Drug Topics - January 2009 - (Page H6) HSE I Clinical FDA APPROVAL Conivaptan now available in single-use, premixed formulation MONA NASHED, PharmD, BCPS Vaprisol (conivaptan hydrochloride injection), the only arginine vasopressin receptor antagonist currently on the market, is now available as a single-use, premixed formulation from Astellas Pharma US Inc. Network Clinical SEE INDEX PAGE 10 For more info on this topic, see www.drugtopics.com Mona Nashed, PharmD, BCPS, is a hospital pharmacist in New Jersey. H6 DRUG TOPICS Januar y 2009 W W W.D R U GTO P I C S .C O M GETTY IMAGES / PHOTODISC / MICHAEL MATISSE Originally approved by the FDA for use in an ampule, conivaptan is now also approved for use as a sterile premixed solution. “Premixed formulations are always ideal, especially for medications utilized in criticalcare patients, such as [conivaptan]. When patients take a turn for the worse in the ICU, every minute counts in preparing the medication and getting it up to the floor,” said Nermin Boles-Attia, pharmacy coordinator at The University Hospital in Newark, N.J. The new 100 mL formulation of conivaptan comes in an Intravia container, a product of Baxter Healthcare Corporation, containing 20 mg of conivaptan hydrochloride in a 5 percent dextrose solution. It has an expiration date of 24 months. The sterile solution in ampules is also still available. Conivaptan was approved for the treatment of euvolemic hyponatremia in December 2005 and later gained an additional indication for hypervolemic hyponatremia in February 2007. Hyponatremia, the most commonly seen electrolyte imbalance in hospitalized patients, is defined as a sharp decrease in the serum concentration of sodium, typically below 135 mEq/L. It is consid- ered one of the most challenging electrolyte disorders to treat and can be lifethreatening. Hyponatremia frequently results from elevated levels of arginine vasopressin (AVP), which regulates water and salt balance in the body. Conivaptan blocks the activity of AVP, resulting in increased urine output without the loss of electrolytes such as sodium and potassium. This effect (aquaresis) helps to increase serum sodium levels in patients with hyponatremia. Conivaptan is contraindicated in patients with hypovolemic hyponatremia, which occurs following decreases in both total body water and total body sodium stores. Conivaptan is not indicated for the treatment of congestive heart failure. It should be used only for the treatment of hyponatremia in patients with underlying heart failure when the expected benefit of raising serum sodium outweighs the increased risk of adverse events. Conivaptan therapy should begin with a loading dose of 20 mg IV administered over 30 minutes, followed by 20 mg administered as a continuous intravenous infusion over 24 hours. Conivaptan can be given for an additional one to three days as a continuous infusion of 20 mg/ day. It can be titrated upward to a maximum dose of 40 mg daily in a continuous infusion. Conivaptan should not be administered for more than four days. Serum sodium, volume, and neurological status must be monitored frequently to prevent an overly rapid correction of sodium. A rise in serum sodium greater than 12 mEq/L over a 24-hour period may result in serious neurologic sequelae. The most common adverse reactions associated with conivaptan therapy include infusion-site reactions, headaches, hypokalemia, orthostatic hypotension, and pyrexia. Conivaptan is known to affect the pharmacokinetics of midazolam, simvastatin, digoxin, and amlodipine. Concomitant use of conivaptan with drugs that are primarily metabolized by CYP3A4 should be closely monitored, or the combination should be avoided. In addition, coadministration of conivaptan with potent CYP3A4 inhibitors, such as ketoconazole, itraconazole, clarithromycin, ritonavir, and indinavir, is contraindicated. The use of conivaptan in patients with hepatic impairment (including ascites, cirrhosis, or portal hypertension) or renal impairment has not been evaluated, and caution is advised when administering conivaptan to these patients. http://www.drugtopics.com http://WWW.DRUGTOPICS.COM
Table of Contents Feed for the Digital Edition of Drug Topics - January 2009 Drug Topics - January 2009 Contents Letters Up Front Up Front in Depth Community Practice Drug Pipeline: What to Watch in 2009 OTC Community-Aquired MRSA Infections New Products Viewpoint Drug Topics - January 2009 Drug Topics - January 2009 - Drug Topics - January 2009 (Page Cover1) Drug Topics - January 2009 - Drug Topics - January 2009 (Page Cover2) Drug Topics - January 2009 - Drug Topics - January 2009 (Page 1) Drug Topics - January 2009 - Drug Topics - January 2009 (Page 2) Drug Topics - January 2009 - Drug Topics - January 2009 (Page 3) Drug Topics - January 2009 - Contents (Page 4) Drug Topics - January 2009 - Contents (Page 5) Drug Topics - January 2009 - Contents (Page 6) Drug Topics - January 2009 - Contents (Page 7) Drug Topics - January 2009 - Contents (Page 8) Drug Topics - January 2009 - Contents (Page 9) Drug Topics - January 2009 - Contents (Page 10) Drug Topics - January 2009 - Contents (Page H1) Drug Topics - January 2009 - Contents (Page H2) Drug Topics - January 2009 - Contents (Page H1) Drug Topics - January 2009 - Contents (Page H2) Drug Topics - January 2009 - Contents (Page H3) Drug Topics - January 2009 - Contents (Page H4) Drug Topics - January 2009 - Contents (Page H5) Drug Topics - January 2009 - Contents (Page H6) Drug Topics - January 2009 - Contents (Page H7) Drug Topics - January 2009 - Contents (Page H8) Drug Topics - January 2009 - Contents (Page 13) Drug Topics - January 2009 - Up Front (Page 14) Drug Topics - January 2009 - Up Front (Page 15) Drug Topics - January 2009 - Up Front (Page 16) Drug Topics - January 2009 - Up Front (Page 17) Drug Topics - January 2009 - Up Front in Depth (Page 18) Drug Topics - January 2009 - Up Front in Depth (Page 19) Drug Topics - January 2009 - Community Practice (Page 20) Drug Topics - January 2009 - Community Practice (Page 20a) Drug Topics - January 2009 - Community Practice (Page 20b) Drug Topics - January 2009 - Community Practice (Page 21) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 22) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 23) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 24) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 25) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 26) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 27) Drug Topics - January 2009 - OTC (Page 28) Drug Topics - January 2009 - OTC (Page 29) Drug Topics - January 2009 - OTC (Page 30) Drug Topics - January 2009 - OTC (Page 31) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 32) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 33) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 34) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 35) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 36) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 37) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 38) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 39) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 40) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 41) Drug Topics - January 2009 - New Products (Page 42) Drug Topics - January 2009 - New Products (Page 43) Drug Topics - January 2009 - New Products (Page 44) Drug Topics - January 2009 - New Products (Page 45) Drug Topics - January 2009 - New Products (Page 46) Drug Topics - January 2009 - New Products (Page 47) Drug Topics - January 2009 - Viewpoint (Page 48) Drug Topics - January 2009 - Viewpoint (Page Cover3) Drug Topics - January 2009 - Viewpoint (Page Cover4)
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