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Overview :
A pharmacist sometimes may need to substitute one
formulation of a drug for another. This may be required by availability, cost
containment, patient convenience or other factors. This can be done safely
provided certain guidelines are observed.
NOTE: These guidelines reflect Texas state law and may vary
in other jurisdictions. These guidelines do not cover substitution of a
generically equivalent product.
Examples: capsules instead of tablets; tablets instead of
liquid
Guidelines for changing a prescribed drug's form at the time
of dispensing:
(1) The patient
consents to the change.
(2) The physician is notified of the change and agrees to
the substitution.
(3) The
formulation dispensed contains the identical amount of active ingredient as the
form originally prescribed.
(4) The
formulation is not enteric-coated or time-released.
(5) The
formulation does not alter clinical outcome for the condition being treated.
where:
• The
contraindication for enteric-coated or time-released forms may reflect the
difficulty in achieving an equivalent time course using alternative
formulations. I would imagine that substituting a time-released tablet for a
time-released capsule with similar release characteristics would be
appropriate. As noted by B. Alpert in Barron's Technology Week (March 4, 2002):
" But controlled-release capsules and tablets are among the hardest drugs
to make, needing layers of tricky ingredients to ensure that medicine trickles
out at predicted levels."
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