FormWeb • Dose restrictions

Houston Methodist

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Houston Methodist

Approved Hospital Formulary

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Dose restrictions

Please review each of these drugs carefully.

acetaminophen	IV acetaminophen is restricted to use only within an ERAS post-operative order set for up to 3 doses (up to 24 hours) only if patient cannot tolerate oral, enteral, or rectal route
amphotericin B	Maximum dose of 1.5 mg/kg/day for conventional amphotericin dose
calcitonin	Reorder allowable after 24 hours; duration of therapy not to exceed 48 hours for total treatment
haloperidol	Haloperidol decanoate (HaldolÂ®) restricted maximum dose - 100 mg per injection.
hetastarch	Restricted to use as a submucosal injection solution only; NOT for systemic use as a plasma volume expander
inotuzumab ozogamicin	Must maintain a minimum of 6 days between doses; may continue treatment for a maximum of up to 6 cycles for patients not proceeding to hematopoietic stem cell transplantation (HSCT)
leuprolide	For inpatient setting, only 3.75mg dose is allowable
methoxsalen	Restricted to extracorporeal use only. Not for direct intravenous administration.
paliperidone	Paliperidone palmitate (Invega SustennaÂ®) restricted maximum dose - 234 mg per month.
prothrombin complex	Dose will be rounded to the nearest vial size
risperiDONE	Risperidone (Risperdal ConstaÂ®) restricted maximum dose - 50 mg every 2 weeks.

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