Commonly Used ICU Meds Lack Information on Product Labels

According to a new study published online in the American Journal of Health-System Pharmacy, researchers found that commonly used ICU injectable medications often have limited, and sometimes inadequate, information for calculating an appropriate dosage.

“Medication product labeling was reviewed to determine if sufficient information is available to appropriately calculate dosing regimens for special intensive care unit (ICU) populations, including patients at extremes of body habitus and patients receiving hemodialysis, continuous renal replacement therapy (CRRT), or extracorporeal membrane oxygenation (ECMO),” explained Candice Eastman, PharmD, and Brian Erstad, PharmD.

Drs Eastman and Erstad examined 100 of the most commonly used injectable medications among adults in the ICU of an academic medical center. They used FDA-approved product labels to review the following:

• adult weight-based dosing;
• weight descriptors;
• dosing of patients at extremes of weight (body mass index of <18.5 or >40 kg/m2); and
• dosing of patients receiving hemodialysis, CRRT, or ECMO.

“Information was ranked for dosing usefulness on a scale of 0 to 3; an information usefulness score of 2 or greater was considered minimally adequate for dosing special ICU populations,” they explained.

According to the findings, of the 100 medications examined, 47 provided information on weight-based dosing, with the labeling of 30% referring to a specific weight descriptor. Further, the labels of 15 medications included dosing information for patients at extremes of body habitus including, underweight, obesity, and extreme obesity, with the labeling of 8 medications receiving an information usefulness score of ≥2.

“Among the 42 medications whose labeling provided hemodialysis-related dosing information, the labeled information of 52% was assigned a usefulness score of ≥2; among the 3 medications with CRRT-related dosing information, the labeling of 1 received a score of ≥2. ECMO-related dosing information was available for 2 medications, with 1 score of ≥2 assigned.”

Based on their findings, Dr Eastman and Erstad concluded that, “information in the product labeling of injectable medications commonly used in the ICU is limited and generally inadequate for calculating an appropriate dose for special ICU populations.”

—Julie Gould  

Reference:

Eastman C, Erstad BL. Availability of information for dosing commonly used medications in special ICU populations. Am J Health Syst Pharm. 2020;77(7):529–534. doi:10.1093/ajhp/zxaa022