Approved Hospital Formulary
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Medications not yet evaluated by P&T are considered NON-FORMULARY. Always check 2 unique patient identifiers - NAME and DATE OF BIRTH - at every step!
Please be sure to document all clinical activities daily.
Please be sure to document all clinical activities daily.
Approved Hospital Formulary
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levonorgestrel
levonorgestrel
- Formulary Miscellaneous Programs
- Restricted Mirena --> Restricted to OB/GYN for treatment of dysfunctional uterine bleeding and menorrhagia.
Last updated: Feb. 3, 2025
- Black Box Warning: Bolded (not boxed): Not Protective Against HIV
- HAZ-MED: Table 2H
PLAN B is discontinued, PLAN B-1 STEP is classified as formulary. Generally limit use to inpatients (ex. rape victims admitted for medical reasons). ER patients should usually receive a prescription to obtain as an outpatient. Rare exception cases possible - use your professional judgement. May be obtained from an outside pharmacy for a specific patient as needed. PLAN B should be given within 72 hours of unprotected intercourse.
MIRENA is classified as formulary status, restricted to OB/GYN for treatment of dysfunctional uterine bleeding and menorrhagia.
MIRENA is supplied by surgery and not stocked by pharmacy.
Reviewed: March 27, 2007 (PLAN B), July 28, 2009 (MIRENA), November 17, 2009 (PLAN B-1STEP)