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Preston Pharmacy News - November 2011

FDA Updates Linezolid Warning

In July the FDA warned the public of reports of serotonin syndrome occurring in patients taking Linezolid with psychiatric medications that work through the brain’s serotonin system. Serotonin syndrome occurs when excessive levels of serotonin build up. Signs and symptoms may include confusion, hyperactivity, mental changes, muscle twitching, sweating, shaking, diarrhea, and fever. In October the FDA announced that most cases of serotonin syndrome occurred in patients taking selective serotonin reuptake inhibitors (SSRI’s) or a serotonin norepinephrine reuptake inhibitor (SNRI’s). It is currently unclear if other psychiatric meds with less serotonergic activity produce the same risk. SSRI’s include citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, and vilazodone. SNRI’s include desvenlafaxine, duloxetine, and venlafaxine.1

Oral Anticoagulants

In the past year we have seen the approval of two new oral anticoagulant agents (Pradaxa and Xarelto) and another in the pipeline (Apixaban). Pradaxa is used to reduce the risk of blood clots and stroke in atrial fibrillation without an artificial valve. Xarelto was approved for thromboembolism prevention after hip or knee replacement surgery. Both of the newer agents are expected to expand on their approved indications in the future. Unlike warfarin, the newer agents do not require routine monitoring or frequent dose adjustments and have fewer drug/food interactions. Warfarin is currently the only agent with an antidote (Vitamin K) though research is underway to develop reversal agents for the newer drugs. You may see the new meds being used as warfarin alternatives.2

Medication Safety

Dangerous Drug Interaction3
Digoxin and Amiodarone – Amiodarone may decrease the clearance of digoxin, increasing the potential for digoxin toxicity. Monitor digoxin levels and check for signs or symptoms of toxicity if Amiodarone is initiated or adjusted.

Digoxin and Verapamil – Verapamil may decrease the clearance of digoxin, increasing the potential for digoxin toxicity. Verapamil may increase the risk of bradycardia and heart block when used with digoxin. Monitor heart rate regularly and check for signs or symptoms of digoxin toxicity.

Look-Alike and Sound-Alike Names4
Statins (HMG-CoA Reductase Inhs) confused with Nystatin
Humalog confused with Humulin
Humalog confused with Novolog
Humulin confused with Novolin
Hydralazine confused with Hydroxyzine
Hydrocodone confused with Oxycodone
Hydromorphone confused with Morphine
Iodine confused with Lodine
Isordil confused with Plendil

New Drug Approvals

Juvisync (sitagliptin and simvastatin) – combination tablet indicated for the treatment of Type 2 diabetes and elevated LDL-cholesterol.5

Combivent Respimat Inhalation Spray (ipratropium bromide and albuterol sulfate) – alternative inhaler for patients with COPD currently using Combivent Inhalation Aerosol. Combivent Inhalation Aerosol will be unavailable after December 31, 2013 because it contains chlorofluorocarbons which decrease the ozone layer.6

Cialis (tadalafil) – commonly used for the treatment of erectile dysfunction, the FDA recently approved Cialis to treat benign prostatic hypertrophy.7

Joke of the Month

What kind of music did the Pilgrims like?
----Plymouth Rock!

References for November, 2011 Issue
  1. U.S. Food and Drug Administration. FDA drug safety communication: updated information about the drug interaction between linezolid (Zyvox) and serotonergic psychiatric medications. Available at: fda.gov. Accessed October 24, 2011.
  2. PL Detail-Document, Comparison of Oral Anticoagulants and Antiplatelets. Pharmacist’s Letter/Prescriber’s Letter. October 2011.
  3. Top ten drug interactions most dangerous to seniors in long-term-care. Available at: drugdanger.com. Accessed September 27, 2011.
  4. Institute for Safe Medication Practices. ISMP’s list of confused drug names. Available at: ismp.org. Accessed April 19, 2011.
  5. U.S. Food and Drug Administration. FDA approves combination therapy Juvisync [press release]. Available at: fda.gov. Accessed October 14, 2011.
  6. U.S. Food and Drug Administration. FDA approves Combivent Respimat (ipratropium bromide and albuterol sulfate) Inhalation Spray. Available at: fda.gov. Accessed October 14, 2011.
  7. U.S. Food and Drug Administration. FDA approves Cialis to treat benign prostatic hyperplasia [press release]. Available at: fda.gov. Accessed October 14, 2011.



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November, 2011