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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.

(And a 32% chance it’s already been asked.)


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This is how InpharmD™ transforms LITERATURE.

What's Being Asked...

What recommendations exist for holding trental prior to surgery?
Please summarize evidence and provide evidence tables for studies leading to the AHA recommendation: "In patients wit...
Are there recommendations on how to convert octreotide SQ/IV to lanreotide?
What is the data for vancomycin levels pre HD? some aim for 15-20 and others recommend 17-25. Also, what is the data ...
Is there literature comparing efficacy and safety between the CGRP Receptor Antagonists?

What would you like to ask InpharmD™?

InpharmD's Answer GPT's Answer

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

Available guidance regarding perioperative management of pentoxifylline (Trental) is inconsistent across sources. A 2022 perioperative medication guideline from the University of Wisconsin Health does not provide specific recommendations on continuation, discontinuation, or timing prior to surgery, but emphasizes individualized risk-benefit assessment and interdisciplinary coordination. In contrast, a 2024 UK Clinical Pharmacy Association review recommends continuing pentoxifylline through su...

A 2022 perioperative medication management clinical practice guideline from the University of Wisconsin Health, developed to standardize perioperative medication practices and reduce complications in patients undergoing procedures requiring anesthesia, recommends that perioperative management of pentoxifylline be coordinated with the surgeon and prescribing provider (strong recommendation, low quality of evidence). The guideline defines “hold” as a temporary interruption of therapy and emphasizes that perioperative medication decisions should involve assessment of risks and benefits and collaboration among the anesthesiologist, surgeon, and prescribing clinician. Within this framework, no specific recommendation is provided regarding continuation, discontinuation, or timing of pentoxifylline prior to surgery. [1] A 2024 UK Clinical Pharmacy Association Handbook of Perioperative Medicines review states that pentoxifylline (Trental) should be continued during both elective and emer...

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A search of the published medical literature revealed 0 studies investigating the researchable question:

What recommendations exist for holding trental prior to surgery?

Level of evidence
D - Case reports or unreliable data  

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[1] University of Wisconsin Hospitals and Clinics Authority. Perioperative Medication Management – Adult/Pediatric – Inpatient/Ambulatory Clinical Practice Guideline. Published August 10, 2022. Accessed May 4, 2026.
[2] UK Clinical Pharmacy Association. Pentoxifylline. In: Handbook of Perioperative Medicines. UKCPA; April 2024. Accessed May 4, 2026.
[3] Waukee Surgery Center. Medications to Stop Prior to Surgery for Surgical Patients. The Iowa Clinic website. Accessed May 4, 2026.
[4] Virginia Interventional Pain & Spine Center. Pre-Procedure Medication Policies. Virginia Interventional Pain & Spine Center; n.d. Accessed May 4, 2026.
[5] Oklahoma Spine Hospital. Preoperative Guidelines For Medications Prior To Surgery. Accessed May 4, 2026.
[6] https://www.neurosurg.org/pdf/preop-guidelines.pdf
InpharmD's Answer GPT's Answer

Author:azkaa@inpharmd.com, PharmD, BCPS + InpharmD™ AI LEARN MORE 

As noted in the current AHA stroke guidelines regarding extended time windows for IV thrombolysis, patients with AIS who have salvageable ischemic penumbra detected on automated perfusion imaging and who are awake with stroke symptoms within 9 hours from the midpoint of sleep or are 4.5 to 9 hours from last known well state may be administered IV thrombolysis. Based on the evidence provided in the guidelines, this recommendation is primarily supported by advanced imaging-selected late-window ...

A 2019 systematic review and meta-analysis investigated the potential of extending the time window for thrombolysis in acute ischemic stroke patients using perfusion imaging to identify salvageable brain tissue. This analysis pooled individual patient data from three trials - EXTEND, ECASS4-EXTEND, and EPITHET - comprising a total of 414 patients who were treated with intravenous alteplase or placebo more than 4.5 hours after stroke onset or upon waking with stroke symptoms. The primary outcome focused on achieving an excellent functional outcome, defined as a modified Rankin Scale (mRS) score of 0-1 at three months. The analysis was adjusted for baseline age and clinical severity, utilizing mixed-effects logistic regression models. The findings revealed that patients administered alteplase presented significantly better functional outcomes, with 36% achieving an mRS score of 0-1 compared to 29% in the placebo group, yielding an adjusted odds ratio of 1.86. Additionally, secondary o...

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A search of the published medical literature revealed 7 studies investigating the researchable question:

What is the evidence leading to the AHA recommendation: "In patients with AIS who have salvageable ischemic penumbra detected on automated perfusion imaging and who (a) awake with stroke symptoms within 9 hours from the midpoint of sleep or (b) are 4.5–9 hours from last known well, IV thrombolysis may be reasonable to improve functional outcomes."

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

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[1] Campbell BCV, Ma H, Ringleb PA, Parsons MW, Churilov L, Bendszus M, Levi CR, Hsu C, Kleinig TJ, Fatar M, Leys D, Molina C, Wijeratne T, Curtze S, Dewey HM, Barber PA, Butcher KS, De Silva DA, Bladin CF, Yassi N, Pfaff JAR, Sharma G, Bivard A, Desmond PM, Schwab S, Schellinger PD, Yan B, Mitchell PJ, Serena J, Toni D, Thijs V, Hacke W, Davis SM, Donnan GA; EXTEND, ECASS-4, and EPITHET Investigators. Extending thrombolysis to 4·5-9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. Lancet. 2019 Jul 13;394(10193):139-147. doi: 10.1016/S0140-6736(19)31053-0. Epub 2019 May 22. Erratum in: Lancet. 2020 Jun 20;395(10241):1906. doi: 10.1016/S0140-6736(20)31322-2.
InpharmD's Answer GPT's Answer

Author:Muna Said, PharmD, BCPS + InpharmD™ AI LEARN MORE 

There appears to be no validated dose conversion between octreotide and lanreotide. However, a Korean Endocrine Society position statement on acromegaly provides guidance for switching between somatostatin analogues; experts recommend initiating lanreotide at its standard doses (60, 90, or 120 mg every 4 weeks) regardless of prior octreotide exposure, followed by biochemical monitoring and dose titration based on response. Retrospective data suggest broadly comparable efficacy between agents,...

A 2019 position statement by the Korean Endocrine Society (KES) outlined expert consensus on the use of somatostatin analogues for the medical management of acromegaly. The statement was developed in response to an increasing number of cases and a growing body of literature addressing pharmacological interventions, with recommendations formulated based on a comprehensive review of available evidence and expert voting where consensus was lacking. The document detailed the biochemical and clinical indications for initiating somatostatin analogue therapy, dosing strategies, switching protocols, prolonged dosing intervals, and special considerations, including preoperative use and hyperglycemia management. Octreotide long-acting release (LAR) was recommended at an initial dose of 20 mg every four weeks, with dose escalation to 30 mg or 40 mg based on biochemical response. Lanreotide autogel (ATG) was advised at starting doses of 60, 90, or 120 mg every four weeks, with the possibility o...

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A search of the published medical literature revealed 1 study investigating the researchable question:

Are there recommendations on how to convert octreotide SQ/IV to lanreotide?

Level of evidence
D - Case reports or unreliable data  

READ MORE→

[1] Chin SO, Ku CR, Kim BJ, et al. Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement. Endocrinol Metab (Seoul). 2019;34(1):53-62. doi:10.3803/EnM.2019.34.1.53
InpharmD's Answer GPT's Answer

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

The 2020 American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) guidelines for the therapeutic drug monitoring of vancomycin acknowledge the lack of data validating the target area under the curve/minimum inhibitory concentration (AUC/MIC) of 400 to 600 mg⋅h/L in the hemodialysis (HD) patient population. In the absence of specific data, ...

According to the 2020 guidelines for the therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus (MRSA) infections from the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP), monitoring serum concentration is essential for guiding vancomycin dosing in patients receiving intermittent hemodialysis (HD), particularly as modern high-permeability dialyzers significantly clear the drug, necessitating more frequent dosing than historical recommendations. Although outcome studies validating the goal area under the curve (AUC) AUC24h of 400 to 600 mg*h/L, used in other populations, are lacking for HD patients, this target is currently recommended. Due to practical limitations in HD patients, monitoring is most often based on predialysis serum concentrations. To ensure the AUC target of 400 to 60...

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

What is the data for vancomycin levels pre HD? some aim for 15-20 and others recommend 17-25 or is trough based dosing with goal 18-20 recommended?
Also, what is the data for AUC dosing in meningitis and CNS infections?

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

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[1] Rybak MJ, Le J, Lodise TP, et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2020;77(11):835-864. doi:10.1093/ajhp/zxaa036
[2] Lewis SJ, Nolin TD. New Vancomycin Dosing Guidelines for Hemodialysis Patients: Rationale, Caveats, and Limitations. Kidney360. 2021;2(8):1313-1315. Published 2021 May 21. doi:10.34067/KID.0000192021
[3] Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017;64(6):e34-e65. doi:10.1093/cid/ciw86
[4] Rybak MJ, Lomaestro BM, Rotschafer JC, et al. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists [published correction appears in Clin Infect Dis. 2009 Nov 1;49(9):1465]. Clin Infect Dis. 2009;49(3):325-327. doi:10.1086/600877
[5] Lodise TP, Drusano G. Vancomycin Area Under the Curve-Guided Dosing and Monitoring for Adult and Pediatric Patients With Suspected or Documented Serious Methicillin-Resistant Staphylococcus aureus Infections: Putting the Safety of Our Patients First. Clin Infect Dis. 2021;72(9):1497-1501. doi:10.1093/cid/ciaa1744
[6] Shokouhi S, Alavi Darazam I. Determination of vancomycin trough level in serum and cerebrospinal fluid of patients with acute community-acquired meningitis: a prospective study. J Infect. 2014;69(5):424-429. doi:10.1016/j.jinf.2014.06.010
[7] Clark L, Skrupky LP, Servais R, Brummitt CF, Dilworth TJ. Examining the Relationship Between Vancomycin Area Under the Concentration Time Curve and Serum Trough Levels in Adults With Presumed or Documented Staphylococcal Infections. Ther Drug Monit. 2019;41(4):483-488. doi:10.1097/FTD.0000000000000622
[8] Liu SP, Xiao J, Liu YL, et al. Systematic review of efficacy, safety and pharmacokinetics of intravenous and intraventricular vancomycin for central nervous system infections. Front Pharmacol. 2022;13:1056148. Published 2022 Nov 18. doi:10.3389/fphar.2022.1056148
[9] Nakazono K, Saito H, Ohkubo A, et al. A higher area under the concentration-time curve/minimum inhibitory concentration target as a potential prognostic factor for vancomycin treatment of methicillin-resistant Staphylococcus aureus meningitis: A case report. IDCases. 2024;37:e02035. Published 2024 Jul 20. doi:10.1016/j.idcr.2024.e02035
InpharmD's Answer GPT's Answer

Author:Rachel Deryck, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Available evidence comparing calcitonin gene-related peptide (CGRP) receptor antagonists is largely derived from meta-analyses and indirect comparisons rather than direct head-to-head randomized trials. However, data from these analyses consistently demonstrate that both gepants (e.g., rimegepant, ubrogepant, zavegepant) for acute treatment and monoclonal antibodies (e.g., erenumab, fremanezumab, galcanezumab, eptinezumab) for prevention are superior to placebo, with generally similar efficac...

A 2024 systematic review and network meta analysis (NMA) of 18 randomized controlled trials (RCTs) including 22,429 patients compared Lasmiditan, Rimegepant, Ubrogepant, and Zavegepant for acute migraine treatment. All agents were superior to placebo. For pain freedom at 2 hours, lasmiditan 100 mg (risk ratio [RR] 1.54; 95% confidence interval [CI] 1.21 to 1.99), lasmiditan 200 mg (RR 1.85; CI 1.46 to 2.40), rimegepant 75 mg (RR 1.82; CI 1.30 to 2.55), and ubrogepant 25 to 100 mg were all effective, with ubrogepant 100 mg ranking highest. For pain relief at 2 hours, lasmiditan 100 mg (RR 1.44; CI 1.34 to 1.55) and 200 mg (RR 1.43; CI 1.33 to 1.54) ranked highest and were superior to lower dose ubrogepant and zavegepant. For most bothersome symptom freedom at 2 hours, rimegepant 75 mg (RR 1.40, CI 1.17 to 1.68) and ubrogepant 50 mg (RR 1.40; CI 1.11 to 1.78) ranked highest. For sustained pain relief at 24 hours, all gepants were effective, including rimegepant, ubrogepant 25 to 100 m...

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A search of the published medical literature revealed 1 study investigating the researchable question:

Is there literature comparing efficacy and safety between the CGRP Receptor Antagonists?

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

READ MORE→

[1] Deng X, Zhou L, Liang C, et al. Comparison of effectiveness and safety of lasmiditan and CGRP-antagonists for the acute treatment of migraine in adults: systematic review and network meta-analysis of randomised trials. J Headache Pain. 2024;25(1):16. Published 2024 Feb 5. doi:10.1186/s10194-024-01723-4
[2] Haridas MP, Tripathy A, Maiti R, Srinivasan A. Efficacy and safety of anti-cgrp monoclonal antibodies in prevention of chronic migraine: a bayesian network meta-analysis. Clin Psychopharmacol Neurosci. 2024;22(1):23-32. doi:10.9758/cpn.23.1109
[3] Asawavichienjinda T, Sathitratanacheewin S, Chokesuwattanaskul R. "Wearing-off" efficacy of CGRP monoclonal antibodies for migraine prevention: A meta-analysis of randomized controlled trials. Cephalalgia. 2023;43(4):3331024231161261. doi:10.1177/03331024231161261
[4] Haghdoost F, Puledda F, Garcia-Azorin D, Huessler EM, Messina R, Pozo-Rosich P. Evaluating the efficacy of CGRP mAbs and gepants for the preventive treatment of migraine: A systematic review and network meta-analysis of phase 3 randomised controlled trials. Cephalalgia. 2023;43(4):3331024231159366. doi:10.1177/03331024231159366
[5] Messina R, Huessler EM, Puledda F, Haghdoost F, Lebedeva ER, Diener HC. Safety and tolerability of monoclonal antibodies targeting the CGRP pathway and gepants in migraine prevention: A systematic review and network meta-analysis. Cephalalgia. 2023;43(3):3331024231152169. doi:10.1177/03331024231152169
[6] Lee S, Staatz CE, Han N, Baek IH. Safety evaluation of oral calcitonin-gene-related peptide receptor antagonists in patients with acute migraine: a systematic review and meta-analysis. Eur J Clin Pharmacol. 2022;78(9):1365-1376. doi:10.1007/s00228-022-03347-6
[7] Masoud AT, Hasan MT, Sayed A, et al. Efficacy of calcitonin gene-related peptide (CGRP) receptor blockers in reducing the number of monthly migraine headache days (MHDs): A network meta-analysis of randomized controlled trials. J Neurol Sci. 2021;427:117505. doi:10.1016/j.jns.2021.117505
[8] Iannone LF, Fattori D, Benemei S, Chiarugi A, Geppetti P, De Cesaris F. Long-Term Effectiveness of Three Anti-CGRP Monoclonal Antibodies in Resistant Chronic Migraine Patients Based on the MIDAS score. CNS Drugs. 2022;36(2):191-202. doi:10.1007/s40263-021-00893-y

Why choose InpharmD™?

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!


     

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


     

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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.)


     

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