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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.)


More than 30 of the world's best health systems hire an InpharmD™ virtual DI pharmacist, yielding:


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This is how InpharmD™ transforms LITERATURE.

What's Being Asked...

what is the evidence for using enteragam to treat pathophysiologic GI conditions?
Is there evidence that long term daily use of melatonin causes harm?
What evidence is there for dosing rifaximin at 600 mg BID or 400 mg TID for hepatic encephalopathy?
What is the risk of myasthenia gravis associated with azithromycin? Based on the risk should it be avoided as an age...
what literature is available to support bevacizumab use in intravitreal injections? Can biosimilars be used for intra...

What would you like to ask InpharmD™?

InpharmD's Answer GPT's Answer

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

Evidence supporting the use of serum-derived bovine immunoglobulin/protein isolate (SBI; EnteraGam®) for pathophysiologic gastrointestinal conditions is limited. Available data consist primarily of narrative reviews, small-scale clinical studies, and case series evaluating conditions such as diarrhea-predominant irritable bowel syndrome (IBS-D), HIV-associated enteropathy, and refractory inflammatory bowel disease (Tables 1-7). These publications suggest that SBI may improve gastrointestinal ...

A 2022 American Gastroenterological Association clinical practice guideline evaluated pharmacologic therapies for irritable bowel syndrome with diarrhea (IBS-D) using the Grading of Recommendations Assessment, Development and Evaluation framework. The guideline provides conditional recommendations for eluxadoline, rifaximin, alosetron, loperamide, tricyclic antidepressants, and antispasmodics, and a conditional recommendation against selective serotonin reuptake inhibitors; however, serum-derived bovine immunoglobulin/protein isolate (SBI; EnteraGam®) was not included among the reviewed or recommended therapies. Therefore, while this guideline provides relevant context regarding evidence-supported pharmacologic options for IBS-D, it does not directly provide evidence supporting the use of EnteraGam® for pathophysiologic gastrointestinal conditions. [1] Multiple review articles have evaluated the potential role of SBI in gastrointestinal disorders characterized by impaired intestin...

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

What is the evidence for using EnteraGam to treat pathophysiologic GI conditions?

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

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[1] Lembo A, Sultan S, Chang L, Heidelbaugh JJ, Smalley W, Verne GN. AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Diarrhea. Gastroenterology. 2022;163(1):137-151. doi:10.1053/j.gastro.2022.04.017
[2] Lucak S, Chang L, Halpert A, Harris LA. Current and emergent pharmacologic treatments for irritable bowel syndrome with diarrhea: evidence-based treatment in practice. Ther Adv Gastroenterol. 2017;10(2):253-275. doi:10.1177/1756283X16663396
[3] Petschow BW, Blikslager AT, Weaver EM, et al. Bovine immunoglobulin protein isolates for the nutritional management of enteropathy. World J Gastroenterol. 2014;20(33):11713-11726. doi:10.3748/wjg.v20.i33.11713
[4] Petschow BW, Burnett BP, Shaw AL, Weaver EM, Klein GL. Dietary requirement for serum-derived bovine immunoglobulins in the clinical management of patients with enteropathy. Dig Dis Sci. 2015;60(1):13-23. doi:10.1007/s10620-014-3322-0
[5] Utay NS, Asmuth DM, Gharakhanian S, Contreras M, Warner CD, Detzel CJ. Potential use of serum-derived bovine immunoglobulin/protein isolate for the management of COVID-19. Drug Dev Res. 2021;82(7):873-879. doi:10.1002/ddr.21841.
[6] Petschow BW, Burnett B, Shaw AL, Weaver EM, Klein GL. Serum-derived bovine immunoglobulin/protein isolate: postulated mechanism of action for management of enteropathy. Clin Exp Gastroenterol. 2014;7:181-190.
InpharmD's Answer GPT's Answer

Author:Tai Huynh, PharmD, BCPS + InpharmD™ AI LEARN MORE 

As with many supplements, large-scale, long-term evidence for melatonin is lacking. Current data are limited to several small studies that suggest no definitive increase in adverse effects occurs with prolonged use of melatonin, and suggest that long-term melatonin exposure would not significantly influence endogenous melatonin levels. However, studies are generally characterized by small sample sizes and a lack of comparative design, and effect of melatonin dosage and timing also require fur...

A 2021 international task force expert opinion suggested melatonin is well-tolerated with the most frequent adverse events being headache, dizziness, and nausea; no serious adverse events have been reported. However, as the majority of evidence for melatonin use is short-term, it is unclear how long-term use may impact patient health. [1] A 2023 narrative review examined chronic administration of melatonin, focusing on its physiological and clinical implications. The review collated data from multiple sources, including PubMed and Google Scholar, incorporating both recent and older studies relevant to its subject matter. Melatonin's effectiveness in inducing sleep was detectable though modest for the general population. While optimal dosage remains unspecified, melatonin's short-term adverse effects were noted as minimal and typically resolving upon cessation of use. Moreover, long-term studies did not show significant differences between melatonin and placebo in terms of adverse...

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A search of the published medical literature revealed 4 studies investigating the researchable question:

Is there evidence that long term daily use of melatonin causes harm?

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

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[1] Palagini L, Manni R, Aguglia E, et al. International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders. Front Psychiatry. 2021;12:688890. Published 2021 Jun 10. doi:10.3389/fpsyt.2021.688890
[2] Givler D, Givler A, Luther PM, et al. Chronic Administration of Melatonin: Physiological and Clinical Considerations. Neurol Int. 2023;15(1):518-533. Published 2023 Mar 15. doi:10.3390/neurolint15010031
InpharmD's Answer GPT's Answer

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

Although the current recommended dose of rifaximin for secondary prevention of recurrent overt hepatic encephalopathy is 550 mg twice daily, evidence supports alternative regimens totaling 1,200 mg/day, including 600 mg twice daily and 400 mg three times daily, in selected clinical settings (Tables 1-9). Systematic reviews and meta-analyses have shown that rifaximin 1,200 mg/day, most commonly administered as 400 mg three times daily, is effective for the treatment and prevention of hepatic e...

The 2026 American College of Gastroenterology (ACG) Practice Guideline on Hepatic Encephalopathy recommends rifaximin at the U.S. Food and Drug Administration-approved dose of 550 mg twice daily to reduce the risk of recurrent overt hepatic encephalopathy in adults. The guideline notes that evidence supporting this recommendation includes a randomized controlled trial in which rifaximin 550 mg twice daily, administered for 6 months primarily in combination with lactulose, reduced the risk of breakthrough overt hepatic encephalopathy by 58% and hepatic encephalopathy-related hospitalization by 50% compared with placebo. Additional systematic review and meta-analysis data, as well as post hoc and observational studies, further support the use of rifaximin, particularly in combination with lactulose, for secondary prevention. [1] The European Association for the Study of the Liver (EASL) 2022 guidelines for the management of hepatic encephalopathy recommends rifaximin as an adjunct ...

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

What evidence is there for dosing rifaximin at 600 mg BID or 400 mg TID for hepatic encephalopathy?

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

READ MORE→

[1] Bajaj JS, Jakab SS, Jesudian AB, et al. ACG Clinical Guideline: Hepatic Encephalopathy. Am J Gastroenterol. 2026;121(3):588-618. doi:10.14309/ajg.0000000000003899
[2] European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatic encephalopathy [published correction appears in J Hepatol. 2023 Sep 26;:]. J Hepatol. 2022;77(3):807-824. doi:10.1016/j.jhep.2022.06.001
[3] Yoshiji H, Nagoshi S, Akahane T, et al. Evidence-based clinical practice guidelines for Liver Cirrhosis 2020. J Gastroenterol. 2021;56(7):593-619. doi:10.1007/s00535-021-01788-x
[4] Fang G, Liu S, Liu B. Preventive and therapeutic effects of rifaximin on hepatic encephalopathy with differential application dosages and strategies: a network meta-analysis. BMC Gastroenterol. 2024;24(1):94. Published 2024 Mar 4. doi:10.1186/s12876-024-03184-0
[5] Eltawil KM. Rifaximin vs conventional oral therapy for hepatic encephalopathy: A meta-analysis. WJG. 2012;18(8):767. doi:10.3748/wjg.v18.i8.767
[6] Zacharias HD, Kamel F, Tan J, Kimer N, Gluud LL, Morgan MY. Rifaximin for prevention and treatment of hepatic encephalopathy in people with cirrhosis. Cochrane Database Syst Rev. 2023;7(7):CD011585. Published 2023 Jul 19. doi:10.1002/14651858.CD011585.pub2
[7] Lawrence KR, Klee JA. Rifaximin for the treatment of hepatic encephalopathy. Pharmacotherapy. 2008;28(8):1019-1032. doi:10.1592/phco.28.8.1019
[8] Wu D, Wu SM, Lu J, Zhou YQ, Xu L, Guo CY. Rifaximin versus Nonabsorbable Disaccharides for the Treatment of Hepatic Encephalopathy: A Meta-Analysis. Gastroenterol Res Pract. 2013;2013:236963. doi:10.1155/2013/236963
InpharmD's Answer GPT's Answer

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

Available literature suggests that azithromycin is associated with a risk of myasthenia gravis (MG) exacerbation and, therefore, may not be an ideal agent for meningococcal prophylaxis in patients with MG who are receiving complement inhibitors. Evidence from case reports, retrospective studies, and reviews indicate that azithromycin can impair neuromuscular transmission and has been linked to worsening MG, although a retrospective analysis found that exacerbations occurred in fewer than 2.5%...

The Centers for Disease Control and Prevention (CDC) clinical guidance for managing meningococcal disease risk in patients receiving complement inhibitors does not provide specific recommendations for the choice of medication for meningitis prophylaxis in these patients. The panel recommends administering both MenACWY and MenB vaccines to individuals receiving a complement inhibitor. Ideally, these meningococcal vaccines should be administered at least 2 weeks before starting the complement inhibitor. However, CDC data suggest that meningococcal vaccines may offer incomplete protection against invasive meningococcal disease in individuals receiving the C5 complement inhibitor eculizumab, with a similar risk likely for those on ravulizumab. Most identified infections in eculizumab patients were caused by non-groupable Neisseria meningitidis, which typically does not lead to invasive disease in individuals with normal immune systems. It has been suggested that, in addition to vaccinat...

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A search of the published medical literature revealed 4 studies investigating the researchable question:

What is the risk of myasthenia gravis associated with azithromycin? Based on the risk should it be avoided as an agent used for meningococcal prophylaxis in patients receiving complement inhibitors?

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

READ MORE→

[1] Centers for Disease Control and Prevention. Clinical Guidance for Managing Meningococcal Disease Risk in Patients Receiving Complement Inhibitor Therapy. Accessed June 25, 2026. https://www.cdc.gov/meningococcal/hcp/clinical-guidance/complement-inhibitor.html
[2] Malpica L, van Duin D, Moll S. Preventing infectious complications when treating non-malignant immune-mediated hematologic disorders. Am J Hematol. 2019;94:1396–1412. doi: 10.1002/ajh.25642
[3] Narayanaswami P, Sanders DB, Wolfe G, et al. International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update. Neurology. 2021;96(3):114-122. doi:10.1212/WNL.0000000000011124
[4] Sheikh S, Alvi U, Soliven B, Rezania K. Drugs That Induce or Cause Deterioration of Myasthenia Gravis: An Update. J Clin Med. 2021;10(7):1537. Published 2021 Apr 6. doi:10.3390/jcm10071537
InpharmD's Answer GPT's Answer

Author:Naveed Aijaz, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Intravitreal injections of bevacizumab (Avastin) remain off-label for ophthalmologic conditions, although efficacy has been demonstrated in clinical studies especially vs ranibizumab. Please refer to the selected guidelines and tertiary literature summaries and also to the following tables for primary literature summaries across various ophthalmologic indications: neovascular age-related macular degeneration (nAMD, Tables 1-2), macular edema/central retinal vein occlusion (CRVO, Tables 3-5), ...

According to the 2024 American Academy of Ophthalmology (AAO) Age-Related Macular Degeneration (AMD) Preferred Practice Pattern (PPP), bevacizumab (Avastin) is a full-length monoclonal antibody that binds all isoforms of vascular endothelial growth factor (VEGF). It is Food and Drug Administration (FDA)-approved only for intravenous oncology use but widely used off-label as an intravitreal injection (1.25 mg) for neovascular age-related macular degeneration (nAMD). The key supporting literature includes the landmark CATT trial, which found bevacizumab and ranibizumab had comparable visual acuity improvements with monthly dosing at 1 and 2 years (Table 1), and the IVAN trial (Table 2), which confirmed similar efficacy outcomes. A 2018 meta-analysis of over 8,000 eyes also found bevacizumab and ranibizumab had equivalent efficacy for best-corrected visual acuity (BCVA). Notably, the CATT study did identify a higher rate of serious systemic adverse events with bevacizumab compared to r...

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A search of the published medical literature revealed 13 studies investigating the researchable question:

What literature is available to support bevacizumab use in intravitreal injections? Can biosimilars be used for intravitreal injections?

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

READ MORE→

[1] Vemulakonda GA, Bailey ST, Kim SJ, et al; American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee. Age-related macular degeneration Preferred Practice Pattern®. Ophthalmology. 2025;132(4):P1-P74. doi:10.1016/j.ophtha.2024.12.018.
[2] Kaiser PK, Schmitz-Valckenberg MS, Holz FG. ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR BIOSIMILARS IN OPHTHALMOLOGY. Retina. 2022;42(12):2243-2250. doi:10.1097/IAE.0000000000003626
[3] Tsivitanidou E, Shakeel A, Warda O. The safety and efficacy of anti-vascular endothelial growth factor biosimilars in retinopathy of prematurity. Acta Paediatr. 2026;115(4):806-811. doi:10.1111/apa.70400.
[4] Lynch SS, Cheng CM. Bevacizumab for neovascular ocular diseases. Ann Pharmacother. 2007;41(4):614-625. doi:10.1345/aph.1H316
[5] Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev. 2019;3(3):CD005139. doi:10.1002/14651858.CD005139.pub4

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.


—   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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