Rx Update: February 2003
Mary Ross, R.Ph., M.B.A., Joan Murhammer, R.Ph., Kevin Bebout,
R. Ph.
First Published: February 2003
Last Revised: February 2003
Peer Review Status: Internally Reviewed
Ezetimibe
Ezetimibe (ZetiaTM, Merck/Schering Plough) is a lipid-lowering agent that selectively inhibits the absorption of cholesterol from the gastrointestinal tract. It is FDA-approved to lower cholesterol levels in patients with primary hypercholesterolemia. Ezetimibe can be used as monotherapy or in combination with an HMG CoA-reductase inhibitor ("statin"). It is also FDA-approved in patients with homozygous familial hypercholesterolemia and homozygous sitosterolemia. Ezetimibe should be used as an adjunct to diet to help lower cholesterol levels.
Ezetimibe is generally well-tolerated. Adverse effects include: upper respiratory tract infection (13%), headache (8%), myalgia (5%), back pain (4%) and sinusitis (4%). When ezetimibe is used in combination with an HMG CoA-reductase inhibitor, slight increases in serum transaminase levels were noted in 1.3% of patients. This elevation in serum transaminase levels has been shown to be reversible upon discontinuation of ezetimibe and the HMG CoA-reductase inhibitor. Patients with moderate to severe hepatic dysfunction should not take ezetimibe.
The recommended dose of ezetimibe is 10 mg orally once daily. Ezetimibe can be taken with or without food. A dosage adjustment is not required for patients with renal dysfunction or with mild hepatic insufficiency. If a patient is taking a bile acid sequestrant (e.g., cholestyramine), in addition to ezetimibe, ezetimibe should be administered at least 2 hours before or 4 hours after the bile acid sequestrant dose. Ezetimibe should not be used in patients younger than 10 years of age. Ezetimibe is available as a 10 mg tablet.
Standardized Concentration and Diluents for IV Medication Policy for Adult Patients
In an effort to improve drug delivery and administration of IV medications in the adult setting, the Pharmacy and Therapeutics Subcommittee has approved a policy to dispense standard concentrations and diluents of IV antibiotics and usual concentrations and diluents for other commonly used IV infusions. The purpose of this initiative is to minimize drug waste, ensure maximum stability, maximize expiration dating, minimize drug preparation time, and improve patient safety (e.g., decreased potential for infusion rate errors).
Commercially available (pre-made) products will be preferred. Other standardized concentrations will be determined by currently available stability and compatibility data and the propensity for the drug to cause pain, irritation, or other adverse effects (e.g., red man's syndrome) upon administration. Exceptions to the standardized concentrations will be made on a case-by-case basis. For patients requiring non-standardized drug concentration or diluent, documentation should be made in the patient's medical record via a physician's order on the A1-a Doctor's Order Form. The order should specify which medications are included and why. An example might read, "All medications except ______ to be placed in D5W due to an increased sodium of (specify number)."