Best Apps For Pharmacists

As a pharmacist, you know that there’s a lot more to your job than filling prescriptions and counting pills. You’re interacting with patients, finding ways to help them with any questions they have about their drugs, and providing expert advice on the best course of action to take.

It’s an incredibly challenging profession, but thankfully, you don’t have to do it alone! There are plenty of apps out there that can help you do your job better, faster, and easier.

We’ve rounded up some of the best apps for pharmacists to help you manage your time on the job—and give your patients a reason to stick with you through thick and thin.

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5 Brilliant Pharmacy Apps for Stressed-Out Pharmacists

Best Apps For Pharmacists

We all check in with our smartphones more than a few times throughout the day. Whether we’re responding to texts or scrolling through our social feeds, it can be difficult to refrain from the distraction of our mobile devices. But what if there was a way to make your phone actually useful at work?

From drug information to patient education, these apps can help you be better at everything that you do.

Epocrates

Epocrates, a point-of-care medical application, is widely regarded as a useful tool for pharmacists. The app itself provides clinical reference information on drugs and has a variety of features such as a drug interaction checker, pill identifier, and drug coverage information for insurance plans. Most of the app’s offerings are free of charge, although additional features may be included for a monthly fee. This includes medicine monographs, peer-reviewed disease content from the BMJ, and labs, ICD-10 codes, and more.

Pocket Pharmacist

The Pocket Pharmacist app provides pharmacist-curated drug information that can be useful if you need to look something up quickly. According to the company’s description, it “feels like you’re talking to a live pharmacist versus reading through an encyclopedia.” The tool is good for drug information, searching for drug interactions, and testing your own knowledge through medication quizzes.

CDC Vaccine Schedules

Here’s a way to have the latest recommended immunization schedules at your fingertips. The CDC’s Vaccine Schedules app visually mimics the printed schedules which are reviewed and published annually, including the most current version of the schedules for children and adolescents, catch-up schedule for children, adult schedule (as recommended by age group and medical conditions), and an adult contraindications and precautions table. Any changes in the schedule are released through app updates.

Drugs.com Medication Guide

Drugs.com offers a comprehensive app filled with information that allows you to check drug interactions, identify pills, and create custom lists and reports. The app also offers in-depth consumer information, FDA alerts, and a complete A-to-Z database of drug information.

Merck Manual Professional

The Merck Manual has long been the go-to source for medical knowledge, and now you can put all that in your pocket-without having to lug around a 20-pound book and flip endlessly through thousands of pages. The app contains thousands of regularly-updated articles, drug reference information, illustrations, and much more-all available for free.

Lexicomp

this tool has unique features such as pharmacogenomics databases, IV compatibility data, patient education leaflets, drug shortage information, and the ability to reorder databases and monograph fields to customize displays.

According to the company, the content is also stored directly on the device, making it feasible to quickly answer questions while on the go even if there’s no internet connection.

Drugs@FDA Express

The FDA’s Drugs@FDA Express app is a free mobile version of the agency’s online database of information on approved drugs. Users can search and browse by drug name, active ingredient, or application number. A list of recent approvals, organized by date, can also be viewed in the ‘Last 7 Days’ Approvals’ option

download issueDownload Issue: Drug Topics March 2020
Creating A Successful Social Media Presence
April 11, 2022
Katie Hobbins

Social media is a great way to gain exposure, but there are many dos-and-don’ts to understand when signing up for a social platform.

Social media continues to show its importance to the practice, physician, and patient by providing physicians with the platform to spread accurate information to the public, arming the practice with free marketing for services and products, and giving access for patients to ask questions to experts in the field.

In a recent session at the American Academy of Dermatology (AAD) Annual Meeting, held March 25 to 29, in Boston, Massachusetts, experts rounded up their top tips and tricks to make social media work best for business needs.

Kavita Mariwalla, MD, Maxim Polansky, MD, and Muneeb Shah, DO, came together to give the audience a “how-to” guide on the basics.

For this, they suggested to post on social media accounts at a consistent pace, ie. once or twice a day. It’s good to be flexible with what social platforms to use on a certain day. Switch it up and use Instagram one day and Twitter the next.

The presenters noted that it helps to find your niche and run with it—think Dr Miami, or Dr Pimple Popper. Doing this can help narrow down a target audience to reach. Show your personality online but, be careful to not cause too much controversy, they said.

Social media can be hard work with sometimes small reward, but tagging, following, and making comments on other accounts can help garner interest. The presenters also said that buying followers to get started is not the way to go.

Social media inherently comes with internet trolls. Trolls are known as accounts that comment or respond to posts, usually in a confrontational manner, or to get a rise out of the original poster.

When this happens, the presenters recommended blocking and reporting them on the platform. You can respond, but mostly, this will only embolden the commenter to continue. It’s important to remember that people are always watching, and sometimes replying to a troll only looks bad on you. As a physician first, sometimes it’s better to just let it go, they said.

As a physician, many may have partnerships with companies that could expand to social media. If a company reaches out for partnership using social media, it’s important to ask:

Is the post on my grid or in my story?
Will the company use one of my images?
What are the usage rights for the sponsored video, how long is the contract?
Will I need to purge any of my prior posts?
How many posts will activate that day/week?
Where will the post live?
Will they use quotes?
Is there exclusivity from other brands?
When and how will I be paid?
How many edits to the content are allowed?
Do I have indemnification against any product liability claims?
When posting from a partnering company or showing products gifted by a company, it needs to be disclosed. Many use the hashtags #ad, #sponsored, and #brandpartner. When items are gifted, many viewers understand the use of the word PR as a clarification.

The presenters continued that, just like in conference presentations, do not copy the intellectual property of other colleagues, post pictures of patients without their written consent, or alter before and after photos.

Lastly, they highlighted their recommendations for apps to use when editing images and creating a landing page for any “Link in Bio” items.

For editing pictures to put on social media, the presenters recommended:

Canva
Capcut
Layout
Snapseed
Unfold
Clipomatic
Splice
Adobe Premiere
Their favorite “Link in Bio” options included:

Beacons
LinkTree
Start Page
Mona
Campsite
Milkshake
This article originally appeared on Dermatology Times.

Reference

Mariwalla K, Polansky MA, Shah M. Don’t be an online tool: #winning in the age of social media. Presented at: 2022 American Academy Dermatology Association Annual Meeting; March 25-29, 2022; Boston, MA.

Paving the Way: Transition from Community to Health System Pharmacy Practice
April 5, 2022
Keith Loria

Conferences | American Pharmacists Association Annual Meeting & Exposition

Making a smooth transition from community pharmacy to health system pharmacy practice is possible, especially for those with marketable skills.

Are you a community pharmacist looking to explore a career change? Are you curious what the market looks like in other areas of pharmacy? Perhaps you’re interested in exploring health-system career options, but not sure where to start?

Marie-Elsie Ade, PharmD, MHA, MSBI, director of pharmacy for Baptist Health South Florida-Homestead Hospital in Homestead, Florida, addressed all of these questions during her presentation on transitioning from community to health system pharmacy at the American Pharmacists Association (APhA) 2022 Annual Meeting & Exposition,1 where she reviewed tips and looked at the tools needed to help pharmacists make the career move.

According to the Bureau of Labor and Statistics, the pharmacy profession—with pharmacists in particular—is seeing a decrease of 2% even though more jobs are available; that figure began dropping even before the pandemic.

“Why would you want to be a pharmacist or transition from community pharmacy to health system pharmacy with such a bleak outlook as opposed to becoming a theatrical makeup artist?” Ade asked. After all, she added, their salary is $106,000 and their growth outlook will increase by 37 percent. The pharmacy profession, on the other hand, is not seeing those numbers.

Among some retail pharmacists, there is a perception that hospital and health system pharmacists don’t have the same levels of stress, and went over the reasons people believe that—some true, some false. She discussed her own experience working retail, filling an average of 200 prescriptions a day with only 1 cashier—who was not available during the busiest hours between 5:00 and 9:00 PM.

“Burnout can lead to fatigue and can lead to high risk of stroke,” she said. “The [WHO] did a study that showed that working more than 55 hours a week will lead to [a] 35% higher risk of stroke and 17% higher risk of dying from heart disease.”

Another reason for moving to health system pharmacy, she noted, is a higher salary. While health system pharmacists start at $96,000 compared with retail that starts at $95,000, growth possibilities show that health system pharmacists will end up making $150,000 compared with $126,000—and in some states, salaries are even higher.

The question of work/life balance is important as well, with the pandemic showing many that money is not everything, so this is another consideration that plays an important role in making a career choice and a possible change.

Abe added that a Flex Jobs study found that 68% of workers want a better work/life balance and flexibility and will take a lower salary if that means that they get to work wherever they want or for reasonable hours. “Stability is one of the reasons we might want to move from retail community to a health system,” she said. “With a health system pharmacy, you have a more stable schedule that you can do.”

If you’ve made the decision to leave, what are the next steps? Ade turned her attention to this question next, and noted that it starts with looking at your strengths, skills, perceived weaknesses, available opportunities and threats, as well as the ability to move on. One must also look at why they are dissatisfied, why they want to move and the pros and cons of making such a move. She suggests that pharmacists keep a journal to organize all their thoughts in order to make a well-informed decision when it’s time to move.

“You may think that you don’t have the skills necessary for the position; however, you bring more to the table than you think,” Ade said. “Don’t be discouraged. You have skills that hospitals, and even residents don’t have, because you have real world experience with those skills.”

When discussing opportunities, Ade noted that right now, the field of pharmacy informatics is booming, and a wanted skill set is pharmacists who can act as translators between IT and clinical positions. She also suggested reading the major journals to learn the latest trends of the profession and what skills pharmacists might need in the future. The Bureau of Labor and Statistics is another excellent tool to learn about salaries and the pharmacy positions available and growing.

Armed with that information, pharmacists can figure out where they stand and their most marketable skills. For instance, not many pharmacists are diabetes educators. “[B]eing a pharmacist and a diabetic educator will really enhance your marketability,” Ade said. “There are a number of certifications you can obtain that can bring you up and make you competitive.”

After all, one might be competing against people who have residency, and feel they can’t move forward. Ade said it doesn’t matter as much as you may think if you market yourself correctly. That may mean starting on a night shift or working swing shifts—shifts that are often undesirable, but that can get a health system hopeful through the door. Ade also suggested looking at smaller health systems to break into a hospital setting.

“The barriers are achievable if you put in the work,” she said.

Reference

Ade M-E. Transitioning from community pharmacy to health-system pharmacy. Presented at: American Pharmacists Association 2022 Annual Meeting and Exposition; March 18-21, 2022; San Antonio, TX.

Empty Nails Are the Cure for What Ailed Them
April 5, 2022
Peter A. Kreckel, RPh
Drug Topics Journal,

Our columnist shares true stories of pharmacists who have left the practice for their own greener pastures.

I frequently remind my fellow pharmacists that their license hangs by a nail on the wall. It is not bolted there; if you are not happy, find yourself a new nail.

Given the current climate of community and hospital practice, I know several pharmacists who will not be looking for a new nail but who instead have given up entirely on this profession. The common thread among these colleagues is that they practice community pharmacy, but I am quite confident the same feelings hold true for my brothers and sisters in hospital pharmacy practice. (I would love to hear their stories as well.)

Each of these pharmacists’ names have been changed.

Bob: Bob wanted to run heavy equipment, like his father. His father insisted that he go to pharmacy school, which he did. Bob graduated at the
top of his class and never worked more than a couple of hours of relief. He loved the bulldozer and the backhoe more than the computer and the counting tray. Because pharmacy was never his passion, we cannot count him among the disgruntled.

Nate: Nate was one of my student pharmacists who had a passion for hospital pharmacy. He practiced in the hospital setting for 7 years. Of all the pharmacists who left the profession, he was truly called to a higher duty: Nate enrolled in the seminary and will be ordained as a priest in the next few years. Sometimes salary, staffing, and satisfaction do not really matter when one hears a higher calling. When we attended morning Mass together, I knew there was something special about him.

Diana: Diana practiced pharmacy for at least 30 years at a grocery store chain. She has been less than pleased for some time with her staffing, management, and environment. She left the profession to take up her passion of baking. She opened a bakery and is extremely satisfied now.

Donna: Donna had an excellent position as a clinical pharmacist. She shared her amazing skills with physicians and nurses, but mostly with patients. Donna and her husband moved away to be closer to family. Although there are numerous opportunities available to her, she would do “anything” to not work in commu- nity pharmacy practice; she is happy being a grandma, and I doubt she will reenter community practice.

Jerry: I met Jerry when he worked as a representative for a drug company. He knew his products well and was an asset to his company. Jerry left that company and took a job practicing community pharmacy for 20 years. Although he is a few years younger than me, the demands from his grocery store chain have made him leave the profession to pursue his true passions. He is an avid fisherman and hunter and will change his income stream from pharmacist to taxidermist and maple sugar manufacturer.

Abe: Of all my pharmacist friends and acquaintances, this loss troubles me the most. Abe comes from a family of pharmacists: his mother, father, and cousins are all pharmacists. He has been out of school only 8 years. During the 8 years he practiced, Abe took a newly opened grocery store pharmacy to the top in prescription volume and sales. The metrics, demands of management, and lack of staffing have made him give up on the profession and work for his mother-in-law’s health care business. He has never been happier and gets to spend time with his growing family.

Enrollments in pharmacy schools are down and for many schools, wait- ing lists no longer exist. Thanks to the glut of pharmacists produced by academia and the miserable working conditions that the 4 major chains— “Corner,”“Three Letter,”“Spark,” and “Lefty”—have created, many excellent, seasoned pharmacists have left the profession to be priests, bakers, taxider- mists, or maple sugar makers… anything but chain pharmacists.

Feel free to send your management my way. I want to keep those nails covered with satisfied licensed pharmacists.

Peter A. Kreckel, RPh, practices community pharmacy in Lemont Furnace, Pennsylvania.

download issueDownload Issue: Drug Topics April 2022
Thriving in a Digital World: Marketing Strategies for Independent Pharmacies
April 4, 2022
Ginny Langbehn
Drug Topics Journal,

Cut through the online noise with these digital marketing tips for your independent pharmacy.

So much has changed over the past few decades in how we consume media. The advent and proliferation of social media, subscription-based news outlets, and the ubiquitous presence of the internet have created an ultrafragmented audience for anyone marketing a product or service. Amid all this “noise,” it has become increasingly difficult to know when, where, and how to get the attention of potential customers.

Do I need a website and social media, or is only one sufficient?
The functions of a website and of social media platforms are different. Independent pharmacies should have both to ensure adequate information about the business is available online.

Which comes first? Creating a social media account is less involved but building a website allows for a compre- hensive digital storefront—a home base if you will—and provides a destination for all other messaging to point. Many free builder tools (GoDaddy, Wix, and Mailchimp, for example) provide easy- to-use templates for simple websites. Good sites will include a welcome message to visitors, bullet points on what sets your business apart from other pharmacies, contact information, a clear photo of the building, and an introduction to your lead pharmacist. Remember, people want to do business with people, not “brands.”

Once your website is in place, social media begins to serve an important function. No matter which platform you choose, social media is a terrific way to add personality to your brand and connect with your audience in a more con- versational way. Facebook and Twitter provide simple avenues to disseminate health care news and updates in a timely manner. With social media, your audience will want to talk to you. Be careful not to provide any diagnostic health care advice or individualized feedback to a patient on social platforms. Keep those conversations between you and patients inside your pharmacy.

How do I choose the right social media platform?
First, identify your customer. If you’re located in a bustling college town, you may be successful with a presence on Instagram or TikTok—but in a market with an older audience, TikTok may be an unwise choice. Most businesses should at least have a Facebook page; consumers tend to use Facebook to find simple information like store hours, location, and information on promotions. A Facebook page also provides a consistent opportunity for businesses to interact and maintain a presence with potential customers.

figure image
Your Digital Marketing To-Do List

What’s next?
Identify your objective before you start. Determine what you want to accomplish in 1 year, then break that down into smaller pieces. Are you looking for new patients or customers, or would you like a higher spend in your store from existing patients? Are you hoping to expand point-of-care services or frontline retail options to generate more revenue?

Each of these goals requires a different marketing approach. Review and assess your progress toward the goal on a monthly or quarterly basis. Don’t wait until the end of the year to “pass” or “fail.”

Decide on your primary message. What is your brand promise? What sets your business apart from other pharmacies? Marketing materials must be consist- ent and include your main message. Each touchpoint with your customers contributes to your pharmacy’s unique voice in the marketplace, and this rein- forcement helps build a clear, consistent reputation across your audience.

Delegate marketing responsibilities. Build the effort into standard daily or weekly pharmacy operations. Whether you choose to do the work yourself or with staff inside your pharmacy, or you contract with a third-party marketing agency, consistency is key. Inconsistent marketing efforts are rarely successful and typically end up being a waste of valuable resources. Choose someone who has an existing interest and ability to engage in these activities regularly to handle the duties.

Start small. Choose simple, measurable initiatives to get started. Once you get comfortable with your public messaging and learn what can be measured, expand from there. Ideally, work up to having 2 or 3 channels activated in 1 marketing campaign.

My budget is limited. How do I know this is working?
In our current age of technology, there are so many tools available to measure the effectiveness of a campaign, especially on social media. Marketers can measure clicks, views, shares, and comments to see what type of content resonates with the audience. Most marketing platforms include tools built into their systems, making these metrics highly visible and easy to understand. Once you have insight into the content that is driving the most response, it becomes easier to identify where to allocate resources most effectively.

Think outside the box.
The most cherished characteristics of an independent pharmacy are the personal service and relationships built between staff and patients. To build on this foundation, pharmacies can and should be asking satisfied patients for positive online reviews. Many consumers consult the internet before choosing to do business with a company. If your pharmacy has an abundance of happy customers recommending your store online, that is a great way to cultivate testimonial “marketing” without spending anything.

Be your best advocate.
A small business should never be the community’s best-kept secret. Every marketing initiative is a conversation with 1 individual at a time, even when communicating to a much larger audience. The enthusiasm that brought you to—and that keeps you going in—the independent pharmacy space is what makes you special in your community. Communicate your passion in an authentic, consistent way and you will be primed for success.

Ginny Langbehn is director of marketing and corporate communications at American Associated Pharmacies (AAP), one of the nation’s largest cooperatives for independent pharmacies.

download issueDownload Issue: Drug Topics April 2022
Telepharmacy Rising: Challenges Accompany the Growth of Telepharmacy Use
April 4, 2022
Fred Gebhart
Drug Topics Journal,

Before the pandemic, telepharmacy and telehealth were nice ideas. Today, they’re crucial to delivering personalized care with limited in-person contact.

Telepharmacy is on a roll. In 2001, when North Dakota became the first state to enact regulations allowing the practice.1 By early 2023, 28 states will allow some form of telepharmacy, and Kansas is poised to finalize regulations later this year, according to telepharmacy services provider TelePharm. Approval is advancing in other jurisdictions as well.

“Through the pandemic, there has been a drastic uptake in technology, especially remote technology,” said Brett H. Barker, PharmD, vice president of operations for NuCara Pharmacy, which operates physical stores and telepharmacies in Illinois, Iowa, Minnesota, North Dakota, and Texas. “I think we jumped forward a decade in about 2 weeks back in March 2021 with [individuals’] comfort levels, uptake, and acceptance of remote care. Telepharmacy is good for patients, good for communities, and good for pharmacists.”

Telepharmacy is also a challenge. Roughly 40% of states do not allow telepharmacy, cautioned Mary Ann Kliethermes, PharmD, director of medication safety and quality for the American Society of Health-System Pharmacists. Among states allowing telepharmacy, no two have adopted the same practice regulations.

figure image
Telepharmacy Permitted States

Payers take similarly diverse approaches. Washington and some other states require commercial insurers to reimburse pharmacists on the same basis as physicians, nurse practitioners, and other health care providers. However, most states are silent on payment parity and most commercial payers still balk at paying for nondispensing services, although that could change as the profession continues to push for provider status at state and federal levels.

Medicare does not recognize pharmacists as providers, Kliethermes noted, although the program does reimburse pharmacists up to $150 per month for complex chronic care management. Medicaid reimbursement for pharmacists varies by state.

The biggest financial difference between a traditional pharmacy and a telepharmacy is the cost structure. The return on investment for a traditional pharmacy depends largely on prescription volume, front-end sales, and pharmacist costs. Telepharmacy lowers the financial bar by sharing pharmacist time across multiple dispensing locations.

According to Barker, reimbursement for remote dispensing is similar to conventional in-person dispensing. The current telepharmacy break-even point is around 70 to 80 prescriptions daily, he said, but the number varies by patient population, prescription mix, payer mix, and other familiar factors.

On the cost side, telepharmacy requires more video hardware than conventional pharmacy to facilitate real-time pharmacist monitoring and conversations, but the cost of off-the-shelf hardware is low—and falling. But best practices, and in many cases state regulations, call for off-site storage of all video and still images from both the remote telepharmacy site and the supervising pharmacist, which increases cloud storage costs.

Telepharmacy software providers typically charge an activation fee and monthly use fees, Barker added. The total cost is roughly equivalent to having a pharmacist on site 1 day per week. Telepharmacy providers should expect to pay for the best technicians available.

figure image
The 3 T’s: Telemedicine, Telehealth, or Telepharmacy?

“You absolutely need rock star pharmacy technicians because they have a higher level of responsibility and visibility in telepharmacy,” Barker said. “You need good problem solvers who can think on their feet and you need a high level of trust. When you have a telepharmacy, the technician is the public face of the pharmacy.”

Getting paid for virtual clinical services can be as challenging as payment for face-to-face clinical services, Kliethermes said. Medicare reimburses pharmacists for telehealth complex chronic care management. One pharmacy provider, Tabula Rasa HealthCare, is being reimbursed under PACE, the federal Program of All-Inclusive Care for the Elderly, which covers frail older adults who are often eligible for Medicare and Medicaid. However, Medicare payments to pharmacists are more the exception than the rule.

“Because Medicare does not recognize pharmacists as providers, it limits reimbursement regardless of the applicable practice act,” she said. “That makes reimbursement challenging because not all of the Medicare telehealth codes are applicable to pharmacists.”

Technicians are also part of the clinical service and revenue mix. A growing number of states allow pharmacy technicians to administer point-of-care tests, immunizations, specimen collection, and other clinical services under pharmacist supervision, Barker noted.

“All of those clinical services can happen safely and effectively through the telepharmacy model,” he said. “At this point, the model is proven and works well. Telepharmacy is letting us extend the reach of our pharmacists and their clinical services. Pharmacists are delivering the same care they provide in a traditional community pharmacy; they’re just delivering it in a different model.”

pharmacy apps

it is common for pharmacy students and pharmacists to encounter patients who are seeking information about the medications they are taking.

Many of the written directions on drug labels are difficult for patients to interpret, especially when they do not have the type of training or extensive knowledge in medications that we do.

Fortunately, mobile apps developed for health care professionals can help solve patients’ medication-related problems. These medical apps are tremendously useful and accommodating to pharmacy students and pharmacists who need to find instant information for a patient.

Here are the highest-rated free medical apps available:

figure image
Epocrates

· Reviews prescription drug and safety information

· Runs drug-drug interactions

· Scans health care insurance formularies for medication coverage

· Calculates body mass index

· Identifies medications by physical characteristics or imprint

· Available for Android and iOS devices

figure image
iPharmacy

· Analyzes drug tablet or capsule based on color, shape, and/or imprint

· Provides detailed medication profiles

· Available for Android and iOS devices

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Pharmacy Lab Values

· Includes more than 150 different lab values that are organized and divided into categories

· Works offline

· Available for Android devices only

figure image
MPR

· Provides detailed drug information

· Checks drug-drug interactions

· Offers up-to-date, concise prescription and OTC drug monographs

· Distributes daily drug news and warnings

· Contains personalized bookmarks for frequently accessed contents

· Accommodates more than 120 different clinical tools, such as calculators

· Available for Android and iOS devices

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Pharmacist’s Letter

· Delivers concise recommendations for patient care

· Contains subscription options for continuing education found in the letter

· Available for Android and iOS devices

figure image
Pocket Pharmacists

· Provides complete drug profile

· Runs drug-drug interactions, precautions, and adverse effects between 2 or more drugs

· Incorporates online resources for medications

· Available for Android and iOS devices

figure image
Shots Immunizations

· Encompasses vaccine schedules and footnotes from the US Centers for Disease Control and Prevention

· Supplies graphics, images, and commentary for vaccines

· Maintains important up-to-date information for each vaccine

· Available for Android and iOS devices

Other useful medical apps:

· Micromedex

· MedCalc

· Medscape

· BlackBag

By providing accurate and thorough information for patients and health care team members, these mobile apps can certainly serve as comprehensive resources for pharmacy students and pharmacists. When all else fails, there is always Dr. Google.

Reference

There’s an app for you: tools for pharmacist use. American Pharmacists Association. July 1, 2015. http://www.pharmacist.com/there-s-app-you-tools-pharmacist-use. Accessed January 4, 2016.

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Clinical Overview: Cabotegravir (Apretude) for HIV Pre-Exposure Prophylaxis
April 15, 2022
Edmond M. Nunes, PharmD, RPh, BCSCP

Cabotegravir is the only current HIV-1 PrEP medication that does need to be taken daily.

Cabotegravir (Apretude) is an injectable FDA-approved HIV-1 integrase strand transfer inhibitor (INSTI) used for pre-exposure prophylaxis (PrEP) in undiagnosed HIV-1 infection.1 Approved in December 2021, it is the first injectable medication available for HIV-1 PrEP. Cabotegravir is the only current HIV-1 PrEP medication that does need to be taken daily.2

Previously approved as a treatment for HIV-1 infection,3 the FDA approved cabotegravir for HIV-1 PrEP based on the results of 2 international trials: HPTN 083 and HPTN 084. Both studies were randomized, double-blind trials comparing the risk of acquiring HIV-1 infection when using either injectable cabotegravir or once daily oral tenofovir disoproxil fumarate/emtricitabine.

Study participants administered cabotegravir were given oral cabotegravir and placebo to take daily for 5 weeks, followed by cabotegravir injections and daily oral placebo tablets. Study participants receiving tenofovir disoproxil fumarate/emtricitabine were given a placebo and tenofovir disoproxil fumarate/emtricitabine to take daily for 5 weeks, followed by daily tenofovir disoproxil fumarate/emtricitabine tablets and placebo injections.

HPTN 083 was a non-inferiority study comparing cabotegravir to tenofovir disoproxil fumarate/emtricitabine. The researchers randomized 4566 cisgender men and transgender women who have sex with men 1:1 to receive either cabotegravir injections every 2 weeks or tenofovir disoproxil fumarate/emtricitabine oral tablets daily for up to 153 weeks.

Study participants in the cabotegravir arm had a 69% reduction in risk of HIV-1 infection incidence when compared to the tenofovir disoproxil fumarate/emtricitabine arm.

HPTN 084 was a superiority study comparing cabotegravir to tenofovir disoproxil fumarate/emtricitabine that enrolled 3224 cisgender women. The researchers randomized participants 1:1 to receive either cabotegravir injections every 2 weeks or tenofovir disoproxil fumarate/emtricitabine oral tablets daily for up to week 153. This study revealed a 90% reduced risk of HIV-1 infection incidence in the cabotegravir group compared to the tenofovir disoproxil fumarate/emtricitabine group.1,2

Mechanism of Action

Cabotegravir is the newest member of the INSTI antiretroviral medication class. HIV uses the enzyme integrase to incorporate its deoxyribonucleic acid (DNA) into the host CD4 cell.1 All medications in the INSTI class bind to the integrase active site, thereby blocking viral DNA integration and subsequent HIV replication.4 Compared with other INSTIs, cabotegravir is one of the more potent agents with a mean 50% inhibitory concentration (IC50) of 3 nM.

Dosage and Administration

The FDA approved 2 dosing schedules for cabotegravir: 1 with and 1 without an optional 28-day oral lead-in. The oral lead-in is not required based on clinical safety and efficacy data from HIV-1 treatment trials.

Regardless of the chosen schedule, cabotegravir is dosed at 600 mg for adults and adolescents weighing at least 35 kilograms. If a dose is missed, prescribers should evaluate patients before continuing therapy to ensure cabotegravir remains the best HIV-1 PrEP choice (see Table 1 for manufacturer suggested make-up schedule).

figure image
If using optional lead-in, patients should receive 30 mg oral cabotegravir once daily for 28 days, followed by cabotegravir injection at months 2 and 3. Cabotegravir is given again at month 5 then repeated every 2 months.

When using the direct to injection regimen, oral cabotegravir is avoided. Cabotegravir injection is given at months 1 and 2. Patients will receive another dose at month 4 then repeat every 2 months.

Supplied as an extended-release cabotegravir 600 mg/3 mL suspension, cabotegravir is given as a gluteal intramuscular injection. Cabotegravir can be stored at 2o to 25o C and is packaged with administration supplies.

If a patient has a BMI exceeding 30 kg/m2, health care providers should consider using a longer needle than provided in the kit. Before administration, they should visually inspect the suspension and discard it if the product is discolored or contains particulate matter.

They should shake the vial vigorously then draw the product aseptically into the provided syringe using the vial adaptor. If the injection is not given immediately, it may be stored in the syringe for up to 2 hours at room temperature.

Adverse Events (AEs)

Prescribers must monitor patients receiving cabotegravir for the development of hepatoxicity and depressive disorders. In clinical trials, injection site reaction was the most commonly reported AE. GI symptoms (diarrhea, nausea, flatulence, and abdominal pain) and neurologic symptoms (headache, pyrexia, fatigue, dizziness, and sleep disorders) were experienced in at least 1% of study participants.

When counseling patients, pharmacists need to remember this medication’s long-acting properties. Cabotegravir remains in the systemic circulation for at least 12 months.

Warnings/Precautions

Pharmacists need to counsel patients, focusing on adherence to testing and dosing schedule, before and during treatment with cabotegravir. Adherence is key to preventing HIV-1 infection and the formation of drug-resistant HIV-1 infection.

Accordingly, cabotegravir is contraindicated in individuals with unknown or positive HIV-1 status. An individual testing positive for HIV-1 must transition from cabotegravir to a complete HIV-1 treatment regimen.

Patients with a previous hypersensitivity reaction to cabotegravir must avoid further use. Medications that may significantly decrease cabotegravir plasma concentrations need to also be avoided.

These medications affect uridine diphosphate glucuronosyltransferase (UGT1A1) and include carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, and rifapentine.

Pregnancy/Lactation

Pregnant women should only use cabotegravir if the expected benefits outweigh potential fetal risks. It is not known whether the use of cabotegravir during pregnancy causes adverse outcomes.

Although data on cabotegravir use in pregnant women has not been evaluated, another INSTI, dolutegravir, is associated with neural tube defects. Providers can enroll pregnant women using cabotegravir with the Antiretroviral Pregnancy Registry to monitor outcomes.

Cabotegravir was present in the milk of lactating animals, but human data are lacking. Women who breastfeed should only take cabotegravir if the expected benefits outweigh the potential risks.

Pharmacists should counsel pregnant women, women of childbearing age, and women breastfeeding children of potential risks. As previously mentioned, practitioners should remember cabotegravir is present in the body for at least 12 months after discontinuation.1

About the Author

Edmond M Nunes, PharmD, RPh, BCSCP is the pharmacy clinical coordinator at Sturdy Memorial Hospital in Attleboro, MA.

References

Apretude prescribing information. December 2021. Accessed March 6, 2022. https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Apretude/pdf/APRETUDE-PI-PIL-IFU.PDF
US food & drug administration. FDA approves first injectable treatment for HIV pre-exposure prevention. Accessed March 6, 2022. https://www.fda.gov/news-events/press-announcements/fda-approves-first-injectable-treatment-hiv-pre-exposure-prevention
Cabenuva prescribing information. February 2022. Accessed March 6, 2022. https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Cabenuva/pdf/CABENUVA-PI-PIL-IFU2-IFU3.PDF
HIV.gov. Integrase strand transfer inhibitors (INSTI). Accessed March 6, 2022. https://clinicalinfo.hiv.gov/en/glossary/integrase-strand-transfer-inhibitor-insti#:~:text=Integrase%20strand%20transfer%20inhibitors%20(INSTIs,integrase%20prevents%20HIV%20from%20replicating.
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Pfizer, BioNTech Data Demonstrate High Immune Response Following COVID-19 Booster in Children 5 Through 11
April 15, 2022
Aislinn Antrim, Associate Editor

The companies plan to submit these data to the FDA in the coming days for an Emergency Use Authorization of a booster dose for children ages 5 through 11 in the United States.

New data from a subanalysis of 30 sera from a phase 2/3 clinical trial of children aged 5 through 11 years of age show a 36-fold increase in SARS-CoV-2 Omicron neutralizing titers following a booster dose of the Pfizer-BioNTech COVID-19 vaccine.1

According to the study, the phase 2/3 trial included 140 children who received a booster dose, which increased neutralizing antibodies by 6-fold against the SARS-CoV-2 wild-type strain in this age group. These data reinforce the potential function of a third dose of the vaccine in maintaining high levels of protection against the virus in this age group. Furthermore, a robust response was observed regardless of prior SARS-CoV-2 infection.1

The phase 1/2/3 trial initially enrolled up to 4500 children aged 6 months to under 12 years in the United States, Finland, Poland, and Spain from more than 90 clinical trial sites. Additional children have been enrolled in all age groups following study amendments and the trial currently includes more than 10,000 children.1

The trial was originally designed to evaluate the safety, tolerability, and immunogenicity of the vaccine on a 2-dose schedule approximately 21 days apart and in 3 age groups: ages 5 to under 12 years; ages 2 to under 5 years; and ages 6 months to under 2 years. Children ages 5 to under 12 years received 2 doses of 10 µg each whereas children under age 5 received a lower 3 µg dose for each injection.1

A primary series of 2 10-µg doses was previously authorized under Emergency Use Authorization (EUA) for children ages 5 to less than 12 in October 2021. A third primary dose is authorized by the FDA for individuals 5 years of age and older with certain kinds of immunocompromise.

In these new data, the vaccine was well tolerated with no new safety signals. Adverse effects can include injection site pain, tiredness, headache, muscle pain, joint pain, fever, and nausea. The companies plan to submit these data to the FDA in the coming days for an EUA of a booster dose for children ages 5 through 11 in the United States.

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