Pharmacy Services  header picture - pharmacy seal (top)
Therapeutic Interchange   header picture - pharmacy seal (bottom)

 

 View:
 •

Other Therapeutic Interchanges
 

 • All Criteria, Guidelines, and Pathways
 
 • Restricted Drug Policy
 
 • All Formulary Tools
 
 • Drug Shortages


HOME

 


H-2 Blocker/Proton Pump Inhibitor Therapeutic Interchange
and IV to PO Conversion (Adults)
 

Historically, a physician’s order has been required to convert non-formulary histamine-type 2 (H-2) antagonist agents and proton proton pump inhibitors (PPIs) to famotidine and pantoprazole, respectively, as well as to change from the intravenous (IV) to oral (PO) route when appropriate. According to two initiatives approved by the Pharmacy and Therapeutics (P&T) Committee, these steps are no longer necessary. These initiatives maintain famotidine as the exclusive formulary H-2 antagonist and pantoprazole as the proton pump inhibitor. Orders for H-2 antagonists will be automatically converted to famotidine; orders for PPIs will be converted to pantoprazole (IV, oral) or omeprazole packet (enteral). Pharmacy may initiate an intravenous to oral conversion of these dosage forms. The aim of these initiatives is to streamline the provision of quality, cost-effective patient care.

Automatic Therapeutic Interchange

This pharmacy-based initiative allows for the interchange of non-formulary H2 antagonists and proton pump inhibitors. Each order for these agents will be converted to therapeutically equivalent doses. This applies to both the intravenous (IV) and the oral (PO) routes of administration. The roles of each health care professional are detailed below.

Pharmacists

·         Convert order to the proper dose and route of H2RA/PPI via CPOE using Per P&T Committee as source of order. 

Physicians

·         Physicians are encouraged to prescribe the formulary agent initially. 

IV to PO Conversion

This pharmacy-based initiative allows for the conversion of IV famotidine or pantoprazole to the oral dosage form when:

·         The patient has a functioning GI tract, defined as tolerating tube feeds at 40 ml/hr or 1000 ml/day of fluids by the enteral/PO route; AND

·         The patient is tolerating other oral medications.

Both criteria must be met before a patient qualifies for conversion to PO therapy. The roles of each health care professional are detailed below.

Pharmacy

·         Pharmacists in involved with the care of a specific patient will review the medication profile for IV orders of H2RA/PPI.

·         Eligible patients will be converted to oral/enteral agents.

·         For each patient converted under this policy, there will be an order entered via CPOE using Per P&T Committee as source of order.

Nursing

  • Nurses are encouraged to identify patients that are eligible for oral/enteral medications and to request that the physician issue an order for oral/enteral famotidine or pantoprazole/omeprazole
  • Nurses are not authorized to write a verbal order without physician authorization.

Physicians

  • Physicians should write initial IV famotidine or pantoprazole orders as "IV/ORAL to be switched when the patient can tolerate oral/enteral medications."
  • If a physician disagrees with the automatic conversion, he/she may override the conversion by noting that the patient is to remain on the IV dosage form in the orders section of the medical record.
     

Table 1.  Proton Pump Inhibitor Therapeutic Interchange
 

Product Ordered

Pantoprazole tablet/
Omeprazole packet

Conversion

Nexium®

PO/PT

Esomeprazole 20 mg qday

40 mg qday

Esomeprazole 40 mg qday

40 mg qday

Esomeprazole 20 mg bid

40 mg qday

Esomeprazole >40 mg qday

Clarify with physician

 

 

Prevacid®

PO/PT

Lansoprazole 15 mg qday

40 mg qday

Lansoprazole 30 mg qday

40 mg qday

Lansoprazole 15 mg bid

40 mg qday

Lansoprazole >30 mg qday

Clarify with physician

 

 

Prilosec®

PO/PT

Omeprazole 20 mg qday

40 mg qday

Omeprazole 40 mg qday

40 mg qday

Omeprazole 20 mg bid

40 mg qday

Omeprazole >40 mg qday

Clarify with physician

 

 

Aciphex®

PO/PT

Rabeprazole 20 mg qday

40 mg qday

Table 2.  Famotidine Dosage Recommendations

Oral Administration - Adults

Duodenal or gastric ulcer

40 mg qhs

GERD

20 mg bid

Stress ulcer prophylaxis

20 mg bid

Hypersecretory conditions

20 mg q6h, may increase to 160 mg q6h

CrCl <50 ml/min

20 mg qday OR 40 mg q48h

IV Administration - Adults

Adequate renal function

20 mg q12h

CrCl <50 ml/min

20 mg qday

 

Please contact the pharmacy at 3-5641 with any questions.

_________________________________________________________________________________________________________
Approved by P&T Committee: 10/09 | Posted on: 10/16/09 | For Internal University of Kentucky Chandler Medical Center Use Only

Comments to Ann Hamlin, Last Modified: October 15, 2009
Copyright © 2002, University of Kentucky Chandler Medical Center
Terms, Conditions & Privacy Statement