When is it ok to Switch?

[aryad]

I have lot of times this thing come up to me and I am not quiet completely sure..

Clindamycin 300 mg is not covered by insurance.. can we switch to 2 caps 150mg?
Glipizide 20 mg with 2 10mg glipizides?

When is it that the strenghts cannot be substituted like this?

Can we dispence two seperate drugs wehn a combination is prescribed w/o conuslting the doctor ( for obvious time constraint) when combination not coverd by insurance or is too expensive? I would not do this but I have seen Pharmacists doing this w/o any reservations.

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[bacillus1]

I have lot of times this thing come up to me and I am not quiet completely sure..

Clindamycin 300 mg is not covered by insurance.. can we switch to 2 caps 150mg?
Glipizide 20 mg with 2 10mg glipizides?

When is it that the strenghts cannot be substituted like this?

Can we dispence two seperate drugs wehn a combination is prescribed w/o conuslting the doctor ( for obvious time constraint) when combination not coverd by insurance or is too expensive? I would not do this but I have seen Pharmacists doing this w/o any reservations.

I believe as long as it's not a controlled realease form, you can give pills of smaller quantities that add up to the same quantity.

 

[ShadowRX]

I have lot of times this thing come up to me and I am not quiet completely sure..

Clindamycin 300 mg is not covered by insurance.. can we switch to 2 caps 150mg?
Glipizide 20 mg with 2 10mg glipizides?

When is it that the strenghts cannot be substituted like this?

Can we dispence two seperate drugs wehn a combination is prescribed w/o conuslting the doctor ( for obvious time constraint) when combination not coverd by insurance or is too expensive? I would not do this but I have seen Pharmacists doing this w/o any reservations.

Glipizide doesn't come in 20mg tabs... 10mg is max per. 2 tabs is understood.

 

[aryad]

Glipizide doesn't come in 20mg tabs... 10mg is max per. 2 tabs is understood.

And your take on clindamycin and combinations?

 

[All4MyDaughter]

I think it's fine to do 2 150 mg instead of the 300 mg. Our in my world (the VA) we frequently dispense a larger mg strength and expect the patient to split the tablets. Happens all the time.

I would call before substituting two single ingredient products for one combo product.

 

[Aznfarmerboi]

I have lot of times this thing come up to me and I am not quiet completely sure..

Clindamycin 300 mg is not covered by insurance.. can we switch to 2 caps 150mg?
Glipizide 20 mg with 2 10mg glipizides?

When is it that the strenghts cannot be substituted like this?

Can we dispence two seperate drugs wehn a combination is prescribed w/o conuslting the doctor ( for obvious time constraint) when combination not coverd by insurance or is too expensive? I would not do this but I have seen Pharmacists doing this w/o any reservations.

If clindamycin 300 is not covered, you can switch it to clinda 150 mg provided you counsel.

In terms of combination drugs, you should always contact the doctor...

 

[aboveliquidice]

I have lot of times this thing come up to me and I am not quiet completely sure..

Clindamycin 300 mg is not covered by insurance.. can we switch to 2 caps 150mg?
Glipizide 20 mg with 2 10mg glipizides?

When is it that the strenghts cannot be substituted like this?

Can we dispence two seperate drugs wehn a combination is prescribed w/o conuslting the doctor ( for obvious time constraint) when combination not coverd by insurance or is too expensive? I would not do this but I have seen Pharmacists doing this w/o any reservations.

No on the combo drugs. This falls in the same category as capsules vs, tablets. They may be similar, but you still need to call and verify/annotate the switch.

 

[bacillus1]

No on the combo drugs. This falls in the same category as capsules vs, tablets. They may be similar, but you still need to call and verify/annotate the switch.

So caps vs. tabs does need a call? I was arguing this with one of the pharmacists in the store where I work, and he said you don't need to call.

 

[aboveliquidice]

So caps vs. tabs does need a call? I was arguing this with one of the pharmacists in the store where I work, and he said you don't need to call.

I believe this depends on state - but yes, by law you would have to call. In practice... Well... That may be a different story.

 

[Old Timer]

Here is where pharmacists must use their professional discretion. So it really depends on each individual situation.

Clindamycin: I have no trouble with this. In fact, for cash paying patients, I recommend this switch as the 300mg is almost twice as expensive for a 7-10 day course of treatment then the equivalent dose of the 150mg capsules.

Glipizide: I would definitely call on this. I would not assume and it is NOT understood. Since doses over 15mg should be split, a single dose of 20mg should be immediately suspect as a dosing error. If the dose is 20mg, it should be split and given BID.

Combination Drugs: Again it depends. We have a doctor who always writes for Lotrisone for welfare patients. After the zillionth phone call with no refusals, I now switch this all the time without asking. Others I may call on. It depends.

 

[aryad]

Thanks everyone for sharing there thoughts. What I heard recently is Aricept 23 mg is going to be hitting the shelves. The 23mg does not provide any benefits over the 10 mg strenght already in the market,only a gimmick by the brand to prolong their product lifecycle as generics start hitting the market soon.
Also interesting thing is that ( although I know numerically not -2 10mg tabs dont add up to 23 mg) 23 mg cannot be switched by 2 10mg tabs ---- very very specific on this.
This is where I was thinking are there any other examples you seen in your practice where a numerical switch is just not possible?

 

[kvl1027]

Thanks everyone for sharing there thoughts. What I heard recently is Aricept 23 mg is going to be hitting the shelves. The 23mg does not provide any benefits over the 10 mg strenght already in the market,only a gimmick by the brand to prolong their product lifecycle as generics start hitting the market soon.
Also interesting thing is that ( although I know numerically not -2 10mg tabs dont add up to 23 mg) 23 mg cannot be switched by 2 10mg tabs ---- very very specific on this.
This is where I was thinking are there any other examples you seen in your practice where a numerical switch is just not possible?

One Example that comes to mind for me was when I called a physician to let him know we didn't have Augmentin 250 and he wanted me to give half of an Augmentin 500. I am sure you can see the issue with this. The dose of Clavulanic acid needed for beta-lactamase inhibition is fixed and doesn't change between the two strengths.

 

[johnconner]

Script comes in for Amoxicillin 200mg chewable tabs. Those are on backorder. Would you switch to Amoxicillin 200mg/5ml suspension without prescriber approval?

 

[kvl1027]

Script comes in for Amoxicillin 200mg chewable tabs. Those are on backorder. Would you switch to Amoxicillin 200mg/5ml suspension without prescriber approval?

Good Question, I guess that would depend. As a parent, I would look at whether or not the pt was waiting with their sick screaming child and the likelihood that they would blow up my pharmacy if I told them I had to call the physician to give the a different same drug.

If they needed to get out of there, I would make the substitution and then call the MD's office to let them know about the sub. To most physicians 200mg amoxil is 200mg amoxil, whether it be in a tablet, capsule, suspension, or gummy bear.

 

[owlegrad]

Script comes in for Amoxicillin 200mg chewable tabs. Those are on backorder. Would you switch to Amoxicillin 200mg/5ml suspension without prescriber approval?

The pharmacokinetics are different though, right? I mean different dosage forms have different bioavailabilities and such, right? I wouldn't think that you can switch these all willy-nilly.

 

[kvl1027]

The pharmacokinetics are different though, right? I mean different dosage forms have different bioavailabilities and such, right? I wouldn't think that you can switch these all willy-nilly.

I don't think the bioavailalibility would be different between a chewable tablet and a suspension. I can't think of any reason why it would be different, but I am open to enlightenment. If it was an extended release product that would be different, but both suspension and chewable tablet are IR.