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JERSEY SHORE HOSPITAL
APPROVED LIST OF THERAPEUTIC SUBSTITUTIONS
Non Formulary Drug Ordered
Approved Formulary
Therapeutic Equivalent
Comments/Medical Staff Approval
Angiotensin Converting
Enzyme (ACE) Inhibitors
Doses of Lisinopril higher than 40 mg
should be divided to BID
Fosinopril (Monopril) 10 mg
Moexipril (Univasc) 7.5 mg
Trandolapril (Mavik) 1 mg
Benazepril ( Lotensin ) 10 mg
Lisinopril (Prinivil, Zestril)
10 mg QD
(There is a 1:1 ratio between the
substituted agent and Lisinopril)
Fosinopril (Monopril) 20 mg
Moexipril (Univasc) 15mg
Trandolapril (Mavik) 2 mg
Benazepril ( Lotensin ) 20 mg
Lisinopril (Prinivil, Zestril)
20mg QD
Antacids
Riopan
Riopan Plus
Maalox
Maalox Plus
Antibiotics
Cefzil (Bid or Q12)
Mylanta
Mylanta Plus
Mylanta
Mylanta Plus
Ceftin (Q12)
(Same dose)
Macrobid (Bid or Q12h)
Macrodantin (Q.I.D.)
(Same Dose/24h)
Cefpodoxime (Vantin) Oral 200
mg BID (Adults)
Cefuroxime Oral (Ceftin)
500 mg BID
Calcium Channel Blockers
Adalat CC (Nifedipine)
Procardia XL (Nifedipine)
(Same dose, same frequency)
Tiazac (Diltiazem)
Dilacor XR (Diltiazem)
Cardiazem CD (Diltiazem)
Cardiazem CD (Diltiazem)
(Same dose, same frequency)
Cardizem LA (Diltiazem)
Cardizem CD
(Same dose, same frequency)
Also on Formulary:
Captopril (Capoten)
Enalapril (Vasotec)
Quinapril (Accupril)
Ramipril (Altace)
Amphogel is also available
Non Formulary Drug Ordered
Diuretics
Lasix 20 mg IV
Lasix 40 mg IV
Lasix 80 mg IV
Grains/mg conversions
1/4 gr.
1/2 gr.
1 gr.
5 gr.
H-2 Antagonist
Cimetidine (Tagamet)
300 mg Q 6 hr, 8hr, 12hr
400 mg Q 12 hr
800 mg QHS
400 mg QHS
Approved Formulary
Therapeutic Equivalent
Comments/Medical Staff Approval
Bumex 0.5 mg IV
Bumex 1.0 mg IV
Bumex 2.0 mg IV
Bumex is substituted for Lasix in a 1:40
ratio
15 mg or 16.2 mg
30 mg or 32.4 mg
60 mg or 65 mg
300 mg or 325 mg
Originally, a grain was defined as the weight of a
grain seed from the middle of an ear of barley.
Today the inconsistencies are due to two different
weight systems, the older apothecary/troy versus
the more modern avoirdupois
Ranitidine (Zantac)
Zantac 150mg BID
Zantac 150mg BID
Zantac 300mg Q HS
Zantac 150mg QD
Ranitidine (Zantac) is the only H-2
antagonist we have in an IV Formulation
Famotidine (Pepcid)
20 mg Q 12 hr
40 mg QHS
20 mg QHS
Zantac 150mg BID
Zantac 300mg Q HS
Zantac 150mg Q HS
Nizatidine (Axid)
150 mg Q 8 hr, 12 hr
300 mg Q HS
150 mg Q HS
Zantac 150mg BID
Zantac 300mg Q HS
Zantac 150 mg Q HS
Intravenous to Oral
Substitution List
Cipro 200mg IV B.I.D.
Cipro 400mg IV B.I.D.
Cipro 400mg IV Q8h
Cipro 250mg tablets B.I.D.
Cipro 500mg tablets B.I.D
Cipro 750mg tablets B.I.D.
Zithromax 500mg IV Q.D.
Zithromax 500mg tablet Q.D.
Zantac 50 IV q 8h
Zantac 150mg tablets B.I.D.
Laxatives
Doxidan
Pericolace
Senokot
Pericolace
Senokot S
Pericolace
This will only be instituted after 48 hours
of IV therapy and only if the patient is
receiving other oral medications
These changes can also be made from
Pericolace to Senokot S
Non Formulary Drug Ordered
Approved Formulary
Therapeutic Equivalent
Comments/Medical Staff Approval
Fluvastatin (Lescol)
20 mg QD
Simvastatin (Zocor)
10 mg QD
Atorvastatin (Lipitor)
also on formulary
Lovastatin (Mevacor)
20 mg QD
Simvastatin (Zocor)
10 mg QD
Fluvastatin (Lescol) XL can be
substituted the same as immediate
release Fluvastatin (Lescol)
Pravastatin (Pravachol)
20 mg QD
Simvastatin (Zocor)
10 mg QD
Lipid Lowering Agents
NSAID Substitution List
Celebrex 100mg/day
Celebrex 200mg/day
Celebrex 400mg/day
Vioxx 12.5mg tablets Q.D.
Vioxx 25mg tablets Q.D.
Vioxx 50mg tablets Q.D.
Pain Medications
Tylox 5mg/500 mg
Percocet 5mg/325 mg
Loratab 2.5/500
½ of Lortab 5/500
Vicodin 5/500
Lortab 5/500
Lorcet Plus 7.5/650
Vicodin ES 7.5/750
Lortab 7.5/500
Lortab 7.5/500
Lorcet 10/650
Vicodin HP 10/660
Lortab10/500
Lortab 10/500
These agents are a combination of
Oxycodone and Acetaminophen
These agents are a combination of
Hydrocodone and Acetaminophen
Potassium
Potassium (delayed release
form, ex: Kdur)
Potassium (immediate release
form, ex: liquid)
Potassium Aliquot
10meq/100ml
In D5w or Nss
Potassium Aliquot
10meq/50ml
In Sterile Water
(Premix)*
The potassium will be substituted on a
mEq/mEq basis of the liquid for the
tablet dose
Non Formulary Drug Ordered
Approved Formulary
Therapeutic Equivalent
Proton Pump Inhibitors
Aciphex 20mg QD
Protonix 40mg QD
Nexium 20mg QD
Nexium 40mg QD
Protonix 40mg QD
Protonix 40mg QD
Prevacid 15mg QD
Prevacid 30mg QD
Protonix 40mg QD
Protonix 40mg QD
Prilosec 10mg QD
Prilosec 20mg QD
Prilosec 40mg QD
Protonix 40mg QD
Protonix 40mg QD
Protonix 40mg QD
Vitamins/Minerals
Stress 600 + Zinc
Stress Vitamin
Stress 600
Stress 600
Centrum
Therapeutic
Multivitamins/Minerals
Caltrate 600 + D
Caltrate 600
Os-Cal 500 +D
Os-Cal 500
Iron (all forms and Strengths)
Ferrous Sulfate 325mg
Misc.
Ambien CR 6.25 mg
Ambien CR 12.5 mg
Ambien 5 mg
Ambien 10 mg
Sonata 5mg
Sonata 10mg
Ambien 5 mg
Ambien 10 mg
Fosamax with D
Fosamax
Comments/Medical Staff Approval
Same dosing frequency
Generic Substitution involves interchanges among nonproprietary (generic) and proprietary (brand name) drugs
having the same chemical composition. This has been approved the Medical Staff and is done routinely by
pharmacy service.
Therapeutic Substitution is the selection of a chemically different drug that is considered to be a therapeutic
alternative with a comparable therapeutic effect. All therapeutic substitutions require Medical Staff approval.
All Therapeutic Substitutions will be treated as a verbal order. The initiator of the action will write the
order change and the physician will countersign it within 24 hours.
The Physician has the option to write “do not substitute” if he/she doesn’t feel the therapeutic
substitution is appropriate.
8/7/2006