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Therapeutic%20interchanges%20sheet%205%2012.pdf

***Not Applied to patients <18 years of age*** Proton Pump Inhibitors
Formulary Medication

Ordered Medication
Ordered when any other PPI is ordered for GT, PEG, NG Esomeprazole (Nexium) Oral Suspension, Lansoprazole (Prevacid) Solutabs Lansoprazole (Prevacid) 15 mg PO Omeprazole (Prilosec) 10 mg PO Dexlansoprazole (Dexilant/Kapidex) 30-60 mg PO Esomeprazole (Nexium) 20-40 mg PO Lansoprazole (Prevacid) 30 mg PO Omeprazole (Prilosec) 20-40 mg PO Omeprazole-Sodium Bicarbonate (Zegerid) 20-40 mg PO Rabeprazole (Aciphex) 20 mg PO Esomeprazole (Nexium) 40 mg IV Lansoprazole (Prevacid) 30 mg IV Patients on Plavix and PPIs may be suggested to switch to Pepcid at either 20 mg BID or 20 mg daily based on renal function. In this case, the pharmacist will write an order in the chart. Simplified lansoprazole solution (SLS) will be substituted at an equivalent dose if a liquid is necessary. H-2 Antagonists
Formulary Medication

Ordered Medication
Cimetidine (Tagamet) 300-400 mg PO Nizatidine (Axid) 150 mg PO Ranitidine (Zantac) 150 mg PO Nizatidine (Axid) 300 mg PO Ranitidine (Zantac) 300 mg PO Ranitidine (Zantac) 50 mg IV q8-12h Cimetidine (Tagamet) 300 mg IV q6h Antacid Formulations
Formulary Medication

Ordered Medication
Any antacid or antacid with simethicone ordered. Prevpac Substitution
Formulary Medication

Ordered Medication
Hmg Co-A Reductase Inhibitors
Formulary Medication { ͌ % LDL Lowering} Ordered Medication { ͌ % LDL Lowering}
Simvastatin (Zocor) 5 mg { ̴ 26%}
Lovastatin (Mevacor) 10 mg { ̴ 21%} Pravastatin (Pravachol) 10 mg { ̴ 22%} Atorvastatin (Lipitor) 5 mg Fluvastatin (Lescol) 20 mg { ̴ 17%} Lovastatin (Mevacor) 20 mg { ̴ 29%} Pravastatin (Pravachol) 20 mg { ̴ 24%} Pitavastatin (Livalo) 1 mg Atorvastatin (Lipitor) 10 mg { ̴ 37%} Fluvastatin (Lescol) 40 mg { ̴ 23%} Lovastatin (Mevacor) 40 mg { ̴ 31%} Pravastatin (Pravachol) 40 mg { ̴ 34%} Rosuvastatin (Crestor) 5 mg { ̴ 43%} Pitavastatin (Livalo) 2 mg Atorvastatin (Lipitor) 20 mg { ̴ 43%} Fluvastatin (Lescol) 80 mg { ̴ 33%} Fluvastatin XR (Lescol XR) 40 mg { ̴ 33%} Lovastatin (Mevacor) 80 mg { ̴ 40%} Pravastatin (Pravachol) 80 mg { ̴ 35%} Rosuvastatin (Crestor) 10 mg { ̴ 50%} Pitavastatin (Livalo) 3 mg Fluvastatin XR (Lescol XR) 80 mg { ̴ 38%} Rosuvastatin (Crestor) 20 mg { ̴ 53%} Pitavastatin (Livalo) 4 mg { ̴ 41%} Atorvastatin (Lipitor) 80 mg { ̴ 60%} Rosuvastatin (Crestor) 40 mg { ̴ 62%} We will not institute our regular therapeutic substitution to Zocor when a patient is on a protease inhibitor due to increased risk for myopathy/rhabdomyolysis. Amprenavir (Agenerase) Atazanavir (Reyataz), Darunavir (Prezista), Fosamprenavir (Lexiva), Indinavir (Crixivan), Lopinavir/Ritonavir (Kaletra), Nelfinavir (Viracept), Ritonavir (Norvir), Saquinavir (Invirase), or Tipranavir (Aptivus) Insulins
Formulary Medication

Ordered Medication
Insulin Aspart (Novolog) Insulin Glulisine (Apidra) Pancreatic Enzymes
Formulary Medication

Ordered Medication
Any pancreatic enzyme ordered at closest similar Electrolyte Supplement
Formulary Medication

Ordered Medication
K-Phos Original 2 tablets (dissolved in 6-8 oz water) Multivitamin Formulations
Formulary Medication

Ordered Medication
Oral Calcium Products
Formulary Medication

Ordered Medication
Calcium with Vitamin D (same dose) 500 mg Fiber Laxatives
Formulary Medication

Ordered Medication
Fluoroquinolone Antibiotics
Dx: Respiratory/Skin/Sinus/Gram Positive/Non Urinary Tract Infections
Formulary Medication
Ordered Medication
Levofloxacin (Levaquin) 500 mg IV daily Levofloxacin (Levaquin) 750 mg IV daily Ophthalmic Quinolone Eye Drops
Formulary Medication

Ordered Medication
Levofloxacin (Quixin) 0.5% Ophthalmic Solution Moxifloxacin (Vigamox) 0.5% Ophthalmic Solution Norfloxacin (Chibroxin) Ophthalmic Solution Ofloxacin (Floxin) 0.3% Ophthalmic Solution As a courtesy to prescribers and nursing, pharmacy will continue to write clarifications for the above substitutions. Electrolyte IV Potassium
Pharmacy Other Modification for Administration Ordered Medication
Central Line maximum rate: 20mEq per hr - MUST USE INFUSION PUMP Peripheral Line maximum rate: 10 mEq per hr - MUST USE INFUSION PUMP **Pharmacy will use Pre-mixed bags unless written by the physician “Do not substitute”** Echinocandin Antifungals
Formulary Medication

Ordered Medication
Caspofungin (Cancidas) 70 mg or 50 mg IVPB Andulafungin (Eraxis) 50 to 200 mg IVPB As a courtesy to prescribers and nursing, pharmacy will continue to write clarifications for the above substitutions. Venlafaxine
Formulary Medication

Ordered Medication
daily Venlafaxine XR (Effexor XR) 75 mg PO daily As a courtesy to prescribers and nursing, pharmacy will continue to write clarifications for the above substitutions. Carvedilol Substitution
Formulary Medication

Ordered Medication
Sedative Agents
Formulary Medication

Ordered Medication
Zaleplon (Sonata) 5-10 mg Eszopiclone (Lunesta) 1 or 2 mg Zolpidem CR (Ambien CR) 6.25 mg Any patient over age 65 for all sedatives Eszopiclone (Lunesta) 3 mg Zaleplon (Sonata) 20 mg Zolpidem CR (Ambien CR) 12.5 mg Flurazepam (Dalmane) 15 mg Estazolam (Prosom) 1 mg Triazolam (Halcion) 0.125 mg Flurazepam (Dalmane) 30 mg Estazolam (Prosom) 2 mg Triazolam (Halcion) 0.25 mg Hydrocodone/Acetaminophen Combinations
Formulary Medication

Ordered Medication
Hydrocodone/Acetaminophen (Lortab) 5/500 Hydrocodone/Acetaminophen (Vicodin) 5/500 Hydrocodone/Acetaminophen (Zydone) 5/400 Hydrocodone/Acetaminophen (Lorcet) 5/500 Hydrocodone/Acetaminophen (Lortab) 7.5/500 Hydrocodone/Acetaminophen (Vicodin ES) 7.5/750 Hydrocodone/Acetaminophen (Lorcet Plus) 7.5/650 Hydrocodone/Acetaminophen (Lortab) 10/500 Hydrocodone/Acetaminophen (Lorcet) 10/650 Hydrocodone/Acetaminophen (Vicodin HP) 10/660 Hydrocodone/Acetaminophen (Maxidone) 10/750 Extended Spectrum Penicillins/Carbapenems
Formulary Medication

Ordered Medication
Piperacillin/Tazobactam (Zosyn) 3.375 gm IV Ticarcillin/Clavulanic Acid (Timentin) 3.1 gm IV Piperacillin/Tazobactam (Zosyn) 2.25 gm IV Ticarcillin/Clavulanic Acid (Timentin) 2 gm IV Imipenem-Cilastatin (Primaxin) 500 mg IV q6h Meropenem (Merrem) 1 gm IV q8h Imipenem-Cilastatin (Primaxin) 500 mg IV q8h to q12h Meropenem (Merrem) 500 mg IV q6h to q8h Dose adjustment for Creatinine Clearance: Pain Medications
Formulary Medication
Ordered Medication
Oxycodone/Aspirin (Percodan) 5/325 Oxycodone/APAP (Tylox) 5/500 Acetaminophen with Codeine #4 60/300 1 tab 2 tabs Butalbital/APAP/Caffeine (Fioricet/Esgic) Butalbital/ASA/Caffeine (Fiorinal) 50/200/40 Butalbital/APAP/Caffeine (Esgic Plus) 50/500/40 Inhaled Bronchodilators
Formulary Medication

Ordered Medication
Levalbuterol (Xopenex) metered dose inhaler Orders for pediatric patients will not be changed. As a courtesy to prescribers and nursing, pharmacy will continue to write clarifications for the above substitutions. Inhaled Steroid
Formulary Medication

Ordered Medication
Budesonide (Pulmicort) 1-2 puffs daily Flunisolide (Aerobid) 2-4 puffs daily Triamcinolone (Azmacort) 4-10 puffs daily Budesonide (Pulmicort) 3 puffs daily Flunisolide (Aerobid) 5-8 puffs daily Triamcinolone (Azmacort) 11-20 puffs daily Budesonide (Pulmicort) > 3 puffs daily Flunisolide (Aerobid) >8 puffs daily Triamcinolone (Azmacort) >20 puffs daily As a courtesy to prescribers and nursing, pharmacy will continue to write clarifications for the above substitutions. Inhaled Steroids/Long Acting Beta Agonists
Formulary Medication

Ordered Medication
Budesonide-Formoterol (Symbicort) 80/4.5 Budesonide-Formoterol (Symbicort) 160/4.5 Fluticasone-Salmeterol (Advair) 250/50 and 500/50 2 puffs BID As a courtesy to prescribers and nursing, pharmacy will continue to write clarifications for the above substitutions. Inhaled Nasal Steroids
Formulary Medication

Ordered Medication
Fluticasone (Veramyst) Triamcinolone (Nasacort AQ) Mometasone (Nasonex) Budesonide (Rhinocort AQ) Beclomethasone (Beconase AQ) Ciclosenide (Omnaris) Antitussives
Formulary Medication

Ordered Medication
For Tube Patients
Guaifenesin Oral Solution 200 - 400mg q4h
Oral Antihistamines
Formulary Medication

Ordered Medication
Cetirizine (Zyrtec) 5 mg PO daily Fexofenadine (Allegra) 30 mg PO BID Cetirizine (Zyrtec) 10 mg PO daily Desloratadine (Clarinex) 5 mg PO daily Fexofenadine (Allegra) 60 mg PO BID Fexofenadine (Allegra) 180 mg PO daily Levocetirizine (Xyzal) 5 mg PO daily Fexofenadine-Pseudoephedrine (Allegra-D) Claritin D (12) – Ordered daily Fexofenadine-Pseudoephedrine (Allegra-D) Claritin D (12) Ordered BID or Claritin D (24) ordered daily Fibric Acid Derivatives
Formulary Medication

Ordered Medication
Antara 43 mg Fenoglide 40 mg Fenofibrate (generic) 50 mg, 54 mg, or 67 mg Fenofibric acid (TriLipix) 45 mg Lofibra 54 mg or 67 mg Lipofen 50 mg Triglide 50 mg Antara 130 mg Fenoglide 120 mg Fenofibrate (generic) 120 mg, 134 mg, 150 mg, 160 mg, or 200 mg Fenofibric acid (TriLipix) 135 mg Lofibra 134 mg, 160 mg, or 200 mg Lipofen 150 mg Phosphate Binders
Formulary Medication

Ordered Medication
Promethazine Substitution
Formulary Medication

Ordered Medication
Promethazine (Phenergan) 12.5 mg IV q4h, q6h, q12h Promethazine (Phenergan) 25 mg IV q4h, q6h, q12h Promethazine (Phenergan) 50 mg IV q4h, q6h, q12h Orders for IV promethazine on L&D and chemotherapy floors (A400 & A200 respectively) will not be autosubstituted. Physicians who choose to prescribe IV promethazine on other floors shall write "Do Not Substitute." In those cases, IV promethazine will be diluted in 50 cc of normal saline. If an order for ondansetron already exists, then autosubstitution will not be made and previous order will remain active. 5-HT3 Antiemetics
Formulary Medication
Ordered Medication
Dolasetron (Anzemet) 12.5 mg IV Granisetron (Granisol) 0.1 mg IV Granisetron (Granisol) 1 mg IV q12h Dolasetron (Anzemet) 100 mg IV q24h Palonosetron (Aloxi) 0.25 mg IV q24h Dolasetron (Anzemet) 100 mg PO q24h Granisetron (Granisol) 2 mg PO q24h ** Excludes Chemotherapy Patients** Bladder Antispasmodics / Incontinence
Formulary Medication

Ordered Medication
Solifenacin (Vesicare) 5 mg PO daily Trospium (Sanctura) 20 mg PO daily Tolterodine (Detrol) 1 mg PO BID Fesoterodine (Toviaz) 4 mg PO daily Solifenacin (Vesicare) 10 mg PO daily Trospium (Sanctura) 20 mg PO BID Tolterodine (Detrol) 2 mg PO BID Fesoterodine (Toviaz) 8 mg PO daily Antiepileptics
Formulary Medication

Ordered Medication
Levetiracetam (Keppra XR) 1000-3000 mg PO daily Phenytoin Equivalents (PE) doses – 1:1 conversion Renal Vitamins
Formulary Medication

Ordered Medication
Renal Caps NephroCaps (contains folic acid, B vitamins, biotin, (contains folic acid, B vitamins, biotin, Hemocyte Plus Iberet Folic 500 Nephron –FA Niferex Chromagen (iron polysaccharides) FolBee Foltx (contains folic acid, B12, and B6) Angiotensin II Receptor Blockers
Formulary Medication

Ordered Medication

Note: Combination Products excluding generic Hyzaar (hctz/irbesartan) - such as Micardis HCT,
Avalide, etc will be converted to the equivalent components.


Source: http://gsnet.goodshepherdhealth.org/images/newspics/flyer3203131725.pdf

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