PSJMC PHARMACY & THERAPEUTICS COMMITTEE APPROVED THERAPEUTIC INTERCHANGE
Generic
Trade
Dose/Route
CARBEPENEMS
*Please see renal dosing table for renal dosing adjustment if needed.
Doripenem
Doribax
250mg ivpb
250mg ivpb
250mg ivpb
250mg ivpb
500mg ivpb
500mg ivpb
Imipenem
Primaxin
250mg ivpb
250mg ivpb
500mg ivpb
500mg ivpb
500mg ivpb
1gm ivpb
CEPHALOSPORINS
*Please see renal dosing table for renal dosing adjustment if needed.
Cefadroxil
Duricef
500mg po
Cefizoxime
Cefizox
1gm ivpb
2gm ivpb
FLUOROQUINOLONES
*Please see renal dosing table for renal dosing adjustment if needed.
Moxifloxacin
Avelox
400mg ivpb
NITORIMIDAZOLES
Metronidazole
MetroGel Vaginal vaginally
PENICILLINS
Ampicillin/Sulbactam
(if unavailable)
Oxacillin
Unasyn
Frequency
To
ANTIBIOTICS
Trade
Dose/Route
Frequency
500mg ivpb
500mg ivpb
500mg ivpb
1gm ivpb
1gm ivpb
1gm ivpb
500mg ivpb
500mg ivpb
500mg ivpb
1gm ivpb
1gm ivpb
1gm ivpb
q24hr
q8hr
q12hr
q12hr
q8hr
q8hr
q24hr
q8hr
q12hr
q12hr
q8hr
q8hr
q12hr
q8hr
q8hr
q8hr
q8hr
q8hr
q12hr
q6hr
q12hr
q12hr
q6hr
q6hr
→
Meropenem*
Merrem
→
Meropenem*
Merrem
bid
q8-12hr
q8-12hr
→
→
Cephalexin*
Ceftriaxone
Keflex
Rocephin
500mg po
1gm ivp
1gm ivp
qid
q24hr
q24hr
q24hr
→
Levofloxacin*
Levaquin
500mg ivpb
q24hr
→
Metronidazole
Vandazole
Vaginal Gel
vaginally
same
→
Ticarcillin/
Clavulanate
Nafcillin
Timentin
2gm ivpb
3.1gm ivpb
same ivpb
same
same
same
same
same
same
same
same, in mgPE
same
prior to chemo
1.5gm ivpb
3gm ivpb
500-2000 mg
ivpb
Generic
→
q4-6 hours
ANTICONVULSANTS
HYDANTOINS
Phenobarbital
Phenytoin
Dilantin
15mg po
30mg po
60mg po
100mg po
ivp/ivpb
Dolasetron
Ondansetron
Anzemet
Zofran
12.5mg ivp
32mg ivpb
→
Phenobarbital
→
Fosphenytoin
Cerebyx
16.2mg po
32.4mg po
64.8mg po
97.2mg po
same ivp/ivpb
Ondansetron
Ondansetron
Zofran
Zofran
4mg ivp
16mg ivpb
ANTIEMETICS
→
prior to chemo →
1
Generic
Prochloperazine
(if unavailable)
ECHINOCANDINS
Caspofungin
Trade
Compazine
Dose/Route
5mg or 10mg
IVP/IM
Cancidas
70mg ivpb
50mg ivpb
Frequency
To
q4hr or q6hr
prn n/v
ANTIFUNGALS
Generic
Ondansetron
Loading dose
→
Micafungin
Maintenance
dose (daily)
ANTIHYPERLIPIDEMIC AGENTS
Trade
Zofran
Dose/Route
4mg ivp
Frequency
same prn n/v
Mycamine
100mg ivpb
100mg ivpb
once
daily
HMG-COA REDUCTASE INHIBITORS
Pravastatin (Pravachol) = no interchange
Any combination product with non-formulary statin included will be interchanged to the individual components (formulary alternative statin plus the other individual component).
During order verification, the pharmacist will enter a comment for the individual agents indicating they are a therapeutic interchange for the original combination product.
Fluvastatin
Lescol
40mg po
qhs
→
Atorvastatin
Lipitor
5mg po
qhs
80mg po
qhs
10mg po
qhs
Lovastatin
Mevacor
20mg po
qhs
→
Atorvastatin
Lipitor
5mg po
qhs
40mg po
qhs
10mg po
qhs
80mg po
qhs
20mg po
qhs
Pitavasatin
Livalo
1mg po
qhs
→
Atorvastatin
Lipitor
5mg po
qhs
2mg po
qhs
10mg po
qhs
4mg po
qhs
20mg po
qhs
Rosuvastatin
Crestor
5mg po
qhs
→
Atorvastatin
Lipitor
20mg po
qhs
10mg po
qhs
40mg po
qhs
20mg po
qhs
80mg po
qhs
40mg po
qhs
80mg po
qhs
Simvastatin
Zocor
10mg po
qhs
→
Atorvastatin
Lipitor
5mg po
qhs
20mg po
qhs
10mg po
qhs
40mg po
qhs
20mg po
qhs
80mg po
qhs
40mg po
qhs
ANTIPSYCHOTIC AGENTS
Quetiapine
Seroquel XR
50mg po
daily
→
Quetiapine
Seroquel
25mg po
bid
150mg po
daily
75mg po
bid
200mg po
daily
100mg po
bid
300mg po
daily
150mg po
bid
400mg po
daily
200mg po
bid
CALCIUM REGULATORS
BISPHOSPHONATES
* Restricted formulary to short stay patients. Inpatient orders are to be automatically substituted with Pamidronate.
Calcitonin
Miacalcin Nasal
nasally
→
Calcitonin
Spray
Zoledronic Acid*
Zometa
4mg ivpb
once
→
Pamidronate
2
Fortical Nasal
Spray
Aredia
nasally
same
90mg ivpb in at
least 500ml NS or
D5W over at least
2 hrs (commonly
once
Generic
Trade
Dose/Route
Frequency
To
Generic
Trade
Dose/Route
over 4hrs)
Frequency
Coreg
3.125mg po
6.25mg po
12.5mg po
25mg po
bid
bid
bid
bid
same po
daily
Bumex
0.5mg iv
1mg iv
1.5mg iv
2mg iv
1.5mg iv
same
various, same dose
(patch)
various, same dose
(patch)
various, same dose
(patch)
various, same dose
(patch)
various, same dose
(patch)
once weekly
same
subcutaneously
same
same
subcutaneously
same
CARDIOVASCULAR AGENTS
BETA BLOCKERS
Carvediolol
Coreg CR
CALCIUM CHANNEL BLOCKERS
Diltazem ER
Cardizem CD
Cardizem LA
Cartia XT
Dilacor XR
Dilt-CD
Dilt-XR
Diltia XT
Diltzac
Tiazac
Taztia XT
DIURETICS (LOOP)
Furosemide
Lasix
(in the event of shortage)
10mg po
20mg po
40mg po
80mg po
daily
daily
daily
daily
→
Carvediolol
all doses po
daily
→
Diltiazem ER
→
Bumetanide
20mg iv
40mg iv
60mg iv
80mg iv
100mg iv
ENDOCRINE AGENTS
HORMONE REPLACEMENT THERAPY
Estrogen
Alora
various (patch)
twice weekly
→
Estrogen
Climara
Estrogen
Esclim
various (patch)
twice weekly
→
Estrogen
Climara
Estrogen
Estraderm
various (patch)
twice weekly
→
Estrogen
Climara
Estrogen
Menostar
various (patch)
once weekly
→
Estrogen
Climara
Estrogen
Vivelle or
Vivelle-Dot
various (patch)
twice weekly
→
Estrogen
Climara
INSULINS
Insulin Lispro Protamine/
Insulin Lispro
Humalog Mix
75/25
subcutaneously
→
Insulin Aspart
Novolog
subcutaneously
→
Insulin Aspart
Protamine/
Insulin Aspart
Insulin Lispro
Novolog Mix
70/30
(FlexPen)
Humalog
GASTROINTESTINAL AGENTS
H2 RECEPTOR ANTAGONISTS
3
once weekly
once weekly
once weekly
once weekly
Generic
Cimetidine
Trade
Tagamet
Nizatidine
Axid
Ranitidine
Zantac
LAXATIVES
*For barium enema patients
Docusate/Casanthranol
Docusate/Casanthranol
Methylcellulose
Senna Concentrate
Peri-Colace
Doxidan
Citrucel
X-Prep*
po
po
po
all doses po
Lactinex
Floranex
all doses po
Dexilant/Kapidex
30mg po
60mg po
20mg po
40mg po
15mg po
30mg po
10mg po
20mg po
20/1100mg po
40/1100mg po
20mg po
NEUTRICEUTICALS
Lactobacillus acidophilus/
Lactobacillus bulgaricus
PROTON PUMP INHIBITORS
Dexalansoprazole
Esomperazole
Nexium
Lansoprazole
Prevacid
Omeprazole
Prilosec
Omeprazole/Sodium Bicarbonate
Zegrid
Rabeprazole
Aciphex
5-ALPHA REDUCTASE INHIBITORS
Dutasteride
Avodart
ANTIMUSCARINIC ANTISPASMOTICS
Trospium
Sanctura
Dose/Route
300mg po
400mg po
800mg po
300mg iv
300mg iv
150mg po
300mg po
50mg iv
150mg po
300mg po
Frequency
qid
bid
qhs
q6-8hr
q12-24h
bid
qhs
bid
bid
qhs
Dose/Route
20mg po
20mg po
40mg po
20mg iv
20mg iv
20mg po
40mg po
20mg iv
20mg po
40mg po
Frequency
bid
bid
bid
q12h
q24h
bid
qhs
bid
bid
qhs
Senokot-S
Senokot-S
Metamucil
Fletcher’s
Castoria
same po
same po
same po
4ml po
same
same
same
prep
Lactobacillus GG
Culturelle
1 capsule po
bid
→
Pantoprazole
Protonix
→
Pantoprazole
Protonix
40mg po
40mg po
40mg po
daily
bid
same
→
Pantoprazole
Protonix
40mg po
same
→
Pantoprazole
Protonix
40mg po
same
→
Pantoprazole
Protonix
40mg po
same
→
Pantoprazole
GENITOURNIARY AGENTS
Protonix
40mg po
same
→
Proscar
5mg po
daily
Detrol LA
2mg po
4mg po
daily
daily
Epogen
2,000 units
subcutaneously
5,000 units
three times per
week
three times per
prep
daily
daily
To
→
Generic
Famotidine
Trade
Pepcid
→
Famotidine
Pepcid
→
Famotidine
Pepcid
→
→
→
→
Docusate/Senna
Docusate/Senna
Psyllium
Senna Concentrate
→
0.5mg po
daily
20mg po
20mg po
daily
→
Tolterodine
bid
HEMATOLOGIC AGENTS
HEMATOPOIETIC AGENTS
*Epogen 40,000 units formulary only for short stay; do not substitute in these patients.
Darbepoetin
Aranesp
25mcg
weekly
subcutaneously
40mcg
weekly
→
4
Finasteride
Epoetin Alpha
Generic
Epoetin*
Trade
Epogen
Dose/Route
subcutaneously
60mcg
subcutaneously
100mcg
subcutaneously
200mcg
subcutaneously
40,000 units
subcutaneously
Frequency
To
Generic
Trade
→
Epoetin
Epogen
Temazepam
Restoril
weekly
weekly
weekly
once weekly
Dose/Route
subcutaneously
8,000 units
subcutaneously
10,000 units
subcutaneously
20,000 units
subcutaneously
10,000 units
subcutaneously
Frequency
week
three times per
week
three times per
week
three times per
week
MWF
15mg po
30mg po
same
HYPNOTICS
BENZODIAZEPINES
Flurazepam
Dalmane
15mg po
30mg po
→
qhs prn
qhs prn
NONBARBITURATE HYPNOTICS
*If Lunesta is a home medication, which is confirmed by the medication reconciliation, then it is a formulary medication. If this is a new medication for the patient then Lunesta remains a nonformulary medication and will continue to be substituted with Ambien. If the physician writes “Do Not Substitute” on the order he/she will still need to fill out the non-formulary request form.
Eszopiclone*
Lunesta
1mg po
→
Zolpidem
Ambien
5mg po
same
2mg po
5mg po
3mg po
10mg po
Zaleplon
Sonata
5mg po
→
Zolpidem
Ambien
5mg po
same
10mg po
10mg po
20mg po
10mg po
Zolpidem Extended Release
Ambien CR
6.25mg po
→
Zolpidem
Ambien
5mg po
same
12.5mg po
10mg po
MISCELLANEOUS
Polyglycitol, Purified
Sorbitol, Sodium
Saliva Substitute
all doses po
→
Biotene Oral
same po
same
Water, Sunflower Oil,
Carboxymethylcellulose,
Balance
Propylene Glycol, Milk
Methylparaben
Protein Extract, Xylitol,
Sodium Benzoate, Flavor,
Flaxseed Oil, Xanthan
Gum, Potassium Sorbate,
Rosemary Extract,
Disodium Phosphate, Zinc
Gluconate, Citric Acid,
Potassium Thiocyanate,
Lactoperoxidase,
Lactoferrin, Lysozyme
Hetastarch 6%
→
Hespan
(6% Hetastarch in
lactated
electrolyte
injection)
Contains:
Na 154mEq/L
Cl 154 mEq/L
Ca -- mEq/L
5
Hetastarch 6%
Hextend (6%
Hetastarch in
0.9%NS)
Contains:
Na 143 mEq/L
Cl 124 mEq/L
Ca 5 mEq/L
K 3 mEq/L
Mg 0.9mEq/L
Generic
Trade
K -- mEq/L
Mg -- mEq/L
Dextrose/
Glucose Units -g/L
Dose/Route
Hydrocodone/Acetaminophen
Lortab 2.5/500
po
Hydrocodone/Acetaminophen
Lortab or Vicodin
5/500
Lortab 7.5/500
po
po
Hydrocodone/Acetaminophen
Vicodin ES
7.5/500
Lortab 7.5/500
Hydrocodone/Acetaminophen
Lortab 10/500
po
Hydrocodone/Acetaminophen
Vicodin HP
10/660
po
Hydrocodone/Acetaminophen
Hydrocodone/Acetaminophen
po
po
ANTIHISTAMINES, LESS SEDATING
Cetirizine
Zyrtec
10mg po
Desloratidine
Clarinex
5mg po
Fexofenadine
Allegra
60mg po
Fexofenadine
Allegra
180mg po
Fexofenadine-Pseudoephedrine
Allegra-D
60mg-120mg
(12 hour)
BETA-2 ADRENERGIC AGONIST INHALATION SOLUTIONS
Levalbuterol
Xopenex
0.63mg
Levalbuterol
Xopenex
BRONCHODILATOR (METHYLXANTHINE)
*Theophylline
*NOTE: Only perform substitution
1.25mg
Frequency
To
Generic
OPIATES
→
Hydrocodone/
Acetaminophen
→
Hydrocodone/
Acetaminophen
→
Hydrocodone/
Acetaminophen
→
Hydrocodone/
Acetaminophen
→
Hydrocodone/
Acetaminophen
→
Hydrocodone/
Acetaminophen
→
Hydrocodone/
Acetaminophen
RESPIRATORY AGENTS
Trade
Dextrose/
Glucose Units
0.99g/L
Lactate
28mEq/L
Dose/Route
Frequency
Norco
½ tab Norco
5/325 po
1 tab Norco
5/325 po
1 tab Norco
7.5/325 po
1 tab Norco
7.5/325 po
1 tab Norco
7.5/325 po
1 tab Norco
10/325 po
1 tab Norco
10/325 po
same
10mg po
10mg po
10mg po
10mg po
5mg-120mg po
daily
daily
daily
daily
same
q6hr
q4hr while
awake
q4hr
same
frequency
q6hr
q4hr while
awake
q4hr
same
frequency
Norco
Norco
Norco
Norco
Norco
Norco
daily
daily
bid
daily
bid
→
→
→
→
→
Loratidine
Loratidine
Loratidine
Loratidine
LoratidinePseudoephedrine
q8hr
q6hr while
awake
q6hr
more frequent
than q6hr
q8hr
q6hr while
awake
q6hr
more frequent
than q6hr
→
Albuterol
1.25mg
→
Albuterol
2.5mg
→
Aminophylline
Aminophylline
Dose=
iv
6
Claritin
Claritin
Claritin
Claritin
Claritin D
(12 hour)
same
same
same
same
same
same
same
Generic
if premixed theophylline
unavailable
Trade
Dose/Route
NASALLY INHALED CORTICOSTERIODS (AQUEOUS)
Triamcinolone
Nasacort AQ
1 spray per
nostril
NASALLY INHALED CORTICOSTERIODS (SUSPENSION)
Budesonide
Rhinocort Aqua
4 sprays per
nostril
Flunisolide
Nasalide
2 sprays per
nostril
Flunisolide
Nasarel
2 sprays per
nostril
Triamcinolone
Nasacort HFA
2 sprays per
nostril
Mometasone
Nasonex
2 sprays per
nostril
ORALLY INHALED BETA-2 ADRENERGIC AGONISTS
Metaproterenol
Alupent
all doses
inhaled
ORALLY INHALED CORTICOSTEROIDS
Mometasone 220mcg DPI
Asmanex
1 puff
2 puffs or 1 puff
2 puffs
Salmeterol
Serevent Inhaler
2 puffs
Frequency
To
Generic
Trade
Dose/Route
Theophylline
Dose/0.8 iv
Aminophylline
Example:
Aminophylline
1000mg =
Theophylline
800mg
Frequency
daily
→
Beclomethasone
Beconase AQ
1 spray per nostril
bid
daily
→
Fluticasone
Flonase
2 sprays per nostril
daily
bid
→
Fluticasone
Flonase
2 sprays per nostril
daily
bid
→
Fluticasone
Flonase
2 sprays per nostril
daily
bid
→
Fluticasone
Flonase
2 sprays per nostril
daily
daily
→
Fluticasone
Flonase
2 sprays per nostril
daily
→
Albuterol
same inhaled
same
→
Fluticasone 110mcg
Fluticasone 220mcg
Fluticasone 220mcg
Salmeterol
Flovent
1 puff
1 puff
2 puffs
1 puff
bid
bid
bid
q12hr
B6, B12, Folic Acid
Calcium Carbonate
(CaCO3) + Vitamin D
FaBB
Oyster shell
+ Vitamin D
po
500mg CaCO3 +
200 International
Units Vitamin D po
po
same
same
Cerovite
Senior
Rena-Vite
po
same
po
same
Phos-NaK
po
same
daily
daily or bid
bid
q12hr
→
SUPPLEMENTS
→
non-prn
→
B6, B12, Folic Acid
Calcium supplements, with or
without vitamin D
Folgard RX 2.2
po
all doses po
Multiple Vitamins
Centrum
po
Multiple Vitamins
Centrum Silver
po
→
Multiple Vitamins
Multiple (water-soluble) Vitamins
Nephro-Vite
po
→
K, Na, Phos
Neutra-Phos
po
→
Multiple (watersoluble) Vitamins
K, Na, Phos
Serevent
Diskus
Multivitamins
7
same
Generic
Trade
Powder
Dose/Route
Frequency
To
Generic
K, Na, Phos
Trade
Powder or
Use K-Phos
Neutral
Tablets when
Phos-NaK
unavailable
Dose/Route
Frequency
THERAPEUTIC SUBSTITUTION FOR NG/GT PATIENTS
Generic
Trade
Dose/Route
Nitrofurantoin monohydrate/
nitrofurantoin macrocrystals
Macrobid
100mg po
Carbamezapine Extended Release
Tegretol XR
po
Divalproex Extended Release
Depakote ER
po
Phenytoin
Dilantin
300mg po
daily
Venlafaxine Extended Release
Effexor XR
po
ANTIDEPRESSANTS
daily
→
Venlafaxine
Aspirin Enteric Coated
Dilitiazem Extended Release
Isosorbide Mononitrate
Cardizem CD
Cardizem LA
Cartia XT
Dilacor XR
Dilt-CD
Dilt-XR
Diltia XT
Diltzac
Tiazac
Taztia XT
Imdur
81mg po
325mg po
120mg po
180mg po
240mg po
300mg po
360mg po
420mg po
various po
Frequency
To
ANTIBIOTICS
bid
→
Generic
Trade
Dose/Route
Frequency
Nitrofurantoin
Suspension
Furadantin
Suspension
50mg ng/gt
qid
ng/gt
daily dose
divided
q6-8hrs
daily dose
divided bid
(ex. 500mg =
250mg bid)
tid
ANTICONVULSANTS
→
Carbamezapine
Suspension
→
Valproic Acid
Syrup
ng/gt
→
Phenytoin
Suspension
100mg ng/gt
Effexor
CARDIOVASCULAR AGENTS
→
Aspirin Chewable
Aspirin
daily
→
Diltiazem
→
daily
8
Isosorbide
Isordil
Nearest equivalent
dose ng/gt
daily dose bid
(ex. 75mg
daily = 37.5mg
bid)
81mg ng/gt
325mg ng/gt
30mg ng/gt
60mg ng/gt
60mg ng/gt
No sub-call MD
90mg ng/gt
No sub-call MD
same
ng/gt
daily dose
q6hr
q8hr
q6hr
-q6hr
--
Generic
Trade
Dose/Route
Frequency
To
Metoprolol Succinate
Toprol XL
daily
daily
→
Verapamil Sustained Release
Verelan
50mg po
100mg po
120mg po
180mg po
240mg po
360mg po
Docusate
Pantoprazole
Colace
Protonix
all doses po
40mg po
Tolterodine Long Acting
Detrol LA
po
Guaifenesin ER
Humibid LA
po
RESPIRATORY AGENTS
→
Guaifenesin
Theophylline
TheoDur/Uniphyl
600mg po
400mg po
300mg po
200mg po
daily
daily
bid
bid
Ferrous sulfate tab
Multivitamin tab
Potassium Chloride Extended
Release
po
Klor-Con/
KDUR
→
Generic
Dinitrate
Metoprolol Tartrate
Metoprolol Tartrate
Verapamil
GASTROINTESTINAL AGENTS
→
Docusate
→
Lansoprazole
Solutab
GEINTOURINARY AGENTS
→
Tolterodine
→
SUPPLEMENTS
→
→
→
1 tab po
po
Updated 09/24/12hd
9
Theophylline Elixir
Ferrous Sulfate
Elixir
Multivitamin liquid
Potassium Chloride
Oral Solution
Trade
Dose/Route
Lopressor
Lopressor
25mg ng/gt
50mg ng/gt
40mg ng/gt
60mg ng/gt
80mg ng/gt
120mg ng/gt
Frequency
divided tid
bid
bid
q8hr
q8hr
q8hr
q8hr
Colace
Prevacid Solutab
same
30mg ng/gt
same
same
Detrol
ng/gt
daily dose
divided bid
(ex. 4mg daily
= 2mg bid)
Organidin NR
ng/gt
Eloxiphyllin
Elixir
150mg ng/gt
100mg ng/gt
150mg ng/gt
100mg ng/gt
daily dose
divided
(ex. 600mg =
200mg tid,
1200mg =
200mg q4hr)
q6hr
q6hr
q6hr
q6hr
same ng/gt
same
5mL ng/gt
same ng/gt
same
same
10