A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

GENERIC NAME  
Lansoprazole Pantoprazole will be automatically substituted for other proton pump inhibitors. When administering PPIs  via feeding tubes auto substitute Lansoprazole Solutabs.

        Pantoprazole (Protonix), injection and oral, is the proton pump inhibitor of choice, with automatic substitution for omeprazole (Prilosec), rabeprazole (Aciphex),  Lansoprazole (Prevacid), and other oral proton pump inhibitors unless the physician has checked the dispense as written block.

Dosing Equivalence (mg)

Lansoprazole

(Prevacid)

Esomeprazole

(Nexium)

Omeprazole

(Prilosec)

Rabeprazole

(Aciphex)

Pantoprazole

(Protonix)

30 qd

20 qd

20 qd

20 qd

20 qd

30 qd

40 qd

40 qd

20 qd

40 qd

30 bid

20-40 bid

20-40 bid

20 bid

40 bid

Lanoprazole Solutabs, 15 mg or 30 mg, may be mixed with water and placed down a very small bore pediatric feeding tube. The granules do not clump or adhere to the tube. 

Lanoprazole

Omeprazole

1-11 years

<= 30 kg

15 mg qd

>= 2 years

< 20 kg

10 mg qd

 

> 30 kg

30 mg qd

 

>=20 kg

20 mg qd

12-17 years

Non erosive GERD

15 mg qd

 

 

 

 

Erosive GERD

30 mg qd

 

 

 

Pantoprazole IV Criteria for use

        Criteria for use of IV Proton Pump Inhibitors (PPIs) are list below.  If a patient does not meet criteria the pharmacist will call the physician and/or leave a chart note recommending conversion to oral therapy.

  • Initial treatment of patients with active upper GI tract bleeding, until they can tolerate oral therapy, usually after three days of therapy.
  • Initial treatment of patients with Zollinger-Ellison syndrome, until they can tolerate oral therapy
  • Stress-ulcer prophylaxis for critical care patients
  • Patients who require PPI therapy who can not tolerate oral or NG PPI therapy

        Patients on IV proton pump inhibitors will have an order entered for the oral route allowing the nurse to use the oral route when the patient is tolerating oral therapy. Proton pump inhibitors may be given by the oral route if the patient does not have active gastrointestinal bleeding, malabsorption syndrome, short bowel syndrome, severe diarrhea, uncontrolled nausea and vomiting, continuous nasogastric suctioning, and is not at risk for aspiration. 

 

Leuprolide Leuprolide P&T Review

        Depot Lupron is recommended for outpatient use, as its action is time dependent and is indicated for treatment of chronic conditions that may be treated on an outpatient basis.  Depot Lupron provides serum levels that plateau within two days after dosing and remain relatively stable for 4-5 weeks.  Injection of Depot Lupron initially stimulates pituitary gonadotropins followed by prolonged suppression.  Repeated dosing at monthly intervals results in decreased secretion of gonadal steroids; consequently, tissues and functions that depend on gonadal steroids for their maintenance become quiescent. The biological effect is strictly time-dependent and not concentration-dependent.

        Pharmacy will not routinely stock Depot Lupron.

        Pharmacy will order and provide Lupron Depot 7.5 mg for patients who are hospitalized and who are not anticipated to be discharged within the next 5 days.  Pharmacists will determine if the patient is nearing discharge before dispensing Lupron.

        Lupron will only be dispensed for FDA approved indications.  Pharmacists will verify the indication before dispensing Lupron.

 

Levalbuterol Autosubstitution with Albuterol

Levalbuterol is non-formulary. Albuterol has been previously approved for automatic substitution at an equivalent dose for levalbuterol (two times levalbuterol dose at the same frequency).

        All patients receiving levalbuterol (those who have orders stating dispense as written) will be converted to an equivalent dose of albuterol after 48 hours of therapy, unless they are allergic to albuterol, receiving levalbuterol at home, or have acute atrial fibrillation. Objective parameters will be monitored by respiratory therapy (heart rate, tremors, nervousness, and blood gases if ordered) from start of levalbuterol to 48 hours after albuterol is started. If a clinically significant decline is not seen, albuterol will be continued. DUE Montoring form

      Data will be collected on all patients, during levalbuterol administration and after conversion to albuterol. This information will be presented to the committee for their review. (see accompanying monitoring tool).

        Currently Levalbuterol accounts for 19% of doses, but 87% of $125,628 in total cost
 

Levetiracetam
  •         Levetiracetam injection is formulary restricted to the following patients:

  •    Patients unable to take oral levetiracetam

  •         Oral bioavailability is 100% and is unaffected by food or enteral nutritional products

  •         Equivalent IV and oral doses result in equivalent Cmax, Cmin, and total systemic exposure

  •         levetiracetam injection cost approximately 13 times more than the oral tablets

  •        Status epilepticus after benzodiazepines (lorazepam) and fosphenytoin have failed

  •         No randomized control trials have been completed for this indication. Only case reports are available.

  •        Levetiracetam oral tablets cost $2.27 per 500 mg versus $29.15 per 500 mg injection ($58.30 for 1000 mg, and $175 for 3000 mg injection). Fosphenytoin injection cost $120.76 per 1000 mg

  •         Pharmacist will contact ordering physicians to convert to oral therapy when the patient is able to take oral medications or has a functional feeding tube.

 

Levofloxacin

 

Dosage Recommendations Per Package Insert

 

Ciprofloxacin Ordered

Levofloxacin Autosubstitution

Moxifloxican Ordered

Acute Bacterial Exacerbation of Chronic Bronchitis

400 mg Q12H

500mg Q24H x 7 days

400 mg Q24H

Acute Bacterial Sinusitis

400 mg Q12H

750mg Q24H 5 days

400 mg Q24H

Bone & Joint

400 mg Q8-12H

DO NOT SUBSTITUTE

 

Community Acquired Pneumonia

 

750mg Q24H x 5 days

400 mg Q24H

Nosocomial Pneumonia

400 mg Q8H

750 mg Q24H x 7-14 days

NOT INDICATED

intra-abdominal

400 mg q12H (plus metronidazole)

750 mg Q24H (plus metronidazole)

400 mg Q24H

Uncomplicated UTI

200 mg Q12H

250mg Q24H x 3 days      

NOT INDICATED

Complicated UTI

400 mg Q12H

250mg Q24H x 10 days

NOT INDICATED

Acute Pyelonephritis

 

250mg Q24H x 10 days

NOT INDICATED

Chronic Bacterial Prostatitis

400 mg Q12H

500 mg Q24H x 28 days

NOT INDICATED

Uncomplicated Skin & Skin Structure Infection

400 mg Q12H

500 mg Q24H 7-10 days

400 mg Q24H

Complicated Skin and Skin Structure Infection

400 mg Q8H

750 mg Q24H 7-14 days

400 mg Q24H

 

Levofloxacin Package Insert Renal Dosing Guidelines

Creatinine Clearance

Nosocomial Pneumonia,

 Community Acquired Pneumonia,

Complicated Skin & Skin Structure Infections, Acute Bacterial Sinusitis

ABECP,

Prostatitis,

Uncomplicated Skin and Skin Structure Infection

Complicate UTI,

Pyelonephritis

>= 50

750 mg Q24H

500 mg Q24h

250 mg Q24H

20-49

750 mg Q48H

500 mg x1, then 250 mg Q24H

250 mg Q24H

10-19

750 mg x 1, then 500 mg Q48H

500 mg x1, then 250 mg Q48H

250 mg Q48H

Hemodialysis/CAPD

750 mg x1, then 500 mg Q48H

500 mgx1, then 250 mg Q48H

 

Lidocaine & Tetracaine Patch Patch Lidocaine & Tetracaine Patch (Synera) P&T, is recommended for addition to formulary, to be made available for relief of pain for superficial venous access and dermatologic procedures; restricted to pediatric patients at least 3 years of age.
Linezolid Linezolid is restricted to VRE

Linezolid is restricted for treatment of documented serious vancomycin resistant Enterococcus faecium infections when no other alternative is available.

Doxycycline and nitrofurantoin are recommended for susceptible VRE lower urinary tract infections.

Linezolid is not recommended for treatment of other documented infections unless the patient is allergic/intolerant to all other antibiotics demonstrating activity against the pathogen.

Lisopro Autosubstitute with Novolog unit for unit

        Novolog (insulin aspart) will be auto-substituted for Humalog (Lispro) as the onset and duration are similar and Novolog is less expensive. 

 

Loratadine Tablet

Loratadine (Claritin) and Claritin D 12 hour (5 mg with 120 of pseudoephedrine) are the P&T recommended formulary non-sedating antihistamines with automatic substitution for desloratadine (Clarinex) fexofenadine (Allegra 30, 60, 180 mg), Allegra D (60 mg fexofenadine with 120 mg pseudoephedrine), Allegra D 24 Hour (180 mg fexofenadine and 240 mg pseudoephedrine), cetirizine (Zyrtec), and Semprex D (8 mg acrivastine with 60 mg pseudoephedrine). They will be stocked in the following dosage forms: Claritin 10 mg, Clartin D 12 hour, and as the syrup 1 mg/ml for pediatric patients.

 P&T/MEC APPROVED 11/2000, updated 3/21/07

 

Non Formulary Medication Ordered

P&T/MEC Approved Auto Substitution

Allegra 30 mg every day, 6-11 years old with renal dysfunction

Claritin 10 mg every other day

Allegra 30 mg BID, 6-11 years old

Claritin 10 mg every day

Allegra 60 mg every day, 12 years and older with renal dysfunction

Claritin 10 mg every other day

Allegra 60 mg BID, 12 years and older

Claritin 10 mg every day

Allegra 180 mg every day, 12 years and older

Claritin 10 mg every day

Allegra D one every 12 hours, 12 years and older

Claritin D one every 12 hours

Allegra D 24H every day

Claritin D one every 12 hours

 

 

Clarinex 5 mg every other day, 12 years and older: Clcr < 30 ml/min or liver impairment

Claritin 10 mg every other day

Clarinex 5 mg every day, 12 years and older

Claritin 10 mg every day

 

 

Zyrtec 2.5 mg every day, 6 months to < 2 years

Maximum dose: 2.5 mg every 12 hours

Do not substitute for patients < 2 years

Zyrtec 2.5 mg every day, 2-5 years old

Maximum 2.5 mg every 12 hours or 5 mg once daily

Claritin 5 mg every day

Zyrtec 5 mg every day, 6-11 years old: clcr < 31 ml/min, on hemodialysis or hepatically impaired

Claritin 10 mg every other day

Zyrtec 5Ė10 mg every day, 6-11 years old

Claritin 10 mg every day

Zyrtec 5 mg every day, 12 years and older: clcr < 31 ml/min, on hemodialysis or hepatically impaired

Claritin 10 mg every other day

Zyrtec 5-10 mg every day, 12 years and older

Claritin 10 mg every day

*Note Claritin dosage in renal impairment, clcr < 30 ml/min, or hepatic failure: 2-5 years old 5 mg every other day, 6 years and older 10 mg every other day.

Lubiprostone (Amitizaģ) Package Insert; this product has a high incidence of nausea (31%), diarrhea (13.2%), and vomiting (4.6%). It is non-formulary and it is not recommended to be initiated in the hospital, but may be used as a continuation of therapy from home.
   

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