Tag: narrow therapeutic index

NTI-Specific Substitution Laws: Which States Have Special Rules for High-Risk Medications

NTI-Specific Substitution Laws: Which States Have Special Rules for High-Risk Medications

Twenty-seven U.S. states have special rules restricting generic substitution for narrow therapeutic index (NTI) drugs like warfarin, levothyroxine, and lithium. These laws vary widely - from outright bans to dual consent requirements - creating a patchwork that affects patient safety, pharmacy workflows, and drug costs.

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