In the midst of the opioid crisis, Boston Medical Center added an intravenous version of Tylenol to its arsenal of drugs for pain management. But IV Tylenol was expensive, and after drugmaker Mallinckrodt Pharmaceuticals increased the price, the hospital projected it was on track to spend $750,000 in 2015 on acetaminophen (the active ingredient in Tylenol) in injectable form.
"It was going to cost us, without the intervention that happened, more than any other drug on our formulary. Think of the most expensive cancer drug," said David Twitchell, Boston Medical Center's chief pharmacy officer. "To me, that didn't seem justified."
A typical dose of acetaminophen in tablet form costs pennies, but the IV version, called Ofirmev, is $40 for a 1,000-milligram dose.
Hospitals throughout the country are working to shift away from opioids, whose addictive properties have spawned a public health crisis.
Recent IV formulations of old drugs such as acetaminophen may present new options in managing pain while fighting the opioid crisis, but a growing body of evidence - including a new study - suggests that IV acetaminophen appears to offer little or no benefit over taking the same drug in pill form for many conditions. There are also studies that suggest a modest benefit, but many hospitals have limited access to the drug to patients who are incapable of taking oral medications due to its high cost and the inconsistent evidence of a clear advantage.
