Skip to main content
Log in

Clinical Aspects of Therapeutic Substitution

  • Clinical Aspects of Therapeutic Substitution
  • Pharmaco Economics
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

A variety of problems are associated with the operation, quality, costs, and benefits of therapeutic substitution programmes. Adequate communication of procedures, events, and failures are essential features ofa safe therapeutic substitution policy. However, case reports of suboptimal therapy and differences in pharmacological profiles of related agents indicate the potential for clinical nonequivalence even between similar drugs of a class. Suboptimal or failed therapy associated with such nonequivalence may offset savings in drug costs resulting from therapeutic substitution. Thus, consultation on behalf of each patient is necessary for optimal therapy and maximum cost savings. Currently. there are no data on the interchangeability of specific agents of a class and the effects of therapeutic substitution on overall treatment costs. Thus, the health and economic outcomes of therapeutic substitution policies are unknown.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • American Academy of Family Physicians. Statement on therapeutic substitution. Kansas City, Missouri, 1988

    Google Scholar 

  • American Academy of Pediatrics. Generic prescribing, generic substitution and therapeutic substitution. Pediatrics 79: 835, 1987

    Google Scholar 

  • American College of Cardiology and American Heart Association. Statement on therapeutic substitution. Bethesda, Maryland and Dallas, Texas. 1988

    Google Scholar 

  • American College of Physicians. Therapeutic substitution and formulary systems. Annals of Internal Medicine 113: 160–163, 1990

    Google Scholar 

  • American College of Rheumatology. Position paper on therapeutic substitution. Atlanta, Georgia, 1988

    Google Scholar 

  • American Osteopathic Association. Statement on therapeutic substitution. Chicago, Illinois, 1986

  • Bazire SR. Sudden death associated with switching monoamine oxidase inhibitors. Drug Intelligence and Clinical Pharmacy 20: 954–955, 1986

    PubMed  CAS  Google Scholar 

  • Bond WS, Berwish NJ, Swift B. Severe withdrawal syndrome after substitution of a short—acting benzodiazepine for a long—acting benzodiazepine. Drug Intelligence and Clinical Pharmacy 19: 742–744, 1985

    PubMed  CAS  Google Scholar 

  • Conell U, Berlin RM. Withdrawal after substitution of a short—acting for a long—acting benzodiazepine. Journal of the American Medical Association 250: 2838–2840, 1983

    Article  PubMed  CAS  Google Scholar 

  • Doering PL, Russell WL, McCormick WE, Klapp DL. Therapeutic substitution in the health maintenance organization outpatient environment. Drug Intelligence and Clinical Pharmacy 22: 125–130, 1988

    PubMed  CAS  Google Scholar 

  • Frishman WH. Clinical differences between beta—adrenergic blocking agents: implications for therapeutic substitution. American Heart Journal 113: 1190–1198, 1987

    Article  PubMed  CAS  Google Scholar 

  • Gallup Organization. Physicians’ altitudes towards prescription drug policies, 1990

    Google Scholar 

  • Gelenberg AJ. Switching MAOI. Biological Psychiatry 7: 36, 1985

    Google Scholar 

  • Levy RA. Therapeutic substitution of cardiovascular drugs in the elderly. Drug Therapy 19: 24–48, 1989

    Google Scholar 

  • Levy RA, Smith DL. Clinical differences among nonsteroidal antiinflammatory drugs: implications for therapeutic substitution in ambulatory patients. DICP: Annals of Pharmacotherapy 23: 76–85, 1989

    PubMed  CAS  Google Scholar 

  • Scharf MB, Jennings SW, Graham JP. Therapeutic substitution: clinical differences among benzodiazepine compounds. US Pharmacist (Hospital Edition) 13: H1–H13, 1988

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Levy, R.A. Clinical Aspects of Therapeutic Substitution. Pharmacoeconomics 1 (Suppl 1), 41–44 (1992). https://doi.org/10.2165/00019053-199200011-00010

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199200011-00010

Keywords

Navigation