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But CMS is confronted with a dilemma if the official, FDA-approved manufacturer’s directions differ from newer, evidence-based recommendations in national compendia. We are hoping the results of our survey, as described below, provide CMS with some baseline information to support its review process.

Before taking our survey, 16% of respondents were not aware of the CMS regulation and interpretive guidelines that require pharmacists to store drugs and biologicals in accordance with the manufacturer’s directions and State and Federal requirements.

- When switching patients from warfarin to XARELTO, discontinue warfarin and start XARELTO as soon as the International Normalized Ratio (INR) is below 3.0 to avoid periods of inadequate anticoagulation.

No clinical trial data are available to guide converting patients from XARELTO to warfarin.

These compendia, which are widely used by pharmacists and drug information vendors, include the American Hospital Formulary Service (AHFS) .

Pharmacists should be able to use evidence-based criteria from the compendia and peer reviewed journals as long as they conform to sterility standards published in the United States Pharmacopeia (USP) Chapter If information on storage, stability, and beyond use dating is not available in the manufacturer’s directions, CMS and The Joint Commission defer to recommendations available through nationally recognized sources.

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The preferred minimum sample size for a C measurement is 1 mg carbon.ISMP would like to thank the 715 practitioners, mostly pharmacy directors and managers, staff pharmacists, clinical pharmacists, and medication safety pharmacists, who responded to our recent survey on drug storage, stability, and beyond use dating of injectable drugs.We conducted the survey to learn more about what resources pharmacists rely on to guide drug storage, stability, and beyond use dating.- For patients currently taking XARELTO and transitioning to an anticoagulant with rapid onset, discontinue XARELTO and give the first dose of the other anticoagulant (oral or parenteral) at the time that the next XARELTO dose would have been taken For patients currently receiving an anticoagulant other than warfarin, start XARELTO 0 to 2 hours prior to the next scheduled evening administration of the drug (e.g., low molecular weight heparin or non-warfarin oral anticoagulant) and omit administration of the other anticoagulant.For unfractionated heparin being administered by continuous infusion, stop the infusion and start XARELTO at the same time.

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After this initial treatment period, the recommended dose of XARELTO is 20 mg taken orally once daily with food, at approximately the same time each day.

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