Among the medical community, there is a growing case against intravenous Tylenol, which gained popularity as hospitals shift away from prescribing opioids for pain management, according to The Washington Post.
Here are six things to know:
1. In 2015, Boston Medical Center added an intravenous version of Tylenol to its supply of pain management drugs, along with other opioid substitutes.
2. Shortly thereafter, drugmaker Mallinckrodt Pharmaceuticals increased the price of the IV Tylenol, leading Boston Medical Center to project it would spend $750,000 on injectable acetaminophen in 2015.
"It was going to cost us, without the intervention that happened, more than any other drug on our formulary." David Twitchell, PharmD, Boston Medical Center's chief pharmacy officer, told The Washington Post. "To me, that didn’t seem justified."
3. A dose of acetaminophen costs pennies as a tablet, but in its IV form, Ofirmev, the medication costs $40 for a 1,000-milligram dose.
4. A new study suggests IV acetaminophen offers little to no benefit over the pill form of the drug, despite the growing trend of pharmaceutical companies formulating old drugs for IV use.
"It just seems very often, physicians have magical thinking about a new preparation of an old drug," study co-author Andrew Leibowitz, MD, system chair of the department of anesthesiology, perioperative and pain medicine at the New York City-based Icahn School of Medicine at Mount Sinai, told The Washington Post.
5. Mallinckrodt Pharmaceuticals suggested the study was significantly flawed and cited two journal articles stating IV acetaminophen reduces hospital costs and decreases opioid use. The pharmaceutical company also stated that half of the patients receiving IV acetaminophen in the study only received one dose, which is a quarter of the approved dose.
"Based on the review evidence available, it doesn’t seem like the IV formulations are significantly better than oral formulations of these medications," said Will Vincent, PharmD, a clinical pharmacy specialist for Boston Medical Center, to The Washington Post. "For some of our patients who are critically ill, if we're not able to use oral medications, we're forced to use the injectable route."
6. Dr. Leibowitz and a co-author, Jashvant Poeran, MD, PhD, noted that drug approvals don't always capture the real-world challenges of using a drug because approvals are based on specific clinical trials.
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