THERAPEUTIC-INTERCHANGE PROGRAM FOR ORAL HISTAMINE H-2-RECEPTOR ANTAGONISTS

A therapeutic-interchange (TI) program for oral histamine H-2-receptor antagonists at a hospital is described. In 1992 the pharmacy and ther apeutics committee at a large teaching hospital accepted cimetidine as the preferred oral H-2-antagonist. However, the program to promote ci metidine met with little success. The manufacturer of nizatidine then offered the hospital that drug at a reduced cost relative to all other members of the drug class. The committee recommended including nizati dine on the formulary; implementing a TI program so that when an order for an oral H-2 antagonist was written nizatidine would be dispensed; deleting cimetidine and ranitidine tablets from the formulary; and re taining cimetidine and ranitidine oral liquid and i.v. formulations. T he program was approved by the medical executive committee and was imp lemented in August 1994. Extensive efforts to inform the pharmacy, med ical, and nursing staffs about the program were undertaken, and the ph armacy established mechanisms for monitoring compliance. Two months in to the program, 97% of eligible patients were receiving nizatidine. Ac tual cost savings in the first four months exceeded $40,000. In July 1 997 the same program was applied to famotidine, which had replaced niz atidine as the most cost-effective H-2 antagonist. A successful TI pro gram for oral H-2 antagonists was achieved by gaining physician suppor t for the program, educating providers, monitoring compliance, and res ponding to changes in drug costs.