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Therapeutic Substitution and Formulary Systems

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Requests for Reprints: Linda Johnson White, Director, Department of Scientific Policy, American College of Physicians, Independence Mall West, Sixth Street at Race, Philadelphia, PA 19106-1572.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;113(2):160-163. doi:10.7326/0003-4819-113-2-160
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The practice of therapeutic drug substitution has become common throughout the United States, often without the awareness of many physicians. It occurs to some extent in more than 52% of the nation's acute care hospitals and more than 30% of health maintenance organizations (HMOs) (1, 2). Therapeutic substitution entails dispensing a drug different in chemical structure from the one originally prescribed. The substitute must be from the same therapeutic class (therapeutic alternate) and have the same pharmacodynamic and pharmacokinetic properties (for example, cefazolin for cefotaxime; cimetidine for ranitidine).

Therapeutic substitution originates in an institution's formulary system. Arising from the need




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