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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...

If a patient has a dystonic reaction to haloperidol, is the risk equally or worse for recurrence if the medication is...
Is propranolol an okay choice for a beta blocker when the patient has myasthenia gravis? Or, is there a better beta b...
What evidence is there to support AUC:MIC dosing of vancomycin for CNS infections?
What are current treatment options for Cyclosporiasis for those that have a Bactrim allergy?
Is there literature surrounding the use of surfactant for RDS in pediatric patients besides neonates?

What would you like to ask InpharmD™?

InpharmD's Answer GPT's Answer

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

Available literature suggests that a history of medication-induced acute dystonia is a major risk factor for subsequent dystonic reactions, with some data reporting up to a sixfold increased relative risk. However, the risk of recurrence with re-exposure to the same agent, specifically haloperidol, is not defined. One dated investigation (see Table 1) found that prior extrapyramidal symptoms predicted recurrence during subsequent antipsychotic treatment; among patients who developed dystonia ...

Several review articles suggest that the risk of recurrent acute dystonia is higher in patients with a prior dystonic reaction; however, evidence specifically evaluating recurrence after haloperidol rechallenge is limited. Acute dystonia is a dopamine D2 receptor-blocking agent-induced movement disorder characterized by involuntary muscle contractions that may involve the neck, jaw, eyes (oculogyric crisis), facial muscles, extremities, or other muscle groups. Symptoms typically occur shortly after exposure, with approximately 50% of reactions occurring within 48 hours and 90% within 5 days of initiating therapy or increasing the dose. High-potency antipsychotics, including haloperidol, have a greater risk of causing acute dystonia due to stronger dopamine receptor blockade. Notably, one dated review article notes that a prior acute dystonic reaction is the strongest risk factor for developing another dystonic reaction, with a reported up to six-fold increased relative risk. Additio...

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

If a patient has a dystonic reaction to haloperidol, is the risk equal or worse for recurrence if the medication is attempted to be administered again?

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

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[1] D'Souza RS, Hooten WM. Extrapyramidal Symptoms. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534115/
[2] Vanegas-Arroyave N, Caroff SN, Citrome L, et al. An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders. CNS Drugs. 2024;38(4):239-254. doi:10.1007/s40263-024-01078-z
[3] van Harten PN, Hoek HW, Kahn RS. Acute dystonia induced by drug treatment. BMJ. 1999;319(7210):623-626. doi:10.1136/bmj.319.7210.623
[4] Robottom BJ, Factor SA, Weiner WJ. Movement Disorders Emergencies Part 2: Hyperkinetic Disorders. Arch Neurol. 2011;68(6):719–724. doi:10.1001/archneurol.2011.117
[5] Holloman LC, Marder SR. Management of acute extrapyramidal effects induced by antipsychotic drugs. Am J Health Syst Pharm. 1997;54(21):2461-2477. doi:10.1093/ajhp/54.21.2461
[6] Balon R, Morreale MK, eds. Pocket Guide to Emergent and Serious Adverse Events in Psychopharmacology. American Psychiatric Association Publishing; 2023. doi:10.1176/appi.books.9781615379903
InpharmD's Answer GPT's Answer

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

Current evidence is insufficient to recommend propranolol over other beta-blockers, or to identify a preferred beta-blocker for patients with myasthenia gravis (MG). Available societal guidelines caution that beta-blockers may worsen MG and should be used with caution, but neither distinguishes among individual agents. Available evidence consists primarily of case reports, small clinical studies, pharmacovigilance data, and expert opinion, with conflicting findings regarding the effects of pr...

The 2020 International Consensus Guidance for Management of Myasthenia Gravis and the Myasthenia Gravis Foundation of America (MGFA) Cautionary Drugs List both identify beta-blockers as medications that may worsen myasthenia gravis (MG) and recommend that they be used with caution. Both resources note that beta-blockers are commonly prescribed for conditions such as hypertension, cardiovascular disease, and migraine but may exacerbate MG symptoms. The 2020 International Consensus Guidance further emphasizes that although many medications have been associated with worsening MG, these reports do not necessarily mean such agents should never be prescribed. Reported associations are often rare or may represent coincidental findings, and treatment decisions should be individualized based on clinical judgment and an assessment of the potential risks and benefits. The guideline also notes that the medications included in its cautionary list represent those with the strongest evidence for w...

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

Is propranolol an okay choice for a beta blocker when the patient has myasthenia gravis? Or, is there a better beta blocker choice?

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

READ MORE→

[1] 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
[2] Myasthenia Gravis Foundation of America. Cautionary drug list. Accessed July 9, 2026. https://myasthenia.org/wp-content/uploads/2024/09/MGFA-Cautionary-Drug-List.pdf
[3] Miranda S, Reid DK, John CS. Myasthenia Gravis. N Engl J Med. 2017;376(13):e25. doi:10.1056/NEJMc1701027
[4] Abicht A, Müller JS, Lochmüller H. Congenital Myasthenic Syndromes Overview. 2003 May 9 [Updated 2021 Dec 23]. In: Adam MP, Bick S, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2026. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1168/
[5] 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:Muna Said, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Current evidence and guideline recommendations for vancomycin therapeutic drug monitoring have shifted from traditional peak/trough-based dose adjustments toward area under the curve (AUC)-guided dosing strategies to optimize efficacy while reducing nephrotoxicity risk. Although trough concentrations were previously targeted at 15 to 20 mg/L for serious methicillin-resistant Staphyloccous aureus (MRSA) infections, updated consensus guidelines no longer recommend trough-only monitoring because...

The revised consensus guidelines on 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) were published to provide updated recommendations in regards to specific dosing and monitoring of vancomycin, which was not reflected in the original consensus guidelines published in 2009. Trough-only monitoring, with a target of 15 to 20 mg/L, is no longer recommended based on efficacy and nephrotoxicity data in patients with serious infections due to MRSA. Given the narrow vancomycin area under the curve (AUC) range for therapeutic effect and minimal acute kidney injury (AKI) risk, it is now recommended that the most accurate and optimal way to manage vancomycin dosing is through AUC-guided dosing and monitoring. [1,2...

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

What evidence is there to support AUC:MIC dosing of vancomycin for CNS infections?

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

READ MORE→

[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] 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
[3] 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
[4] Finch NA, Zasowski EJ, Murray KP, et al. A Quasi-Experiment To Study the Impact of Vancomycin Area under the Concentration-Time Curve-Guided Dosing on Vancomycin-Associated Nephrotoxicity. Antimicrob Agents Chemother. 2017;61(12):e01293-17. Published 2017 Nov 22. doi:10.1128/AAC.01293-17
[5] Neely MN, Kato L, Youn G, et al. Prospective Trial on the Use of Trough Concentration versus Area under the Curve To Determine Therapeutic Vancomycin Dosing. Antimicrob Agents Chemother. 2018;62(2):e02042-17. Published 2018 Jan 25. doi:10.1128/AAC.02042-17
[6] Lim AS, Foo SHW, Benjamin Seng JJ, Magdeline Ng TT, Chng HT, Han Z. Area-Under-Curve-Guided Versus Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-Analysis. Ther Drug Monit. 2023;45(4):519-532. doi:10.1097/FTD.0000000000001075
[7] 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
[8] Tsutsuura M, Moriyama H, Kojima N, et al. The monitoring of vancomycin: a systematic review and meta-analyses of area under the concentration-time curve-guided dosing and trough-guided dosing. BMC Infect Dis. 2021;21(1):153. Published 2021 Feb 6. doi:10.1186/s12879-021-05858-6
InpharmD's Answer GPT's Answer

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

Cyclosporiasis treatment options for patients with a sulfonamide (Bactrim/TMP-SMX) allergy are limited, as no alternative has demonstrated efficacy comparable to TMP-SMX. Current CDC guidance states that no highly effective alternative has been identified and suggests symptomatic management, use of an alternative antimicrobial supported by limited evidence, or TMP-SMX desensitization in carefully selected patients with non–life-threatening sulfonamide allergy who require treatment. Available ...

The CDC clinical guidance on clinical care of cyclosporiasis states that no highly effective alternative has been identified for patients with a sulfonamide allergy or intolerance. Potential approaches include observation and symptomatic management, use of an antibiotic supported by limited evidence, or trimethoprim-sulfamethoxazole (TMP-SMX) desensitization in carefully selected patients who require treatment, have been evaluated by an allergist, and do not have a life-threatening allergy. The CDC notes that ciprofloxacin has shown only modest activity in a small study of patients with HIV and has generally been ineffective in immunocompetent patients, while several other antimicrobials, including nitazoxanide, albendazole, azithromycin, doxycycline, metronidazole, tetracycline, tinidazole, and trimethoprim alone, have not demonstrated reliable efficacy. Similarly, the American Family Physician review states that no effective alternative has been identified for patients with sulfa...

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

What are current treatment options for Cyclosporiasis for those that have a Bactrim allergy?

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

READ MORE→

[1] Centers for Disease Control and Prevention (CDC). Clinical care of cyclosporiasis. Updated March 8, 2024. Accessed July 9, 2026. https://www.cdc.gov/cyclosporiasis/hcp/clinical-care/index.html
[2] Kucik CJ, Martin GL, Sortor BV. Common intestinal parasites. Am Fam Physician. 2004;69(5):1161-1168.
[3] Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV. National Institutes of Health; HIV Medicine Association; Infectious Diseases Society of America. Updated May 27, 2026. Accessed July 9, 2026.
[4] La Hoz RM, Morris MI; AST Infectious Diseases Community of Practice. Intestinal parasites including Cryptosporidium, Cyclospora, Giardia, and Microsporidia, Entamoeba histolytica, Strongyloides, Schistosomiasis, and Echinococcus: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13618. doi:10.1111/ctr.13618
[5] Giangaspero A, Gasser RB. Human cyclosporiasis. Lancet Infect Dis. 2019;19(7):e226-e236. doi:10.1016/S1473-3099(18)30789-8
[6] Li J, Wang R, Chen Y, Xiao L, Zhang L. Cyclospora cayetanensis infection in humans: biological characteristics, clinical features, epidemiology, detection method and treatment. Parasitology. 2020;147(2):160-170. doi:10.1017/S0031182019001471
InpharmD's Answer GPT's Answer

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

Surfactant therapy has been investigated in pediatric patients with respiratory distress syndrome (RDS) beyond the neonatal period, with available studies suggesting potential improvements in oxygenation and respiratory outcomes. However, evidence remains limited by small sample sizes, heterogeneous patient populations (ages ranging up to 21 years), and variability in surfactant formulations, dosing regimens, and administration strategies.

A 2008 review of surfactant therapy for pediatric acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) described encouraging findings from controlled studies in children up to 21 years of age. Early studies evaluating intratracheal surfactant administration demonstrated improvements in oxygenation, with some reports of reduced ventilator days and intensive care unit length of stay (see Tables 1-2). A subsequent multicenter randomized controlled trial (see Table 3) evaluated calfactant (Infasurf®) in 153 pediatric patients with ALI/ARDS (age range, 1 week to 21 years) and found that surfactant therapy resulted in improved oxygenation, reduced oxygenation index, decreased mortality, and improved response to conventional mechanical ventilation compared with placebo. However, benefits appeared greatest among patients with direct lung injury forms of ALI/ARDS, and differences in study design, patient populations, and disease severity limited the generalizability of find...

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

Is there literature surrounding the use of surfactant for RDS in pediatric patients besides neonates?

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

READ MORE→

[1] Willson DF, Chess PR, Notter RH. Surfactant for pediatric acute lung injury. Pediatr Clin North Am. 2008;55(3):545-ix. doi:10.1016/j.pcl.2008.02.016
[2] Ren X, Jiang Q, Wang L, Yuan X, Chen D, Xu G. Safety and efficacy of pulmonary surfactant therapy for acute respiratory distress syndrome in children: a systematic review and meta-analysis. BMC Pulm Med. 2025;25(1):250. Published 2025 May 21. doi:10.1186/s12890-025-03728-4

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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