Medications Approved for Automatic Therapeutic Interchange Dosage Conversion Guidelines (Note: “Therapeutic Interchange” should be placed in the order comments
Topical Antivirals
Medication Ordered
Brand Name
Available Dosages
Frequency
Formulary Medication
Dose
Frequency
Acyclovir
Zovirax Cream
5%
As prescribed
Docosonal 10%
(Abreva)
-
Same as prescribed (up to 5x/day)
Penciclovir
Denavir Cream
1%
As prescribed
Acyclovir/HCT
Xerese Cream
5%/1%
As prescribed
Acyclovir
Zovirax Ointment
5%
As prescribed
Formulary, Restricted as an alternative to docosonal when application to a large surface are is required
Medications Approved for Automatic Therapeutic Interchange Dosage Conversion Guidelines
(Note: “Therapeutic Interchange” should be placed in the order comments
Topical Antivirals
Medication
Ordered
Brand Name
Available Dosages
Frequency
Formulary Medication
Dose
Frequency
Acyclovir
Zovirax Cream
5%
As prescribed
Docosonal 10%
(Abreva)
-
Same as prescribed (up to 5x/day)
Penciclovir
Denavir Cream
1%
As prescribed
Acyclovir/HCT
Xerese Cream
5%/1%
As prescribed
Acyclovir
Zovirax Ointment
5%
As prescribed
Formulary, Restricted as an alternative to docosonal when application to a large surface are is required
Zovirax 5% 30gm ointment ($643.47), Zovirax 5gm cream ($315.35), Denavir 1% 5gm cream ($267.39), Xerese 5gm cream ($310.83), Abreva 10% 2gm cream ($14.11)