 2 diabetes mellitus presents multiple treatment dilemmas for prescribers and healthcare clinicians. The number of oral agents for treating diabetes has increased over the past decade, and the best treatment regimen for each patient often varies based on comorbid conditions and treatment goals. Hence, understanding the risks and benefits of each agent is vital. While the number of agents for treating type 2 diabetes mellitus continues to increase, prescribers and clinicians may struggle with the need to individualize care as a means to improve treatment outcomes.


Daryn K. Norwood, PharmD, BCPS, CGP, FASCP

Latest:

Emerging therapies for treating type 2 diabetes

Type 2 diabetes mellitus presents multiple treatment dilemmas for prescribers and healthcare clinicians. The number of oral agents for treating diabetes has increased over the past decade, and the best treatment regimen for each patient often varies based on comorbid conditions and treatment goals. Hence, understanding the risks and benefits of each agent is vital. While the number of agents for treating type 2 diabetes mellitus continues to increase, prescribers and clinicians may struggle with the need to individualize care as a means to improve treatment outcomes.


Vy P. Pham, PharmD

Latest:

Drugs in Perspective: Takeda's and Lundbeck’s Brintellix

Major depressive disorder (MDD) is a medical illness that is characterized by depressed mood, hopelessness, and loss of interest.1 According to the National Institute of Mental Health (NIMH), approximately 6.7% of US adult population experienced MDD, with 30.4% of these cases (2.0% of U.S. adult population) classified as severe.


Adriana Alvidrez, PharmD, BCPS

Latest:

Drugs in Perspective: Takeda's and Lundbeck’s Brintellix

Major depressive disorder (MDD) is a medical illness that is characterized by depressed mood, hopelessness, and loss of interest.1 According to the National Institute of Mental Health (NIMH), approximately 6.7% of US adult population experienced MDD, with 30.4% of these cases (2.0% of U.S. adult population) classified as severe.


Julie A. Murphy, PharmD, BCPS, FASHP, FCCP

Latest:

Drugs in Perspective: Liraglutide for the treatment of obesity

Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that received FDA approval for the treatment of diabetes mellitus in 2010. The mechanism of action includes slowing gastric emptying, increasing glucose-dependent insulin secretion, decreasing inappropriate glucagon release, and instilling a feeling of satiety. Liraglutide is administered once daily by subcutaneous injection. Common adverse effects of liraglutide include nausea (28%), diarrhea (17%), vomiting (11%), and constipation (10%).


Michelle N. Mangan, PharmD, RPh, BCACP, CDE

Latest:

Drugs in Perspective: Liraglutide for the treatment of obesity

Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that received FDA approval for the treatment of diabetes mellitus in 2010. The mechanism of action includes slowing gastric emptying, increasing glucose-dependent insulin secretion, decreasing inappropriate glucagon release, and instilling a feeling of satiety. Liraglutide is administered once daily by subcutaneous injection. Common adverse effects of liraglutide include nausea (28%), diarrhea (17%), vomiting (11%), and constipation (10%).


Yana A. Doughty, BSPS, PharmD candidate

Latest:

Drugs in Perspective: Liraglutide for the treatment of obesity

Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that received FDA approval for the treatment of diabetes mellitus in 2010. The mechanism of action includes slowing gastric emptying, increasing glucose-dependent insulin secretion, decreasing inappropriate glucagon release, and instilling a feeling of satiety. Liraglutide is administered once daily by subcutaneous injection. Common adverse effects of liraglutide include nausea (28%), diarrhea (17%), vomiting (11%), and constipation (10%).

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