Itraconazole Oral SOL 10MG/ML Oral Sol, 150ML (Sporanox)

Itraconazole Oral SOL 10MG/ML Oral Sol, 150ML (Sporanox)

Non-Formulary Use Criteria: 1. Diabetic or circulatory disorders evidenced by absence of pedal pulses and/or extremity hair loss due to poor circulation, or abnormal monofilament exam demonstrating
loss of sensation. 2. Onychomycosis requests meeting criteria will be approved for terbinafine (Lamisil ) 250 mg daily for 6 to 12 weeks for fingernails or toenails respectively. Formulary Restrictions: ****RESTRICTED TO HISTOPLASMOSIS, BLASTOMYCOSIS, ASPERGILLOSIS, AND SYSTEMIC MYCOSIS** **NOT APPROVED FOR ONYCHOMYCOSIS**Formulary Restrictions: RESTRICTED TO HISTOPLASMOSIS, BLASTOMYCOSIS, ASPERGILLOSIS, AND SYSTEMIC MYCOSIS** **NOT APPROVED FOR ONYCHOMYCOSIS

Dr. M Blatstein

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