FormWeb • flutemetamol F-18

Ochsner Health

Ochsner Health System Formulary

Formulary Addition Request Questions or Suggestions?

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Medications listed are available on OH EPIC Formulary, unless otherwise noted.
Not all formulary medications are available at each facility. Please refer to your local pharmacy for available inventory.

Ochsner Health

Ochsner Health System Formulary

Formulary Addition Request Questions or Suggestions?

HIGH ALERT: Please review policy carefully.

Search results for:

flutemetamol F-18

flutemetamol F-18

Drug Name	Form	Strength	Infusion Center Available	Restricted	Non-formulary	Ambulatory Available	Interchange	REMS
Vizamyl	INJECTION, INTRAVENOUS

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OH Epic Formulary, available via order set, restricted to:

Indication: Positron Emission Tomography (PET) imaging of the brain to estimate amyloid beta neuritic plaque density in adults with cognitive impairment for:

Evaluation of Alzheimer’s disease (AD) and other causes of cognitive decline
Selection of patients who are indicated for amyloid beta-directed therapy as described in the prescribing information of the therapeutic products

Service line: Radiology
Formulary location: Outpatient
Service location: Outpatient Clinic (Nuclear Medicine)
Patient population: Adults ≥ 18 years old
Prior authorization required: Yes
Restriction/criteria of use (all will apply unless specified): N/A

Last updated: Sep. 13, 2025

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