June 17

In this Issue:

FDA Recommendations regarding patients taking simvastatin

Critical Drug Shortages

Home Health face-to-face note now in WebCIS

Meaningful Use update: Gillings School of Global Public Health collaboration

New enhancement to WebXchange directory

FDA Recommendations regarding patients taking simvastatin

Last week, the FDA released a statement that provides the following recommendations for clinicians regarding patients taking simvastatin at the 80 mg dose.


FDA recommends that healthcare professionals should:

•           Maintain patients on simvastatin 80 mg only if they have been taking this dose for 12 or more months without evidence of muscle toxicity.

•           Not start new patients on simvastatin 80 mg.

•           Place patients who do not meet their LDL cholesterol (LDL-C) goal on simvastatin 40 mg on alternative LDL-C lowering treatment(s) that provides greater LDL-C lowering (see Relative LDL-lowering Efficacy of Statin and Statin-based Therapies below).

•           Follow the recommendations in the simvastatin-containing medicines labels regarding drugs that may increase the risk for muscle injury when used with simvastatin (see Simvastatin Dose Limitations below).

•           Switch patients who need to be initiated on a drug that interacts with simvastatin to an alternative statin with less potential for the drug-drug interaction.

•           Report adverse events involving simvastatin-containing medicines to the FDA MedWatch program using the information in the "Contact Us" box at the bottom of this page.


The full FDA statement is available at:  http://www.fda.gov/Drugs/DrugSafety/ucm256581.htm


Next week, UNC Health Care will use the data warehouse to identify patients within WebcCIS who have simvastatin at the 80 mg dose as an active med on their med list. Every primary care and cardiology provider with patients identified through WebCIS will receive a list from ISD through their medical director. Please review this list and consider the FDA's recommendations for your patients.


In addition to sending the list of identified patients, UNC Health Care will draft a letter that can be used to notify identified patients of the change in the FDA recommendation regarding simvastatin. A copy of this draft letter will be sent all PCPs and cardiologists through their medical directors. Clinics and providers will be responsible for communicating this information to their patients, either through distribution of the letter or by phone calls from the clinic.


If you have any questions about the FDA recommendation, please call e-mail Dr. Donald Spencer, Vice President and Medical Director of Ambulatory Care at dspencer@med.unc.edu.

Critical New Drug Shortages

Azithromycin IV – Reserve all remaining supply for treatment of pertussis.

Cyanocobalamin Injection – Down to a 1 week supply.


Gentamicin IV –

Whenever possible use or convert patients to tobramycin.  Situations in which it may not be appropriate to switch to tobramycin are:

  • Use of synergy in treatment of endocarditis (strep, enterococcus):  (dosing typically 1 mg/kg Q8 hr or 1.5 mg/kg Q12 hr).  Gentamicin is no longer recommended for synergy dosing in NATIVE valve endocarditis caused by staphylococcus aureus.  Gentamicin may still be used for synergy dosing for PROSTHETIC valve endocarditis caused by staphylococcus aureus.
  • Use for synergy in other Gram positive coccal infections (e.g., Group B strep neonatal meningitis)
  • Rarely, an organism that is resistant to tobramycin but susceptible to gentamicin

Hydralazine IV – Down to a 1 week supply.  Labetalol suggested as an alternative to consider.

Prochlorperazine IV – Now in short supply – have about 3 weeks.  Use oral or other alternatives when possible.

Valproate IV – Down to a 1-2 week supply.


A list of all drug shortages and current supply status is posted on the Intranet at:  

Home Health face-to-face note now in WebCIS

A new “face-to-face” note is available in the WebCIS discharge summary to indicate that care instructions were given to a home health patient.

When a physician completes this form at discharge from the hospital or referral from a clinic, the requirement has been completed. A reminder will be present on discharge summaries to fill out this form when appropriate.


Please make every effort to complete this form in WebCIS. UNC Home Health and Rex Home Services cannot bill for Medicare patients who do not have the appropriate documentation for completed face-to-face encounters.  This note is provided in WebCIS because effective April 1, 2011, Medicare requires all physicians to certify that they, or a Nurse Practitioner acting on their behalf, have had a face-to-face encounter with home health patients. Click here to review additional details.

Meaningful Use update: Gillings School of Global Public Health collaboration

As a part of our efforts to achieve Meaningful Use (MU), researchers from the UNC Gillings School of Global Public Health are collaborating with UNC Health Care to assess the current MU-related readiness and capacity for change within each Department/Division’s outpatient practice. Click here to review additional details.

New enhancement to WebXchange directory

We have added an additional feature to the WebXchange directory that allows you to display special instructions on your profile. To add or change special instructions on your WebXchange directory profile, please call the Communications office at 966-2354 or the hospital operator at 966-4131.  These instructions are limited to 240 characters including spaces. For an example of how special instructions appear in the web, you may look at my profile. Just search for McCotter under last name and you will see the special instruction listing on the right hand side.

-Tom McCotter, Director, Telecommunications Service Division