The FDA is notifying health care professionals that the 32 mg, single IV dose of the anti-nausea drug Zofran (ondansetron hydrochloride) will no longer be marketed because of the potential for QT prolongation, which may result in potentially fatal cardiac arrhythmia. The 32 mg dose has been removed from the Zofran drug label. FDA is now working with the manufacturers of all ondansetron 32 mg injectable products (brand and generic) to voluntarily recall them from the market. These drugs are sold pre-mixed in solutions of either dextrose or sodium chloride in plastic containers.
A previous Drug Safety Communication, issued on June 29, 2012, communicated that the 32 mg single IV dose should be avoided due to the risk of QT prolongation, which can lead to torsades de pointes. Instead of a single 32 mg IV dose, the FDA recommends an IV regimen of 0.15 mg/kg (or a max dose of 16 mg) every 4 hours for three doses to prevent chemotherapy-induced nausea and vomiting. In addition, oral ondansetron remains effective for the prevention of chemotherapy-induced nausea and vomiting.
FDA anticipates that generic ondansetron 32 mg products will be removed from the market through early 2013. FDA does not anticipate that removal of the 32 mg IV dose of ondansetron currently sold as pre-mixed injections will contribute to a drug shortage of IV ondansetron, as the 32 mg dose makes up a very small percentage of the current market.
The American Society of Health Systems Pharmacists (ASHP) has announced a shortage of the 1.5 mg transdermal scopolamine system (Transderm-Scop). The two manufacturers of Transderm-Scop, Baxter and Novartis, state the shortage is due to increased demand. All package sizes are on back order and product is being released as it becomes available.
There are a number of alternatives to the scopolamine patch for your hospice patients. Consider atropine 1% ophthalmic solution, 2-4 drops PO/SL every 4 hours PRN or hyoscyamine (Levsin®) 0.125 – 0.25 mg PO/SL every 4 hours PRN. Hyoscyamine is also available in an extended-release (12-hour) formulation that is dosed 0.375 mg PO BID or TID. If the patient is unable to swallow, glycopyrrolate (Robinul®) can be given SC, IM and IV at a dose of 0.1 – 0.2 mg every 6 hours PRN.
Let us know… Have you been affected by the scopolamine patch shortage?
|Yes, i think you should. You are in your comroft zone right now with the ideal work environment for you, but you have to ask yourself what your ultimate goal in life really is. Is emotional satisfaction all that you'll ever need? Your girls are growing up, I'm sure you'll be planning for their college education soon, and that requires money. Sometimes you can't afford to be sentimental about things. If the offer you get from the other side is genuine and affords your family more financial security than your present job, then I think it's time for you to move on in your career and your life. Good luck.
Posted 9/18/2012 10:05:51 PM
|I see patients. Hookers have cutrsmeos and clients. OK, it is just a joke! Since I see some TennCare patients, the analogy does not hold up under scrutiny. I see patients because I ascribe to the medical model of care and expertise. Not that I am an expert in what my patients should do, but I am an expert in how they might accomplish their goals, how I might help, and things concerning human change. There is a bit of the sacred in the term patient, it evokes trusted care. Client is an economic term. Since I see my patients as brave people struggling with difficult changes, I do them the honor of calling them patients. And I honor my approach to them as well.I do some work as a photographer. They are clients. I do a job. As a psychologist, as a therapist, I have some sacred responsibility and the term patient honors that.And it is not a power trip issue either. The people that work for me call me Dr. Monroe. The patients I work for call me Trey.Trey
Posted 9/18/2012 02:39:24 AM
|I was greatly disappointed to find out there were no scop patches for my Mom when she was dying. Had to use atropine eye gtts which didn't do much towards the end. I am a nurse and took care of my mom at home with hospice. I know how effective the patches are due to my experience working in a NH and taking care of hospice patients. If I knew the patches weren't available I wouldn't have went with hospice. It really bothered me to hear my mom fill up with fluid so bad in her lungs that it sounded like she was drowning and I have to live with that. It makes me sick. Then when I called hospice they stated there was a pill they could order and this was just minutes before she passed. Lets just say this has changed my mind on working for hospice at this time.
-- Lisa Winn
Posted 6/2/2012 06:15:23 PM
|Also, we already use all the other recommendations as well. I don't suppose that is could have anything to do with this garbage the FDA is pulling about "unapproved drugs" that they allowed to be on the market for the last 20 years and now decide they are unapproved??? (i.e. atropine 1% ophth sol went from around $2 per 15ml bottle to $35 per bottle OVERNIGHT. Same thing with generic hyoscyamine..... Believe me, I could go on and on, but I will refrain. Follow the money. Am I the only pharmacist on the planet that thinks the PDUF could be a conflict of interest?
-- Linda McMahan, R.Ph.
Posted 6/2/2012 06:14:25 PM
|Our practice has been tremendously impacted by the TD-Scop shortage. Also, in the recent days when we have been able to acquire an allocated amount (way insufficient to meet needs), the cost we pay per patch has almost doubled.
-- Linda McMahan, R.Ph.
Posted 6/2/2012 06:13:48 PM
This final article in our pediatric series will focus on the management of some of the most common non-pain symptoms encountered in pediatric palliative care. Research is notoriously lacking in this area, so much of what is done in pediatric palliative care is derived from the general pediatric population, from adult palliative care, or simply from clinical experience.
Specific symptom complexes that are addressed include: anxiety & depression, agitation, insomnia, anorexia-cachexia, nausea-vomiting, constipation, and dyspnea. Specific medication strategies will be presented for managing each of these troubling symptoms in pediatric hospice patients.
|That takes us up to the next level. Great psoitng.
Posted 4/3/2013 01:07:18 AM
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