Intravenous to Oral Conversion of Antihypertensives: A Toolkit for Guideline Development

Dasta, Joseph F.; Boucher, Bradley A.; Brophy, Gretchen M.; Cohen, Henry; Hassan, Erkan; MacLaren, Robert; Muzykovsky, Karina; Pass, Steven E.; Seybert, Amy L.

doi:10.1345/aph.1p086

Cited by 14 publications

(12 citation statements)

References 47 publications

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“…1-3,6 Once blood pressure is stabilized, transitioning to enteral (PO) antihypertensives can be challenging because many parenteral medications lack a direct PO counterpart. 7 Whereas guidelines and recommendations support rapid blood pressure control with intravenous (IV) agents, how to most efficiently convert to PO antihypertensives is largely unknown. 1,8…”

Section: Introductionmentioning

confidence: 99%

Faster Transition From Intravenous to Oral Antihypertensives Associated With Improved Outcomes After Aortic Dissection

2019

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Background: After stabilization with intravenous (IV) antihypertensives, the impact of speed-of-transition from IV to enteral (PO) medications in the intensive care unit (ICU) is unknown. Objective: To assess ICU length of stay (LOS) based on transition time from IV to PO antihypertensive therapy. Methods: Retrospective study of aortic dissection patients admitted from June 2013 to July 2017 at a tertiary teaching hospital. Patients were grouped based on achieving full transition to PO medications in either ≤72 hours or >72 hours from the first PO dose. Secondary end points included hospital LOS, IV infusion volume, medication cost, and time spent with arterial/central lines. Results: A total of 56 patients transitioned completely from IV to PO therapy in ≤72 hours, and 72 patients required more than 72 hours. Demographics, IV and PO medication choices, and timing of first PO medication administration were similar between groups. ICU LOS was shorter in the group transitioned in ≤72 hours compared with those who took longer to transition (3.6 vs 10.5 days; P < 0.001). Hospital LOS, IV infusion volume, and cost were also significantly lower in the ≤72-hour group ( P < 0.001). The rapid transition group also spent less time with arterial lines (44 vs 156 hours, P < 0.001) and central lines (45 vs 242 hours, P < 0.001). Conclusion and Relevance: In this cohort, transitioning to PO antihypertensives in ≤72 hours was associated with shorter ICU LOS and improvement in other measured outcomes. These observational data are the first to describe a potentially critical juncture in postdissection care; a prospective study is warranted.

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Section: Introductionmentioning

confidence: 99%

Faster Transition From Intravenous to Oral Antihypertensives Associated With Improved Outcomes After Aortic Dissection

2019

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“…There are numerous published reports demonstrating the benefit of conversion from intravenous (IV) to oral therapy including antimicrobials, acid suppressants, and antihypertensives [5][6][7]. This creates a mutually beneficial relationship for the hospital and patient by decreasing drug costs, reducing the risks of adverse drug reactions related to IV access, and potentially shortening hospital length of stay [5][6][7].…”

Section: Introduction Backgroundmentioning

confidence: 99%

“…This creates a mutually beneficial relationship for the hospital and patient by decreasing drug costs, reducing the risks of adverse drug reactions related to IV access, and potentially shortening hospital length of stay [5][6][7].…”

Section: Introduction Backgroundmentioning

confidence: 99%

The impact of pharmacy mediated conversion from intravenous to oral corticosteroids in patients with an exacerbation of chronic obstructive pulmonary disease

Alshibani¹,

Basilim²,

Warholak³

et al. 2017

J Transl Sci

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Purpose: The purpose of this study was to evaluate a pharmacist initiated conversion program from intravenous (IV) to oral corticosteroids in patients with chronic obstructive pulmonary disease (COPD) exacerbations. Methods:We conducted a retrospective observational study of patients who were admitted with a diagnosis of COPD exacerbation. The historical control group, included patients admitted between October 1 and December 31, 2013, did not have any intervention from pharmacists regarding conversion. The post intervention group, included patients admitted between October 1 and December 31, 2014, exposed to the new conversion program. Electronic medical records were reviewed for: time needed for conversion, hospital length of stay, and readmission rate for both groups.Results: There were a total of 122 patients in the study. A low number of patients in the post intervention group (n = 11, 22%) received pharmacist intervention. No significant difference was observed in hospital length of stay, time to conversion, or 30-day readmission rates. More patients in the intervention group received methylprednisolone as initial IV therapy (P = 0.002). Conclusions:Among patients with COPD exacerbations, the automatic pharmacist medicated conversion program did not affect time to conversion, hospital length of stay, or readmission rates.

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“…Appropriately transitioning quickly from IV nicardipine to oral (PO) antihypertensive therapy provides an opportunity to expedite transfer out of the ICU. 15 We hypothesized that pharmacist-led interdisciplinary management would reduce ICU stay and associated costs.…”

Section: Introductionmentioning

confidence: 99%

Reducing Cost and Intravenous Duration of Nicardipine in Intracerebral Hemorrhage Patients via an Interdisciplinary Approach

Shah

Lynn

Petrovich

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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Intravenous to Oral Conversion of Antihypertensives: A Toolkit for Guideline Development

Cited by 14 publications

References 47 publications

Faster Transition From Intravenous to Oral Antihypertensives Associated With Improved Outcomes After Aortic Dissection

Faster Transition From Intravenous to Oral Antihypertensives Associated With Improved Outcomes After Aortic Dissection

The impact of pharmacy mediated conversion from intravenous to oral corticosteroids in patients with an exacerbation of chronic obstructive pulmonary disease

Reducing Cost and Intravenous Duration of Nicardipine in Intracerebral Hemorrhage Patients via an Interdisciplinary Approach

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