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What is InpharmD™?

Literature searching is tedious. InpharmD™ is here to help.

Clinical pharmacists can ask any question, anytime, from anywhere, and we’ll perform a custom literature search.

(And a 32% chance it’s already been asked.)


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This is how InpharmD™ transforms LITERATURE.

What's Being Asked...

What is the incidence of interaction of SSRIs with methylene blue? What would be the alternative to methylene blue if...
what is the evidence for using an IV IIb/IIIa inhibitor as bridge therapy while off oral P2Y12 inhibitors (in setting...
what is the evidence for using enteragam to treat pathophysiologic GI conditions?
Is there evidence that long term daily use of melatonin causes harm?
What evidence is there for dosing rifaximin at 600 mg BID or 400 mg TID for hepatic encephalopathy?

What would you like to ask InpharmD™?

InpharmD's Answer GPT's Answer

Author:Naveed Aijaz, PharmD, BCPS + InpharmD™ AI LEARN MORE 

As a diagnosis of exclusion, the prevalence of serotonin syndrome is difficult to quantify due to the high index of suspicion needed by the physician. Some epidemiological data suggest an incidence rate of 14%-16% when overdosing on an SSRI and an 0.6-2.3 case per 10,000 years when triptans are co-administrated with SSRI. Other analyses suggest the incidence of confusion or neuropsychiatric symptoms among patients taking SRIs who received methylene blue to be as high as 38043%. However, patie...

The increasing incidence rates of serotonin syndrome are believed to parallel the increased frequency of selective serotonin reuptake inhibitor (SSRI)/selective norepinephrine reuptake inhibitor (SNRI) use. Symptoms of serotonin syndrome may also be confused with other central nervous system pathologies or overlooked entirely, as recognition of serotonin syndrome is more a diagnosis of exclusion and requires a high index of suspicion. Combination with other drugs (e.g., monoamine oxidase inhibitors [MAOIs], tricyclic antidepressants, cough medicine, etc.) may also potentiate the risk of developing serotonin syndrome. Because of these factors, measuring the incidence rate of serotonin syndrome caused by SSRI/SNRI and methylene blue is deemed a difficult endeavor. [1,2] Methylene blue can precipitate severe serotonin toxicity when administered to patients taking SSRIs due to its mechanisms as a potent reversible inhibitor of monoamine oxidase A (MAO-A), the enzyme responsible for s...

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A search of the published medical literature revealed 3 studies investigating the researchable question:

What is the incidence of interaction of SSRIs with methylene blue? What would be the alternative to methylene blue if a provider wanted to examine for a leak?

Level of evidence
C - Multiple studies with limitations or conflicting results  

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[1] Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013;13(4):533-540.
[2] Boyer EW, Shannon M. The serotonin syndrome [published correction appears in N Engl J Med. 2007 Jun 7;356(23):2437] [published correction appears in N Engl J Med. 2009 Oct 22;361(17):1714]. N Engl J Med. 2005;352(11):1112-1120. doi:10.1056/NEJMra041867
[3] Stanford SC, Stanford BJ, Gillman PK. Risk of severe serotonin toxicity following co-administration of methylene blue and serotonin reuptake inhibitors: an update on a case report of post-operative delirium. J Psychopharmacol. 2010;24(10):1433-1438. doi:10.1177/0269881109105450
[4] Ng BK, Cameron AJ. The role of methylene blue in serotonin syndrome: a systematic review. Psychosomatics. 2010;51(3):194-200. doi:10.1176/appi.psy.51.3.194
[5] White KP, Sinagra D, Dip F, et al. Indocyanine green fluorescence versus blue dye, technetium-99M, and the dual-marker combination of technetium-99M + blue dye for sentinel lymph node detection in early breast cancer-meta-analysis including consistency analysis. Surgery. 2024;175(4):963-973. doi:10.1016/j.surg.2023.10.021
InpharmD's Answer GPT's Answer

Author:Tai Huynh, PharmD, BCPS + InpharmD™ AI LEARN MORE 

There is a paucity of data to support the use of GPIIb/IIa inhibitors as acute bridge therapy following PCI (<1 month) for patients not on oral P2Y12 inhibitor therapy. In general, data to support the use of GPIIb/IIa inhibitors in patients with myocardial infarction was established largely before the use of oral DAPT. Additionally, data evaluating their use in the setting of PCI is limited to administration either prior to or during PCI, rather than following the procedure, to ensure cove...

The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Guidelines for the management of ST-elevation myocardial infarction (STEMI), published in 2013, recommend treatment with an intravenous (IV) GPIIb/IIIa receptor antagonist such as abciximab, high-bolus-dose tirofiban, or double-bolus eptifibatide at the time of primary percutaneous coronary intervention (PCI), with or without stenting or clopidogrel pretreatment, in selected patients with STEMI who are receiving unfractionated heparin (UFH). In general, evidence to support the use of IV GPIIb/IIIa receptor antagonists in patients with STEMI was established largely before the use of oral dual antiplatelet therapy (DAPT). Although several studies have failed to show a benefit with the administration of “upstream” GP IIb/IIIa receptor antagonists before primary PCI in the setting of DAPT with either UFH or bivalirudin anticoagulation, a meta-analysis suggests abciximab may be useful in this setting. The...

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A search of the published medical literature revealed 2 studies investigating the researchable question:

What is the evidence for using an IV IIb/IIIa inhibitor as bridge therapy while off oral P2Y12 inhibitors (in setting of very recent PCI <1 month)?

Level of evidence
C - Multiple studies with limitations or conflicting results  

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[1] O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv. 2013;82(1):E1-E27. doi:10.1002/ccd.24776
[2] Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2014 Dec 23;130(25):e433-4. Dosage error in article text]. Circulation. 2014;130(25):e344-e426. doi:10.1161/CIR.0000000000000134
[3] Halvorsen S, Mehilli J, Cassese S, et al. Linee guida ESC 2022 per la valutazione cardiovascolare e la gestione dei pazienti sottoposti a chirurgia non cardiaca elaborate dalla task force per la valutazione cardiovascolare e la gestione dei pazienti sottoposti a chirurgia non cardiaca della Società Europea di Cardiologia (ESC) con il patrocinio della European Society of Anaesthesiology and Intensive Care (ESAIC) [2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery Developed by the task force for cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology (ESC) Endorsed by the European Society of Anaesthesiology and Intensive Care (ESAIC)]. G Ital Cardiol (Rome). 2023;24(1 Suppl 1):e1-e102. doi:10.1714/3956.39326
[4] Zaman AG, Aleem Q. Pharmacology before, during and after percutaneous coronary intervention. Heart. Published online November 4, 2020. doi:10.1136/heartjnl-2019-315090
[5] Howard JP, Jones DA, Gallagher S, et al. Glycoprotein IIb/IIIa inhibitors use and outcome after percutaneous coronary intervention for non-ST elevation myocardial infarction. Biomed Res Int. 2014;2014:643981. doi:10.1155/2014/643981
[6] Blanchart K, Heudel T, Ardouin P, et al. Glycoprotein IIb/IIIa inhibitors use in the setting of primary percutaneous coronary intervention for ST elevation myocardial infarction in patients pre-treated with newer P2Y12 inhibitors. Clin Cardiol. 2021;44(8):1080-1088. doi:10.1002/clc.23654
InpharmD's Answer GPT's Answer

Author:AJ Carvajal, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Evidence supporting the use of serum-derived bovine immunoglobulin/protein isolate (SBI; EnteraGam®) for pathophysiologic gastrointestinal conditions is limited. Available data consist primarily of narrative reviews, small-scale clinical studies, and case series evaluating conditions such as diarrhea-predominant irritable bowel syndrome (IBS-D), HIV-associated enteropathy, and refractory inflammatory bowel disease (Tables 1-7). These publications suggest that SBI may improve gastrointestinal ...

A 2022 American Gastroenterological Association clinical practice guideline evaluated pharmacologic therapies for irritable bowel syndrome with diarrhea (IBS-D) using the Grading of Recommendations Assessment, Development and Evaluation framework. The guideline provides conditional recommendations for eluxadoline, rifaximin, alosetron, loperamide, tricyclic antidepressants, and antispasmodics, and a conditional recommendation against selective serotonin reuptake inhibitors; however, serum-derived bovine immunoglobulin/protein isolate (SBI; EnteraGam®) was not included among the reviewed or recommended therapies. Therefore, while this guideline provides relevant context regarding evidence-supported pharmacologic options for IBS-D, it does not directly provide evidence supporting the use of EnteraGam® for pathophysiologic gastrointestinal conditions. [1] Multiple review articles have evaluated the potential role of SBI in gastrointestinal disorders characterized by impaired intestin...

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A search of the published medical literature revealed 7 studies investigating the researchable question:

What is the evidence for using EnteraGam to treat pathophysiologic GI conditions?

Level of evidence
C - Multiple studies with limitations or conflicting results  

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[1] Lembo A, Sultan S, Chang L, Heidelbaugh JJ, Smalley W, Verne GN. AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Diarrhea. Gastroenterology. 2022;163(1):137-151. doi:10.1053/j.gastro.2022.04.017
[2] Lucak S, Chang L, Halpert A, Harris LA. Current and emergent pharmacologic treatments for irritable bowel syndrome with diarrhea: evidence-based treatment in practice. Ther Adv Gastroenterol. 2017;10(2):253-275. doi:10.1177/1756283X16663396
[3] Petschow BW, Blikslager AT, Weaver EM, et al. Bovine immunoglobulin protein isolates for the nutritional management of enteropathy. World J Gastroenterol. 2014;20(33):11713-11726. doi:10.3748/wjg.v20.i33.11713
[4] Petschow BW, Burnett BP, Shaw AL, Weaver EM, Klein GL. Dietary requirement for serum-derived bovine immunoglobulins in the clinical management of patients with enteropathy. Dig Dis Sci. 2015;60(1):13-23. doi:10.1007/s10620-014-3322-0
[5] Utay NS, Asmuth DM, Gharakhanian S, Contreras M, Warner CD, Detzel CJ. Potential use of serum-derived bovine immunoglobulin/protein isolate for the management of COVID-19. Drug Dev Res. 2021;82(7):873-879. doi:10.1002/ddr.21841.
[6] Petschow BW, Burnett B, Shaw AL, Weaver EM, Klein GL. Serum-derived bovine immunoglobulin/protein isolate: postulated mechanism of action for management of enteropathy. Clin Exp Gastroenterol. 2014;7:181-190.
InpharmD's Answer GPT's Answer

Author:Tai Huynh, PharmD, BCPS + InpharmD™ AI LEARN MORE 

As with many supplements, large-scale, long-term evidence for melatonin is lacking. Current data are limited to several small studies that suggest no definitive increase in adverse effects occurs with prolonged use of melatonin, and suggest that long-term melatonin exposure would not significantly influence endogenous melatonin levels. However, studies are generally characterized by small sample sizes and a lack of comparative design, and effect of melatonin dosage and timing also require fur...

A 2021 international task force expert opinion suggested melatonin is well-tolerated with the most frequent adverse events being headache, dizziness, and nausea; no serious adverse events have been reported. However, as the majority of evidence for melatonin use is short-term, it is unclear how long-term use may impact patient health. [1] A 2023 narrative review examined chronic administration of melatonin, focusing on its physiological and clinical implications. The review collated data from multiple sources, including PubMed and Google Scholar, incorporating both recent and older studies relevant to its subject matter. Melatonin's effectiveness in inducing sleep was detectable though modest for the general population. While optimal dosage remains unspecified, melatonin's short-term adverse effects were noted as minimal and typically resolving upon cessation of use. Moreover, long-term studies did not show significant differences between melatonin and placebo in terms of adverse...

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A search of the published medical literature revealed 4 studies investigating the researchable question:

Is there evidence that long term daily use of melatonin causes harm?

Level of evidence
C - Multiple studies with limitations or conflicting results  

READ MORE→

[1] Palagini L, Manni R, Aguglia E, et al. International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders. Front Psychiatry. 2021;12:688890. Published 2021 Jun 10. doi:10.3389/fpsyt.2021.688890
[2] Givler D, Givler A, Luther PM, et al. Chronic Administration of Melatonin: Physiological and Clinical Considerations. Neurol Int. 2023;15(1):518-533. Published 2023 Mar 15. doi:10.3390/neurolint15010031
InpharmD's Answer GPT's Answer

Author:zophia@inpharmd.com, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Although the current recommended dose of rifaximin for secondary prevention of recurrent overt hepatic encephalopathy is 550 mg twice daily, evidence supports alternative regimens totaling 1,200 mg/day, including 600 mg twice daily and 400 mg three times daily, in selected clinical settings (Tables 1-9). Systematic reviews and meta-analyses have shown that rifaximin 1,200 mg/day, most commonly administered as 400 mg three times daily, is effective for the treatment and prevention of hepatic e...

The 2026 American College of Gastroenterology (ACG) Practice Guideline on Hepatic Encephalopathy recommends rifaximin at the U.S. Food and Drug Administration-approved dose of 550 mg twice daily to reduce the risk of recurrent overt hepatic encephalopathy in adults. The guideline notes that evidence supporting this recommendation includes a randomized controlled trial in which rifaximin 550 mg twice daily, administered for 6 months primarily in combination with lactulose, reduced the risk of breakthrough overt hepatic encephalopathy by 58% and hepatic encephalopathy-related hospitalization by 50% compared with placebo. Additional systematic review and meta-analysis data, as well as post hoc and observational studies, further support the use of rifaximin, particularly in combination with lactulose, for secondary prevention. [1] The European Association for the Study of the Liver (EASL) 2022 guidelines for the management of hepatic encephalopathy recommends rifaximin as an adjunct ...

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A search of the published medical literature revealed 9 studies investigating the researchable question:

What evidence is there for dosing rifaximin at 600 mg BID or 400 mg TID for hepatic encephalopathy?

Level of evidence
B - One high-quality study or multiple studies with limitations  

READ MORE→

[1] Bajaj JS, Jakab SS, Jesudian AB, et al. ACG Clinical Guideline: Hepatic Encephalopathy. Am J Gastroenterol. 2026;121(3):588-618. doi:10.14309/ajg.0000000000003899
[2] European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatic encephalopathy [published correction appears in J Hepatol. 2023 Sep 26;:]. J Hepatol. 2022;77(3):807-824. doi:10.1016/j.jhep.2022.06.001
[3] Yoshiji H, Nagoshi S, Akahane T, et al. Evidence-based clinical practice guidelines for Liver Cirrhosis 2020. J Gastroenterol. 2021;56(7):593-619. doi:10.1007/s00535-021-01788-x
[4] Fang G, Liu S, Liu B. Preventive and therapeutic effects of rifaximin on hepatic encephalopathy with differential application dosages and strategies: a network meta-analysis. BMC Gastroenterol. 2024;24(1):94. Published 2024 Mar 4. doi:10.1186/s12876-024-03184-0
[5] Eltawil KM. Rifaximin vs conventional oral therapy for hepatic encephalopathy: A meta-analysis. WJG. 2012;18(8):767. doi:10.3748/wjg.v18.i8.767
[6] Zacharias HD, Kamel F, Tan J, Kimer N, Gluud LL, Morgan MY. Rifaximin for prevention and treatment of hepatic encephalopathy in people with cirrhosis. Cochrane Database Syst Rev. 2023;7(7):CD011585. Published 2023 Jul 19. doi:10.1002/14651858.CD011585.pub2
[7] Lawrence KR, Klee JA. Rifaximin for the treatment of hepatic encephalopathy. Pharmacotherapy. 2008;28(8):1019-1032. doi:10.1592/phco.28.8.1019
[8] Wu D, Wu SM, Lu J, Zhou YQ, Xu L, Guo CY. Rifaximin versus Nonabsorbable Disaccharides for the Treatment of Hepatic Encephalopathy: A Meta-Analysis. Gastroenterol Res Pract. 2013;2013:236963. doi:10.1155/2013/236963

Why choose InpharmD™?

Find answers, not documents.

Before InpharmD™


BeforeTime
Your team spends hours per week cobbling together literature from different studies, many behind paywalls, leaving little time for action.
BeforeTime
TI opportunities are discovered (or presented by third parties) months after the fact, resulting in costly missed savings.
BeforeTime
Decisions may be made without a complete picture, or pushed out while gathering consensus.

After InpharmD™


BeforeTime
InpharmD™ delivers customized, actionable drug information in real time, so you can focus on execution.
BeforeTime
Your team stays informed immediately when new data emerges or prices change, and you’ll always be the first to know when any changes impact your formulary.
BeforeTime
With InpharmD™, your team can make faster, more informed decisions and move forward with confidence.

What Clinical Pharmacists Are Saying...


     

Assists in our research and is a great way or us to get an answer to a medical question without spending an average of 2 hours researching UptoDate or PubMed ourselves.


—   Jordan C., PharmD, New Jersey

     

Huge time saver with thorough responses.


—   Jane D., PharmD, Georgia

     

I’d never heard of a DI pharmacist before, now I have one. In. My. Pocket. Amazing!


     

Holy Shhh. Cow! Holy Cow! These summaries are beautiful.


—   Jane D., PharmD, Georgia

     

I just want to say: This is such a brilliant idea! You people are genius.


     

OH MY GOD WHERE HAVE YOU BEEN ALL MY LIFE!


     

I can’t tell you how much time I spend literature searching. And how I CANNOT STAND PAYWALLS. THIS IS UNBELIEVABLE!! (covers face for sec) thank you, thank you, thank you!


     

So they’re basically connecting academic researchers with front line providers and then automating everything. It’s simply brilliant.


     

The clinical pharmacist was our secret weapon anyway. (Smiles wryly) This pharmacist AI seems superhuman. I’m just blown away, honestly. (Looks at camera somberly.)


     

It’s an ENTIRE DI DEPARTMENT, that lives in Epic. Give me a second. I’m just having a hard time wrapping my head around that.


     

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Stop reading and just download the app already! I’ve tried all of them. This is by far the most advanced, best-in-class.


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