Download HVPA Rx Enquirer Special Edition

HVPA Rx Enquirer Special Edition
aka Your Hallmark Card honoring
National Patient Safety Awareness Week – March 9th - 15th
Updates on Medication/Herbal Safety
New Drug Interactions with Coumadin® (warfarin)
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Arava® (leflunomide), used in the treatment of rheumatoid arthritis, may potentiate the effects of
warfarin by inhibiting its metabolism. Patients previously stabilized on warfarin may experience
a significant increase in INR within just a few days of starting Arava®.
Tequin® (gatifloxacin) and Levaquin® (levofloxacin), like other quinolones, may increase the
INR due to inhibition of warfarin metabolism. For patients stabilized on warfarin, the INR should
be monitored when any fluoroquinolone is started or stopped.
Avlimil….Sister of Viagra® or Herbal Troublemaker? (May just want to recommend a V-8)
Avlimil, a natural product promoted for the treatment of female sexual dysfunction, is being widely
advertised on television, radio ads, and in women’s magazines. It has been packaged to resemble oral
contraceptives or hormone replacement products. But what is it, exactly?
The product contains a combination of eleven herbs (quantities of individual ingredients unknown). The
major herbs in Avlimil are reported to be Salvia officinalis (sage leaf) and rubus idaeus (red raspberry
leaf). Other ingredients include kudzu root extract, red clover extract, Capsicum pepper, Licorice root,
Bayberry fruit, Damiana leaf, Valeriana root, Ginger root and Black cohosh root.
With the exception of damiana, which has been shown to improve sexual performance of impotent male
rats, there is no evidence that any of the eleven herbs in Avlimil can improve female sexual function.
Advertising cites an unpublished clinical trial of 40 women taking Avlimil for three months
with good results, but to date, there are no published clinical trials. But there are safety
concerns.
Sage contains the neurotoxin thujone. It is contraindicated during pregnancy and may
interfere with hypoglycemic and anticonvulsant therapies and may potentiate the sedative
effects of other drugs.
Licorice, red raspberry, and black cohosh may cause uterine stimulation. Red
clover, kudzu, and black cohosh may have estrogenic effects and should be avoided by women with
endometriosis as well as breast, uterine, or ovarian cancer.
The cost of Avlimil is about $1.65 per day (http://www.avlimil.com).
FDA Safety Alert- Permax® and Cardiac Valvulopathy
Post-marketing surveillance for Permax® (pergolide mesylate) has identified the development of cardiac
valvulopathy involving one or more valves in a small number of patients. The pathological assessment
of valves that were surgically removed was consistent with the valvulopathy associated with carcinoid
syndrome and with the use of other ergot alkaloid drugs. In the reports made to Lilly, aortic, mitral and
tricuspid valves were involved. In some cases the symptoms or manifestations of valvulopathy improved
with cessation of pergolide therapy. Valve replacement was required in two patients.
America’s Riskiest Drugs
http://www.forbes.com
• Insulin
• Morphine
• Heparin
• Warfarin
• Potassium Chloride
Avoid Atrovent® and Combivent® Inhalers in Patients with Peanut Allergy
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The use of Atrovent or Combivent inhalers by patients allergic to peanuts and/or
soybeans could cause a life-threatening reaction.
Both medications contain soya lecithin, a substance related to peanuts. Soya lecithin can
contain small amounts of soy protein and is used as a suspending agent in the Atrovent and
Combivent inhalers.
About 10% of patients who are allergic to peanuts will have an allergic reaction to soy protein.
Atrovent nasal spray and inhalation solution can be used safely as they do not contain soya
lecithin.
What’s in a NAME? Sound Alike Concerns
Serzone® vs. Seroquel®
Bristol-Myers Squibb notified healthcare professionals of medication errors due to name confusion
between Serzone, indicated for the treatment of depression, and Seroquel, a product of AstraZeneca,
indicated for the treatment of schizophrenia. The overlapping strengths (100 mg and 200 mg), the
dosage form (tablets), the dosing interval (BID), and the fact that these two products are stocked close
together in pharmacies were critical in causing these medication errors.
Zyvox® vs. Zovirax®
A published report describes a pharmacist who misread a prescription for Zyvox (linezolid) 600 mg as
Zovirax (acyclovir) 600 mg BID. Similar names and strengths likely contributed to this error.
Beware of mistaking aripiprazole (Abilify®), a new antipsychotic agent, for a proton pump
inhibitor (PPI).
Celebrex and Celexa...Lantus and Lente insulin...Lamisil and Lamictal...Plavix and Paxil...Aricept
and Aciphex...Singulair and Sinequan...and on and on.
Medication Safety: Moving from Illusion to Reality
JAMA. 2003;289:1154-6.
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Adverse drug events (ADEs) occur in 6.5% to 20% of hospitalized patients; many ADEs are
avoidable
Several interventions have been demonstrated to improve ambulatory drug use in older persons,
including curbing overuse of medications by identifying inappropriate medications and stopping
their use and addressing underuse of beneficial medications.
Incidence and Preventability of Adverse Drug Events Among Older Persons in the Ambulatory
Setting
JAMA.2003;289:1107-1116.
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Cohort study of all Medicare enrollees cared by a multispecialty group practice during a 12-month
study period (27,617 enrollees).
There were 1523 identified adverse drug events, of which 27.6% were considered preventable.
Cardiovascular medications (24.5%), followed by diuretics (22.1%), nonopioid analgesics
(15.4%), hypoglycemics (10.9%), and anticoagulants (10.2%) were the most common medication
categories associated with preventable adverse drug events.
Electrolyte/renal (26.6%), gastrointestinal tract (21.1%), hemorrhagic (15.9%),
metabolic/endocrine (13.8%) and neuropsychiatric (8.6%) events were the most common types of
preventable adverse drug events.
A publication by the HVPA Pharmacy Department: Lori Kostoff, Pharm. D. and Laurie Wesolowicz, Pharm.D.
Under the direction of Dr. Jeffrey Sanfield, Chairman of the HVPA Pharmacy and Therapeutics Committee.