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.
Search results for:

sildenafil

sildenafil
  • Restricted Revatio --> Restricted to pulmonology, cardiology, rheumatology, and pediatric critical care for the treatment of pulmonary hypertension.
  • Restricted Revatio IV --> Restricted to pulmonology, cardiology, rheumatology, or pediatric critical care.
  • Restricted Miscellaneous Program Formulary
Drug Name Form Strength Formulary Unrestricted Formulary Restricted Non-Formulary Interchange
Revatio IV SOLUTION, INTRAVENOUS 10 mg/12.5 mL      
Revatio SUSPENSION, ORAL 10 mg/mL      
Revatio TABLET, ORAL 20 mg      
Viagra TABLET, ORAL 25 mg, 50 mg, 100 mg      
VIEW MORE Phosphodiesterase Type 5 Inhibitors
CLASS
240812
Comments:

 

Initiation of therapy: Revatio is restricted to pulmonology, cardiology, rheumatology, and pediatric critical care for the treatment of pulmonary hypertension.

Maintenance therapy: Revatio (oral) may be continued by any prescriber.

 

REVATIO IV is classified as FORMULARY, RESTRICTED to Pulmonology, Cardiology, Rheumatology, or Pediatric Critical Care as above.

 

Viagra tablets (sildenafil 25 mg, 50 mg, 100 mg) are non-formulary.

 

Reviewed: September 28, 2005 (Revatio), December 15, 2005 (Viagra), April 27, 2010 (Revatio IV)

 

Last updated: Apr. 24, 2026






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