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North Mississippi Medical Center

Pharmacy Home Formulary Request Form P&T Approved Substitutions

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MISSISSIPPI POISON CONTROL CENTER 1-800-222-1222 -- EMERGENCY CONTACT FOR NERVE AGENT/ORGANOPHOSPHATE POISONING 1-800-222-MEMA (6362)

North Mississippi Medical Center

Pharmacy Home Formulary Request Form P&T Approved Substitutions

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LIRAGLUTIDE

LIRAGLUTIDE

Drug Name	Form	Strength
Victoza	SOLUTION, SUBCUTANEOUS	18 mg/3 mL

VIEW MORE Anorexigenic Agents, Miscellaneous, Incretin Mimetics
CLASS

Comments:

Per P&T Committee, patient to automatically use own home supply if can be made available from home within 24 hours. If unavailable, pharmacy to supply.

Last updated: Oct. 9, 2025

MISSISSIPPI POISON CONTROL CENTER 1-800-222-1222 -- EMERGENCY CONTACT FOR NERVE AGENT/ORGANOPHOSPHATE POISONING 1-800-222-MEMA (6362)
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