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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...

Hello, Every time I verify Robaxin IV orders, EPIC tells me to watch out in renally impaired patients due to PEG to...
Can bortezomib (Velcade) be given subcutaneously in the arm?
What is the evidence for using Mirena for endometriosis? What is the safety profile for Mirena, including long term s...
Is there any literature or recommendations available to support the use of a glucagon infusion for treatment of hypog...
What evidence exists regarding an association between acetaminophen/paracetamol exposure during pregnancy or early ch...

What would you like to ask InpharmD™?

InpharmD's Answer GPT's Answer

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

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  

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[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

InpharmD's Answer GPT's Answer

Author: AJ Carvajal, PharmD, BCPS + InpharmD™ AI  

As landmark trials for bortezomib did not evaluate pharmacokinetic data via subcutaneous injection in the arm, efficacy and safety of injection at upper arm sites is uncertain, especially in pediatric patients. Published literature, however, reports frequent subcutaneous administration into the arm in clinical practice, resulting in greater tolerability compared to abdominal injections. Additionally, a recent case report (see Table 1) also described routine arm administration without associat...

Recommendations regarding subcutaneous administration of bortezomib caution to ensure medication is delivered into adipose tissue and not muscle, which is dependent on site selection. Several factors, such as skin thickness and subcutaneous fat, appropriate skinfold technique prior to injection, injection angle, and needle length, play a role in site selection. Nursing management suggestions note that sites should be rotated using common subcutaneous site selection, which include the abdomen, the upper arm, and the upper outer aspects of the thighs; however, it should be noted that upper arm sites were not included in pharmacokinetic studies for subcutaneous bortezomib, and thus efficacy and safety at this injection site remain uncertain. Guidance provided was also specific to adult male and female patients, with no recommendations for pediatric adipose tissue composition. [1] The phase 3 study for bortezomib did not evaluate subcutaneous administration into the arm, and pharmaco...

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

Can Velcade be given subcutaneously in the arm?

Level of evidence
D - Case reports or unreliable data  

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[1] Kurtin S, Knop CS, Milliron T. Subcutaneous administration of bortezomib: strategies to reduce injection site reactions. J Adv Pract Oncol. 2012;3(6):406-410. doi:10.6004/jadpro.2012.3.6.8
[2] Martin JR, Beegle NL, Zhu Y, Hanisch EM. Subcutaneous Administration of Bortezomib: A Pilot Survey of Oncology Nurses. J Adv Pract Oncol. 2015;6(4):308-318. doi:10.6004/jadpro.2015.6.4.2
[3] Ohgiya D, Tsuchiya T, Suyama T, et al. An acceptable incidence of infusion site reactions after subcutaneous bortezomib administration in the upper arm in Japanese patients with multiple myeloma. Acta Haemat...

InpharmD's Answer GPT's Answer

Author: Frances Beckett-Ansa, PharmD, BCPS + InpharmD™ AI  

Available evidence suggests that levonorgestrel-releasing intrauterine device (Mirena) may help reduce endometriosis-related pain, improve quality of life, and lower recurrence rates, with effectiveness comparable to other hormonal options. It is generally well tolerated for long-term use, with common side effects including irregular bleeding, ovarian cysts, bloating, and skin changes, while avoiding the systemic hypoestrogenic effects seen with some alternatives. Overall, Mirena offers a fav...

Based on a 2021 Cochrane meta-analysis of four randomised controlled trials involving 157 women, the evidence supporting post-operative levonorgestrel-releasing intrauterine system (LNG-IUD) use for endometriosis is of very low to low certainty, primarily due to risk of bias and imprecision. Compared to expectant management, two studies suggested LNG-IUD may improve dysmenorrhoea at 12 months (RCT 1: median VAS 81 vs. 50, p= 0.006; RCT 2: VAS fall by 50 vs. 30, p= 0.021), but a meta-analysis was not possible. One study reported a significant improvement in quality of life with LNG-IUD (mean change to 70.3 vs. 57.0, p= 0.014), and another found higher patient satisfaction (RR 1.5; 95% CI 0.90 to 2.49). However, LNG-IUD was also associated with significantly higher rates of adverse events, specifically melasma (p=0.015) and bloating (p=0.021). In a single comparison with GnRH-a, the analysis found no conclusive evidence that LNG-IUD was superior for chronic pelvic pain at 12 months (M...

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A search of the published medical literature revealed 3 studies investigating the researchable question:

What is the evidence for using Mirena for endometriosis? What is the safety profile for Mirena, including long-term safety and side effects?

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

READ MORE→

[1] Gibbons T, Georgiou EX, Cheong YC, Wise MR. Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database Syst Rev. 2021;12(12):CD005072. Published 2021 Dec 20. doi:10.1002/14651858.CD005072.pub4
[2] Song SY, Park M, Lee GW, et al. Efficacy of levonorgestrel releasing intrauterine system as a postoperative maintenance therapy of endometriosis: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2018;231:85-92. doi:10.1016/j.ejogrb.2018.10.014
[3] Lan S, Ling L, Jianhong Z, Xijing J, Lihui W. Analysis of the levonorgestrel-rele...

InpharmD's Answer GPT's Answer

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

Although guidelines consistently highlight glucagon as an essential rescue therapy for severe hypoglycemia, available recommendations focus on single or limited parenteral or intranasal doses rather than continuous infusion. Evidence assessing glucagon infusion for hypoglycemia management is sparse and primarily derived from small observational reports in neonates and infants with refractory hypoglycemia, where results suggest potential benefit (see Tables 1-2). However, the relevance of thes...

The 2025 Standard of Diabetes Care outlines comprehensive components for diabetes management, including general treatment goals, guidelines, and quality evaluation tools. Glucagon prescriptions are given consideration for individuals hospitalized due to severe hypoglycemia, those with impaired awareness of hypoglycemia, or patients at high risk for future hypoglycemic events (e.g., end-stage kidney disease, intensive insulin management, frailty), specifically for managing any future severe episodes. Chapter 6 of the Standard of Diabetes Care, which addresses glycemic goals and hypoglycemia management, explicitly recommends that glucagon be prescribed for all individuals taking insulin or at high risk for hypoglycemia, indicating its use for people unable or unwilling to orally consume carbohydrates during a hypoglycemic event. This ensures that essential rescue medication (injection, nasal spray, autoinjector) is available for at-risk patients to manage severe hypoglycemic episodes...

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

Is there any literature or recommendations available to support the use of a glucagon infusion for treatment of hypoglycemia?

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

READ MORE→

[1] American Diabetes Association Professional Practice Committee. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S128-S145. doi:10.2337/dc25-S006
[2] American Diabetes Association Professional Practice Committee. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S321-S334. doi:10.2337/dc25-S016
[3] Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline....

InpharmD's Answer GPT's Answer

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

An overwhelming amount of published literature has described the safety and efficacy of acetaminophen in pregnancy, as well as detailed the risks of fever to the fetus and symptomatic discomfort to the mother if left untreated. The claim for acetaminophen as a causal agent of autism comes from observational studies with methodological flaws that report possible correlation, but not causation. Additionally, confounding factors, including maternal illness, genetics, and environmental influences...

The U.S. Food and Drug Administration (FDA) recently published a press announcement that they will be initiating a label change for acetaminophen and other products due to growing evidence of acetaminophen use in pregnant women potentially linking to increased risk of neurological conditions such as autism in children. However, while an association is described in many studies, a causal relationship has not been established, and there are contrary studies in the scientific literature. [1] A 2021 meta-analysis examined the association between prenatal and postnatal acetaminophen exposure and the development of autism spectrum conditions (ASC) and attention-deficit/hyperactivity disorder (ADHD) symptoms in childhood. This comprehensive analysis leveraged data from six European population-based birth cohorts involving a total of 73,881 mother-child pairs. The study utilized maternal questionnaires and interviews to gather information on acetaminophen use during pregnancy and up to 1...

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

What evidence exists regarding an association between acetaminophen/paracetamol exposure during pregnancy or early childhood and the subsequent development of autism spectrum disorder?

Level of evidence
A - Multiple high-quality studies with consistent results  

READ MORE→

[1] U.S. Food and Drug Administration (FDA). FDA Responds to Evidence of Possible Association Between Autism and Acetaminophen Use During Pregnancy. Published September 22, 2025. Accessed September 25, 2025.
[2] Alemany S, Avella-García C, Liew Z, et al. Prenatal and postnatal exposure to acetaminophen in relation to autism spectrum and attention-deficit and hyperactivity symptoms in childhood: Meta-analysis in six European population-based cohorts. Eur J Epidemiol. 2021;36(10):993-1004. doi:10.1007/s10654-021-00754-4
[3] Masarwa R, Levine H, Gorelik E, Reif S, Perlman A, Matok I. Prenat...

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.


  Jane D., PharmD, Georgia

     

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.


     

Sorry just give me a second, my mind is blown.


     

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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