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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.

HIGH ALERT: Please review policy carefully.

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mitoMYcin

mitoMYcin
Drug Name Form Strength Infusion Center Available Restricted Non-formulary Ambulatory Available Interchange REMS
Jelmyto KIT, URETERAL 40 mg      
Mutamycin POWDER FOR INJECTION, INTRAVENOUS 5 mg        
MitoMYcin POWDER FOR INJECTION, INTRAVENOUS 20 mg; 40 mg        
VIEW MORE Antineoplastic Agents
CLASS
100000
High Alert Drug : Policy
Additional Information and Links

OHS.PHARM.OS.052 Management of Medication Extravasation and Antidotes

Jelmyto:

  • Indication: Treatment of adult patients with low-grade upper tract urothelial cancer (LG-UTUC)
  • Service Line: Urology, Oncology
  • Formulary Location: Outpatient
  • Service location: Outpatient procedural area, Clinic
  • Patient Population: Adults
  • Prior Authorization Required: yes
  • Restriction/Criteria of Use: (all will apply, unless specify)
    • Residual low-grade, low volume (e.g., 5-15 mm) UTUC tumor.
    • Not a candidate for or are not seeking nephroureterectomy as a definitive treatment.
    • Verify pregnancy status in females of reproductive potential prior to initiating Jelmyto
Last updated: Dec. 23, 2024
Rhazdrugs mitoMYcin

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