Rx Update: April 2003

Transition from Intravenous to Oral Drug Therapy

Mary Ross, R.Ph., M.B.A., Joan Murhammer, R.Ph., Kevin Bebout, R. Ph.
First Published: April 2003
Last Revised: April 2003
Peer Review Status: Internally Reviewed

Converting patients from intravenous to oral drug therapy as soon as possible is advantageous and more convenient to the patient and nursing staff, as well as being more cost effective. Nurses, pharmacists and physicians can collaborate to identify potential candidates for conversion from intravenous to oral therapy, thereby providing patients with cost-effective alternatives when appropriate.

Oral therapy increases patient mobility and comfort. It can prevent complications from IV therapy such as phlebitis (reported to affect as many as 30-70% of all infusions),^1,2 septicemia due to line infection, tissue damage from extravasation, etc. Oral medications are less expensive than intravenous medications and have fewer hidden costs. Oral medications require less nursing and pharmacy preparation and administration time. Converting to an oral medication earlier in therapy may decrease the patient's length of stay.

Patients who are candidates for conversion to oral drug therapy should have a condition treatable by an oral form of the medication, have a functioning GI tract for adequate absorption (use caution in cases of diarrhea or vomiting), and currently be receiving a soft or regular diet and/or taking other oral medications. The patient's condition should also be improving as indicated from clinical findings (e.g., temperature and white blood cell count are returning toward normal in a patient being treated for an infection).

Conversion to oral therapy is not recommended in patients who are critically ill or whose condition is deteriorating, on a protocol or study which specifies the IV form of the medication, NPO, have uncontrolled nausea or vomiting, or the administration of oral medications by an established feeding tube is not possible or advisable.

Medications which have been targeted and reviewed by the Pharmacy and Therapeutics (P&T) Subcommittee for transition from intravenous to oral therapy include:

 

IV Therapy	Oral Therapy
Ampicillin/sulbactam	Amoxicillin/clavulanate
Azithromycin	Azithromycin
Bumetanide	Bumetanide
Cefazolin	Cephalexin
Ceftriaxone	Cefpodoxime
Cimetidine	Cimetidine
Dexamethasone	Dexamethasone
Erythromycin	Erythromycin
Famotidine	Famotidine
Fluconazole	Fluconazole
Furosemide	Furosemide
Hydrocortisone	Hydrocortisone
Ketorolac	Ibuprofen
Levofloxacin	Levofloxacin
Linezolid	Linezolid
Methylprednisolone	Methylprednisolone
Pantoprazole	Lansoprazole
Trimethoprim/Sulfamethoxazole	Trimethoprim/Sulfamethoxazole
Voriconazole	Voriconazole

Please contact the pharmacy satellite serving your patient care area or the Drug Information Center at 6-2600 for oral conversion doses.

¹Formulary 1997; 32: 944-59
²Pharmacotherapy 1997; 2: 271-6

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