Therapeutic Interchange List
Medications that may be interchanged by pharmacy for the ordered medication per Policy R-40, “Therapeutic Substitution”
NOTE: Shaded drugs are the medications to be substituted to.
For questions about the Therapeutic Interchange List, please contact Norm Hamada, ext. 47386.
ANGIOTENSIN CONVERTING ENZYME INHIBITORS
| Benazepril (Lotensin®) | 5 mg | 10 mg | 20 mg | 40 mg | 80 mg |
|---|---|---|---|---|---|
| Fosinopril (Monopril®) | -- | 10 mg | 20 mg | 40 mg | 80 mg |
| Lisinopril (Zestril®) | 5 mg | 10 mg | 20 mg | 40 mg | 80 mg |
| Moexepril (Univasc®) | 3.75 mg | 7.5 mg | 15 mg | 30 mg | 60 mg |
| Perindopril (Aceon®) | 2 mg | 4 mg | 8 mg | 16 mg | -- |
| Quinapril (Accupril®) | 5 mg | 10 mg | 20 mg | 40 mg | 80 mg |
| Ramipril (Altace®) | 1.25 mg | 2.5 mg | 5 mg | 10 mg | 20 mg |
| Trandolapril (Mavik®) | 0.5 mg | 1 mg | 2 mg | 4 mg | 8 mg |
ANGIOTENSIN RECEPTOR BLOCKERS
| Losartan (Cozaar®) | 25 mg | 50 mg | 100 mg | -- |
|---|---|---|---|---|
| Candesartan (Atacand®) | 4 mg | 8 mg | 16 mg | 32 mg |
| Azilsartan (Edarbi®) | -- | -- | 40mg | 80mg |
| Eprosartan (Teveten®) | 400 mg | 600 mg | 800mg | -- |
| Irbesartan (Avapro®) | 75 mg | 150 mg | 300 mg | -- |
| Olmesartan (Benicar®) | 5 mg | 10 mg | 20 mg | 40 mg |
| Telmisartan (Micardis®) | -- | 20 mg | 40 mg | 80 mg |
| Valsartan (Diovan®) | 40 mg | 80 mg | 160 mg | 320 mg |
H2 ANTAGONISTS
| Famotidine (Pepcid®) | 20 mg QDay | 20 mg BID |
|---|---|---|
| Ranitidine (Zantac®)1 | 150 mg QDay | 150 mg BID |
| Cimetidine (Tagamet®) | 400 mg QDay | 800 mg BID |
| Nizatidine (Axid®) | 150 mg QDay | 150 mg BID |
1Note: NICU auto-sub ranitidine
PROTON PUMP INHIBITORS
| Pantoprazole (Protonix®) | 20 mg | 40 mg |
|---|---|---|
| Dexlansoprazole (Dexilant®) | 30 mg | 60 mg |
| Esomeprazole (Nexium®) | 20 mg | 40 mg |
| Lansoprazole (Prevacid®) | 15 mg | 30 mg |
| Omeprazole (Prilosec®) | 10 mg | 20 mg |
| Rabeprazole (Aciphex®) | -- | 20 mg |
HMG CoA REDUCTASE INHIBITORS
| Atorvastatin (Lipitor®) | -- | -- | 10 mg | 20 mg | 40 mg | 80 mg | QDay |
|---|---|---|---|---|---|---|---|
| Pravastatin (Pravachol®) | 10 mg | 20 mg | 40 mg | 80 mg | -- | -- | QDay |
| Fluvastatin (Lescol®, Lescol XL®) | 20 mg | 40 mg | 80 mg (XL) | -- | -- | -- | QHS (XL QDay) |
| Lovastatin (Mevacor®) | 10 mg | 20 mg | 40 mg | 80 mg | -- | -- | QHS |
| Pitavastatin (Livalo®) | -- | 1 mg | 2 mg | 4 mg | -- | -- | QDay |
| Rosuvastatin (Crestor®) | -- | -- | -- | 5 mg | 10 mg | 20 or 40mg | QDay |
| Simvastatin (Zocor®) | 5 mg | 10 mg | 20 mg | 40 mg | 80 mg | -- | QHS |
| Atorvastatin/ ezetimibe (Liptruzet®) | -- | -- | -- | -- | 10/10 mg or 20/10mg | 40/10 or 80/10mg | QDay |
| Simvastatin/ezetimibe (Vytorin®) | -- | -- | -- | 10 mg /10 mg | 20 mg/10 mg to 40 mg/10 mg | 40 mg/10 mg to 80 mg/10 mg | QHS |
FENOFIBRIC ACID & FENOFIBRATES
| Fenofibrate/Impax Labs (film-coated tablets)*; F** | 54 mg | -- | 160 mg |
|---|---|---|---|
| TriLipix ® (delayed-release capsules); FA | 45 mg | -- | 135 mg |
| Antara® (micronized capsules); F | 43 mg | -- | 130 mg |
| Fenoglide® (MeltDose tablets); F | 40 mg | -- | 120 mg |
| TriCor® (nanocrystal tablets); F | 48 mg | -- | 145 mg |
| Triglide® (IDD-P); F | 50 mg | -- | 160 mg+ |
| Lofibra® (micronized capsules)*F | 67 mg | 134 mg | 200 mg |
| Lofibra® (film-coated tablets)*; F | 54 mg | -- | 160 mg |
| Lipofen® (lidose capsules); F | 50 mg | -- | 150 mg |
| Fenofibrate/Impax Labs (micronized capsules)*; F | 67 mg | 134 mg | 200 mg |
| Fenofibrate/Ranbaxy Pharmaceuticals (film-coated tablets)*; F | 54 mg | -- | 160 mg |
Note: dose equivalence is base on % lipid reduction and initial/max dose. *FDA AB equivalence; + FDA BX equivalence FA=Fenofibric acid; F= Fenofibrate
INSULIN
| Insulin lispro (Humalog®) | 1 unit | Insulin aspart (Novolog®) | 1 unit |
|---|---|---|---|
| Insulin regular (Humulin R®) | 1 unit | Insulin regular (Novolin R®) | 1 unit |
| Insulin isophane, NPH (Humulin N®) | 1 unit | Insulin NPH (Novolin N®) | 1 unit |
| Insulin isophane/regular 70/30 (Humulin 70/30®) | 1 unit | Insulin NPH/regular (Novolin 70/30®) | 1 unit |
LEVALBUTEROL TO ALBUTEROL NEBULIZER
| Levalbuterol (Xopenex®) | Frequency | Albuterol | Frequency |
|---|---|---|---|
| 1.25 mg | q1h-q4h | 2.5 mg | as ordered |
| 1.25 mg | q6h | 2.5 mg | q4h |
| 1.25 mg | q8h | 2.5 mg | q6h |
| 0.63 mg | q1h-q4h | 1.25 mg | as ordered |
ADVAIR ® TO SYMBICORT®
| Symbicort® | 80 mcg/4.5 mcg 2 puff twice daily | 160 mcg/4.5 mcg 2 puffs twice daily |
|---|---|---|
| Advair Diskus® | 100 mcg/50 mcg 1 puff Q12hrs | 250 mcg/50 mcg, 500 mcg/50 mcg 1 puff Q12hrs |
| Advair® HFA | 45 mcg/21 mcg 2 puffs Q12hrs | 115 mcg/21 mcg, 230 mcg/21 mcg 2 puffs Q12hrs |
| Dulera® | 100mcg/5mcg 2 puffs Q12hrs | 200mcg/5mcg 2 puffs Q12hrs |
INHALED CORTICOSTEROIDS – Adults ≥ 12 years
| Medication/strengths available | Comparative daily doses | ||
| Low | Medium | High | |
| Fluticasone HFA (Flovent-HFA®) 44 mcg/inh, 110 mcg/inh | 88 to 220 mcg | 220 to 440 mcg | > 440 mcg |
|---|---|---|---|
| Beclomethasone HFA (QVAR Redihaler®) 40 mcg/inh, 80 mcg/inh | 80 to 240 mcg | 280 to 480 mcg | > 480 mcg |
| Budesonide DPI (Pulmicort Flexhaler®) 90 mcg/inh, 180 mcg/inh | 180 to 540 mcg | 630 to 1200 mcg | > 1200 mcg |
| Ciclesonide HFA (Alvesco®) 80 mcg/inh, 160 mcg/inh | 160 to 320 mcg | 400 to 640 mcg | > 640 mcg |
| Flunisolide HFA (Aerospan®) 80 mcg/inh | 320 mcg | 400 to 640 mcg | > 640 mcg |
| Fluticasone DPI (Flovent Diskus®) 50 mcg/blister, 100 mcg/blister, 250 mcg/blister | 100 to 300 mcg | 350 to 500 mcg | > 500 mcg |
| Mometasone DPI (Asmanex Twisthaler®) 110 mcg/inh, 220 mcg/inh | 220 mcg | 440 mcg | > 440 mcg |
INHALED CORTICOSTEROIDS – Peds 5-11 years
| Medication/strengths available | Comparative daily doses | ||
| Low | Medium | High | |
| Fluticasone HFA (Flovent HFA®) 44 mcg/inh, 110 mcg/inh | 88 to 176 mcg | 176 to 440 mcg | > 440 mcg |
|---|---|---|---|
| Beclomethasone HFA (QVAR Redihaler®) 40 mcg/inh, 80 mcg/inh | 80 mcg to 160 mcg | 200 mcg to 320 mcg | > 320 mcg |
| Budesonide DPI (Pulmicort Flexhaler®) 90 mcg/inh, 180 mcg/inh | 180 mcg to 360 mcg | 450 mcg to 720 mcg | > 800 mcg |
| Ciclesonide HFA (Alvesco®) 80 mcg/inh, 160 mcg/inh | 80 mcg to 160 mcg | > 160 mcg to 320 mcg | > 320 mcg |
| Flunisolide HFA (Aerospan®) 80 mcg/inh | 160 mcg | 320 mcg | ≥ 640 mcg |
| Fluticasone DPI (Flovent Diskus®) 50 mcg/blister, 100 mcg/blister, 250 mcg/blister | 100 mcg to 200 mcg | 250 mcg to 400 mcg | > 400 mcg |
| Mometasone DPI (Asmanex Twisthaler®) 110 mcg/inh, 220 mcg/inh | 110 mcg | 220 mcg to 440 mcg | > 440 mcg |
* low dose therapy for peds < 4 years is higher than that for peds 5-11 years due to a lower dose delivered via face mask
SECOND GENERATION ANTIHISTAMINES
| Loratadine (Claritin®) | 20 mg PO QDay |
|---|---|
| Cetirizine (Zyrtec®) | 5-10 mg PO QDay |
| Desloratadine (Clarinex®) | 10 mg PO QDay |
| Fexofenadine (Allegra®) | 60 mg PO BID |
| Fexofenadine (Allegra®) | 180 mg PO QDay |
| Levocetirizine (Xyzal®) | 2.5-5 mg PO QDay |
OPIOID ANALGESICS
| Hydrocodone/ acetaminophen oral solution (Hycet®) | 7.5 mg/ 325 mg per 15 mL |
|---|---|
| Hydrocodone/ acetaminophen oral solution (Lortab® Elixir) | 7.5 mg/500 mg per 15 mL |
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