Therapeutic Interchange Program Research Articles

Effects of clinical decision support and pharmacist prescribing authority on a therapeutic interchange program.

Results of an evaluation of therapeutic interchange (TI) program outcomes with use of prescriber alerts alone or in combination with pharmacist prescribing are reported. A retrospective single-center study was conducted to compare TI outcomes before incorporation of prescriber alerts encouraging formulary agent use into the electronic medical record (period 1), after alert implementation (period 2), and after implementation and expansion of TI protocols including pharmacist prescribing authority (period 3). The evaluation focused on TI orders for 3 drug classes: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (HMG-CoA RIs). The primary outcome was formulary medication utilization. In total, 2,881, 2,700, and 3,088 prescriptions for medications in the ACEI, ARB, or HMG-CoA RI class were ordered during periods 1, 2, and 3, respectively. Overall formulary adherence improved from 78.3% in period 1 to 97.6% in period 2 and 99.2% in period 3 (p < 0.001 for both comparisons with period 1). The percentages of inappropriate dosing conversions were 51.6%, 37.2%, and 2.4% in periods 1, 2, and 3, respectively; the corresponding percentages of inappropriate discharge medications were 64.5%, 16.3%, and 2.4%. Percentages of formulary medications in 3 medication classes, considered separately and together, increased with the implementation of TI alerts for prescribers and the addition of TI-related pharmacist prescribing authority. Over the same study periods, percentages of inappropriate dosing conversions and inappropriate discharge medications decreased.

Angiotensin Converting Enzyme Inhibitors and Sartans in a Geriatric Setting: Impact of Therapeutic Interchange

Background: Therapeutic interchange is widely used in geriatric settings, such as angiotensin enzyme converting inhibitors and angiotensin II receptor antagonists and angiotensin receptor blockers (sartans). Objective: we evaluate the clinical impact (efficacy and tolerance) of a therapeutic interchange program for noncomplicated hypertension. Method: 13 patients receiving angiotensin enzyme converting inhibitors and 7 patients under sartans were followed-up during 6 months after a therapeutic interchange to a first line drug: Ramipril and valsartan, respectively. Results: all the substitutions were well tolerated and no significant difference was observed for diastolic and systolic pressure after therapeutic interchange. Conclusion: therapeutic interchange on angiotensin enzyme converting inhibitors and sartans in the context of hypertension seem safe based on our clinical data.

Sex/Gender-Based Pharmacology and Statin Utilization Amongst Elderly Patients with Diabetes.

The purpose of this study was to explore the ten-year trends in utilization of bioequivalent doses of statin amongst elderly patients with diabetes according to sex/gender in Ontario, Canada. A cohort of patients with diabetes (>65 years) was constructed using the Ontario Diabetes Database Statin utilization data (2003-2012) was obtained from the Ontario Drug Benefit Program for both women and men. Bioequivalent doses for statins were calculated according to the dosing conversion factor in therapeutic interchange programs in clinical practice. Utilization pattern of high potency (Atorvastatin and Rosuvastatin) vs. low potency statins (Simvastatin, Lovastatin, Fluvastatin, Pravastatin) were also analyzed. The average bioequivalent Simvastatin utilization in 2003 was 29.22 mg/day for women and 30.35 mg/day for men. By 2008, this gap in dosing was higher for both women and men and by 2013 it had increased to 47.75 mg/day for women and 52.98 mg/day for men. For average number of day supply per year, there was no significant trend of changes over the 10-year period, although the use of high potency statins increased significantly (P<0.001) for both women and men. No differences were seen for sex/gender; either for the 10-year period or for each year. There has been significant increase in bioequivalent statin utilization amongst elderly patients with diabetes in Ontario; for both men and women. In a publicly-funded healthcare system such as Ontario, there were no sex/gender differences in the utilization of high potency statin (Atorvastatin and Rosuvastatin) amongst elderly patient with diabetes.

Efficacy and Safety Evaluation of a Large Niacin Therapeutic Interchange Program

An extended-release niacin product (Niaspan, Abbott Laboratories) was identified as a product with a less costly therapeutic alternative; a therapeutic product interchange was implemented. To evaluate the efficacy and safety of a product therapeutic interchange from Niaspan to a controlled-release niacin product (Slo-Niacin, Upsher-Smith Laboratories) among patients at a large US Department of Veterans Affairs health care facility. Patients with active prescriptions for Niaspan underwent a therapeutic product interchange to Slo-Niacin; following conversion of the product, the medical record for each patient was reviewed and pre- and postconversion clinical information and conversion details were transcribed into a database for subsequent analysis and study. The primary efficacy end point was pre- and postconversion level of low-density lipoprotein cholesterol; secondary efficacy end points were levels of serum total cholesterol, high-density lipoprotein cholesterol, and triglycerides. Abnormal serum liver enzyme levels greater than 3 times the upper limits of normal was the primary safety end point; blood hemoglobin A1c was assessed as a secondary safety end point. A total of 5321 patients' medical records were reviewed; for the efficacy evaluation, 539 patients were maintained on a daily dose of Slo-Niacin that was the same as the previous Niaspan dose. The dosage of any other concurrently prescribed dyslipidemia medication was unchanged. Analysis of these cases indicated that the conversion of Niaspan to Slo-Niacin was not associated with a difference in serum lipids over a mean (SD) of 503.9 (98.0) postconversion observation days with the exception of a decrease in mean serum triglyceride concentration of 19.8 mg/dL (p = 0.0003). Evaluation of all 5321 patients given Slo-Niacin for up to 724 days did not detect any safety differences between Slo-Niacin and Niaspan. Local facility cost avoidance exceeded $800,000 in the first postconversion year. Data from a medication use evaluation of modified-release niacin products therapeutic interchange in a large US Department of Veterans Affairs health care facility show that the switch from Niaspan to Slo-Niacin had no negative effects on lipid-altering efficacy or safety but generated significant cost avoidance.

Non-formulary drugs: situation analysis

BackgroundThe analysis of Non-formulary drugs (NFD) most frequently prescribed is important in managing a hospital's formulary.PurposeDetermine the most frequently prescribed and dispensed NFD in a 376 bed community hospital.Materials and...

Successful Implementation of a P&T-Approved Therapeutic Interchange Program of Angiotensin II Receptor Blockers in a Medical Center in Taiwan

Objective Therapeutic interchange is not a common practice in the medical society in Asia. We used clinic blood pressure readings, patients' tolerance, and cost saving as measures to evaluate the impact of a therapeutic interchange program implemented at a medical center in Taiwan. Methods Taipei Medical University-Wan Fang Hospital initiated a therapeutic interchange program involving angiotensin II receptor blockers (ARBs). Data were retrospectively collected for 444 outpatients who were converted from other ARBs to candesartan. Evaluation of therapeutic efficacy, adverse effects associated with therapy, and drug costs was conducted before and after the program implementation. Results Patients whose treatment was converted to candesartan experienced no statistically significant differences in blood pressure, and the average number of antihypertensive agents used per patient remained unchanged. A direct cost savings of US$62,237 was estimated for the 444 patients studied. Only 3.15% of the patients developed adverse drug reactions potentially related to candesartan, and none required hospitalization. Conclusions Based on the results of this retrospective chart review, the present ARB therapeutic interchange program was successfully developed and implemented. This is the first study to establish the positive impact of a well-run ARB therapeutic interchange program in Taiwan.

ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing—2010

Results of the 2010 ASHP national survey of pharmacy practice in hospital settings are described. A stratified random sample of pharmacy directors at 1968 general and children's medical-surgical hospitals in the United States was surveyed by Internet and mail. SDI Health LLC supplied data on hospital characteristics; the survey sample was drawn from the SDI Health hospital database. In this national probability sample survey, the response rate was 28.8%. Patient-specific pharmacist activities are increasing, as shown by the substantial use of pharmacist empowered therapeutic interchange programs, extensive prevalence of pharmacist review of medication orders before doses are available for administration to patients, and the widespread use of pharmacist consultations by prescribers, with almost complete acceptance of pharmacist recommendations. Pharmacists are also leading antibiotic stewardship programs, managing anticoagulation medication therapy, addressing pharmaceutical waste management, and standardizing i.v. infusion concentrations. Electronic health information is rapidly being adopted, with the use of electronic medical records and computerized prescriber-order-entry to improve prescribing and use of medications. Metrics are commonly used to track and monitor trends in operational, clinical, and safety performance in hospital pharmacy departments. Pharmacist and pharmacy technician staffing has increased significantly, while vacancy rates have declined. Pharmacists contribute to improving prescribing and transcribing. Patient safety is now a priority for medication management.

Literature review on the structure and operation of Pharmacy and Therapeutics Committees

To review the literature on the structure and operation of hospital Pharmacy and Therapeutics Committees from an international point of view and examine the factors that influence decision-making of these committees. We performed a literature search in the Medline and Embase databases from 1997 to January 2009 with the search terms: formulary system decision making, pharmacy and therapeutics committee, formularies hospital, drug formulary, survey, drug selection and outcome assessment health care. Inclusion criteria were the following: studies analyzing Pharmacy and Therapeutics Committees published in English or Spanish from 1997 to January 2009. Exclusion criteria were: publications which were editorials or opinion pieces, studies relating to one hospital, and studies where full text could not be attained. The analysis was divided into structural/organizational data and data on factors affecting the decision-making process. Seventeen studies met the inclusion criteria. Pharmacy and Therapeutics Committees and formularies were present in more than 90% of the hospitals in four of the five countries examined. Therapeutic interchange programs existed only in two of these countries. The mean number of committee members ranged between six and eight. More than 89% of the committees included a pharmacist. Standard operating procedures were implemented by 89% of the committees. The most influential factors in the decision-making were clinical trial results or drug costs rather than pharmacoeconomic studies. Other local organization-dependent factors were also important. The structure and operating procedures of Hospital Pharmacy and Therapeutics Committees are similar in select Western countries. Information from clinical trials is the most influential factor in the decision-making process.

Outcomes of an Erythropoietic Growth Factor Interchange Program in Hospitalized Chronic Hemodialysis Patients

Background The substantial cost of erythropoietic growth factors (EGFs), darbepoetin alfa and epoetin alfa, has led many institutions to evaluate EGF usage and costs in the hospital setting. The primary objectives of this study were to determine the clinical impact on hemoglobin (Hb) concentration, postdischarge epoetin alfa dose requirements, and the economic impact of a darbepoetin alfa for epoetin alfa therapeutic interchange program in hospitalized hemodialysis patients. Methods A retrospective review was conducted in 79 patients (43 during a control period and 36 during the interchange period). The control group consisted of chronic hemodialysis patients admitted to the hospital before the therapeutic interchange program was implemented (September 2002 through September 2003); the interchange group included patients admitted after implementation of the interchange program (October 2003 through October 2004). Clinical parameters including Hb concentration, concomitant iron therapy, packed red blood cell (PRBC) transfusions, EGF dose and cost were collected beginning 2 months prior to hospitalization, during hospitalization, through 2 months post hospital discharge. Results No differences were observed between groups in baseline demographics. There was a greater decrease in Hb concentration in the control group compared to the interchange group, but this did not achieve statistical significance (0.5 g/dL vs 0.3 g/dL, respectively; P = 0.67). EGF dose requirements did not differ between the two groups, nor did the total EGF cost per patient admission before and after hospitalization. Total cost per patient during hospitalization was $164 ± 144 in the control group and $165 ± 156 in the interchange EGF group ( P= 0.97). Conclusion: In the treatment of anemia in hospitalized chronic hemodialysis patients, there were no differences seen in Hb concentration, EGF dose requirements, or overall EGF cost per patient admission. Implementation of the interchange program allowed for market share gains to permit an overall economic benefit across all patients in the amount of $300,000 annually.

Darbepoetin Alfa Therapeutic Interchange Protocol for Anemia in Dialysis

Erythropoiesis-stimulating proteins, such as erythropoietin alfa and darbepoetin alfa, have positively impacted anemia management. These medications improve patient outcomes and quality of life. Their costs, however, remain a major barrier for health systems. To evaluate the development, implementation, and cost-effectiveness of an inpatient therapeutic interchange protocol for erythropoiesis-stimulating proteins at a large, tertiary care, university-affiliated health system. Virginia Commonwealth University Health System (VCUHS) developed and implemented a therapeutic interchange program to convert therapy for all inpatients undergoing dialysis from erythropoietin alfa to darbepoetin alfa for treatment of chronic kidney disease-related anemia. An evaluation of the economic impact of this program on drug expenditures over a fiscal quarter (2003) was conducted using historical comparator data (2002). Preliminary evaluation of the program demonstrated cost-savings and reduced drug utilization of erythropoiesis-stimulating proteins in hospitalized dialysis patients. For the first quarter of 2003 compared with the first quarter of 2002, VCUHS realized a cost-savings of nearly 10,000 US dollars, which was related to the program's aggressive screening procedure. When these data were normalized for equal numbers of patients in each group receiving one of the drugs, the actual cost-savings was over 2000 US dollars. These cost-savings are largely due to reduced utilization of these expensive biotechnology products with implementation of a dosing protocol. VCUHS has successfully developed and implemented a darbepoetin alfa therapeutic interchange protocol for hospitalized dialysis patients. This has translated into reduced use of erythropoiesis-stimulating proteins, resulting in cost-savings for the health system.

Promethazine Adverse Events after Implementation of a Medication Shortage Interchange

Prochlorperazine and droperidol were commonly used antiemetics at the University of Pittsburgh Medical Center-Presbyterian Hospital until a shortage of prochlorperazine occurred and a black box warning was added to droperidol prescribing information. Subsequently, promethazine was selected as the approved intravenous antiemetic for therapeutic interchange in December 2001. Promethazine use and adverse drug events (ADEs) were investigated following review of a serious ADE that identified promethazine use as a probable contributing factor. To illustrate ADEs associated with promethazine and characterize high-risk patients. An ADE database analysis identified promethazine ADEs reported from 2000 to 2003. Promethazine utilization and ADEs were compared with those of other antiemetics during the pre- and post-interchange periods. Promethazine utilization increased significantly during the post-interchange period compared with all other antiemetics (p < 0.001). Promethazine ADEs increased from one event during the pre-interchange period to 13 events during the post-interchange period. Causality assessment using the Naranjo algorithm ranged from possible to probable. The promethazine ADE rate per 10 000 doses was significantly higher than the combined ADE rate for all other antiemetics (p < 0.001; incident rate ratio [IRR] 4.32). Elderly patients (aged > or =65 y) experienced more promethazine ADEs than younger patients (p = 0.005; IRR 4.68). Concurrent use of opioids and/or sedating drugs contributed to promethazine ADEs in 11 of 14 (78.6%) patients. Geriatric status is a significant risk factor for promethazine ADEs. Concomitant use of sedating drugs may further increase the risk for ADEs. Therapeutic interchange programs should be monitored for both ADEs and utilization.

Impact of an Automatic Therapeutic Interchange Program on Discharge Medication Selection

This brief report describes the effect of an automatic therapeutic interchange program on patients' discharge medications. Pharmacists at a medical center were authorized to convert various nonformulary medications to formulary equivalents. To determine which medications were prescribed to the patients upon hospital discharge, automatic interchanges during June 2001 to September 2001 were identified. Of those identified, 94 met study inclusion criteria. Complete information was obtained for 46 patients. Inpatient and outpatient pharmacy records were reviewed retrospectively for a 3-month period postdischarge. In the majority (67.4%) of cases, the patient's preadmission medication was continued on an outpatient basis. In 17.4% of the cases, the therapeutic interchange medication was continued on an outpatient basis. In 15.3% of the cases, patients were prescribed medications that were neither preadmission nor the interchanged medications. These results demonstrate that an automatic interchange program has the potential to influence outpatient therapy.

Low-Molecular-Weight Heparin Therapy for Patients Undergoing Total Knee Replacement Surgery: Cost and Outcomes

Objective: In March 1997, a community hospital system changed the low-molecular-weight heparin (LMWH) product on formulary from enoxaparin to dalteparin through a therapeutic interchange for all uses except patients undergoing total knee replacement (TKR) surgery. In October 1997, therapeutic interchange of LMWHs (enoxaparin to dalteparin) was instituted for patients undergoing TKR surgery. The cost equivalence of these therapies in TKR surgery was evaluated. Methods: A cohort of patients admitted to three health-system facilities who underwent primary TKR surgery between July 1, 1996 and December 31, 1998 was assembled retrospectively. Costs and outcomes associated with a formulary interchange for LMWH products (from enoxaparin to dalteparin) initiated in October 1997 for TKR surgery were analyzed using data abstracted hospital records and decision support systems. To evaluate equivalence between the drugs, the difference in median inpatient health care costs (with 95% confidence intervals [CIs]) was calculated. Equivalence of outcomes (eg, adverse events) in terms of risk ratios was also evaluated. Results: Inpatient costs were essentially equivalent for patients treated with enoxaparin (n = 88) and dalteparin (n = 101), with a slightly higher median cost among enoxaparin-treated patients ($172 [95% CI, -$17 to + $395]). CIs for the crude and regression-adjusted findings included the possibility of no cost difference (ie, $0). The median time to hospital discharge was identical, at 6 days. Outcomes were otherwise similar between the two groups. Conclusions: Our therapeutic interchange program was successful. Inpatient costs were equivalent when patients were treated with either enoxaparin or dalteparin for TKR surgery.

Pharmacy-Administered IV to Oral Therapeutic Interchange Program: Development, Implementation, and Cost-Assessment

This study describes the development, implementation, and estimated vs. actual cost benefits of an IV to oral therapeutic interchange program. Secondary objectives were determining patient eligibility criteria and selecting medications for future inclusion in the program. Medical charts were reviewed to determine which patients were appropriate candidates for the interchange. Targeted medications were selected by reviewing the literature and the institution's drug expenditures. Five medications — famotidine, ciprofloxacin, levofloxacin, fluconazole, and azithromycin — were selected for the initial stages of the program. Preimplementation cost analysis suggested that the interchange would yield cost savings of more than $30,000 per year in medication costs alone. The interchange was piloted on a single nursing unit to determine best procedures and possible barriers to implementation. Data collected in the first 6 months after implementation indicated greater potential cost benefits than originally estimated. Including more medications in the interchange would further reduce drug acquisition costs.

Formulary management of colony-stimulating factors.

The outcome of a formulary interchange from filgrastim to sargramostim for the amelioration of neutropenia for outpatients receiving myelosuppressive chemotherapy was evaluated. The pharmacy department at the James Graham Brown Cancer Center of the University of Louisville Hospital implemented a therapeutic interchange program by following the Joint Commission on Accreditation of Healthcare Organizations performance methodology, incorporating four key elements: plan, do, check, and act. After the pharmacy and therapeutics committee agreed that filgrastim and sargramostim are therapeutically equivalent, the pharmacy initiated the interchange, with a commitment to collect outcomes data to analyze the impact of the program on patient outcomes. Inclusion criteria included patient age of > or = 18 years, the presence of solid tumors or lymphoma, and current treatment with traditional chemotherapy. Patient demographics and cycle-specific data were collected for 31 patients receiving sargramostim and 20 patients receiving filgrastim from August 2000 to July 2001. Absolute neutrophil counts (ANCs) were measured before initiating and after discontinuing colony-stimulating factors. The majority (70%) of all growth factor use was initiated within one to four days of the last chemotherapy dose. No appreciable difference was found between agents for median ANC at any measured time point. The majority of patients exceeded the target ANC of 1500 cells/mm3 at the time of growth factor discontinuation. There were no significant differences in the number of patients that had adverse effects or in the number of cycles resulting in an adverse event between groups. Sargramostim demonstrated a 21% cost savings over filgrastim ($1036 versus $1318, respectively). The formulary switch from filgrastim to sargramostim resulted in a significant cost savings for the institution without increasing incidence of adverse effects and negative outcomes associated with growth factor use.

Survey of hospital policies regarding low-molecular-weight heparins.

Hospital policies regarding the use of low-molecular-weight heparins (LMWHs) were studied. A questionnaire addressing the formulary status of LMWH products, the use of prescribing guidelines, programs for therapeutic interchange, and policies to promote alternatives to LMWHs when appropriate was prepared. The questionnaire was mailed in January 2001 to pharmacy directors at 70 hospitals located in 19 states. All the hospitals were members of a national group purchasing organization. Forty-nine usable responses were received, for a response rate of 70%. Enoxaparin and dalteparin were the LMWH products most likely to be on the respondents' formularies (98% and 29% of hospitals, respectively). About 29% of the hospitals reported having guidelines on the use of LMWHs. Among hospitals that did not, most indicated that they were considering or would like to implement such guidelines. The most commonly cited barrier to the development and implementation of guidelines was lack of pharmacy personnel. Ten percent of the respondents reported having therapeutic-interchange programs for LMWHs. Cited barriers to therapeutic interchange programs included lack of therapeutic equivalence among products and lack of comparable labeled indications. Policies to promote alternatives to LMWHs were reported by 18% of the respondents. A multihospital survey showed that many hospitals wanted but relatively few had prescribing guidelines for LMWHs.

Outcomes of an amlodipine-to-felodipine therapeutic interchange program.

Journal Article Outcomes of an amlodipine-to-felodipine therapeutic interchange program Get access Derrik R. Lcdr Clay, Pharm.D., Derrik R. Lcdr Clay, Pharm.D. Clinical Pharmacist Pharmacy Department, Portsmouth Naval Medical Center, Portsmouth, VA; at the time of this study he was Assistant Division Director of Pharmacy, Charleston Naval Hospital (CNH), Charleston, SC Search for other works by this author on: Oxford Academic Google Scholar Michael P. Bourg, Pharm.D., Michael P. Bourg, Pharm.D. Clinical Pharmacist and Assistant Department Director Pharmacy Department, CNH Address reprint requests to LT Bourg at the Department of Pharmacy, Charleston Naval Hospital, 3600 Rivers Avenue, Charleston, SC 29405, or to chr1mpb@chr10.med.navy.mil. Search for other works by this author on: Oxford Academic Google Scholar David B. Lawrence, Pharm.D., BCPS David B. Lawrence, Pharm.D., BCPS Clinical Education Consultant Pfizer, Inc., and Clinical Assistant Professor, College of Pharmacy, Medical University of South Carolina, Charleston Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 57, Issue 17, 1 September 2000, Pages 1604–1607, https://doi.org/10.1093/ajhp/57.17.1604 Published: 01 September 2000

Therapeutic-Interchange Programs: Potential Consequences of Automatic Conversion of Cimetidine to Another H2-Antagonist

The goal of this study was to determine—through an evaluation of the literature—if other H2-receptor antagonists work as well as cimetidine to improve the accuracy and precision of glomerular filtration rate (GFR) measurements following an automatic therapeutic interchange. A PubMed query was conducted for articles (published in the past 10 years) related to creatinine clearance, glomerular filtration rate (GFR), H2-receptor antagonists, and the H2-antagonist drugs. References from these articles were then reviewed to identify further sources. It was found that ranitidine and famotidine do not significantly inhibit tubular creatinine secretion and therefore have no effects on plasma creatinine or creatinine clearance. The literature search failed to provide information on nizatidine's effect on creatinine or creatinine clearance. Cimetidine appears to be the only H2-receptor antagonist with the ability to improve the accuracy and precision of GFR measurements. These conclusions imply that non-FDA approved uses must also be considered when designing and implementing therapeutic interchange programs.

Strategies for Therapeutic Interchange of Biotechnology Medicines: Proceedings of an Invitational Conference

An invitational conference was held to plan a therapeutic interchange program for biotechnology products. The expanding use of biotechnology products has created new challenges and opportunities for organizations who want to implement these programs — with the dual goal of cutting costs and improving quality of care. Successful therapeutic interchange programs can use a variety of strategies, from gentle persuasion based on clinical effectiveness and cost savings to mandatory compliance and automatic substitution. After outlining risk-management considerations and motivations, as well as the barriers to the therapeutic interchange of biotechnology products, the participants identified the following key steps: (1) list biotechnology products that are potential candidates for therapeutic interchange; (2) establish an overall plan for therapeutic interchange programs; (3) select the specific biotechnology products that will be considered for therapeutic interchange; (4) devise a strategy for therapeutic interchange of the selected products; (5) implement the plan; and (6) track program success. The strategy must include a process for ongoing monitoring of clinical and economic outcomes to ensure that the program is meeting its objectives and provide feedback to program participants.

Therapeutic Interchange of H2 Antagonists: Cost Savings and Impact on Outcomes

The objective of this study was to measure the annual cost savings associated with implementation of a histamine-2 receptor (H2) antagonist therapeutic interchange program and to compare specific preimplementation and postimplementation outcome measures, specifically the incidence of adverse drug reactions (ADRs) and treatment failures. An analysis of all H2 antagonist patients was conducted at a private 59-bed, long-term, acute-care facility—1-year prior to and 1 year after an H2 antagonist therapeutic interchange program was implemented. The institution achieved a 99+% conversion of market share to famotidine products. Cost savings during the first year equaled $14,141. No ADRs associated with H2 antagonists were reported during the 1-year preimplementation study period. One ADR potentially associated with H2 antagonists was reported during the 1-year postimplementation study period. There was one treatment failure during each of the study periods.