Safe formulation substitution

[LaurieB]

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Hi there!

I am a med student at Loyola and I volunteer at a free clinic in Chicago. Our dispensary is very small and we often run out of very common drugs (eg. Lipitor and Nexium) and have to substitute with another brand name (most of our dispensary is made up of donated samples). This is not the ideal situation, but it is one that we have to live with due to lack of resources. I would like to create a list of safe formulary sustitutions with dosage equivalents for some common drugs/doses to present to our attending physicians and use as a guideline for our substitutions. Are there any authorities on this? Does anyone know where I could find this information? Are there PDA programs for this sort of thing?

Thanks in advance for your help and input!
Laurie

 

[GravyRPH]

Hi there!

I am a med student at Loyola and I volunteer at a free clinic in Chicago. Our dispensary is very small and we often run out of very common drugs (eg. Lipitor and Nexium) and have to substitute with another brand name (most of our dispensary is made up of donated samples). This is not the ideal situation, but it is one that we have to live with due to lack of resources. I would like to create a list of safe formulary sustitutions with dosage equivalents for some common drugs/doses to present to our attending physicians and use as a guideline for our substitutions. Are there any authorities on this? Does anyone know where I could find this information? Are there PDA programs for this sort of thing?

Thanks in advance for your help and input!
Laurie

I don't know of any, besides a good pharmacist. I can spout of conversions for probably most of the meds you'd want off the top of my head, but no references to back those up. The LDL/HDL/TG decrease rates for the statins are readily available, so that should help you with those conversions. There are pretty much standard adult doses for the PPI's, you can equate them based on that.

 

[Caverject]

Hi there!

I am a med student at Loyola and I volunteer at a free clinic in Chicago. Our dispensary is very small and we often run out of very common drugs (eg. Lipitor and Nexium) and have to substitute with another brand name (most of our dispensary is made up of donated samples). This is not the ideal situation, but it is one that we have to live with due to lack of resources. I would like to create a list of safe formulary sustitutions with dosage equivalents for some common drugs/doses to present to our attending physicians and use as a guideline for our substitutions. Are there any authorities on this? Does anyone know where I could find this information? Are there PDA programs for this sort of thing?

Thanks in advance for your help and input!
Laurie

Are you the one doing the dispensing or is there a pharmacist there too?

 

[bananaface]

Therepeutic interchange needs to be treated like what it is: a change in medication. You could cause a patient serious harm by failing to screen for drug interactions or failing to anticipate potential variation in metabolic potentials. In short, each situation needs to be assesed individually.

 

[ZpackSux]

Hi there!

I am a med student at Loyola and I volunteer at a free clinic in Chicago. Our dispensary is very small and we often run out of very common drugs (eg. Lipitor and Nexium) and have to substitute with another brand name (most of our dispensary is made up of donated samples). This is not the ideal situation, but it is one that we have to live with due to lack of resources. I would like to create a list of safe formulary sustitutions with dosage equivalents for some common drugs/doses to present to our attending physicians and use as a guideline for our substitutions. Are there any authorities on this? Does anyone know where I could find this information? Are there PDA programs for this sort of thing?

Thanks in advance for your help and input!
Laurie

I have a list of formulary substitutions which I've used at 5 different hospitals. I'll try to post it when I get back to work.

 

[LaurieB]

Thanks for all your input. To answer your questions, we do not have a pharmacist. The clinic is almost entirely run by volunteers. There is one pharmacist who does quite a bit for the clinc, but he only has a little time each week and is not available during our clinic hours.

Instead, we utilize the dispensary under our attending physicians' direction. They determine the "prescription" and we check out samples to give to the patients. We see them every 3 months, but they can come back in and get refills monthly with a nurse visit. This is where we run into problems. It is not unusual for the dispensary to run out of common medications and the nurses will not make a substitution unless we write for one on the chart. This means that there are times when the patients can't get any meds and they have to make another doctor's appt. to get a substitution.

We primarily have a problem with statins and PPI's and it would be nice to have a therepuetic interchange chart at hand for some of these common drugs to evaluate our options for substitutions more readily and to help us choose an appropriate substitution for the patient should we run out of something. It would also be helpful to identify drugs that shouldn't be interchanged (eg. depression medications). This would not only be a useful tool in the clinic, it would also help us in trying to manage the dispensary.

So say I have a patient on Lipitor 20mg daily and after reviewing the warnings and possible drug interactions, I want to indicate Crestor as an acceptable substitution, what would be the equivalent dosage? 10mg daily?

I hope this more clearly explains our situation and what I'm trying to do. I appreciate any information or input you might have.

Thanks!
Laurie

 

[LaurieB]

I have a list of formulary substitutions which I've used at 5 different hospitals. I'll try to post it when I get back to work.

Thanks so much!!

 

[ZpackSux]

Thanks so much!!

Ok.. I don't have the Statins memorized but I have PPIs

Prevacid 30mg = Protonix 40mg
Prilosec 20mg = Protonix 40mg
Nexium 40mg = Protonix 40mg
Aciphex 20mg = Protonix 40mg

 

[ZpackSux]

Laurie,

It's interesting that the classes of drugs you're concerned with are PPIs and Statins. Not sure what kind of clinic you're involved with but Wyeth and Merck can help you out.

Wyeth sells the Protonix to hospitals at 16 cents per tablet and Merck will sell every strength of Zocor to hospitals at 10 to 20 cents per tablet. Quite a bargain from regular wholesale cost.

This is possible if you sign a market share agreement with them where you dispense 50% + PPI with Protonix and 90%+ statins with Zocor.

It's a very common practice for hospitals. Not sure if your clinic qualifies for it. Good Luck?

 

[LaurieB]

Laurie,

It's interesting that the classes of drugs you're concerned with are PPIs and Statins. Not sure what kind of clinic you're involved with but Wyeth and Merck can help you out.

Wyeth sells the Protonix to hospitals at 16 cents per tablet and Merck will sell every strength of Zocor to hospitals at 10 to 20 cents per tablet. Quite a bargain from regular wholesale cost.

This is possible if you sign a market share agreement with them where you dispense 50% + PPI with Protonix and 90%+ statins with Zocor.

It's a very common practice for hospitals. Not sure if your clinic qualifies for it. Good Luck?

That's interesting. I think since we're a free clinic and our patients are all below the poverty line, drug companies aren't that interested in cutting any deals with us. I could be wrong though so I'll definately look into it. Right now we have a hard enough time trying to enroll patients in the indigent drug programs to take the pressure off our dispensary and to ensure continuity.

Thanks for the PPI conversions! Are there any rules of thumb for switching between omezaprole and ranitidine or is that a no-no?

Laurie

 

[ZpackSux]

That's interesting. I think since we're a free clinic and our patients are all below the poverty line, drug companies aren't that interested in cutting any deals with us. I could be wrong though so I'll definately look into it. Right now we have a hard enough time trying to enroll patients in the indigent drug programs to take the pressure off our dispensary and to ensure continuity.

Thanks for the PPI conversions! Are there any rules of thumb for switching between omezaprole and ranitidine or is that a no-no?

Laurie

Well, omeprazole(Prilosec) and ranitidine exhibit different mechanism of action..one is a proton pump inhibitor and the other is an Histamine II blocker. I believe long term efficacy of PPI is superior over H2 blockers. Then again, H2 blockers will increase the PH quicker providing a faster relief.

That being said, if you were going to sub a PPI with ranitidine, I would recommend the following.

Prilosec 30mg QD, sub it with ranitidine 150mg BID or famotidine 20mg BID.

 

[LaurieB]

While browsing around for a therapuetic interchange chart for statins, I came across the interchange guidelines for Mercy Medical Center and St. Luke's Hospital.

http://www.crjointpt.com/Interchange Chart.htm

I thought I'd share the link and see what you guys think.

Laurie

 

[ZpackSux]

While browsing around for a therapuetic interchange chart for statins, I came across the interchange guidelines for Mercy Medical Center and St. Luke's Hospital.

http://www.crjointpt.com/Interchange Chart.htm

I thought I'd share the link and see what you guys think.

Laurie

That's pretty much what we have. Looks good to me 👍