FormWeb • oxyCODONE

Henry Ford Health

Approved Hospital Formulary

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Brand name products with an equivalent generic may not be available to order at Henry Ford Health. For questions, contact inpatient pharmacy.

Henry Ford Health

Approved Hospital Formulary

FormWeb QuickStart Questions or Suggestions? Pharmacy Intranet

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oxyCODONE

oxyCODONE

Drug Name	Form	Strength	Clinic Use Only	Inpatient Restrictions	Outpatient Restrictions	Non-Formulary
Xtampza ER	CAPSULE, EXTENDED RELEASE, ORAL	9 mg; 18 mg; 27 mg; 36 mg
OxyCODONE HYDROCHLORIDE	TABLET, ORAL	5 mg; 10 mg; 15 mg

VIEW MORE central nervous system agents, analgesics, narcotic analgesics
CLASS

High Alert Drug : Policy

Therapeutic Alternative:

PAIN MEDICATIONS
Ordered Drug	Therapeutic Alternate
Oxycodone/Aspirin, any frequency	Oxycodone 5 mg + Aspirin 325 mg, same frequency
Oxycodone/Acetaminophen, any frequency	Oxycodone same dose + Acetaminophen 325 mg, same frequency

PAIN MEDICATIONS: OXYCODONE EXTENDED RELEASE
Ordered Drug	Therapeutic Alternate
Oxycodone HCl 10 mg tablet (OxyContin)	Oxycodone base 9 mg capsule (Xtampza)
Oxycodone HCl 20 mg tablet (OxyContin)	Oxycodone base 18 mg capsule (Xtampza)
Oxycodone HCl 30 mg tablet (OxyContin)	Oxycodone base 27 mg capsule (Xtampza)
Oxycodone HCl 40 mg tablet (OxyContin)	Oxycodone base 36 mg capsule (Xtampza)

Last updated: Mar. 3, 2021

Black Box Warning Oral solution: Risk of errors
Black Box Warning Controlled release: Abuse potential
Look Alike Sound Alike Do Not Confuse oxyCODONE with HYDROcodone.
REMS View FDA REMS Info
Therapeutic Interchange Tier 1: Therapeutic Interchange and Custom Therapeutic Alternates

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