Intravenous to oral conversion of antihypertensives: a toolkit for guideline development.
OBJECTIVE
To provide a toolkit of information for hospitals to use in developing intravenous to oral conversion protocols for antihypertensives.


METHODS
Articles describing intravenous to oral conversion protocols for any therapeutic category were identified in an English-language MEDLINE search (1990-April 2010) using a wide variety of MeSH terms. References from selected articles were reviewed for additional material.


METHODS
Experimental and observational English-language studies and review articles that focused on oral transition of intravenous drugs were selected.


RESULTS
Most of the literature on conversion from intravenous to oral formulations involves antimicrobials. There is considerable evidence documenting reduced costs and improved patient flow through the health-care system following implementing these protocols with drugs like antimicrobials, histamine-2 receptor antagonists, and proton pump inhibitors. Although antihypertensives have not been studied, principles and implementation strategies used for other drug classes can be applied to antihypertensives. Guidance is provided on framing the problem, issues surrounding oral absorption principles, information pertaining to oral conversion in specific disease states, and implementation and documentation strategies. Detailed tables of oral and intravenous antihypertensives are provided.


CONCLUSIONS
We recommend that hospitals consider developing protocols on conversion of intravenous to oral antihypertensives in an attempt to reduce unnecessarily prolonged intravenous therapy. Information contained in this article can be used as a toolkit to select information specific to the characteristics of individual health-care systems.
Dasta
Joseph F
JF
The Ohio State University, Columbus, OH, USA. jdasta@mail.utexas.edu
Boucher
Bradley A
BA
Brophy
Gretchen M
GM
Cohen
Henry
H
Hassan
Erkan
E
Maclaren
Robert
R
Muzykovsky
Karina
K
Martin
Steven J
SJ
Pass
Steven E
SE
Seybert
Amy L
AL
D000284:Administration, Oral; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007297:Inpatients; D017410:Practice Guidelines as Topic
D000959:Antihypertensive Agents