April                                                                                             2003

 

FORMULARY ADDITIONS

 

Aripiprazole

(Abilify® )

10 mg, 15 mg, 30 mg tablets

 

Aripiprazole is a psychotropic drug indicated for the treatment of schizophrenia.  The exact mechanism of action is unknown.  Aripiprazole’s pharmacological profile is unique with potent partial agonistic actions at dopamine D2 and serotonin 5-HT1A receptors, and antagonism of 5-HT2A receptors. Actions at other receptors, such as α1-adrenergic, may explain other clinical effects of aripiprazole. 

 

Aripiprazole should be used with caution in patients at risk for seizures and those with concomitant Alzheimer’s disease.  Aripiprazole may be associated with orthostatic hypotension, perhaps due to its α1-adrenergic receptor antagonism.  Aripiprazole should be used with caution in patients with known cardiovascular disease, cerebrovascular disease, or conditions which would predispose patients to hypotension.

 

Neuroleptic Malignant Syndrome (NMS) has been associated with aripiprazole usage.  Discontinue treatment if NMS occurs.   Tardive Dyskinesia may also occur as a result of therapy.  Elderly patients, women especially, appear to be at higher risk of developing TD.  Due to this risk, patients should receive the smallest possible dose for the shortest amount of time possible.

 

The most common adverse effects of aripiprazole include headache, anxiety and insomnia.  Given the primary CNS effects of aripiprazole, caution should be used when it is taken in combination with other centrally acting drugs and alcohol. Due to its α1-adrenergic receptor antagonism, aripiprazole has the potential to enhance the effect of certain antihypertensive agents.

 

 

DRUG AND FOOD INTERACTIONS:  There are no reported interactions with food.

 

 

DOSAGE AND ADMINISTRATION:

 

This product is restricted for use in psychiatry.  The recommended starting and target dose for aripiprazole is 10 or 15 mg once daily. Dosage increases should not be made before 2 weeks, the time needed to achieve steady state.  No dosage adjustments are required based on age, renal or hepatic function. 

 

Escitalopram Oxalate

(Lexapro®)

10 mg, 20 mg film-coated tablets

 

Escitalopram, a highly selective serotonin reuptake inhibitor (SSRI), is the pure S-enantiomer (single isomer) of citalopram and is indicated for the treatment of major depressive disorder.  Escitalopram inhibits serotonin reuptake with no or very low affinity for serotonergic and other receptors.

 

Escitalopram is contraindicated in patients with known hypersensitivity to citalopram or escitalopram and in patients using an MAO Inhibitor.  Use caution when administering escitalopram with drugs metabolized by CYP2D6.  Because escitalopram is the active isomer of racemic citalopram (Celexa®), the two agents should not be coadministered.

 

Given the primary CNS effects of escitalopram, caution should be used when administered with other centrally acting agents.  Because lithium may enhance the serotonergic effects of escitalopram, caution should be exercised when these two agents are coadministered.  Due to postmarketing reports of weakness, hyperreflexia and incoordination following the use of other SSRI’s and sumatriptan, appropriate observation is advised when concomitant use of these two agents is clinically warranted.

 

The most common adverse reactions reported in placebo-controlled trials were nausea, insomnia, diarrhea and ejaculation disorder. 

 

 

DRUG AND FOOD INTERACTIONS:  There are no reported interactions with food.

 

 

DOSAGE AND ADMINISTRATION:

 

The recommended dose of escitalopram is 10 mg once daily.  Dose increases should occur after a minimum of one week.  No dosage adjustment is necessary for patients with mild or moderate renal impairment, however, escitalopram should be used with caution in patients with severe renal impairment.  The 10 mg daily dose is recommended for most elderly patients and those with hepatic impairment. 

 

Caspofungin

(Cancidas®)

50 mg, 70 mg powder for injection

 

Caspofungin belongs to a class of antifungal drugs (glucan synthesis inhibitors) that inhibit the synthesis of β(1,3)-D-glucan, an integral component of the fungal cell wall. Caspofungin has shown activity against Candida species and Aspergillus fumigatus.

 

Caspofungin is indicated for the treatment of candidemia and the following Candida infections: intra-abdominal abscesses, peritonitis and pleural space infections. Caspofungin has not been studied in endocarditis, osteomyelitis, and meningitis due

to Candida.  Caspofungin is indicated in esophageal candidiasis and invasive aspergillosis in patients who are refractory to or intolerant of other therapies.  Caspofungin has not been studied as initial therapy for invasive aspergillosis.  The most commonly reported adverse reactions include fever, phlebitis/thrombophlebitis, and headache. Possible histamine-mediated symptoms have been reported including isolated reports of rash, facial swelling, pruritus, sensation of warmth, or bronchospasm. Anaphylaxis has been reported during administration of caspofungin.

 

Concomitant use of caspofungin with cyclosporine is not recommended unless the potential benefit outweighs the potential risk to the patient, due to possible elevation of liver enzymes.

 

DOSAGE AND ADMINISTRATION:

 

Caspofungin must be ordered using the antifungal order form.

 

In candidemia, other Candida infections and invasive aspergillosis, a single 70-mg loading dose should be administered on Day 1, followed by 50 mg daily thereafter.  Caspofungin should be administered by slow IV infusion over approximately 1 hour. In general, antifungal therapy should continue for at least 14 days after the last positive culture. Patients who remain persistently neutropenic may warrant a longer course of therapy pending resolution of the neutropenia. The safety information on treatment durations longer than 2 weeks is limited, however, available data suggest that Caspofungin continues to be well tolerated with longer courses of therapy.

 

In esophageal candidiasis, 50 mg daily should be administered by slow IV infusion over approximately 1 hour.

 

Patients with mild hepatic insufficiency do not need a dosage adjustment. For patients with moderate hepatic insufficiency, caspofungin 35 mg daily is recommended. Patients on rifampin should receive 70 mg of caspofungin daily. Patients on nevirapine, efavirenz,

carbamazepine, dexamethasone, or phenytoin may require an increase in dose to 70 mg of caspofungin daily.

 

Do not mix or co-infuse caspofungin with other medications, as there are no data available on the compatibility of caspofungin with other intravenous substances, additives, or medications. DO NOT USE DILUENTS CONTAINING DEXTROSE (α-D-GLUCOSE), as caspofungin is not stable in diluents containing dextrose.

 

Formulary Additions and Deletions Not Listed in 2002-2003 Formulary Publication

Generic Name

Trade Name

Therapeutic Class

Action

Date

Comments

Alendronate once-weekly

Fosamax

Bisphosphonate

Added

6/25/02

 

Amphotericin B Suspension

Fungizone

Antifungal

Deleted

1/8/02

Discontinued by manufacturer

Antithymocyte Globulin (rabbit)

Thymoglobulin

Immunosuppressant

Added

3/28/01

 

Aripiprazole

Abilify

Antipsychotic

Added

3/25/03

Restricted to psychiatry

Aspirin/Dipyridamole

Aggrenox

Antiplatelet Agent

Added

2/25/03

 

Bosentan

Tracleer

Pulmonary hypertension agent

Added

8/21/02

Restricted to pulmonary services

Brimonidine

Alphagan

Ophthalmic agent

Added

8/21/02

 

Camphorated Tincture of Opium

Paregoric

Analgesic

Deleted

10/11/02

Discontinued by manufacturer

Caspofungin

Caspofungin

Antifungal

Added

3/25/03

Order form restriction

Colchicine 0.5mg

Colchicine

Antigout

Deleted

1/22/02

 

Colchicine 0.6mg

Colchicine

Antigout

Added

1/2202

 

Dalteparin

Fragmin

LMW Heparin

Deleted

2/25/03

 

Dexmedetomidine

Precedex

General anesthetic

Added

10/22/02

 

Dexamethasone-Neomycin Sulfate-Polymyxin B Sulfate Ophthalmic Solution

Dexacidin

Ophthalmic anti-inflammatory/antibiotic

Added

3/26/02

 

Docusate Compound Enema

Therevac-Plus

 

Deleted

8/7/02

Discontinued by manufacturer

Dutasteride

Avodart

BPH Agent

Added

2/25/03

 

Ertapenem

Invanz

Antibiotic

Added

3/26/02

Restricted to complicated/severe intra-abdominal infections and diabetic foot ulcers

Escitalopram

Lexapro

Antidepressant

Added

3/25/03

 

Ethosuximide

Zarontin

Anticonvulsant

Deleted

6/25/02

 

Felbamate

Felbatol

Anticonvulsant

Deleted

6/25/02

 

Fenofibrate

Tricor

Antilipemic

Added

6/25/02

 

Fexofenadine

Allegra, Allegra-D

Antihistamine

Deleted

 

 

Fish Oil Concentrate

 

Dietary Supplement

Added

1/25/03

 

Fondaparin

Arixtra

Anticoagulant

Added

3/26//2

Restricted to Orthopedics

Hyaluronate/Chondroitin

Duovisc

Ophthalmic agent

Added

8/21/02

 

Hepatitis A Inactivatd and Hepatitis B-Recominant Vaccine

Twinrix

Vaccine

Added

10/11/02

 

Hydrocortisone-Neomycin Sulfate-Polymyxin B Sulfate Ophthalmic Solution

Cortisporin

Ophthalmic anti-inflammatory/antibiotic

Deleted

3/26/02

 

Insulin Lispro Mix

Humalog Mix 75/25

Insulin

Added

6/25/02

 

Ketoprofen

Orudis