InpharmD™





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What is InpharmD™?


Literature searching is tedious. InpharmD™ is here to help.

Healthcare providers can ask any question, anytime, from anywhere, and we’ll perform a custom literature search.

(And a 32% chance it’s already been asked.)


Average hours saved per day

Average journal articles summarized per literature search

Estimated improvement in healthcare decision-making

This is how InpharmD transforms LITERATURE.

What's Being Asked...

Find answers, not documents.

Can venetoclax be crushed? If so, how long is the drug stable for?
I am helping someone with a clinical question from an outpatient center. It is a behavior health center and the quest...
What is the safety and efficacy data to support methocarbamol use in pediatric patients (specifically < 16 years old)?
What new data exists from 2024 that demonstrates the effectiveness of nirsevimab in preventing hospitalization in inf...
What is the role of droxydopa for vasopressor weaning in critically ill patients?

What would you like to ask InpharmD?

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InpharmD's Answer GPT's Answer

Author: AJ Carvajal, PharmD, BCPS + InpharmD AI

INTRODUCTION BY INPHARMD RESEARCHER

The package insert for venetoclax states not to chew, crush, or break tablets prior to swallowing. However, crushing venetoclax has been attempted in limited studies, including a crossover study reporting similar bioavailability and plasma concentrations between crushed and intact venetoclax tablets. This was contradicted in a 2022 case report which described elevated plasma concentrations in a patient using crushed venetoclax tablets, which was thought to lead to neutropenia. Stability data ...

A 2023 review article discussed the clinical pharmacokinetics and pharmacodynamics of venetoclax, a BCL-2 inhibitor approved for various hematological malignancies. Venetoclax is noted to have challenging physicochemical properties as it has low aqueous solubility. This has posed challenges for drug formulation and administration. The impact of crushing or grinding venetoclax tablets on its bioavailability was evaluated in a three-way, crossover study in healthy adults (see Table 1). Crushed and finely ground venetoclax tablets had similar bioavailability to intact venetoclax tablets, with only a slightly lower peak plasma concentration, which was not considered clinically significant. Therefore, the authors consider crushing or grinding venetoclax tablets to be a viable alternative method of administration for patients who have difficulty swallowing whole tablets. [1] A 2022 case report describes a 74-year-old man with acute myeloid leukemia (AML) who experienced increased bloo...

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

Can venetoclax be crushed? If so, how long is the drug stable for?

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

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[1] Salem AH, Menon RM. Clinical pharmacokinetics and pharmacodynamics of venetoclax, a selective B-cell lymphoma-2 inhibitor. Clin Transl Sci. 2024;17(5):e13807. doi:10.1111/cts.13807
[2] Anzai M, Yasu T, Gando Y, Shirota M, Kobayashi M. Increased blood levels of venetoclax due to intake of crushed venetoclax tablets. Ann Hematol. 2022;101(9):2097-2098. doi:10.1007/s00277-022-04871-2
[3] Marinoff AE, Aaronson K, Agrawal AK, et al. Venetoclax in combination with chemotherapy as treatment for pediatric advanced hematologic malignancies. Pediatric Blood & Cancer. 2023;70(6):e30335. doi:10.1...

InpharmD's Answer GPT's Answer

Author: Sunita Pirmal, PharmD, BCPS + InpharmD AI

INTRODUCTION BY INPHARMD RESEARCHER

Literature on the concomitant use of psychedelics (such as LSD, psilocybin, and MDMA) and antidepressants or antipsychotics is limited to pharmacokinetic trials and systematic reviews, mostly based on clinical trials with healthy patients or case reports. MDMA imparts its effect on serotonin, norepinephrine, and dopamine, while psilocybin and LSD impact serotonergic neurotransmission, resulting in the potential for serotonin syndrome when these agents are coadministered with antidepressants.

Mechanistically, 3,4-methylenedioxymethamphetamine (MDMA) is described as an amphetamine derivative, operating in 2 different mechanisms to increase the central nervous system's serotonin concentration. At a typical dose of 1.7 mg/kg, MDMA promotes serotonin neuronal efflux by altering the chemical gradient that moves serotonin away from the intercellular space and influences the same reuptake transporter used by serotonin reuptake inhibitors (SSRIs). Additionally, MDMA is metabolized by and can inhibit CYP2D6 which allows some SSRIs to have the potential to inhibit MDMA metabolism. However, there is a lack of data investigating the drug-drug interaction (DDI) between SSRIs and MDMA given the potential of both drugs to raise synaptic cleft serotonin levels and the potential pharmacokinetic interaction if the SSRI is a potent CYP450 2D6 inhibitor. It has been proposed that many of the symptoms of MDMA toxicity may overlap with serotonin syndrome. This may result in some cases of sero...

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

What is the harm (from a drug-drug interaction standpoint) in patients who choose to take either LSD, Psilocybin, or MDMA alongside their antidepressant or antipsychotic medication?

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

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[1] Dobry Y, Rice T, Sher L. Ecstasy use and serotonin syndrome: a neglected danger to adolescents and young adults prescribed selective serotonin reuptake inhibitors. Int J Adolesc Med Health. 2013;25(3):193-199. doi:10.1515/ijamh-2013-0052
[2] Sarparast A, Thomas K, Malcolm B, Stauffer CS. Drug-drug interactions between psychiatric medications and MDMA or psilocybin: a systematic review. Psychopharmacology (Berl). 2022;239(6):1945-1976. doi:10.1007/s00213-022-06083-y
[3] Halman A, Kong G, Sarris J, Perkins D. Drug-drug interactions involving classic psychedelics: A systematic review. J ...

InpharmD's Answer GPT's Answer

Author: Neil Patel, PharmD, BCPS + InpharmD AI

INTRODUCTION BY INPHARMD RESEARCHER

While some societies and expert recommendations suggest that use of muscle relaxants like methocarbamol is reasonable in pediatric patients, data is limited regarding the use of methocarbamol. Available studies for surgical pain and cerebral palsy suggest methocarbamol may potentially improve clinical parameters without significant adverse outcomes, with use in pediatric post-surgery patients limited to an adjunct role for analgesic treatment. More robust data, as well as further research wit...

While a few articles from medical organizations and expert societies briefly discuss the use of methocarbamol in pediatric surgical patients, there remains a notable lack of robust evidence supporting their use. One study examining spinal fusion surgeries for pediatric patients with idiopathic scoliosis proposed intravenous (IV) methocarbamol at 15 mg/kg (up to 1000 mg) Q8H, transitioning to an oral formulation of 500-1000 mg Q8H. However, the author acknowledged the absence of systematic research evaluating its efficacy for pain relief. Similarly, other articles provided comparative dosing suggestions for utilizing muscle relaxants to manage intraoperative pain in children, despite little supporting data. Overall, it appears guidance statements are primarily based on expert opinion, highlighting the need for more rigorous investigations in pediatric surgical populations. [1-3] A 2021 systematic review summarized outcomes associated with post-operative analgesia after posterior sp...

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

What is the safety and efficacy data to support methocarbamol use in pediatric patients (specifically less than 16 years old)?

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

READ MORE→

[1] Lee CS, Merchant S, Chidambaran V. Postoperative Pain Management in Pediatric Spinal Fusion Surgery for Idiopathic Scoliosis. Paediatr Drugs. 2020;22(6):575-601. doi:10.1007/s40272-020-00423-1
[2] Gal DB, Clyde CO, Colvin EL, et al. Management of routine postoperative pain for children undergoing cardiac surgery: a Paediatric Acute Care Cardiology Collaborative Clinical Practice Guideline. Cardiol Young. 2022;32(12):1881-1893. doi:10.1017/S1047951122003559
[3] Mavi J. Update of postoperative pain management following pectus excavatum repair. SOJAPM. 2014;1(1). doi: 10.15226/2374-684X/...

InpharmD's Answer GPT's Answer

Author: Tai Huynh, PharmD, BCPS + InpharmD AI

INTRODUCTION BY INPHARMD RESEARCHER

A recently published follow-up study to the MELODY trial in infants who received a single dose of nirsevimab during their first respiratory syncytial virus (RSV) season reported no increase in incidence of RSV lower respiratory tract infections or hospitalization due to RSV. Pooled data reporting immunization efficacy in a 2024 meta-analysis similarly found an 88.4% effectiveness rate associated with nirsevimab administration when assessing the incidence of hospital admission due to RSV, furt...

A meta-analysis (N= 45,238 patients) published in 2024 analyzed five randomized controlled trials (RCTs), seven real-world reports, and one official report from health authorities to determine the efficacy of nirsevimab in the prevention of lower respiratory tract diseases (LRTD) secondary to respiratory syncytial virus (RSV) in children and newborns. Studies included patients aged <2 years who had at least one dose of nirsevimab for RSV prevention. Pooled data assessing the incidence of hospital admission due to RSV led to an immunization efficacy of 88.40% (95% confidence interval [CI] 84.70% to 91.21%). However, immunization efficacy waned and the risk of breakthrough infections increased as observation time continued. A higher risk of breakthrough infections in studies with observation times ≥150 days versus <150 days was seen (risk ratio [RR] 2.170; 95% CI 1.860 to 2.532), with findings contradicted by a meta-regression analysis on the effect of observation time on immunizatio...

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

What new data exists from 2024 that demonstrates the effectiveness of nirsevimab in preventing hospitalization in infants due to RSV?

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

READ MORE→

[1] Riccò M, Cascio A, Corrado S, et al. Impact of Nirsevimab Immunization on Pediatric Hospitalization Rates: A Systematic Review and Meta-Analysis (2024). Vaccines (Basel). 2024;12(6):640. Published 2024 Jun 8. doi:10.3390/vaccines12060640

InpharmD's Answer GPT's Answer

Author: Naveed Aijaz, PharmD, BCPS + InpharmD AI

INTRODUCTION BY INPHARMD RESEARCHER

Limited data from retrospective studies and case reports suggest droxidopa may be safe and effective for hypotension in critical care patients. However, there is a lack of direct comparisons except for one study that did not find a difference between using atomoxetine, droxidopa, or both agents. Treatments in this study would differ based on the providers' discretion, and critically ill patients may have presented with confounding factors that were not controlled.

A 2024 poster abstract describes a study that evaluated the safety and effectiveness of droxidopa administered through gastric tubes in adult intensive care patients. A total of 21 patients met the criteria to be included in the analysis. The median age was 62 years old, with 33% being female. Most patients (80.5%) were admitted to a cardiac ICU. The most common reason for admission was heart transplantation, which accounted for 19% of cases. The most common starting dose of droxidopa was 100 mg administered every 8 hours. The maximum dose used was 600 mg every 8 hours. Prior to starting droxidopa, all patients had tried at least one adjunct agent to help wean off vasopressors, including midodrine (100%), pseudoephedrine (52%), fludrocortisone (48%), and pyridostigmine (9.5%). A total of 954 doses of droxidopa were administered via gastric tubes during the study period. The most frequent type of gastric tube used was nasogastric tubes, making up 57% of administrations. The primary o...

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

What is the role of droxydopa for vasopressor weaning in critically ill patients?

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

READ MORE→

[1] Webb A, Lauren Casal G, Culshaw J, et al. 940: safety and effectiveness of droxidopa administration for persistent hypotension via gastric tube. Critical Care Medicine. 2024;52(1):S442. doi: 10.1097/01.ccm.0001001924.44320.37

What They're Saying...

Read some reviews from our users below:


     

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., APP, 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., APP, 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.


     

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., APP, Georgia

     

InpharmD provides quick answers with useful information.


     

InpharmD provides updated, scientifically supported data.


     

InpharmD provides evidence based recommendations to questions.


     

Provides concise and detailed information.


     

InpharmD is doing an excellent job. I was provided timely answers to clinical questions related to pharmacy.


     

InpharmD links conclusions from various studies and provides a rapid response to questions.


     

InpharmD provides excellent explanations about drug uses, drug side effects, and drug studies.


     

InpharmD is a very useful resource. I appreciate that I get my answers answered quickly.


     

InpharmD provides detailed answers but I would like to see more focused conclusions.


     

InpharmD provides useful drug information and comparisons.


     

InpharmD is easily accessible and provides answers with supported evidence.


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