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Medicines Q&As
Switching between liquid and tablet/capsule formulations - Which
medicines require extra care?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals
Before using this Q&A, read the disclaimer at https:/ /www.sps.nhs.uk/articles/about-ukmi-medicines-qas/
Date prepared: 16
th
July 2020, Minor Update 19
th
July 2021
Background
Prescribers may be unaware that for a small number of medicines, there are differences in equivalent
doses of oral formulations of the same medicine. Consequently, when switching a patient from one
oral formulation to another, for example, switching from tablets or capsules to a liquid to aid
administration in a patient with swallowing difficulties, dose adjustment and/or additional monitoring
may be required. There may also be other concerns relating to the suitability of the formulation for the
patient.
Answer
When changing the formulation of a patient’s medication, prescribers and pharmacists should first
consider whether the drug or formulation is affected by any of the general issues listed in Table 1.
Table 2 provides a summary of medicines where prescribers may need to consider dose adjustments
and dosing advice is given where available. In instances where it may not be possible to achieve a
dose that is exactly the same, practical advice such as additional patient monitoring is suggested.
There are other resources that can be read alongside this Q&A which consider the administration of
medicines to patients with swallowing difficulties:
• Supporting patients with swallowing difficulties: Medicines and dysphagia
• How can medicines be managed for Parkinson's disease patients with swallowing difficulties?
• How do you convert from co-beneldopa (Madopar
®
) prolonged-release capsules to dispersible
tablets?
• Crushing tablets or opening capsules in a care home setting
Table 1: General problems to be considered when switching between oral formulations of the
same drug:
Administration differences:
Administration instructions may differ between formulations, e.g. with respect to taking
with/without food. Consult product literature and ensure that the patient is correctly advised.
Brand-specific medicines:
Some medications have a demonstrable difference in clinical effect between each manufacturer’s
versions of the product and should be prescribed by brand name. There may be variations in the
licensed indications of different brands of the same medicine. Caution should be exercised when
changing formulation of any medicine usually prescribed by brand both when changing
formulation within a brand and when changing between brands.
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Medicines Q&As
Consider consulting these medicines Q&As:
• Which medicines should be considered for brand-name prescribing in primary care?
• What are the differences between different brands of mesalazine tablets?
The MHRA has issued advice about switching between different manufacturers’ products for
antiepileptic drugs (1) and for tacrolimus (2).
Excipients:
Switching formulations may expose the patient to different excipients. The following non-
exhaustive list of excipients may cause problems for certain patient groups: Arachis (peanut) oil;
sesame oil; sugars and artificial sweeteners e.g. aspartame or sorbitol; ethanol (alcohol) and
propylene glycol; gluten and lactose (3,4). Some patients may refuse to accept formulations
containing animal and/or insect derived substances due to their religious or other beliefs.
Consider consulting these medicines Q&As for further information:
• Arachis oil in medicines - what are the risks of developing peanut allergy?
• What factors need to be considered when prescribing for lactose intolerant adults?
• What factors to consider when advising on medicines suitable for a Halal diet?
• Excipients: What are the general considerations for vegan patients?
Health and safety considerations:
Drugs which are cytotoxic, carcinogenic, genotoxic, or teratogenic may have different handling
requirements for different formulations (e.g. solid vs liquid).
Licensing differences:
In some cases, the licensed indications/contraindications for one formulation of a drug may be
different from another formulation. Prescribers should ensure that the required formulation is
licensed for the relevant indication. If use of the product is outside the product licence, the GMC’s
guidance on the subject should be followed (5).
Modified release formulations:
Frequency of dosing may be different for liquids/plain tablets/plain capsules than for the
modified-release formulation, even if the total daily dose remains the same. There is a Q&A
available entitled ‘Switching from modified release doxazosin to standard release doxazosin in
patients with hypertension’.
Narrow therapeutic index medicines:
Unless two formulations have been proven to be bioequivalent, it may be wise to be vigilant for a
fall in efficacy or increase in adverse effects when changing formulations. This particularly
applies to any medicine for which therapeutic levels are monitored.
Site of action:
Some formulations are designed to deliver the drug to a particular location in the gut. Changing
the formulation may change the site to which the drug is delivered, and thus the therapeutic
effect. This has particular significance for certain groups of patients, for example those fed via an
enteral feeding tube or treated for bowel disorders. There is a Q&A available entitled ‘How do the
different types of enteral feeding tubes available affect drug administration?’
Unlicensed formulations:
Care should be taken when transferring between licensed and unlicensed formulations, as
bioequivalence and bioavailability data for unlicensed formulations may be lacking.
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Table 2: Medicines where additional therapeutic monitoring or dose adjustment is necessary when switching between liquid and tablet/capsule formulations of
the same drug.
Drug
Brand names
Summary of dose-equivalence information
Alfacalcidol
One-Alpha 2microgram/mL oral drops.
One-Alpha 0.25microgram, 0.5microgram and
1microgram soft capsules.
Using the integral dropper, ONE drop of One-Alpha 2microgram/mL oral drops
contains 0.1microgram alfacalcidol (6).
Captopril
Noyada 5mg/5mL oral solution.
Noyada 25mg/5mL oral solution.
Re-titration should be performed if patients are changed between Noyada oral
solution and other captopril formulations (7).
Carbamazepine
Tegretol 100mg/5mL liquid.
Tegretol 100mg, 200mg and 400mg tablets.
Tegretol 200mg and 400mg prolonged release tablets.
A given dose of Tegretol liquid will produce higher peak levels than the same dose
in tablet form. When switching a patient from tablets to liquid, the same total daily
dose may be used but divided in smaller, more frequent, doses (8).
Chloral hydrate/
Chloral betaine
Welldorm elixir 143mg/5mL (chloral hydrate).
Welldorm 707mg (chloral betaine) tablets.
Welldorm 707mg tablets contain 707mg chloral betaine, equivalent to 414mg of
chloral hydrate (9). The dose of both the tablet and elixir formulations is given in
terms of chloral hydrate content (9,10). This means 15mL chloral hydrate
143mg/5mL elixir is approximately equivalent to ONE 707mg chloral betaine tablet.
Ciclosporin
Capimune 25mg, 50mg and 100mg soft capsules.
Deximune 25mg, 50mg and 100mg soft capsules.
Neoral oral solution 100mg/mL.
Neoral 10 mg, 25 mg, 50 mg and 100 mg soft gelatin
capsules.
Sandimmun 25mg, 50mg and 100mg soft capsules.
Sandimmun oral solution 100mg/mL.
Neoral oral solution and Neoral soft gelatin capsules are bioequivalent (11).
Sandimmun oral solution and Sandimmun soft gelatin capsules are bioequivalent;
although the inter- and intra-subject variability ranges between 18 to 74%. (12).
However, Sandimmun and Neoral capsules have different bioavailabilities and peak
concentrations (11). The switch from one oral ciclosporin formulation to another
should be made under physician supervision, including monitoring of blood levels of
ciclosporin for transplantation patients (13).
Citalopram
Cipramil Drops 40mg/mL.
Cipramil 20mg tablets.
Cipramil oral drop solution has an approximately 25% higher bioavailability
compared to tablets. FOUR oral drops (8mg) is equivalent to ONE 10mg tablet (14).
Clobazam
Frisium 10mg tablets.
Perizam 1mg/mL and 2mg/mL oral suspension.
Tapclob 5mg/5mL and 10mg/5mL oral suspension.
Caution must be taken when switching between clobazam products as the mean
peak concentration on single dose administration for the suspension is higher than
that observed for the tablet formulation (15,16). This may lead to an increased risk
of respiratory depression and sedation which may be most noticeable when
switching to the oral suspension from tablets (15).
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Clomethiazole
Heminevrin syrup 31.5mg/mL.
Heminevrin capsules 192mg.
Heminevrin syrup contains 50mg/mL clomethiazole edisilate equivalent to
31.5mg/mL clomethiazole (17). Heminevrin capsules contain 192mg clomethiazole;
as a result of differences in bioavailability between the capsules and the syrup, ONE
capsule is considered therapeutically equivalent to 5mL syrup (18).
Clozapine
Clozaril tablets 25mg and 100mg.
Denzapine 50mg/mL oral suspension.
Denzapine 25mg, 50mg, 100mg and 200mg tablets.
Zaponex 25mg and 100mg tablets.
Zaponex 12.5mg, 25mg, 50mg, 100mg and 200mg
orodispersible tablets
There has been controversy over the bioequivalence or otherwise of different
brands of clozapine; some reports indicate that it is possible to switch between
brands but there are reports of exacerbation of psychotic symptoms in patients who
were switched between brands (18).
If changing between clozapine brands, the patient, prescriber and supplying
pharmacist must all be registered with the appropriate patient monitoring service (3).
Co-amoxiclav
Augmentin 125/31 suspension and Augmentin 250/62
suspension.
Augmentin Duo powder for oral suspension 400/57.
Augmentin 375mg and 625mg tablets.
Oral preparations contain a mixture of amoxicillin (as the trihydrate) and clavulanic
acid (as potassium clavulanate); the proportions are expressed in the form x/y
where x and y are the strengths in mg of amoxicillin and clavulanic acid respectively
(3). The tablets cannot be directly converted to suspension; the proportions of the
two drugs in the medication (amoxicillin and clavulanic acid) are different in the two
preparations (19). Augmentin Duo suspension also has a different ratio of
amoxicillin/clavulanic acid to standard Augmentin suspension (20). The licensed
doses for each product should therefore be used, rather than attempting to calculate
an exact equivalence.
Dasatinib
Sprycel 10 mg/mL powder for oral suspension.
Sprycel 20mg, 50mg, 80mg, 100mg, 140mg film-
coated tablets.
Sprycel film-coated tablets and Sprycel powder for oral suspension are not
bioequivalent. Patients can be switched between formulations provided the correct
dosing recommendations for the dosage form are followed. Consult product
literature for the licensed body weight tiered dosing recommendations (21).
Digoxin
Lanoxin PG elixir 50microgram/mL.
Lanoxin PG Tablets (62.5microgram), Lanoxin 125
Tablets (125microgram) and Lanoxin 0.25mg Tablets
(250microgram).
The bioavailability of orally administered Lanoxin is approximately 63% in tablet
form and 75% as the elixir (22). This equates to ONE 62.5microgram tablet being
approximately equivalent to 50microgram (1mL) elixir (19). However, the
manufacturer is aware of one study showing no clinically relevant difference in
bioavailability of digoxin tablets and elixir and state that most clinicians suggest that
these dosage forms can usually be used interchangeably (19,23). Digoxin has a low
therapeutic index so cautious dose determination is essential and individual patient
factors must be considered during formulation changes. Patients’ plasma
concentrations should be monitored appropriately.
Emtricitabine
Emtriva 10mg/mL oral solution.
Emtriva 200mg hard capsules.
Due to a difference in bioavailability, 24mL Emtriva 10mg/mL oral solution (240mg)
is approximately equivalent to ONE Emtriva 200mg hard capsule (24).
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Everolimus
Votubia 1mg, 2mg, 3mg, 5mg dispersible tablets.
Votubia 2.5mg, 5mg, 10mg tablets.
Votubia tablets and Votubia dispersible tablets are not to be used interchangeably.
When switching pharmaceutical forms, the dose should be adjusted to the closest
milligram strength of the new pharmaceutical form and the everolimus trough
concentration assessed at least 1 week later (25). Consult product literature for
details of therapeutic drug monitoring.
Fusidic acid
Fucidin 250mg/5mL oral suspension (fusidic acid).
Fucidin 250mg tablets (sodium fusidate).
Fusidic acid oral suspension is absorbed only in the stomach and upper gut, whilst
sodium fusidate tablets are absorbed throughout the whole length of the
gastrointestinal tract (19). Therefore, doses recommended for the suspension are
proportionately higher than those for sodium fusidate tablets (3). Each 5mL fusidic
acid 250mg/5mL suspension (250mg) is therapeutically equivalent to 175mg sodium
fusidate (26). NEWT guidelines suggest 15mL fusidic acid 250mg/5mL suspension
(750mg) is approximately equivalent to TWO sodium fusidate 250mg tablets
(500mg) (19).
Itraconazole
Sporanox 10mg/mL oral solution.
Sporanox 100mg capsules.
Sporanox-Pulse 100mg capsules.
It is not recommended that Sporanox capsules and Sporanox oral solution be used
interchangeably. This is because drug exposure is greater with the oral solution
than with the capsules when the same dose of drug is given (27). Doses and
licensed indications differ between formulations; consult product literature.
Levothyroxine
Eltroxin 25micrograms per 5mL oral solution.
Eltroxin 100micrograms per 5mL oral solution.
Eltroxin 25mcg, 50mcg and 100mcg tablets.
Patients switching from the oral solution to the tablet form or from the tablet form to
the oral solution should be monitored closely (28).
Lithium
Lithium citrate:
Li-Liquid 509mg/5mL and 1018mg/5mL oral syrup.
Priadel 520mg/5mL liquid.
Lithium carbonate:
Priadel 200mg and 400mg modified-release tablets.
Camcolit 400mg controlled release tablets.
Liskonum 450mg modified-release tablets.
Lithium carbonate 250mg tablets (non-proprietary).
Lithium citrate tetrahydrate 520 mg is equivalent to lithium carbonate 204 mg (3).
This means that:
• 5mL Li-Liquid 509mg/5mL oral syrup (509mg) is approximately equivalent
to 200mg lithium carbonate.
• 5mL Li-Liquid 1018mg/5mL oral syrup (1018mg) is approximately
equivalent to 400mg lithium carbonate.
• 5mL Priadel 520mg/5mL liquid (520mg) is approximately equivalent to
204mg lithium carbonate.
All lithium preparations vary widely in bioavailability (3). Prescriptions should specify
brand and formulation; changing the preparation requires the same precautions as
initiation of treatment (3). As most lithium tablets are modified-release, when lithium
is given as a liquid the total daily dose of lithium will need to be given in divided
doses (19).
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Mebeverine
Mebeverine 50mg/5mL oral suspension.
Mebeverine 135mg tablets.
Aurobeverine MR 200mg modified-release capsules
hard.
Colofac 135 mg tablets.
Colofac MR 200mg modified-release capsules.
Licensed doses differ between formulations; consult product literature (3,29).
Mercaptopurine
Xaluprine 20mg/mL oral suspension.
Hanixol 50mg tablets.
Mercaptopurine 50mg tablets.
Xaluprine oral suspension and mercaptopurine tablets are not bioequivalent with
respect to peak plasma concentration; intensified haematological monitoring is
advised when switching formulations (30).
Metronidazole
Metronidazole 200mg/5mL oral suspension.
Flagyl 200mg and 400mg tablets.
Metronidazole 200mg, 400mg and 500mg tablets.
Tablets are metronidazole base whilst suspension is metronidazole benzoate (3). In
general, tablets and suspension may be used interchangeably. However,
metronidazole benzoate is hydrolysed to metronidazole base in the stomach (31)
and therefore the suspension should not be used for administration via enteral tubes
terminating in the jejunum (19).
Mycophenolate
CellCept 1g/5mL powder for oral suspension (as
mycophenolate mofetil),
CellCept 250mg capsules and 500mg film-coated
tablets (as mycophenolate mofetil),
Myfenax 250mg hard capsules (as mycophenolate
mofetil),
Myfenax 500mg tablets (as mycophenolate mofetil),
Ceptava 180mg and 360mg (mycophenolic acid)
gastro-resistant tablets (as mycophenolate sodium),
Myfortic 180mg and 360mg (mycophenolic acid)
gastro-resistant tablets (as mycophenolate sodium).
Mycophenolic sodium 720mg is approximately equivalent to mycophenolate mofetil
1g. Avoid unnecessary switching because of their pharmacokinetic differences
(3,32).
Phenytoin
Epanutin 30mg/5mL oral suspension.
Epanutin Infatabs 50mg chewable tablets.
Phenytoin sodium 100mg tablets.
Phenytoin sodium 25mg, 50mg, 100mg and 300mg
capsules.
Preparations containing phenytoin sodium (capsules and tablets) are not
bioequivalent to those containing phenytoin base (such as Epanutin Infatabs and
Epanutin suspension); 100mg phenytoin sodium is approximately equivalent to
92mg phenytoin base. The dose is the same for all phenytoin products when
initiating therapy. However, if switching between these products the difference in
phenytoin content may be clinically significant. Therefore plasma-phenytoin
concentration monitoring is recommended (3).
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Posaconazole
Noxafil 40mg/mL oral suspension.
Noxafil 100mg gastro-resistant tablets.
Posaconazole oral suspension is not interchangeable with tablets due to the
difference in frequency of dosing, administration with food and plasma drug
concentration achieved. Where possible, tablets should be used in preference to
suspension because tablets have a higher bioavailability (33). See individual
product literature for specific dosing regimens according to indication.
Raltegravir
Isentress 100mg granules for oral suspension.
Isentress 25mg and 100mg chewable tablets.
Isentress 400mg and 600mg film-coated tablets.
Because the formulations have different pharmacokinetic profiles, neither the
chewable tablets nor the granules for oral suspension should be substituted for the
400mg or 600mg film-coated tablet (34). Doses and licensed indications differ
between formulations; consult product literature.
Selegiline
hydrochloride
Eldepryl 5mg and 10mg tablets.
Zelapar 1.25mg oral lyophilisates (orodispersible
tablets).
ONE 10mg selegiline hydrochloride tablet is equivalent to ONE 1.25mg oral
lyophilisate tablet (Zelapar
®
) (3,35).
Sirolimus
Rapamune 1mg/mL oral solution.
Rapamune 500microgram, 1mg and 2mg coated
tablets.
The 500microgram tablet is not fully bioequivalent to the 1mg, 2mg and 5mg tablets;
multiples of the 500microgram tablets should not be used as a substitute for other
tablet strengths (3,36). Patients can be switched from Rapamune oral solution to the
tablet formulation and receive the same dose. Sirolimus trough concentration should
be checked 1 to 2 weeks after switching formulations to confirm that it is within the
recommended target range (36).
Stiripentol
Diacomit 250 mg and 500mg powder for oral
suspension in sachet.
Diacomit 250mg and 500mg hard capsules.
Whilst the capsules and powder for oral suspension do not differ in terms of overall
drug exposure, the sachet formulation has a slightly higher peak concentration
(23%) than the capsules and thus the formulations are not bioequivalent (37).
Dosing adjustment is not required when switching between formulations (38).
Clinical supervision is necessary in case of problems with tolerability (37).
Tacrolimus
Adoport 0.5mg, 0.75mg, 1mg, 2mg and 5mg hard
capsules.
Advagraf 0.5mg, 1mg, 3mg, and 5mg prolonged-
release hard capsules.
Capexion 0.5mg, 1mg and 5mg hard capsules.
Dailiport 0.5mg, 1mg, 2mg, 3mg and 5mg prolonged-
release hard capsules.
Envarsus 0.75mg, 1mg and 4mg prolonged-release
tablets.
Modigraf 0.2mg and 1mg granules for oral suspension.
Prograf 0.5mg, 1mg and 5mg hard capsules.
Modigraf should not be switched with the prolonged-release capsules as a clinically
relevant difference in bioavailability between the two formulations cannot be
excluded. In general, inadvertent, unintentional or unsupervised switching of
immediate- or prolonged-release formulations of tacrolimus is unsafe (39).
Switching between products has been associated with reports of toxicity and graft
rejection. If a prescriber considers that switching a patient to a different brand of oral
tacrolimus would be of benefit, the change requires careful supervision and
therapeutic monitoring by an appropriate specialist (2).
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Tenofovir
disoproxil
Viread 33mg/g granules (tenofovir disoproxil fumarate).
Viread 123mg, 163mg, 204mg and 245mg film-coated
tablets (tenofovir disoproxil fumarate).
7.5 scoops of Viread granules contain approximately 245mg tenofovir disoproxil as
fumarate (3,40).
Valproate
Sodium valproate
Epilim 200mg and 500mg gastro-resistant tablets.
Epilim 100mg crushable tablets.
Epilim 200mg/5mL Liquid (sugar free).
Epilim 200mg/5mL Syrup.
Episenta 150mg, 300mg prolonged-release capsules.
Episenta 500mg and 1000mg prolonged-release
granules (sachets).
Epival CR 300mg, 500mg prolonged-release tablets.
Sodium valproate and valproic acid
Epilim Chrono 200mg, 300mg and 500mg modified-
release tablets.
Epilim Chronosphere 50mg, 100mg, 250mg, 500mg,
750mg and 1000mg modified-release granules
(sachets).
Valproic acid
Convulex 150mg, 300mg and 500mg gastro-resistant
capsules.
Valproate semisodium
Depakote 250mg and 500mg gastro-resistant tablets.
Syonell 250mg, 500mg gastro-resistant tablets.
Belvo 250mg, 500mg gastro-resistant tablets.
Valproate is available in the UK in three forms: sodium valproate, valproic acid (both
licensed for the treatment of epilepsy), and semi-sodium valproate (licensed for the
treatment of acute mania). Both semi-sodium valproate and sodium valproate are
metabolised to valproic acid, which is responsible for the pharmacological activity of
all three preparations (41). The information in the literature concerning equivalence
of valproate products is conflicting but the following may be helpful:
• In patients where adequate epileptic control has been achieved, Epilim
Chronosphere and Epilim Chrono formulations are interchangeable with
other conventional or prolonged release formulations of Epilim on an
equivalent daily dosage basis (42,43).
• Convulex has a 1:1 dose relationship with products containing sodium
valproate so treatment can be initiated at the same total daily dose (44) but
nevertheless care is needed if switching or making changes (3).
• Based on the amount of valproic acid generated, 500mg Depakote is
approximately equivalent to 577mg Epilim. However, Depakote and Epilim
are not bioequivalent and display different characteristics (45).
• If switching from semi-sodium valproate (Depakote) to sodium valproate, a
slightly higher (approximately 10%) dose of sodium valproate is
recommended (41).
All switches should be carried out with care and close patient monitoring (19). The
pharmacological (or therapeutic) effects of valproic acid may not be clearly
correlated with the total or free (unbound) plasma valproic acid levels. (42-44).
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Valsartan
Diovan 3mg/ml oral solution
Valsartan tablets
Valsartan capsules
The systemic exposure and peak plasma concentration of valsartan is about 1.7-
fold and 2.2-fold higher with the solution compared to the tablets (46).
When converting from tablets to oral solution, halve the tablet dose and monitor
blood pressure carefully titrating the dose as required (31,46),
When switching from valsartan oral solution to valsartan tablets, initially the same
dose in mg should be given, with frequent blood pressure monitoring. The dose
should be titrated according to blood pressure response, taking into account
potential under-dosing (46,47).
The manufacturer of valsartan capsules has no data on switching between valsartan
capsules and valsartan oral solution (48).
Vardenafil
Levitra 10 mg orodispersible tablets.
Levitra 5mg, 10 mg and 20mg film-coated tablets.
Levitra 10 mg orodispersible tablets and 10 mg film-coated tablets are not
bioequivalent (3,49). Therefore, the orodispersible formulation should not be used
as an equivalent to vardenafil 10mg film-coated tablets. The maximum dose for
Levitra orodispersible tablet is 10 mg/day (49). Levitra 10mg orodispersible tablets
must be taken without liquid and immediately upon release from the blister (49).
Vitamin E
Alpha tocopheryl acetate 100mg chewable tablets.
Alpha tocopheryl acetate oral suspension 500mg/5mL.
Alpha tocopheryl acetate 75, 100, 200, 250, 400, 600,
1000units Capsules.
D-alpha tocopherol (as tocofersolan) oral solution
50mg/mL.
Different preparations may contain different forms of vitamin E, with doses
expressed in different ways. Tocopherol equivalents are as follows (50):
1 mg dl-alpha tocopheryl acetate = 1 international unit
1 mg dl-alpha tocopherol = 1.1 international units
1 mg d-alpha tocopheryl acetate = 1.36 international units
1 mg d-alpha tocopherol = 1.49 international units
1 mg d-alpha tocopheryl acid succinate = 1.21 international units
1 mg dl-alpha tocopheryl acid succinate = 0.89 international units
Vitamin K
Vitamin K is available as phytomenadione (fat-soluble) or menadiol (water-soluble). The indications are different for each, as are the
formulations available (3). It is important to specify which form of vitamin K, as well as which formulation, is required.
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Summary
Special considerations may be required when changing the formulation of a patient’s medicines, for
instance from solid to liquid forms. This may be due to the nature of the drug (e.g. narrow therapeutic
index) or due to the bioavailability or salt form of the drug itself. Patient factors such as the inclusion
of excipients known to be harmful in some patient groups may need to be considered.
If any of the factors in Tables 1 or 2 of this Q&A apply, caution should be exercised, and extra
monitoring may be necessary after a change in formulation.
Limitations
• Although effort has been made to achieve completeness, it is not guaranteed that every
relevant medicine is included.
• Prescribers should familiarise themselves with the prescribing information for any medicine
they prescribe, either via the manufacturer’s product information or the current edition of the
British National Formulary (BNF).
• Differences relating to administration instructions rather than dose and frequency of
administration are not included.
• Only licensed, branded oral formulations routinely used in the UK have been considered.
• Switching between tablets and capsules has not been included.
References
1. Medicines and Healthcare products Regulatory Agency. Antiepileptic drugs: updated advice
on switching between different manufacturers’ products. Drug Safety Update volume 11,
issue 4; November 2017: 5. Accessed online via https://www.gov.uk/drug-safety-
update/antiepileptic-drugs-updated-advice-on-switching-between-different-manufacturers-
products on 03/03/20.
2. Medicines and Healthcare products Regulatory Agency. Oral tacrolimus products: reminder to
prescribe and dispense by brand name only. Drug Safety Update volume 11, issue 4;
November 2017: 3. Accessed online via https://www.gov.uk/drug-safety-update/oral-
tacrolimus-products-reminder-to-prescribe-and-dispense-by-brand-name-only on 03/03/20.
3. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and
Pharmaceutical Press. Accessed online via http://www.medicinescomplete.com on 05/03/20
4. Arthur S, Burgess A. How to identify and manage ‘problem’ excipients in medicines for
children. The Pharmaceutical Journal, July 2017, Vol 299, No 7903, online | DOI:
10.1211/PJ.2017.20203121
5. Prescribing guidance: Prescribing unlicensed medicines. Accessed online via
http://www.gmc-uk.org/guidance/ethical_guidance/14327.asp on 21/05/20.
6. Leo Laboratories Ltd. Summary of Product Characteristics for One-Alpha Drops. Last updated
on the eMC 20/02/19. Accessed online via: http://www.medicines.org.uk/emc/ on04/03/20.
7. Martindale Pharma. Summary of Product Characteristics for Noyada 25mg/5ml Oral Solution.
Last updated on the eMC 15/01/19. Accessed online via: http://www.medicines.org.uk/emc/
on 04/03/20.
8. Novartis Pharmaceuticals UK Ltd. Summary of Product Characteristics for Tegretol
100mg/5mL Liquid. Last updated on the eMC 24/02/20. Accessed online via:
http://www.medicines.org.uk/emc/ on 04/03/20.
9. Marlborough Pharmaceuticals Ltd. Summary of Product Characteristics for Welldorm 707mg
Tablets. Last updated on the eMC 06/02/15. Accessed online via:
http://www.medicines.org.uk/emc/ on 04/03/20.
10. Marlborough Pharmaceuticals Ltd. Summary of Product Characteristics for Welldorm Elixir.
Last updated on the eMC 01/07/14. Accessed online via: http://www.medicines.org.uk/emc/
on 04/03/20.
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Medicines Q&As
11. Novartis Pharmaceuticals UK Ltd. Summary of Product Characteristics for Neoral Soft Gelatin
Capsules. Last updated on the eMC 10 Mar 2020. Accessed online via:
http://www.medicines.org.uk/emc/ on 08/07/20.
12. Novartis Pharmaceuticals UK Ltd. Summary of Product Characteristics for Sandimmun Oral
Solution. Last updated on the eMC 10 Mar 2020. Accessed online via:
http://www.medicines.org.uk/emc/ on 08/07/20.
13. Novartis Pharmaceuticals UK Ltd. Summary of Product Characteristics for Neoral Oral
Solution. Last updated on the eMC 10 Mar 2020. Accessed online via:
http://www.medicines.org.uk/emc/ on 13/05/20.
14. Lundbeck Ltd. Summary of Product Characteristics for Cipramil Drops 40mg/mL. Last
updated on the eMC19/05/20. Accessed online via: http://www.medicines.org.uk/emc/ on
04/06/20.
15. Rosemont Pharmaceuticals Limited. Summary of Product Characteristics for Perizam
1mg/mL Oral Suspension. Last updated on the eMC 17/05/18. Accessed online via
http://www.medicinescomplete.com/ on 04/03/20.
16. Martindale Pharma. Summary of Product Characteristics for Tapclob 5mg/5mL Oral
Suspension. Last updated on the eMC 19/06/19. Accessed online via
http://www.medicinescomplete.com/ on 08/07/20.
17. Cheplapharm Arzneimittel GmbH. Summary of Product Characteristics for Heminevrin
31.5mg/mL syrup. Last updated on the eMC 07/06/18. Accessed online via:
http://www.medicines.org.uk/emc/ on 04/03/20.
18. Brayfield A (ed), Martindale: The Complete Drug Reference. London: Pharmaceutical Press
Accessed online via http://www.medicinescomplete.com/ on 13/03/20 and 03/04/20.
19. Smyth J (Editor). The NEWT Guidelines. Betsi Cadwaladr University Local Health Board
(East). Accessed online via http://www.newtguidelines.com/ on 06/03/20.
20. GlaxoSmithKline UK. Summary of Product Characteristics for Augmentin Duo 400/57 powder
for oral suspension (mixed fruit flavour). Last updated on the eMC 23/12/19. Accessed online
via: http://www.medicines.org.uk/emc / on 04/03/20.
21. Bristol-Myers Squibb Pharmaceuticals Ltd. Summary of Product Characteristics for Sprycel
10 mg/mL powder for oral suspension. Last updated on the eMC 04/05/20. Accessed online
via: http://www.medicines.org.uk/emc/ on 04/06/20.
22. Aspen. Summary of Product Characteristics for Lanoxin PG Elixir. Last updated on the eMC
03/03/20. Accessed online via: http://www.medicines.org.uk/emc/ on 04/03/20.
23. Personal communication with Medical information. Aspen. 15/09/17
24. Gilead Sciences Ltd. Summary of Product Characteristics for Emtriva 10mg/ml oral solution.
Last updated on the eMC12/05/19. Accessed online via: http://www.medicines.org.uk/emc/
on 04/03/20.
25. Novartis Pharmaceuticals UK Ltd. Summary of Product Characteristics for Votubia 1mg
Dispersible Tablets. Last updated on the eMC 10/09/18. Accessed online via:
http://www.medicines.org.uk/emc/ on 04/03/20.
26. Leo Laboratories Ltd. Summary of Product Characteristics for Fucidin 250mg/5ml Oral
Suspension. Last updated on the eMC 21/08/19. Accessed online via:
http://www.medicines.org.uk/emc/ on 04/03/20.
27. Janssen-Cilag Ltd. Summary of Product Characteristics for Sporanox 10mg/ml Oral Solution.
Last updated on the eMC 01/03/18. Accessed online via: http://www.medicines.org.uk/emc/
on 04/03/20.
28. ADVANZ Pharma. Summary of Product Characteristics for Eltroxin 100micrograms per 5ml
Oral Solution. Last updated on the eMC 04/09/13. Accessed online via:
http://www.medicines.org.uk/emc/ on 04/03/20.
29. Kinedexe UK Limited. Summary of Product Characteristics for Mebeverine hydrochloride
50mg/5mL oral suspension. Last revised 26/03/18. Accessed online via
https://mhraproductsprod.blob.core.windows.net/docs-
20200406/57091d926634d7880f2c8fdbd8a15b18bb110bf5 on 14/04/20.
Available through Specialist Pharmacy Service at
www.sps.nhs.uk
Medicines Q&As
30. Nova Laboratories Ltd. Summary of Product Characteristics for Xaluprine 20mg/mL oral
suspension. Last updated on the eMC 07/05/19. Accessed online via:
http://www.medicines.org.uk/emc/ on 04/03/20.
31. White W and Bradnam V. Handbook of Drug Administration via Enteral Feeding Tubes
Accessed online via www.medicinescomplete.com on 12/03/20.
32. Novartis Pharmaceuticals UK Ltd. Summary of Product Characteristics for Myfortic 360mg
gastro-resistant tablets. Last updated on the eMC 10/03/20. Accessed online via:
http://www.medicines.org.uk/emc/ on 09/06/20.
33. Merck Sharp & Dohme Ltd. Summary of Product Characteristics for Noxafil 100mg gastro-
resistant tablets. Last updated on the eMC 29/10/19. Accessed online via:
http://www.medicines.org.uk/emc/ on 04/03/20.
34. Merck Sharp & Dohme Ltd. Summary of Product Characteristics for Isentress 100mg
granules for oral suspension. Last updated on the eMC 29/11/18. Accessed online via:
http://www.medicines.org.uk/emc/ on 04/03/20.
35. Cephalon (UK) Ltd. Summary of Product Characteristics for Zelapar 1.25 mg Oral
Lyophilisate. Last updated on the eMC 28/09/15. Accessed online via:
http://www.medicines.org.uk/emc/ on 04/03/20.
36. Pfizer Ltd. Summary of Product Characteristics for Rapamune 0.5mg coated tablets. Last
updated on the eMC 21/06/19. Accessed online via: http://www.medicines.org.uk/emc/ on
04/03/20.
37. Alan Pharmaceuticals. Summary of Product Characteristics for Diacomit 250 mg powder for
oral suspension in sachet. Last updated on the eMC 31/05/19. Accessed online via:
http://www.medicines.org.uk/emc/ on 05/03/20.
38. Personal communication with Medical information. Alan Pharmaceuticals.12/05/20.
39. Astellas Pharma Ltd. Summary of Product Characteristics for Modigraf 0.2mg granules for
oral suspension. Last updated on the eMC 27/09/19. Accessed online via:
http://www.medicines.org.uk/emc/ on 04/03/20.
40. Gilead Sciences Ltd. Summary of Product Characteristics for Viread 33mg/g granules. Last
updated on the eMC 30/01/20. Accessed online via: http://www.medicines.org.uk/emc/ on
04/03/20.
41. Taylor D, Barnes T, Young A. The Maudsley Prescribing Guidelines 13th Edition. Wiley-
Blackwell UK. (2018).
42. Sanofi. Summary of Product Characteristics for Epilim liquid 200mg/5ml. Last updated on the
eMC 21/04/20. Accessed online via: http://www.medicines.org.uk/emc/ on 11/06/20.
43. Sanofi. Summary of Product Characteristics for Epilim Chronosphere MR 100mg modified
release granules. Last updated on the eMC 21/04/20. Accessed online via:
http://www.medicines.org.uk/emc/ on 11/06/20.
44. Gerot Lannach UK Limited. Summary of Product Characteristics for Convulex 150mg
capsules. Last updated on the eMC 15/04/20. Accessed online via
http://www.medicines.org.uk/emc/ on 17/04/20.
45. Personal communication with Medical information. Sanofi on 15/07/21.
46. Novartis Pharmaceuticals UK Ltd. Summary of Product Characteristics for Diovan 3mg/mL
oral solution. Last updated on the eMC 28/02/20. Accessed online via
http://www.medicines.org.uk/emc/ on 9/7/20.
47. Mylan. Summary of Product Characteristics for Valsartan 40mg film-coated tablets. Last
updated on the eMC 11/05/20. Accessed online via http://www.medicines.org.uk/emc/ on
8/7/20.
48. Personal communication with Medical information. Mylan on 15/7/20 and 16/7/20.
49. Bayer plc. Summary of Product Characteristics for Levitra 10mg orodispersible tablets. Last
updated on the eMC 21/05/20. Accessed online via: http://www.medicines.org.uk/emc/ on
11/06/20.
Available through Specialist Pharmacy Service at
www.sps.nhs.uk
Medicines Q&As
50. Micromedex Solutions. DRUGDEX Drug Evaluations: Vitamin E. Accessed online via
http://www.micromedexsolutions.com/home/dispatch on 20/04/20.
Quality Assurance
Prepared by
Gill Lewis, South West Medicines Information, Bristol based on original work by Jen Smith, West
Midlands Medicines Information and Jill Forrest, South West Medicines Information.
Date Prepared
16
th
July 2020, Minor update 19
th
July 2021
Checked by
Michèle Skipp, South West Medicines Information, Bristol.
Date of check
16
th
July 2020, Minor update 19
th
July 2021
Search strategy
• https://www.sps.nhs.uk/home/medicines/ [search terms: “equivalent”, “equivalence”,
“formulation”, “convert”, “conversion”, “converting”, “oral”, “swallowing” “excipients”, “enteral”]]
• https://www.medicinescomplete.com/mc/bnf/current/ [“conversion”]
• http://access.newtguidelines.com/ [“bioavailability”] also checked each monograph
• https://www.medicinescomplete.com/mc/tubes/current/ [“conversion”]
• https://www.medicinescomplete.com/mc/ahfs/current/ [“bioequivalent”]
• Past enquiries and in-house databases.
