Know Your Way Around Salt Forms

We're getting questions about how to prevent mix-ups with meds that have different salt forms (iron, potassium, etc).

Drugs are often combined with a salt to help increase absorption...effectiveness...tolerability...or stability.

For example, calcium CITRATE is better absorbed than calcium CARBONATE if stomach acid is low...and doxycycline MONOHYDRATE might cause less stomach upset than doxycycline HYCLATE.

But there's no clinical difference between hydroxyzine HYDROCHLORIDE (Atarax, etc) and hydroxyzine PAMOATE (Vistaril, etc). Both have the same efficacy and side effects.

Clarify Rxs written just as the active drug when it comes in multiple salt forms. For example, a "metoprolol" Rx could be for metoprolol SUCCINATE (Toprol-XL, etc) or metoprolol TARTRATE (Lopressor, etc). The succinate salt is preferred for treating heart failure...and is usually dosed ONCE daily compared to TWICE daily with the tartrate form.

Double-check that you select the right salt form. For instance, accidentally dispensing topical hydrocortisone VALERATE instead of hydrocortisone ACETATE could lead to skin thinning or other side effects...since the valerate products are more potent.

Prevent dispensing mix-ups by highlighting different salt forms with shelf tags or stickers...or by storing them in separate bins.

And be meticulous when putting these meds on pharmacy shelves...so they end up in the right place.

Follow your state laws and pharmacy's policies on substituting salt forms. Different salt forms are considered different meds...and may require prescriber approval before switching.

To learn more about salt forms and ways to avoid errors, see our technician tutorial, What Drug Names Really Mean. And get our chart, Drugs With Different Salt Forms, for more examples.

Key References

  • Ann Intern Med 2016;165(12):867-8
  • J Pharm Sci 2010;99(4):1639-53
Pharmacy Technician's Letter. Feb 2018, No. 340213



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