Therapeutic interchange provides pharmacists with the authorization to use a formulary therapeutic alternative in place of a nonformulary medication or a non-preferred formulary medication without having to contact the prescriber. Drugs appropriate for therapeutic interchange are drug products with different chemical structures that are expected to have similar therapeutic effects and safety profiles when administered to patients in therapeutically equivalent doses. The authorization of a therapeutic interchange and notification of the prescriber should occur according to the organization’s policy. In some organizations, prescribers agree to the therapeutic interchange process as part of their overall agreement to follow the organization’s policies when they are granted prescribing privileges. Other organizations require that the prescriber be notified each time a medication is interchanged. A process should be established for when the prescriber wishes to opt out of the interchange. Adequate educational initiatives should be undertaken to ensure that everyone affected (prescribers, patients, pharmacists, nurses, and other health care professionals) is notified of the therapeutic interchange. Guidelines on therapeutic interchange are available elsewhere.41