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Therapeutic interchange

TJUH Therapeutic Interchange

To Jump to the page of the Therapeutic Interchange press ‘CTRL’ and click on the heading in the table of
contents, or the name in “Index by Class” or “Index by Drug” lists

Contents

Index by Class
TJUH Therapeutic Interchange
Index by Drug
TJUH Therapeutic Interchange
TJUH Therapeutic Interchange
Antihistamine Agents

Non-Sedating Antihistamine Therapeutic Interchange

Desloratidine (Clarinex®) oral 5 mg daily Fexofenadine (Allegra®) oral 60 mg BID or 180mg daily Levocetirizine (Xyzal®) oral 2.5 mg to 5 mg daily
Cardiovascular Agents
Angiotensin Receptor Antagonist Therapeutic Interchange
Patients will receive valsartan (Diovan®) as ordered. All ARBS EXCEPT CANDESARTAN AND LOSARTAN will be
converted to valsartan (Diovan®)

Beta Adrenergic Blocking Agents Therapeutic Interchange
Carvedilol controlled release(Coreg® CR) oral Carvedilol immediate release(Coreg®) oral 10 mg daily * When switching from carvedilol 12.5 mg or 25 mg twice daily, a starting dose of COREG CR 20 mg or 40 mg once daily, respectively, may be warranted for elderly patients or those at increased risk of hypotension, dizziness, or syncope. Subsequent titration to higher doses should, as appropriate, be made after an interval of at least 2 weeks. TJUH Therapeutic Interchange
Fibrate Derivatives Therapeutic Interchange
Fenofibrate, micronized capsules (Antara®) Fenofibrate micronized capsules (Lofibra®)
HMG-CoA Reductase Inhibitor Therapeutic Interchange
Formulary Preferred: atorvastatin (Lipitor®). Patients receiving atorvastatin as an outpatient will be continued on
that agent.
Formulary Reserved: rosuvastatin (Crestor®) and pravastatin (Pravachol®). Patients receiving either
rosuvastatin or pravastatin as an outpatient will be continued on that agent. Inpatients will not be initiated on the
reserved agents, UNLESS they are required due to drug-drug interactions or previous intolerances to other HMG-
CoA reductase inhibitors. This should be confirmed with the prescribing physician.
Non-formulary: simvastatin, pitavastatin, fluvastatin, lovastatin. Due to drug interactions and risk of myalgias,
simvastatin was removed from formulary, per the recommendation of the Cardiology and Thrombosis
Subcommittee.
Non-formulary statin
Formulary statin
at same frequency
TJUH Therapeutic Interchange
Please incorporate the preferred versus reserved statins into your practice. As with all therapeutic interchanges, please ensure patients are therapeutically interchanged back to their home statin and dose at discharge, if necessary. Source: Vytorin*
%↓ LDL-C

Central Nervous System Agents

Benzodiazepine Therapeutic Interchange
Lorazepam (Ativan®) at same frequency Selective Serotonin Reuptake Inhibitor Therapeutic Interchange
Paroxetine controlled release (Paxil CR®) oral Paroxetine (Paxil®) at same frequency
Endocrine/Hormones and Synthetic Agents

Insulin Therapeutic Interchange

Sulfonylurea Agents Therapeutic Interchange
NOTE: Once the daily dose has reached GLYburide 10 mg/day or GLIPizide 20 mg/day the dose is usually split into two
divided doses
Glyburide (Glynase® PresTab®) micronized
TJUH Therapeutic Interchange
Inhaled Corticosteroid Therapeutic Interchange
The preferred inhaled corticosteroid on the TJUH formulary is mometasone (Asmanex®). Orders for other inhaled corticosteroid will be dispensed as an equivalent dose of mometasone unless the patient is ventilated. Patients with a tracheostomy and/or ventilated will use beclomethasone HFA. The equivalent dose for beclomethasone and mometasone can be derived from the following table. Ventilated
Mometasone
(Asmanex®)
TJUH Therapeutic Interchange


Nasal Corticosteroid Therapeutic Interchange
Budesonide (Rhinocort®) nasal 1 to 4 sprays in each nostril daily Ciclesonide (Omnaris®) nasal 2 sprays in each nostril daily Flunisolide (Nasarel®) nasal 2 sprays in each nostril BID or TID Fluticasone furoate (Veramyst®) nasal 2 sprays in each nostril daily Mometasone (Nasonex®) nasal 2 sprays in each nostril daily Triamcinolone (Nasacort AQ®) nasal 1 to 2 sprays in each nostril daily

Inhaled Beta-2 Agonist Therapeutic Interchange

Nebulized Adminsitration
Levalbuterol (Xopenex)
Albuterol (Proventil, Ventolin)
2.5 mg / 3 mL at the same frequency levalbuterol was ordered 2.5 mg / 3 mL at the same frequency levalbuterol was ordered MDI Administration
Levalbuterol (Xopenex)
Albuterol (Proventil, Ventolin)
90 mcg / actuation (puff) at the same frequency levalbuterol was ordered

Nebulized Medication Therapeutic Interchange

Ventilated Patients
Aerogen Aerogen System Neb Treatment
DuoNeb* 2.5 – 0.5 mg / 3 mL at the same frequency as Combivent and not more often than Q 4 hours Albuterol 2.5 mg / 0.5 mL at same frequency Ipratropium 0.5 mg / 2.5 mL at the same frequency and not more often than Q 4 hours. All Patients
Albuterol 2.5 mg / 3 mL neb with Ipratropium DuoNeb 2.5 – 0.5 mg / 3 mL at the same frequency as albuterol Albuterol MDI PRN order
Albuterol nebulization PRN (at same frequency of MDI order)+
Ipratropium MDI PRN order
Ipratropium nebulization PRN (at same frequency of MDI order)+
Combivent MDI PRN order
DuoNeb nebulization PRN (at same frequency of MDI order)+
Beclomethasone MDI (80mcg) 4 puffs Q 12 hours *DuoNeb contains 2.5 mg albuterol with ipratropium 0.5 mg in 3 mL +Exception: patients may receive MDI PRN if they also have a standing (around-the-clock) order
for the same MDI.
TJUH Therapeutic Interchange
Gastrointestinal Agents

Antiemetic Therapeutic Interchange
** Bodine Infusion Center ONLY **
Ondansetron (Zofran®) 8 mg IV/PO 16 mg IV/PO 24 mg IV/PO 32 mg IV/PO
H-2 Antagonist Therapeutic Interchange

Proton Pump Inhibitor Therapeutic Interchange
TJUH Therapeutic Interchange
Ophthalmic Agents (adopted from Wills Eye Hospital)

Prostaglandin Agonist Ophthalmics Therapeutic Interchange
Bimatoprost (Lumigan®) ophthalmic 0.03% Travoprost (Travatan®) ophthalmic 0.004% 1 drop affected eye(s) QHS
Antibiotic Ophthalmics Therapeutic Interchange
Ofloxacin (Floxin®) ophthalmic 0.3% 1 drop affected eye(s) Ciprofloxacin ophthalmic solution and ointment will not be interchanged when prescribed for treatment of Pseudomonas sp. Infections.
Systemic Corticosteroid Therapeutic Interchange
** Wills Eye Hospital ONLY ** for giant cell arteritis
Methylprednisolone (Solu Medrol®) injection

Source: http://www.jeffersonhospital.org/files/nursing-orientation/advanced-practice-files/therapeutic-interchanges.pdf