10/05/15: FDA Safety Warning: Medications Stored in Becton-Dickinson (BD) Syringes

Recently, BD Medical announced to their customers that their oral plastic syringes are not FDA-cleared for storage of compounded pharmaceuticals or for the purpose of repackaging liquid medications.  Storing medications in BD syringes has been shown to reduce their potency due to a drug interaction with the rubber stopper found in certain lots of syringes.  Affected sizes include 1mL, 3mL, 5mL, 10mL, 20mL and 30mL.  BD oral syringes may continue to be used for immediate administration purposes only.   When the intention is storing compounded or repackaged medication, alternate oral syringes are recommended.

In response to this warning, Enclara Pharmacia has moved completely to NeoMed syringes for storage and for administration.  The product used prior by Enclara Pharmacia was Exactamed that differs from NeoMed in available sizes and color of syringe cap as follows:

Former product, ExactamedSizes - 1mL, 3mL, 5mL, 10mL;  Cap color - Blue

New product, NeoMed:  Sizes - 1mL, 3mL, 6mL, 12mL;  Cap color - Orange

For more information on this FDA warning, please click here to review.

10/05/15: Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer's Dementia

Patients with Alzheimer's disease frequently experience agitation and other behavioral problems. With heightened awareness on the harms and lack of benefit of prescribing antipsychotics in this population, there exists a need for safe and effective alternative therapies.

A study on a novel combination medication, dextromethorphan-quinidine (Nuedexta®), recently published in JAMA describes the potential effectiveness of this medication for the management of agitation in patients with Alzheimer’s dementia.  JL Cummings and colleagues led a Phase 2 randomized, multicenter, double-blind placebo-controlled 10 week trial using a sequential parallel comparison design on patients with probable Alzheimer's disease and agitation. Patients assigned to the dextromethorphan-quinidine group reported improvement in behavioral symptoms compared to those receiving placebo that was felt to be clinically significant. Although more research is needed, this two drug combination may offer relief of agitation in some patients.

Link to JAMA (09/22/2015)

09/24/15: Injectable Morphine Drug Shortage

Manufacturers of injectable morphine alerted the industry on September 18th of a shortage of select strengths of morphine injectable including the 10mg/mL strength, commonly used in hospice. Injectable morphine strengths 0.5 mg/mL, 1mg/mL, 2mg/mL, 4mg/mL & 50mg/mL remain available.  Manufacturing delays and increased demand for product were cited as sources of the shortage. West-Ward Pharmaceuticals, the manufacturer of morphine injectable 10mg/ml, estimates replenishment of stock in the 4th quarter 2015.  A release date cannot be estimated at this time for other strengths of shorted manufactured product.

For more information on this shortage, please click here to review the ASHP Drug Shortage Bulletin.

09/16/15: Availability of Heart Failure Medications in Hospice Care

Symptom management for patients with end-stage heart failure (HF) is demanding.  Additionally, the medications most effective for palliation are cardiac-specific (i.e., intravenous furosemide and inotropes) and may not be readily available in the home due to lack of practice guidelines and expertise of hospice staff.  The use of hospice by patients with HF is rising, making the need to assess treatment practices vital. In this descriptive study, Lum HD, et al used quantitative and qualitative survey data to assess medication availability and hospice clinician approaches, respectively, to HF treatment for opportunities to individualize cardiac care at end-of-life.

Link to Am J Hosp Palliat Care (08/31/2015)

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