Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF July 23, 2010 Issue | Archived Issues

New Faces

Miguel Burch, M.D. ...

Fardad Esmailian, M.D. ...

Robert Figlin, M.D. ...

Ali Khoynezhad, M.D., Ph.D. ...

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Pharmacy Focus

Boxed Warning added to Arava® (leflunomide)

Furosemide (Lasix®) injection shortage

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Meetings and Events

Vasculitis: Current Concepts and Best Practices – July 31

Medical Mission to Guatemala Informational Meeting – Aug. 22

Rehabilitation Topics on the Neurological and Neurovascular Treatment of Stroke – Sept. 11

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Pharmacy Focus

Boxed Warning added to Arava® (leflunomide)

The U.S Food and Drug Administration is adding information on severe liver injury to the Boxed Warning of Arava® (leflunomide), a drug used to treat rheumatoid arthritis, to highlight the risk of severe liver injury in patients using this drug. Leflunomide already has a Boxed Warning stating that this medication is contraindicated in pregnant women, or women of childbearing potential who were not using reliable contraception.

The decision to add information on severe liver injury to the Boxed Warning was based on FDA’s review of 49 case reports of severe liver injury, including 14 cases of fatal liver failure, between August 2002 and May 2009. In this review, the greatest risk for liver injury was seen in patients taking other drugs known to cause liver injury, and patients with pre-existing liver disease.

Recommendations on how to reduce the risk of liver injury are outlined in the prescribing information

Furosemide (Lasix®) injection shortage

There is currently a nationwide shortage of injectable furosemide (Lasix®). It is anticipated that the furosemide injection will once again become available in September.

In the meantime, Cedars-Sinai's P&T Committee has approved an automatic substitution for furosemide injection to bumetanide (Bumex®) injection at a 40:1 ratio (furosemide 40mg=bumetanide 1mg). Please attempt to convert as many patients as possible to oral furosemide if patients are able to tolerate oral medications and be aware that orders for furosemide injection will be automatically substituted to bumetanide injection at an equipotent dose. Furosemide drips will not be automatically substituted and will continue to be dispensed as furosemide.