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Health Care Policy and Law
March 9, 2020

The Skyrocketing Cost of Rectal Indomethacin

Author Affiliations
  • 1Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston
  • 2University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
  • 3Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 4Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 5Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
JAMA Intern Med. 2020;180(5):631-632. doi:10.1001/jamainternmed.2020.0099

Acute pancreatitis is the most common major complication of endoscopic retrograde cholangiopancreatography (ERCP), occurring in 3% to 15% of cases and in up to 40% of procedures if preventive measures are not used. About 5% of patients who develop pancreatitis after ERCP have a severe course, characterized by local and systemic complications, prolonged hospitalization, and occasional death.1 Considering that about 600 000 ERCPs are performed annually in the US, ERCP-related pancreatitis is an important and costly problem.

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    1 Comment for this article
    Compounding Suppositories
    Kenneth Dandurand, BA, BS, R.PH.,MS | Clinical Pharmacy Associates
    I agree with the authors that seldom used off-label drugs can defy reasonable pricing. The use of compounding pharmacies can get tricky as the FDA can classify the making of significant batches of product that are not patient specific as manufacturing creating a need for a manufacturing license. The Hospital Pharmacy can compound suppositories for patient use and there are several sources on-line for formulas. Ingredients are mainly polyethylene glycol and indomethacin powder.