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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...

Is there any evidence of motixafortide use in pediatric patients?
What ECMO dosing strategies exist for aztreonam, cefazolin, and cefepime? (assuming normal renal function)
-what is the risk of thrombocytopenia (HIT) from IV heparin infusion (Therapeutic/treament) versus SQ heparin for VT...
Is there an indication for using concomitant Inhaled and systemic corticosteroids routinely
How long after completing IV ceftriaxone desensitization should the first therapeutic dose be given?

What would you like to ask InpharmD™?

InpharmD's Answer GPT's Answer

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

At the present time, we were unable to identify any published clinical trials, case studies/series, or pharmacokinetic studies evaluating motixafortide in pediatric patients. However, limited unpublished data derived from company press releases describe real-world use of motixafortide, with the overall patient cohorts including individuals as young as 14 years; caution is warranted, as the data are not peer-reviewed, and specific outcomes for pediatric and adolescent patients remain unknown.

According to recent press releases from Ayrmid, a biopharmaceutical company that holds the licensed rights to motixafortide, the drug has been used in real‑world practice to mobilize hematopoietic stem cells (HSCs) in patients with sickle cell disease. The reported patient cohorts ranged from 14 to 50 years of age. These observations are from an unpublished, non-peer-reviewed context, and no detailed efficacy or safety outcomes were provided specifically for the adolescent or pediatric patients. Furthermore, the reports do not delineate the specific number of patients aged 14-18 years. [1,2]

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A search of the published medical literature revealed 0 studies investigating the researchable question:

Is there any evidence of motixafortide use in pediatric patients?

Level of evidence
X - No data  

READ MORE→

[1] Ayrmid Reports Additional New Real‑World Data on Motixafortide for Stem Cell Mobilization in Sickle Cell Disease and Beta‑Thalassemia. BioSpace. February 4, 2026. Accessed February 27, 2026. https://www.biospace.com/press-releases/ayrmid-reports-additional-new-real-world-data-on-motixafortide-for-stem-cell-mobilization-in-sickle-cell-disease-and-beta-thalassemia
[2] Ayrmid Ltd. Ayrmid reports promising new real‑world data on motixafortide for stem cell mobilization in sickle cell disease. Press release. Dec 6, 2025. Accessed February 27, 2026. http://gamida-cell.com/press_release/ayrmid-reports-promising-new-real-world-data-on-motixafortide-for-stem-cell-mobilization-in-sickle-cell-disease/

InpharmD's Answer GPT's Answer

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

Extracorporeal membrane oxygenation (ECMO) dosing strategies for aztreonam, cefazolin, and cefepime are not well defined, and the available literature consists primarily of case reports, case series, and pharmacokinetic (PK) studies without corresponding clinical outcomes. Antibiotic PK and pharmacodynamics (PD) may be significantly altered during ECMO due to increased volume of distribution, altered clearance, and drug adsorption to circuit components. Data describing aztreonam dosing in ECM...

A 2020 review aimed to examine how the use of extracorporeal membrane oxygenation (ECMO) impacts antibiotic pharmacokinetics and consequently influences dosing requirements in critically ill adult ECMO patients. The use of ECMO is associated with a high frequency of antibiotic use due to its complications, such as the risk of infection due to invasive cannulation and immunosuppression from critical illness and mechanical support devices. Antibiotic pharmacokinetics and pharmacodynamics are significantly altered in ECMO due to factors like increased volume of distribution, altered clearance, and adsorption into circuit components. These changes complicate the selection, management, and dosing of antibiotics. While literature on this topic is limited, recent research has shed light on antibiotic pharmacokinetics during ECMO support. Key findings include the influence of antibiotic properties on drug loss in the ECMO circuit, the need for separate dosing considerations for adults compa...

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

What ECMO dosing strategies exist for aztreonam, cefazolin, and cefepime? (assuming normal renal function)?

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

READ MORE→

[1] Abdul-Aziz MH, Roberts JA. Antibiotic dosing during extracorporeal membrane oxygenation: does the system matter?. Curr Opin Anaesthesiol. 2020;33(1):71-82. doi:10.1097/ACO.0000000000000810
[2] Gomez F, Veita J, Laudanski K. Antibiotics and ECMO in the Adult Population-Persistent Challenges and Practical Guides. Antibiotics (Basel). 2022;11(3):338. Published 2022 Mar 4. doi:10.3390/antibiotics11030338
[3] Pina-Sánchez M, Rua M, López-Causapé C, et al. Ceftazidime-avibactam plus aztreonam cocktail for the treatment of VIM-producing Pseudomonas aeruginosa infections: good enough to have another?. J Antimicrob Chemother. 2025;80(5):1371-1376. doi:10.1093/jac/dkaf083
[4] Pau-Parra A, Núñez-Núñez M, Sadyrbaeva-Dolgova S, et al. [Translated article] National survey and consensus document on dosing strategies for beta-lactam antibiotics against multidrug-resistant gram-negative bacilli (MDR-GNB) in critically ill patients undergoing extracorporeal life-support techniques: The DOSEBL study protocol. Farm Hosp. 2025;49(3):T179-T183. doi:10.1016/j.farma.2024.11.005
[5] Northwestern Medicine. Northwestern Medicine Antimicrobial ECMO Dosing Guidance.; 2024. https://adsp.nm.org/uploads/1/4/3/0/143064172/nm_antimicrobial_ecmo_dosing.pdf. Accessed February 26, 2026.

InpharmD's Answer GPT's Answer

Author:Younghee Kwon, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Observed heparin-induced thrombocytopenia (HIT) incidence appears higher with therapeutic-dose intravenous (IV) unfractionated heparin (UFH) than with prophylactic subcutaneous (SQ) UFH, although route-specific risk remains incompletely defined. In one large institutional cohort, new HIT occurred in 0.76% of patients receiving therapeutic IV heparin compared with <0.1% among those receiving subcutaneous prophylaxis, likely reflecting differences in exposure intensity and patient population ra...

The 2005 meta-analysis evaluated 15 studies including 7,287 patients receiving prophylactic-dose unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) prevention in surgical and medical inpatient settings, with HIT defined as a ≥50% platelet decrease or platelet count <100 × 10⁹/L plus a positive laboratory assay. In randomized controlled trials measuring HIT, LMWH was associated with a significantly lower risk compared with UFH, with an odds ratio of 0.10 (95% CI 0.01–0.82; p = 0.03). In prospective comparative studies measuring heparin induced thrombocytopenia (HIT), the odds ratio was similarly 0.10 (95% CI 0.03–0.33; p <0.001). When all 15 studies were analyzed for thrombocytopenia regardless of laboratory confirmation, the pooled odds ratio was 0.47 (95% CI 0.22–1.02; p = 0.06). The inverse variance–weighted absolute risk of HIT was 2.6% (95% CI 1.5–3.8%) with prophylactic UFH and 0.2% (95% CI 0.1–0.4%) with LMWH.The inverse varian...

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A search of the published medical literature revealed 1 study investigating the researchable question:

What is the risk of thrombocytopenia (HIT) from IV heparin infusion (therapeutic/treament) versus SQ heparin for VTE prophylaxis? What is the frequency of platelet monitoring for each (SQ versus IV)?

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

READ MORE→

[1] Martel N, Lee J, Wells PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood. 2005;106(8):2710-2715. doi:10.1182/blood-2005-04-1546
[2] Girolami B, Prandoni P, Stefani PM, et al. The incidence of heparin-induced thrombocytopenia in hospitalized medical patients treated with subcutaneous unfractionated heparin: a prospective cohort study. Blood. 2003;101(8):2955-2959. doi:10.1182/blood-2002-07-2201
[3] Cuker A, Arepally GM, Chong BH, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv. 2018;2(22):3360-3392. doi:10.1182/bloodadvances.2018024489
[4] Linkins LA, Dans AL, Moores LK, et al. Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e495S-e530S. doi:10.1378/chest.11-2303
InpharmD's Answer GPT's Answer

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

Current guidelines (GOLD 2025 and GINA 2025) recommend systemic corticosteroids for acute exacerbations but do not address their routine concomitant use with inhaled corticosteroids (ICS). Evidence from randomized controlled trials and systematic reviews in acute asthma demonstrates insufficient or inconsistent clinical benefit with the addition of ICS to systemic corticosteroids, although one meta-analysis reported reduced hospital admissions with high-dose ICS plus systemic corticosteroids ...

Both the 2025 GOLD and GINA guidelines for COPD and asthma, respectively, do not address concomitant use of inhaled corticosteroids (ICS) and systemic corticosteroids. While in the GOLD guidelines, exacerbations of COPD may require treatment using systemic corticosteroids that could overlap with current ICS, this is an acute phase of treatment and not meant for routine exposure. GOLD does not recommend systemic corticosteroids for more than 5 days, which includes hospital exposure. The same principle applies within the GINA guidelines which recommends systemic corticosteroids primarily for moderate or severe exacerbations, especially if patients fail to respond to ICS-containing medications. However, GINA does provide slightly more context, suggesting systemic corticosteroids can be continued for 5-7 days in adults, or 3-5 days in children post-exacerbation. During this time, maintenance ICS-containing medication dose may be increased in the next 2-4 weeks, meaning that concomitant ...

READ MORE→

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

Is there an indication for using concomitant Inhaled and systemic corticosteroids routinely?

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

READ MORE→

[1] 2025 GOLD Report. Global initiative for chronic obstructive lung disease. Accessed February 25, 2026. https://goldcopd.org/2025-gold-report/
[2] Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2025 update. Accessed February 25, 2026. https://ginasthma.org
[3] Edmonds ML, Milan SJ, Camargo CA Jr, Pollack CV, Rowe BH. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database Syst Rev. 2012;12(12):CD002308. Published 2012 Dec 12. doi:10.1002/14651858.CD002308.pub2
[4] Edmonds ML, Milan SJ, Brenner BE, Camargo CA Jr, Rowe BH. Inhaled steroids for acute asthma following emergency department discharge. Cochrane Database Syst Rev. 2012;12(12):CD002316. Published 2012 Dec 12. doi:10.1002/14651858.CD002316.pub2
[5] Kearns N, Maijers I, Harper J, Beasley R, Weatherall M. Inhaled Corticosteroids in Acute Asthma: A Systemic Review and Meta-Analysis. J Allergy Clin Immunol Pract. 2020;8(2):605-617.e6. doi:10.1016/j.jaip.2019.08.051
InpharmD's Answer GPT's Answer

Author:Younghee Kwon, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Literature directly addressing the timing of the first therapeutic ceftriaxone dose after intravenous (IV) desensitization is limited and relies largely on institutional protocols. These protocols describe ceftriaxone desensitization as a series of incremental doses administered every 15 minutes, followed by a 15- to 30-minute observation period, after which the full therapeutic dose is given if tolerated. Induced tolerance is temporary and maintained only with uninterrupted dosing, with some...

A 2019 review on antimicrobial desensitization describes the process as inducing a temporary state of drug tolerance that reverses within hours to days after discontinuation, requiring repeat desensitization for future courses if therapy is interrupted. For ceftriaxone, the review references an intravenous cephalosporin desensitization protocol using incremental doses administered every 15 minutes, reaching completion in approximately 2 hours and 15 minutes, followed by a 30-minute observation period before administration of the full therapeutic dose. Refer to Table 1 for the full desensitization protocol. [1,2] According to a 2023 Baptist Health antibiotic graded dose challenge and desensitization protocol, intravenous ceftriaxone desensitization involves escalating doses administered every 15 minutes, each infused over 15 minutes and followed immediately by the next scheduled dose. After the final desensitization dose, the patient is observed for 15 to 30 minutes; if tolerated,...

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

How long after completing IV ceftriaxone desensitization should the first therapeutic dose be given?

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

READ MORE→

[1] Chastain DB, Hutzley VJ, Parekh J, Alegro JVG. Antimicrobial Desensitization: A Review of Published Protocols. Pharmacy (Basel). 2019;7(3):112. Published 2019 Aug 9. doi:10.3390/pharmacy7030112
[2] Win PH, Brown H, Zankar A, Ballas ZK, Hussain I. Rapid intravenous cephalosporin desensitization. J Allergy Clin Immunol. 2005;116(1):225-228. doi:10.1016/j.jaci.2005.03.037
[3] Baptist Health. Antimicrobial Stewardship Sub-Committee: Antibiotic graded dose challenge and desensitization guideline. Published June 21, 2023. Accessed February 24, 2026. https://www.baptisthealth.com/-/media/documents/care-and-services/infectious-diseases/antibiotic-gdc-and-desensitization-guideline__6-21-23.pdf?rev=1cfcd610e395423caa8611837969e89b&hash=515A4AC24FF6AD3E4C150496E3C49913
[4] Khan DA, Banerji A, Bernstein JA, et al. Cephalosporin Allergy: Current Understanding and Future Challenges. J Allergy Clin Immunol Pract. 2019;7(7):2105-2114. doi:10.1016/j.jaip.2019.06.001

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.


     

Sorry just give me a second, my mind is blown.


     

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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