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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.

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This is how InpharmD™ transforms LITERATURE.

What's Being Asked...

Are there recommendations for IV or PO methylprednisolone dosing for cauda equina syndrome?
What is the dose of octreotide for carcinoid crisis associated with neuroendocrine tumor?
What medication is most similar to Qelbree (viloxazine)?
When should intravenous alteplase be used for frostbite injury?
Is there any information about the use of remimazilam in patients with mitochondrial disorders?

What would you like to ask InpharmD™?

InpharmD's Answer GPT's Answer

Author: Dylan Brown, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

Methylprednisolone regimens for management of cauda equina syndrome widely vary in dose and duration, and are primarily derived from case reports (see Tables 1-4). Treatment strategies mainly consist of intravenous administration, ranging from 250 mg to 1 g daily, with adjunct pharmacotherapy (e.g., oral prednisone, intrathecal methylprednisolone) provided, thus limiting consensus on the most optimal dosing for this patient population.

Clinical trials evaluating the use of methylprednisolone in the management of spinal cord injuries have studied various dosage regimens. One of the first clinical trials, the National Acute Spinal Cord Injury Study (NASCIS 1, published in 1984), compared methylprednisolone given as a 100 mg bolus followed by 25 mg every 6 hours for 10 days versus 1,000 mg bolus followed by 250 mg every 6 hours for 10 days. No difference in observed improvements occurred between the high- and low-dose groups, but there was a significantly increased incidence of wound infections in the high-dose group (9.3% vs. 2.6%) as well as a slightly higher incidence of sepsis, pulmonary embolism, and death within 14 days. In the subsequent trial (NASCIS II, published in 1990), patients received methylprednisolone as a 30 mg/kg bolus followed by 5.4 mg/kg for 23 hours, which was found to produce similar effects on motor and sensory scores compared to naloxone 5.4 mg/kg bolus followed by 0.5 mg/kg/h for 23 hours a...

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

Are there recommendations for IV or PO methylprednisolone dosing for cauda equina syndrome?

Level of evidence
D - Case reports or unreliable data  

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[1] Cheung V, Hoshide R, Bansal V, Kasper E, Chen CC. Methylprednisolone in the management of spinal cord injuries: Lessons from randomized, controlled trials. Surg Neurol Int. 2015;6:142. Published 2015 Aug 24. doi:10.4103/2152-7806.163452
[2] Bracken MB, Collins WF, Freeman DF, et al. Efficacy of methylprednisolone in acute spinal cord injury. JAMA. 1984;251(1):45-52.
[3] Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N...

InpharmD's Answer GPT's Answer

Author: Rachel Deryck, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

Octreotide dosing for carcinoid crisis associated with neuroendocrine tumors varies based on clinical presentation and procedural context. For acute episodes, intravenous boluses of 100-500 mcg can be administered and repeated as needed, followed by continuous infusion at 50-300 mcg/h or higher in severe cases. The optimal dosing of octreotide to prevent carcinoid crisis remains unclear; however, prophylactic administration before surgery is common, with regimens such as 50-100 mcg/h IV infus...

A 2017 consensus guideline from the European Neuroendocrine Tumor Society (ENETS) explored the optimal pre- and perioperative management of patients with neuroendocrine tumors (NETs), emphasizing the prevention of complications like carcinoid syndrome and carcinoid crisis. The optimal dosing of octreotide to prevent carcinoid crisis remains unclear. Intravenous (IV) octreotide reverses rapid crisis and is the cornerstone of prophylaxis, replacing older therapies. For patients on long-acting somatostatin analogs, these should be continued. No standard regimen exists, but for minor procedures, subcutaneous octreotide (100–200 mcg, 2–3 times/day) may suffice, with IV infusions available if needed. For major operations, subcutaneous octreotide (100 mcg, 3 times/day for 2 weeks) or IV octreotide starting at 50–100 mcg/h (mean 100–200 mcg/h) is commonly used, initiated 12 hours before surgery and continued for 48 hours postoperatively. Doses up to 500 mcg/h may be required for severe symp...

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

How best to dose octreotide for carcinoid crisis associated with neuroendocrine tumor?

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

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[1] Kaltsas G, Caplin M, Davies P, et al. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Pre- and Perioperative Therapy in Patients with Neuroendocrine Tumors. Neuroendocrinology. 2017;105(3):245-254. doi:10.1159/000461583
[2] National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Neuroendocrine and Adrenal Tumors. Version 2.2024. Updated August 1, 2024. Accessed December 3, 2024. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1448
[3] Oberg K, Kvols L, Caplin M, et al. Consensus report on the use of so...

InpharmD's Answer GPT's Answer

Author: Rachel Deryck, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

Limited data suggests that viloxazine ER is most similar to atomoxetine among FDA-approved non-stimulant ADHD medications, as both are serotonin-norepinephrine reuptake inhibitors. While direct comparisons are scarce, one small crossover trial indicated viloxazine ER may offer greater improvements in ADHD symptoms and tolerability (Table 1). Unlike atomoxetine, which is effective for anxiety disorders, viloxazine ER has demonstrated antidepressant activity, potentially benefiting patients wit...

Viloxazine (Qelbree) became only the second nonstimulant FDA-approved medication for treatment of attention-deficit/hyperactivity disorder (ADHD) in adults in 2022, following atomoxetine, another serotonin-norepinephrine reuptake inhibitor. In pediatric patients, viloxazine extended release (ER) was approved in 2021 for treatment of ADHD in patients aged 6 to 17 years; additionally, clonidine ER and guanfacine ER may also be utilized as nonstimulant options in children. While most studies have investigated the efficacy and safety of viloxazine ER compared to placebo, one open-label crossover trial compared viloxazine ER versus atomoxetine in 50 patients (35 children and 15 adults; see Table 1). The study revealed significantly greater improvement with viloxazine ER in several efficacy endpoints, including change in ADHD-Rating Scale-5 or Adult ADHD Investigator Symptom Rating Scale (AISRS) total and inattention and hyperactivity subscale scores from baseline. Fewer patients also dis...

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

What other med is most similar to Qelbree (viloxazine)?

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

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[1] Newcorn JH, Krone B, Dittmann RW. Nonstimulant Treatments for ADHD. Child Adolesc Psychiatr Clin N Am. 2022;31(3):417-435. doi:10.1016/j.chc.2022.03.005
[2] Childress A, Sottile R, Khanbijian S. Viloxazine extended-release capsules for the treatment of attention-deficit/ hyperactivity disorder in adult patients. Expert Rev Neurother. 2023;23(11):945-953. doi:10.1080/14737175.2023.2265068
[3] Radonjić NV, Bellato A, Khoury NM, Cortese S, Faraone SV. Nonstimulant Medications for Attention-Deficit/Hyperactivity Disorder (ADHD) in Adults: Systematic Review and Meta-analysis. CNS Drugs. 20...

InpharmD's Answer GPT's Answer

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

INTRODUCTION BY INPHARMD™ RESEARCHER

Consensus guidelines recommend thrombolytic therapy with tissue plasminogen activator (tPA) within 24 hours of thawing for severe frostbite injuries extending to the proximal interphalangeal joints or beyond. Early administration, preferably within 12 hours, is associated with improved tissue salvage and reduced amputation risk. Current treatment protocols emphasize concurrent heparin use and imaging to guide therapy, with careful monitoring in appropriate medical facilities. Clinical evidenc...

Per the Wilderness Medical Society clinical practice guidelines for the prevention and treatment of frostbite, thrombolytic therapy with tissue plasminogen activator (tPA) should be administered either intravenously (IV) or intra-arterially, within 24 hours of tissue thawing. Therapy with tPA has demonstrated potential to salvage tissue, with retrospective studies showing significant reductions in amputation rates. Emerging evidence suggests the importance of early intervention, ideally within 12 hours, as delays may substantially decrease tissue salvage efficacy. Due to the potential risks associated with tPA (systemic and catheter site bleeding, compartment syndrome, and failure to salvage tissue), a risk-benefit analysis is essential before initiating thrombolytic therapy, which is recommended only for deep frostbite injuries extending to the proximal interphalangeal joints of digits or more proximally. Additionally, current protocols advocate a tPA bolus followed by continuous i...

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

What data is available for using alteplase in management of frost bite?

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

READ MORE→

[1] McIntosh SE, Freer L, Grissom CK, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update. Wilderness Environ Med. 2019;30(4S):S19-S32. doi:10.1016/j.wem.2019.05.002
[2] Drinane J, Kotamarti VS, O'Connor C, et al. Thrombolytic Salvage of Threatened Frostbitten Extremities and Digits: A Systematic Review. J Burn Care Res. 2019;40(5):541-549. doi:10.1093/jbcr/irz097

InpharmD's Answer GPT's Answer

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

INTRODUCTION BY INPHARMD™ RESEARCHER

Several case reports describe the successful use of remimazolam for induction of anesthesia in adult and pediatric patients with mitochondrial disorders (Tables 1-8), with infusions and bolus amounts widely ranging. Given the scarcity of data on the use of remimazolam in this patient population, however, further robust research is needed to clarify its efficacy and safety.

Several review articles detail the pharmacological attributes, clinical applications, and safety of remimazolam, a novel benzodiazepine recognized for its ultra-short action, rapid onset, and predictable recovery profile with minimal side effects. Available review of literature synthesized data from various studies to highlight remimazolam's utility in various patient populations, including patients with mitochondrial myopathy, encephalopathy, lactic acidosis, stroke-like episodes (MELAS) syndrome for diverse medical procedures. Ongoing investigations are exploring the optimal dosing of remimazolam in critical care contexts, particularly for pediatric and high-risk patient populations. However, significant research is warranted to fine-tune dosing regimens that maximize remimazolam's efficacy while minimizing risks, particularly in vulnerable groups such as those with MELAS syndrome, where careful sedation management is imperative. Given the available literature evaluating the use o...

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A search of the published medical literature revealed 8 studies investigating the researchable question:

Is there any information about the use of remimazilam in patients with mitochondrial disorders?

Level of evidence
D - Case reports or unreliable data  

READ MORE→

[1] Hu Q, Liu X, Wen C, Li D, Lei X. Remimazolam: An Updated Review of a New Sedative and Anaesthetic. Drug Des Devel Ther. 2022;16:3957-3974. Published 2022 Nov 15. doi:10.2147/DDDT.S384155
[2] Kuklin V, Hansen TG. Remimazolam for sedation and anesthesia in children: A scoping review. Acta Anaesthesiol Scand. 2024;68(7):862-870. doi:10.1111/aas.14439

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 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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