IV to PO Flashcards
INCLUSION criteria:
- The patient is on a medication therapy listed in the protocol.
- The patient is taking and tolerating other oral medications.
- The patient is tolerating an oral diet (NG tube feeding exclusions listed below).
- Clinical status is improving as demonstrated by, but not limited to, a trend towards:
a. Afebrile (less than 100.4F) in past 24hr (for antimicrobials)
b. WBC wnl (for antimicrobials)
c. HR<100 bpm (as applicable)
d. SBP>100mmHg (as applicable)
e. Advancing diet
Ondansetron
a. Do not convert for patients receiving chemotherapy or with chemotherapy planned
APAP
IV Dose*
1gm IV q6-8h
(Note: IV APAP restrictions to be followed per P&T Committee)
PO Dose
975mg-1000mg PO q6-8h
PO Bioavailability
85-98%
Ampicillin and sulbactam
IV Dose*
1.5 to 3 gm Q6h
PO Dose
Amoxicillin and clavulanate 875/125 mg Q12h
PO Bioavailability
Amoxicillin nearly complete oral absorption: AUC was 93% of intravenous
Azithromycin
IV Dose*
250-500mg IV q24h
PO Dose
Same dose and interval
PO Bioavailability
38%
Ceftriaxone
IV Dose*
1 gm or 2 gm q 24h
PO Dose
Cefdinir 300 mg Q 12h
PO Bioavailability
Capsule 16% to 21%; suspension 25%
Chlorothiazide/ Hydrochlorothiazide
(Chlorothiazide)
500-1000mg IV q12-24h
(Hydrochlorothiazide)
12.5-100 mg PO q24h (max 50mg for HTN)
Ciprofloxacin
200-400mg IV q8-24h
250-500mg PO q8-24h‡
60-80%
Clindamycin
300-900mg IV q6-8h
150-450mg PO q6-8h
90%
Digoxin (maintenance)
Arrhythmia: 0.125-0.5 mg IV q24h
HF: 2.4 to 3.6 mcg/kg IV/IM q24h
Same dose and interval
60-80%
Doxycycline
100-200mg IV q12-24h
Same dose and interval
100%
Ethacrynic Acid
0.5-1mg/kg IV
50-200mg PO/day
(consult with MD to determine best frequency, and titrate to effect)
100%
Famotidine
20-40mg IV q12-24h
Same dose and interval
40-45%
Fluconazole
100-400mg IV q24h
Same dose and interval
> 90%
Folic Acid
1mg IV q24h
Same dose and interval
76-93%
Fosphenytoin/Phenytoin
100-300mg** IV q8-24h
Same dose and interval‡
80-100%
Levetiracetam
500-1500mg IV q24h
Same dose and interval
100%
Levofloxacin
250-750mg IV q24h
Same dose and interval
50-80%
Levothyroxine
25-100mcg IV q24h
IV dose is around 50% of oral dose*** ‡
Restricted to patients who have not received levothyroxine > 3 days AND cannot take orally.
(ex: 50mcg IV q24h=100mcg PO q24h)
50-80%
Linezolid
600mg IV q12h
Same dose and interval
100%
Metoclopramide
5-20mg IV q4-6h
Same dose and interval
80%
Metronidazole
250-500mg IV q6-8h
Same dose and interval
100%
Multivitamin
1 vial IV q24h
1 tablet PO q24h
100% RDA
Ondansetron
4-8 mg per dose
Same dose and interval. *Add linked order for ODT (or regular tablet if ODT not available) and leave IV order, in the event that patient no longer meets criteria for PO
100%
Pantoprazole
40mg IV q24h
Same dose and interval†
77%
Thiamine
100mg IV q24h
Same dose and interval
5.3%
Voriconazole
3 to 4 mg/kg IV q12 hours
200 mg PO q 12h
96%
EXCLUSION criteria*:
- Pediatric and neonatal patients.
- The physician specifically indicates “do not convert to oral route” or similar instruction.
- The patient is NPO (and no other medications are being administered orally).
- The patient has diminished gut perfusion (i.e. shock, vasopressor therapy).
- Persistent nausea and vomiting, diarrhea
- The patient has compromised oral absorption (i.e. continuous NG suction, persistent N/V or diarrhea, active GIB, ileus, GI obstruction, reduced GI transit time from malabsorption or short bowel syndromes).
- The patient is on continuous tube feeding, the tube feeding cannot be interrupted, and the medication being evaluated is known to interact with enteral formulas (i.e. fluoroquinolones, phenytoin, levothyroxine).
- The patient is neutropenic (ANC<500 cells/mm3).
* patients excluded may be eligible for conversion to oral therapy on a later date.
