AUGUST 2001

 

FORMULARY ADDITIONS

 

Ramipril (AltaceÒ)

1.25 mg, 2.5 mg, 5 mg, 10 mg Capsules

 

          Ramipril, an angiotensin converting enzyme inhibitor (ACEI), is indicated for the treatment of hypertension, heart failure, and recently for reduction in risk of myocardial infarction, stroke, and death from cardiovascular causes.  Angiotensin converting enzyme (ACE) catalyzes the conversion of angiotensin I to angiotensin II.  Angiotensin II causes vasoconstriction and sodium and water retention, which induces left ventricular remodeling.  Ramipril, a prodrug, has an active metabolite with a half-life of 13-17 hours in patients with normal renal function and an approximate duration of action of 24 hours.  The usual dose is 2.5-20 mg daily, given once or twice daily (max 20 mg daily).  The half-life is prolonged in patients with impaired renal dysfunction and dosage reduction may be necessary to avoid accumulation.  Adverse effects associated with ramipril include cough, headache, dizziness, hypotension, syncope, elevated serum creatinine and potassium, and less commonly, hypersensitivity reactions and acute renal failure. All ACEIs are pregnancy category C during the first trimester and category D during the second and third trimester; ramipril should be avoided during lactation.

            All ACEIs interact with diuretics/sympathomimetics, resulting in additive hypotension; with potassium sparing diuretics, resulting in hyperkalemia; and lithium, resulting in lithium toxicity.  The drugs in this class also interact with NSAIDs, with loss of hypotensive action and deterioration of renal function as potential effects.

          Recently, results of the HOPE trial and MICRO-HOPE trial were published indicating that ramipril may have beneficial effects in reducing mortality rates associated with myocardial infarction, and stroke.  The HOPE trial was a placebo-controlled, double- blinded, multicenter clinical trial in which 9297 high risk patients (evidence of vascular disease or diabetes with one other cardiovascular risk factor but no known evidence of low ejection fraction or CHF) received vitamin E (400 IU daily) with ramipril (2.5 to 10 mg daily) or placebo.  Specific inclusion criteria included adults aged 55 years, history of coronary artery disease, stroke, peripheral vascular disease, or diabetes, and at least one other cardiovascular risk factor. Primary endpoints were MI, stroke, or death from cardiovascular causes. Secondary endpoints included death from any cause, revascularization, and hospitalization for unstable angina, or heart failure, and complications related to diabetes.  Ramipril significantly reduced the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who were not known to have a low ejection fraction or heart failure.  MICRO-HOPE, a substudy, used the same endpoints and focused on the effects of ramipril on cardiovascular and microvascular outcomes in diabetic patients.  Ramipril was beneficial for cardiovascular events and overt nephropathy in people with diabetes.  This treatment represents a vasculoprotective and renoprotective effect for people with diabetes.  Without direct comparisons within these studies, the likelihood that this benefit represents a class effect cannot be excluded.

 

FOOD/DRUG INTERACTION:  May be taken without regard to food.

 

Ziprasidone (GeodonÒ)

20 mg, 40 mg, 60 mg, and 80 mg capsules

 

          Ziprasidone, an atypical antipsychotic agent structurally resembling risperidone, is indicated for the treatment of schizophrenia.  Ziprasidone is a combined serotonin and dopamine receptor antagonist. It is a potent 5-HT2A antagonist, with greater affinity than other atypicals.  Efficacy has been found to be comparable to haloperidol.

            Ziprasidone therapy should be initiated at a dose of 20 mg twice daily with food.  The dose may be increased, based on response, up to 80 mg twice daily.  Dosage adjustments should occur at intervals of not less than 2 days.  Patients should be observed for improvement for several weeks before upward dosage adjustment to ensure the use of the lowest effective dose.

            Ziprasidone is extensively hepatically metabolized, mainly by CYP3A4. Agents which inhibit CYP3A4 would be expected to increase the AUC of ziprasidone. Carbamazepine, a CYP3A4 inducer, has been shown to decrease the AUC, while ketoconazole, a CYP3A4 inhibitor, has been shown to increase the AUC.  Cimetidine, a CYP3A4 inhibitor, at 800 mg QD, has shown no effect on ziprasidone pharmacokinetics. Caution should be used when combining ziprasidone with agents which inhibit CYP3A4. In patients with mild to moderate hepatic impairment, the AUC of ziprasidone is increased. Renal impairment and hemodialysis do not alter the pharmacokinetics of ziprasidone.     

            When deciding which antipsychotic to use, ziprasidone’s greater capacity to prolong the QT/QTc interval should be considered.  Prolongation of the QTc interval has been associated with torsades de pointes-type arrhythmia and sudden death.  Ziprasidone is contraindicated and should not be used with any other medications that prolong the QTc interval . This includes (not a complete list) quinidine, dofetilide, pimozode, sotalol, thioridazine, moxifloxacin, and sparfloxacin.  For a complete list of drugs that prolong the QT interval or induce torsades de pointes, visit www.Torsades.org.  Ziprasidone is also contraindicated in patients with a known history of QT prolongation (including long QT syndrome), history of cardiac arrhythmias, recent acute myocardial infarction, or uncompensated heart failure.  Ziprasidone should be discontinued in patients who are found to have persistent QTc measurements >500 msec.      

            Side effects of ziprasidone include dyspepsia, constipation, nausea, abdominal pain, dry mouth, sedation, headache, postural hypotension, dizziness, insomnia, akathisia, rash, hypokalemia, and hypomagnesemia.  Hypokalemia may increase the risk of QT prolongation and arrhythmia. Extrapyramidal effects occurred in 5% of patients in trials. Transient prolactin elevation has been observed, which returned to baseline levels within the dosing interval.

            Weight gain has not been observed in most trials with ziprasidone.  Weight loss was observed in patients switched from olanzapine or risperidone to ziprasidone. Reductions in total cholesterol, LDL cholesterol, and triglycerides were also observed in ziprasidone-treated patients, independent of weight changes.

            Patients on ziprasidone should be monitored for electrolyte disturbances and for any symptoms suggestive of the occurrence of torsades, such as dizziness, palpitations, or syncope.

Any deficiency of potassium or magnesium should be corrected before proceeding with treatment.  Patients at risk for hypokalemia or hypomagnesemia (namely those on diuretic therapy) must be monitored periodically for any deficiencies.

 

FOOD/DRUG INTERACTION:  Administration with food is recommended to increase absorption.

 

Dofetilide (TikosynÔ)

125 mcg, 250 mcg, 500 mcg capsules

 

Restricted to Cardiology

 

          Dofetilide is a selective class III antiarrhythmic agent approved for both acute cardioversion of atrial fibrillation/atrial flutter and maintenance of normal sinus rhythm.

            Dofetilide is a derivative of the non-beta-blocking moiety of sotalol.  It blocks potassium channels which results in lengthening of the effective refractory period by prolongation of the action potential, without blocking the sodium channels or fast inward sodium current.  Dofetilide is active against atrial and ventricular reentrant tachyarrhythmias and fibrillation.  This agent lengthens the effective refractory period and functional refractory period in the atrium and ventricle, the effective refractory period of the accessory pathways, and the duration of the atrial and ventricular monophasic action potential, without effects on intracardiac conduction, sinus cycle length or sinus node recovery. Dofetilide has no effects on blood pressure and exerts a slight negative chronotropic effect, but does not exert a negative inotropic effect.  Dofetilide produces a dose-dependent and plasma concentration-dependent prolongation of the QT interval.  This type of prolongation has been associated with the development of torsade de pointes. The extent of QT prolongation is influenced by heart rate, with partial reverse rate dependence.

            Dofetilide is well absorbed after oral administration.  The half-life of dofetilide is 7 to 13 hours.  The majority of the dose (1/2-1/3) is excreted unchanged in the urine and the remainder is metabolized to essentially inactive metabolites by CYP3A4.  The metabolites of dofetilide have some class I and some class III antiarrhythmic activity, but only at very high concentrations.

          Prolongation of the QT interval during dofetilide therapy has been associated with torsade de pointes and increasing premature ventricular contractions in up to 3%. This has been the primary concern for the use of this drug.

            Medications which inhibit CYP3A4 (eg, erythromycin, ketoconazole) may inhibit dofetilide metabolism resulting in increased dofetilide levels.  These increased serum levels will increase the risk of adverse reactions and drug-induced arrhythmias. Dofetilide does not appear to inhibit CYP isozymes, nor does dofetilide appear to interact with the pharmacokinetics or pharmacodynamics of digoxin, propranolol or warfarin.

            It is recommended that this agent is initiated in the hospital with at least 72 hours of cardiac monitoring. Dosage must be individualized according to calculated creatinine clearance and QTc interval. Typical initial dose is 500 mcg BID. Dosage should be reduced in patients with impaired renal function and those who develop excessive QT prolongation (> 500 msec or 550 msec in patients with ventricular conduction abnormalities).

            Because of concerns about torsades de pointes, the manufacturer has limited availability of the product to hospitals and prescribers who have completed an education program.

 

FOOD/DRUG INTERACTION:  May be taken without regard to food.

 

Formulary Additions Not Listed in 2001-2002 Formulary Publication

DRUG

DATE

ACTION

COMMENTS

Dofetilide

6/26/01

Added (restricted to cardiology)

 

Oxcarbazepine

2/27/01

Added

 

Ramipril

6/26/01

Added

 

Thymocyte Globulin (rabbit)

3/28/01

Added

 

Ziprasidone

6/26/01

Added