Errors & Omissions

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, correct an error.

Below is information on revisions, corrections, or modifications to existing monographs that have been identified in the past 12 months. Information dating later than 12 months can be accessed in our Archived Errors & Omissions.

Sulfacetamide and Prednisolone - October 2008

Error in the Dosing field of the Sulfacetamide and Prednisolone monograph in Lexi-Drugs, Drug Information Handbook, 17th edition (both domestic and international editions), Drug Information Handbook for Dentistry, 14th edition, Drug Information Handbook for Nursing, 10th edition, and Drug Information Handbook for Advanced Practice Nursing, 9th edition.

The monograph previously read:

Dosing
Conjunctivitis: Ophthalmic: Children > 2 months:

It has been corrected to read:

Dosing
Conjunctivitis: Ophthalmic: Children ≥ 6 years:

These changes have been automatically posted to online and hand-held reference sources, but the error will persist in the current print editions.

Vasopressin - June 2008

Error in the Dosing - Adults field of the Vasopressin monograph in Lexi-Drugs handheld applications and the following print publications, Geriatric Dosage Handbook, 13th edition, Drug Information Handbook for Nursing, 10th edition, and Drug Information Handbook for Advanced Practice Nursing, 9th edition.

The monograph previously read:

Dosing-Adults:
GI hemorrhage (unlabeled use):
Continuous I.V. infusion: 0.5 milliunits/kg/hour (0.0005 unit/kg/hour); double dosage as needed every 30 minutes to a maximum of 10 milliunits/kg/hour
I.V.: Initial: 0.2-0.4 unit/minute, then titrate dose as needed; if bleeding stops, continue at same dose for 12 hours, taper off over 24-48 hours.

It has been corrected to read:

Dosing-Adults:
GI/variceal hemorrhage (unlabeled use):
Continuous I.V. infusion: Dilute in NS or D5W to 0.1-1 unit/mL. Note: Other therapies may be preferred.
Variceal hemorrhage (unlabeled use) [AASLD guidelines, 2007]:
Adults: Initial: 0.2-0.4 units/minute, may titrate dose as needed to a maximum dose of 0.8 units/minute; maximum duration: 24 hours at highest effective dose continuously (to reduce incidence of adverse effects). Patient should also receive I.V. nitroglycerin concurrently to prevent myocardial ischemic complications; monitor closely for signs/symptoms of ischemia (myocardial, peripheral, bowel)

These changes have been automatically posted to hand-held reference sources, but the error will persist in the current print editions.

Concerns Related to Overdose/Toxicology Information

Similar to other pharmacology references, Lexi-Comp’s monographs include a limited presentation of overdose/toxicology information derived primarily from FDA-approved product labeling. This should not be considered complete and/or may not adequately reflect current medical practice, and therefore should not be the basis of treatment decisions. Optimal care decisions are made based upon specific patient details. Consider consultation with a poison control center. To reach poison control centers in the United States, and its territories, call 1-800-222-1222.

Removal of physostigmine as a treatment option in tricyclic antidepressant (TCA) overdose/acute toxicity - March 2008

Previous approaches to the management of TCA overdose events suggested that physostigmine may be effective in the reversal of CNS toxicities and/or vagolytic tachyarrhythmias originating from acute intoxication with agents likely to induce an anticholinergic syndrome. However, current clinical practice acknowledges the potential for significant toxicity resulting from this approach.

Clinically significant complications, including asystole and seizures, have been reported following the administration of physostigmine in TCA-poisoned patients. Patients with bradycardia and/or prolonged QRS duration may be at particular risk for physostigmine-associated toxicities. Therefore, physostigmine is not recommended in the setting of TCA intoxication. Treatment of these patients is complex and requires clinical decisions based upon patient-specific details. Consultation with a poison control center is highly recommended.

Changes regarding the use of physostigmine have been made to our online and hand-held reference sources; however, these changes will not be reflected in current editions of our print publications, including the Drug Information Handbook, 16th edition, Geriatric Dosage Handbook, 13th edition, Drug Information Handbook for Psychiatry, 6th edition and Pediatric Dosage Handbook, 14th edition.

Methocarbamol – March 2008

Error in the Overdosage/Toxicology field of the Methocarbamol monograph in Lexi-Drugs and reference publications including Drug Information Handbook, 16th edition, Geriatric Dosage Handbook, 13th edition, and Drug Information Handbook for Psychiatry,6th edition.

The monograph previously read:

Overdosage/Toxicology: Symptoms include cardiac arrhythmias, nausea, vomiting, drowsiness, and coma. Treatment is supportive following attempts to enhance drug elimination. Hypotension should be treated with I.V. fluids and/or Trendelenburg positioning. Dialysis, hemoperfusion, and osmotic diuresis have all been useful in reducing serum drug concentrations. The patient should be observed for possible relapses due to incomplete gastric emptying.

It has been corrected to read:

Overdosage/Toxicology: Symptoms include cardiac arrhythmias, nausea, vomiting, drowsiness, and coma. Treatment is supportive following attempts to enhance drug elimination. Hypotension should be treated with I.V. fluids and/or Trendelenburg positioning. The patient should be observed for possible relapses due to incomplete gastric emptying.

Dialysis, hemoperfusion and/or osmotic diuresis were previously recommended as possibly efficacious treatment strategies to reduce serum concentrations of excessive methocarbamol ingestion. However, clinical literature does not support diuresis or effective removal of methocarbamol by dialysis in chronic renally impaired patients, so these practices can no longer be recommended. Current labeling of methocarbamol states that the effectiveness of hemodialysis in managing overdose is unknown.

Factor IX Complete (Human) – February 2008

Error in the Use field of the Factor IX Complex (Human) monograph in Lexi-Drugs and reference publications including Drug Information Handbook , 16th edition.

The monograph previously read:

Use: Control bleeding in patients with factor IX deficiency (hemophilia B or Christmas disease) Note: Factor   IX concentrate containing only factor IX is also available and preferable for this indication.
  Prevention/control of bleeding in hemophilia A patients with inhibitors to factor VIII
  Prevention/control of bleeding in patients with factor VII deficiency
  Emergency correction of the coagulopathy of warfarin excess in critical situations

It has been corrected to read:

Use:  Control bleeding in patients with factor IX deficiency (hemophilia B or Christmas disease) Note: Factor IX concentrate containing only factor IX is also available and preferable for this indication.

Use: Unlabeled/Investigational: Emergency correction of the coagulopathy of warfarin excess in critical situations. Note: Products contain low/non-therapeutic levels of Factor VII component

Changes to the Dosage field have also been made to correspond with the changes in Use fields. These changes have been automatically posted to online and hand-held reference sources, but the error will persist in the current print editions.

Topotecan – January 2008

Error in the Use field of the Topotecan monograph in the Drug Information Handbook for Oncology, 7th edition and Lexi-Drugs .

The monograph previously read:

Use: Treatment of nonsmall cell lung cancer, myelodysplastic syndrome, sarcoma (pediatrics), neuroblastoma (pediatrics), refractory solid tumors (pediatrics)

Unlabeled uses: Treatment of nonsmall cell lung cancer, sarcoma (pediatrics)

It has been corrected to read:

Use:  Treatment of ovarian cancer and small cell lung cancer; cervical cancer (in combination with cisplatin)

Use: Unlabeled/Investigational: Investigational: Treatment of nonsmall cell lung cancer, myelodysplastic syndrome, sarcoma (pediatrics), neuroblastoma (pediatrics), refractory solid tumors

These changes have been automatically posted to online and hand-held reference sources, but the error will persist in the current print edition.

Lidocaine – August 2007

Error in the Usual Dosage / Dosage (Usual) field of the Lidocaine monograph in the Pediatric Dosage Handbook, 14th Edition both domestic and international versions and Pediatric Lexi-Drugs.

The monograph previously read:

Usual Dosage

Children (PALS 2005 guidelines):

E.T.: 2-3 mg; flush with 5 mL of NS and follow with 5 assisted manual ventilations

It has been corrected to read:

Usual Dosage

Children (PALS 2005 guidelines):

E.T.: 2-3 mg/kg; flush with 5 mL of NS and follow with 5 assisted manual ventilations

These changes have been automatically posted to online and hand-held reference sources, but the error will persist in the current print edition.

Aliskiren – August 2007

Error in the Contraindications field of the Aliskiren monograph in Lexi-Drugs (both online and handheld applications)

The monograph previously read:

Contraindications Hypersensitivity to aliskiren or any component of the formulation; history of idiopathic or hereditary angioedema; history of ACE inhibitor- or ARB-related angioedema; bilateral renal artery stenosis; pregnancy

It has been corrected to read:

Contraindications There are no contraindications listed in manufacturer's labeling.

These changes have been automatically posted to online and hand-held reference sources.