October 31, 2025
Clozapine is a highly effective atypical antipsychotic, but it’s not without drawbacks (Table 1). Historically, patients, prescribers and pharmacies were required to enroll in the Clozapine REMS program due to the drug’s potential to cause agranulocytosis. The REMS program was officially eliminated on June 13th, 2025, though the FDA still recommends that prescribers monitor absolute […]
Read MoreAugust 19, 2025
Our hospice partners occasionally ask how to convert patients from one antiseizure medication (ASM) to another. These requests are usually driven by cost or formulary considerations, but other common reasons include lack of efficacy, intolerable adverse effects, and problematic drug-drug interactions. Ideally, formulary / cost shouldn’t be the sole basis for rotating to an alternate […]
Read MoreApril 14, 2025
In light of the ongoing opioid crisis, there’s been a significant push to develop new medications for pain that have fewer side effects and lower risks of addiction and overdose. The highly anticipated approval of suzetrigine (trade name Journavx) in January 2025 marks the first time in over 20 years that a drug from a […]
Read MoreFebruary 3, 2025
Generally speaking, the use of vitamins at end of life is not beneficial. Still, hospice patients with age-related macular degeneration (AMD) might be reluctant to stop taking their eye vitamins out of fear of going blind during their final months of life. AMD is a degenerative disease that damages the macula (the central portion of […]
Read MoreOctober 30, 2024
Phenazopyridine (Pyridium) is a urinary analgesic that’s been around for over 100 years.1-3 In fact, the Food and Drug Administration (FDA) considers it a “grandfathered” drug, so safety and efficacy data from clinical trials is limited and its therapeutic role is based primarily on clinical observations.1,2 It’s solely a urinary analgesic (through an unknown mechanism) […]
Read MoreSeptember 10, 2024
As hospices operate with limited funds, minimizing drug costs is important. Therapeutic substitution, where one drug is replaced with a less expensive drug, is one tool to help with this. One substitution we’re occasionally asked about is using valproic acid (VPA) (Depakene) in place of divalproex sodium (Depakote). VPA costs about half as much as […]
Read MoreJuly 8, 2024
The oral route is by far the most popular and convenient means of drug administration, even in the hospice setting. However, for various reasons (e.g., dysphagia, nausea / vomiting, bowel obstruction, obtundation) as many as 70% of hospice patients will need their medications to be administered by non-oral routes.a-c Rectal drug administration is probably done […]
Read MoreMay 20, 2024
ALS (Amyotrophic Lateral Sclerosis), also known as Lou Gehrig’s disease, is an incurable progressive neurodegenerative disorder that leads to weakness, spasticity, and incoordination of the muscles involved in speaking, swallowing, breathing, and ambulation. Background1-4 Its onset most often occurs between the ages of 40 and 70, with a median survival time of 30 months, but […]
Read MoreApril 10, 2024
Occasionally, hospice clinicians may encounter patients with enteral feeding tubes (FTs). These tubes are used to provide enteral nutrition (EN) in individuals with a functioning GI tract who are otherwise unable to be fed orally.1 There are numerous types of tubes out there which are generally classified by insertion site and where in the body […]
Read MoreFebruary 6, 2024
If you’ve ever used software that checks for drug interactions, you’ve come across alerts regarding QT interval prolongation. But you work in hospice…are these still significant and what can you do about them? Let’s start with some basics1 -6: QT interval – a measure of ventricular repolarization in the heart QTc interval – QT interval […]
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