Formulary Removal of Cholesterol Drug From Inpatient Setting

Inpatient administration of the cholesterol medication Zetia (ezetimibe; Merck) may be clinically warranted for only a small group of patients who are unresponsive or intolerant to statin therapy, according to research presented at the 2018 ASHP Summer Meetings and Exhibition.

Hypercholesterolemia, which is linked to an increased risk for cardiovascular disease, is a major cause of morbidity and mortality across the nation and HMG-CoA reductase inhibitors (statins) are the most popular drug option for treatment. Oftentimes use of nonstatin therapies do not provide adequate atherosclerotic cardiovascular disease risk-reduction benefit. However, nonstatin therapies are used for patients who are unresponsive or intolerant to statins. 

Researchers, led by Dharti Patel, PGY-2 Internal Medicine Pharmacy Resident at Yale New Haven Hospital, and colleagues, performed a retrospective chart review of patients aged 18 years and older who received Zetia during an inpatient admission in order to better understand the drug’s use in the inpatient setting and to also assess the potential for formulary removal. The data collected during the study included, patient age, gender, allergy to statin and reaction history, hospital length of stay, ordering service-line, Zetia indication for use, Zetia monotherapy vs a combination with statin, and if Zetia was a new start in the inpatient setting.

The researchers identified 100 patients in their retrospective analysis. According to the findings, the average hospital length of stay was 5 days. Roughly 19% of patients had a documented allergy to statin medications, and the majority of patients observed did not have a documented reaction to statins in their allergy history. Notably, six patients had myalgia listed as an intolerance, and one patient had hives documented for their statin reaction history. Further findings suggest that the primary indication for Zetia use was for hypercholesterolemia and/or hyperlipidemia among 87% of patients. Roughly 71% of patients were on statin therapy concurrently with Zetia, and Lipitor (atorvastatin; Pfizer) was the most commonly prescribed statin. The researchers noted that only five patients started Zetia as a new medication during the study.  

“Results of this drug-use evaluation revealed that a minority of patients had a documented history of statin intolerance and the majority were on concomitant statin therapy,” the researchers concluded. “The findings from this review resulted in formulary optimization through the removal of ezetimibe from the inpatient health-system formulary.”

—Julie Gould