Table 1

Intravenous to oral medication conversion and criteria

DrugIntravenous doseOral doseMedication-specific criteria
Anti-infectives*
 Azithromycin250 mg–500 mg q24 hoursSame dose and frequency
 Ciprofloxacin200 mg any frequency
400 mg q12 hours
400 mg q8 hours
250 mg same frequency
500 mg same frequency
750 mg q12 hours
Exclude patients receiving tube feeds from conversion.
 Clindamycin600–900 mg q6–8 hours50% of intravenous dose at the equivalent frequency, that is, three times per day or four times per day
 Doxycycline100 mg q12 hoursSame dose and frequency
 Fluconazole100 mg–400 mg q24 hoursSame dose and frequency
 Levofloxacin250–750 mg any frequencySame dose and frequencyExclude patients receiving tube feeds from conversion.
 Linezolid600 mg q12 hoursSame dose and frequency
 Metronidazole500 mg q6–q8 hoursSame dose and frequencyExclude patients being treated for Clostridioides difficile concurrently with oral vancomycin.
 Moxifloxacin400 mgSame dose and frequencyExclude patients receiving tube feeds conversion.
Anticonvulsants†
 FosphenytoinScheduled regimenPhenytoin: Total daily dose of fosphenytoin divided three times per dayExclude patients receiving tube feeds from conversion.
 Lacosamide50 mg–200 mg q12 hoursSame dose and frequency
 Levetiracetam500 mg–1500 mg intravenous two times per daySame dose and frequency
 Valproic acid5–60 mg/kg/dayDivide total intravenous dose into 2–4 doses per day
H2RA
 Famotidine20–40 mgSame dose and frequency
 Ranitidine50 mg q6–q8 hours150 mg two times per day
 Levothyroxine12.5 μg–300 μg q24 hours2 x intravenous doseExclude patients receiving tube feeds conversion
Prior to conversion, ensure potential converted dose is equal to home dose. If not, contact provider for clarification.
 Pantoprazole40 mgPantoprazole: Same dose and frequency
Lansoprazole Solu-Tab: 30 mg same frequency
  • *Remember anti-infective specific cAnti-infective Specific Criteria.

  • †Remember anticonvulsant specific exclusion c Anticonvulsant Specific Exclusion Criteria.

  • H2RA, H2 receptor antagonist; q, every.