To ensure that we are providing our clients with the industry's best and most current clinical information, we complete a "post-publication" process and receive feedback regarding opportunities to add additional information or, in rare cases, make revisions.
Below is information on revisions, corrections, or modifications to existing monographs that have been identified in the past 12 months.
Ibrutinib – November 2023
Revision in the Dosing: Adjustment for Toxicity: Adult field of the Ibrutinib monograph in the Lexi-Drugs and Drug Facts and Comparisons databases, available online and in mobile apps.
The monograph previously read:
Dosing: Adjustment for Toxicity: Adult (only portion of field impacted is presented):
Restart at 280 mg once daily
It has been revised to read:
Dosing: Adjustment for Toxicity: Adult (only portion of field impacted is presented):
Restart at 140 mg once daily
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Albumin – October 2023
Revision in the Dosing: Adult field of the Albumin monograph in the Lexi-Drugs database, available online and in mobile apps.
The monograph previously read:
Dosing: Adult (only portion of field impacted is presented):
25% albumin: IV: Initial: 1 g/kg daily for 2 days (maximum: 100 g/day), followed by 20 to 50 g daily until norepinephrine, terlipressin, or midodrine plus octreotide until adequate intravascular volume is achieved (ie, central venous pressure goal) (AASLD [Biggins 2021], Angeli 1999, Boyer 2016, Cavallin 2015, Kwong 2021, Runyon 2013, Wong 2021)
It has been revised to read:
Dosing: Adult (only portion of field impacted is presented):
25% albumin: IV: Initial: 1 g/kg daily for 2 days (maximum: 100 g/day), followed by 20 to 50 g daily until clinical outcome is achieved (AASLD [Biggins 2021], Angeli 1999, Boyer 2016, Cavallin 2015, Kwong 2021, Runyon 2013, Wong 2021).
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Esmolol – August 2023
Revision in the following fields of the Esmolol monograph in the Pediatric & Neonatal Lexi-Drugs database, available online and in mobile apps, as well as the following print publications: Pediatric & Neonatal Dosage Handbook 30th edition
The monograph previously read:
Use
(missing content)
Clinical Practice Guidelines: Pediatric
(missing content)
Dosing: Neonatal
(missing content)
Dosing: Pediatric
(missing content)
Dosing: Altered Kidney Function: Pediatric
(missing content)
Dosing: Hepatic Impairment: Pediatric
(missing content)
Monitoring Parameters
(missing content)
It has been revised to read:
Use:
Treatment of supraventricular tachycardia (primarily to control ventricular rate in patients with atrial fibrillation or flutter) (FDA approved in adults); treatment of noncompensatory sinus tachycardia (FDA approved in adults); treatment of perioperative tachycardia and hypertension (FDA approved in adults).
Clinical Practice Guidelines: Pediatric
Hypertension:
AAP, Screening and Management of High Blood Pressure in Children and Adolescents, September 2017
NHBPEP Working Group, The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, May 2005
Dosing: Neonatal
Note: Dose must be titrated to individual response and tolerance.
Postoperative hypertension
Postoperative hypertension (congenital heart disease): Limited data available; further studies are needed. An open-label trial used the following dosing guidelines to treat postoperative hypertension following cardiac surgery; dose was titrated until blood pressure was ≤90th percentile for age; final dose required was significantly higher in patients with aortic coarctation repair than in patients with repair of other congenital heart defects (Wiest 1998):
Term neonates:
PNA 0 to 7 days: Continuous IV infusion: Initial: 50 mcg/kg/minute; titrate dose by 25 to 50 mcg/kg/minute every 20 minutes; maximum dose: 1,000 mcg/kg/minute (Wiest 1998).
PNA 8 to 28 days: Continuous IV infusion: Initial: 75 mcg/kg/minute; titrate dose by 50 mcg/kg/minute every 20 minutes; maximum dose: 1,000 mcg/kg/minute (Wiest 1998).
Dosing: Pediatric
Note: Dose must be titrated to individual response and tolerance.
Hypertension, acute severe with significant, life-threatening symptoms
Hypertension, acute severe with significant, life-threatening symptoms (eg, seizures): Limited data available:
Infants, Children, and Adolescents: Continuous IV infusion: 100 to 500 mcg/kg/minute infusion (AAP [Flynn 2017]); another approach is to initiate therapy with a bolus of 100 to 500 mcg/kg over 1 minute, followed by an infusion of 25 to 100 mcg/kg/minute; titrate as needed up to 500 mcg/kg/minute (Park 2021).
Postoperative hypertension
Postoperative hypertension (congenital heart disease): Limited data available; large effective dose range reported:
Infants and Children: Initial IV bolus: 100 to 500 mcg/kg over 1 minute, followed by continuous IV infusion: Initial rate: 100 to 500 mcg/kg/minute; titrate to effect; range of effective doses: 125 to 1,000 mcg/kg/minute; higher doses may be needed in patients after repair of coarctation of the aorta (Park 2021, Tabbutt 2008a, Tabbutt 2008b, Wiest 1998).
Supraventricular tachycardia
Supraventricular tachycardia (SVT): Limited data available:
Children and Adolescents: Initial IV bolus: 100 to 500 mcg/kg over 1 minute followed by a continuous IV infusion: Initial rate: 25 to 100 mcg/kg/minute; titrate by 25 to 50 mcg/kg/minute; usual maintenance dose: 50 to 500 mcg/kg/minute (Park 2021); doses up to 1,000 mcg/kg/minute have been reported (Trippel 1991).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Dosing: Altered Kidney Function: Pediatric
Infants, Children, and Adolescents: No dosage adjustment necessary. Not removed by hemodialysis, peritoneal dialysis, or CRRT; supplemental dose is not necessary (Aronoff 2007).
Dosing: Hepatic Impairment: Pediatric
There are no pediatric-specific recommendations; based on experience in adult patients, no dosage adjustment required.
Monitoring Parameters
Blood pressure, ECG, heart rate, respiratory rate, IV site; serum potassium (especially with renal impairment).
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Blood thinners – June 2023
Revision in the "How is this drug best taken?" field of the Arabic translation of patient information in the Patient Education – Adult Medication database, available online as well as in the following print publications: Patient leaflets. This issue occurred in the following leaflets:
- Bemiparin (Patient Education - Adult Medication)
- Danaparoid (Patient Education - Adult Medication)
- Danaparoid (Patient Education - Pediatric Medication)
- Enoxaparin (Patient Education - Adult Medication)
- Enoxaparin (Patient Education - Pediatric Medication)
- Enoxaparin Multi-Dose Vials (Patient Education - Adult Medication) – DFS leaflet
- Enoxaparin Prefilled Syringes (Patient Education - Adult Medication) – DFS leaflet
- Tinzaparin (Patient Education - Adult Medication)
The monograph previously read:
How is this drug best taken? (only portion of field impacted is presented):
This drug must be given into muscle/
It has been revised to read:
How is this drug best taken? (only portion of field impacted is presented):
This drug must not be given into a muscle/
These changes have been automatically posted to online and mobile app databases. Please update your mobile application to get the updated monograph.
Bivalirudin – June 2023
Revision in the Nursing Physical Assessment/Monitoring field of the Bivalirudin monograph in the Lexi-Drugs database, available online and in mobile apps.
The monograph previously read:
Nursing Physical Assessment/Monitoring (only portion of field impacted is presented):
For intramuscular administration only. Check ordered labs and report any abnormalities. Monitor blood pressure. Monitor patients for signs and symptoms of bleeding (bruising or bleeding that is not normal, changes in menstrual periods like lots of bleeding, spotting, or bleeding between cycles, nosebleeds that won't stop, bowel movements that are red or black like tar, throwing up blood or liquid that looks like coffee grounds) and neurological impairment (midline back pain, sensory defects, motor defects, bowel dysfunction, and bladder dysfunction). Educate patients on bleeding precautions including avoiding invasive procedures, activities that could cause injuries, and how to handle bleeding emergencies. Advise patients to tell all doctors and dentists about use of an anticoagulant.
It has been revised to read:
Nursing Physical Assessment/Monitoring (only portion of field impacted is presented):
Check ordered labs and report any abnormalities. Monitor blood pressure. Monitor patients for signs and symptoms of bleeding (bruising or bleeding that is not normal, changes in menstrual periods like lots of bleeding, spotting, or bleeding between cycles, nosebleeds that won't stop, bowel movements that are red or black like tar, throwing up blood or liquid that looks like coffee grounds) and neurological impairment (midline back pain, sensory defects, motor defects, bowel dysfunction, and bladder dysfunction). Educate patients on bleeding precautions.
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Capecitabine – March 2023
Revision in the Dosing: Adult field of the Capecitabine monograph in the Lexi-Drugs and Drug Facts and Comparisons databases, available online and in mobile apps.
The monograph previously read:
Dosing: Adult (only portion of field impacted is presented):
Thymic malignancies, refractory (off-label use): CAP-GEM regimen: Oral: 650 mg/m2 on days 1 to 14 every 21 days (in combination with gemcitabine) until disease progression.
It has been revised to read:
Dosing: Adult (only portion of field impacted is presented):
Thymic malignancies, refractory (off-label use): CAP-GEM regimen: Oral: 650 mg/m2 twice daily on days 1 to 14 every 21 days (in combination with gemcitabine) until disease progression.
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Metoclopramide – March 2023
Revision in the Administration: Intranasal and Storage/Stability fields of the Metoclopramide monograph in the Lexi-Drugs and Drug Facts and Comparisons databases, available online and in mobile apps, as well as the following print publications: Adult Drug Information Handbook 31st edition, Pediatric & Neonatal Dosage Handbook 29th edition.
The monograph previously read:
Administration: Intranasal (only portion of field impacted is presented):
Discard after 4 months, even if bottle is not completely empty.
Storage/Stability (only portion of field impacted is presented):
Use within 4 months of opening bottle.
It has been revised to read:
Administration: Intranasal (only portion of field impacted is presented):
Discard after 4 weeks, even if bottle is not completely empty.
Storage/Stability (only portion of field impacted is presented):
Use within 4 weeks of opening bottle.
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Propofol – March 2023
Revision in the Dosing: Adult field of the Propofol monograph in the Lexi-Drugs database, available online and in mobile apps.
The monograph previously read:
Dosing: Adult (only portion of field impacted is presented):
Prior to use, consult local/state regulations and institutional policies and procedures regarding administration and monitoring requirements; dosing practices may vary. For dosing in obese patients, use ideal body weight or adjusted body weight for initial weight-based dosing, unless otherwise indicated.
It has been revised to read:
Dosing: Adult (only portion of field impacted is presented):
Prior to use, consult local/state regulations and institutional policies and procedures regarding administration and monitoring requirements; dosing practices may vary.
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Thioguanine – February 2023
Revision in the Extemporaneously Prepared field of the Thioguanine monograph in the Lexi-Drugs, Pediatric and Neonatal Lexi-Drugs, and Drug Facts and Comparisons databases, available online and in mobile apps, as well as the following print publications: Drug Information Handbook for Oncology 17th edition, Pediatric and Neonatal Dosage Handbook 29th edition.
The monograph previously read:
Extemporaneously Prepared (only portion of field impacted is presented):
Ora-Plus and Ora-Sweet: Crush fifteen 40 mg thioguanine tablets in a mortar and reduce to a fine powder. Add 5 mL of Ora-Plus in incremental proportions and mix to a uniform paste. Transfer to a graduated amber glass bottle, rinse mortar with Ora-Sweet and add sufficient quantity to make 30 mL. Label “shake well.” Stable for 63 days at room temperature.
Methylcellulose and simple syrup: Crush fifteen 40 mg thioguanine tablets in a mortar and reduce to a fine powder. Add 3.33 mL of methylcellulose 1% in incremental proportions and mix to a uniform paste. Transfer to a graduated amber glass bottle, rinse mortar with simple syrup and add sufficient quantity to make 30 mL. Label “shake well.” Stable for 63 days at room temperature.
It has been revised to read:
Extemporaneously Prepared (only portion of field impacted is presented):
Ora-Plus and Ora-Sweet: Crush five 40 mg thioguanine tablets in a mortar and reduce to a fine powder. Add 5 mL of Ora-Plus in incremental proportions and mix to a uniform paste. Transfer to a graduated amber glass bottle, rinse mortar with Ora-Sweet and add sufficient quantity to make 10 mL. Label “shake well.” Stable for 63 days at room temperature.
Methylcellulose and simple syrup: Crush five 40 mg thioguanine tablets in a mortar and reduce to a fine powder. Add 3.33 mL of methylcellulose 1% in incremental proportions and mix to a uniform paste. Transfer to a graduated amber glass bottle, rinse mortar with simple syrup and add sufficient quantity to make 10 mL. Label “shake well.” Stable for 63 days at room temperature.
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.