Intravenous to Oral Therapy Conversion

Patient Name	Current IV Medication	Indication	Dose & Frequency	Oral Dosage Form Available	Oral Dose	Oral Frequency & Dosing Times	Check Answer
Adam Anderson	Ciprofloxacin	Bacterial prostatitis, chronic	400 mg IV q12h	tablet	mg
	Methylprednisolone Sodium Succinate	Asthma	40 mg IV q24h	Prednisone, tablet	mg
	Levothyroxine	Hypothyroidism	80 mcg IV q24h	tablet	mcg

Patient Name	Current IV Medication	Indication	Dose & Frequency	Oral Dosage Form Available	Oral Dose	Oral Frequency & Dosing Times	Check Answer
Brenda Brown	Enalaprilat	Hypertension	1.25 mg IV q6h	tablet	mg
	Morphine Sulfate	Chronic pain (severe)	3.4 mg/hr continous IV infusion	extended-release tablet (Mallinckrodt)	mg
	Voriconazole	Aspergillosis, Invasive	200 mg IV q12h	tablet	mg

Patient Name	Current IV Medication	Indication	Dose & Frequency	Oral Dosage Form Available	Oral Dose	Oral Frequency & Dosing Times	Check Answer
Catherine Coulter	Metoclopramide	Gastroparesis	10 mg IV q8h	tablet	mg
	Levetiracetam	Status epilepticus	500 mg IV q12h	tablet	mg
	Phenytoin	Status epilepticus	200 mg IV q8h	capsule	mg

Use hospital IV-TO-PO Substitution List to find approved conversion information.

Use information in Lexicomp to find administration times (e.g. effect of food).

Background:

Switching from intravenous (IV) to oral (PO) therapy as soon as patients are clinically stable can reduce the length of hospitalization and lower associated costs.
Medications involved in switch therapy include antibiotics, analgesics, antipsychotics, and antivirals.
Patients are more comfortable if they do not have an IV catheter in place.

Attachment to an IV pole can restrict movement, which can hinder early and/or frequent ambulation.
Patients who continue to receive parenteral therapy are at an increased risk for infusion-related adverse events.
The presence of an IV catheter provides a portal for bacterial and fungal growth.

Sequential IV-to-PO therapy refers to the act of replacing a parenteral version of a medication with its oral counterpart.

An example is the conversion of famotidine 20 mg IV to famotidine 20 mg PO.

When switching from an IV to a PO form of the same medication, care must be taken to determine both an equivalent dosing amount (e.g. 200 mg) as well as dosing frequency (e.g. q12 hours) for the new oral medication.
Dosage formulations and bioavailability play an important role in conversion therapy.

When medications are administered intravenously, the bioavailability is 100% because they are administered directly into the blood.
For oral medications, bioavailability may be less due to the variability in the rate and extent of dissolution of the oral form and the total amount that is absorbed into the systemic circulation.
In addition, specific administration times may need to be determined to ensure oral medications are given correctly in respect to meals (e.g. some need to be taken before meals, others afterwards).