Vancomycin

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jewel2

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What's in vancocin puvules is it powder or paste? I'm thinking it's powder but I was just wondering... Thx!
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The contents in Vancocin capsules is very hard, and it can take hours to dissolve outside of the body. So if someone has a peg tube, they really need to be on the solution.
 
I thought Vancocin capsules were not being manufactured, at least for the time being. Are they available again?

In the past few years, I've always just mixed vancomycin IV solution with sterile water, put it into a bulk bottle, and labeled it for oral use.
 
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rph3664 said:
I thought Vancocin capsules were not being manufactured, at least for the time being. Are they available again?

In the past few years, I've always just mixed vancomycin IV solution with sterile water, put it into a bulk bottle, and labeled it for oral use.
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Yes- this is typical for compounds (and 10000x cheaper than pills). The pulvules are pulvules. Did you Google it?
 
rxlea said:
Using the IV to make oral solution is WAY cheaper.
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Yeah, I don't know of any hospital that doesn't do this. I can see the caps might have a niche market in outpatient setting, but that's about it.
 
xiphoid2010 said:
Yeah, I don't know of any hospital that doesn't do this. I can see the caps might have a niche market in outpatient setting, but that's about it.
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Yeah, when we discharge, we compound some for the patient to get from our outpatient pharmacy. That way it's cheaper for us both. At my IPPE rotation, they compounded the oral solution for outpatients (it was a community compounding pharmacy).
 
rph3664 said:
I thought Vancocin capsules were not being manufactured, at least for the time being. Are they available again?
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...as far as I know.

The compounded solution is great for peg tubes, but not so great for oral administration. It has to be refrigerated, and it tastes nasty.
I haven't had anyone ask to flavor the compound yet, but maybe that's an option? :idea:
 
Ah, yes, pulvules. I stand corrected, because it's a Lilly product. 😳

Now that you folks mention it, when we've used it recently for C. diff, it's been for an adult, but at my old job, one person in our department had it prescribed for her young son, and IIRC it was flavored with cherry syrup and he didn't have any problems with taking it.
 
Has fidaxomicin made a name for itself for treating C. diff?
I know a huge problem with c diff is the recurrence rate. Fidaxomicin significantly reduces this issue and it's also been shown to be more effective to treat the hyper virulent c diff strain. I know Vanco is much cheaper, but in the long run (because of the reduced recurrence rate) it should save hospitals money.

I know this because I invest in pharma/biotechs and I remember reading through all of Optimers posters for the Fidaxomicin clinical trials. I'm just wondering if Fida is actually selling well.
 
I would be very very surprised if fidaxomycin did not require ID consult/ require a PA. Its way too expensive to be used as a first line treatment and I have yet to see it used in practice. Then again, I have been seeing a bunch of c diff. readmits...maybe I should do an mue.

disclosure: I own a smidge of optr
 
PhaseIII said:
Has fidaxomicin made a name for itself for treating C. diff?
I know a huge problem with c diff is the recurrence rate. Fidaxomicin significantly reduces this issue and it's also been shown to be more effective to treat the hyper virulent c diff strain. I know Vanco is much cheaper, but in the long run (because of the reduced recurrence rate) it should save hospitals money.

I know this because I invest in pharma/biotechs and I remember reading through all of Optimers posters for the Fidaxomicin clinical trials. I'm just wondering if Fida is actually selling well.
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Nope. Keeping that stuff in the arsenal. Vanco is doing us just fine right now.
 
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PhaseIII said:
Has fidaxomicin made a name for itself for treating C. diff?
I know a huge problem with c diff is the recurrence rate. Fidaxomicin significantly reduces this issue and it's also been shown to be more effective to treat the hyper virulent c diff strain. I know Vanco is much cheaper, but in the long run (because of the reduced recurrence rate) it should save hospitals money.

I know this because I invest in pharma/biotechs and I remember reading through all of Optimers posters for the Fidaxomicin clinical trials. I'm just wondering if Fida is actually selling well.
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We have a bottle still sitting unopened in our hospital's non-form section.
 
psychoandy said:
I would be very very surprised if fidaxomycin did not require ID consult/ require a PA. Its way too expensive to be used as a first line treatment and I have yet to see it used in practice. Then again, I have been seeing a bunch of c diff. readmits...maybe I should do an mue.

disclosure: I own a smidge of optr
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Cost (not AWP) is $3,500 for a 10-day course! We about fell off our chairs when we saw that.
 
rph3664 said:
Cost (not AWP) is $3,500 for a 10-day course! We about fell off our chairs when we saw that.
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Alinia used to be next after flagyl and vanc, and that runs $1500 something for 10 days.
 
Question for inpatient pharmacists. Can PCRs identify NAP1 strains?
 
do you guys see vanc pulse or taper dosing? What regimens? I've had a hard time finding any one recommended dosing regimen for recurrent CDAD
 
Ackj said:
I actually went to a presentation about Aricept 23 when it first came out, and they claimed it had different PK or release rate or something so it peaks at a different time than the regular stuff. Still kind of a wild idea.
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The question then we must ask is then:
in a once daily drug that has 100% bioavailability and a 3 day half life, does timed release change anything?
 
Aricept 23 makes me want to punch someone. So does Exparel. Pristiq. Ofirmev. That's my short list right now.
 
Not to mention all the fenofibrate formulations. 🙄
 
007rx said:
Question for inpatient pharmacists. Can PCRs identify NAP1 strains?
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Yes, they can. Most clinical labs don't test this, as it doesn't affect treatment. Ribotyping is done mainly for epidemiologic/research purposes.

spacecowgirl said:
do you guys see vanc pulse or taper dosing? What regimens? I've had a hard time finding any one recommended dosing regimen for recurrent CDAD
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There isn't really any one recommended dose. The literature behind pulse-dosed or tapered vancomycin is pretty scant, like the majority of C. diff treatment (aside from fidaxomicin, but that has it's own unrelated issues). Here's the one we use:

125mg PO q6h x 7d
125mg PO q8h x7d
125mg PO q12h x7d
125mg PO daily x7d
125mg PO QOD x7d

Whether it works or not is another story.

Somewhat related question: how do you folks feel about doses higher than 125mg? Based on stool concentration data and C. diff vancomycin MICs, it really doesn't make much sense to me. I know the guidelines recommend 500mg for severe infections, but there is honestly no literature backing that (that I've been able to find, at least).
 
owlegrad said:
Eh, too late, too many replies. :laugh:
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I always go to the threadlist and open everything in several tabs, so when I replied to that post I had no idea it was the wrong thread. I thought it was the drug rep one as well :laugh:
 
PhaseIII said:
Has fidaxomicin made a name for itself for treating C. diff?
I know a huge problem with c diff is the recurrence rate. Fidaxomicin significantly reduces this issue and it's also been shown to be more effective to treat the hyper virulent c diff strain. I know Vanco is much cheaper, but in the long run (because of the reduced recurrence rate) it should save hospitals money.

I know this because I invest in pharma/biotechs and I remember reading through all of Optimers posters for the Fidaxomicin clinical trials. I'm just wondering if Fida is actually selling well.
Click to expand...

Ummm...check your facts fidaxomicin is NOT better for NAP1/027 strains.
 
spacecowgirl said:
Aricept 23 makes me want to punch someone. So does Exparel. Pristiq. Ofirmev. That's my short list right now.
Click to expand...

Whats wrong with Exparel?
PCRX was another company I invested in... Seemed way better than just bupivacaine.
From what I remember it can provide relief for up to 72 hours, while bupivacaine alone is just 8hrs. Also, none of the bad side effects that an opioid based analgesic has.
 
KARM12 said:
Ummm...check your facts fidaxomicin is NOT better for NAP1/027 strains.
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Actually, you know what, I went back and looked at my notes, and OPTR ran two phase 3 clinical trials. On 1st trial Vanco did better treating the BI/NAP1/027 strains, on the 2nd trial Fida was better. IMO, the sample size was just too small and the study wasnt designed for just these strain to come to a true conclusion...

Why do you say it isnt better? Has there been a larger sample size study?

My notes:
Recurrence rates for the hypervirulent strain BI/NAP1/027 are very different in the first phase 3 trial and second phase 3 trial
first phase 3 trial: [FDX] 16/59 (27.1%) vs [VCN] 14/67 (20.9%)
second phase 3 trial: [FDX] 12/54 (22.2%) vs. [VCN]18/47 (38.3%)

So first trial: 6.2% more had a recurrence when treated with Fida
Second trial: 16.1% more had a recurrence when treated with Vanco
Again, the sample size was small and there was no statistical significance reached
 
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PhaseIII said:
Actually, you know what, I went back and looked at my notes, and OPTR ran two phase 3 clinical trials. On 1st trial Vanco did better treating the BI/NAP1/027 strains, on the 2nd trial Fida was better. IMO, the sample size was just too small and the study wasnt designed for just these strain to come to a true conclusion...

Why do you say it isnt better? Has there been a larger sample size study?

My notes:
Recurrence rates for the hypervirulent strain BI/NAP1/027 are very different in the first phase 3 trial and second phase 3 trial
first phase 3 trial: [FDX] 16/59 (27.1%) vs [VCN] 14/67 (20.9%)
second phase 3 trial: [FDX] 12/54 (22.2%) vs. [VCN]18/47 (38.3%)

So first trial: 6.2% more had a recurrence when treated with Fida
Second trial: 16.1% more had a recurrence when treated with Vanco
Again, the sample size was small and there was no statistical significance reached
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Saying something is "better" is not accurate:
http://www.nejm.org/doi/full/10.1056/NEJMoa0910812#t=article
 
KARM12 said:
Saying something is "better" is not accurate:
http://www.nejm.org/doi/full/10.1056/NEJMoa0910812#t=article
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? Yea, thats the first trial...
Cant find the poster for the 2nd, but this is good enough: http://investor.optimerpharma.com/releasedetail.cfm?ReleaseID=457907

Well, it is more effective in the 2nd trial.. wouldnt that make it "better" in the 2nd trial

You came off saying its "NOT better"... as if there should be no comparison between the two

EDIT: is this better?
"BI/NAP1/027 Subgroup Analyses Shows a Clinically Meaningful Reduction in Recurrence Rates for Fidaxomicin versus Vancocin(R)"
 
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1.) clinicians don't trust press releases
2.) after reading the above link for 10 seconds, that study is clearly a non-inferiority trial as well, with an underpowered secondary endpoint/subgroup analysis that showed lower recurrence with fidaxo.
3.) if you're trying to play stocks, the clinical/statistical stuff does not matter as much as how other investors perceive how important it is. For example, DNDN.
 
KARM12 said:
Saying something is "better" is not accurate:
http://www.nejm.org/doi/full/10.1056/NEJMoa0910812#t=article
Click to expand...

PhaseIII said:
Well, it is more effective in the 2nd trial.. wouldnt that make it "better" in the 2nd trial
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It's the whole "statistically significant vs clinically significant" BS that people always try and grill you about when you do Journal Clubs. In that study it did perform better. It wasn't a statistically significant difference, but in that small group of patients, they had lower recurrence rates than the vanco group. But you can't say that it's better (even though it was) because it wasn't sufficiently powered, and could have just been a random occurrence.

It's too risky for a drug to go straight for superiority, because it's a hard thing to prove. You'll very rarely see something that you can actually say is "better" right out of the box. Non-inferiority is easier to accomplish, and it's a safe way to get your drug on the market, and maybe you can do superiority studies later on.
 
PhaseIII said:
Whats wrong with Exparel?
PCRX was another company I invested in... Seemed way better than just bupivacaine.
From what I remember it can provide relief for up to 72 hours, while bupivacaine alone is just 8hrs. Also, none of the bad side effects that an opioid based analgesic has.
Click to expand...
:laugh: I guess nothing if you have unlimited funds and do not require insurance coverage. No one is going to use this product when you can use a peripheral nerve catheter for a fraction of the cost (which can be titrated or stopped if undesirable side effect occur).
 
I always compounded it ith cherry syrup.
 
spacecowgirl said:
:laugh: I guess nothing if you have unlimited funds and do not require insurance coverage. No one is going to use this product when you can use a peripheral nerve catheter for a fraction of the cost (which can be titrated or stopped if undesirable side effect occur).
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Lol! I just find it interesting how most of the newly approved drugs dont sell as well (or even come close) as management says they will. Im never a long term stock holder, so i dont really care if sales dont meet expectations, im just a little curious what actual sales end up being.

psychoandy said:
3.) if you're trying to play stocks, the clinical/statistical stuff does not matter as much as how other investors perceive how important it is. For example, DNDN.
Click to expand...

Lol, yea i know the hype is important... but for me, if im holding through PDUFA, i try to look through the trials as closely as i can and be sure the odds are in my favor
 
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