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Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 1 of 22 2/7/2019
No order needed to change to elixir as long as bioequivalence is the same. (P&T, 11/04)
No order needed to change route to via tube as long as drug is non-sustained release. (P&T, 11/04)
No order needed to change dilute or concentration on standard drips (7300-VIII-106)
NONFORMULARY FORMULARY P&T
approve
d
Accolate bid Singulair 10 mg daily (adults) 5mg daily (peds)
Accupril 2.5mg or 5 mg Altace 1.25mg
Accupril 10, 20, 40, 80 mg Altace 2.5mg, 5 mg, 10 mg, 20 mg (max)
Accuzyme ointment Santyl
Aceon 2, 4, 8, 16 Altace 2.5 mg, 5 mg, 10 mg, 20 mg (max)
Aciphex 20 mg daily Prilosec 20 mg daily (except if drug interaction, use Protonix) 11/15/1
0
Aclovate 0.05% crm or oint Tridesilon or Desowen 0.05%
Actonel 5 mg/day Fosamax 35 mg/week
Actonel 35 mg/week Fosamax 70 mg/week
Adderall XR 20 mg q day Adderall 10 mg bid 11/2016
Advair Diskus 100/50 1 inhalation bid Advair HFA 45/21, 2 puffs bid, Except for Isolation pt 5/11/10
Advair Diskus 250/50 1 inhalation bid Advair HFA 115/21, 2 puffs bid, Except for Isolation pt 5/11/10
Advair Diskus 500/50 1 inhalation bid Advair HFA 230/21, 2 puffs bid, Except for Isolation pt 5/11/10
Advair in Isolation patients Advair Diskus (administered per Resp Care) 5/11/10
Aerozin spray Benzoin swab
AlitraQ Perative
Allegra 60 mg bid or 180 mg q day Claritin 10 mg daily 5/10/11
Allegra-D bid Claritin-D bid 5/10/11
Alternagel (600 mg/5 ml) Aluminum hydroxide (320mg/5ml), use ½ ordered dose 7/2012
Ambien CR 12.5mg Ambien 10mg
Ambisome Abelcet (can use whichever is least expensive), ID only 11/14/1
1
Aminophylline 100 mg qid Theo-Dur 100 mg tid
Aminophylline ordered as 1000mg in 500ml,
pharmacy may change to 500mg in 250ml
Same concentration, not a therapeutic interchange
Anaprox (naproxen) 275 mg , 500 mg Naprosyn 375 mg, 500 mg
Ancef 1gm pre-op for pt ≤ 120 kg Ancef 2gm pre-op
Ancef 1gm or 2gm pre-op for Pt > 120 kg Ancef 3 gm pre-op 7/2015
Ancef IV 500 mg q8h Ancef IV 1g q8h
Ancef IV q 6 h Ancef IV q 8 h (same # of days/hrs as original order)
Ansaid 50 mg q6h or 100 mh bid Naprosyn 375 mg bid
Ansaid 100 mg tid Naprosyn 500 mg bid
Antacid Al, Mg, Simethicone XS
Antara 43 mg, 130 mg See Fenofibrate 9/4/12
Antifungals (oral and topical) DC- when Diflucan ordered
Anusol Ointment Tucks Ointment
Anzemet 100mg or 1.8mg/kg IV or PO daily Zofran 24mg po first, then 32mg IV if PO not effective DAILY
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 2 of 22 2/7/2019
Anzemet 12.5 mg (any interval, prn) Zofran 4mg q 8hr (prn)
Anzemet 25 mg (any interval, prn) Zofran 8mg q 8hr (prn)
Apidra (short acting insulin) No TI, recommend Humalog. 9/8/09
Aricept (donepezil) 23 mg Dispensing 2 x 10 mg tabs 5/2016
Arixtra CrCl < 30, contraindicated. Cardiac exception for CrCl 20-30, ok x 1 dose, then Clinical Pharmacist to TI
to Heparin Infusion (implement seq # 693 or # 24683 and sign “per TI”)
5/11/10
Artificial Tears See chart at the end of this document 2/2018
Asacol (mesalamine) Delzicol (mesalamine), same dose and frequency 10/2013
Ascriptin Ecotrin
Atacand (candesartan) 4, 8, 16 & 32mg Cozaar (losartan) 25 mg, 25mg, 50 mg, 100 mg 11/1/10
Augmentin 250 mg tid Augmentin 500 mg bid
Augmentin chewables Use Augmentin susp
Avapro (irbesartan) 75 mg, 150mg, 300 mg Cozaar (losartan) 25mg, 50 mg, 100 mg 11/1/10
Aveenobar Aveenobath
Avelox IV (during shortage situations)
Levaquin IV:
CrCl ≥ 50, Levaquin 750 mg IV q 24 hrs
CrCl 20-50 Levaquin 750 mg IV q 48 hrs
CrCl 10-19, Levaquin 500 mg IV q 48 hrs
CrCl < 10 or HD: Levaquin 500 mg IV q 36 hrs
01/06/1
5
09/2017
Avinza 120, 150, 180 & 210 mg daily MS Contin 60, 75, 90, 100 mg bid
Avinza 30, 60, 90 mg daily MS Contin 15, 30, 45 mg bid
Axid 150 mg bid Pepcid 20 mg bid
Axid 150mg, 300 mh q hs Pepcid 20 mg, 40 mg q hs
Banana Bag diluent LR Banana bags diluent is NS
Beclovent Azmacort (same puffs and intervals)
Beconase AQ regular strength Flonase (same # sprays) daily 5/1/12
Benicar (olmesartan) 5, 10, 20 & 40 mg Cozaar (losartan) 25 mg , 25mg, 50 mg, 100 mg 11/1/10
Betapace AF Sotalol (same drug, different indication) 5/2017
Biaxin XL 1000mg DAILY Biaxin 500 mg bid
Breast cream (Lanolin) Lansinoh Breast Cream
Bufferin (Buffered ASA) Ecotrin
Bumex IV 1mg (exception: neonates, no TI) No TI to Demadex IV, call physician 10/2014
Bumex PO 0.5 mg, 1mg, 2mg Demadex PO 5 mg, 10mg, 20 mg
BUTT cream (adults) Vasolex 11/14/1
1
Byetta (exenatide) No TI, must call MD. 9/8/09
Caduet (combo, use individual products) Amlodipine and atorvastatin 9/4/12
Calan Verapamil IR same dose and schedule 8/14
Calan SR
120 mg po daily
180 mg po daily
240 mg po daily
360 mg po daily
120 mg po BID
(same total daily dose given qAM)
Verapamil ER capsules 120 mg po qAM
Verapamil ER capsules 180 mg po qAM
Verapamil ER capsules 240 mg po qAM
Verapamil ER capsules 360 mg (2 x 180 mg) po qAM
Verapamil ER capsules 240 mg po qAM
8/14
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 3 of 22 2/7/2019
180 mg po BID
240 mg po BID
Verapamil ER capsules 360 mg (2 x 180 mg) po qAM
Verapamil ER capsules 480 mg (2 x 240 mg) po qAM
Calcitonin injection
(approx. $2,100 per 400 unit vial) - 24 hrs automatic stop after 2 doses and/or DC if serum Ca is
< 14. Providers can follow up on calcium or ionized calcium
daily as needed.
- Round to 200 units or 400 units.
7/3/18
Calcium Carbonate Products:
ORAL Calcium Formulary Products Elemental Calcium
Calcium Carbonate Chewable 500 mg (Tums) 200 mg
Calcium Carbonate tabs 1,250 mg (Oscal-500) 500 mg
Calcium Carbonate tabs 600 mg (Caltrate-D) 600 mg
Calcium Carbonate 1,250 mg/5ml Suspension 500 mg/5ml
Calcium Gluconate (shortage)
1 gm IV
The TI is for all Ca gluc excluding
NICU and ca drips (PTH) patients.
Calcium Chloride
333 mg IV
3/9/18
Caphosol (sodium phosphate) Biotene (polyglycitol) 11/12
Cardura XL 4 and 8mg Cardura 4 and 8mg daily at bed time respectively. 10/6/09
Cataflam 50 mg tid Naprosyn 500 mg bid
Ceclor 250mg & 500mg caps Ceftin 250mg & 500mg caps
Ceclor susp Ceftin susp
Cecon (ascorbic acid) 90 mg/ml Vit C (ascorbic acid)100 mg/ml syrup 3/3/10
Cefizox q 12hr Mefoxin q 8 hrs
Cefotan (q 12 hrs) Mefoxin (q 8 hrs)
Cefizox (q 8 or 12 hrs) Mefoxin (q 8 hrs)
Cefzil susp Ceftin susp
Celexa 10mg daily Lexapro 5mg daily
Celexa 20mg, 40mg daily Lexapro 10mg, 20mg daily
Cephalothin (Keflin) q4h or q6h Ancef q8h
Cerebyx loading doses (1 gm), during
shortage
Phenytoin 1 gm 5/11/10
Cerebyx Maintenance Doses, during
shortages
May change maintenance doses (ie. 100mg q 8hr) to generic
phenytoin (exception: patient with poor IV access)
Cetacaine spray used at bedside Cepacol or Chloraseptic spray at bedside
Chapstick Blistex
Chromogen FA Niferex 15- Forte
Cipro XR 500mg, 1000mg daily Cipro 250 mg , 500 mg bid
Claforan 500mg Rocephin 500 mg q 24 hrs
Claforan (ADULT indications) 1 gm –2 gm Rocephin 1 gm q 24 hrs
Clarinex 5mg daily Claritin 10 mg daily 5/10/11
Claritin D, all strengths Claritin D 10 mg/240 mg
Clotrimazole (Gyne-Lotrimin) Miconazole
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 4 of 22 2/7/2019
Combivent 2 puffs q6h
Used on ventilator patients only in ICU.
Combivent Respimat 1 puff q6 hr
Used on ventilator patients only in ICU.
3/2014
Copaxone (glatiramer) No TI, pt to bring own, do not order 9/8/09
Cordran 0.05% crm, oint, lotion Kenalog 0.025% oint,crm,lotion
Coreg CR 10, 20, 40, 80 mg daily Coreg 3.125 mg, 6.25 mg, 12.5 mg, 25 mg bid
Cortone Solu-cortef
Covera-HS
180 mg po qHS
240 mg po qHS
360 mg po qHS
480 mg po qHS
Verapamil ER capsules 180 mg po qAM
Verapamil ER capsules 240 mg po qAM
Verapamil ER capsules 360 mg (2 x 180 mg) po qAM
Verapamil ER capsules 480 mg (2 x 240 mg) po qAM
8/14
Cyclocort 0.1% crm or lotion Diprosone 0.05% oint
Cyclocort 0.1% ointment Lidex 0.05% crm, oint, soln
D51/4NS (adults only not peds) D51/2NS (adults only- not peds)
D50 Shortage, give D10 Hypoglycemia orders (#2513) :
▪ If patient can swallow, use juice, milk or peanut butter
crackers
▪ Or, Glucagon 1 mg SQ or IM (peak action is 10-15
minutes). Located in Accudose/Omnicell machines
▪ IV D50W indicated interchange to D10W:
▪ BG 60-69, give D10W 75 ml* (instead of D50W 15 ml)
▪ BG 50-59, give D10W 100 ml* (instead of D50W 20 ml)
▪ BG 30-49, give D10W 125 ml* (instead of D50W 25 ml)
▪ BG < 30, give D10W 150 ml* (instead of D50W 30 ml)
▪ *Infuse over 10-15 minutes
▪ D10W 250 ml is located in unit machines.
Hyperkalemia orders (#42874):
- if D50W is indicated, use D10W 250ml over 15 minutes prior
to administration of IV insulin per physician’s orders.
Endotool Userss
Substitution chart for Dextrose using D10W
Grams Dextrose D50W vol (mL) D10W vol (mL)
10 gm 20 ml 100 ml
15 gm 30 ml 150 ml
20 gm 40 ml 200 ml
3/5/13
09/2017
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 5 of 22 2/7/2019
25 gm 50 ml 250 ml
30 gm 60 ml 300 ml
35 gm 70 ml 350 ml
40 gm 80 ml 400 ml
45 gm 90 ml 450 ml
50 gm 100 ml 500 ml
Dakins
Full Strength = 0.5%
Half-Strength = 0.25%
Quarter Strength = 0.125%
Dalmane Restoril (same dose, but if pt > 65yo, use 15 mg)
Daypro 1200 mg Naprosyn 500 mg tid
Daypro 600 mg Naprosyn 375 mg bid
Decaspray 0.04% Kenalog aerosol
Demadex IV
5 mg
10 mg
20-60 mg
60-80 mg
100 mg
No TI to Bumex IV, call physician
0.5 mg
1 mg
2 mg
3 mg
4 mg
10/2014
Demerol 3 day stop
Denavir ointment Zovirax ointment
Detrol Detrol LA
Dexilant 30, 60 mg daily Prilosec 20mg, 40 mg daily ( if drug interaction, use Protonix) 11/15/1
0
Diflucan IV or PO q12h Diflucan q24h (Same DAILY dose)
Dilacor XR Cardizem CD
Dilantin 300 mg (IV or susp) daily Dilantin 100 mg q8h (IV or susp)
Dilaudid PCAs: when PCA vials on
backorder (can’t make)
Call MD, use Morphine or Demerol PCA or bolus with Dilaudid
Diltiazem Extended Release Tablet (Q day)
Cardiazem LA
Matzim LA tab(120mg, 180mg, 240mg, 300mg, 360 mg, 420mg)
Diltiazem Extended Release Capsule (Q day)
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 6 of 22 2/7/2019
Cardiazem CD
Dilacor XR
Dilt-XR
Dilt-CD
Taztia XT
Tiazac
Cartia XT (180 mg, 240 mg, 300 mg, 360 mg, 420 mg)
Diltiazem Sustained Release Caps (Q 12 hr)
Diltiazem SR
Diltiazem ER (q 12 hrs) generic 60 mg, 90 mg, 120 mg
Diltiazem Immediate Release Tab (tid, qid)
Cardiazem
Diltiazem generic 30 mg, 60 mg, 90 mg, 120 mg
Diprolene 0.05% ointment Temovate 0.05% ointment
Diprolene AF 0.05% cream Temovate 0.05% cream
Ditropan XL 5 mg daily Ditropan 2.5 mg bid
Ditropan XL 10 mg daily Ditropan 5 mg bid
Ditropan XL 15 mg daily Ditropan 5 mg tid
Ditropan XL 20 mg daily Ditropan 7.5 mg tid
Ditropan XL 30 mg daily Ditropan 10 mg tid
Dobutrex IV in any soln other than D5W D5W for diluent (even diabetic pt)
Doral Restoril (same dose- but if pt > 65yo use 15 mg)
Doribax 500mg q 8hr Merrem 1 gm q 8 hr
See CrCl chart for renal adjustments
7/2013
Doxidan = Biscodyl Dulcolax
Duricef Keflex (same dose-double interval )
Dyazide Maxzide 25 mg
EES 400 mg E-mycin or erythromycin base
Effexor bid or tid
Exception: TF (need immediate release)
Effexor XR daily (same total daily dose)
Exception: TF (need immediate release)
Elocon 0.1% crm, oint, lotion Lidex 0.05% crm, oint, soln
Emend 5 day course: 150mg IV on Day 1 & Day 4 (we do not stock po) 8/16/11
Emla cream L.M.X.4
Empirin # 3 Tylenol #3
Enablex (darifenacin) 7.5 and 15mg q day Vesicare (solifenacin) 5 and 10mg once daily 10/6/09
Enlon (endrophonium) Enlon Plus (endrophonium & atropine)
Ensure Clinical Strength or Complete Ensure Enlive bid 2/2016
Enterals See chart at end of this document
Entex LA Entex PSE
Erthromycin (any brand) E-mycin or erthromycin base)
Erythormycin on backorder Call MD, use Zitromax or Biaxin for tx and Reglan for motility
Erythormycin ophthalmic 0.5% for neonates
on backorder
Use azithromycin ophthalmic 9/8/09
Estraderm patch (q 3 days) Climara patch (q 7 days)
Ethyl Chloride spray Fluori-Methan Spray
Famvir (famicyclovir)
125-250 mg bid (suppressive)
Valtrex
500mg bid
10/6/09,
12/2013
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 7 of 22 2/7/2019
500 mg q 8 hr (treatment herpes zoster)
250 mg q 8 hr (treatment genital herpes)
1 gm tid (usually for 7 days)
1 gm bid (usually for 7-10 days)
Feldene 10 mg, 20 mg daily Naprosyn 375 mg, 500 mg tid
Fenofibrate, may be given without regard to
meals
43mg or 67 mg (or any dose < 100)
130 mg, 134 mg, 200 mg (or any dose > 100)
If capsules are ordered, dispense tablets
Capsules: 43 mg, 67 mg, 130 mg, 134 mg,
200 mg
Fenofibrate generic 54 mg TABLET , 1:1 interchange (example:
Fenoglide 2 tabs of 43 mg will be switched to 2 tabs of 54 mg)
Fenofibrate generic 160 mg TABLET (max dose)
Tablets: 54 mg, 160 mg
Fenofibric acid 35 mg, 105 mg See Fenofibrate 9/4/12
Fenoglide 40mg, 120mg See Fenofibrate 9/4/12
Ferraheme NO TI, call MD (can use Ferrlicet), do not order 10/6/09
Fibricor 35mg, 105 mg See Fenofibrate 9/4/12
Flagyl Q6h Flagyl q8h
Flagyl IV (shortage) 500 mg q 8 hrs Cleocin IV 900 mg q 8 hrs 6/2014
Fleet Prep Kit 3 (discontinued) LoSo Prep Kit 02/10
Fleet enema Mineral Oil enema: Exception: bowel prep or specific order for
“saline” or ”sodium phosphate”
11/12
Florastor Culturelle 07/11
Flovent (fluticasone) inhaler
44 mcg 1-2 puffs bid
110 mcg 1 puff bid
110 mcg 2 puffs bid (max dose)
Pulmicort (budesonide) nebulizer
0.25 mg neb bid
0.25 mg neb bid
0.5 mg neb bid
11/2016
Floxin Otic Ciloxin Opth
Folic Acid 0.4 mg Folic Acid 1 mg 9/8/09
Forteo (teriparatide) pen call MD…We will NOT order this outpatient drug
Fosamax 10 mg/day Fosamax 70 mg/week
Fosamax 5 mg/day Fosamax 35 mg/week
Fragmin Lovenox, see 500-56 Attachment F:
Low Molecular Weight Heparin Dosing Guidelines 12/10
Gaviscon liquid Maalox XS 10/12
Gelusil or Gelusil M Maalox XS
Gentamicin /Ampicillin combo for pre-op
hysterectomy
Ancef 2 gm IV x 1 dose or 3 gm x 1 if pt > 120 kg 7/15
Glynase 1.5 mg, 3 mg, 6 mg Diabeta/micronase 2.5 mg, 5 mg, 10 mg
Golytely 3 tbsp Miralax, 1 packet
Granix (TBO- filgastrim) Neupogen (or Neupogen to Granix, whichever in stock) 12/2013
Gyne-Lotrimin Miconazole
H2 antagonist SUSPENSION Pepcid 20 mg tabs crushed
Halcion 0.125 mg, 0.25 mg Restoril 15 mg, 30 mg ( unless pt > 65yo then 15mg)
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 8 of 22 2/7/2019
Halog 0.1% crm, oint, or soln Lidex 0.05% crm, oint, soln
Heparin IV infusions in any soln other than
what we have pre-mixed
Pre-mixed Heparin will be at a concentration of 50 units/ml:
25,000 units in 500 ml of fluid (either D5W or 0.45NS,
depending on supply). Note that D5W can be used in diabetic
patients due to the very low volume.
Heparin 5,000 units SQ q 8-12 hrs for
prophylaxis
During shortage situations, TI to:
Lovenon 30-40 mg SQ q 24 hrs (dose based on CrCl)
9/2/14
Heparin SQ for CrCl > 30 AND BMI > 40
AND weight > 100 mg
Heparin 7,500 units SQ q 8 hrs (Clinical Pharmacist only TI) 3/2018
Humabid DM , one or two tabs a day
(600 mg Guaif– 30mg Methorphan)
Tussibid (1200 mg Guaif – 60mg Methorphan), one tab a day
Hurricaine spray Cetacaine spray…Do not use PRN or at bedside!
Hycomine PV Tuss or QV tussin
Indocin 25 mg (1 tsp) q6h Ibuprofen 600 mg (2 Tbsp) tid
Indocin SR 75mg q12h Naprosyn 500 mg bid
Insulin Novolog mix 70/30 Humalog 75/25
Insulin, Novolin 70/30 Humulin 70/30
Insulin, Novolin N Humulin N
Insulin, Novolin R Humulin R
Insulin, NovoLog Humalog
Insulin Sliding Scale (Regular) Humalog 8/6/13
Integrelin Aggrastat 12/2013
Iron Products See chart at end of this document
Iron products (oral) Ferrous Sulfate 325 mg (65 mg elemental iron) or
Fergon 27 mg elemental irom
Isoptin Verapamil IR same dose and schedule 8/14
Isoptin SR
120 mg po daily
180 mg po daily
240 mg po daily
360 mg po daily
120 mg po BID
180 mg po BID
240 mg po BID
(same total daily dose given qAM)
Verapamil ER capsules 120 mg po qAM
Verapamil ER capsules 180 mg po qAM
Verapamil ER capsules 240 mg po qAM
Verapamil ER capsules 360 mg (2 x180 mg) po qAM
Verapamil ER capsules 240 mg po qAM
Verapamil ER capsules 360 mg (2 x 180 mg) po qAM
Verapamil ER capsules 480 mg (2 x 240 mg) po qAM
8/14
Isopto Tears (5% hydromellose) Naure Tears (4% hydromellose) 1/4/201
1
IV fluids/diluent Change to standard diluent (see policy 7300-VIII-106)
Juvisync (combo, use individual products) Januvia plus simvastatin 9/4/12
Kadian 20 or 30 mg q 12 hrs MS Contin 15 mg q 8 hrs
Kadian 20 or 30 mg q 24 hrs MS Contin 15 mg q 12 hrs
Kadian 50 mg q 12 hrs MS Contin 30 mg q 8 hrs
Kadian 50 or 60 mg q 24 hrs MS Contin 30 mg q 12 hrs
Kadian 60 mg q 12 hrs MS Contin 45 mg q 8 hrs
Kadian 100 mg q 12 hrs MS Contin 60 mg q 8 hrs
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 9 of 22 2/7/2019
Kadian 100 mg q 24 hrs MS Contin 60 mg q 12 hrs
Kaolin and pectin Pepto Bismol
Kaopectate Pepto Bismol
KCL bolus in fluid other than SWFI KCL bolus in SWFI
KCL supplement 10 mEq, 20 mEq K-dur 10 mEq
KCL supplement 8mEq Micro-K 8 mEq
Keftab Keflex
Kovia Accuzyme
Kytril 1-2mg Po or IV (any interval) Zofran 8 mg PO first, then 16 mg IV if PO not effective DAILY
Latisse Xalatan (latanoprost) 8/6/13
Lescol 20mg, 40, and 80 mg (per day) Lipitor 10 mg (total daily dose administered q am) 9/4/12
Levemir (long acting insulin) Lantus (1:1 conversion)
Exception: Allowed for use in GWP only (Catagoty B)
1/2016
Lidex E 0.05% cream Lidex 0.05% crm, oint, soln
Lipofen 50 mg, 150 mg See Fenofibrate 9/4/12
Livalo (pitavastatin) 1, 2, 4 mg Pravachol (pracastatin) 20, 40, 80 mg 9/4/12
LOC (Laxative of Choice) No TI. RN to check w/ patient, then call MD to obtain an order. 9/8/09
Locold 1% soln Tridesilon or Desowen 0.05%
Lodine 200 mg bid, tid, qid Naprosyn 375 mg bid
Lodine 300 mg bid Naprosyn 375 mg bid
Lodine 300 mg tid or qid Naprosyn 500 mg bid
Lodine 400 mg bid or tid Naprosyn 500 mg bid
Lofibra 134 mg, 200 mg, 160 mg See Fenofibrate 9/4/12
Lortab Elixir Hycet Elixir (ml for ml). Both contain 7.5mg Hydrocodone, but
Hycet has APAP 325mg and Lortab has APAP 500mg
Lortab (HYDROcodone with 500 mg
acetaminophen)
Norco ((HYDROcodone with 325 mg acetaminophen) Approve
03/201,
effective
6/4/13
Lotensin 2.5 mg & 5 mg Altace 1.25mg
Lotensin 10 mg, 20 mg, 40mg, 80 mg Altace 2.5mg, 5 mg, 10mg, 30 mg (max)
Lovenox for CrCl > 30 AND BMI > 40
AND weight > 100 mg
For VTE Prophylaxis
Lovenox 40 mg SQ q 12 hrs (Clinical Pharmacist TI only) 3/2018
Lovenox for CrCl < 30 and weight > 100 kg
for VTE Prophylaxis
DC Lovenox
Give Heparin 7,500 units SQ q 12 hrs
02/2019
Lovenox (or Heparin, Arixtra or Coumadin)
ordered with “newer” oral anticoagulants that
work immediately (Pradaxa, Eliquis or
Xarelto)
DC Lovenox 6/2013
Lovenox rounding , see 500-56, Attachment F: Dose Rounding, if patient weighs….. Give
Lovenox 1 mg/kg q 12 hrs (< 50 kg) 40 mg q 12 hrs
Lovenox 1 mg/kg q 12hrs (50-69 kg) 60 mg q 12 hrs
Lovenox 1 mg/kg q 12hrs (70-89 kg) 80 mg q 12 hrs
01/2012
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 10 of 22 2/7/2019
Lovenox 1 mg/kg q 12 hrs (90-109 kg) 100 mg q 12 hrs
Lovenox 1 mg/kg q 12 hrs (110-129 kg) 120 mg q 12 hrs
Lovenox 1 mg/kg q 12 hrs (130-144 kg) 140 mg q 12 hrs
Lovenox 1 mg/kg q 12 hrs (145-154 kg) 150 mg q 12 hrs
Lovenox 1 mg/kg q 12 hrs (155-169 kg) 160 mg q 12 hrs
Lovenox 1 mg/kg q 12 hrs (170 kg and up) 180 mg q 12 hrs (maximum dose)
Lumigan (any strength) Xalatan (latanoprost) 8/6/13
Lunesta 1, 2 mg Ambien 5 mg
Lunesta 3mg Ambien 10 mg
Maalox and Maalox XS May interchange both in shortage situation 10/12
Maalox XS, Plus or TC Al, Mg, Simethicone XS
Macrodantin 100 mg qid Macrobid 100 mg bid
Magic Mouth Wash (shortage of Nystatin
suspension)
Modified Magic Mouth Wash (mixed without Nustatin) Plus
Mycelex trouche tid
2/2019
Mag Oxide 250 mg and Magtrate 500 mg Mag Ox 400 mg
Mannitol 25% 500 cc Mannitol 20 % 500 cc
Mavik 0.5 mg, 1mg, 2mg, 4mg, 8mg Altace 1.25 mg, 2.5mg, 5mg, 10mg, 20 mg (max)
Maxalt 5 mg Imitrex 50 mg
Maxalt 10 mg Imitrex 100 mg
Maxiflor 0.05% crm Diprosone 0.05% oint
Maxiflor 0.05% ointment Lidex 0.05% crm, oint, soln
Maxipime No TI to Fortaz, call MD
Meclomen 100 mg tid or qid Naprosyn 500 mg tid
Meclomen 50 mg qid Naprosyn 500 mg tid
Menthol 0.25% compounded Sarna 5%
Merrem (Merrem is FORMULARY and
administered over 4 hrs)-TI IS ONLY FOR
SHORTAGES
1-2 gm IV q 8 hrs (over 4 hrs)
Doribax 500 mg IV q 8 hrs
7/2010
Mevacor 10 mg, 20 mg and 40mg Lipitor 10 mg (total daily dose administered q am) 9/4/12
Mevacor 80 mg Lipitor 20 mg (total daily dose administered q am) 9/4/12
Micardis (telmisartan) 20mg, 40mg, 80 mg, Cozaar (losartan) 25mg, 50 mg, 100 mg 11/1/10
Minocin IV Doxycycline 100 mg IV q 12 hrs
Mobic (meloxicam) 7.5mg, 15 mg Naprosyn 375 mg, 500 mg bid
MOM/MO MOM + MO
Monopril 5 mg, 10 mg, 20 mg Lisinopril 5 mg, 10 mg, 20 mg
Monopril 40mg-80mg Lisinopril 40 mg
Morphine IV (during shortage),
1-2 mg IV q 3 hrs prn severe pain
Dilaudid IV for non-ICU surgical patients (during shortage)
0.25-0.5 mg IV q 3 hrs prn severe pain
12/11/1
2
Morphine prn with CrCl < 30 DC Morphine, order Dilaudid 0.25 mg IV q 3 hrs prn severe
pain
01/06/1
5
Mucofen and Mucofen LA Humibid LA
MVI (Multi dose vitamins)
MVI q day in hyperal during shortage
See Vitamin Chart at the end of this document
MVI in hyperal q M, W, F during shortage
10/2013
Mylanta or Mylanta II Maalox XS
Nafcillin shortage Oxacillin
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 11 of 22 2/7/2019
Nalfon 200 mg qid or 300 mg tid Naprosyn 375 mg bid
Nalfon 300 mg qid or 600 mg tid or qid Naprosyn 500 mg bid
Namenda (memantine)
5 mg po q day
5 mg po bid
5 mg po q am, 10 mg po q pm
10 mg po bid
Namenda XR (memantine)
7 mg po q day
14 mg po q day
21 mg po q day
28 mg po q day
03/2014
Naprosyn 250 mg bid Naprosyn 375 mg bid
Nasacort (triamcinolone) Flonase (fluticasone) 2 sprays in each nostril daily 5/1/12
Nasarel (flunisolide) Flonase (fluticasone) 2 sprays in each nostril daily 5/1/12
Nasonex (mometasone) Flonase (fluticasone) 2 sprays in each nostril daily 5/1/12
Nature’s Tears (hypromellous) 0.4% Refresh (carboxymethylcellulose) 1% 8/7/12
NeoCortef 1% ointment Cortisporin 1% ointment
Neodecadron crm Neo-Synalar crm
Nephrocap Renovite
Neupogen (filgastrim) Granix (or Granix to Neupogen, whichever in stock) 12/2013
Nexium
PO: 20mg, 40 mg
IV: 20mg, 40 mg (daily or bid)
Tube: 20mg, 40 mg
PO: Protonix 40 mg po q day
IV: Protonix 20mg, 40 mg (daily or bid)
Tube: Prevacid 30mg, 60 mg ODT
11/15/1
0
Niacor, Nicotinic acid short acting Niacin (same dose)
Niaspan, Nicotinic acid ER Slo-Niacin (same dose)
Niferex- 150 Ferrous Sulfate 300 mg tid (60mg Fe
Norflex 100 mg bid Flexeril 10 mg tid
Norflex 50 mg tid Flexeril 10 mg bid
Noroxin 400 mg bid Cipro 250 mg bid
Novolin 70/30 Humulin 70/30
Novolin N Humulin N
Novolin R Humulin R
NovoLog Humalog
Novolog mix 70/30 Humalog 75/25
Nystatin Suspension (shortage) Mycelex (clotrimazole) trouche tid 2/2019
Ocuflox eye drops Ciloxan eye drops
Ofirmev (acetaminophen IV) any dose 1 gm IV q 6 hrs x 2 doses in Post-op patients only (not prn)
If < 50 kg, or 2-12 y/o, use 15 mg/kg IV q 6 hrs x 2 doses
7/2014
Optison (perflutren) Definity (perflutren), use orders # 27027 10/2014
Orudis 50 mg q6h or 75 mg tid or Naprosyn 500 mg tid
Oruvail 200 mg daily Naprosyn 500 mg tid
Oxacillin IV Nafcillin IV
Oyster Shell Calcium Oyster Shell Calcium with Vit D
Pancreatic Enzymes New starts will be with Creon
(Will not stock Pancreaze, Zenpep- use patient’s own supply)
11/2017
Parafon Forte DSC 500 mg tid/qid Flexeril 10 mg tid
Parafon Forte DSC 750 mg tid Flexeril 10 mg tid
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 12 of 22 2/7/2019
Parafon Forte DSC 750 mg qid Flexeril 10 mg qid
Paxil CR 12.5 mg , 25 mg, 37.5 mg q day Paxil 10 mg, 20 mg, 40 mg q day
PBs (premixed) q12h or q24h in dextrose Keep in dextrose (even diabetic pts)
PD (Peritoneal Dialysis) fluids:
Low magnesium
PD (Peritoneal Dialysis) fluids:
High magnesium
Pepcid IV (during shortage) 20 mg IV bid Protonix IV 40 mg IV q 24 hrs
5/2014
Pepcid IVPB or continuous infusion Pepcid IV push over 2 minutes
Pepcid and PPI together DC PPI unless it is patient’s home med, policy 7300-IV-50 11/1/10
Percocet 20mg (10mg x 2 tabs) Must call MD (obtain new order for oxycodone plus APAP)
Percocet- No strength indicated Percocet 5 mg (the 5mg is the default strength)
Percodan Percocet
Peri-colace Senekot-S
Phazyme 95 and 125 Phazyme 180
Phenylephrine eye drops During shortage situations: Cyclomydril eye drops 9/2/14
Phosphate Must follow P&T guidelines
Plamanate Albumin 5%
Plendil (felodinpine) Norvasc (amlodipine) same dose and interval 8/2016
Post-op Prophylactic antibiotics “x 3 doses” Change to “x 2 doses” to not exceed 24 hrs
Potassium Must follow P&T guidelines
PPF (plasmanate) Albumin 5%
Pramosone 1% crm, oint, lotion Hydrocortisone 1% cream, oint
Pramosone 2.5% crm, oint, lotion Hydrocortisone 2% crm or lotion
Prevacid
PO: 15-30mg, 60 mg
IV: none, use Protonix
Tube: use Prevacid ODT
PO: Protonix 20mg, 40 mg
IV: Protonix
Tube: Prevacid ODT
11/15/1
0
Prilosec po Protonix po 9/2/14
Primaxin
500 mg, 750 mg, 1gm IV any interval
250 mg IV any interval
Merrem, usual dose 1-2 gm q 8 hrs, Adjust for CrCl per 7300-VII-40A
2013
Pristiq 50 mg, 100 mg Effexor XR 37.5mg, 75 mg
Probiotic Culturelle
Procardia 10 mg (short-acting, immediate
release)
CALL MD due to increased risk of arrythmias, MI & stroke.
ALTERNATIVES:
Capoten 12.5mg-25mg po q8h prn (onset 5-25min)
Catapres 0.1-0.2mg po X 1, then 0.1 mg q1h to max 0.8mg
(onset 30-60 min)
Vasotec 1.25mg IV over 5 min then q6h prn (onset 15 min)
Normodyne 20 mg IVP over 2 min, then 40-80mg q 10 min
(onset 5-15 min)
Lopressor 2.5-5mg iv q6h
Procrit dose in ESRD Max of 30,000 units per week 3/2014
Profilnine (3 F-PCC), but will use up current
stock
Kcentra (4-F- PCC) 10/2013
Prosom Restoril 15mg-30mg (if pt >65yo then 15mg)
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 13 of 22 2/7/2019
Protonix
PO: no TI
IV: no TI
Tube: 20mg, 40mg, use Prevacid ODT
PO: dispense as ordered
IV: use Protonix
Tube: Prevacid ODT 30mg, 60 mg
11/15/1
0
Protonix 40 mg “bid” Change to “Q Day”. Exceptions: GI Bleed or “bid
is patient’s home dose regimen
11/2015
Protonix IV …during shortage 40 mg IV q day
Or
40 mg IV bid
– NON-GI BLEED and IV PPI ordered:
– Pantoprazole 40 mg PO q day (BID dosing is
reserved for GI bleed and H.Pylori patients) or
– Famotidine (Pepcid®) IV or PO 20 mg BID (if CrCl
< 50 ml/min, use q day)
– GI BLEED and IV PPI Ordered
– Pantoprazole 80 mg PO BID x 2 doses, then 40 mg
PO BID or
– Lansoprazole 60 mg via NGT BID x 2 doses, then
30 mg via NGT BID
07/2017
Provigil 100mg, 200mg Nuvigil 150 mg, 250 mg 10/5/10
Psorcon 0.05% cream Temovate 0.05% cream
PV Tussin (hydrocodone) Hycodan (hydrocodone & homatropine) 9-3-13
Qvar Inhaler
40 mcg 1-2 puffs bid
80 mcg 1 puff bid
160-320 mcg 1-2 puffs bid
Pulmicort (budesonide) nebulizer
0.25 mg neb bid
0.25 mg neb bid
0.5 mg neb bid
8/13/13
11/2016
Rapaflo (silodosin) 8 mg q day Flomax (tamsulosin) 0.4 mg q day 09/2015
Relafen 1000 mg daily Naprosyn 375 mg bid
Relafen 750 mg or 1000 mg bid Naprosyn 500 mg tid
Relafen 1500 mg or 2000 mg daily Naprosyn 500 mg tid
Remeron (mirtazapine) Solutabs Use generic mirtazapine (7.5mg is no longer manufacturered) 9/8/09
Renagel (sevelamer hydrochloride) Renvela (sevelamer carbonate)
Restoril 30 mg in pt > 65yo Restoril 15mg
Rhinocort (budesonide) Flonase (fluticasone) 2 sprays in each nostril daily 5/1/12
Risperdal 0.5mg, 1mg, 2mg Risperdal-M 0.5mg, 1mg, 2mg (Orally disintegrating tablets)
Robitussin CF Call MD- recommend (psuedoephedrine + Cardec DM) +
Robitussin
Robitussin PE Call MD- recommend pseudoephedrine + robitussin
Rocephin < 1g in PEDS (any interval) Rocephin 250mg,500mg,750mg q24h (if dosing 50mg/kg round
up; if dosing 100mg/kg round down)
Rocephin (Adults and Peds) q 12 hrs
If not documented as meningitis, call physician. If not
meningitis, change to q 24 hrs.
Serax 10mg, 15mg, 30mg Ativan 0.5mg, 1mg, 2mg
Serevent MDI 2 puffs bid Serevent Discus 1 puff bid
Simcor (combo, use individual ingredients) Niacin ER plus simvastatin
Singulair 4mg Singulair 5mg
Slo-bid 100 mg, 200 mg, 300 mg bid Theo-Dur 100 mg, 200 mg , 300 mg bid
Slo-Niacin (any dose) Niaspan 500 mg qhs
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 14 of 22 2/7/2019
Slo-Phyllin 125 mg bid Slo-bid 125 mg bid
Slo-Phyllin 250 mg bid Theo-Dur 200 mg bid
Sodium Bicarbonate IV Shortage See Flyer Restricted Indications:
• Perfusion/Open Heart
• NICU – restrictions and conservation measures per Medical Director
• Alkalization of urine ONLY when ORAL Sodium bicarb CANNOT BE USED:
o Drug overdose: Tricyclic, salicylates, methyl alcohol, and barbiturate
o Hemolytic reactions (blood transfusion reactions/crush injuries) requiring alkalization of urine to decrease nephrotoxicity of blood pigments.
o Chemotherapy: alkalization of urine required to reduce toxicity.
• Other indications require approval from Dr J Clements, Dr M Austin, Dr B Yusuf, Dr P Kaplan, Dr D Chatoth, or Dr A Bier. Must enter the approving physician and indication in the CPOE med order comment.
Other Ordering Restrictions:
• No more partial Sodium bicarb vials. Increments of 50 mEq are only allowed (ex: 50, 100, 150 mEq/L) to avoid waste.
• Only one liter of sodium bicarb IVFs will be dispensed at a time. Nursing/pharmacy communication prior to the next bag needed. We avoid significant waste with this process.
• Pharmacists have been asked to call for clarification of any order that there may be questions about – even if an appropriate indication is documented
Alternatives to Na Bicarb IV:
• Oral Sodium Bicarbonate 650 mg tablets o Sodium Bicarb: 7 tablets (650 mg each) = 50 mEq NaHCO3 IV.
• Sodium Acetate IV can be used to replace Sodium Bicarb in IVF. o Sodium acetate 40 mEq = approximately 35 mEq of sodium
bicarb.
o Sodium acetate is on national shortage and we recommend using full 40 mEq vial (ex: 40 mEq, 80 mEq increments) to avoid waste
• Do NOT use if there is significant impairment of liver function
• Lactated Ringers, confirm the K+ level is normal, for mild acidosis.
5/2017
Sodium Phosphate IV (during shortage) If patients unable to replace via enteral route, give NaPO4 for
PO4 < 2 and K > 4.
If K < 4, use KPhosp IV
8/6/13
For patients on Electrolyte Replacement Protocol when IV
Phos replacement is necessary
• PO4 = 1.6-2.4 and K+ < 4.5: Potassium Phosphate
15 mM IVPB over 4 hours may be substituted.
• PO4 < 1.5 and K+ < 4.2: Potassium Phosphate 30
mM IVPB over 6 hours may be substituted.
12/13
(ASAP
approval
from
P&T
Chairs)
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 15 of 22 2/7/2019
• If KCl run is ordered concurrently, omit 20 mEq
KCl IV/po for every 15 mM of KPhos.
Check to see how much KCl has already been
administered.
• If K+ parameters are outside limits, call MD for
alternative instructions.
• Write order to clarify and coordinate changes
between nursing and pharmacy. Solu-Medrol IV ≤ 60 mg /day Predinsone 60 mg po q day 01/06/1
5
Sonata (zaleplon) Ambien (zolpidem)
Surfak Colace
Synalar 0.01% crm or soln Tridesilon or Desowen 0.05%
Synalar 0.025% oint Kenalog 0.025% oint,crm,lotion
Tablets Orally disintegrating tablets if same strength is available
Tagamet 200mg-400mg bid, tid or qid Pepcid 20 mg bid
Tagamet 800 mg Pepcid 40 mg qhs
Tagamet IV any dose any interval Pepcid IV 20 mg q12h
Terazol 7 Miconozole (monistat) 7
Terbutaline (Brethine) Only allowed in GWP, call MD & suggest albuterol
Tetevan (eprosartan) 200mg, 200-400mg,
600mg, 800mg
Cozaar (losartan) 25 mg , 25mg, 50 mg, 100 mg 11/1/10
Theophylline ORAL (any brand) Uniphyl (theophylline), same mg to mg, q day. Max dose is 600
mg
Comes as 400 mg and 600 mg (can be halved, but not crushed)
3/2017
Theophylline elixir Use only if clinically necessary (i.e. tube) or if you can’t get
dose close enough with tabs (rare…..renal patient on low dose)
Theophylline extended release (during
shortage situations), 600 mg max daily dose
Theophylline elixir, same total daily dose, but divided q 8 hrs.
Max daily dose is 600 mg
3/2/16
Theophylline** IV drip in any soln other than
D5W
D5W for diluent (even diabetic pt)
**exception for Drs Weinberg, McGann, Sineway and Kaplan
Theravac Plus mini-enemas Enimeez mini-enemas (this has no benzocaine) Must be unit
dosed.
Thiamine IV 100 mg daily (during shortage
situations)
Thiamine IV 500 mg IV q8h x 3 days, then
100 mg po daily (during shortage situations)
Thiamine 100 mg po daily
Thiamine 200 mg po BID x 3 days, then 100 mg po daily for
“Alcohol Withdrawal Orders”.
2/2018
Throat sprays and lozenges Cepacol spray and lozenges
Tiazac Cardizem CD
Titralac Tums
Tobi (tobramycin) for inhalation (nebulizer) Use Tobramycin vials, same dose
Topicort 0.05% gel Lidex 0.05% oint
Topicort 0.25% cr or oint Lidex 0.05% crm, oint
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 16 of 22 2/7/2019
Topicort LP 0.05% crm Lidex 0.05% crm
Toradol 5 day stop and must follow guidelines
Toradol 30 mg (>65yo, crcl<50,wt<50kg) Toradol 15 mg (max 60mg/day)
Toradol 60 mg IM (followed by IM doses) Toradol 30 mg (followed by IM doses)
Toviaz Detrol LA, not to exceed 2mg in patients taking strong CYP3A4
inhibitors or if CrCl < 30.
12/11/1
2
Trace element package in TPN during
shortage Addamel N (European product, approved by FDA) 10/2013
Tracleer (bosentan)
Patient to use their own home med if possible. No new starts
allowed.
Transderm Nitro patch Nitro-Dur patch
Travatan 0.004% (travoprost + benzalkonium)
Or
Travatan Z 0.004% (travoprost)
Xalatan (latanoprost) 8/6/13
Tricor 54 mg, 160 mg See Fenofibrate 9/4/12
Tridesilon 0.05% oint Kenalog 0.025% oint,crm,lotion
Triglide 50 mg, 160 mg See Fenofibrate 9/4/12
Trilipix 45mg, 135 mg See Fenofibrate 9/4/12
Tube feedings See chart at end of this document
Tussinex (hydrocodone & phenytoloxamine) Hycodan (hydrocodone & homatropine) 9-3-13
Tussi-organidin DM Robitussin DM (generic interchange)
Tuss-Organidin Robitussin AC (generic interchange)
Tylox Percocet
Ultracet Ultram 50mg plus Acetaminophen 325mg
Ultravate 0.05% cr or oint Temovate 0.05% cr or oint
Unasyn (ampicillin/sulbactam) IV shortage
During the shortage, call physician. No TI
Only during a shortage of Unasyn, call MD and recommend:
- Gynecological, use Mefoxin or Rocephin + Flagyl
- Intra-abdominal, use Mefoxin or Rocephin + Flagyl (or
Invanz alone if Cephalosporin allergy)
- Skin and Soft Tissue, use Ancef (or Invanz alone if
Cephalosporin allergy)
- Head and Neck, use Cleocin
09/2015
Univasc 15 mg and 22.5 mg Altace 5 mg
Univasc 3.75 mg, 7.5 mg, 30 mg, 60mg Altace 1.25 mg, 2.5 mg, 10 mg, 20mg (max)
Urised, 2 tabs (atropine, methenamine,
hyoscyamine, methylene blue, benzoic acid)
Uribel (methenamine, phosphate , hyoscyamine, methylene
blue)
Uroxatrol (alfuzosin) 10 mg po q day Flomax (tamsulosin) 0.4 mg po q day 12015
Urso 250mg Actigall 300mg
Utira-C Uribel (methenamine, phosphate , hyoscyamine, methylene
blue)
Valsartan (Diovan)- shortage
Diovan 40 mg
Diovan 80 mg
Diovan 160 mg
Diovan 320 mg
To Cozaar (Losartan)
Cozaar 25 mg
Cozaar 25 mg
Cozaar 50 mg
Cozaar 100 mg
7/2018
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 17 of 22 2/7/2019
Valisone 0.1% crm or lotion Kenalog 0.025% oint,crm,lotion
Valisone 0.1% oint Diprosone 0.05% oint
Vancomycin post op orders “x 2 doses” Vancomycin post op doses “x 1 dose” 02/11
Vancomycin 250 mg po Vancomycin 125 mg po q 6 hrs
Vancomycin 500 mg po NEW STARTS are restricted to Critical
Care areas, but can continue upon transfer. Consider de-
escalation after 3 days.
7/3/18
Vasolex ointment (DC by manufacturer) Venelex (trypsin free) ointment 9/2015
Vasotec Lisinopril – same dose
Vasotec IV Formulary- dispense
Venofer 100mg Ferrlicet 125 mg in 100ml NS over 1 hr 10/09
Venofer 200mg Ferrlicet 250mg in 150-200 ml NS over 2 hrs 10/09
Veramyst (fluticasone) Flonase (fluticasone) 2 sprays in each nostril daily 5/1/12
Verelan
120 mg po qAM
180 mg po qAM
240 mg po qAM
360 mg po qAM
480 mg po qAM
Verapamil ER capsules 120 mg po qAM
Verapamil ER capsules 180 mg po qAM
Verapamil ER capsules 240 mg po qAM
Verapamil ER capsules 360 mg (2 x 180 mg) po qAM
Verapamil ER capsules 480 mg (2 x 240 mg) po qAM
8/14
Verelan PM
100 mg po qHS
200 mg po qHS
300 mg po qHS
400 mg po qHS
Verapamil ER capsules 120 mg po qAM
Verapamil ER capsules 180 mg po qAM
Verapamil ER capsules 300 mg (1 x 120 + 1 x 180 mg) po qAM
Verapamil ER capsules 360 mg (2 x 180 mg) po qAM
8/14
Vigamox eye drops 3% Ciprofloxacin eye drops 3%
Vitamins See chart at end of this document
Vitamin K route: IM or Sub Q
(EXCEPTION: Neonates may receive IM)
If ordered IM and patient is npo, give SQ.
If ordered IM and patient can take orals, give po
10/12
Voltaren 25mg-50mg q6-8h Naprosyn 500 mg bid
Voltaren XR 75 mg bid Naprosyn 500 mg bid
Vytorin (combo, use individual agents) Zetia plus simvastatin 9/4/12
Wellbutrin SR Wellbutrin XL (same total dose, administered q day)
(maximum of 400mg/day)
Westcort 0.2% crm or lotion Kenalog 0.025% oint,crm,lotion
Xanax XR –Daily (same total daily dose) Xanax tid (same total daily dose)
Xifaxan (rifaximin) 400 mg tid Xifaxan 550 mg bid 5/10/11
Xopenex q 2hrs, q 4 hrs Q 6 hrs
Xyzal (levocetirizine) 5 mg daily Allergra 180 mg daily. 9/8/09
Zantac IV 150mg/day (ie 50mg q8h or LV) Pepcid IV 20 mg q12h
Zantac PO 75mg any interval Pepcid 10mg bid
Zantac PO 150, 300 mg Pepcid 20 mg bid, 40 mh q hs
Zinacef (750mg-1.5mg q 8hr) Rocephin 1gm q 24hr
Zofran po Using ODT exlusively 12/09
Zomig 2.5 mg, 5 mg Imitrex 50 mg, 100 mg
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 18 of 22 2/7/2019
Zosyn any dose for CrCl > 20 Zosyn 3.375 gm q 8 hr over 4 hrs if CrCl is > 20
Zyban Wellbutrin SR
Zyrtec 5 or 10 mg daily Claritin 10 mg
Zytrec D Claritin D
Verapamil products: do not stock SR tablets Calan Verapamil IR same dose and schedule 8/14
Isoptin Verapamil IR same dose and schedule 8/14
Calan SR
120 mg po daily
180 mg po daily
240 mg po daily
360 mg po daily
120 mg po BID
180 mg po BID
240 mg po BID
(same total daily dose given qAM)
Verapamil ER capsules 120 mg po qAM
Verapamil ER capsules 180 mg po qAM
Verapamil ER capsules 240 mg po qAM
Verapamil ER capsules 360 mg (2 x 180 mg) po qAM
Verapamil ER capsules 240 mg po qAM
Verapamil ER capsules 360 mg (2 x 180 mg) po qAM
Verapamil ER capsules 480 mg (2 x 240 mg) po qAM
8/14
Isoptin SR
120 mg po daily
180 mg po daily
240 mg po daily
360 mg po daily
120 mg po BID
180 mg po BID
240 mg po BID
(same total daily dose given qAM)
Verapamil ER capsules 120 mg po qAM
Verapamil ER capsules 180 mg po qAM
Verapamil ER capsules 240 mg po qAM
Verapamil ER capsules 360 mg (2 x180 mg) po qAM
Verapamil ER capsules 240 mg po qAM
Verapamil ER capsules 360 mg (2 x 180 mg) po qAM
Verapamil ER capsules 480 mg (2 x 240 mg) po qAM
8/14
Covera-HS
180 mg po qHS
240 mg po qHS
360 mg po qHS
480 mg po qHS
Verapamil ER capsules 180 mg po qAM
Verapamil ER capsules 240 mg po qAM
Verapamil ER capsules 360 mg (2 x 180 mg) po qAM
Verapamil ER capsules 480 mg (2 x 240 mg) po qAM
8/14
Verelan
120 mg po qAM
180 mg po qAM
240 mg po qAM
360 mg po qAM
480 mg po qAM
Verapamil ER capsules 120 mg po qAM
Verapamil ER capsules 180 mg po qAM
Verapamil ER capsules 240 mg po qAM
Verapamil ER capsules 360 mg (2 x 180 mg) po qAM
Verapamil ER capsules 480 mg (2 x 240 mg) po qAM
8/14
Verelan PM
100 mg po qHS
200 mg po qHS
300 mg po qHS
Verapamil ER capsules 120 mg po qAM
Verapamil ER capsules 180 mg po qAM
Verapamil ER capsules 300 mg (1 x 120 + 1 x 180 mg) po qAM
8/14
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 19 of 22 2/7/2019
400 mg po qHS Verapamil ER capsules 360 mg (2 x 180 mg) po qAM
If “Per tube”
ER 480 mg = immediate release 120 mg (1 x 80 mg + 1 x 40 mg tab) QID
ER 360 mg = immediate release 120 mg (1 x 80 mg + 1 x 40 mg tab) TID
ER 240 mg = immediate release 80 mg tab TID
ER 180 mg = immediate release 60 mg (1 and ½ X 40 mg tab) TID
ER 120 mg = immediate release 40 mg tab TID
8/14
Enteral and Tube feeding TI Chart
Nonformulary Formulary
Boost Ensure Complete
Ensure Plus Ensure Complete
Ensure Ensure Complete
Ensure Pudding Ensure Pudding
Fibersource Jevity 1.2
Glytrol oral Glucerna Shakes
Glucerna oral Glucerna Shakes
Glytrol Glucerna 1.2
HepaticAid oral Osmolite 1.5
Hepatic Aid TF Osmolite 1.5
Impact Glutamine Vital High Protein
Impact Vital High Protein
Isosource 1.0 Osmolite 1.5
Isosource 1.2 Osmolite 1.5
Jevity oral Ensure Complete
Nutren 1.0 TF Osmolite 1.5
Nutren 1.0 oral Ensure Complete
Nutren 2.0 TwoCal HN
Nutren Jr. oral Pediasure
Nutren Jr. TF Pediasure
Nutren Pulmonary TF Osmolite 1.5
Nutren Pulmonary Oral Osmolite 1.5
Nutren Renal Nepro
Nutrihep oral Osmolite 1.5
Nutrivent Osmolite 1.5
Osmolite 1.0 Osmolite 1.5
Optimental Vital AF 1.2
Oxepa Pivot
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 20 of 22 2/7/2019
Peptamen Vital AF 1.2
Promod Beneprotein
Pulmocare oral Ensure Complete
Pulmocare TF Osmolite 1.5
Replete oral Ensure Complete
Suplena Nepro
TwoCal HN oral TwoCal HN cans
Vital HN oral Vital AF 1.2 cans
Vivonex Vital AF 1.2
Inhalation Medication TI (see policy 7300-VII-60) The exceptions to this policy include:
• Patients who receive inhalers at home and are admitted for non-respiratory issues.
Pharmacy will implement the initial interchange on all, however Respiratory
Care will evaluate for “non-respiratory issues and order MDI if needed.
• Locations: NICU, GWP, ED and CEC, Glancy Rehab, GECC
Ordered
Metered Dose Inhaler (MDI): Note: HFA = hydrofluoroalkane,
propellant in the inhaler
Pharmacy Will Dispense
Nebulized Medications: All nebulizer meds will be administered as unit dose
or diluted with saline with other medication to a
total volume of at least 2.5 ml
Albuterol
(Proventil, Ventolin, Proair) HFA
Albuterol 2.5 mg at the same scheduled frequency
PLUS
Albuterol 2.5 mg q 4 hrs PRN for SOB and wheezing.
Albuterol/ Ipratropium
(Combivent or Respimat)
Albuterol 2.5 mg & Ipratropruim 0 .5 mg at the same
scheduled frequency
PLUS
Albuterol 2.5 mg q 4 hrs PRN for SOB and wheezing .
Dulera (formoterol and mometasone)
100 mcg/5 mcg or 200 mcg/5 mcg
Pulmicort (budesonide )
0.25 mg or 0.5 mg BID
PLUS
Brovana (aformoterol) 15 mcg BID This should never
be PRN.
Budesonide & Formoterol HFA
(Symbicort 80/4.5)
Pulmicort (budesonide ) 0.25 mg BID
PLUS
Brovana (aformoterol) 15 mcg BID
This should never be PRN.
Budesonide & Formoterol HFA
(Symbicort 160/4.5)
Pulmicort (budesonide ) 0 .5 mg BID
PLUS
Brovana (aformoterol) 15 mcg BID
This should never be PRN.
Fluticasone and Salmeterol HFA Pulmicort (budesonide ) 0.25 mg BID
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 21 of 22 2/7/2019
(Advair 45/21)
PLUS
Brovana (aformoterol) 15 mcg BID
This should never be PRN.
Fluticasone and Salmeterol HFA
(Advair 115/21)
Pulmicort (budesonide ) 0.5 mg BID
PLUS
Brovana (aformoterol) 15 mcg BID
This should never be PRN.
Fluticasone and Salmeterol HFA
(Advair 230/21)
Pulmicort (budesonide ) 0 .5 mg BID
PLUS
Brovana (aformoterol) 15 mcg BID
This should never be PRN.
Fluticasone HFA
(Flovent 110 or 44 mcg)
Pulmocort (budesonide) 0.25 mg BID
Fluticasone HFA
(Flovent 220 mcg)
Pulmicort (budesonide) 0.5 mg BID
Ipratropium HFA (Atrovent)
Ipratropium 0.5 mg at the same frequency
Levalbuterol HFA (Xopenex) Xopenex 1.25 mg at the same frequency
PLUS
Xopenex 1.25 mg q 6 hrs PRN for SOB and wheezing.
Tiotropium (Spiriva)
Atrovent 0.5 mg qid
Other Interchanges:
Ordered:
Dispensed:
Mucomyst (acetylcysteine)
and
Neut (4% sodium bicarbonate )
or
Pulmozyme (dornase)
- DC Mucomyst, continue Neut or Pulmozyme
- Do not mix Pulmozyme with other nebulized medications.
Also administer separately in the nebulizer.
VITAMIN and IRON chart
Vitamins/Iron Product NON-FORMULARY
Examples of non-form products MD might order
(use TI to left of product)
T.I.
(Therapeutic Interchange)
VITAMINS
Multi Centrum, Ocuvite, Ocuvite with lutein any
standard Multivitamin
Thera-Tab
Geriatric or Minerals Centrum silver, Optivite, any multivitamin with
minerals
Thera-M
B-12 and/or intrinsic factor
Folic Acid and/or IRON
Chromagen** Hemocyte F, Chromagen FA**, Folbic, Folbee, Foltx,
Hemocyte Plus, Hemocyte F, Proferrin Forte, Ferocon,
Niferex 150 Forte
Ferrex Forte 150
Therapeutic Interchange List
Alphabetical Listing
Revised 02-2019 See related Restricted Medications, 7300-VII-10, Attachment B
Page 22 of 22 2/7/2019
PRENATAL-Calcium and
IRON
Stuartnatal 1+1, any prenatal vitamin Prenatal Plus
RENAL Nephrocap, Metanx, Dialyvite, Diatx, Nephplex Nephro-vite
B complex w/ C vitamin
(stress/substance abuse)
Vicon C (discontinued), Allbee C Folbee CZ
Iron products
(no vitamin component)
Also see Vitamin with iron products above
Proferrin ES
Ferrous Sulfate 325 mg
(65 mg elemental iron) OR
Ferrous Gluconate (27 mg
elemental iron)
* Chewable form available for plain and prenatal MVI
** Trinsicon, Chromagen and Chromagen FA are no longer made by the manufacturer
Artificial Tears Generic Equivalent Brands GMC Stocks: Carboxymethylcellulose
1%
TheraTears Gel
Refresh Liquigel
Lubricant Eye Gel (does not indicate Pres Free)
Hypromellose eye drop
Nature Tears
Mineral Oil
White Petrolatum
AWKA Tears Opth Oint
LubriFresh P.M. Oint
(if ointment not available, TI to 1-2 drops in each eye)
Artificial Tears Oint
or
Refresh P.M. Oint
Lubricant eye oint, Preservative Free
Polyvinyl Alcohol 1.4% Liquifilm Tears Drops Artificial Tears Soln
Lubricant Eye Drops, (contains Preservative)