xopenex to albuterol auto-sub

[xiphoid2010]

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Hey guys, I want to see what you guys do for auto-sub out there.

My current hospital has a autosub in place. xopenex 1.25 neb = albuterol 2.5, and xopenex 0.63 = albuterol 1.25. But at my residency training site, we do xopenex 0.63 or 1.25 = albuterol 2.5.

I would love to eliminate the albuterol 1.25 from the formulary and go with my residency site's policy, but technically speaking levoalbuterol = 2x albuterol due to pure (R) enantiomer vs. racemic albuterol.

So I want to see what's going on out there. Is 0.63 = 2.5 the norm or the exception out there? What the the rational/evidence used for the 4x conversion? P&T is coming up next week, so thanks in advance.

 

[R xxx]

We do 2.5 for everything. We don't get a lot of xopenex orders and when we do, the physician usually writes DNS.

 

[Praziquantel86]

We limit Xopenex up front through our CPOE. Any request has to go through our non-formulary pager system (we very rarely get paged, that minor inconvenience is pretty much enough to stop anybody from even trying).

We recommend the 2.5 neb for pretty much anyone outside of pediatrics when it is requested, though.

 

[xiphoid2010]

We limit Xopenex up front through our CPOE. Any request has to go through our non-formulary pager system (we very rarely get paged, that minor inconvenience is pretty much enough to stop anybody from even trying).

We recommend the 2.5 neb for pretty much anyone outside of pediatrics when it is requested, though.

Ah, CPOE, how I miss thee.... I am working with dinky paper charts and paper MARs, which like stone age compared to my VA residency. 😡 So physicians pretty much write whatever they want, and I'm left trying to implement auto-subs through P&T to cover all these random s**t they order.

But being an evidence based person, what's the evidence to convert 0.63 xopenex to 2.5 albuterol? That's a 4x conversion when it's only a 2x by pharmacology. I can't just go to P&T and say "everyone else does it".

 

[Praziquantel86]

Ah, CPOE, how I miss thee.... I am working with dinky paper charts and paper MARs, which like stone age compared to my VA residency. 😡 So physicians pretty much write whatever they want, and I'm left trying to implement auto-subs through P&T to cover all these random s**t they order.

But being an evidence based person, what's the evidence to convert 0.63 xopenex to 2.5 albuterol? That's a 4x conversion when it's only a 2x by pharmacology. I can't just go to P&T and say "everyone else does it".

I don't think the evidence is there in the way you're looking for it, honestly. It's just that the evidence for Xopenex sucks. HR difference of 3BPM might get you an FDA approval, but not hospital P+T.

Your best bet might be to take baby steps. Get the Xopenex sub approved for both strengths of albuterol and make a huge deal out of ot (focus on housestaff) - then do an MUE on albuterol usage. Hopefully your rates of use will be low enough that you can just get the 1.25 deleted based on non-usage.

 

[PharmDstudent]

The host hospital only keeps Xopenex 1.25 on-hand, not 0.63. 😉