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.
Similar content being viewed by others
References
American Academy of Family Physicians. Statement on therapeutic substitution. Kansas City, Missouri, 1988
American Academy of Pediatrics. Generic prescribing, generic substitution and therapeutic substitution. Pediatrics 79: 835, 1987
American College of Cardiology and American Heart Association. Statement on therapeutic substitution. Bethesda, Maryland and Dallas, Texas. 1988
American College of Physicians. Therapeutic substitution and formulary systems. Annals of Internal Medicine 113: 160–163, 1990
American College of Rheumatology. Position paper on therapeutic substitution. Atlanta, Georgia, 1988
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
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
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
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
Frishman WH. Clinical differences between beta—adrenergic blocking agents: implications for therapeutic substitution. American Heart Journal 113: 1190–1198, 1987
Gallup Organization. Physicians’ altitudes towards prescription drug policies, 1990
Gelenberg AJ. Switching MAOI. Biological Psychiatry 7: 36, 1985
Levy RA. Therapeutic substitution of cardiovascular drugs in the elderly. Drug Therapy 19: 24–48, 1989
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
Scharf MB, Jennings SW, Graham JP. Therapeutic substitution: clinical differences among benzodiazepine compounds. US Pharmacist (Hospital Edition) 13: H1–H13, 1988
Author information
Authors and Affiliations
Rights 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
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-199200011-00010