HDGH, LDMH and WRH Formulary
HDGH, ESH and WRH (Met & Ouellette) Formulary / Therapeutic Interchange List

Medications highlighted:
red = specific to WRH-Ouellette only!
blue = specific to LDMH only!
green = specific to WRH-Met only!
crossed out = Non-Formulary and will be therapeutically interchanged.

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ANTI-INFECTIVE AGENTS



Antibiotics

Aminoglycosides

Amikacin SulphateAmikin
     250 mg/mL injection

Gentamicin SulphateGaramycin Sulphate
     40 mg/mL vial for injection

Tobramycin SulphateNebcin
     40 mg/mL vial, 1.2 g/vial for injection

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Cephalosporins

ceFAZolin (1st generation)Ancef, Kefzol
     500 mg prepared syringe/vial for injection
     1 g pharmacy prepared syringe/vial for injection
     10 g vial for injection
THERAPEUTIC INTERCHANGE: All orders for ceFAZolin IV q6h or greater than 1 g IV q8h will be automatically substituted to ceFAZolin 1 g IV q8h. Exceptions include: CNS infections, endocarditis, abscesses, necrotizing fasciitis, paediatrics patients (P&T Nov/99)

Cephalexin (1st generation)Keflex
     250 mg/5 mL suspension
     250 mg, 500 mg tablet

Cephalothin (1st generation)Keflin
THERAPEUTIC INTERCHANGE: All orders for cephalothin will be automatically substituted to ceFAZolin at the same dose and frequency.

Cefaclor (2nd generation)Ceclor
THERAPEUTIC INTERCHANGE:
     cefaclor in paediatric patients (less than 14 years old) = cefprozil po q12h at the same dose
     cefaclor in adults patients (greater than 14 years old) = cefuroxime po q12h at the same dose


Cefprozil (2nd generation)Cefzil
     125 mg/5 mL suspension
THERAPEUTIC INTERCHANGE: All orders for cefprozil will be automatically substituted to cefuroxime (same dose & frequency) paediatrics exempted.

Cefuroxime Axetil (2nd generation)Ceftin
     125 mg/5 mL reconstituted suspension
     250 mg, 500 mg tablet
     750 mg vial for injection
     750 mg spiked bag
THERAPEUTIC INTERCHANGE: All orders for cefuroxime 1.5 g IV q8h will be automatically substituted to cefuroxime 750 mg IV q8h. Exceptions include: CNS infections, endocarditis, abscesses, necrotizing fasciitis, and paediatrics patients. (P&T Nov/99)

Cefixime (3rd generation)Suprax
     100 mg/5 ml reconstituted suspension
     400 mg tablet

Cefotaxime (3rd generation)Claforan
THERAPEUTIC INTERCHANGE: All orders for cefotaxime will be automatically substituted as follows:
     cefotaxime 1 g IV (any frequency) = cefTRIAXone 1 g IV q24h
     cefotaxime 2 g IV q6h = cefTRIAXone 2 g IV q12h (Meningitis)


Ceftazidime (3rd generation)Ceptaz, Fortaz
     1 g vial, 2 g vial for injection
     1 g spiked bag, 2 g spiked bag
THERAPEUTIC INTERCHANGE: All orders for ceftazidime 2 g will be automatically substituted as listed below. Exceptions include: CNS infections, endocarditis, abscesses, necrotizing fasciitis, and paediatrics patients. (P&T Nov/99)
     ceftazidime 2 g IV q8h = ceftazidime 1 g IV q8h
     ceftazidime 2 g IV q12h = ceftazidime 1 g IV q12h


cefTRIAXone (3rd generation)Rocephin
     250 mg vial, 1 g vial, 2 g vial for injection
     250 mg, 1 g, 2 g spiked bag
THERAPEUTIC INTERCHANGE: All orders for cefTRIAXone 2 g IV q24h or 1 g IV q12h will be automatically substituted to cefTRIAXone 1 g IV q24h. Exceptions include: CNS infections, endocarditis, abscesses, necrotizing fasciitis, and paediatrics patients. (P&T Nov/99)

CefepimeMaxipime
     2 g vial for injection
RESTRICTED AGENT: Reserved for use by Infectious disease or if ID is not available for ICU physicians.

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Miscellaneous Beta Lactams

1) Carbapenemes

Imipenem/cilastatinPrimaxin
THERAPEUTIC INTERCHANGE:
     primaxin 500 mg IV q6-8h = meropenem 500 mg IV q6-8h
     primaxin 1 g IV q6-8h = meropenem 1 g IV q6h
     primaxin X mg IV q12h = meropenem same strength IV q12h
Note: RPh will dose adjust for renal function


ErtapenemInvanz
     1 g vial for injection
RESTRICTED AGENT: Reserved for use by ID specialist and if ID is not available, ICU physicians (P&T Nov 07)

MeropenemMerrem
     500 mg vial, 1 g vial for injection
     500 mg, 1 g spiked bags
RESTRICTED AGENT: Restricted for use by ID Specialists or if ID is not available for ICU physicians.
THERAPEUTIC INTERCHANGE: All orders for Meropenem will be substituted by the Pharmacist to an appropriate dose.
     meropenem 1 g IV q8h = meropenem 500 mg IV q6h (CrCl greater than 50 mL/min)
     meropenem 1 g IV q12h = meropenem 500 mg IV q8h (CrCl 30-49 mL/min)
     meropenem 500 mg IV q12h = meropenem 500 mg IV q12h (CrCl 10-29 mL/min)
     meropenem 500 mg IV q24h = meropenem 500 mg IV q24h (CrCl less than 10 mL/min)


2) Cephamycins

Cefotetan (2nd generation)Cefotan
THERAPEUTIC INTERCHANGE: All orders cefotetan will be automatically substituted to cefoxitin to an appropriate dose.
     cefotetan = cefoxitin 1 g IV q6h (CrCl greater than 50 mL/min)
     cefotetan = cefoxitin 1 g IV q8h (CrCl 30-49 mL/min)
     cefotetan = cefoxitin 1 g IV q12h (CrCl 10-29 mL/min)
     cefotetan = cefoxitin 1 g IV q24h (CrCl less than 10 mL/min)
     cefotetan 1 g IV on call = cefoxitin 2 g IV on call


Cefoxitin (2nd generation)Mefoxin
     1 g, 2 g vial for injection

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Chloramphenicol

ChloramphenicolChloromycetin, Pentamycetin
     1 g vial for injection

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Macrolides

AzithromycinZithromax
     40 mg/mL oral suspension
     250 mg tablet
     500 mg spiked IV bag
THERAPEUTIC INTERCHANGE: Any orders for azithromycin 1200 mg po qweek for MAC prophylaxis in HIV positive patients will be substituted to azithromycin 1250 mg po qweek.
Any orders for azithromycin 500 mg po daily will be substituted to azithromycin 500 mg po day 1 then 250 mg po days 2-5 (leave on 500 mg q24h if combined with B-lactam for the Tx of CAP)


ClarithromycinBiaxin
     250 mg tablets
RESTRICTED AGENT: Restricted to H. pylori/Mycobacterium Avium Complex (MAC) (P&T March/02)
THERAPEUTIC INTERCHANGE: If not for above indication then, clarithromycin 250 mg or 500 mg tablets po q12h will be automatically substituted to azithromycin 500 mg day 1, then 250 mg day 2-5 for adults. (a 5 day ASO will be applied)
Clarithromycin suspension will be automatically substituted to azithromycin suspension. Note: For pediatric patients, the pharmacist will determine indication and dose accordingly. (P&T April/00)


Erythromycin BaseE-Mycin
     250 mg tablet
THERAPEUTIC INTERCHANGE: All orders for erythromycin stearate, erythromycin base EC, or erythromycin estolate will be automatically substituted to erythromycin base 250mg po q6h.

Erythromycin LactobionateErythrocin, Ilotycin
     500 mg, 1 g vial for injection
     *Gluceptate and Lactobionate salts are considered to be equivalent. Only one is stocked.
THERAPEUTIC INTERCHANGE: All orders for erythromycin IV will be automatically substituted to azithromycin 500 mg IV q24h. Exception: erythromycin IV for prokinetic reasons, a 4-day ASO will be applied unless a duration is specified.(P&T April/00)

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Penicillins

AmoxicillinAmoxil
     250 mg, 500 mg capsule
     250 mg/5 mL suspension
THERAPEUTIC INTERCHANGE: All orders for ampicillin po q6h will be automatically substituted to amoxicillin po q8h at the same strength.

Amoxicillin / ClavulanateClavulin
     250 mg/5 mL suspension
     250 mg, 500 mg, 875 mg tablet

AmpicillinAmpicin
     500 mg, 1 g, 2 g vials and spiked bags
THERAPEUTIC INTERCHANGE: All orders for ampicillin po q6h will be automatically substituted to amoxicillin po q8h at the same strength.

CloxacillinTegopen, Orbenin
     125 mg/5mL suspension
     250 mg, 500 mg capsule
     1 g, 2 g vials and spiked bags

Penicillin G SodiumCrystapen
     5 Million Units/vial, 10 Million Units/vial for injection
THERAPEUTIC INTERCHANGE: All orders for penicillin G IV will be automatically substituted to penicillin G sodium IV (P&T March/99)

Penicillin V PotassiumPen VK
     300 mg tablet

Piperacillin SodiumPipracil
     2 g, 3 g, 4 g vial for injection
THERAPEUTIC INTERCHANGE: All orders for ticarcillin will be automatically substituted to piperacillin.

Piperacillin / TazobactamTazocin
     2 g/0.25 g vial, 4 g/0.5 g vial for injection
THERAPEUTIC INTERCHANGE: All orders for piperacillin/tazobactam 3.375 g will be substituted as follows:
     CrCl graeter than 30 mL/min give 4.5 g q8h
     CrCl less than 30 mL/min give 4.5 g q12h
     Dialysis 2.25 g q12h


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Quinolones

CiprofloxacinCipro
     500 mg tablet
     10 g/100 mL oral suspension
     200 mg, 400 mg premixed IV bag
**Note: Ciprofloxacin is to be used for systemic infections only. Any orders for Ciprofloxacin for UTI will be substituted to NORfloxacin.

LevofloxacinLevaquin
     250 mg, 500 mg tablet
     250 mg/50 mL, 500 mg/100 mL, 750 mg/150 mL premixed IV bags
RESTRICTED: Levofloxacin is restricted for the treatment of pseudomonas plus gram positive only.
THERAPEUTIC INTERCHANGE: All other orders for levofloxacin will be automatically substituted to moxifloxacin.
     levofloxacin 250-750 mg iv or po (any frequency) = moxifloxacin 400 mg iv or po (respectively) q24h


MOXIfloxacinAvelox
     400 mg tablet
     400 mg/250 mL premixed IV bag

NORfloxacinNoroxin
     400 mg tablet

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Sulfonamides

Sulfamethoxazole / TrimethoprimSeptra, Bactrim, Co-trimoxazole
     200 mg/40 mg/5 mL suspension
     400 mg/80 mg, 800 mg/160 mg (DS) tablet
     80 mg/16 mg/mL vial for injection

SulfasalazineSalazopyrin
     500 mg enteric coated tablet

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Tetracyclines

Demeclocycline HClDeclomycin
     150 mg tablet

Doxycycline HyclateVibramycin
     100 mg tablet
     100 mg/vial for injection
THERAPEUTIC INTERCHANGE: All orders for minocycline 50 mg or 100 mg will be automatically substituted to doxycyline 100 mg po q12h. All orders for tetracycline 250 mg or 500 mg po qid will be automatically substituted to doxycycline 100 mg po q12h (P&T Nov/97). Exemption - Tetracycline can be used as part of H. Pylori treatment regimen.

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Miscellaneous Antibiotics

BacitracinBasiject
     50,000 Units/vial powder

ClindamycinDalacin C
     75 mg/5mL suspension
     150 mg capsule
     150 mg/vial, 300mg/vial , 600/mg vial for injection
THERAPEUTIC INTERCHANGE:
     clindamycin 150 mg po q6h = clindamycin 300 mg po q6h
     clindamycin IV q6h = clindamycin IV q8h (same dosage)
     clindamycin 900 mg iv q8h = clindamycin 600 mg iv q8h
Exceptions include: endocarditis, CNS infections, closed space infections prior to surgery, necrotizing fasciitis, and paediatric patients. (P&T Nov/99)


ColistimethateColistin
     150 mg vial
RESTRICTED AGENT: Restricted for use by Infectious Diseases and ICU physicians. (P&T Dec/13)

DaptomycinCubicin
     500 mg vial
RESTRICTED AGENT: Restricted for use by ID Specialists or ICU physicians. (P&T May/09)

LinezolidZyvoxam
     600 mg tablet
     600 mg premixed IV bag
RESTRICTED AGENT: Restricted for use by Infectious Diseases or ICU physicians. (P&T Nov/01)

VancomycinVancocin
     50 mg/mL pharmacy prepared suspension
     500 mg vial, 1 g vial for injection
     500 mg, 1g spiked bags
RESTRICTED AGENT: A “Vancomycin Order Form” must accompany each vancomycin order.
THERAPEUTIC INTERCHANGE: Vancomycin po for C. difficile with be substituted to vancomycin 125 mg po qid and the automatic stop order will be extended to 10 days (unless physician writes ‘no sub’)


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Antifungals

Azoles

FluconazoleDiflucan
     100 mg tablet
     50 mg/5 mL suspension
     200 mg/100 mL IV premixed bag
Note: Entire daily dose of fluconazole will be administered q24h

KetoconazoleNizoral
     200 mg tablet
RESTRICTED AGENT: Reserved for patient's with Cushing's Syndrome

VoriconazoleVfend
     50 mg, 200 mg tablet
RESTRICTED AGENT: Reserved for ID specialists, ICU physicians, and Oncologists.

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Echinocandins

CaspofunginCancidas
     50 MG, 70 mg/vial for injection
RESTRICTED AGENT: Reserved for ID specialists, ICU physicians, and Oncologists.

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Polyenes

Amphotericin B — Fungizone
     50 mg/vial for injection

NystatinMycostatin, Nadostine
     500,000 Unit tablet
     100,000 Unit/mL suspension

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Antimycobacterials


Antituberculous Agents

Ethambutol HClMyambutol
     100 mg, 400 mg tablet

IsoniazidINH, Nydrazid
     300 mg tablet

PyrazinamideTebrazid
     500 mg tablet

Rifampin — Rifadin, Rimactane
     150 mg, 300 mg capsule
     10 mg/mL pharmacy prepared suspension
RESTRICTED AGENT / SPECIAL ACCESS: 300 mg injection

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Miscellaneous Antimycobacterials

DapsoneAvlosulfone
     500 mg tablet

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Antivirals
AcyclovirZovirax
     200mg, 800mg tablet
     500mg/vial for injection

FamciclovirFamvir
THERAPEUTIC INTERCHANGE: Any orders for famciclovir with be substituted to acyclovir as follows:



HSV suppression:



Famciclovir

250 mg po q12h
125 mg po q12h
125 mg po q24h

Acyclovir

400 mg po q12h (CrCl greater than or equal to 30 ml/min)
400 mg po q12h (CrCl 10-29 ml/min)
200 mg po q12h (CrCl less than 10 ml/min)


HSV treatment (Oral):



Famciclovir

500 mg po q12h x 5 days
500 mg po q24h x 5 days
250 mg po q24h x 5 days

Acyclovir

200 mg po 5xday x 5 days (CrCl greater than or equal to 30 ml/min)
200 mg po 5xday x 5 days (CrCl 10-29 ml/min)
200 mg po q12h x 5 days (CrCl less than 10 ml/min)


HSV treatment (Genital):



Famciclovir

125 mg po q12h
125 mg po q24h
125 mg po q48h

Acyclovir

400 mg po q8h (CrCl greater than or equal to 30 ml/min)
400 mg po q8h (CrCl 10-29 ml/min)
400 mg po q12h (CrCl less than 10 ml/min)


Zoster (VZV):




Famciclovir

500 mg po q8h
500 mg po q12h
500 mg po q24h
250 mg po q48h

Acyclovir

800 mg po 5xday x 5 days (CrCl greater than 50 ml/min)
800 mg po 5xday x 5 days (CrCl 30-49 ml/min)
800 mg po q8h (CrCl 10-29 ml/min)
800 mg po q12h (CrCl less than 10 ml/min)

GanciclovirCytovene
     500mg/vial injection

OsteltamivirTamiflu
     75 mg cap
RESTRICTED: Limited use for treatment (Not prophylaxis)

ValacyclovirValtrex
THERAPEUTIC INTERCHANGE: Any orders for valacyclovir with be substituted to acyclovir as follows:



HSV suppression:



Valacyclovir

500-1000 mg po q24h
500 mg po q24h
500 mg po q24-48h

Acyclovir

400 mg po q12h (CrCl greater than or equal to 30 ml/min)
400 mg po q12h (CrCl 10-29 ml/min)
200 mg po q12h (CrCl less than 10 ml/min)


HSV treatment (Oral):




Valacyclovir

2000 mg po q12h x 1 day
1000 mg po q12h x 1 day
500 mg po q12h x 1 day
500 mg po x 1 dose

Acyclovir

200 mg po 5xday x 5 days (CrCl greater than or equal to 50 ml/min)
200 mg po 5xday x 5 days (CrCl 30-49 ml/min)
200 mg po 5xday x 5 days (CrCl 10-29 ml/min)
200 mg po q12h x 5 days (CrCl less than 10 ml/min)


HSV treatment (Genital):



Valacyclovir

500-1000 mg po q12h
500-1000 mg q24h
500 mg po q24h

Acyclovir

400 mg po q8h (CrCl greater than or equal to 30 ml/min)
400 mg po q8h (CrCl 10-29 ml/min)
400 mg po q12h (CrCl less than 10 ml/min)


Zoster (VZV):



Valacyclovir

1000 mg po q8h
1000 mg po q12h
1000 mg po q24h

Acyclovir

800 mg po 5xday (CrCl greater than or equal to 30 ml/min)
800 mg po q8h (CrCl 10-29 ml/min)
800 mg po q12h (CrCl less than 10 ml/min)

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Antiretrovirals


lamiVUDine3TCHeptovir
RESTRICTED: An antiretroviral, reverse transcriptase inhibitor for use in prevention of maternal-fetal HIV transmission prior to giving birth and for pediatric patients born to HIV infected mothers. (Met Campus Only)


NevirapineViramune
RESTRICTED: An antiretroviral, reverse transcriptase inhibitor for use in prevention of maternal-fetal HIV transmission prior to giving birth and for pediatric patients born to HIV infected mothers. (Met Campus Only)


ZidovudineRetrovir
     10 mg/ml injection (20 ml vial), 10 mg/ml oral syrup (240 ml)
RESTRICTED: An antiretroviral, reverse transcriptase inhibitor for use in prevention of maternal-fetal HIV transmission prior to giving birth and for pediatric patients born to HIV infected mothers. (Met Campus Only)


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Antiprotazoal Agents


Chloroquine PhosphateAralen phosphate
     250 mg tablet (equivalent to 150 mg chloroquine base)

HydroxychloroquinePlaquenil
     200 mg tablet

metroNIDAZOLEFlagyl
     50 mg/mL pharmacy prepared suspension
     250 mg tablet
     500 mg premixed iv bag
THERAPEUTIC INTERCHANGE: All orders for metroNIDAZOLE po for treatment of C. difficile, the automatic stop order will be extended to 10 days.
     metroNIDAZOLE iv q6h = metroNIDAZOLE iv q8h
     metroNIDAZOLE iv/po 1 g q24h = metroNIDAZOLE iv/po 500 mg q8h


Pentamidine IsethionatePentacarinat, Pentam 300
     300 mg/vial for injection

Primaquine
     26.3 mg tablet

PyrimethamineDaraprim
     25 mg tablet

quiNINE
     200 mg, 300 mg capsule

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Urinary Anti-Infectives


FosfomycinMonurol
     3 g packet
RESTRICTED: For drug resistant organisms.

Nitrofurantoin macroMacrodantin
THERAPEUTIC INTERCHANGE: All orders for nitrofurantoin macro (Macrodantin) 50 mg q6h will be automatically substituted with nitrofurantoin mono (Macrobid) 100 mg q12h. (MAC Apr./13)

Nitrofurantoin monoMacrobid
     100 mg capsule

TrimethoprimProloprim
     100 mg tablet

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ANTINEOPLASTIC AGENTS
ChlorambucilLeukeran
     2 mg tablet (Met Only)

CyclophosphamideProcytox, Cytoxan
     25 mg, 50 mg tablet
     1000 mg/vial injection

Cyproterone AcetateAndrocur
     50 mg tablet

EtoposideVepesid
     50 mg tab

FlutamideEuflex
     250 mg tablet

HydroxyureaHydrea
     500 mg capsule

MegestrolMegace
     40 mg, 160 mg tablet

MelphalanAlkeran
     2 mg tablet

MethotrexateAmethopterin, Mexate
     2.5 mg tablet
     25 mg/mL injection

MidostaurinRydapt
     25 mg capsule
RESTRICTED: To Oncology Practitioners (Met Only)


TamoxifenNovaldex
     10 mg tab

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AUTONOMIC DRUGS

Parasympathomimetic Agents


Bethanechol ChlorideUrecholine, Duvoid
     10mg, 25mg tablet
     5mg/mL injection

Neostigmine — Prostigmin
     0.5mg/mL (1:2000), 1 mg/mL (1:1000) injection

Pyridostigmine Bromide — Mestinon
     60mg tablet, 180mg SR tablet (Supraspan)

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Anticholinergic Agents


Antiparkinsonian Agents

Benztropine MesylateCogentin, Bensylate
     2mg tablet
     2mg/2 mL injection

DonepezilAricept
     5 mg tablet, 10 mg tablet (to be given at hs)

Galantamine ERReminyl ER
     8 mg, 16 mg capsule

RivastigmineExelon
     1.5 mg, 3 mg capsule

Trihexyphenidyl HClArtane
     2mg tablet

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Antimuscarinics/Antispasmodics

AclidiniumTudorza Genuair
THERAPEUTIC INTERCHANGE: All orders for aclidinium will be automatically substituted to tiotropium bromide.
     aclidinium 400 mcg 1 puff bid = tiotropium bromide 18 mcg cap for inhalation once daily


Atropine Sulfate
     0.4mg/mL amp, 0.6mg/mL amp for injection
     1mg/10 mL prefilled syringe
     1 mg/10 mL auto-injector (restricted for CBRN use only)

Dicyclomine HClBentylol, Formulex
     10mg tablet
     10mg/5 mL syrup

Formoterol/AclidiniumDuaklir Genuair
THERAPEUTIC INTERCHANGE: Use patient's own med first, if uable to obtain within 24 hrs then pharmacy to automatically substitute to Ultibro Breezehaler.
     Duaklir Genuair 12/400 mcg inhaler - 1 inhalation bid = Ultibro 110/50 mcg Breezehaler - 1 cap for inhalation once daily


GlycopyrrolateRobinul
     0.4mg/2 mL vial for injection

Glycopyrrolate BreezehalerSeebri Breezehaler
THERAPEUTIC INTERCHANGE: All orders for glycopyrrolate breezehaler will be automatically substituted to tiotropium bromide.
     glycopyrrolate breezehaler 50 mcg once daily = tiotropium bromide 18 mcg cap for inhalation once daily


Hyoscine ButylbromidebusCOPAN
     10mg tablet
     20mg/mL amp for injection

Ipratroprium BromideAtrovent
     250 mcg/mL inhaled solution
     500 mcg/2 mL nebule
     20 mcg/spray MDI
     21 mcg/spray nasal spray
THERAPEUTIC INTERCHANGE:
     Ipratroprium bromide 0.25 mg/ml (solution) = Ipratroprium bromide MDI 2 puffs (40 mcg) at the same frequency,
     unless the physician writes "no substitution". (WRH-Ouellette Only)
     Ipratroprium bromide 0.5 mg/2 ml (1 nebule) = Ipratroprium bromide MDI 4 puffs (80 mcg) at the same frequency,
     unless the physician writes "no substitution". (WRH-Ouellette Only)


Olodaterol/TiotropiumInspiolto Respimat
THERAPEUTIC INTERCHANGE: Use patient's own med first, if uable to obtain within 24 hrs then pharmacy to automatically substitute to Ultibro Breezehaler.
     Inspiolto Respimat 2.5/2.5 mcg inhaler - 2 inhalations once daily = Ultibro 110/50 mcg Breezehaler - 1 cap for inhalation once daily


Scopolamine HydrobromideScopolamine, Transderm V
     0.4mg/mL amp for injection
     1.5mg patch

Tiotropium BromideSpiriva
     18 mcg capsules for inhalation
     Inhalation device

UmeclidiniumIncruze Ellipta
THERAPEUTIC INTERCHANGE: All orders for umeclidinium will be automatically substituted to tiotropium bromide.
     umeclidinium 62.5 mcg 1 puff once daily = tiotropium bromide 18 mcg cap for inhalation once daily


Vilanterol/UmeclidiniumAnoro Ellipta
THERAPEUTIC INTERCHANGE: Use patient's own med first, if uable to obtain within 24 hrs then pharmacy to automatically substitute to Ultibro Breezehaler.
     Anoro Ellipta 62.5/25 mcg inhaler - 1 inhalation once daily = Ultibro 110/50 mcg Breezehaler - 1 cap for inhalation once daily


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Sympathomimetic Agents

α-Adrenergic Agonists

MidodrineAmatine
     5 mg tablet

PhenylephrineNeo-Synephrine
     10mg/mL amp for injection

β-Adrenergic Agonists

Non-Selective β-adrenergic agonists

IsoproterenolIsuprel
     0.2mg/mL amp for injection
     1mg/5 mL injectiom

Selective β-1 adrenergic agonists

DOBUTamineDobutrex
     250mg/20 mL vial for injection

DOPamineIntropin
     1.6mg/mL IV bag (400mg)
     0.8mg/mL IV bag (200mg)
     200mg/5 mL vial for injection (Back order)

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Selective β-2 adrenergic agonists

SalbutamolVentolin
     100 mcg/spray MDI
     2.5 mg/2.5 mL nebule
     5 mg/mL inhaled solution
     5 mg/5 mL injection

THERAPEUTIC INTERCHANGE: All orders for salbutamol CFC MDI will be automatically substituted to salbutamol HFA MDI.
     Salbutamol 2.5 mg/2.5 ml (1 nebule) = Salbutamol MDI 4 puffs. (WRH-Ouellette Only)
     Salbutamol 5 mg/1 ml (solution) = Salbutamol MDI 4 puffs (*8 puffs for vented patients). (WRH-Ouellette Only)


Salbutamol / Ipratropium BromideCombivent
     2.5mg salbutamol /0.5mg Ipratropium nebule
     Combivent MDI *discontinued by manufacturer*
THERAPEUTIC INTERCHANGE:
     Combivent MDI = Salbutamol MDI and Ipratropium MDI same dose at the same frequency.
     Combivent Nebule = Salbutamol MDI 4 puffs and Ipratropium MDI 4 puffs,unless the physician indicates "no substitution". (WRH-Ouellette Only)


TerbutalineBricanyl
THERAPEUTIC INTERCHANGE: Orders for terbutaline 0.5 mg turbuhaler 1 puff prn (max 6 doses/24 hours) = salbutamol MDI 2-4 puffs q4h prn

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α and β-Adrenergic Agents

ePHEDrine Sulfate
     50 mg/mL amp for injection

EPINEPHrineAdrenalin
     1 mg/10 mL (1:10,000) 18G prefilled syringe (for intracardiac administration)
     1 mg/10 mL (1:10,000) 21G prefilled syringe
     1 mg/mL (1:1000) amp, 30 mg/30 mL vial for injection
     30 mg/30 mL vial topical solution

NorEPINEPHrineLevophed
     4 mg/4 mL amp for injection

PseudoePHEDrineSudafed, Robidrine
     30 mg/5mL oral syrup
     60 mg tablet

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Sympatholytic Agents

PhentolamineRogitine
     5 mg/ml for injection

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Skeletal Muscle Relaxants

Centrally Acting Skeletal Muscle Relaxants

CyclobenzaprineFlexeril
     10 mg tablet

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Direct-Acting Skeletal Muscle Relaxants

Dantrolene SodiumDantrium
     25 mg tablet
     20 mg/mL vial for injection

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GABA-Derivative Skeletal Muscle Relaxants

BaclofenLioresal
     10mg tablet

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Neuromuscular Blocking Agents

CisatracuriumNimbex
     20 mg/10 mL for injection

RocuroniumZemuron
     50 mg/ 5 mL vial for injection

Succinylcholine ChlorideAnectine, Quelicin
     200 mg/ 10 mL vial for injection

VecuroniumNorcuron
     10 mg vial for injection (LDMH only)


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Skeletal Muscle Relaxants, Miscellaneous

Orphenadrine CitrateNorflex
     100 mg tablet

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Miscellaneous Autonomics

NicotineNicoderm, Nicorette
     7 mg, 14 mg, 21 mg patch
     2 mg mint flavoured gum

VareniclineChampix
     0.5mg, 1mg tablet

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BLOOD FORMATION & COAGULATION

Antianemia Drugs

Iron Preparations

FeramaxPolysaccharide-iron complex
THERAPEUTIC INTERCHANGE: Feramax (polysaccharide-iron complex) 300 mg daily = ferrous sulphate 300 mg bid
     Feramax (polysaccharide-iron complex) 300 mg bid = ferrous sulphate 300 mg tid


Ferrous FumaratePalafer
THERAPEUTIC INTERCHANGE: All orders from ferrous fumarate 300 mg tablets will be substituted to ferrous sulphate 300 mg tabs.

Ferric GluconateFerrlecit
     62.5 mg/5 mL vial for injection

Ferrous GluconateFergon
THERAPEUTIC INTERCHANGE: All orders from ferrous gluconate 300 mg tablets will be substituted to ferrous sulphate 300 mg tabs.

Ferrous SulfateFer-In-Sol, Slow-Fe
     75 mg/mL oral drops
     150 mg/5 mL oral solution
     300 mg tablet
THERAPEUTIC INTERCHANGE: All orders for ferrous sulphate LA (Slow-Fe) 160 mg (50 mg elemental iron) will be autosubstituted to ferrous sulphate 300 mg (60 mg elemental iron) (P&T May/03)
THERAPEUTIC INTERCHANGE: All orders for ferrous sulphate/folic acid LA 160 mg/0.4 mg (Slow-Fe-Folic) will be autosubstituted to ferrous sulphate 300 mg (60 mg elemental iron) + folic acid 1mg (P&T May/03)


FerumoxytolFeraheme
     510 mg/17 mL vial for injection
RESTRICTED AGENT: Reserved for use in iron deficient anemic patients with CKD not receiving dialysis. (P&T May 2013)

iron SUCROSEVenofer
     100 mg/5 mL vial for injection

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Liver and Stomach Preparations

CyanocobalminVitamin B12
     100 mcg tablet, 1000 mcg tablet
     100 mcg/mL vial, 1000 mcg/mL vial for injection
THERAPEUTIC INTERCHANGE:
     cyanocobalamin 250 mcg = cyanocobalamin 200 mcg
     cyanocobalamin 1200 mcg = cyanocobalamin 1000 mcg


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Antithrombotic Agents

Anticoagulants

Coumarin Derivatives

WarfarinCoumadin
     1 mg, 2 mg, 2.5 mg, 5 mg tablets

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Direct Thrombin Inhibitors

Argatroban
     250 mg/2.5 mL vial for injection

BivalirudinAngiomax
     250 mg vial for injection
RESTRICTED AGENT: Reserved for use by cardiology for PCI.

DabigatranPradaxa
     75 mg, 110 mg, 150 mg capsules

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Heparins

DalteparinFragmin
     2500 units PFS, 5000 units PFS, 7500 units PFS, 10000 units PFS, 12500 units PFS, 15000 units PFS, 18000 units PFS for injection.
Note: Treatment doses of dalteparin will be rounded to facilitate the use of prefilled syringes.(P&T Dec/13)

EnoxaparinLovenox
     30 mg PFS, 40 mg PFS, 60 mg PFS, 80 mg PFS, 100 mg PFS for injection
     300 mg/3 mL multi-dose vial for injection
THERAPEUTIC INTERCHANGE: All orders for enoxaparin will be automatically substituted to dalteparin. Exception: Enoxaparin will be used for treatment dosing for Acute Coronary Syndrome patients.

FondaparinuxArixtra
     2.5 mg/0.5ml PFS, 7.5 mg/0.6ml PFS for injection

Heparin
     100 units/mL (10 mL) vial, 1000 units/mL (10 mL) vial
     1000 unit/500 mL IV bag, 2000 unit/1000 mL IV bag, 25 000 unit/500 mL IV bag
     5000 unit/0.5 mL vial for injection

TinzaparinInnohep
THERAPEUTIC INTERCHANGE: All orders for tinzaparin will be automatically substituted to dalteparin.


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Anticoagulants, Miscellaneous

Platelet-Aggregation Inhibitors

AbciximabReopro
     10 mg/5 mL vial for Injection
RESTRICTED AGENT: Reserved for use by cardiology for PCI

ApixabanEliquis
     2.5 mg, 5 mg tablet

ClopidogrelPlavix
     75 mg and 300 mg tablet

EdoxabanLixiana
     30 mg tablet
RESTRICTED AGENT: Reserved for continuation of home therapy only.

EptifibatideIntegrelin
     20 mg/10 mL vial, 75 mg/100 mL vial for injection

RiVAROxabanXarelto
     10 mg, 15 mg, 20 mg tablet

TicagrelorBrilinta
     90 mg tablet

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Thrombolytic Agents

Alteplaset-PA, Activase, Cathflow
     2 mg vial, 100mg vial for injection

TenecteplaseTNK
     50mg vial for injection

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Hematopoietic Agents

Darbepoetin AlfaAranesp
     30 mcg PFS, 40 mcg PFS, 50 mcg PFS, 60 mcg PFS, 80 mcg PFS, 100 mcg PFS, 150 mcg PFS for injection
RESTRICTED AGENT: Reserved for use by nephrology.

Epoetin AlfaEprex
     1000 unit PFS, 2000 unit PFS, 3000 unit PFS,
     4000 unit PFS, 5000 unit PFS, 6000 unit PFS,
     8000 unit PFS, 10000 unit PFS, 40 000 unit PFS for injection
     20 000 unit vial for injection
RESTRICTED AGENT: Reserved for use by nephrology.

FilgrastimGrastofil
     300 mcg/0.5 mL PFS for injection
RESTRICTED AGENT: Limited to oncology and intensive care unit.
     1. For treatment of neutropenic fever in a decompensating patient in the intensive care unit (ICU) or with plans to be admitted into the ICU.
     2. Enhance stem cell engraftment in post-autologous hematopoietic stem cell transplant admitted to Oncology service after autologous bone marrow transplant (day 1+ transfer).


FilgrastimNeupogen
     300 mcg/mL vial for injection
RESTRICTED AGENT: Neupogen will only be used in the following cases:
     Includes Grastofil restrictions for use and one of the following-
     1. For pediatric patients, who are unable to achieve the appropriate dose with the pre-filled syringes of Grastofil (300mcg and 480mcg).
     2. For patients who are unable to use available forms of Grastofil due to documented latex allergy.


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Hemorrheologic Agents

PentoxifyllineTRENtal
     400 mg tablet

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Antihemorrheologic Agents

Antiheparin Agents

Protamine
     50 mg/5 mL vial for injection

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Hemostatics

Factor VIIaNiastase
     2.4 mg vial for injection
RESTRICTED AGENT: Reserved for use by Intensivists and Emergency Room Physicians.

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Antifibrinolytics

Tranexamic AcidCyklokapron
     500 mg tablet, 1000 mg/10 mL vial for injection

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CARDIOVASCULAR DRUGS

Cardiac Drugs

Antiarrhythmic Agents

Class Ia Antiarrhythmics

DisopyramideNorpace, Rhythmodan
     150 mg capsule

ProcainamidePronestyl, Procan
     375 mg capsule, 500 mg SR tablet
     1000 mg/10 mL vial for injection
THERAPEUTIC INTERCHANGE: All orders for Pronestyl SR will by autosubstituted to Procan SR (based on 50 mg/kg/day) (P&T May/03)

Patient Weight (kg) (supplied)
40 to 50
60 to 70
80 to 90
greater than 100 kg

Pronestyl SR

500 mg q6h
750 mg q6h
1,000 mg q6h
1,250 mg q6h

Procan SR

1,000 mg q12h
1,500 mg q12h
2,000 mg q12h
2,500 mg q12h

Class Ib Antiarrhythmics

LidocaineXylocaine
     0.5% - 250 mg/50 mL vial for injection
     1% - 20 mg/2 mL neb, 50 mg/5 mL neb, 200 mg/20 mL vial, 500 mg/50 mL vial, 500 mg/50 mL with epi vial for injection
     1.5% - 450 mg/30 mL vial for injection
     2% - 100 mg/5 mL neb, 400 mg/20 mL jelly, 400 mg/20 mL vial, 1g/50 mL vial, 1g/50 mL with epi vial for injection
     4% - 2 g/50 mL vial for topical use
     5% - 35 g topical ointment
     0.4% - 2 g/500 mL dextrose

Class Ic Antiarrhythmics

FlecainideTambocor
     100 mg tablet

PropafenoneRythmol
     300 mg tablet

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Class II Antiarrhythmics

AcebutololMonitan, Rhotral, Sectral
     100 mg, 200 mg tablet

AtenololTenormin
     50 mg tablet

bisOPROLOLMonocor
     5 mg, 10 mg tablet

CarvedilolCoreg
     3.125 mg, 6.25 mg, 12.5 mg, 25 mg tablet

EsmololBrevibloc
     100 mg/ 10 mL vial for injection
     2500 mg/ 250 mL premixed IV bag

LabetololTrandate
     100 mg tablet
     100 mg/20 mL vial for injection

MetoprololLopressor
     10 mg/mL pharmacy prepared oral solution
     25 mg, 50 mg tablet
     5 mg/5 mL amp for injection

NadololCorgard
THERAPEUTIC INTERCHANGE: All orders for Nadolol daily will by autosubstituted to Propranolol bid (same daily dose) (P&T Feb/17)

NebivololBystolic
THERAPEUTIC INTERCHANGE: All orders for Nebivolol will by autosubstituted to Metoprolol
      Nebivolol 2.5 mg po once daily = Metoprolol 12.5 mg po q12h
      Nebivolol 5 mg po once daily = Metoprolol 25 mg po q12h
      Nebivolol 10 mg po once daily = Metoprolol 50 mg po q12h
      Nebivolol 20-40 mg po once daily = Metoprolol 100 mg po q12h
*MRP to assess any doses not fitting in the dosing ranges listed above.
**Pediatrics exempted


PropranololInderal
     10 mg, 40 mg tablet
     60 mg, 80 mg, LA capsule

SotalolSotacor
     80 mg tablet

TimololBlocadren
     12.5 mg/5 mL, 25 mg/5 mL opth solution (may be given po)

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Class III Antiarrhythmics

AmiodaroneCordarone
     200 mg tablet
     150 mg/3 mL vial, 900 mg/18 mL vial for injection

VernakalantBrinavess
     500 mg/25 ml vial
RESTRICTED AGENT: Restricted to Cardiology / Emergency physicians only.

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Class IV Antiarrhythmics

AdenosineAdenocard
     6 mg/2 mL vial for injection

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Antiarrhythmic, Miscellaneous

DigoxinLanoxin
     0.05 mg/mL elixir
     0.0625 mg tablet, 0.125 mg tablet, 0.25 mg tablet
     0.5 mg/2 mL amp for injection, 0.05 mg/mL amp for injection

Magnesium Sulfate
     2 g/10 mL vial for injection
THERAPEUTIC INTERCHANGE: Any orders for magnesium IV 1-3 mg = 2 mg IV
     Any orders for magnesium IV 4 mg = 2 x 2 mg IV


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Cardiotonic Agents

DigoxinLanoxin
     0.05 mg/mL elixir
     0.0625 mg tablet, 0.125 mg tablet, 0.25 mg tablet
     0.5 mg/2 mL amp for injection

MilrinonePrimacor
     10 mg/10 mL vial for injection

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Antilipemic Agents

Bile Acid Sequestrants

Cholestyramine ResinQuestran
     4 g packet for oral suspension (orange flavoured)

Colesevelam Lodalis
THERAPEUTIC INTERCHANGE:
      Colesevelam 1.875 g (3 tabs x 625 mg tabs) BID = Cholestyramine 4 g (packet) po once daily
      Colesevelam 3.75 g (sachet) once daily = Cholestyramine 4 g (packet) po once daily


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Fibric Acid Derivatives

BezafibrateBezalip
THERAPEUTIC INTERCHANGE: bezafibrate 200 mg, or 400 mg, or 600 mg or SR 400 mg will be automatically substituted with fenofibrate micro 200 mg hs.

Fenofibrate MicroLipidil
     100 mg, 200 mg capsule
THERAPEUTIC INTERCHANGE: Any order for fenofibrate (any strength, frequency or formulation) will be substituted with fenofibrate micro 200 mg qhs.

GemfibrozilLopid
THERAPEUTIC INTERCHANGE: Any orders for gemfibrozil 600 or 1200 mg will be substituted with fenofibrate micro 200 mg qhs.

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HMG-CoA Reductase Inhibitors

AtorvastatinLipitor
      10 mg, 20 mg, 40 mg, tablet

FluvastatinLescol
THERAPEUTIC INTERCHANGE:
      fluvastatin 20-80 mg = atorvastatin 10 mg at hs *if no significant interaction exists.


LovastatinMevacor
THERAPEUTIC INTERCHANGE:
     lovastatin 20-40 mg/day = atorvastatin 10 mg/day at hs *if no significant interaction exists.
     lovastatin 80 mg/day = atorvastatin 20 mg/day at hs *if no significant interaction exists.


PravastatinPravachol
THERAPEUTIC INTERCHANGE:
     pravastatin 10-20 mg/day = atorvastatin 10 mg/day at hs *if no significant interaction exists.
     pravastatin 40 mg/day = atorvastatin 20 mg/day at hs *if no significant interaction exists.


RosuvastatinCrestor
      10 mg, 40 mg tablet

SimvastatinZocor
THERAPEUTIC INTERCHANGE:
     simvastatin 10 mg = atorvastatin 5 mg/day at hs
     simvastatin 20 mg = atorvastatin 10 mg/day at hs
     simvastatin 40 mg = atorvastatin 20 mg/day at hs
     simvastatin 80 mg = atorvastatin 40 mg/day at hs



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Antilipemic, Miscellaneous

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Hypotensive Agents

Alpha-Adrenegic Blocking Agents

CarvedilolCoreg
     3.125 mg, 6.25 mg, 12.5 mg, 25 mg tablet

LabetololTrandate
     100 mg tablet
     100 mg/20 mL vial for injection

PrazosinMinipress
     1 mg, 2 mg, 5 mg tablet
RESTRICTED AGENT: For Psychiatry Only.

TerazosinHytrin
     1 mg, 5 mg tablet

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Beta-Adrenergic Blocking Agents

AcebutololMonitan, Rhotral, Sectral
     100 mg, 200 mg tablet

AtenololTenormin
     50 mg tablet

bisOPROLOLMonocor
     5 mg, 10 mg tablet

CarvedilolCoreg
     3.125 mg, 6.25 mg, 12.5 mg, 25 mg tablet

EsmololBrevibloc
     100 mg/10 mL ampule for injection
     2500 mg/ 250 mL premixed IV bag

LabetololTrandate
     100 mg tablet
     100 mg/20 mL vial for injection

MetoprololLopressor
     10 mg/mL pharmacy prepared syringe
     25 mg, 50 mg tablet
     5 mg/5 mL ampule for injection

nadololCorgard
THERAPEUTIC INTERCHANGE: All orders for Nadolol daily will by autosubstituted to Propranolol bid (same daily dose) (P&T Feb/17)

NebivololBystolic
THERAPEUTIC INTERCHANGE: All orders for Nebivolol will by autosubstituted to Metoprolol
      Nebivolol 2.5 mg po once daily = Metoprolol 12.5 mg po q12h
      Nebivolol 5 mg po once daily = Metoprolol 25 mg po q12h
      Nebivolol 10 mg po once daily = Metoprolol 50 mg po q12h
      Nebivolol 20-40 mg po once daily = Metoprolol 100 mg po q12h
*MRP to assess any doses not fitting in the dosing ranges listed above.
**Pediatrics exempted


PropranololInderal
     10 mg, 40 mg tablet
     60 mg, 80 mg, LA capsule

SotalolSotacor
     80 mg tablet

TimololBlocadren
     12.5 mg/5 mL, 25 mg/5 mL po solution

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Calcium-Channel Blocking Agents

Dihydropyridines

amLODIPineNorvasc
     5 mg tablet

felodipinePlendil
THERAPEUTIC INTERCHANGE: All orders for felodipine will be automatically substituted to amLODIPine at the same dose & frequency, maximum 10 mg/day.

NIFEdipine PAAdalat PA
THERAPEUTIC INTERCHANGE:
     nifedipine PA 20 mg bid = nifedipine XL 30 mg once daily
     nifedipine PA 40 mg bid = nifedipine XL 60 mg once daily

NIFEdipine XLAdalat XL
     20 mg XL, 30 mg XL, 60 mg XL tablet

niMODipineNimotop
     30 mg Capsule

Non-Dihydropyridines

DiltiazemCardizem
     30 mg tablet
     25 mg/5 mL vial for injection

Diltiazem ERCardizem ER, Tiazac
     120 mg, 180 mg extended-release capsule

Diltiazem SRCardizem SR
THERAPEUTIC INTERCHANGE:
     diltiazem SR 60 mg bid = diltiazem ER (Tiazac) 120 mg once daily
     diltiazem SR 90 mg bid = diltiazem ER (Tiazac) 180 mg once daily
     diltiazem SR 120 mg bid = diltiazem ER (Tiazac) 240 mg once daily


Diltiazem CDCardizem CD
THERAPEUTIC INTERCHANGE:
     diltiazem CD 120 mg once daily = diltiazem ER (Tiazac) 120 mg once daily
     diltiazem CD 180 mg once daily = diltiazem ER (Tiazac) 180 mg once daily
     diltiazem CD 240 mg once daily = diltiazem ER (Tiazac) 240 mg once daily


VerapamilIsoptin
     10 mg/mL pharmacy prepared suspension
     80 mg, 120 mg tablet
     180 mg, 240 mg sustained-release tablet
     5 mg/2 mL vial for injection

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Central Alpha-Agonists

cloNIDineCatapres, Dixarit
     0.025 mg, 0.1 mg tablet

MethyldopaAldomet
     250 mg
THERAPEUTIC INTERCHANGE: All orders for Aldoril (methyldopa/HCTZ) will be autosubstitued to the separate agents. (methyldopa 250mg + HCTZ 12.5mg for Aldomet 250/15mg, methyldopa 250mg + HCTZ 25mg for Aldomet 250/25mg) (P&T May/03)

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Direct Vasodilators

hydrALAZINEApresoline
     10 mg, 25 mg tablet
     20 mg/ampule for injection
THERAPEUTIC INTERCHANGE: Any orders for hydrALAZINE 25 mg IM will be automatically substituted to hydrALAZINE 20 mg IM

MinoxidilLoniten
     2.5 mg, 10 mg tablet

NitroprussideNipride
     50 mg/vial for injection

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Diuretics

Carbonic Anhydrase Inhibitors

acetaZOLAMIDEDiamox
     500 mg vial
     250 mg tablet
THERAPEUTIC INTERCHANGE: All orders for acetaZOLAMIDE 500 mg SR po bid will be autosubstituted to acetaZOLAMIDE 250 mg po qid (P&T May/03)

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Loop Diuretics

Ethacrynic AcidEdecrin
     25 mg tablet
     50 mg/vial for injection

FurosemideLasix
     10 mg/mL oral syrup
     20 mg tablet, 40 mg tablet
     40 mg/ 4 mL vial for injection

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Osmotic Diuretics

MannitolOsmitrol
     20% in 500 mL water for infusion
     12.5 g/50 mL vials (25%)

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Potassium-Sparing Diuretics

aMILorideMidamor
     5 mg tab

aMILoride (in combination with HCTZ)Moduret
     5 mg/50 mg HCTZ

Spironolactone — Spirontin, Aldactone
     25 mg tablet, 100 mg tablet

Triamterene (in combination with HCTZ)Dyazide
     50 mg/25 mg HCTZ

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Thiazide Diuretics

hydroCHLOROTHIAZIDEHydroDIURIL
     25 mg tablet

IndapamideLozide
     2.5 mg tablet

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Thiazide-Like Diuretics

MetolazoneZaroxolyn
     2.5 mg tablet

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Diuretics, Miscellaneous

TheophyllineTheo-Dur
     150 mg, 300 mg SR tablet

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Renin-Angiotensin-Aldosterone System Inhibitors

Angiotensin-Converting Enzyme Inhibitors

BenazaprilLotensin
THERAPEUTIC INTERCHANGE:
     benazapril 5-10 mg/day = perindopril 2 mg once daily
     benazapril 20 mg/day = perindopril 4 mg once daily
     benazapril 30 mg/day or greater = perindopril 8 mg once daily


CaptoprilCapoten
THERAPEUTIC INTERCHANGE:
     captopen 25 mg/day = perindopril 2 mg once daily
     captopen 50 mg/day = perindopril 4 mg once daily
     captopen 100 mg/day or greater = perindopril 8 mg once daily


CilazaprilInhibace
THERAPEUTIC INTERCHANGE:
     cilazapril 1-2.5 mg/day = perindopril 2 mg once daily
     cilazapril 5 mg/day = perindopril 4 mg once daily
     cilazapril 10 mg/day = perindopril 8 mg once daily


EnalaprilVasotec
THERAPEUTIC INTERCHANGE:Any orders for enalapril po will be substituted as follows:
     enalapril 2.5-15 mg/day = perindopril 2 mg once daily
     enalapril 20 mg/day = perindopril 4 mg once daily
     enalapril greater than 20 mg/day = perindopril 8 mg once daily


     Note: Enalapril (Vasotec) 1.25 mg/ml Injection is formulary.

FosinoprilMonopril
THERAPEUTIC INTERCHANGE:
     fosinopril 5 mg/day = perindopril 2 mg once daily
     fosinopril 10-30 mg/day = perindopril 4 mg once daily
     fosinopril greater than 30 mg/day = perindopril 8 mg once daily


LisinoprilZestril, Prinivil
     5 mg, 10 mg tablets

PerindoprilCoversyl
     2 mg, 4 mg, 8 mg tablets

QuinaprilAccupril
THERAPEUTIC INTERCHANGE:
     quinapril 10 mg/day = perindopril 2 mg once daily
     quinapril 20 mg/day = perindopril 4 mg once daily
     quinapril 40 mg/day or greater = perindopril 8 mg once daily


RamiprilAltace
     1.25 mg, 2.5 mg, 5 mg capsules

TrandaloprilMavik
     0.5 mg, 1 mg, 4 mg capsules

Angiotensin II Receptor Antagonists

CandesartanAtacand
THERAPEUTIC INTERCHANGE:
     candesartan 4 mg = valsartan 40 mg
     candesartan 8 mg = valsartan 80 mg
     candesartan 16 mg = valsartan 160 mg
     candesartan 32 mg = valsartan 320 mg


EprosartanTeveten
THERAPEUTIC INTERCHANGE:
     eprosartan 400 mg = valsartan 80 mg
     eprosartan 600 mg = valsartan 160 mg
     eprosartan 800 mg = valsartan 320 mg


IrbesartanAvapro
     150 mg tablet

LosartanCozaar
THERAPEUTIC INTERCHANGE:
     losartan 25 mg = valsartan 40 mg
     losartan 50 mg = valsartan 80 mg
     losartan 100 mg = valsartan 160 mg


OlmesartanBenicar
THERAPEUTIC INTERCHANGE:
     olmesartan 20 mg = valsartan 80 mg
     olmesartan 40 mg = valsartan 160 mg


Sacubitril/ValsartanEntresto
     24/26 mg tablets
     49/51 mg tablets
     97/103 mg tablets

TelmisartanMicardis
THERAPEUTIC INTERCHANGE:
     telmisartan 20 mg = valsartan 80 mg
     telmisartan 40 mg = valsartan 160 mg
     telmisartan 80 mg = valsartan 320 mg


ValsartanDiovan
     80 mg, 160 mg tablet

Mineralocorticoid (Aldosterone) Receptor Antagonists

SpironolactoneSpirontin, Aldactone
     25 mg, 100 mg tablet

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Hypotensive Agents, Combination Products

Viacoram
THERAPEUTIC INTERCHANGE: Pharmacy will supply individual components of combo medication.
     Viacoram 3.5/2.5 mg tablet = perindopril 4 mg and amlodipine 2.5 mg (same directions)
     Viacoram 7/5 mg tablet = perindopril 8 mg and amlodipine 5 mg (same directions)
     Viacoram 14/10 mg tablet = perindopril 16 mg and amlodipine 10 mg (same directions)

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Hypotensive Agents, Miscellaneous

PhentolamineRogitine
     5 mg/mL vial for injection

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Vasodilating Agents

Nitrates and Nitrites

Isosorbide DinitrateIsordil
     10 mg, 30 mg tablet

Isosorbide mononitrateImdur
     60 mg SR tablet

Nitroglycerin, ParenteralNitroject, Tridil
     50 mg/10 mL injection

Nitroglycerin, SublingualNitrospray, Nitrostat
     0.4 mg spray
THERAPEUTIC INTERCHANGE: All orders for nitroglycerin sublingual tablet 0.3mg or 0.6mg will be automatically substituted to nitroglycerin spray 0.4mg (P&T May/03)

Nitroglycerin, TransdermalNitro-Dur, Transderm Nitro
     0.2 mg/h, 0.4 mg/h, 0.6 mg/h patch
THERAPEUTIC INTERCHANGE: All orders for nitropatch will be automatically substituted to 12 hours on 12 hours off unless otherwise specified (P&T nov 07)

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Vasodilating Agents, Miscellaneous

AlprostadilProstaglandin, Prostin VR
     500 mcg/ml ampule for injection

DipyridamolePersantine
     25 mg, 50 mg tablet
     50 mg/10 mL ampule for injection

Dipyridamole (in combination ASA)Aggrenox
     200 mg/25 mg capsule

Epoprostenol SodiumFlolan
      1.5 mg vial and diluent for inhalation (available in 15 mcg/ml and 30 mcg/ml kits)

Papavarine HCl
     65 mg/ 2 mL vial for injection

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Sclerosing Agents

Ethanolamine OleateEthamolin
     50 mg/mL ampule for injection

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CENTRAL NERVOUS SYSTEM AGENTS

Central Nervous System Agents

General Anesthetics

Barbiturates

Inhalation Anesthetics

DesfluraneSuprane
     Inhalation gas

IsofluraneForane
     Inhalation gas

SevofluraneUltane
     Inhalation gas

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General Anethetics, Miscellaneous

EtomidateAmidate
     20 mg/10 mL vial for injection
SPECIAL ACCESS: Requires proper documentation (attached with drug) to be filled out and sent to pharmacy for special access approval.

Ketamine HClKetamine
     200 mg/20 mL, 500 mg/10 mL vial for injection

PropofolDiprivan
     1000 mg/100 mL, 200 mg/20 mL vial for injection

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Analgesics and Antipyretics

Non Steroidal Anti-inflammatory Agents

1) Cylooxygenase-2 (COX-2) Inhibitors

CelecoxibCeleBREX
     100 mg, 200 mg capsules

2) Salicylates

Acetylsalicylic AcidASA, Aspirin
     80 mg chew tablet
     325 mg tablet
     160 mg and 650 mg suppository

Acetylsalicylic Acid, Enteric CoatedNovasen, Entrophen
     80 mg, 325 mg tablet
THERAPEUTIC INTERCHANGE: All orders for ECASA 80 mg will be automatically substituted to ECASA 81 mg. All orders for ECASA via feeding tube will be automatically substituted to ASA at an equivalent dosage.

3) Other Non-Steroidal Anti-Inflammatory Agents

DiclofenacVoltaren
     25 mg, 50 mg tablet
     75 mg, 100 mg SR tablet

Diclofenac/MisoprostolArthrotec
     50/200 mg, 75/200 mg tablet

IbuprofenAdvil, Motrin
     20 mg/mL suspension
     200 mg, 300 mg, 400 mg tablet

IndomethacinIndocid
     25 mg, 50 mg capsule
     100 mg suppository
     IV RESTRICTED: to the NICU for patent ductus arteriosus closure in verylow birth weight babies.

KetorolacToradol
     30 mg/mL amp for injection
     10 mg tablets

NaproxenNaprosyn, Anaprox
     250 mg, 375 mg tablet
     250 mg, 375 mg enteric coated tablet

Naproxen and EsomeprazoleVimovo
THERAPEUTIC INTERCHANGE: Use patient's own first. If unable to obtain within 24 hrs then Vimovo 375 mg/20 mg twice daily will be automatically substituted to Naproxen 375 mg twice daily and Pantoprazole 40 mg once daily.

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Opiate Analgesics

AC&C
THERAPEUTIC INTERCHANGE: All orders for AC&C will be automatically substituted to Tylenol + codeine, based on codeine content.
      AC&C 8 mg (222's) = Tylenol No. 1
      AC&C 8 mg (282's) = Tylenol No. 2
      AC&C 8 mg (292's) = Tylenol No. 3


Codeine
     5 mg/mL syrup
     30 mg tablet
     30 mg/mL vial for injection

Codeine / Acetaminophen / Caffeine Tylenol No. 1/2/3/4
     8 mg/160 mg/0 mg/5 mL syrup
     8 mg/325 mg/30 mg tablet (Tylenol No. 1)
     15 mg/300 mg/15 mg tablet (Tylenol No. 2)
     30 mg/300 mg/15 mg tablet (Tylenol No. 3)
     60 mg/300 mg/0 mg tablet (Tylenol No. 4)

fentaNYLDuragesic
     12 mcg/h, 25mcg/h, 50mcg/h, 75mcg/h, 100mcg/h patch
     100 mcg/2 mL, 250 mcg/5 mL, 1000 mcg/20 mL vial for injection
THERAPEUTIC INTERCHANGE: All orders for fentanyl 12.5 mcg patch will be substituted with fentanyl 12 mcg patch.

HYDROmorphoneDilaudid, Dilaudid HP/XP
     1 mg/mL, 5 mg/5 mL solution
     2 mg, 4 mg tablet
     2 mg/mL, 10 mg/mL (Dilaudid HP), 50 mg/5 mL (Dilaudid HP),
     500 mg/50 mL (Dilaudid HP) vial for injection

HYDROmorphone, controlled releaseHydromorph Contin
     3 mg, 6 mg, 12 mg, 24 mg, 30 mg capsule

MorphineMS IR
     5 mg/mL solution
     5 mg, 10 mg IR (immediate release) tablet
     2 mg/mL, 10 mg/mL, 15 mg/mL, 50 mg/ml vial for injection
     30 mg/30 mL PCA

Morphine, controlled releaseM.O.S., MSContin, MEslon
     10 mg, 15 mg, 30 mg, 60 mg, 100 mg, SR capsule
THERAPEUTIC INTERCHANGE: All orders for MS Contin will be automatically substituted to M-Eslon, same dose and frequency (P&T Jan/00)

Morphine EpiduralEpimorph
     5 mg/10 mL vial for injection

MeperidineDemerol
     50 mg/mL injection
RESTRICTED AGENT: For use in patients with documented anaphylactic allergic reactions to morphine and dilaudid OR drug induced rigors (ie. secondary to chemotherapy) OR for post-op shivering OR antepartum/laboring.

MethadoneMetadol
     10 mg/mL oral solution
     1 mg, 5 mg, 25 mg tablet

Opium / BelladonnaB&O
THERAPEUTIC INTERCHANGE: All orders for B&O suppositories prn for bladder spasms will be automatically substituted to Hyoscine (Buscopan) 10 mg sc injection daily prn. *Pediatrics exempted.

oxyCODONEOxyNeo
     5 mg, 10 mg, 20 mg, 40 mg CR (controlled release) tablets

oxyCODONE / AcetaminophenOxycocet, Percocet
     5 mg/325 mg tablet

REMIfentanilUltiva
     2 mg vial for injection

SUFentanilSufenta
     250 mcg/5 mL vial for injection

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Opiate Partial Agonists

Buprenorphine/NaloxoneSuboxone
     2 mg buprenorphine / 0.5 mg naloxone tablets
     8 mg buprenorphine / 2 mg naloxone tablets

NalbuphineNubain
     10 mg/mL vial for injection (LDMH only)


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Analgesics & Antipyretics, Miscellaneous

AcetaminophenTylenol, Tempra
     80 mg/mL solution, 320 mg/10 mL elixir
     325 mg tablet
     120 mg, 650 mg suppository
THERAPEUTIC INTERCHANGE:
     acetaminophen 500 mg tablet = acetaminophen 650 mg tablet (same frequency, not to exceed 4 g/day)
     acetaminophen 1000 mg = acetaminophen 975 mg (same frequency, not to exceed 4 g/day)
     acetaminophen elixir 325 mg = acetaminophen elixir 320 mg (same frequency, not to exceed 4 g/day)
     acetaminophen any PRN order = acetaminophen 325-650 mg (320-640 mg if liquid) Q4H PRN (same route, not to exceed 4 g/day)(P&T Dec/13)


Pediatrics: Acetaminophen 40 mg/kg/dose rectally x1 dose only, may be used for peri-operative analgesia.
Approved by Dept. of Anesthesia Sept. 2008

Acetaminophen ERTylenol Arthritis Pain
THERAPEUTIC INTERCHANGE:
     acetaminophen ER 650 mg tablet bid or q12h = acetaminophen 325 mg tablet q6h
     acetaminophen ER 650 mg tablet tid or q8h = acetaminophen 325 mg tablet q4h
     acetaminophen ER 1300 mg tablet bid or q12h = acetaminophen 650 mg tablet q6h
     acetaminophen ER 1300 mg tablet tid or q8h = acetaminophen 975 mg tablet q6h

Acetaminophen/traMADolTramACET
     325 mg acetaminophen/37.5 mg traMADol tablets

Tapentadol extended releaseNucynta ER
THERAPEUTIC INTERCHANGE: All orders for tapentadol ER will be automatically substituted to traMADol ER
     tapentadol ER 50 mg q12h = traMADol ER 100 mg q24h
     tapentadol ER 100 mg q12h = traMADol ER 200 mg q24h


traMADol ERTridural ER, Ralivia ER
     100 mg, 200 mg and 300 mg tablets

Tapentadol immediate releaseNucynta IR
THERAPEUTIC INTERCHANGE: All orders for tapentadol IR will be automatically substituted to traMADol IR
     tapentadol IR 50 mg q4-6h prn = traMADol IR 50 mg q4-6h prn
     tapentadol IR 100 mg q4-6h prn = traMADol IR 100 mg q4-6h prn


traMADol IRUltram IR
     50 mg tablet

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Opiate Antagonists

Naloxone HClNarcan
     0.4 mg/mL amp, 2 mg/2 mL vial, 4 mg/10 mL vial for injection

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Anticonvulsants

Barbiturates

PHENobarbitalNembutal
     5 mg/mL elixir
     15 mg, 30 mg tablet
     30 mg/mL, 120 mg/mL amp for injection

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Benzodiazepines

clonazePAMRivotril
     0.5 mg, 2 mg tablet

DiazepamValium
     1 mg/mL oral solution
     2 mg, 5 mg tablet
     10 mg/2 mL vial for injection

LORazepamAtivan
     0.5 mg, 1 mg tablet
     2 mg/mL vial for injection

MidazolamVersed
     2 mg/2 mL, 5 mg/5 mL, 10 mg/2 mL, 50 mg/10 mL vial for injection

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Hydantoins

FosphenytoinCerebyx
     750 mg/10 mL (equal to 500 mg/10 mL of phenytoin)

PhenytoinDilantin
     25 mg/mL oral suspension
     50 mg chew tablet, 100 mg capsule
     100 mg/2 mL, 250 mg/5 mL vial for injection
To ensure complete and consistent absorption of phenytoin suspension via NG tube:
1) stop tube feed for 1/2 hour after flushing NG tube with 20 mL water
2) mix prescribed dose of phenytoin suspension (shake well) with a double volume of water (i.e., 5 mL phenytoin suspension with 10 mL water)
3) administer phentoin/water mixture
5) restart tube feed 1/2 hour after giving phenytoin


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Succinimides

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Anticonvulsants, Miscellaneous

carBAMazepineTegretol
     20 mg/mL oral suspension
     200 mg tablet
     100 mg, 200 mg chew tablet
     200 mg, 400 mg controlled-release tablet

DIvalproEX SodiumEpival
     125 mg, 250 mg, 500 mg EC (enteric-coated) tablet

GabapentinNeurontin
     100 mg, 300 mg, 400 mg capsule

LevetiracetamKeppra
     250 mg, 500 mg tablet
RESTRICTED/SPECIAL ACCESS: IV formulation restricted to Met and Ouellette Campuses Critical Care and Neurology as an antiepileptic agent to be used for refractory status epiletpticus.
     100 mg/ml (5 ml) vial for injection


Magnesium Sulfate
     2 g/10 mL injection
THERAPEUTIC INTERCHANGE: Any orders for magnesium IV 1-3 mg = 2 mg IV
      Any orders for magnesium IV 4 mg = 2 x 2 mg IV


PregabalinLyrica
     25 mg, 50 mg, 75 mg, 150 mg capsule

PrimidoneMysoline
     250 mg tablet

TopiramateTopamax
     25 mg, 100 mg tablet

valproATE SODIUMDepaconEpiject
RESTRICTED/SPECIAL ACCESS: IV formulation restricted to Met and Ouellette Campuses Critical Care and Neurology as an antiepileptic agent to be used for refractory status epiletpticus.
     100 mg/ml (5 ml) vial for injection


valproIC ACIDDepakene
     50 mg/mL oral syrup
     250 mg capsule
     500 mg EC (enteric-coated) capsule


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Psycotherapeutic Agents

Antidepressants

Monoamine Oxidase Inhibitor (MAOI)

MoclobemideManerix
     100 mg, 150 mg tablet

Selective Norepinepherine-Reuptake Inhibitors (SNRI)

DesvenlafaxinePristiq
THERAPEUTIC INTERCHANGE: Any orders for desvenlafaxine will be automatically substituted to venlafaxine.
     desvenlafaxine SR 50 mg once daily = venlafaxine XR 75 mg once daily
     desvenlafaxine SR 100 mg once daily = venlafaxine XR 150 mg once daily


DuloxetineCymbalta
     30 mg, 60 mg capsules

VenlafaxineEffexor, Effexor XR
     37.5 mg, 75 mg, 150 mg extended-release capsule (XR)

Selective Serotonin-Reuptake Inhibitors (SSRI)

CitalopramCeleXA
     20 mg tablet

EscitalopramCipralex
     10 mg, 20 mg tablet

FLUoxetineProzac
     20 mg/5 mL oral solution
     10 mg, 20 mg capsule

FluvoxamineLuvox
     50 mg tablet

PARoxetinePaxil
     10 mg, 20 mg, 30 mg tablet

SertralineZoloft
     25 mg, 50 mg capsule

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Serotonin Modulators

traZODoneDesyrel
     10 mg/mL pharmacy prepared oral suspension
     50 mg, 150 mg tablet

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Tricyclics and Other Norepinepherine-Reuptake Inhibitors

AmitriptylineElavil
     10 mg, 25 mg, 50 mg tablet

clomiPRAMINEAnafranil
     10 mg, 25 mg, 50 mg tablet

DesipramineNorpramin
     10 mg, 25 mg tablet

DoxepinSINEquan
     10 mg, 25 mg, 50 mg capsule

ImipramineTofranil
     10 mg, 25 mg, 75 mg tablet

norTRIPTYLINEAventyl
     10 mg, 25 mg capsule

TrimipramineSurmontil
     25 mg tablet

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Antidepressants, Miscellaneous

BuproprionWellbutrin
     150 mg XL, 300 mg XL tablet
THERAPEUTIC INTERCHANGE: All orders for Wellbutrin SR will be automatically substituted to Wellbutrin XL on a 1:1 ratio with Wellbutrin XL being given once daily - for example if Wellbutrin SR 150 mg bid would be substituted with Wellbutrin XL 300 mg daily)

MirtazapineRemeron
     15 mg, 30 mg tablet

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Antipsychotics

Antypical Antipsychotics

ARIPiprazoleAbilify
     2 mg, 5 mg, 10 mg, 15 mg, 30 mg tablet
RESTRICTION: Restricted to psychiatry for initiation of therapy.

ClozapineClozaril
     25 mg, 100 mg tablet

OLANZapineZyPREXA, Zydis
     2.5 mg, 5 mg, 10 mg tablet
     5 mg, 10 mg wafer (Zydis)
     10 mg/mL vial for IM injection

PaliperidoneInvega, Invega Sustenna
     3 mg, 6 mg tablet
     50 mg, 75 mg, 100 mg, 150 mg injection

QUEtiapineSEROquel, SEROquel XR
     25 mg, 100 mg, 200 mg tablet
     50 mg, 200 mg XR tablet

RisperidoneRisperdal
     1 mg/mL oral solution
     0.25 mg, 1 mg tablet
     0.5 mg, 1 mg, 2 mg wafer (M-Tab)

Risperidone — Risperdal Consta
     25 mg/2 mL vial for IM injection (long acting depot)
RESTRICTION: One dose only prior to discharge by psychiatrists.

ZiprasidoneZeldox
     20 mg, 40 mg, 60 mg capsule

Butyrophenones

HaloperidolHaldol, Haldol-LA
     2 mg/mL oral solution
     0.5 mg, 1mg, 2 mg, 5mg, 10 mg tablet
     5 mg/mL amp, 100 mg/mL vial for IM injection (long-acting depot)

Phenothiazines

chlorproMAZINELargactil, Thorazine
     25 mg, 100 mg tablet

Fluphenazine DecanoateModecate
     100 mg/1 mL ampule for IM injection

Flupenthixol DecanoateFluanxol Depot
     40 mg/2 mL, 200 mg/2 mL ampule for IM injection

PerphenazineTrilafon
     4mg tablet, 8 mg tablet

ProchlorperazineStemetil
     5 mg, 10 mg tablets
     10 mg suppository

TrifluoperazineStelazine
     1 mg, 5 mg tablet

Thioxanthenes

Zuclopenthixol AcetateClopixol Accuphase
     50 mg/mL injection

Zuclopenthixol DecanoateClopixol Depot
     200 mg/mL injection

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Antipsychotic, Miscellaneous

LoxapineLoxapac
     5 mg, 10 mg, 25 mg tablet
     50 mg/mL amp

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Anorexigenic Agents & Respiratory & Cerebral Stimulants

Amphetamines

DextroamphetamineDexedrin
     5 mg tablet

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Anorexigenic Agents & Respiratory & Cerebral Stimulants, Miscellaneous

CaffeineCaffeine
     IV RESTRICTED: to pediatrics for the treatment of apnea of prematurity.


MethyphenidateRitalin
     10 mg tablet

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Anxiolytics, Sedatives & Hypnotics

Barbiturates

PHENobarbitalNembutal
     5 mg/mL elixir
     15 mg, 30 mg tablet
     30 mg/mL, 120 mg/mL amp for injection

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Benzodiazepine

ALPRAZolamXanax
THERAPEUTIC INTERCHANGE:
     ALPRAZolam 0.25 mg = LORazepam 0.5 mg
     ALPRAZolam 0.5 mg = LORazepam 1 mg

BromazepamLectopam
THERAPEUTIC INTERCHANGE:
     bromazepam 1.5 mg = LORazepam 0.25 mg
     bromazepam 3 mg = LORazepam 0.5 mg
     bromazepam 6 mg = LORazepam 1 mg

chlordiazePOXIDELibrium
     5 mg, 10 mg, 25 mg capsule

ClobazamFrisium
     10 mg tablet

clonazePAMRivotril
     0.5 mg, 2 mg tablets

ClorazepateTranxene
THERAPEUTIC INTERCHANGE:
     clorazepate 3.75 mg = chlordiazepoxide 5 mg
     clorazepate 7.5 mg = chlordiazepoxide 10 mg


DiazepamValium
     1 mg/mL oral solution
     2 mg, 5 mg tablet
     10 mg/2 mL vial for injection

FlurazepamDalmane
THERAPEUTIC INTERCHANGE:
     flurazepam 15 mg = oxazepam 15 mg (LDMH Only)
     flurazepam 30 mg = oxazepam 30 mg (LDMH Only)

     flurazepam 15 mg = temazepam 15 mg
     flurazepam 30 mg = temazepam 30 mg


LORazepamAtivan
     0.5 mg, 1 mg, tablet
     2 mg/mL amp for injection

MidazolamVersed
     2 mg/2 mL, 5 mg/5 mL, 10 mg/2 mL, 50 mg/10 mL vial for injection

NitrazepamMogadon
THERAPEUTIC INTERCHANGE:
     nitrazepam 5 mg = oxazepam 15 mg (LDHM Only)
     nitrazepam 10 mg = oxazepam 30 mg (LDMH Only)

     nitrazepam 5 mg = temazepam 15 mg
     nitrazepam 10 mg = temazepam 30 mg


OxazepamSerax
     10 mg, 15 mg tablet

TemazepamRestoril
     15 mg capsule

TriazolamHalcion
THERAPEUTIC INTERCHANGE:
     triazolam 0.125 mg = oxazepam 15 mg
     triazolam 0.25 mg = oxazepam 30 mg


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Anxiolytics, Sedatives & Hypnotics; Miscellaneous

busPIRonebusPAR
     10 mg tablet

Chloral HydrateNoctec
     100 mg/mL oral syrup
RESTRICTED: For Pediatric use Only

DexmedetomidinePrecedex
     200 mcg/2 mL vial for injection

hydrOXYzine HClAtarax
     10 mg/5 mL syrup
     10 mg, 25 mg, 50 mg capsule
     50 mg/mL vial for injection

MethotrimeprazineNozinan
     2 mg, 5 mg, 25 mg tablet
     25 mg/mL amp for injection

Paraldehyde
     500 mcg/5 mL amp for injection

ZopicloneImovane
     7.5 mg tablet
THERAPEUTIC INTERCHANGE: All orders for zopiclone 5mg will be automatically substituted to zopiclone 3.75 mg.

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Antimanic Agents

carBAMazepineTegretol
     20 mg/mL oral suspension
     200 mg tablet
     100 mg, 200 mg chew tablet
     200 mg, 400 mg controlled-release tablet

GabapentinNeurontin
     100 mg, 300 mg, 400 mg capsule

Lithium CarbonateCarbolith, Lithane
     150 mg, 300 mg capsule

valproIC ACIDDepakene
     50 mg/mL oral syrup
     250 mg capsule,
     500 mg EC (enteric-coated) capsule

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Antimigrane Agents

Selective Seretonin Agonists

SUMAtriptanImitrex
     6 mg/0.5 mL vial for injection

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Antimigrane Agents, Miscellaneous

Ergonovine
     0.25 mg/mL amp for injection
RESTRICTED: to OB (Met Campus)


PropranololInderal
     10 mg, 40 mg tablet
     60 mg, 80 mg LA capsule

TimololBlocadren
     12.5 mg/5 mL, 25 mg/5 mL PO Solution

valproIC ACIDDepakene
     50 mg/mL oral syrup
     250 mg capsule,
     500 mg EC (enteric-coated) capsule

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Central Nervous System Agents, Miscellaneous

AmantadineSymmetrel
     10 mg/mL syrup
     100 mg capsule

EntacaponeComtan
     200 mg tab

FlumazenilAnexate
     0.5 mg/5 mL vial for injection

Levodopa / CarbidopaSinemet
     100 mg/10 mg, 100 mg/25 mg, 250 mg/25 mg tablet
     100 mg/25 mg, 200 mg/25 mg controlled-release tablet
THERAPEUTIC INTERCHANGE: All orders for levodopa/benserazide will be autosubstituted to levodopa/carbidopa (same dose levodopa and frequency) (P&T May/03)

PramipexoleMirapex
     0.25 mg tablet

PrimidoneMysoline
     250 mg tablet

SugammadexBridion
     100 mg/ml (5 ml) vial for injection
RESTRICTED: Restricted to Critical Care and Anesthesia

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DIAGNOSTIC AGENTS

Adrenocortical Insufficiency

CosyntropinCortrosyn
     250 mcg/vial for injection
THERAPEUTIC INTERCHANGE: All orders for ACTH will be automatically substituted to cosyntropin.

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Gallbladder Function

Cholecystokinase
THERAPEUTIC INTERCHANGE: All orders for cholecystokinase will be automatically substituted to sincalide.

SincalideKinevac
     5 mcg/vial for injection

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Pituitary Function

L’Arginine
     7.5 g/30 mL vial or injection

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Tuberculosis

TuberculinTB Skin Test
     5 TU/0.1 mL injection

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ELECTROLYTIC, CALORIE & WATER BALANCE


Alkalinizing Agents


Sodium Bicarbonate
     325 mg tablets
     10 mEq/10 mL (pediatric), 50 Meq/50 mL prefilled syringes
     42 g/50 mL vial for injection
THERAPEUTIC INTERCHANGE: Any orders for 500 mg tablets will be substituted to 2 x 325 mg (same frequency)

Sodium CitrateCitraflow
     4% prefilled syringe for injection
Renal Dialysis use only

Anticoagulant Citrate Dextrose SolnACD Soln
     500 ml, 1000 ml bag for injection
Renal Dialysis use only

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Ammonia Detoxicants


LactuloseAcilac, Chronulac, Laxative Of Choice
     667 mg/mL (15 mL, 30 mL) oral syrup
THERAPEUTIC INTERCHANGE: Any order for laxative of choice will be automatically supplied with lactulose 30 ml bid prn

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Replacement Preparations


Calcium Salts

Calcium CarbonateOs-Cal
     1250 mg tablet (equivalent to 500 mg elemental calcium)
THERAPEUTIC INTERCHANGE: All orders for calcium carbonate 1500 mg (600 mg elemental calcium) will be automatically substituted to calcium carbonate 1250 mg (500 mg elemental calcium).

Calcium CarbonateTums
THERAPEUTIC INTERCHANGE:
     Tums = Os-Cal 250 (calcium carbonate 625 mg)
     Tums ES, Tums Ultra, or for Renal Patients = Os-Cal 500 (calcium carbonate 1250 mg)


Calcium Chloride
     1000 mg/10 mL pre filled syringe for injection

Calcium Gluconate
     100 mg/mL 10% (10 mL) vial for injection
THERAPEUTIC INTERCHANGE: Any orders for calcium 1 g IV will be automatically substituted to 2 g IV
     2.5% gel (non-formulary)
NON-FORMULARY / RESTRICTED AGENT: Calcium gluconate gel is non-formulary item reserved for use only in hydrofluoric acid (HF) burns. It is stocked in the Emergency Room only.

Calcium Lactacte/gluconate/carbonateCalcium Sandoz Forte
THERAPEUTIC INTERCHANGE: Any orders for calcium effervescent 500 mg tabs (any frequency) will be automatically substituted to calcium liquid 500 mg (25 ml) same frequency.

Calcium LactogluconateSoluCAL
     500 mg/25 ml (500 mg elemental calcium) oral liquid

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Magnesium Salts

Magnesium GlucoheptonateMagnesium Rougier
     100 mg/mL (15 mL, 30 mL) oral liquid
THERAPEUTIC INTERCHANGE: Any orders for magnesium supplement liquid will be automatically substituted to magnesium glucoheptonate liquid (same elemental magnesium and frequency).

Magnesium Oxide
     420 mg (250 mg elemental magnesium) tablet
THERAPEUTIC INTERCHANGE: Any orders for magnesium supplement tablets will be automatically substituted to magnesium oxide 420 mg tablets (same elemental magnesium and frequency).

Magnesium HydroxideMilk of Magnesia
     30 mL oral liquid

Magnesium Sulfate
     2 g/10 mL vial for injection
THERAPEUTIC INTERCHANGE: Any orders for magnesium 1-3 mg IV will be automatically substituted to 2 mg IV
      Any orders for magnesium 4 mg IV will be automatically substituted to 2 x 2 mg IV


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Potassium Supplements

Potassium Acetate
     4mEq/mL (50 mL) vial for injection

Potassium Chloride, liquid
     20 mEq/15 mL (10 %) oral solution
THERAPEUTIC INTERCHANGE: All potassium liquids will be automatically substituted to KCl 10% solution at the equivalent mEq of potassium.
Any NEW orders for oral potassium started in hospital with no stop date with automatically have a 3 day automatic stop assigned to them.
*Exception will be patients on oral potassium supplementation at home, which is continued while in hospital OR for Pediatric patients.


Apo K OR Slow K
     8 mEq tablet (600 mg)
THERAPEUTIC INTERCHANGE:      Apo K OR Slow K 8 mEq (600 mg) = K-Dur 10 mEq
Any NEW orders for oral potassium started in hospital with no stop date with automatically have a 3 day automatic stop assigned to them.
*Exception will be patients on oral potassium supplementation at home, which is continued while in hospital OR for Pediatric patients.


Potassium Chloride SRK-Dur
     20 mEq tablet
THERAPEUTIC INTERCHANGE: All orders for potassium citrate 25 mmol will be automatically substituted to K-Dur 20mEq.
Any NEW orders for oral potassium started in hospital with no stop date with automatically have a 3 day automatic stop assigned to them.
*Exception will be patients on oral potassium supplementation at home, which is continued while in hospital OR for Pediatric patients.


Potassium Chloride, premixed IV bags
     40 mEq/20 mL vial for injection
     20 mEq/L Ringer’s Lactate, 2/3 1/3, D5/.45, Normal Saline,
     40 mEq/L Normal Saline, 2/3 1/3
     10 mEq/100 mL mini bag
     20 mEq/100 mL mini bag
     40 mEq/100 mL mini bag
THERAPEUTIC INTERCHANGE: All orders for KCl up to 29 mEq/L will be automatically substituted to 20 mEq/L.
     All orders for KCl 30-49 mEq/L will be automatically substituted to 40 mEq/L
NOTE: KCl concentrate (2 mEq/ml vials for injection) will no longer be stored outside of pharmacy.


Potassium Phosphate
     4.5 mmol (potassium) 3 mmol (Phosphorus)/mL vial for injection

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Sodium Salts

Sodium Acetate
     4 mEq/mL (50 mL) vial for injection

Sodium Chloride
     0.9% (10 mL) preservative-free poly-amps, 0.9% (10 mL) bacteriostatic vial
     3% (hypertonic) IV solution
     4 mEq/mL (30 mL) vial for injection
     1 g capsule

Sodium Phosphate
     3 mmol (sodium) 4 mmol (phosphorus)/ mL (10 mL) vial for injection

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Electrolyte Solutions

PhosphorusPhosphate Novartis
     500 mg (elemental) effervesent tablets

Trace MetalsMicro-6, Micro-Zn
     Per mL (Micro-6, adult): zinc 5 mg, copper 1 mg, manganese 0.5 mg, chromium 10 mcg, selenium 60 mcg, iodide 75 mcg
     Per mL (Micro-g, pediatric): zinc 3 mg, copper 0.4 mg, manganese 0.1 mg, chromium 4 mcg, selenium 20 mcg, iodide 60 mcg
     Per mL (Micro-Zn): zinc 1mg

Zinc Citrate
     50 mg tablet

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Ion-Removing Agents


Potassium Removing Resins

Sodium Polysterene SulfonateKayexalate
     1.25g/5 mL powder

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Caloric Agents


Amino AcidsTravasol
     5% with/without electrolytes and 16.6% dextrose (Central TNA) 2000 mL bag
     5% with/without electrolytes and 10% dextrose (peripheral TNA) 2000 mL bag

Dextrose
     5%, 10%, 20%, 40%, 50%, 60% IV solution (50, 100, 250, 500, 1000 mL bags)
     50% dextrose (25 g/50 mL vial)
     50% dextrose (25 g/50 mL prefilled syringe)

Fat EmulsionsInralipid
     20% (250, 500 mL bags)

Glucose Tolerance Drink
     100 g/330 mL
     Glucose 5 g chewable tablets
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Diuretics


Carbonic Anhydrase Inhibitors

acetaZOLAMIDEDiamox
     500 mg vial
     250 mg tablet
THERAPEUTIC INTERCHANGE: All orders for acetaZOLAMIDE 500 mg SR po bid will be autosubstituted to acetaZOLAMIDE 250 mg po qid (P&T May/03)

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Loop Diuretics

Ethacrynic AcidEdecrin
     25 mg tablet
     50 mg/ vial for injection

FurosemideLasix
     10 mg/mL oral syrup
     20 mg tablet, 40 mg tablet
     40 mg/ 4 mL vial for injection

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Osmotic Diuretics

MannitolOsmitrol
     20% in 500 mL water for infusion
     12.5 g/50 mL vials (25%)

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Potassium-Sparing Diuretics

aMILorideMidamor
     5 mg tab

aMILoride (in combination with HCTZ)Moduret
     5 mg/50 mg HCTZ

SpironolactoneSpirontin
     25 mg tablet

Triamterene (in combination with HCTZ)Dyazide
     50 mg/25 mg HCTZ

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Thiazide Diuretics

hydroCHLOROTHIAZIDEHydroDIURIL
     25 mg tablet

IndapamideLozide
     2.5 mg tablet

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Thiazide-Like Diuretics

MetolazoneZaroxolyn
     2.5 mg tablet

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Diuretics, Miscellaneous

TheophyllineTheo-Dur
     150 mg, 300 mg SR tablet

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Irrigating Solutions


Acetic Acid Irrigation
     0.125%, 0.25%, 1%, 4% compounded solution (made by pharmacy)

Ringer’s lactate

Peritoneal Dialysis Solution

Sodium Chloride Irrigation
     0.9% irrigation

Sterile Water for Irrigation

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ENZYMES

Urate-Oxidase (Recombinant)


RasburicaseFasturtec
     1.5 mg/vial injection. WRH Only (obtain from Met if required at Oue).
RESTRICTED AGENT: The restrictions for use are as follows:
     Uric acid greater than or equal to 475 umol/L in patients with bulky tumour type who require immediate chemotherapy and are at high risk for or have tumour lysis.
     -Bulky tumour types include:
     o Advanced Burkitt’s lymphoma (or Burkitt’s-like lymphoma)
     o Lymphoblastic lymphoma or acute myeloid leukemia with WBC greater than or equal to 100x109/L or WBC greater than or equal to 100x109/L and LDH greater than or equal to 2 x ULN.


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RESPIRATORY TRACT AGENTS

Antihistamines

First Generation Antihistamines

Cyproheptadine— Periactin
     4 mg tablet
RESTRICTED USE: To the ER, ICU, pediatricians and GI physicians for use in severe serotonin syndrome in consultation with a toxicologist.

diphenhydrAMINE HCl — Benadryl, Allerdryl
     25 mg caplet
     6.25 mg/5 mL oral syringe
     50 mg/mL vial for injection

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Second Generation Antihistamines

CetirizineReactine
     cetirizine 10 mg tablet

DesloratadineAerius
THERAPEUTIC INTERCHANGE:
     desloratadine 5 mg = cetirizine 10 mg once daily


FexofenadineAllegra
THERAPEUTIC INTERCHANGE:
     fexofenadine 60 mg bid= cetirizine 10 mg once daily
     fexofenadine 120 mg once daily = cetirizine 10 mg once daily


LoratadineClaritin
THERAPEUTIC INTERCHANGE:
     loratadine 10 mg once daily = cetirizine 10 mg once daily

LIQUID RESTRICTED: to the pediatric population when other antihistamines have failed or are contraindicated.


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Antitussives

Codeine
     5 mg/mL oral syrup
     30 mg tablet

Dextromethorphan (Sugar Free) — Robitussin DM, Koffex DM
     30 mg/10 mL oral solution

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Bronchodialators

Adrenergic Agents

Non-Selective β-adrenergic agonists

IsoproterenolIsuprel
     0.2mg/mL amp for injection

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Selective β-2 adrenergic agonists

FenoterolBerotec
THERAPEUTIC INTERCHANGE: fenoterol 100 mcg inhaler = salbutamol 100 mcg MDI

Ipratropium/FenoterolDuovent
THERAPEUTIC INTERCHANGE: ipratropium/fenoterol nebule = ipratropium MDI 4puffs + salbutamol MDI 4 puffs unless the physician writes NO SUB - then combivent nebule

Fluticasone/VilanterolBreo Ellipta
THERAPEUTIC INTERCHANGE: Use patient's own first. If unable to obtain within 24 hrs then the Breo Ellipta inhaler will be automatically substituted to Advair Diskus.
     Breo Ellipta 100/25 mcg inhaler 1 puff once daily = Advair 250/50 mcg Diskus 1 puff bid
     Breo Ellipta 200/25 mcg inhaler 1 puff once daily = Advair 500/50 mcg Diskus 1 puff bid


Formoterol/BudesonideSymbicort
THERAPEUTIC INTERCHANGE: Use patient's own first. If unable to obtain within 24 hrs then the Zenhale inhaler will be automatically substituted to Advair Diskus.
     Symbicort 100 turbuhaler 2 puffs bid = Advair 250 Diskus 1 puff bid *Note: Not dose equivalent for inhaled corticosteroid component. MRP must be contacted for clarification if any doses aren't within therapeutic range described above.
     Symbicort 200 turbuhaler 2 puffs bid = Advair 250 Diskus 1 puff bid


Mometasone/FormoterolZenhale
THERAPEUTIC INTERCHANGE: Use patient's own first. If unable to obtain within 24 hrs then the Zenhale inhaler will be automatically substituted to Advair Diskus.
     Zenhale 100/5 mcg MDI 2 puffs bid = Advair 250/50 mcg Diskus 1 puff bid
     Zenhale 200/5 mcg MDI 2 puffs bid = Advair 500/50 mcg Diskus 1 puff bid


Salbutamol — Ventolin
     100 mcg/spray MDI
     2.5 mg/2.5 mL nebule
     5mg/mL inhaled solution
THERAPEUTIC INTERCHANGE: All orders for salbutamol 2.5 mg (1 nebule) inhaled solution will be automatically substituted to salbutamol MDI 4 puffs. All orders for salbutamol 5 mg inhaled solution will be automatically substituted to salbutamol MDI 8 puffs. All orders for salbutamol CFC MDI will be automatically substituted to salbutamol HFA MDI, unless the physician indicates "no substitution".

Salbutamol / Ipratropium Bromide — Combivent
     2.5 mg salbutamol / 0.5 mg Ipratropium nebule
     Combivent MDI *discontinued by manufacturer*
THERAPEUTIC INTERCHANGE: All orders for Combivent MDI will be automatically substituted to salbutamol MDI and Ipratropium MDI same dose at the same frequency.
All orders for Combivent nebule will be automatically substituted to salbutamol MDI 4 puffs and Ipratropium MDI 4 puffs (same frequency), unless the physician indicates "no substitution".


Salmeterol/FluticasoneAdvair
THERAPEUTIC INTERCHANGE: Use patient's own first. If unable to obtain within 24 hrs then Advair will be automatically substituted as follows:
      100/50 mcg Diskus OR 125/25 mcg MDI 1 puff bid = Use patient's own home med
      125/25 mcg MDI 2 puffs bid = 250/50 mcg Diskus 1 inhalation bid
      250/25 mcg MDI 1 puff bid = 250/50 mcg Diskus 1 inhalation bid
      250/25 mcg MDI 2 puffs bid = 500/50 mcg Diskus 1 inhalation bid


TerbutalineBricanyl
THERAPEUTIC INTERCHANGE: Orders for Bricanyl turbuhaler will be automatically substituted to salbutamol.
     Terbutaline 0.5 mg turbuhaler 1 puff prn (max 6 doses/24 hours) = Salbutamol MDI 2-4 puffs q4h prn.


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α and β-Adrenergic Agents

ePHEDrine Sulfate
     50 mg/mL amp for injection

EPINEPHrineAdrenalin
     1 mg/10 mL (1:10,000) 18G prefilled syringe (for intracardiac administration)
     1 mg/10 mL (1:10,000) 21G prefilled syringe
     1 mg/mL (1:1000) amp, 20 mg/30 mL vial for injection

NorEPINEPHrineLevophed
     4 mg/4 mL amp for injection

PseudoePHEDrineSudafed, Robidrine
     30 mg/5 mL oral syrup
     60 mg tablet

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Anticholinergics

Atropine

Ipratroprium

Tiotroprium

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Expectorants

Guaifenesin (Sugar Free)Robitussin
     100 mg/5 mL oral solution

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Mucolytic Agents

AcetylcysteineMucomyst
     200 mg/mL inhaled/ oral/ IV solution

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Miscellaneous

Sodium chloride 7% hypertonic solnNebusal
     4 ml nebule for inhalation
THERAPEUTIC INTERCHANGE: Any orders for Sodium Chloride 3% for inhalation will be automatically substituted to Sodium Chloride 3.95% for inhalation.
     Note: to obtain 3.95% use 2 ml of the 7% NaCl nebule plus 2 ml of normal saline. *NICU exempted*

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EYE, EAR, NOSE & THROAT PREPARATIONS


Anti-Infectives


Antibacterials

ChloramphenicolChloromycetin
     0.5% ophthalmic drops

Ciprofloxacin/DexamethasoneCiprodex
     0.3%/0.1% otic drops

ErythromycinIlosone
     0.5% ophthalmic ointment

Framycetin/Gramicidin/DexamethasoneSofracort
THERAPEUTIC INTERCHANGE: All orders for Sofracort otic solution will be automatically substituted with Ciprodex otic solution.

GatifloxacinZymar
     0.3% ophthalmic drops

GentamicinGaramycin
THERAPEUTIC INTERCHANGE: All orders for Gentamicin ophthalmic drops/ointment will be autosubstituted to Tobramycin ophthlamic drops/ointment.

TobramycinTobrex
     0.3% ophthalmic drops, 0.3% ophthalmic ointment

Tobramycin / DexamethasoneTobradex
     0.3%/0.1% ophthalmic drops/ointment

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Antivirals

Trifluridine — Viroptic
     1% ophthalmic drop

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Miscellaneous Anti-Infective

CetylpyridiniumCepacol
     lozenge (LDMH only)


Chlorhexidine GluconatePeriogard
     0.12% oral rinse

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Anti-Inflammatory Agents

Corticosteroids

Beclomethasone Dipropionate_AqueousBeconase, Beconase Aqueous
     50 mcg nasal inhalation, 50 mcg nasal aqueous spray

Budesonide NasalRhinocort Nasal
THERAPEUTIC INTERCHANGE: budesonide 64 mcg nasal spray (1-2 sprays bid) = beclomethasone dipropionate aqueous 2 sprays into each nostril bid (pediatrics exempted)

Ciclesonide nasalOmnaris
THERAPEUTIC INTERCHANGE: ciclesonide nasal spray = beclomethasone dipropionate aqueous 2 sprays into each nostril bid (pediatrics exempted)

DexamethasoneMaxidex
     0.1% ophthalmic drops, 0.1% ophthalmic ointment

FlunisolideNasarel, Nasalide
THERAPEUTIC INTERCHANGE: flunisolide nasal spray = beclomethasone dipropionate aqueous 2 sprays into each nostril bid (pediatrics exempted)

FluoromethaloneFlarex, FML
     0.1% opthalmic drops

Fluticasone FuroateAvamys
THERAPEUTIC INTERCHANGE: fluticasone furoate nasal spray = beclomethasone dipropionate aqueous 2 sprays into each nostril bid (pediatrics exempted)

Fluticasone PropionateFlonase
THERAPEUTIC INTERCHANGE: fluticasone propionate nasal spray = beclomethasone dipropionate aqueous 2 sprays into each nostril bid (pediatrics exempted)

Mometasone nasalNasonex
THERAPEUTIC INTERCHANGE: mometasone nasal spray = beclomethasone dipropionate aqueous 2 sprays into each nostril bid (pediatrics exempted)

TriamcinoloneNasacort, Nasacort AQ
THERAPEUTIC INTERCHANGE: triamcinolone nasal spray = beclomethasone dipropionate aqueous 2 sprays into each nostril bid (pediatrics exempted)

prednisoLONEOpthoTate, Pred Mild, Pred Forte
     0.12%, 1% opthalmic drops

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Nonsteroidal Anti-inflamatory Agents

BromfenacProlensa
THERAPEUTIC INTERCHANGE: **Use patient's own first. If unable to obtain within 24 hours, then interchange**
     Bromfenac 0.07% Opth drops 1 drop daily = Diclofenac 0.1% Opth drops 1 drop qid.


DiclofenacVoltaren Ophtha
     0.1% opthalmic drops

KetorolacAcular
THERAPEUTIC INTERCHANGE: **Use patient's own first. If unable to obtain within 24 hours, then interchange**
     Ketorolac 0.5% Opth drops 1 drop qid = Diclofenac 0.1% Opth drops 1 drop qid.
     Ketorolac 0.4% Opth drops 1 drop qid = Diclofenac 0.1% Opth drops 1 drop qid.
     Ketorolac 0.45% Opth drops 1 drop qid = Diclofenac 0.1% Opth drops 1 drop qid.


NepafenacNevanac
THERAPEUTIC INTERCHANGE: **Use patient's own first. If unable to obtain within 24 hours, then interchange**
     Nepafenac 0.1% Opth drops 1 drop tid = Diclofenac 0.1% Opth drops 1 drop qid.


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Local Anesthetics

BenzydamineTantum
     0.15% solution

LidocaineXylocaine
     2% viscous (15 mL)
     2% Jelly (30 mL)
     12 mg/dose endotracheal spray (30 mL)
     4% topical solution (50 mL)

TetracaineAmetop
     0.5%, 1% eye drops (minims)

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Mydriatics

AtropineIsopto Atropine
     1% eye drop (5 mL, minims)

CyclopentolateCyclogyl
     1% eye drop (15 mL, minims)

DipivefrinPropine
     0.1% eye drop

Homatropine HBrIsopto Homatropine
THERAPEUTIC INTERCHANGE: Homatropine Opth Drops **Use patient's own first. If unable to obtain within 24 hours, then interchange to Atropine Opth Drops same dose and frequency.

PhenyepherineMydfrin
     2.5% eye drops (5 mL, minims), 10% eye drops (minims)

TropicamideMydriacyl
     0.5% eye drops (15 mL), 1% eye drop (minims)

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Mouthwashes & Gargles

Hydrogen Peroxide
     3% solution

Povidone-IodineBetadine
     1% mouthwash
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Vasoconstrictors

EPINEPHrineAdrenalin
     1:1000 nasal solution (30 mg/30 mL)

PhenyepherineMydfrin
     2.5% eye drops (5 mL, minims), 10% eye drops (minims)

XylometazolineOtrivin
     0.1% nasal spray (20 mL), 0.1% nasal drops (25 mL)

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Antiglaucoma Agents

Alpha Adrenergic Agonists

BrimonidineAlphagan
     0.2% eye drop (5 mL)

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Beta Adrenergic Agonists

BetaxololBetoptic S
     0.25% eye drop (5 mL)

LevobunololBetagan
     0.25% (10 mL), 0.5% eye drop (5 mL)

TimololTimoptic
     0.25%, 0.5% eye drops (5 mL)

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Carbonic Anhydrase Inhibitors

DorzolamideTrusopt
     2% eye drop (5 mL)

Dorzolamide / TimololCosopt
     2%/0.5% eye drop (10 mL)

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Miotics

Acetylcholine ChlorideMiochol-E
     1% eye drop

PilocarpineMiocarpine
     1%, 2%, 4% eye drop (15 mL and minims)

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Prostoglandin Analogs

LatanoprostXalatan
     0.005% eye drop (2.5 mL)

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Miscellaneous EENT Drugs

Artificial Tears
THERAPEUTIC INTERCHANGE: All orders for “artificial tears” solutions will be automatically substituted to polyvinyl alcohol 1.4% solution (P&T May/03)

ApraclonidineIopidine
     0.5% eye drops (5 mL)

Balanced Salt Solution
     500 mL bag, 500 ml bottle
     15 mL bottles
     BSS "PLUS" (Enriched with Bicarbonate, Dextrose and Glutathiione) 500 ml bottles

Hydroxypropyl MethylcelluloseIsopto Tears
THERAPEUTIC INTERCHANGE: All orders for hydroxypropyl methylcellulose 0.5%, 1% or dextran solutions will be automatically substituted to polyvinyl alcohol 1.4% solution.

Ipratropium BromideAtrovent
     21 mcg nasal spray (30 mL)

Mineral Oil / PetrolatumLacrilubeDuolube — Systane Nightime
THERAPEUTIC INTERCHANGE: All orders for Lacrilube (any directions) will be automatically substituted to Duolube (same directions) (preferred agent) OR Systane Nightime (same directions).

Mineral Oil (Light)
     10 mL and 30 mL bottles

Polyvinyl AlcoholRefresh, Tears Plus
     1.4% eye drops

Sodium Chloride
     5% eye drops (15 mL)— Muro-128
     0.9% nasal spray (30 mL), 0.9% nasal drops (30 mL) — Salinex

Sodium HyaluronateVitrax
     3% Prefilled syringe (0.65 mL)

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GASTROINTESTINAL DRUGS

Antacids & Adsorbants


Aluminum hydroxide / Magnesium hydroxideDiovol
     40 mg/40 mg/mL suspension

Aluminum hydroxide / AlginateGaviscon
     Suspension, tablet
THERAPEUTIC INTERCHANGE: Doses greater than 20 ml of Gaviscon liquid will be substituted to 20 ml (same frequency)

Calcium Carbonate
     1250 mg (500 mg elemental Ca+) tablet

CharcoalCharac
     25 g/112 mL suspension, 50 g/225 mL suspension

Charcoal with SorbitolCharactol
     25 g/125 mL suspension, 50 g/250 mL suspension

Magnesium HydroxideMilk of Magnesia, MOM
     30 mL oral suspension

Phosphate SodiumPhosphate Sandoz
     500 mg effervescent tablet

Sodium bicarbonate
     325 mg tablet
THERAPEUTIC INTERCHANGE: Any orders for 500 mg tablets will be substituted to 2 x 325 mg (same frequency)

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Antidiarrhea Agents

AttapulgiteKaopectate
     1200 mg/30 mL suspension

Bismuth SubsalicyatePepto-Bismol
     262 mg caplet
RESTRICTED USE: For H Pylori treatment Only

Diphenoxylate / AtropineLomotil
     2.5 mg/0.025 mg tablet

Lactobacillus acidophilusBacid
     1 billion U capsule

LoperamideImodium
     0.2 mg/mL solution, 2 mg tablet

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Antiflatulents

SimethiconeOvol, Phazyme
     40 mg/mL oral drops
     80 mg chew tablet

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Cathartics & Laxatives

bisACODYLDulcolax
     5 mg tablet
     10 mg suppository

Docusate CalciumSurfak
THERAPEUTIC INTERCHANGE: RPh to consult the Opioid/Non-Opioid Bowel Protocols for alternatives for any NEW orders. RPh to dose or may hold OTC med as per MAC policy for homemeds.

Docusate SodiumColace
THERAPEUTIC INTERCHANGE: RPh to consult the Opioid/Non-Opioid Bowel Protocols for alternatives for any NEW orders. RPh to dose or may hold OTC med as per MAC policy for homemeds.

Electrolyte LavagePeglyte, Colyte, Golytely
     4 L oral solution (for bowel evacuation)

Glycerin
     1.8 g (pediatric), 2.65 g (adult) suppository

Magnesium CitrateCitroMag
     300 mL oral solution (from Stores)

Magnesium Glucoheptonate — Magnesium Rougier
     10 mg/mL oral solution (15 mL, 30 mL)

Magnesium Hydroxide — Milk of Magnesia
     80 mg/mL oral suspension (30 mL)

Magnesium Hydroxide / Cascara suspensionCas-Mag
     Oral suspension (30 mL)

Mineral OilHeavy Mineral Oil
     Oral suspension (15 mL, 30 mL)

Polyethlene GlycolPeg3350, Laxaday
     17 g oral powder sachet

Psyllium Hydrophilic MucilloidMetamucil
     Oral powder
THERAPEUTIC INTERCHANGE: Any orders for Metamucil powder will be automatically substituted to Metamucil powder 7 grams (one rounded teaspoonful) at the same prescribed frequency.

SennaSenekot
     1.7 mg/mL oral liquid, 8.6 mg tablet

Sodium PhosphateFleet
     rectal enema (from Stores)

Sodium PicosulphatePicoSalax
     citric acid, magnesium oxide packets

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Digestants

LactaseLactaid
     tablet (LDMH only)


Pancrelipase (lipase/amylase/protease)Cotazym
     8,000 U/30,000 U/30,000 U (Cotazym) plain capsule
     8,000 U/30,000 U/30,000 U (Cotazym ECS 8) enteric-coated capsule
     20,000 U/55,000 U/55,000 U (Cotazym ECS 20) enteric-coated capsule

Pancrelipase (lipase/amylase/protease) — Viokace
     10,440 units tablet (10,440 U/56,400 U/57,100 U)
THERAPEUTIC INTERCHANGE: All orders for the Pancrease brand tablet will be automatically substituted to Viokace tablet.
NOTE: Orders for unclogging blocked feeding tubes will contain one Pancrelipase (Viokace) 10,440 units tablet and one Sodium Bicarbonate 325 mg tablet.

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Emetics

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Gastrointestinal Antiemetics

aprepitantEmend Oral
     80 mg and 150 mg tablets
RESTRICTED AGENT: Aprepitant tablets reserved to chemotherapy induced nausea and vomiting who have high emetic risk and anthracycline and cyclophosphamide containing regimens. (Met Campus Only)


dimenhyDRINATEGravol
     3 mg/mL oral liquid
     50 mg tablet
     25 mg, 50 mg, 100 mg suppository
     50 mg/mL ampule for injection
THERAPEUTIC INTERCHANGE: Any dimenhyDRINATE PRN order will be substituted to dimenhyDRINATE IV/IM/PO Q4H PRN.
     Note: 25 mg dose initially recommended for elderly due to risk of anticholinergic effects.


Doxylamine / PyridoxineDiclectin
     10 mg/10 mg tablet

fosaprepitantEmend IVCinvanti IV
     150 mg vial for injection
RESTRICTED AGENT: Fosaprepitant IV reserved to chemotherapy induced nausea and vomiting patients who cannot take oral formulation and have high emetic risk and anthracycline and cyclophosphamide containing regimens. (Met Campus Only)


GranisetronKytril
     1 mg/1 mL vial for injection
RESTRICTED AGENT: Granisetron IV reserved to the Pediatric population receiving chemotherapy who are refractory to ondasetron and dimenhydrinate. (Met Campus Only)


OndansetronZofran
     4 mg, 8 mg tablet
     4 mg/2 mL vial for injection
THERAPEUTIC INTERCHANGE: Please note the therapeutic interchange for the specific indications:
     Ondansetron 8 mg IV/PO q4h or q6h (for chemo induced N/V) = Ondansetron 8 mg IV/PO q8h *pediatrics exempt*
     Ondansetron 8 mg IV/PO q4h or q6h prn (for chemo induced N/V) = Ondansetron 8 mg IV/PO q8h prn *pediatrics exempt*
     Ondansetron 8 mg IV/PO q4h or q6h (for PONV) = Ondansetron 4 mg IV/PO q12h *pediatrics exempt*
     Ondansetron 8 mg IV/PO q4h or q6h prn (for PONV) = Ondansetron 4 mg IV/PO q12h prn *pediatrics exempt*
     Ondansetron 8 mg IV/PO q4h or q6h (for N/V in pregnancy) = Ondansetron 4 mg IV/PO q8h *pediatrics exempt*
     Ondansetron 8 mg IV/PO q4h or q6h prn (for N/V in pregnancy) = Ondansetron 4 mg IV/PO q8h prn *pediatrics exempt*


ProchlorperazineStemetil
     5 mg, 10 mg tablet
     10 mg suppository

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Antiulcer Agents & Acid Suppressants

Histamine H2-Antagonists

CimetidineTagamet
THERAPEUTIC INTERCHANGE:
     cimetidine po = ranitidine 150 mg po bid (or equivalent)
     cimetidine 300 mg IV = ranitidne 50 mg IV q8h


FamotidinePepcid
THERAPEUTIC INTERCHANGE:
     famotidine 20 mg po bid = ranitidine 150 mg po bid
     famotidine 20 mg iv q12h = ranitidine 50 mg iv q8h


NizatadineAxid
THERAPEUTIC INTERCHANGE: nizatadine = ranitidine (same dose and frequency)

RanitidineZantac
     15 mg/mL oral solution, 150 mg tablet
     25 mg/mL injection, 50 mg pharmacy prepared IV bags

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Prostoglandins

MisoprostolCytotec
     200 mcg tablet

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Protectants

SucralfateSulcrate
     200 mg/mL suspension, 1 g tablet

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Proton Pump Inhibitors

DexlansoprazoleDexilant
THERAPEUTIC INTERCHANGE:
     dexlansoprazole 30 mg/day = pantoprazole 20 mg once daily
     dexlansoprazole 60 mg/day = pantoprazole 40 mg once daily


LansoprazolePrevacid
THERAPEUTIC INTERCHANGE:
     lansoprazole 30 mg/day = pantoprazole 40 mg once daily
     lansprazole 30 mg/day for NG/FT use = lansoprazole fastab 30 mg once daily


Lansoprazole FastabPrevacid Fastab
     30 mg fast tablet
*Note: Only if the patient is unable to swallow then lansoprazole fastabs will be supplied.

OmeprazoleLosec
THERAPEUTIC INTERCHANGE:
     omeprazole 20-40 mg/day = pantoprazole 40 mg once daily
     omeprazole greater than 40 mg/day = consult MD
     omeprazole 20-40 mg/day for NG/FT use = lansoprazole fastab 30 mg once daily


PantoprazolePantoloc
     40 mg tablet
     40 mg/vial for injection
RESTRICTED AGENT: Pantoprazole IV reserved for use in acute upper GI bleeds only. (80 mg IV bolus followed by 8 mg/hr X 72 hrs, followed by pantoprazole 40 mg daily po thereafter.)

RabeprazolePariet
THERAPEUTIC INTERCHANGE:
     rabeprazole 20-40 mg/day = pantoprazole 40 mg once daily
     rabeprazole greater than 40 mg/day = consult MD
     rabeprazole 20-40 mg/day for NG/FT use = lansoprazole fastab 30 mg once daily


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Prokinetic Agents

MetoclopramideReglan, Maxeran
     1 mg/mL oral solution, 10 mg tablet
     5 mg/mL vial for injection

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Anti-Inflammatory Agents

5-Aminosalicylic AcidAsacol, Salofalk
     400 mg, 500 mg enteric-coated tablet
     500 mg suppository
     4 G/60 ml enema

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GI Miscellaneous

DomperidoneMotilium
     10 mg tablet
THERAPEUTIC INTERCHANGE: Any orders for Domperidone suspension will be automatically interchanged to Domperidone tablets (same dose & frequency).
THERAPEUTIC INTERCHANGE: For any doses exceeding 30 mg/day for patients older than 60 years of age will be substituted to 30 mg tid (before meals).


RifAXIMinZaxine
     550 mg tablet
RESTRICTED AGENT: restricted to internal medicine physicians.

TrimebutineModulon
     200 mg tablet

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HEAVY METAL ANTAGONIST

HydroxocobalaminCyanokit
      2.5G powder for solution for infusion

Deferoxamine MesylateDesferal
     500 mg/vial injection

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HORMONES & SYNTHETIC SUBSTITUTES

Adrenals

BetamethasoneCelestone
     6 mg/mL vial for injection

BudesonidePulmicort
     0.25 mg/mL nebule (0.5 mg/neb), 0.5 mg/mL nebule (1 mg/neb)
THERAPEUTIC INTERCHANGE: Use patient's own first. If unable to obtain within 24 hrs then the budesonide turbuhaler will be automatically substituted to ciclesonide (pediatrics exempted).
     budesonide 100 mcg bid = ciclesonide 100 mcg once daily
     budesonide 200 mcg bid = ciclesonide 200 mcg once daily
     budesonide 400 mcg bid = ciclesonide 400 mcg once daily


Cortisone Acetate
     25 mg tablet

Beclomethasone dipropionate HFAQvar
THERAPEUTIC INTERCHANGE: Use patient's own first. If unable to obtain within 24 hrs then the beclomethasone inhaler will be automatically substituted to ciclesonide (pediatrics exempted).
     beclomethasone 50 mcg bid = ciclesonide 100 mcg once daily
     beclomethasone 100 mcg bid = ciclesonide 200 mcg once daily
     beclomethasone 200 mcg bid = ciclesonide 400 mcg bid


CiclesonideAlvesco
     100 mcg, 200 mcg inhaler

DexamethasoneDecadron
     0.5 mg, 4 mg tablet
     4 mg/mL vial for injection, 10 mg/mL vial for injection

FludrocortisoneFlorinef
     0.1 mg tablet

FluticasoneFlovent-HFA
     50 mcg MDI RESTRICTED: For Pediatric use Only.
THERPEUTIC INTERCHANGE: Use patient's own first. If unable to obtain within 24 hrs then the fluticasone inhaler will be automatically substituted to ciclesonide (pediatrics exempted).
     fluticasone 125 mcg bid = ciclesonide 200 mcg once daily
     fluticasone 250 mcg bid = ciclesonide 400 mcg once daily
     fluticasone 500 mcg bid = ciclesonide 400 mcg bid


Hydrocortisone Sodium SuccinateCortef, Solu-CORTEF
     20 mg tablet
     100 mg/vial, 250 mg/vial, 500 mg/vial, 1000 mg/vial for injection injection

methylPREDNISolone Acetate (IM)Depo-Medrol
     40 mg/mL, 80 mg/mL vial for injection

methylPREDNISolone Sodium Succinate (IV)Solu-MEDROL
     40 mg/vial, 125 mg/vial, 500 mg/vial, 1000 mg/vial for injection

MometasoneAsmanex
THERPEUTIC INTERCHANGE: Use patient's own first. If unable to obtain within 24 hrs then the mometasone twisthaler will be automatically substituted to ciclesonide (pediatrics exempted).
     mometasone 200 mcg one daily = ciclesonide 200 mcg once daily
     mometasone 400 mcg once daily OR 200 mcg bid = ciclesonide 400 mcg once daily


prednisoLONEPediapred
     5 mg/5 mL oral liquid

predniSONE
     1 mg, 5 mg, 50 mg tablet

Triamcinolone AcetonideKenalog
     50 mg/5 mL, 200 mg/5 mL injection

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Androgens

DanazolCyclomen
     50 mg capsule

Testosterone CypionateDepo-Testosterone
     100 mg/mL injection

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Contraceptives

Ethinyl Estradiol / LevonogestrelMin Ovral
     0.03 mg / 0.15 mg tablet
RESTRICTED AGENT: For the treatment of hypermenorrhea.

LevonogestrelPlan B
     0.75 mg tablet
RESTRICTED AGENT: Emergency contraceptive use only.

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Estrogens

EstradiolEstraderm
     25 mcg, 50 mcg, 100 mcg patch (LDMH only)


Estrogens, ConjugatedCES, Premarin
     25 mg/vial for injection
     0.3 mg, 0.625 mg, 0.9 mg, 1.25 mg tablet

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Gonadotropins

Gonadorelin AcetateLutrepulse
     0.8 mg/vial for injection
THERAPEUTIC INTERCHANGE: All orders for gonadorelin HCl will be automatically substituted to gonadorelin acetate.

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Anti-Diabetic Agents

Biguanides

metFORMINGlucophage
     500 mg tablet
THERAPEUTIC INTERCHANGE: Any orders for metFORMIN 850 mg will be automatically substituted to metFORMIN 750 mg.

metFORMIN ERGlumetza
THERAPEUTIC INTERCHANGE: All Orders for metFORMIN ER will be automatically substituted to metFORMIN.
     metFORMIN ER 1000 mg q24h = metFORMIN 500 mg q12h
     metFORMIN ER 1500 mg q24h = metFORMIN 500 mg q8h
     metFORMIN ER 2000 mg q24h = metFORMIN 1000 mg q12h


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Insulins

THERAPEUTIC INTERCHANGE: All HumuLIN insulins will be autosub to NovoLIN insulins.

Insulin AspartNovoRAPID

Insulin Aspart/Insulin aspart Protamine crystals 30/70NovoMIX 30

Insulin DetemirLevemir

Insulin GlargineLantus

Insulin LisproHumaLOG
THERAPEUTIC INTERCHANGE: All orders for Insulin Lispro will be autosub to Insulin Aspart. Exceptions include: patients previously stabilized on insulin lispro.

Insulin Lispro/Insulin Lispro Protamine 25/75HumaLOG MIX 25

Insulin Lispro/Insulin Lispro Protamine 50/50HumaLOG MIX 50

Insulin RegularNovoLIN Toronto, HumuLIN R

Insulin Regular / NPH 30/70NovoLIN 30/70, HumuLIN 30/70

Insulin Regular / NPH 40/60NovoLIN 40/60, HumuLIN 40/60

Insulin Regular / NPH 50/50NovoLIN 50/50, HumuLIN 50/50

Insulin NPHNovoLIN NPH, HumuLIN N

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Meglitanides

RepaglinideGluconorm
     0.5 mg, 1 mg, 2 mg tablet

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Sulfonylureas

gliCLAZIDEDiamicron, Diamicron MR
     80 mg tablet
     30 mg MR tablet
THERAPEUTIC INTERCHANGE: Any orders for gliCLAZIDE MR bid will be substituted to once daily dosing (with breakfast) unless the therapeutic need is documented to support the bid dosing regimen.

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Anti-Diabetic Agents, Miscellaneous

empagliflozinJardiance
     10 mg, 25 mg tablet

sAXagliptanOnglyza
THERAPEUTIC INTERCHANGE: Any orders for sAXagliptan will be automatically substituted to sitaGLIPtan.
     sAXagliptan 5 mg once daily (CrCl greater than 50 mL/min) = sitaGLIPtan 100 mg with breakfast
     sAXagliptan 5 mg once daily (CrCl 30-50 mL/min) = sitaGLIPtan 50 mg with breakfast
     sAXagliptan 5 mg once daily (CrCl less than 30 mL/min) = sitaGLIPtan 25 mg with breakfast
     sAXagliptan 5 mg once daily (ESRD) = sitaGLIPtan 25 mg with breakfast


sitaGLIPtanJanuvia
     50 mg, 100 mg tablet

sitaGLIPtan/metFORMINJanumet
THERAPEUTIC INTERCHANGE: Any orders for Janumet will be substituted to the equivalent dosage of sitGLIPtan and metFORMIN, as separate tablets.


sitaGLIPtan/metformin
50/500 mg daily
50/500 mg bid
50/850 mg daily
50/850 mg bid
50/1000 mg daily
50/1000 mg bid
supplied
sitaGLIPtan 50 mg daily AND metFORMIN 500 mg daily
sitaGLIPtan 100 mg daily AND metFORMIN 500 mg bid
sitaGLIPtan 50 mg daily AND metFORMIN 750 mg daily
sitaGLIPtan 100 mg daily AND metFORMIN 750 mg bid
sitaGLIPtan 50 mg daily AND metFORMIN 1000 mg daily
sitaGLIPtan 100 mg daily AND metFORMIN 1000 mg bid

sitaGLIPtan/metFORMIN XRJanumet XR
THERAPEUTIC INTERCHANGE: Any orders for Janumet XR will be substituted to the equivalent dosage of sitGLIPtan and metFORMIN, as separate tablets.


sitaGLIPtan/metFORMIN XR
XR 50/500 mg daily
XR 50/1000 mg daily
XR 50/1000 mg 2 tabs daily
XR 100/1000 mg daily
supplied
sitaGLIPtan 50 mg daily AND metFORMIN 250 mg bid
sitaGLIPtan 50 mg daily AND metFORMIN 500 mg bid
sitaGLIPtan 100 mg daily AND metFORMIN 1000 mg bid
sitaGLIPtan 100 mg daily AND metFORMIN 500 mg bid

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Antihypoglycemic Agents

Glycogenolytic Agents

Glucagon
     1 mg/vial for injection

Glucose
     5 g tablet

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Parathyroid

Calcitonin, SalmonCalcimar
     200 Units/mL (2 ml multidose vial) for injection

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Pituitary

DesmopressinDDAVP
     0.1 mg tablet
     10 mcg/spray nasal spray
     4 mcg/mL ampule for injection (fridge)

VasopressinPitressin
     20 Units/mL vial for injection

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Progestins

medroxyPROGESTERone AcetateProvera, Depo-Provera
     5 mg, 100 mg tablet
     250 mg/5 mL, 150 mg/mL depot vial for injection

ProgesteronePrometrium
     100 mg capsule (Met Only)


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Thyroid & Anti-Thyroid Agents

Thyroid Agents

LiothyronineCytomel
     5 mcg, 25 mcg tablet

LevothyroxineSynthroid, Eltroxin
     25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125 mcg, 137 mcg 150 mcg, 175 mcg tablet
     500 mcg/vial for injection

Thyroid
     60 mg tablets

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Anti-Thyroid Agent

MethimazoleTapazole
     5 mg tablet

Potassium IodideLugol’s Solution
     100 mL bottle

PropylthiouracilPropyl-Thyracil
     100 mg tablet

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LOCAL ANESTHETICS
BenzydamineTantum
     0.15% oral rinse

BupivicaineMarcaine
     0.25%, 0.5%, 0.75% injection
     0.75% spinal injection
     0.1% epidural syringe

Bupivicaine / EPINEPHrineMarcaine E
     0.25% / 1:200000 injection
     0.5% / 1:200000 injection

Bupivicaine / fentaNYL Epidural Syringe
     0.1% / 2mcg/ml epidural - 50 ml syringe, 250 ml bag
     0.125% / 2mcg/ml epidural syringe

LidocaineXylocaine
     0.5% vial, 1% vial/polyamp, 1.5% vial, 2% vial/polyamp for injection

Lidocaine CO2Xylocaine CO2
     2% injection

Lidocaine, epiduralXylocaine Spinal 5%
     50 mg/mL injection

Lidocaine / EPINEPHrine
     0.5% + 0.005mg/ml EPINEPHrine (1:200000) injection
     1% + 0.01mg/ml EPINEPHrine (1:100000) injection
     1.5% + 0.005mg.ml EPINEPHrine (1:200000) injection
     2% + 0.01mg/ml (1:100000) injection

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OXYTOCICS
CarbetocinDuratocin
     100 mcg/ml injection (LDMH and WRH-Met only)

Carboprost — Hemabate
     250 mcg/amp injection (LDMH only)


Dinoprostone — Cervidil
     10 mg vaginal insert (WRH-Met only)


OxytocinSyntocinon
     10 Units/mL ampule for injection

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SERUMS, TOXOIDS & VACCINES

Serums

AntiveninAntivipmyn
     Combo pak - Antivipmyn vial and 10 ml vial of NaCl diluent supplied

Digoxin Immune FabDigifab
     40 mg/vial for injection

Tetanus Immune GlobulinHyperTET
     250 Units/syringe

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Toxoids

Tetanus / DiptheriaTD Adsorbed
     0.5 mL vial for injection
THERPEUTIC INTERCHANGE: See Tdap information below.

Tetanus Diptheris Acellular Pertussis (Tdap)Adacel, Boostrix
     Adacel 0.5 ml vial for injection, Boostrix 0.5 ml prefilled syringe for injection
Note: To be given if patient has not received dose in their teen years. Patients 19-64 require only one additional Pertussis vaccine for their lifetime so if they have already received a Tdap vaccine in adulthood then they should only get the Td vaccine.

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Vaccines

Haemophilus BAct HiB
     0.5 mL vial for injection

Hepatitis BEngerix-B, Recombivax HB
     1 mL vial for injection

Influenza A & BFluzone

Measles / Mumps / RubellaPriorix
     0.5 mL vial for injection

Meningococcal PolysaccharideMenactra
     0.5 mL vial for injection

Pertussis / Diptheria / Tetanus / PolioQuadracel
     0.5 mL vial for injection

Pertussis / Diptheria / Tetanus / Polio / Haemophilus BPentacel
     0.5 mL vial for injection

Pneumococcal 23-valentPneumovax, Pneumo-23
     0.5 mL vial for injection

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SKIN & MUCOUS MEMBRANE AGENTS

Anti-infectives

Antibacterials

BacitracinBaciguent
     500 Units/g ointment (30 g tube)

Fusidic AcidFucidin
     2% cream/ointment

Fusidic Acid with HydrocortisoneFucidin HC
THERAPEUTIC INTERCHANGE: All orders for 1% HC in Fusidic Acid cream or ointment will be compounded by Pharmacy.

GentamicinGaramycin topical
THERAPEUTIC INTERCHANGE: Orders for Gentamicin ointment for the prevention of PD catheter exit site infections will be autosubstituted to Mupirocin 2% oint (Bactroban). All other orders for Gentamicin cream/ointment will be substituted to Polysporin cream/ointment.

MupirocinBactroban
     2% ointment
THERAPEUTIC INTERCHANGE: Orders for Mupirocin 2% cream (including those for the prevention of PD catheter exit site infections) will be autosubstituted to Mupirocin 2% oint.

Polymyxin / BacitracinPolysporin ointment
     Per g: 10,000U/500U
THERAPEUTIC INTERCHANGE: All orders for Neosporin ointment will be autosubstituted to Polysporin ointment (P&T May/03)

Polymyxin / GramicidinPolysporin Cream
     Per g: 10,000U/0.25 mg
THERAPEUTIC INTERCHANGE: All orders for Neosporin cream will be autosubstituted to Polysporin cream (P&T May/03)

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Antifungals

THERAPEUTIC INTERCHANGE: All orders for vaginal antifungal therapy with cream, suppository or ovules (ie: clotimazole, econazole, nystatin, terconazole, tioconazole) will be substituted to miconazole 400mg ovules qhs x 3 days, except in pregnant patients, who will receive a 7-day course of therapy with miconazole 2% vaginal cream, unless duration is otherwise specified by the prescribing physician. Pharmacy will check for “azole” allergies prior to substituting nystatin orders (P&T Mar/98)

Ciclopirox 1% creamLoprox
THERAPEUTIC INTERCHANGE: All orders for ciclopirox will be autosubstituted to clotrimazole 1% cream (P&T May/03)

ClotrimazoleCanesten
     1% cream (30 g, 500 g)
THERAPEUTIC INTERCHANGE: All orders for ciclopirox or terbinafine will be autosubstituted to clotrimazole 1% cream (P&T May/03)
THERAPEUTIC INTERCHANGE: All orders for Vioform-HC will be autosubstituted to clotrimazole/HC (1%/1%) cream (P&T May/03)


Betamethasone dipropionate 0.05% / Clotrimazole 1%Lotriderm
THERAPEUTIC INTERCHANGE: All orders for Lotriderm will be automatically substituted with Betamethasone dipropionate 0.05% cr and Clotrimazole 1% cr (supplied as separate agents)

Gentian Violet
     1% topical solution (25 mL)

KetoconazoleNizoral
     2% shampoo (60 mL)
THERAPEUTIC INTERCHANGE: All orders for ketoconazole 2% cream will be automatically substituted to clotrimazole 1% cream (P&T May/03)

MiconazoleMonistat, Micatin
     2% vaginal cream w/ applicator (5 g), 400 mg vaginal ovule
THERAPEUTIC INTERCHANGE: All orders for miconazole 2% cream will be automatically substituted to clotrimazole 1% cream (P&T May/03)
THERAPEUTIC INTERCHANGE: All orders for clotrimazole vaginal cream or suppository will be automatically substituted to Miconazole-3 400 mg ovules x 3days (non-pregnant) and Miconazole 2% vaginal cream x 7days (pregnant)


NystatinNyaderm, Mycostatin, Nilstat
     100,000 Units/g cream (15 g), 100,000 units/g powder (15 g)
THERAPEUTIC INTERCHANGE: All orders for Kenacomb or Kenacomb Mild will be autosubstituted to Nystatin + 1% hydrocortisone (P&T May/03)

TolnaftateTinactin
     1% topical powder (108 g)

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Scabicides & Pediculicides

PermethrinNix
     1% cream rinse (56 g), 5% dermal cream (30 g)
THERAPEUTIC INTERCHANGE: All orders for crotamiton (Eurax) or lindane will be autosubstitued to permethrin 5% dermal cream as a single treatment.

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Local Anti-Infectives, Miscellaneous

ChlorhexidineBactigras
     10 X 10 cm, 15 X 20 cm dressings

ClindamycinDalacin 2%
     2% vaginal cream (40 gm) (LDMH only)


FramycetinSofra-Tulle
THERAPEUTIC INTERCHANGE: All orders for framycetin will be autosubstitued to bactigras 10 X 10 cm dressing

metroNIDAZOLEFlagyl, MetroGel, Noritate
     10% vaginal cream (60 mL), 1% gel (60 g), 1% cream (45 g)

Silver sulfADIAZINEFlamazine
     1% cream (20 g)

Povidone-IodineBetadine, Bridine
     10% douche (250 mL), 1% solution (500 mL)

Tincture of BenzoinFriars Balsam
      solution (100 mL)

Tincture of Iodine
     5% solution (25 mL)

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Anti-Inflammatory Agents

Betamethasone DipropionateDiprosone
     0.05% cream (50 mL) / ointment (15 mL) / lotion (30 mL) (HIGH POTENCY)
THERAPEUTIC INTERCHANGE: All orders for “high” potency topical corticosteroid preparations will automatically be interchanged with betamethasone dipropionate 0.05% ointment, cream, or lotion (P&T May/03)

Betamethasone and Salicylic acidDiprosalic
     ointment (50 gm) / lotion (30 mL)

Betamethasone Sodium PhosphateBetnesol
     5 mg rectal enema (100 mL)

Betamethasone ValerateCelestoderm, Ectosone, Valisone
     0.1% cream (15 g, 454 g) / ointment (454 g) / lotion (75 mL), scalp lotion (75 mL)
     0.05% cream (454 g) (INTERMEDIATE POTENCY)
THERAPEUTIC INTERCHANGE: All orders for “intermediate” potency topical corticosteroid preparations will automatically be interchanged with betamethasone valerate 0.1% cream/lotion or 0.05% ointment (P&T May/03)

Clobetasole-17-propionateDermovate
     0.05% cream (15 mL) / ointment (15 g) / scalp lotion (60 mL) (VERY HIGH POTENCY)
THERAPEUTIC INTERCHANGE: All orders for “very high” potency topical corticosteroid preparations will be automatically interchanged with clobetasol proprionate 0.05% ointment, cream, or lotion (P&T May/03)

DiclofenacVoltaren Emulgel
     1.16% Gel (30 g) (TOPICAL NSAID)

Hydrocortisone AcetateCotate, Emo-Cort, Hycort
     1% lotion (60 mL) / cream (15 g) / ointment (454 g) (LOW POTENCY)
     100 mg/60 mL enema (Hycort)
THERAPEUTIC INTERCHANGE: All orders for hydrocortisone enema (Cortifoam) will be automatically substituted to hydrocortisone acetate enema (Hycort).
THERAPEUTIC INTERCHANGE: All orders for “low” potency topical corticosteroid preparations will be automatically interchanged with hydrocortisone 1% ointment, cream, or lotion (P&T May/03)


Hydrocortisone / UreaUremol HC
     1% HC in Uremol cream or lotion

Hydrocortisone / Zinc SulfateAnusol HC
     0.5% / 0.5% ointment (15 g)
     10 mg / 10 mg suppository

Triamcinolone AcetonideKenacomb
     0.1% dental paste (7.5 g)

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Antipruritics & Local Anesthetics

BenzocaineHurricane
     20% spray (59 mL) (for oral or mucosal application)

Calamine
     Lotion (100 mL)

Lidocaine — Xylocaine
     2% topical jelly, 5% ointment, 12 mg/dose endotracheal spray

Lidocaine/ChlorhexidineInstillagel
      6 ml, 11 ml
THERAPEUTIC INTERCHANGE: All orders for Lidocaine Urojet will be autosubstituted to Instillagel.

Mineral Oil (Light)
     10 mL and 30 mL bottles

Phenazopyridine HClPhenazo
     200 mg tablet
THERAPEUTIC INTERCHANGE: All orders for phenazopyridine 100 mg will be autosubstituted to 200 mg.

TetracaineAmetop
     4% gel

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EMOLLIENTS, DEMULCENTS & PROTECTANTS – 84:24.00

DimethiconeBarriere
     20% cream

Pectin / GelatinOrabase
     5g buccal ointment

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Keratolytic Agents 84:28.00

UreaUremol
     10% cream, 12% lotion
     22% cream

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Miscellaneous Skin & Mucous Membrane Agents 84:36.00

CollagenaseSantyl
     250U/g ointment
RESTRICTED: ET consult required.

Petrolatum/Mineral Oil OintAquaphor
     ointment

Phenol liquidP&S Liquid

Red Clover SalveRed clover Salve
     60 g salve
RESTRICTED: for the treatment of radiation dermatitis.

Zinc OxideZincofax
     15% cream

Zinc SulfateAnusol
     0.5% ointment, 10 mg suppository

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SMOOTH MUSCLE RELAXANTS

Genitourinary Smooth Muscle Relaxants

OxybutininDitropan
     1 mg/mL syrup
     5 mg tablet
THERAPEUTIC INTERCHANGE: All orders for oxybutinin LA 5 mg and 10 mg daily will be automatically substituted to oxybutinin 2.5 mg bid and 5 mg bid respectively.

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Respiratory Smooth Muscle Relaxants

AminophyllinePhyllocontin
     250 mg/10 mL amp for injection
THERAPEUTIC INTERCHANGE: Any orders for aminophylline tabs will be automatically substituted to theophylline 80 mg/15 ml liquid (RPh to dose).
TheophyllineTheoDur SR, Theolair
     80 mg/15mL oral elixir
     100 mg, 300 mg sustained release tablet

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VITAMINS
Vitamin A

Vitamin AAquasol A
     10,000 units capsule

CyanocobalaminVitamin B12
     100 mcg, 1000 mcg tablet
     100 mcg/mL, 1000 mcg/mL amp for injection

Folic AcidFolvite
     1 mg, 5 mg tablets
     50 mg/10 mL vial for injection

Pyridoxine HClVitamin B6
     25 mg tablet
     3 g/30 mL vial for injection

ThiamineBetaxin, Vitamin B1
     100 mg tablet
     100 mg/mL amp for injection

Vitamin B complex / Vitamin CFortisvitamin B&C
     300 mg capsule

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Vitamin C

Ascorbic AcidVitamin C
     500 mg tablet

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Vitamin D

AlfacalcidolOne-Alpha
     2 mcg/mL oral solution
     0.25 mcg, 1 mcg capsule
THERAPEUTIC INTERCHANGE:
     alfacalcidol for injection = calcitriol for injection


CalcitriolRocaltrol Calcijex Inj
     1 mcg/mL amp for injection
THERAPEUTIC INTERCHANGE:
     calcitriol oral = alfacalcidol oral (same dose and given at bedtime)
Note: Orders by Nephrology / Nephro RPh exempted.


CholecalciferolVitamin D3
     400 units, 1000 units tablets
THERAPEUTIC INERCHANGE:
     cholecalciferol less than 1000 units per day = cholecalciferol 1000 units per day
     cholecalciferol greater than 1000 units per day = cholecalciferol (round to the nearest 1000 units)


ErgocalciferolVitamin D
     400 units, 1000 units tablets
     50,000 units capsule — Osteoforte

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Vitamin E

Vitamin EAquasol-E
     100 units capsule, 400 units capsule

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Vitamin K Activity

PhytonadioneVitamin K
     10 mg/mL amp for injection (may be given orally)

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Multivitamin Preparations

MultivitaminsHexavite
     Suspension (Infantol)
     RESTRICTED AGENT: Liquid (Polivisol) for pediatrics only
     Tablet
     Adult injection (MVI 12, MVI 1000)

Prenatal multivitaminsPrenavite
     Tablets (LDMH & WRH Met Campus only)


Multivitamins with LuteinVitalux-S

Vitamin A, D, C dropsTri-Vi-Sol

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UNCLASSIFIED THERAPEUTIC AGENTS – 92:00
AdalimumabHumira
     40 mg/0.8 ml injection

AlendronateFosamax
     10 mg, 70 mg tablet (LDMH only)


AlfuzosinXatral
THERAPEUTIC INTERCHANGE:
     alfuzosin 10 tablet once daily = tamsulosin 0.4 mg once daily at bedtime


AllopurinolZyloprim
     100 mg, 300 mg tablet

Alpha-1-Proteinase InhibitorProlastin
     1000 mg/vial injection

azaTHIOprineImuran
     50 mg tablet, 100 mg/20 mL injection

BromocriptineParlodel
     2.5 mg tablet

ClopidogrelPlavix
     75 mg and 300 mg tablet

Colchicine
     0.6 mg tablet

cycloSPORINENeoral
     25 mg, 100 mg capsule, 100 mg/mL solution, 50 mg/mL injection

Dimethyl SulfoxideRimso 50
     50% solution

EptifibatideIntegrelin
     0.75 mg/mL injection, 2 mg/mL injection

Ethyl Alcohol
     Dehydrated Alcohol 100% v/v (7.89g/10 ml) for injection

Eyestream
     118 ml ophthalmic irrigating soln

Fluorescein Sodium
     2% ophth minims, 1 mg ophth strips

FomepizoleAntizol
     1.5 G/1.5 ml injection

IdarucizumabPraxbind
     50 mg/ml injection kit

inFLIXimabRemicade
     100 mg/vial injection
RESTRICTED AGENT: Restricted for GI use for first dose only. (TB skin test & Chest X-Ray required prior to therapy). (P&T May/07)

Leucovorin Calcium
     5 mg tablet, 10 mg/mL injection

LevocarnitineCarnitor
     200 mg/ml injection

Lozenge

MesnaUromitexan
     100 mg/mL injection

Methylene Blue
     1% injection

Moi-Stir Dry Mouth Solution

Mycophenolate MofetilCellcept
     250 mg capsule

Mycophenolate SodiumMyfortic
     180 mg EC tablet

OctreotideSandoSTATIN
     100 mcg/mL injection, 500 mcg/mL injection

Pamidronate DisodiumAredia
THERAPEUTIC INTERCHANGE: Any orders for pamidronate will be autosubstituted to Zoledronic acid 4 mg/100 ml NS IV (over 15 minutes).

Pralidoxime2-PAM, Protopam
     1 g/vial injection
SPECIAL ACCESS

SilodosinRapaflo
THERAPEUTIC INTERCHANGE:
     silodosin 4 mg once daily = tamsulosin 0.4 mg once daily at bedtime
     silodosin 8 mg once daily = tamsulosin 0.8 mg once daily at bedtime


Silver Nitrate Applicators

Sterile TalcSteritalc
     Powder - 2 g vial
     Spray - 3 g aerosol

Surgifoam

Tacrolimus ERAdvagraf ER
     0.5 mg, 1 mg, 5 mg capsules

Tacrolimus IRPrograf IR
     0.5 mg, 1 mg capsules

Tamsulosin SRFlomax SR
     0.4 mg SR capsule (once daily at bedtime)

Zoledronic AcidZometa
     4 mg/5 ml vial for injection