sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY January 2014 | Archived Issues

Despite Challenges, There Are Reasons for Optimism

Message From the Chair

The start of a new year is generally associated with both uncertainty and optimism. 2014 has plenty of both. The principal uncertainty in our professional life is the impact of changes in the healthcare insurance markets driven by the further implementation of the Affordable Care Act. Whether you are optimistic or not depends to a large part on whether you think this is a good or bad thing.

» Read more

Cedars-Sinai Retains Surgical Jeopardy Title

Cedars-Sinai has won its third straight Surgical Jeopardy title at the Annual Scientific Meeting of the Southern California Chapter of the American College of Surgeons. General surgery residents Doug Liou, MD, and Matt Singer, MD, earned the trophy, known as the Dowden Cup.

» Read more

Assurant Health Is an Option for Patients With Non-Employer Insurance

Patients who have individual and family health insurance can sign up for one of several Assurant Health plans that include coverage for Cedars-Sinai and most of its physicians.

» Read more

Semper Vigilans

Saving Lives and Mentoring the Next Generation With the Civil Air Patrol

By Harry Sax, MD, MHCM
Professor and Vice Chair, Administration, Department of Surgery

Ever look up when you're out and see a low-flying plane with red, white and blue markings? Do you wonder who might be looking for you if you're lost, or trapped on your rooftop after a flood? Are your kids interested in aerospace, yet you don't want to spend thousands of dollars on flying lessons? The Civil Air Patrol (CAP) may be the answer.

» Read more

New VP to Help Lead Clinical Transformation

Sharon Isonaka, MD, has been named vice president of Clinical Transformation at Cedars-Sinai. Isonaka will have a leadership role in efforts to improve clinical efficiency across the health system.


 

» Read more

Circle of Friends Honorees for December

The Circle of Friends program honored 303 people in December. Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai.

» Read more

Addition to Formulary Declined; PCEA Order Set Changed

Pharmacy Focus

The Pharmacy and Therapeutics Committee declined to add recombinant human thrombin to the formulary and took other actions at its Dec. 3 meeting. The committee also reduced the approved concentration of an epidural pain medication. In addition, the U.S. Food and Drug Administration has issued warnings about methylphenidate products, some sodium phosphate medications and acetaminophen. The agency also added to the lists of contraindicated medications and drug interactions for Victrelis (boceprevir).

» Read more

Despite Challenges, There Are Reasons for Optimism

Message From the Chair

The start of a new year is generally associated with both uncertainty and optimism. 2014 has plenty of both. The principal uncertainty in our professional life is the impact of changes in the healthcare insurance markets driven by the further implementation of the Affordable Care Act. Whether you are optimistic or not depends to a large part on whether you think this is a good or bad thing.

It may be of some comfort to remember that American medical care and, by extension, the business of Cedars-Sinai has already been moving in the direction of increasing value (defined as the relationship between costs and benefits) in most of the things we do. That said, there are many opportunities to further increase efficiencies, ease of access and rational utilization of services. Indeed, focusing on these important measures is our best chance to avoid a situation where high-end services are not available to those who need them. It is ever more clear that if we do not maintain an informed but resolute attitude to doing more with less, others with a fiduciary rather than medical perspective will impose it.

There should be no illusion that this will be easy — only that it is not impossible. The rate of increase in healthcare expenditures has been slowed (see innumerable editorials about "bending the cost curve"). For example, length of stay at our institution has been decreased dramatically by 25 percent (4.07 to 2.97 days) in the last eight years, and many procedures that would have resulted in an inpatient stay have been converted to outpatient or 23-hour stays. This has occurred even though case-mix-adjusted discharges (a measure of severity and activity) have increased from about 79,000 to 95,500, an annual growth rate of 2.37 percent. Even with this improvement, our overall length of stay is greater than the median when compared to other academic medical centers. It is clear we still have much work to do.

Increasingly our hospital has become a surgical hospital. This is good, as most predictors of hospital viability hinge on this trend coupled with an ability to better manage chronic medical conditions in an outpatient setting. Much effort is being directed to reducing the expenses of surgical procedures by improving efficiency and lowering cost in selected high-volume procedures such as joint replacement. Our future will depend on expanding what we have learned in these early efforts to other procedures which appear to be outliers in cost. Unless we are successful in cost control, we will be excluded from the increasing number of "narrow networks" being formed by insurance companies. Reducing our costs will require cooperation across the institution and, most definitely, good will among all our physician entities. In future editions of Sutures and in other forums, we will learn much more about these issues and our Cedars-Sinai Medicine initiative, led in our department by Harry Sax, MD, MHCM.

Another reason for optimism is the remarkable personal and professional qualities of our current house staff. Their enthusiasm is mirrored by the pleasure most of us have in interacting with them in the care of our patients. Further evidence that this is likely to continue is the superb roster of resident applicants in our growing residency programs. These candidates represent virtually every top-flight medical school. In general surgery, orthopedic, urology and CT surgery, between 25 percent and 40 percent of all senior students interested in a surgical specialty apply to a Cedars-Sinai surgical residency.

While the next few years will be interesting in many ways, we can take pride that we have considerable strength in the market and in our academic stature. We can face up to the challenges handed us.

Bruce L. Gewertz, MD
Surgeon-in-Chief
H and S Nichols Distinguished Chair in Surgery
Chair, Department of Surgery
Vice President, Interventional Services
Vice Dean, Academic Affairs

Cedars-Sinai Retains Surgical Jeopardy Title

Doug Liou, MD, (left) and Matt Singer, MD, with the Dowden Cup

Cedars-Sinai has won its third straight Surgical Jeopardy title at the Annual Scientific Meeting of the Southern California Chapter of the American College of Surgeons. General surgery residents Doug Liou, MD, and Matt Singer, MD, earned the trophy, known as the Dowden Cup.

This year's contest among Southern California residency programs was the sixth annual competition based on the TV game show "Jeopardy!"

The meeting took place Jan. 17-19 in Santa Barbara.

Assurant Health Is an Option for Patients With Non-Employer Insurance

Cedars-Sinai has learned of another option for patients who have individual and family health insurance that includes coverage for the medical center and most of its physicians. This information regarding patients with non-employer, non-group insurance does not apply to Cedars-Sinai employees who receive employer-provided health insurance from Cedars-Sinai.

The insurance company is Assurant Health, which offers Affordable Care Act-compliant plans in California. Among its options is a full range of PPO network plans that use the Aetna broad preferred provider organization network.

These plans are part of Assurant's major medical insurance offerings and must be purchased directly from the company or a registered agent; plans are not part of the Covered California health benefit exchange. The latest date to enroll in an Assurant Health plan is March 15, for an effective date of April 1.

For more information and to enroll, patients can call Assurant Health at 800-358-9931 or visit the company's website.

In addition to the Assurant Health offerings, the following options are still open for enrollment and provide coverage for care from Cedars-Sinai and most of its physicians.

Plans available through the Covered California health benefit exchange:

  • Health Net Bronze PPO
  • Health Net Catastrophic PPO (available to people under age 30)
  • Health Net Tribal PPO (available to Native Americans and Alaska natives with certain incomes)

Plans available through an insurance broker or insurance company directly (off the exchange):

  • Health Net Platinum PPO
  • Health Net Gold PPO
  • Health Net Silver PPO
  • Health Net Bronze PPO
  • Health Net Catastrophic PPO (available to people under age 30)

If patients have already selected a plan but would prefer to change to a different one, they have until March 15 to switch. Additional information is available in the "frequently asked questions" section at cedars-sinai.edu/insurance.

Many people who want to come to Cedars-Sinai may be concerned about out-of-pocket costs such as deductibles and co-pays for hospital services. To make things easier, Cedars-Sinai offers a variety of financial assistance programs that are available to those with a wide range of incomes.

Cedars-Sinai has sent a letter to patients who have individual and family health insurance, informing them of the Assurant Health plans and other options for coverage from Cedars-Sinai and most of its physicians. To see the letter, click the PDF link below.

For the most up-to-date information and guidance, visit cedars-sinai.edu/insurance or email insurance@cshs.org.

Letter to Patients - January 2014 (PDF)

Semper Vigilans

The Civil Air Patrol's missions are emergency services, aerospace education and cadet programs.

Saving Lives and Mentoring the Next Generation With the Civil Air Patrol

By Harry Sax, MD, MHCM
Professor and Vice Chair, Administration, Department of Surgery

Ever look up when you're out and see a low-flying plane with red, white and blue markings? Do you wonder who might be looking for you if you're lost, or trapped on your rooftop after a flood? Are your kids interested in aerospace, yet you don't want to spend thousands of dollars on flying lessons?

The Civil Air Patrol (CAP) may be the answer.

CAP was formed early in the Second World War, so that civilian pilots could patrol the coasts for German warships and submarines, freeing up military pilots and planes for the war effort in Europe and the Pacific. After the war, and with the formation of the Air Force, it became an auxiliary, with governmental funding and specific missions. Today, CAP has 52 wings, 550 aircraft and three missions: emergency services, aerospace education and cadet programs. Its motto is "semper vigilans," Latin for "always vigilant."

I have been a general aviation pilot since 1985, and I joined CAP in 2006, while in Rhode Island. I was drawn by both the opportunity to fly differently than my normal cross-country trips, as well as the chance to work with cadets to share my knowledge and enthusiasm, just as I did with residents. As a physician, I also was able to serve the squadron as a medical officer.

Since relocating to Los Angeles, I have been active with Squadron 51, based at Santa Monica Airport. We have a Cessna 182 on the field, and I have had the opportunity to fly both in a training environment as well as on missions in the mountains north of Los Angeles. In addition, our squadron has cadets, aged 12 to 21, who participate in aerospace and military education, including flights with orientation pilots such as myself. The enthusiasm I witness as they take the controls (at altitude, of course), and watching their growth with subsequent flights, is as rewarding as helping a resident through a case.

I'm not paid for my time during flights or missions, but the costs of fuel and the plane are reimbursed in many cases. The squadron has both adult and senior members, many of whom have a background in aviation but are not pilots. Their breadth of experience in the government and military is fascinating.

If you're interested in expanding your horizons, both metaphorically and literally, I would urge you to check out the CAP website — members.gocivilairpatrol.com.

Happy New Year and travel safely. And if you are venturing out, take a 406 personal locator beacon. If something happens, we'll find you.

Harry Sax, MD, MHCM, with a group of cadets from Squadron 51

New VP to Help Lead Clinical Transformation

Sharon Isonaka, MD, has been named vice president of Clinical Transformation at Cedars-Sinai.

Isonaka will have a leadership role in efforts to improve clinical efficiency across the health system. She will participate in Cedars-Sinai Medicine initiatives to improve the appropriateness of care and to safely reduce length of stay and cost per case. Isonaka also will support efforts to improve clinical case management and will help develop and implement the physician adviser program.

She will be involved with the medical center, Cedars-Sinai Medical Group and Cedars-Sinai Health Associates. Isonaka will lead a number of new initiatives that will prepare the organization for value-based care, and she will help to develop and implement Cedars-Sinai's patient engagement strategy.

Isonaka is a former vice president at Amgen, where she worked for eight years in the area of value demonstration and payer reimbursement. Before Amgen, she was senior vice president at Optum (which was called Ingenix at the time), a subsidiary of United Healthcare, and previously at Cerner and Value Health Sciences. She started her career at Cigna and was based at Cedars-Sinai.

She received her undergraduate and master's degrees from Stanford University and attended the Baylor College of Medicine. Isonaka completed a pediatric residency and chief residency at Yale-New Haven Hospital and completed fellowships in neonatology at Yale and Children's Hospital Los Angeles.

Isonaka started at Cedars-Sinai on Jan. 7.

Circle of Friends Honorees for December

The Circle of Friends program honored 303 people in December.

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

Click here for more information about the program and for a list of past honorees.

  • Kenneth Adashek, MD
  • Mary Jane L. Ahorro
  • Hasanian A. Al-Jilaihawi
  • Kaelian L. Aldrich
  • Ehsan Ali, MD
  • Daniel C. Allison, MD
  • Farin Amersi, MD
  • Paula J. Anastasia Davis, RN, MN, AOCN
  • Pedrina Arguera
  • Leonard B. Asin, DPM
  • M. William Audeh, MD
  • Lilia G. Ayap
  • Esther Baik, MD
  • C. Noel Bairey Merz, MD
  • Dwight L. Baldoman
  • Tina G. Ban, RN
  • Dulce T. Baranda
  • Eli Baron, MD
  • Lisa F. Bell, RN
  • Latesha Marie Benjamin
  • Jason A. Berkley, DO
  • Charito A. Bernal, RN
  • Robert M. Bernstein, MD
  • Page A. Bertolotti, RN, BSN, OCN
  • Keith L. Black, MD
  • Brendan Boland, MD
  • Glenn D. Braunstein, MD
  • Earl W. Brien, MD
  • Barry J. Brock, MD
  • Philip G. Brooks, MD
  • Mathew H. Bui, MD
  • Christiane Michele J. Burnison, MD
  • Michael A. Bush, MD
  • Neyra Cannon, CNA
  • Carla Carrillo, RN
  • Breta Carroll, MD
  • Ilana Cass, MD
  • Claudia Castellanos, LVN
  • Bojan Cercek, MD, PhD
  • Kirk Y. Chang, MD
  • Piyaporn Chantravat, RN
  • Yzhar Charuzi, MD
  • Connie Chein, MD
  • Wen Cheng, MD
  • Sumeet S. Chugh, MD
  • Alice P. Chung, MD
  • Janet M. Clarke-Platt, RN
  • Paul Cohart, MD
  • J. Louis Cohen, MD
  • Jason S. Cohen, MD
  • Myles J. Cohen, MD
  • Amber L. Cole
  • Martin Cooper, MD
  • Stephen R. Corday, MD
  • Smada U. Couch
  • Charlotte Rae S. Creencia, RN
  • Alice C. Cruz, MD
  • Amy Cruz
  • Scott A. Cunneen, MD
  • Catherine M. Dang, MD
  • Moise Danielpour, MD
  • Robert M. Davidson, MD
  • Timothy T. Davis, MD
  • Dorshey M. Dean
  • Rick B. Delamarter, MD
  • Maria L. Delioukina, MD
  • Ryan DellaMaggiora, MD
  • Stephen C. Deutsch, MD
  • Alice R. Dick, MD
  • Harrison H. Dinh
  • Tiana Dowty, RN
  • Ricardo Duarte
  • Marla C. Dubinsky, MD
  • Cheryl L. Dunnett, MD
  • Joshua D. Ellenhorn, MD
  • Jonathan C. Ellis, MD
  • Shervin Eshaghian, MD
  • Fardad Esmailian, MD
  • Richard Essner, MD
  • Jeannifer W. Estrada, RN
  • Moses J. Fallas, MD
  • Margaret R. Farrell, RN, BSN
  • Sharmayne Farrior, RN
  • Joy S. Feld, MD
  • Marshal P. Fichman, MD
  • Robert A. Figlin, MD
  • Jeremy S. Fine, MD
  • Harris R. Fisk, MD
  • Phillip R. Fleshner, MD
  • Charles A. Forscher, MD
  • Eleni Fotiadis, RN
  • Nichole R. Freeman
  • Stuart Friedman, MD
  • David M. Frisch, MD
  • Gerhard J. Fuchs, MD
  • Ivor L. Geft, MD
  • Joel M. Geiderman, MD
  • Roshawn Y. Gilmore
  • Eli Ginsburg, MD
  • Armando E. Giuliano, MD
  • Stacia L. Godboldt, RN
  • Richard N. Gold, MD
  • Neil J. Goldberg, MD
  • Ted Goldstein, MD
  • Jeffrey S. Goodman, MD
  • Martin N. Gordon, MD
  • Richard F. Gordon
  • Richard E. Gould, MD
  • Steven B. Graff-Radford, DDS
  • Stephen L. Graham, MD
  • Jeffrey R. Gramer, MD
  • Leland M. Green, MD
  • Ana V. Guardado
  • Mary Ann F. Guarin
  • Kapil Gupta, MD, MPH
  • Victor Gura, MD
  • Jovanna S. Habeebullah
  • Solomon I. Hamburg, MD
  • Michele A. Hamilton, MD
  • Jenifer Braga Harris
  • Michael D. Harris, MD
  • Emmanuel E. Hernandez
  • Rafael M. Hernandez
  • Gail K. Higa
  • David M. Hoffman, MD
  • Stuart Holden, MD
  • Lalima A. Hoq, MD, MPH
  • Antoinette Hubenette, MD
  • Eva Huerta
  • Edward Hunt, RN
  • Carole H. Hurvitz, MD
  • Asma Hussaini, MS, PA-C
  • Andrew F. Ippoliti, MD
  • Michelle Israel, MD
  • Laith H. Jamil, MD
  • Jay L. Jordan, MD
  • Stanley C. Jordan, MD
  • David Y. Josephson, MD
  • Debra R. Judelson, MD
  • Sheila Kar, MD
  • Dmitry Karayev, MD
  • Beth Y. Karlan, MD
  • Scott R. Karlan, MD
  • Harold L. Karpman, MD
  • David Kawashiri, MD
  • Ilan Kedan, MD, MPH
  • Elizabeth B. Kelly, RN
  • Walter F. Kerwin, MD
  • Raj Khandwalla, MD
  • Ali Khoynezhad, MD, PhD
  • Jason A. Kirk, MD
  • Michelle M. Kittleson, MD, PhD
  • Ellen B. Klapper, MD
  • Robert Klapper, MD
  • Alan H. Klein, MD
  • Jon A. Kobashigawa, MD
  • Sara R. Kossuth, DO
  • Honore G. Kotler, NP
  • Ryan H. Kotton, MD
  • Evan B. Koursh, MD
  • Alla Kucher, RN
  • Lesley Kugler
  • Anand Kumar
  • Salvador B. Lara, RN
  • Barbara R. Leanse, BSW
  • Caroline Lee, MD
  • Ronald S. Leuchter, MD
  • Michael M. Levine, MD
  • Richard A. Lewis, MD
  • Andrew J. Li, MD
  • Michael C. Lill, MD
  • Julie Lim, RN
  • Simon K. Lo, MD
  • Joseph Loewy, MD
  • Patrick D. Lyden, MD
  • Shirley R. Macaraeg, RN
  • James F. MacDonald, RN, BSN, MPH
  • David F. MacFarland
  • Ezra Maguen, MD
  • Rajendra Makkar, MD
  • Dwight L. Makoff, MD
  • William J. Mandel, MD
  • Cynthia M. Martin
  • Lisa Massey, RN
  • Bryan M. May, RN
  • Philomena McAndrew, MD
  • Robert J. McKenna Jr., MD
  • Brian P. Mekelburg, MD
  • Shlomo Melmed, MD
  • Rita Mendoza
  • Stewart Middler, MD, PhD
  • Amin Joseph Mirhadi, MD
  • Monica M. Mita, MD, MDSc
  • Patricia A. Moore
  • Lawrence A. Mora, MD
  • Jaime D. Moriguchi, MD
  • Anna E. Motley
  • Zuri Murrell, MD
  • Arpine Nahabedian, RN
  • Ronald B. Natale, MD
  • Alan C. Newman, DDS
  • Christopher S. Ng, MD
  • Roy D. Nini, MD
  • Nicholas N. Nissen, MD
  • Donald F. Nortman, MD
  • Guy D. Paiement, MD
  • Jignesh K. Patel, MD, PhD
  • Brad Penenberg, MD
  • Alice Peng, MD
  • Phyllis E. Peterson
  • Edward H. Phillips Jr., MD
  • Mark Pimentel, MD
  • Edwin M. Posadas, MD
  • Ralph T. Potkin, MD
  • Rosario Pulido
  • Soroush A. Ramin, MD
  • Danny Ramzy, MD, PhD
  • Jeffrey Rapp, MD
  • Sheldon Reiss, MD
  • Richard M. Ress, MD
  • Mary Roberts
  • Amina S. Rodriguez
  • Neil E. Romanoff, MD
  • Digna E. Romero
  • Hyacinth P. Rosales, RN
  • Barry E. Rosenbloom, MD
  • Karen A. Ross, RN
  • Steven M. Rudd, MD
  • Jeremy D. Rudnick, MD
  • Paul A. Rudnick, MD
  • Paula Ruiz, PA-C
  • Susan Sackey
  • Stephen A. Sacks, MD
  • Mina Sadeghi   
  • Gloria D. Salapare, RN
  • Bernard Salick, MD
  • Vivian L. Salle, RN
  • Howard M. Sandler, MD, MS
  • Jason Sanicola  
  • Gregory P. Sarna, MD
  • Jay N. Schapira, MD
  • Kevin Scher, MD
  • Wouter I. Schievink, MD
  • Larry Schwartz, MD
  • Prediman K. Shah, MD
  • Omid A. Shaye, MD
  • Michael M. Shehata, MD
  • Jeffrey H. Sherman, MD
  • Robert J. Siegel, MD
  • Allan W. Silberman, MD, PhD
  • Amanuel Sima, MD
  • Julia Sladek, MD
  • Enrique Slodownik, MD
  • Liliana Sloninsky, MD
  • Andrew Ira Spitzer, MD
  • Theodore N. Stein, MD
  • Jerrold H. Steiner, MD
  • Colin Stokol, MD
  • Daniel J. Stone, MD, MPH, MBA
  • Leslie Stricke, MD
  • Ronald Sue, MD
  • Kazu Suzuki, DPM
  • Nicholas R. Szumski, MD
  • Lillian Szydlo, MD
  • Michele Tagliati, MD
  • Teresa Tanka
  • Stephan R. Targan, MD
  • Nattapaun Thepyasuwan, DO
  • Tram T. Tran, MD
  • Alfredo Trento, MD
  • Diane M. Tryciecky, RN
  • Mark P. Tuazon, RN
  • Stefan A. Unterhalter, MD, MB
  • Mark K. Urman, MD
  • Jacqueline Valenzuela, RN
  • Michael B. Van Scoy-Mosher, MD
  • Aleksandra Vartapetova
  • Eric Vasiliauskas, MD
  • Swamy R. Venuturupalli, MD
  • Robert A. Vescio, MD
  • Ronald G. Victor, MD
  • Mark W. Vogel, MD
  • Andrew S. Wachtel, MD
  • Daniel J. Wallace, MD
  • Christine S. Walsh, MD
  • Arthur I. Waltuch, MD
  • Xunzhang Wang, MD
  • Brenda M. Webb, RN
  • Ariel E. Weber, RN, BSN, CCRN
  • Alan Weinberger, MD
  • Jason L. Weiner, Rabbi
  • Jonathan M. Weiner, MD
  • Sara S. Well
  • Robert N. Wolfe, MD
  • Edward M. Wolin, MD
  • Teresita L. Wong-Vasquez, RN
  • Paige Woodward, NP
  • Veronica T. Wootton
  • Philip A. Yalowitz, MD
  • Clement C. Yang, MD
  • John S. Yu, MD
  • Sauchuen Yu
  • Jason Zimmerman

Addition to Formulary Declined; PCEA Order Set Changed

Pharmacy Focus

The Pharmacy and Therapeutics Committee declined to add recombinant human thrombin to the formulary and took other actions at its Dec. 3 meeting. The committee also reduced the approved concentration of an epidural pain medication.

In addition, the U.S. Food and Drug Administration has issued warnings about methylphenidate products, some sodium phosphate medications and acetaminophen. The agency also added to the lists of contraindicated medications and drug interactions for Victrelis (boceprevir).

P and T Committee Approvals - Dec. 3 (PDF)  

PCEA Order Set Changed

Starting Jan. 22, the hydromorphone concentration in the hydromorphone/bupivacaine epidural will be reduced from 50mcg/ml to 25mcg/ml in the patient-controlled epidural analgesia (PCEA) CS-Link™ order set (1471). The Pharmacy and Therapeutics Committee approved the change.

FDA Warns of Priapism Risk With ADHD Medication

The U.S. Food and Drug Administration is warning that methylphenidate products, one type of stimulant drug used to treat attention deficit hyperactivity disorder (ADHD), may in rare instances cause prolonged and sometimes painful erections known as priapism.

Based on a recent review of methylphenidate products, the FDA updated drug labels and patient medication guides to include information about the rare but serious risk of priapism.

The FDA recommends that healthcare professionals talk to male patients and their caregivers to make sure they know the signs and symptoms of priapism and stress the need for immediate medical treatment should it occur. Younger males, especially those who have not yet reached puberty, may not recognize the problem or may be embarrassed to tell anyone if it occurs.

To learn more, visit this FDA Web page.

Constipation Drug Can Cause Harm if Taken More Than Once a Day

The FDA is warning of rare but serious harm from over-the-counter sodium phosphate medications used to treat constipation, if more than one dose is taken in 24 hours.

The agency has received reports of severe dehydration and changes in the levels of serum electrolytes from taking more than the recommended dose of OTC sodium phosphate products. The result can be serious adverse effects on organs, such as the kidneys and heart, and in some cases death.

These medications are available under the brand name Fleet and in generic formulations.

To learn more, visit this FDA Web page.

Limit Acetaminophen to 325 Milligrams per Unit, FDA says

The FDA is recommending that healthcare professionals stop prescribing and dispensing prescription combination drug products that contain more than 325 milligrams of acetaminophen per tablet, capsule or other dosage unit.

There are no available data to show that taking more than 325 mg of acetaminophen per dosage unit provides additional benefit that outweighs the added risks for liver injury, the agency said.

In the near future, the FDA said, it may withdraw approval for products containing more than 325 mg per dosage unit.

To learn more, visit this FDA Web page.

Contraindications, Interactions Updated for Victrelis

The FDA has approved changes to the Victrelis (boceprevir) package insert to expand the list of contraindicated medications and to update the drug interaction section.

Doxazosin, silodosin and tamsulosin, which are alpha 1-adrenoceptor antagonists, were added to the contraindications section due to the potential for alpha 1-adrenoceptor antagonist-associated adverse events such as hypotension and priapism.

In the drug interaction section, the calcium channel blockers amlodipine, diltiazem, nisoldipine and verapamil were added.