Drug Therapy Committee Highlights: February 2003
Volume XIII, Issue 3
Ivermectin (Stromectol):
APPROVED WITH RESTRICTIONS
The Committee approved the addition of ivermectin (Stromectol)
to Formulary with the following restriction: Infectious Disease approval required.
It is the standard of therapy in treating Strongyloides and Echinococcus granulosis
infections.
Lovastatin ER (Altocor):
NOT APPROVED FOR FORMULARY ADDITION
The Committee reviewed the request for the addition of lovastatin
ER (Altocor) to the PCHI Grid Formulary. Lovastatin ER is formulated to provide
a once-daily dosing with a twice-daily release of drug. The data suggest
that lovastatin ER does not offer the same degree of LDL reduction despite
the extended-release technology. Currently, fluvastatin and atorvastatin
offer the best LDL reductions for the associated cost. The Committee denied
the addition of lovastatin ER (Altocor) to Formulary because there does not
appear to be a substantial benefit over lovastatin immediate release.
Ezetimibe (Zetia):
APPROVED
APPROVED FOR RED-TIER PCHI GRID
The Committee reviewed the request for the addition of ezetimibe (Zetia) to the PCHI Grid Formulary. Ezetimibe is indicated as monotherapy for patients with primary hypercholesterolemia and combination therapy in conjunction with HMG-CoA reductase inhibitors. Ezetimibe acts unlike other available antihyperlipidemic agents. Its mechanism of action is to prevent the absorption of cholesterol within the small intestine. This is believed to be a complementary action to the statins, which prevent the production of cholesterol within the liver. The role of ezetimibe may be as monotherapy for patients who need small reductions in LDL and are intolerant to other lipid-lowering medications. Additionally, the use in combination therapy should be considered only after titration of the statin dose has been accomplished within patient tolerance, and further LDL reductions are needed. The Committee approved ezetimibe (Zetia) to be added to the red tier on the PCHI grid and the MGH Formulary to maintain continuity of care. A future newsletter publication to outline the appropriate utilization of this agent will be made available soon.