Pharmacy & Therapeutics - February 2008 - (Page 87)

NEW DRUGS from 93.3 million to 110.2 million, but the number of hospitals operating 24-hour EDs decreased by 12%. In the remaining EDs, ambulances were sometimes diverted to another facility every minute. The lead study author suggested that EDs were closing because emergency patients are “money-losers” for hospitals. Planned admissions are usually more lucrative because patients can be scheduled more conveniently and can be prescreened for health insurance. However, he said, “these perverse incentives are causing dangerous delays in potentially lifesaving emergency care, even for those with insurance.” EDs might also be overcrowded if patients have poor access to primary care. Adequate access to preventive care with appropriate drug therapy might help address medical problems before they become emergencies. (Source: Health Affairs online, January 11, 2008.) DRUG NEWS was safe, well tolerated, and significantly superior to placebo in reducing the pain of diabetic peripheral neuropathy (DPN), say researchers from Germany. In a 12week, double-blind trial, 396 patients with painful DPN were randomly assigned to receive placebo or pregabalin 150, 300, or 600 mg/day. By the second week, pain scores among patients receiving 600 mg/day were significantly lower than scores of patients receiving placebo. The 600-mg dose also improved patients’ overall health status. At all doses, the patients reported improved quality of life. Treatment-related adverse effects included dizziness, peripheral edema, and somnolence, all of which increased with higher doses, but few patients stopped treatment because of adverse effects. (Source: Eur J Pain 2008;203–213.) dents had said that a pharmacist must verify orders before drugs could be removed from ADCs. In 2007, that percentage increased to 64%, but only 59% of the respondents reported that all cabinets could provide a direct interface between the pharmacy information system and ADCs so that pharmacists can approve the drugs before they are removed from the cabinet. New ADC guidelines to prevent errors were drafted in 2007. (Sources: ISMP Newsletter, January 17, 2008, www.ismp.org/tools/guidelines/ labelformats/comments/default.asp.) Marketing for Heart Failure Drug (BiDil) Halted Nitromed has stopped marketing its fixed-dose combination of isosorbide dinitrate and hydralazine (BiDil), a threetimes-daily tablet indicated for AfricanAmericans with heart failure. However, the currently approved version of the drug will still be available for patients while the company works on an extended-release formulation. The FDA approved BiDil in 2005 after it was associated with a 43% drop in relative mortality and a 39% decrease in the relative risk of hospitalizations for heart failure over 10 months in the randomized African-American Hear t Failure Trial (A-HeFT). Yet BiDil did not catch on, perhaps because some considered it a costly combination of two generically available drugs. Despite growth in prescriptions, the company believes that a larger marketing effort is needed. NitroMed is eliminating about 70 of its 90 positions. The company plans to file its NDA for the extended-release formulation in 2010. (Sources: The Heart, January 16, 2008; Associated Press, January 17, 2008.) Stress Echocardiography? Exercise ECG? Or Both? Although electrocardiography (ECG) during exercise provides valuable information about the heart’s rhythm and electrical activity, it might not always be accurate in its predictions, especially at an intermediate-to-high workload, say researchers from Italy. They compared the prognostic value of exercise ECG with pharmacological stress echo cardiography using dipyridamole (Persantine, Boehringer Ingelheim) or dobutamine (Lilly). The study enrolled 131 patients with diabetes and 804 patients without diabetes who had positive exercise ECG findings. Ischemia during stress echocardiography was independently associated with an increased risk of hard events (death and myocardial infarction [MI]), as well as major events (death, MI, and late revascularization); a non-ischemic test result predicted a favorable outcome. The results of stress echocardiography added prognostic value to those of positive exercise ECG results. Both dia- Safeguards Needed For Dispensing Cabinets The use of automated dispensing or distribution cabinets (ADCs) can decrease the amount of time before a drug is available for administration, helps ensure greater security, and reduces the risk of medication errors—but only when certain safeguards are used consistently. A survey conducted by the Institute for Safe Medication Practices (ISMP) in 2007 showed that although use of ADCs has become prevalent in the last decade, safety improvements have not been as widespread as needed to maximize the benefits of the technology. For example, in both the 2007 and the ISMP’s earlier 1999 survey, only 18% of respondents reported that another person verifies drug placement in the ADC. Requiring another practitioner to double-check a drug removed via an override, before pharmacy review, increased by only 10%. In 1999, only 28% of respon- Pregabalin (Lyrica) and Diabetic Peripheral Neuropathy Twice-daily pregabalin (Lyrica, Pfizer) Vol. 33 No. 2 • February 2008 • P&T® 87 http://www.ismp.org/tools/guidelines/labelformats/comments/default.asp http://www.ismp.org/tools/guidelines/labelformats/comments/default.asp

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Pharmacy & Therapeutics - February 2008 Contents Editorial Medication Errors Prescription: Washington The Language of (Forgive Us) Change, As P&T Enters the Digital Age New Drugs/Drug News/New Medical Devices Drug Forecast Use and Outcomes of Antifibrinolytic Therapy in Patients Undergoing Cardiothoracic Surgery at 20 Academic Medical Centers in the United States Evaluation of the Management of Acute Venous Thromboembolism and Its Outcomes: One Institution's Experience American Society of Hematology, 49th Annual Meeting Pharmaceutical Approval Update

Pharmacy & Therapeutics - February 2008

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