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Rpharmy Memorial

Approved Hospital Formulary

Formulary Addition Requisition (Position 1)

Rpharmy Memorial Formweb Change Request (Position 2)

Questions & Suggestions (Position 3)

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Rpharmy Memorial

Approved Hospital Formulary

Formulary Addition Requisition (Position 1)

Rpharmy Memorial Formweb Change Request (Position 2)

Restricted

Please review each of these drugs carefully.

acetaminophen	Acetaminophen IV - See Drug Detail Page
alosetron	Restricted to registered physicians
baricitinib	Use should be restricted to only those patients who meet EUA criteria
bortezomib	only stock the brand name Velcade product at all sites to decrease the risk of the alternative product accidentally being used when ordered via the SQ route
cabazitaxel	Restricted to Outpatient (see IP criteria for use)
DAPTOmycin	Reserved for MRSA infections ONLY if clinical intolerance to or failure of first line agents; not in pneumonia
omeprazole	See Drug Detail Page
valGANciclovir	ID approval needed. Exception: Unrestricted use for solid organ and bone marrow transplant patients.

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