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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...

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...
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...

What would you like to ask InpharmD™?

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  

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[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

InpharmD's Answer GPT's Answer

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

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  

READ MORE→

[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 LEARN MORE 

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...

READ MORE→

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...

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.


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Huge time saver with thorough responses.


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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.)


     

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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