Download Express Scripts Drug Information & Wellness Center Drug Information Updates

April 2011
Volume 3 Issue 3
Express Scripts Drug Information & Wellness Center
Drug Information Updates
In the News:
Special points of interest:
April 30th – Take Back Your Medications Day!
• Take your expired and unwanted medications for proper disposal
− Controlled, non-controlled, and over-the-counter medication
− Liquid products and cream in original containers
− Sharps will not be accepted
• Saturday April 30th from 10:00 a.m. to 2:00 p.m.
• Visit www.DEA.gov to find a participating location near you!
> In the News
New Formulations and Indications:
> Drug Information Question
> New Formulations and Indications
> New Generic Approvals
> Newly Approved Drugs
> Apps of the Month
Gralise (gabapentin) by Abbott
Class: Anticonvulsant, gamma-aminobutyric acid (GABA) analogue
Indication: Management of postherpetic neuralgia in adults
MOA: The mechanism of analgesic action is unknown but animal models suggests that gabapentin
prevents allodynia and hyperalgesia
New formulation: Extended release formulation of the approved drug gabapentin
Dosing: 300 mg po once daily on day 1, then 600 mg po once daily on day 2, then 900 mg po once daily
on days 3-6, then 1200 mg po once daily on days 7-10, then 1500 mg po once daily on days 11-14, then
1800 mg po once daily thereafter. Gralise should be taken with the evening meal.
Abstral (fentanyl) by ProStrakan
Class: Analgesic
Indication: Management of breakthrough pain in cancer patients, 18 years and older, who are already
receiving and who are tolerant to opioid therapy for their underlying persistent cancer pain.
MOA: pure opioid receptor agonist
New formulation: sublingual
Dosing: Initial dose is 100mcg sublingually. Titrate dose individually to a tolerable dose. Do not use more
than 2 doses per breakthrough episode and do not repeat a dose within 2 hours. Limit to 4 doses per day
once successful dose is found.
Viramune XR (nevirapine) by Boehringer Ingelheim
Class: Anitretroviral
Indication: HIV infection
MOA: nonnucleaside reverse transcriptase inhibitor (NNRTI). Binds directly to reverse transcriptase and
blocks RNA & DNA-dependent polymerase activities by causing disruption of the enzyme’s catalytic site
New formulation: extended release tablets (24 hour formulation)
Dosing: For patients not already taking immediate release nevirapine, start at 200mg orally once daily for
14 days, then increase to 400mg once daily. For patients switching from immediate release, start at
400mg orally once daily. In either case, do not start therapy if CD4 counts > 250 cells/mm³ for women or
> 400 cells/mm³ for men
Invega (paliperidone) by Janssen, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.
Class: Antipsychotic
Indication: Schizophrenia and schizoaffective disorder
MOA: Unknown. Proposed mechanism is the antagonism of the central dopamine Type 2 and serotonin
Type 2 receptors. Also an antagonist of alpha-1-adrenergic, alpha-2-adrenergic and H1 receptors.
New indication: Now indicated for treatment of schizophrenia in children 12-17 years of age
Dosing: Initial dose of 3 mg/day orally. May increase in increments of 3 mg/day at intervals of more than
5 days to a maximum of 6 mg/day for children weighing < 51kg or to 12 mg/day for children >51 kg
Page 2
Express Scripts Drug Information & Wellness Center
Volume 3 Issue 3
New Generic Approvals:
GENERIC
BRAND
Exemestane tablets (now available)
Fexofenadine tablets (brand and generic now available OTC)
Imiquimod cream, 5% (now available)
Aromasin
Allegra
Aldara
Newly Approved Drugs
Horizant (gabapentin enacarbil)
Class: Gamma aminobutyric acid class
Indication: moderate to severe primary RLS in adults
MOA: Prodrug of gabapentin, binds to the alpha-2-delta subunit of voltage-activated calcium channels
Interaction: None listed, however, interactions are assumed to be the same as gabapentin, including inhibition of CYP450 enzymes
Dosing: 600mg by mouth once daily. Should be taken with food at approximately 5pm
Natroba (spinosad)
Class: Pediculicide
Indication: Pediculosis capitis (head lice)
MOA: Causes neuronal excitation of lice followed by paralysis and death
Interaction: none
Dosing: Apply a sufficient amount of suspension to dry scalp, leave on for 10 minutes, then rinse with warm water. Repeat application if live lice
are still present 7 days after initial treatment
Yervoy (ipilimumab)
Class: Antineoplastic agent, monoclonal antibody
Indication: Malignant melanoma, unresectable or metastatic
MOA: Blocks interaction of cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) with its ligands, causing augmentation of T-cell activation and
proliferation
Interactions: none listed
Dosing: 3 mg/kg IV infusion over 90 minutes every 3 weeks for a total of 4 doses. Must be completed within 16 weeks
Benlysta (belimumab)
Class: Monoclonal antibody, immunological agent
Indication: Adult patients with active, antibody positive systemic lupus erythematosus already receiving standard therapy
MOA: Inhibits survival of B cells, including autoreactive B cells, and reduces differentiation of B cells into immunoglobulin-producing plasma cells
Interaction: Interacts with most live vaccines
Dosing: 10 mg/kg IV infusion over 1 hour every 2 weeks for the first 3 doses and every 4 weeks thereafter
Recent Guideline Updates
American Heart Association (AHA)
2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients with Unstable Angina/Non STElevation Myocardial Infarction (Updating the 2007 Guideline): A Report of the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines Circulation. 2011 Mar 28.
♦ Available from: http://circ.ahajournals.org/cgi/reprint/CIR.0b013e31820f2f3e
Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic
Thromboembolic Pulmonary Hypertension: A Scientific Statement from the American Heart Association Circulation.
2011 Mar 21.
♦ Available from: http://circ.ahajournals.org/cgi/reprint/CIR.0b013e318214914fv1
American Stroke Association (ASA)
Guidelines for the Primary Prevention of Stroke: A Guideline for Healthcare Professionals from the American Heart
Association/American Stroke Association Stroke. 2011;42:517-84.
♦ Available from: http://stroke.ahajournals.org/cgi/reprint/42/2/517?maxtoshow=&hits=10&RESULTFORMAT=&fulltext
=seondary+prevention&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
Guidelines for the Prevention of Stroke in Patients with Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association Stroke. 2011;42:227-76.
♦ Available from: http://stroke.ahajournals.org/cgi/reprint/42/1/227
Page 3
Express Scripts Drug Information & Wellness Center
Volume 3 Issue 3
Drug Information Question
What is the proper disposal of medications including controlled substances?
The Illinois EPA promotes environmentally friendly disposal of unwanted or expired medications by increasing education and providing opportunities within the community for collecting or dropping off medications.
Illinois EPA recommends taking unwanted or expired medication to a pharmaceutical collection program. The EPA
website allows you to search by county for local disposal sites. The disposal sites accept non-hazardous medications
including prescribed or over-the-counter medications, vitamins, supplements, homeopathic remedies, creams, oils,
ointments, and suppositories. However, only law enforcement agencies,
such as police departments, will accept controlled substances. Sharps
may be accepted if there is a separate bin for proper disposal provided by
the disposal site.
LOCAL DISPOSAL SITES
Police Departments
1.Maryville
2.Collinsville
3.Alton
Pharmacies
1.Schnucks – Godfrey
2.Schnucks – Granite City
All medications dropped off at a disposal site will be placed together in a
bin, picked up, and delivered to a plant where they will be properly incinerated.
No disposal site near you? Don’t worry! Many communities hold yearly events to collect unused, unwanted, or expired medications. If disposal sites or collection events are not available, APhA recommends crushing the medication
and dissolving it in a small amount of water, and then mixing it with an unappetizing substance such as kitty litter or
coffee grounds. The mixture should be placed in a sealed bag (double bagging is recommended) and discarded in the
trash.
Do NOT flush medications down the toilet!
Flushing medications down the toilet poses potential safety, health, and environmental hazards.
However, there is a list of less than 30 controlled II substances that the FDA still recommends to
flush for proper disposal. This list can found on the FDA website.
For more information on proper disposal of medications or information on annual collection event in
your local area, please visit http://www.epa.state.il.us/medication-disposal/
Express Scripts
Drug Information & Wellness Center
Southern Illinois University Edwardsville
Page 4
Volume 3 Issue 3
Monday — Friday
8 a.m. — 4 p.m.
(618) 650-5142
Apps of the Month
The following applications for smartphones have been reviewed and critiqued by students and pharmacists:
Name
Cost
ChildrensMD
Free
MyFitnessPal
Free
STAT Adult
Immunization
Free
*Charge for
children’s schedule
Pocket First Aid
and CPR from the
AHA
$3.99
Content
• Guidance based on children’s
symptoms, including dosing information under the recommended
age for common OTC medications
• Calorie counter and fitness tracker
with the largest food database of
any app
• Immunization schedules by age
and indication for adults
• First aid and emergency
information
• Definitions of medical terms, prefixes/suffixes, and abbreviations
Quick Medical
Terminology and
Abbreviation
$0.99
RxShortages
Free
• Quick and easy access to drug
shortage information from ASHP
and FDA
Lose It
Free
• Stay within daily calorie budget!
This app allows you to track your
food and exercise
Depression Check
Free
• Series of 29 questions to help determine risk of depression, anxiety,
PTSD, and bipolar
PolyGlot Med
Free
• Spanish medical translator with
immediate audio translation
WebMD
Free
• Health information from WebMD
on your mobile device
iRxHelper
$0.99
• Helps track your prescriptions
Rating (1-5)