Approved Formulary
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Restricted Medications
| Per policy, use of these medications is restricted as noted below: | |
|---|---|
| generic (Brand) | Restrictions |
| abatacept (Orencia) | Restricted from being administered at IMH, including ICS. |
| Actemra - see tocilizumab | |
| Actonel - see risedronate | |
| adalimumab (Humira) | Restricted from being administered at IMH, including ICS. |
| albuterol (ProAir, Ventolin) | Inhalers restricted to ventilator patients, SNF only. Inpatient orders will be converted to albuterol nebs. |
| albuterol-ipratropium (Combivent) | Inhalers restricted to ventilator patients, SNF only. Inpatient orders will be converted to albuterol-ipratropium (DuoNeb) nebs. |
| alendronate (Fosamax) | HB-SNF only, hold for inpatients |
| aprepitant (Emend) | ANES use only for PONV. |
| Aredia - see pamidronate | |
| Atrovent - see ipratropium | |
| Avycaz - see cefTAZidime - avibactam | |
| belimumab (Benlysta) | Restricted from being administered at IMH, including ICS. |
| Benlysta - see belimumab | |
| Boniva - see ibandronate | |
| buprenorphine (Subutex, Suboxone) | New starts of buprenorphine for pain or dependence treatment will not be allowed at IHS. Indications for buprenorphine are limited to the following: (1) Continuation of buprenorphine therapy for the maintenance of opioid dependence when the patient is admitted for a medical condition other than opioid addiction. (2) Continuation of chronic pain management if buprenorphine was taken prior to admission. See policy for more details. |
| calcitonin (Miacalcin) | Use injection for Paget's disease and hypercalcemia (for hypercalcemia, restricted to ICS and 24 hours duration for inpatients). Use nasal spray for osteoporosis. |
| ceftaroline (Teflaro) | ID use only |
| cefTAZidime - avibactam (Avycaz) | ID use only |
| ceftolozane - tazobactam (Zerbaxa) | ID use only |
| Cinqair - see reslizumab | |
| colistimethate (Colistin) | ID use only |
| Colistin - see colistimethate | |
| Combivent - see albuterol-ipratropium | |
| Cubicin - see DAPTOmycin | |
| dalfopristin-quinupristin (Synercid) | ID use only |
| DAPTOmycin (Cubicin) | ID use only |
| denosumab (Prolia, Xgeva) | Restricted from being administered at IMH, including ICS. |
| Depo-Testosterone - see testosterone | |
| Dificid - see fidaxomicin | |
| Dolophine - see methadone | |
| droperidol (Inapsine) | Restricted to ED and Anesthesia departments only (IV/IM) |
| Emend - see aprepitant | |
| Entyvio - see vedolizumab | |
| fidaxomicin (Dificid) | ID use only |
| Fosamax - see alendronate | |
| Humira - see adalimumab | |
| ibandronate (Boniva) | HB-SNF only, hold for inpatients |
| Inapsine - see droperidol | |
| Inflectra - see inFLIXimab | |
| inFLIXimab (Remicade, Inflectra) | Restricted from being administered at IMH, including ICS. |
| ipratropium (Atrovent) | Inhalers restricted to ventilator patients, SNF only. Inpatient orders will be converted to ipratropium nebs. |
| leuprolide (Lupron) | Restricted from being administered at IMH, including ICS. |
| levalbuterol (Xopenex) | DNS orders |
| Lupron - see leuprolide | |
| methadone (Dolophine) | A. Methadone may be dispensed for the treatment of pain. This includes using methadone as a part of a formal pain management program in which a patient is switched from other licit drugs to methadone to control or gradually reduce dosage. B. Methadone may only be used to maintain narcotic addiction or to detoxify a patient when the prescriber is registered by the DEA as a narcotic treatment facility (NTF). In such cases, the drug may only be administered by the NFT. See policy for more details. |
| Miacalcin - see calcitonin | |
| octreotide (SandoSTATIN LAR) | Restricted from being administered at IMH, including ICS. |
| Orencia - see abatacept | |
| pamidronate (Aredia) | Outpatient Only (for osteoporosis) |
| ProAir - see albuterol | |
| Prolia - see denosumab | |
| Reclast - see zoledronic acid | |
| Remicade - see inFLIXimab | |
| reslizumab (Cinqair) | Restricted from being administered at IMH, including ICS. |
| risedronate (Actonel) | HB-SNF only, hold for inpatients |
| SandoSTATIN LAR - see octreotide | |
| Sivextro - see tedizolid | |
| Stelara - see ustekinumab | |
| Suboxone - see buprenorphine | |
| Subutex - see buprenorphine | |
| Synercid - see dalfopristin-quinupristin | |
| tedizolid (Sivextro) | ID use only |
| Teflaro - see ceftaroline | |
| testosterone (Depo-Testosterone) | testosterone injection is special-order only for ICS, hold for inpatients/SNF. |
| tigecycline (Tygacil) | ID use only |
| tocilizumab (Actemra) | Restricted from being administered at IMH, including ICS. |
| Tygacil - see tigecycline | |
| ustekinumab (Stelara) | Restricted from being administered at IMH, including ICS. |
| vedolizumab (Entyvio) | Restricted from being administered at IMH, including ICS. |
| Ventolin - see albuterol | |
| Xgeva - see denosumab | |
| Xopenex - see levalbuterol | |
| Zerbaxa - see ceftolozane - tazobactam | |
| zoledronic acid (Reclast, Zometa) | Reclast (osteoporosis): Outpatient Only Zometa (hypercalcemia): not restricted. |
| Zometa - see zoledronic acid | |
| last updated: 02/06/2023 | |