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JERSEY SHORE HOSPITAL
APPROVED LIST OF THERAPEUTIC SUBSTITUTIONS
Non Formulary Drug
Ordered
Approved Formulary
Therapeutic Equivalent
Comments/Medical Staff Approval
Doses of Lisinopril higher than 40 mg
should be divided to BID
Angiotensin Converting
Enzyme (ACE) Inhibitors
Fosinopril (Monopril) 10 mg
Moexipril (Univasc) 7.5 mg
Trandolapril (Mavik) 1 mg
Benazepril ( Lotensin ) 10 mg
Lisinopril (Prinivil, Zestril)
10 mg QD
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
Mylanta Plus
Antibiotics
Avelox 400mg IV (Q24)
Levaquin 750mg IV (Q24)
Cefzil (Bid or Q12)
Ceftin (Q12)
Macrobid (Bid or Q12h)
Macrodantin (Q.I.D.)
(Same Dose/24h)
Cefpodoxime (Vantin) Oral
200 mg BID (Adults)
Cefuroxime Oral (Ceftin)
500 mg BID
Inhalation therapy
Advair HFA 45/21
Dosed as 2 puffs BID
Advair 100/50
Dosed as 1 puff BID
Advair HFA 115/21
Dosed as 2 puffs BID
Advair 250/50
Dosed as 1 puff BID
Advair HFA 230/21
Dosed as 2 puffs BID
Advair 500/50
Dosed as 1 puff BID
Xopenex 1.25 mg SVN
Albuterol 2.5mg SVN
Also on Formulary:
Captopril (Capoten)
Enalapril (Vasotec)
Quinapril (Accupril)
Ramipril (Altace)
Renal dosing adjustment required
Non Formulary Drug
Ordered
Calcium Channel Blockers
Adalat CC (Nifedipine)
Approved Formulary
Therapeutic Equivalent
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)
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
Comments/Medical Staff Approval
Bumex 0.5 mg IV
Bumex 1.0 mg IV
Bumex 2.0 mg IV
15 mg or 16.2 mg
30 mg or 32.4 mg
60 mg or 65 mg
300 mg or 325 mg
*Both agents are formulary
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
Non Formulary Drug
Ordered
Approved Formulary
Therapeutic Equivalent
Comments/Medical Staff Approval
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.
This will only be instituted after 48
hours of IV therapy and only if the
patient is receiving other oral
medications
Zithromax 500mg IV Q.D.
Zithromax 500mg tablet Q.D.
Zantac 50 IV q 8h
Zantac 150mg tablets B.I.D.
Intravenous to Oral
Substitution List
Insulins
Rapid/Short acting
Apidra
Novolog
Humalog
Novolin R
Humulin R
Intermediate acting
Novolin N
Humulin N
Long Acting ( Basal)
Lantus
Premixes
Humulin 70/30
Novolin 70/30
Novolog 70/30
Humalog 75/25
Novolog
Same dosage
Humulin N
Same dosage
Lantus
Same dosage
Humulin 70/30
Same dosage
Laxatives
Doxidan
Senna -S
Peri Colace
Senna- 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
Vioxx 12.5mg tablets Q.D.
Vioxx 25mg tablets Q.D.
Vioxx 50mg tablets Q.D.
Celebrex 100mg/day
Celebrex 200mg/day
Celebrex 400mg/day
Pain Medications
Tylox 5mg/500 mg
Percocet 5mg/325 mg
These agents are a combination of
Oxycodone and Acetaminophen
Oxy IR 5mg
Percocet 5mg/325 mg
Oxy IR is only Oxycodone in an
immediate release form. Patient must
not be allergic to Acetaminophen
Lortab 2.5/500
½ of Lortab 5/325
Vicodin 5/500
Lortab 5/325
Lorcet Plus 7.5/650
Vicodin ES 7.5/750
Lortab 7.5/325
Lortab 7.5/325
Lorcet 10/650
Vicodin HP 10/660
Lortab10/325
Lortab 10/325
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/100ml
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
Topical Steroids/
Low Potency
Aclometasone diproprionate
(Aclovate ) 0.05% cr/oint
Desonide
(DesOwen) 0.05% cr
Flucinolone acetonide
(Synalar) 0.01% cr/soln
Hydrocortisone (Hytone ,
Cortaid other): 0.25%, 0.5%,
1%, 2.5%
Hydrocortisone 1% Cream
Comments/Medical Staff Approval
Non Formulary Drug
Ordered
Approved Formulary
Therapeutic Equivalent
Topical Steroids/
Medium Potency
Betamethasone dipropionate
(Diprosone) Lotion 0.05%.
Clocortolone pivalate
(Cloderm) 0.1% cr
Desoximetasone
(Topicort) 0.05% cr
Fluocinolone acetonide
(Synalar) 0.025% cr
Fluticasone propionate
(Cutivate) 0.05% cr, 0.005%
oint
Hydrocortisone valerate
(Westcort) 0.2% cr/oint
Mometasone furoate
(Elocon) 0.1% cr/oint/lotion
Triamcinolone (Aristocort,
Kenalog) 0.025%, 0.1%,
0.5% cr,oint, aerosol
Betamethasone Valerate
(Valisone) 0.1% cr
Comments/Medical Staff Approval
Non Formulary Drug
Ordered
Approved Formulary
Therapeutic Equivalent
Topical Steroids/
High Potency
Amcinonide (Cyclocort)
0.1% cr/oint/lotion
Augmented betamethasone
dipropionate (Diprolene)
0.05% cr
Desoximetasone (Topicort)
0.25% cr/oint 0.05% gel
Diflorasone diacetate
(Maxiflor) 0.05% cr, oint
Betamethasone Dipropionate
(Diprosone) 0.05% cr
Fluocinolone acetonide
(Synalar) 0.2% cr
Fluocinonide (Lidex)
0.05% cr,oint,gel
Halcinonide (Halog)
0.1% oint
Topical Steroids/
Very High Potency
Clobetasol propionate
(Temovate) 0.05% cr, oint
Augmented Betamethasone
Dipropionate (Diprolene)
0.05% oint
Diflorasone diacetate
(Psorcon) 0.05% cr, oint
Halobetasol propionate
(Ultravate) 0.05% cr, oint
Vitamins/Minerals
Vitamin A all strengths OTC
Vitamin A 10,000 units
Vitamin C all strengths OTC
Vitamin C 500 mg
Vitamin D all strengths OTC
Vitamin D 400 units
Vitamin E all strengths OTC
Vitamin E 400 units
Comments/Medical Staff Approval
Non Formulary Drug
Ordered
Approved Formulary
Therapeutic Equivalent
Comments/Medical Staff Approval
Stress 600 + Zinc
Stress Vitamin
B-complex with C
Same dosing frequency
Centrum
Multivit (various)
Thera M
Thera M
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
Misc.
Ambien 5 mg
Ambien 10 mg
Sonata 5mg
Sonata 10mg
Ambien 5 mg
Ambien 10 mg
Fosamax with D
Fosamax
Trilipix 45
Tricor 48
Lipofen 50
Fenofibrate 48
Trilipix 135
Tricor 145
Lipofen 150
Fenofibrate 145
Claritin D
Zyrtec D
Allegra D 12
Xyzal 5
Clarinex 5
Zyrtec 10mg
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.
Reviewed 10/2010, 3/2013