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.
Bivalirudin – December 2024
Revision in the Dosing: Pediatric field of the Bivalirudin 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: Pediatric & Neonatal Dosage Handbook 31st edition.
The monograph previously read:
Dosing: Pediatric (only portion of field impacted is presented):
| Bivalirudin ECMO/ECLS in Infants, Children, and Adolescents: Dose Adjustments to Achieve Target aPTT | ||
| aPTT | Bivalirudin titration | Time to repeat aPTTa |
| >20 seconds below goal range | Increase infusion rate by 20% | 2 hours |
| 10 to 20 seconds below goal range | Increase infusion rate by 10% | 2 hours |
| Within goal range | No change | 12 hours; decrease frequency based on clinical scenario |
| 10 to 20 seconds above goal range | Decrease infusion rate by 10% | 2 hours |
| >20 seconds above goal range | Hold for 1 hour then decrease infusion rate by 20% | 2 hours |
| a Consider more frequent anti-factor Xa monitoring based on clinical scenario. | ||
| Adapted from Seelhammer 2021. | ||
It has been revised to read:
Dosing: Pediatric (only portion of field impacted is presented):
| Bivalirudin ECMO/ECLS in Infants, Children, and Adolescents: Dose Adjustments to Achieve Target aPTT | ||
| aPTT | Bivalirudin titration | Time to repeat aPTTa |
| >20 seconds below goal range | Increase infusion rate by 20% | 2 hours |
| 10 to 20 seconds below goal range | Increase infusion rate by 10% | 2 hours |
| Within goal range | No change | 12 hours; decrease frequency based on clinical scenario |
| 10 to 20 seconds above goal range | Decrease infusion rate by 10% | 2 hours |
| >20 seconds above goal range | Hold for 1 hour then decrease infusion rate by 20% | 2 hours |
| a Consider more frequent aPTT monitoring based on clinical scenario. | ||
| Adapted from Seelhammer 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.
Foscarnet – October 2024
Revision in the Administration: Pediatric field of the Foscarnet monograph in the Lexi-Drugs and Drug Facts and Comparisons databases, available online and in mobile apps.
The monograph previously read:
Administration: Pediatric (only portion of field impacted is presented):
IV: Administer using an infusion pump at a rate not to exceed 1 mg/kg/minute (ie, 60 mg/kg/dose over 1 hour or 120 mg/kg/dose over 2 hours) (HHS [OI pediatric] 2024). To mitigate nephrotoxicity risk, adequate hydration is recommended (eg, 10 to 20 mL/kg [maximum: 1,000 mL] of NS as appropriate prior to first dose, then 10 to 20 mL of NS [maximum: 1,000 mL] as appropriate concurrently with subsequent doses, with adjustment of fluid amount based on patient-specific factors) (HHS [OI pediatric 2024], Hiskey 2022, Jayaweera 1997, Marshall 2009, manufacturer's labeling).
It has been revised to read:
Administration: Pediatric (only portion of field impacted is presented):
IV: Administer using an infusion pump at a rate not to exceed 1 mg/kg/minute (ie, 60 mg/kg/dose over 1 hour or 120 mg/kg/dose over 2 hours) (HHS [OI pediatric] 2024). To mitigate nephrotoxicity risk, adequate hydration is recommended (eg, 10 to 20 mL/kg [maximum: 1,000 mL] of NS as appropriate prior to first dose, then 10 to 20 mL/kg of NS [maximum: 1,000 mL] as appropriate concurrently with subsequent doses, with adjustment of fluid amount based on patient-specific factors) (HHS [OI pediatric 2024], Hiskey 2022, Jayaweera 1997, Marshall 2009, manufacturer's labeling).
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Zoledronic Acid – October 2024
Revision in the Dosing: Pediatric field of the Zoledronic Acid monograph in the Lexi-Drugs and Drug Facts and Comparisons databases, available online and in mobile apps.
The monograph previously read:
Dosing: Pediatric (only portion of field impacted is presented):
Osteoporosis, primary (eg, osteogenesis imperfecta) or secondary:
Children <2 years: Very limited data available:
Every-6-month dosing: IV: 0.05 mg every 6 months (Kumar 2023).
It has been revised to read:
Dosing: Pediatric (only portion of field impacted is presented):
Osteoporosis, primary (eg, osteogenesis imperfecta) or secondary:
Children <2 years: Very limited data available:
Every-6-month dosing: IV: 0.05 mg/kg/dose every 6 months (Kumar 2023).
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Talquetamab – October 2024
Revision in the Dosing: Adult field of the Talquetamab 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):
| Recommendations for Restarting Talquetamaba After Dose Delay | ||
| Last talquetamab dose administered | Duration of delay from the last talquetamab dose administered | Actionb |
| Biweekly (every 2 weeks) talquetamab dosing schedule | ||
| SUBQ: 0.8 mg/kg (treatment dose) | 15 to 28 days | Continue talquetamab weekly dosing schedule at treatment dose (0.8 mg/kg once every 2 weeks). |
It has been revised to read:
Dosing: Adult (only portion of field impacted is presented):
| Recommendations for Restarting Talquetamaba After Dose Delay | ||
| Last talquetamab dose administered | Duration of delay from the last talquetamab dose administered | Actionb |
| Biweekly (every 2 weeks) talquetamab dosing schedule | ||
| SUBQ: 0.8 mg/kg (treatment dose) | 15 to 28 days | Continue talquetamab dosing schedule at treatment dose (0.8 mg/kg once every 2 weeks). |
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Risperidone – August 2024
Revision in the Dosing: Altered Liver Function: Adult field of the Risperidone monograph in the Lexi-Drugs and Drug Facts and Comparisons databases, available online and in mobile apps, as well as the following print publication: Adult Drug Information Handbook 33rd edition.
The monograph previously read:
Dosing: Altered Liver Function: Adult (only portion of field impacted is presented):
IM ER suspension: Initiate with oral dosing (0.5 mg twice daily for 1 week then 1 mg twice daily or 2 mg once daily for 1 week); if tolerated, begin 25 mg IM ER suspension every 2 weeks; continue oral dosing for 3 weeks after the first IM injection. An initial IM dose of 12.5 mg may also be considered.
It has been revised to read:
Dosing: Altered Liver Function: Adult (only portion of field impacted is presented):
IM ER suspension (Risperdal Consta and Rykindo): Note: Must establish tolerability using oral risperidone before first injection; the manufacturer recommends patients should be able to achieve and tolerate an oral dose of at least 2 mg/day for at least 1 week before converting to IM ER suspension in patients with impaired liver function. Due to delayed onset of the first IM ER suspension injection, an oral antipsychotic at an effective dose is overlapped for the first 3 weeks for Risperdal Consta and for the first week for Rykindo.
Initial: 25 mg IM ER suspension every 2 weeks. An initial IM dose of 12.5 mg may also be considered.
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Flecainide – July 2024
Revision in the Dosing: Adult field of the flecainide 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):
Atrial fibrillation/flutter, pharmacologic cardioversion (off-label use):
Note: May be used on an outpatient basis (“Pill-in-the-pocket”); however, an initial inpatient cardioversion trial should have been successful before sending patient home on this therapy. Patient must be taking an atrioventricular (AV) nodal-blocking agent (eg, beta-blocker, nondihydropyridine calcium channel blocker) prior to initiation of flecainide. AV nodal-blocking agent is generally administered ≤30 minutes before flecainide (Alboni 2004, Joglar 2024).
It has been revised to read:
Dosing: Adult (only portion of field impacted is presented):
Atrial fibrillation/flutter, pharmacologic cardioversion (off-label use):
Note: May be used on an outpatient basis (“Pill-in-the-pocket”); however, an initial inpatient cardioversion trial should have been successful before sending patient home on this therapy. Patient must be taking an atrioventricular (AV) nodal-blocking agent (eg, beta-blocker, nondihydropyridine calcium channel blocker) prior to initiation of flecainide. AV nodal-blocking agent is generally administered ≥30 minutes before flecainide (Alboni 2004, Joglar 2024).
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Propafenone – July 2024
Revision in the Dosing: Adult field of the propafenone 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):
Atrial fibrillation/flutter, pharmacologic cardioversion (off-label use):
Note: May be used on an outpatient basis (“Pill-in-the-pocket”); however, an initial inpatient cardioversion trial should have been successful before sending patient home on this therapy. Patient must be taking an atrioventricular (AV) nodal-blocking agent (eg, beta-blocker, nondihydropyridine calcium channel blocker) prior to initiation of propafenone. AV nodal-blocking agent is generally administered ≤30 minutes before propafenone (Alboni 2004, Joglar 2024).
It has been revised to read:
Dosing: Adult (only portion of field impacted is presented):
Atrial fibrillation/flutter, pharmacologic cardioversion (off-label use):
Note: May be used on an outpatient basis (“Pill-in-the-pocket”); however, an initial inpatient cardioversion trial should have been successful before sending patient home on this therapy. Patient must be taking an atrioventricular (AV) nodal-blocking agent (eg, beta-blocker, nondihydropyridine calcium channel blocker) prior to initiation of propafenone. AV nodal-blocking agent is generally administered ≥30 minutes before propafenone (Alboni 2004, Joglar 2024).
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Vinblastine – June 2024
Revision in the Dosing: Hepatic Impairment field of the Vinblastine monograph in the Lexi-Drugs and Drug Facts and Comparisons databases, available online and in mobile apps, as well as the following print publications: Pediatric & Neonatal Dosage Handbook 30th edition; Drug Information Handbook for Oncology 17th edition.
The monograph previously read:
Dosing: Hepatic Impairment: Adult and Pediatric (only portion of field impacted is presented):
Toxicity may be increased in patients with hepatic dysfunction. The manufacturer’s labeling recommends the following adjustment:
Serum bilirubin >3 mg/dL: Administer 50% of dose.
The following adjustments have also been recommended (Floyd 2006, Superfin 2007):
Serum bilirubin 1.5 to 3 mg/dL or transaminases 2 to 3 times ULN: Administer 50% of dose.
Serum bilirubin >3 times ULN: Avoid use.
It has been revised to read:
Dosing: Hepatic Impairment: Adult and Pediatric (only portion of field impacted is presented):
Toxicity may be increased in patients with hepatic dysfunction (manufacturer’s labeling).
Serum bilirubin 1.5 to 3 mg/dL: Reduce dose by 50% (Floyd 2006, Superfin 2007).
Serum bilirubin >3 mg/dL: Conflicting information exists; some sources recommend to avoid use (Floyd 2006, Superfin 2007), while other sources suggest reducing the dose by 50% (Krens 2019, manufacturer’s labeling).
Transaminases 2 to 3 times ULN: Administer 50% of dose (Floyd 2006).
Transaminases >3 times ULN: Avoid use (Floyd 2006).
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Alteplase – April 2024
Revision in the Alteplase IV Compatibility with D5W (Dextrose 5% in Water) monograph in the Trissel’s IV Compatibility database, available online and in mobile apps.
The monograph previously read (only portion of table impacted is presented):
| Study | Drug 1 |
| Study 3 | Alteplase 0.05 mg/mL |
It has been revised to read (only portion of table impacted is presented):
| Study | Drug 1 |
| Study 3 | Alteplase 0.5 mg/mL |
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Nadroparin – March 2024
Revision in the Dosing: Adult field of the Nadroparin 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):
Weight-based dosing: SUBQ: Initial:
Fixed dosing: SUBQ: Initial:
It has been revised to read:
Dosing: Adult (only portion of field impacted is presented):
Weight-based dosing: Initial:
Fixed dosing: Initial:
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.
Leucovorin Calcium – March 2024
Revision in the Dosing: Adult field of the Leucovorin Calcium 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):
Colorectal cancer, advanced: IV: 200 mg/m2/day over ≥3 minutes for 5 days every 4 weeks for 2 cycles, then every 4 to 5 weeks (in combination with fluorouracil) or 20 mg/m2/day for 5 days every 4 weeks for 2 cycles, then every 4 to 5 weeks (in combination with fluorouracil). Note: Multiple leucovorin-containing regimens are available for the treatment of colorectal cancer; may be in combination with other agents (eg, monoclonal antibodies). Refer to appropriate literature/guidelines for additional details.
FOLFOXIRI regimens: IV: 200 mg/m2 over 2 hours on day 1 every 14 days (in combination with fluorouracil, oxaliplatin, and irinotecan) until disease progression or unacceptable toxicity up to a maximum of 12 cycles (Falcone 2007). Refer to protocol for further information.
It has been revised to read:
Dosing: Adult (only portion of field impacted is presented):
Colorectal cancer, advanced: IV: 200 mg/m2/day over ≥3 minutes for 5 days every 4 weeks for 2 cycles, then every 4 to 5 weeks (in combination with fluorouracil) or 20 mg/m2/day for 5 days every 4 weeks for 2 cycles, then every 4 to 5 weeks (in combination with fluorouracil). Note: Multiple leucovorin-containing regimens are available for the treatment of colorectal cancer; may be in combination with other agents (eg, monoclonal antibodies). Refer to appropriate literature/guidelines for additional details.
These changes have been automatically posted to online and mobile app databases. Please update your mobile Lexi-Drugs application to get the updated monograph.