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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 is the severity of the drug interaction between meropenem and valproic acid? If use is required concurrently, wh...
Please summarize the evidence for IV push cefepime including clinical outcomes and instructions for reconstitution an...
What is the stability data of cefepime and vancomycin in peritoneal fluid for intraperitoneal administration?
The recommendation for a fluid bolus in a septic patient is 30 mL/kg. Is there any evidence that supports rounding do...
What is the allergy cross-reactivity risk between meropenem and ampicillin?

What would you like to ask InpharmD™?

InpharmD™'s Answer GPT's Answer

Author: Brenda Nguyen, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

See Tables 3-6 for a summary of case reports describing the occurrence of seizures as a result of decreased serum valproic acid concentrations during concomitant use with meropenem. Seizures typically stopped and valproic acid concentrations increased to therapeutic levels once meropenem was discontinued. In general, if concomitant administration of valproic acid and meropenem (or other carbapenems) is necessary, very close monitoring and dose adjustment of valproic acid is recommended to avo...

A 2020 review article provided relevant pharmacokinetic and follow-up studies regarding the interaction between carbapenems and valproic acid. One cited pharmacokinetic study of 36 patients reported a continual decrease in valproic acid concentrations for up to 7 days after discontinuing meropenem, which then gradually increased to baseline concentrations after 8 to 14 days. In general, the effects seem to last for 7 days, followed by a 7- to 14-day recovery period after stopping carbapenem, suggesting an interaction via enzyme inhibition. [1,2] A 2018 review notes that the majority of data describing drug interactions of valproic acid and carbapenems are based primarily on case reports and retrospective studies. The mechanism responsible for the interaction between valproic acid and carbapenems is largely unknown, but it is thought that carbapenems act by inhibiting the activity of the acylpeptide hydrolase enzyme that converts valproic acid-glucuronide to valproic acid. This le...

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A search of the published medical literature revealed 6 studies investigating the researchable question:

What is the severity of the drug interaction between meropenem and valproic acid? If use is required concurrently, what steps should clinicians take to ensure patient does not have a breakthrough seizures (increasing valproic acid dose, adding another agent etc.)

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

READ MORE→

[1] Al-Quteimat O, Laila A. Valproate Interaction With Carbapenems: Review and Recommendations. Hosp Pharm. 2020;55(3):181-187. doi:10.1177/0018578719831974
[2] Haroutiunian S, Ratz Y, Rabinovich B, Adam M, Hoffman A. Valproic acid plasma concentration decreases in a dose-independent manner following administration of meropenem: a retrospective study. J Clin Pharmacol. 2009;49(11):1363-1369. doi:10.1177/0091270009334377
[3] John R. Horn P, Philip D. Hansten P. Valproic acid and carbapenem antibiotics interaction. Pharmacy Times. 2018;84(10)

InpharmD™'s Answer GPT's Answer

Author: Younghee Kwon, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

See Table 1 for recommendations of IV antibiotic push dosing and reconstitution. IV push cefepime appears to have a similar rate of treatment response to IV piggyback while benefiting from a significantly lower time to administration. However, data appears limited in the critically ill population.

A 2023 study abstract describes the effectiveness of intravenous push (IVP) versus extended infusion (EI) cefepime in hematopoietic stem cell transplant (HSCT) recipients with neutropenic fever. The retrospective analysis included 120 patients, with 40 receiving IVP cefepime and 80 receiving EI cefepime for at least 48 hours. The primary outcome, defervescence at 72 hours, occurred in 70% of IVP patients and 63.8% of EI patients, which was not statistically significant. Secondary outcomes, including 30-day in-hospital mortality, ICU transfer within 72 hours, ICU length of stay, hospital length of stay, breakthrough infection, and escalation of gram-negative therapy within 72 hours, were also similar between the two groups. The study concluded that no significant differences in clinical outcomes were observed when administering cefepime as IVP or EI for the treatment of neutropenic fever in HSCT recipients. [1]

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

What is the evidence for IV push cefepime including clinical outcomes and instructions for reconstitution and administration?

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

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[1] Rust TJ, Krause TM, Saw S. 2562. Retrospective analysis of cefepime intravenous push versus extended infusion for the treatment of neutropenic fever. Open Forum Infectious Diseases. 2023;10(Supplement_2):ofad500.2179. doi: 10.1093/ofid/ofad500.2179

InpharmD™'s Answer GPT's Answer

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

INTRODUCTION BY INPHARMD™ RESEARCHER

Cefepime generally maintains over 90% of its concentration for 7 days at 4°C and 4 days at 25°C in pH-neutral peritoneal fluid solutions, with a significant decline to 12 hours at 37°C. In contrast, vancomycin demonstrates greater stability, remaining stable for 28 days at room temperature and for 14 days in both icodextrin and dextrose-based solutions when stored at 4°C and 25°C. At 37°C, vancomycin’s stability ranges from 1 to 4 days, depending on the specific solution. For more details o...

The 2022 International Society for Peritoneal Dialysis (ISPD) guideline provides recommendations on prevention and treatment of peritonitis. It was emphasized that the stability and compatibility of antibiotics in peritoneal dialysis (PD), as described in a 2022 review article, is one of the factors influencing treatment success. The panel states that cefepime remains stable for 14 days in dextrose-based PD solutions when refrigerated, while vancomycin is stable for 28 days at room temperature, though higher ambient temperatures reduce its stability. Additionally, vancomycin’s stability in icodextrin-based PD solutions has been confirmed for 14 days at both 4°C and 25°C. [1-5] According to a 2022 review article on stability and compatibility of antibiotics in PD solutions, cefepime is less commonly used for PD-related peritonitis compared to other cephalosporins, and stability data for intraperitoneal (IP) administration is limited. Cefepime 312.5 mg in a 1.25 L bicarbonate compa...

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

What is the stability data of cefepime and vancomycin in peritoneal fluid for intraperitoneal administration?

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

READ MORE→

[1] Li PK, Chow KM, Cho Y, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment [published correction appears in Perit Dial Int. 2023 May;43(3):279. doi: 10.1177/08968608231166870] [published correction appears in Perit Dial Int. 2024 May;44(3):223. doi: 10.1177/08968608241251453]. Perit Dial Int. 2022;42(2):110-153. doi:10.1177/08968608221080586
[2] So SWY, Chen L, Woo AYH, et al. Stability and compatibility of antibiotics in peritoneal dialysis solutions. Clin Kidney J. 2022;15(6):1071-1078. Published 2022 Jan 17. doi:10.1093/ckj/sfac012
[3] William...

InpharmD™'s Answer GPT's Answer

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

INTRODUCTION BY INPHARMD™ RESEARCHER

Studies comparing restrictive versus standard fluid administration in adult septic patients have generally reported similar outcomes in mortality and serious adverse events, suggesting that a lower fluid dose may be an acceptable strategy in critical care. However, direct comparisons specifically between the 30 mL/kg dose recommended by the Surviving Sepsis Campaign (SSC) and rounding down to 500 mL or 1,000 mL are more limited. The 30 mL/kg fluid bolus recommendation has also been criticized...

The recommendation for a 30 mL/kg crystalloid fluid bolus in a septic patient was established by the Surviving Sepsis Campaign (SSC), with the current guidelines published in 2018 still recommending the bolus regimen (strong recommendation, low quality of evidence). Since its publication, reviews and commentaries from real world settings note the minimal supporting clinical data and reliance on expert opinion for this recommendation. These reviews suggest that the 30 mL/kg fluid challenge can needlessly expose patients to large volumes of fluid, and could actually be harmful by overloading organ function and paradoxically worsening shock. Other guidelines like American College of Emergency Physicians (ACEP) recommend individualizing fluid resuscitation needs for each patient. [1-3] A 2020 review discussing the lack of supporting evidence for fluid resuscitation in septic shock recommends a flat initial bolus of 500 mL of balanced crystalloid solutions, followed by monitoring of p...

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

The recommendation for a fluid bolus in a septic patient is 30 mL/kg. Is there any evidence that supports rounding down to the nearest 500 mL or 1000 mL?

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

READ MORE→

[1] Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med. 2018;44(6):925-928. doi:10.1007/s00134-018-5085-0
[2] Marik PE, Byrne L, van Haren F. Fluid resuscitation in sepsis: the great 30 mL per kg hoax. J Thorac Dis. 2020;12(Suppl 1):S37-S47. doi:10.21037/jtd.2019.12.84
[3] Spiegel R, Hockstein M, Waters J, Goyal M. The Survival of the Surviving Sepsis Campaign. Med Clin North Am. 2022;106(6):1109-1117. doi:10.1016/j.mcna.2022.08.006
[4] MacGillivray N. Dr Latta of Leith: pioneer in the treatment of cholera by intravenous saline infusion. J ...

InpharmD™'s Answer GPT's Answer

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

INTRODUCTION BY INPHARMD™ RESEARCHER

While data specific to cross-reactivity between meropenem and ampicillin is lacking, existing guidelines suggest that carbapenems can be administered to patients with a history of penicillin or cephalosporin allergy without the need for additional testing, even in cases of prior anaphylactic reactions. The overall incidence of carbapenem allergy is low, with clinical cross-reactivity rates between carbapenems and penicillins generally reported to be less than 1%. This suggests that meropenem ...

The American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American College of Allergy, Asthma, and Immunology (ACAAI) developed the 2022 practice parameter update on drug allergies, which addresses the topic of beta-lactam cross-reactivity. It was highlighted that guidance on administering carbapenems to patients with penicillin allergy has changed since the previous drug allergy practice parameter update. Though not specific to ampicillin, the panel suggests that in patients with a history of penicillin or cephalosporin allergy, carbapenems may be administered without testing or additional precautions, even in cases where the previous reaction was anaphylactic (conditional recommendation, moderate certainty of evidence). [1] The reported incidence of carbapenem allergy ranges from 0.3% to 3.7%. Clinical cross-reactivity between carbapenems and other beta-lactams is low, with multiple review articles reporting a cross-sensitivity risk of less than 1% between penicil...

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A search of the published medical literature revealed 6 studies investigating the researchable question:

In patients with true allergy to penicillin, what is the chance of cross-reactivity with meropenem?

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

READ MORE→

[1] Khan DA, Banerji A, Blumenthal KG, et al. Drug allergy: A 2022 practice parameter update. J Allergy Clin Immunol. 2022;150(6):1333-1393. doi:10.1016/j.jaci.2022.08.028
[2] Kula B, Djordjevic G, Robinson JL. A systematic review: can one prescribe carbapenems to patients with IgE-mediated allergy to penicillins or cephalosporins? [published correction appears in Clin Infect Dis. 2015 Jan 1;60(1):175] [published correction appears in Clin Infect Dis. 2015 Jan 1;60(1):175. doi: 10.1093/cid/ciu858]. Clin Infect Dis. 2014;59(8):1113-1122. doi:10.1093/cid/ciu587
[3] Picard M, Robitaille G, K...

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’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 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.


     

Wow. . Just wow.


     

Answers are evidence based and help me make clinical decisions. Quick turn around time for some urgent questions.


     

Was bragging about you and your outstanding business the other day while on vacation. I recently used your service and was blown away at how fast and thorough I got your response


     

It would be helpful to provide a discussion of the questions frequently submitted to InpharmD. Other than that it is excellent, please keep it up!


     

A must have resource for evidence based medicine!


     

All information provided is up to date.


     

Provides a good summary of information with citations.


     

Answers clinically relevant questions with quick responses.


     

The review of evidence provided is excellent.


     

I find the vaccination guideline information the most useful.


     

The tables provided from the studies used to formulate the responses are very helpful for review.


     

It is helpful that InpharmD provides indications to treat adverse effects of various drugs in similar classes.


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