Therapeutic interchange

Levothyroxine (L-thyroxine, T4) is the drug of choice for thyroid hormone replacement and suppressive therapy because it is chemically stable, relatively inexpensive, free of antigenicity, and has uniform potency however, any of the commercially available thyroid preparations can be used. Once a particular product is selected, therapeutic interchange is discouraged. 

In hospital settings, the pharmacy department generally implements a therapeutic interchange program as adopted by the Pharmacy and... 

Schachtner, J.M., et al., "Prevalence and Cost Savings of Therapeutic Interchange Among U. S. Hospitals," Am.. Health-System Pharm., 59, 529-533 (2002). 

Chase SL, Peterson AM, Wordell CJ. Therapeutic interchange program for oral histamine H2-receptor antagonists. Am.. HUh.-Syst. Pharm. 1998 55 1382-1386. Green J. Point the formulary system and the emperor s new clothes. Am.. Hasp. Pharm. 1986 43 2830-2833. 

The results of a therapeutic interchange program, in which 78 patients with acid peptic disease requiring proton pump inhibitor therapy (both newly diagnosed patients and those previously stabilized on omeprazole) were treated with lansoprazole, have been retrospectively analysed (12). Although the switch was associated with considerable pharmaceutical savings, there was an overall lansoprazole-associated failure rate of 28%. Reported lack of efficacy required withdrawal of lansoprazole in 15%, while adverse effects required withdrawal of lansoprazole in 13% of patients (versus none with omeprazole). The main adverse effect was diarrhea. 

Amidon PB, Jankovich R, Stoukides CA, Kaul AF. Proton pump inhibitor therapy preliminary results of a therapeutic interchange program. Am J Manag Care 2000 6(5) 593-601. 

UACH ° To evaluate impact OA of antibiotic therapeutic interchange program Target drug programs Acid-reduction therapy Pre/post None Efficacy indicators, ADRs, DCA Decreased cost of daily antibiotic therapy in study group Input costs not considered... 

To evaluate cost impact of therapeutic interchange program for H2RA therapy... 

American Medical Association. AMA policy on drug formularies and therapeutic interchange in inpatient and ambulatory patient care settings. Am. J. Hosp. Pharm. 

Carroll, N.V. Formularies and therapeutic interchange The health care setting makes a difference. Am. J. Health-Syst. Pharm. 1999, 56 (5), 467- -472. 

Dispensing prescription and over-the-counter medications, including therapeutic interchange Providing for delivery of medications to patients homes... 

Infectious diseases pharmacists typically practice in a hospital setting that allows them to devote all their time to managing antimicrobial therapy. All aspects of infectious diseases pharmacotherapy, including interventions on antimicrobial selection, antimicrobial dosing, and intravenous-to-oral conversion are the responsibility of the infectious diseases pharmacist. In addition, the pharmacist is usually responsible for analyzing new antimicrobials for formulary inclusion, medication use evaluations, and antimicrobial restriction or therapeutic interchange policies. 

In hospitals with a significant pharmacy influence on antimicrobial therapy, it may be impossible for the infectious diseases pharmacist to perform all the functions described here. Instead, the pharmacist may need to delegate the responsibility for conducting standardized antimicrobial protocols (therapeutic interchange, intravenous to oral, aminoglycoside pharmacokinetics) to other pharmacists, while maintaining accountability for the quality of these programs. 

Another regulatory issue is therapeutic interchange of medications. PBM clinical departments often set up internal protocols for alternate product substitution within a therapeutic class. The National Association of Boards of Pharmacy contends that therapeutic substitution is practicing pharmacy. In one of its position papers, the Academy of Managed Care Pharmacy supports the use of therapeutic interchange programs. The Academy of Managed Care Pharmacy contends that this decision is ultimately that of the physician. 

Where We Stand, Therapeutic Interchange, Position Paper. Revised by the AMCP Board of Directors, Academy of Managed Care Pharmacy 100 North Pitt Street, Suite 400, Alexandria, Virginia 22314, 1999, November (www.amcp. org). 

Therapeutic Interchange The authorized exchange of therapeutic alternatives in accordance with previously established and approved written guidelines or protocols within a formulary system. ... 

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