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What is InpharmD™?


Literature searching is tedious. InpharmD™ is here to help.

Clinical pharmacists can ask any question, anytime, from anywhere, and we’ll perform a custom literature search.

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This is how InpharmD™ transforms LITERATURE.

What's Being Asked...

Do statins cause an increase in a1c?
What is the evidence for high-dose ampicillin/sulbactam for carbapenem resistant Acinetobacter baumanii infections? D...
Are any commercially available FMT products currently available on the US market? If not, what are the recommended a...
What are the maternal and neonatal risks and benefits associated with the use of SSRIs (if any) during pregnancy - re...
Hello, Every time I verify Robaxin IV orders, EPIC tells me to watch out in renally impaired patients due to PEG to...

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InpharmD's Answer GPT's Answer

Author:Neil Patel, PharmD, BCPS + InpharmD™ AI LEARN MORE 

The use of various statins has been associated with new-onset diabetes and increased A1c. The mechanism for this effect is possibly linked to statins’ inhibitory effects on insulin sensitivity and secretion. Certain statins may increase the risk of diabetes onset (e.g., simvastatin, atorvastatin, and rosuvastatin). A greater risk for incident diabetes has also been associated with higher doses, higher potency, and longer duration of statin use. Another meta-analysis found that lower target le...

There are multiple theories as to how statin therapy may increase the risk of diabetes, but a consensus has not been met. In vitro studies have found that diabetogenic statins can reduce insulin sensitivity and insulin secretion through inhibition of HMGCoAR (the main target of statin therapy) or impairing beta-cell function. Laasko et al. have noted that the majority of studies implicate simvastatin, atorvastatin, and rosuvastatin as the most diabetogenic statins in population-based studies, clinical studies, and in vitro experiments. A 2019 review concluded diabetic risk appears to be a classwide effect, with pravastatin and pitavastatin potentially having less impact on risk. Mechanistically, pitavastatin does not appear to impair adipocyte maturation at clinical doses, which may lead to improved leptin and adiponectin secretion. However, these studies and experiments are performed in vastly different scenarios, which makes it difficult to draw universal conclusions from the resu...

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A search of the published medical literature revealed 9 studies investigating the researchable question:

Do statins cause an increase in A1c?

Level of evidence
B - One high-quality study or multiple studies with limitations  

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[1] Laakso M, Kuusisto J. Diabetes Secondary to Treatment with Statins. Curr Diab Rep. 2017;17(2):10. doi:10.1007/s11892-017-0837-8
[2] Carmena R, Betteridge DJ. Diabetogenic Action of Statins: Mechanisms. Curr Atheroscler Rep. 2019;21(6):23. Published 2019 Apr 30. doi:10.1007/s11883-019-0780-z
[3] Robinson JG. Statins and diabetes risk: how real is it and what are the mechanisms?. Curr Opin Lipidol. 2015;26(3):228-235. doi:10.1097/MOL.0000000000000172
[4] Ooba N, Tanaka S, Yasukawa Y, et al. Effect of high-potency statins on HbA1c in patients with or without diabetes mellitus. J Pharm H...

InpharmD's Answer GPT's Answer

Author:Neil Patel, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Based on available evidence, high-dose ampicillin/sulbactam (with daily sulbactam doses of 6-9 grams) is a rational and effective treatment for carbapenem-resistant Acinetobacter baumannii (CRAB), as the sulbactam component has intrinsic antibacterial activity against the bacterium. Clinical studies, including randomized trials, show that regimens based on high-dose ampicillin/sulbactam have success rates comparable to colistin, often with a better safety profile. However, due to the high res...

A 2024 review provides an overview on current treatments for carbapenem-resistant A. baumannii (CRAB). Ampicillin-sulbactam is a unique β-lactam/β-lactamase inhibitor where the sulbactam component itself has direct, intrinsic antibacterial activity against Acinetobacter baumannii by binding to its penicillin-binding proteins. For CRAB infections, which are typically highly resistant, high-dose ampicillin-sulbactam (with daily sulbactam doses of 6 g to 9 g) is a valuable therapeutic strategy. This approach is pharmacologically rational, as sulbactam exhibits time-dependent activity, and high-dose, extended-infusion regimens are designed to maximize the time that drug concentrations remain above the pathogen's elevated minimum inhibitory concentration (MIC). Clinical evidence, primarily from smaller randomized trials and observational studies, shows that high-dose ampicillin-sulbactam-based regimens have clinical success and mortality rates comparable to, and sometimes better than, co...

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A search of the published medical literature revealed 2 studies investigating the researchable question:

What is the evidence for high-dose ampicillin/sulbactam for carbapenem resistant Acinetobacter baumanii infections? Does this always need to be combination therapy? ?

Level of evidence
C - Multiple studies with limitations or conflicting results  

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[1] Choi SJ, Kim ES. Optimizing Treatment for Carbapenem-Resistant Acinetobacter baumannii Complex Infections: A Review of Current Evidence. Infect Chemother. 2024;56(2):171-187. doi:10.3947/ic.2024.0055
[2] Liu J, Shu Y, Zhu F, et al. Comparative efficacy and safety of combination therapy with high-dose sulbactam or colistin with additional antibacterial agents for multiple drug-resistant and extensively drug-resistant Acinetobacter baumannii infections: A systematic review and network meta-analysis. J Glob Antimicrob Resist. 2021;24:136-147. doi:10.1016/j.jgar.2020.08.021

InpharmD's Answer GPT's Answer

Author:Kevin Shin, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Rebyota, by Ferring Pharmaceuticals Inc, is a donor human stool suspension currently available in the US market for treatment of Clostridioides difficile infection (CDI) as FMT. Alternatives include Vowst (oral fecal microbiota spore capsule), and other antimicrobials administered orally like fidaxomicin, vancomycin, and metronidazole. Although FMT may be more effective compared to other agents, it is generally not considered for primary CDI.

A 2022 meta-analysis compared the recurrence rate of Clostridioides difficile infection (CDI) of fidaxomicin versus vancomycin. Randomized and observational studies of adult patients with recurrence rates for each treatment group were included for analysis. Use of fecal microbiota transplantation led to study exclusion. From a total of 6 included studies (N= 3944), the CDI recurrence rate was 16.1% in the fidaxomicin group versus 25.4% in the vancomycin group, equating to a 31% risk reduction of recurrence for fidaxomicin (risk ratio 0.69; 95% confidence interval [CI] 0.52 to 0.91). A similar trend was observed when analyzing subgroups of patients with initial CDI, first recurrent CDI, non-severe and severe CDI, and in both inpatient and outpatient settings. While the results may seem to favor fidaxomicin, a high heterogeneity was reported between studies. Many observational studies tend to focus on patient populations with high risk of recurrence, and the difference in definition a...

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A search of the published medical literature revealed 2 studies investigating the researchable question:

Are any commercially available FMT products currently available on the US market? If not, what are the recommended alternatives for CDI.

Level of evidence
C - Multiple studies with limitations or conflicting results  

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[1] Liao JX, Appaneal HJ, Vicent ML, Vyas A, LaPlante KL. Path of least recurrence: A systematic review and meta-analysis of fidaxomicin versus vancomycin for Clostridioides difficile infection. Pharmacotherapy. 2022;42(11):810-827. doi:10.1002/phar.2734
[2] Singh T, Bedi P, Bumrah K, et al. Fecal Microbiota Transplantation and Medical Therapy for Clostridium difficile Infection : Meta-analysis of Randomized Controlled Trials. J Clin Gastroenterol. 2022;56(10):881-888. doi:10.1097/MCG.0000000000001610
[3] Okumura H, Fukushima A, Taieb V, Shoji S, English M. Fidaxomicin compared with vanco...

InpharmD's Answer GPT's Answer

Author:Dena Homayounieh, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Available evidence suggests that SSRIs are effective for maintaining maternal mental health during pregnancy and generally have a more favorable safety profile than serotonin norepinephrine reuptake inhibitors (SNRIs). However, data indicate that SSRI use may be associated with a small absolute risk of birth defects, preterm birth, poor neonatal adaptation, and, if taken during the first trimester, potential cardiac malformations. SSRIs may also modestly increase the risk of persistent pulmon...

According to a statement from the American College of Obstetricians and Gynecologists (ACOG) reaffirmed in 2014, the absolute risks of birth defects associated with the use of selective serotonin reuptake inhibitors (SSRIs) identified in some case-control studies were not significant or small. However, the risk of depression relapse if treatment is discontinued should be considered. Therefore, they recommend that treatment with SSRIs or SNRIs during pregnancy should be individualized (Level C recommendation). Of note, paroxetine (Paxil) should be avoided by pregnant women and women who plan to become pregnant (Level B recommendation). [1] A 2020 review described the human and animal literature reporting the effects of perinatal SSRIs on anxiety and depression in offspring. A cross-sectional study and another population-based study revealed that maternal depression symptoms (not prenatal SSRI exposure) are related to anxiety and depression symptoms of their children. Several smal...

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A search of the published medical literature revealed 5 studies investigating the researchable question:

What are the maternal and neonatal risks and benefits associated with the use of SSRIs (if any) during pregnancy - regarding fetal development, long-term neurodevelopmental outcomes?

Level of evidence
B - One high-quality study or multiple studies with limitations  

READ MORE→

[1] ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008;111(4):1001-20. Reaffirmed in 2014.
[2] Fischer Fumeaux CJ, Morisod Harari M, Weisskopf E, et al. Risk-benefit balance assessment of SSRI antidepressant use during pregnancy and lactation based on best available evidence - an update. Expert Opin Drug Saf. 2019;18(10):949-963. doi:10.1080/14740338.2019.1658740
[3] Biffi A, Cantarutti A, Rea F,...

InpharmD's Answer GPT's Answer

Author:Dena Homayounieh, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Although methocarbamol appears to be relatively safe in patients with renal impairment, the intravenous formulation is contraindicated in patients with renal insufficiency due to the presence of polyethylene glycol 300 in the vehicle. Even though the amount of polyethylene glycol present in this preparation is well within the limits of safety, this contraindication exists due to the possibility of acidosis and nephrotoxicity observed when polyethylene glycol is administered in high concentrat...

A 2024 commentary examines the debated topic of polyethylene glycol (PEG) toxicity associated with intravenous methocarbamol. The commentary delves into the potential risks and evidence concerning PEG-related metabolic acidosis and nephrotoxicity, particularly in patients with renal dysfunction. Intravenous methocarbamol, widely prescribed as an antispasmodic muscle relaxant, contains PEG as an excipient, which has been implicated in adverse events in patients with compromised renal function. This publication brings to light that, despite the presence of such warnings in prescribing information, there is a marked absence of case reports or observational studies substantiating these adverse outcomes. The authors explore both sides of the argument by presenting past findings of PEG toxicity in other medications, yet highlighting the lack of concrete evidence specifically linking PEG in intravenous methocarbamol to clinical toxicity. Included in the discussion are comparisons with othe...

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A search of the published medical literature revealed 2 studies investigating the researchable question:

Every time I verify Robaxin IV orders, EPIC tells me to watch out in renally impaired patients due to PEG toxicity. How real or how often does this occur? Can this be reduced by lowering the dose?

Level of evidence
D - Case reports or unreliable data  

READ MORE→

[1] Chan E, Waggoner C, Boylan PM. Commentary: Is Polyethylene Glycol Toxicity From Intravenous Methocarbamol Fact or Fiction?. J Pain Palliat Care Pharmacother. 2024;38(2):180-184. doi:10.1080/15360288.2024.2345322

Why choose us?

Find answers, not documents.

Before InpharmD™


BeforeTime
Your team spends hours per week cobbling together literature from different studies, many behind paywalls, leaving little time for action.
BeforeTime
TI opportunities are discovered (or presented by third parties) months after the fact, resulting in costly missed savings.
BeforeTime
Decisions may be made without a complete picture, or pushed out while gathering consensus.

After InpharmD™


BeforeTime
InpharmD™ delivers customized, actionable drug information in real time, so you can focus on execution.
BeforeTime
Your team stays informed immediately when new data emerges or prices change, and you’ll always be the first to know when any changes impact your formulary.
BeforeTime
With InpharmD™, your team can make faster, more informed decisions and move forward with confidence.

What Clinical Pharmacists Are Saying...


     

Assists in our research and is a great way or us to get an answer to a medical question without spending an average of 2 hours researching UptoDate or PubMed ourselves.


  Jordan C., PharmD, New Jersey

     

Huge time saver with thorough responses.


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I’d never heard of a DI pharmacist before, now I have one. In. My. Pocket. Amazing!


     

Holy Shhh. Cow! Holy Cow! These summaries are beautiful.


  Jane D., PharmD, Georgia

     

I just want to say: This is such a brilliant idea! You people are genius.


     

OH MY GOD WHERE HAVE YOU BEEN ALL MY LIFE!


     

I can’t tell you how much time I spend literature searching. And how I CANNOT STAND PAYWALLS. THIS IS UNBELIEVABLE!! (covers face for sec) thank you, thank you, thank you!


     

So they’re basically connecting academic researchers with front line providers and then automating everything. It’s simply brilliant.


     

The clinical pharmacist was our secret weapon anyway. (Smiles wryly) This pharmacist AI seems superhuman. I’m just blown away, honestly. (Looks at camera somberly.)


     

It’s an ENTIRE DI DEPARTMENT, that lives in Epic. Give me a second. I’m just having a hard time wrapping my head around that.


     

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Stop reading and just download the app already! I’ve tried all of them. This is by far the most advanced, best-in-class.


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