Formulary for 30 days only. Is this order for less than 31 days? MLP Requires Cosign / Non-Formulary Use Criteria:
**01. Control of severe agitation in psychiatric patients** **02. When lack of sleep causes an exacerbation of psychiatric illness** **03. Part of a prolonged taper schedule** **04. Detoxification for substance abuse** **05. Failure of standard modalities for seizure disorders ( 4th line therapy)** **06. Long-term use for terminally ill patients for palliative care ( e.g. hospice patients)****07. Adjunct to neuroleptic therapy to stabilize psychosis** **08. Second line therapy for anti-mania** **09. Psychotic syndromes presenting with catatonia ( refer to BOP Schizophrenia Clinical Practice Guideline)****10. Akathisia which is non-responsive to beta blocker at maximum dose or unsuccessful conversion to another antipsychotic agent**

Formulary for 30 days only. Is this order for less than 31 days? MLP Requires Cosign / Formulary for 30 days only. Is this order for less than 31 days? MLP Requires Cosign / Non-Formulary Use Criteria:
**01. Control of severe agitation in psychiatric patients** **02. When lack of sleep causes an exacerbation of psychiatric illness** **03. Part of a prolonged taper schedule** **04. Detoxification for substance abuse** **05. Failure of standard modalities for seizure disorders ( 4th line therapy)** **06. Long-term use for terminally ill patients for palliative care ( e.g. hospice patients)****07. Adjunct to neuroleptic therapy to stabilize psychosis** **08. Second line therapy for anti-mania** **09. Psychotic syndromes presenting with catatonia ( refer to BOP Schizophrenia Clinical Practice Guideline)****10. Akathisia which is non-responsive to beta blocker at maximum dose or unsuccessful conversion to another antipsychotic agent**

Formulary for 30 days only. Is this order for less than 31 days? MLP Requires Cosign / Formulary for 30 days only. Is this order for less than 31 days? MLP Requires Cosign / Non-Formulary Use Criteria:
**01. Control of severe agitation in psychiatric patients** **02. When lack of sleep causes an exacerbation of psychiatric illness** **03. Part of a prolonged taper schedule** **04. Detoxification for substance abuse** **05. Failure of standard modalities for seizure disorders ( 4th line therapy)** **06. Long-term use for terminally ill patients for palliative care ( e.g. hospice patients)****07. Adjunct to neuroleptic therapy to stabilize psychosis** **08. Second line therapy for anti-mania** **09. Psychotic syndromes presenting with catatonia ( refer to BOP Schizophrenia Clinical Practice Guideline)****10. Akathisia which is non-responsive to beta blocker at maximum dose or unsuccessful conversion to another antipsychotic agent**

Formulary for 30 days only. Is this order for less than 31 days? MLP Requires Cosign / Formulary for 30 days only. Is this order for less than 31 days? MLP Requires Cosign / Non-Formulary Use Criteria:
**01. Control of severe agitation in psychiatric patients** **02. When lack of sleep causes an exacerbation of psychiatric illness** **03. Part of a prolonged taper schedule** **04. Detoxification for substance abuse** **05. Failure of standard modalities for seizure disorders ( 4th line therapy)** **06. Long-term use for terminally ill patients for palliative care ( e.g. hospice patients)****07. Adjunct to neuroleptic therapy to stabilize psychosis** **08. Second line therapy for anti-mania** **09. Psychotic syndromes presenting with catatonia ( refer to BOP Schizophrenia Clinical Practice Guideline)****10. Akathisia which is non-responsive to beta blocker at maximum dose or unsuccessful conversion to another antipsychotic agent**

SECOND LINE THERAPY FOR MOST INDICATIONS, MLP Requires Cosign

Advisories: FLUOXETINE IS PREFERRED SSRI FOLLOWED BY SERTRALINE, NON-COMPLIANT PATIENTS SHOULD BE EVALUATED FOR RETURN TO PILL LINE STATUS ON A CASE BY CASE BASIS. MLP Requires Cosign. NON-Formulary: 01. Control of severe agitation in psychiatric patients 02. When lack of sleep causes an exacerbation of psychiatric illness 03. Part of a prolonged taper schedule 04. Detoxification for substance abuse 05. Failure of standard modalities for seizure disorders ( 4th line therapy) 06. Long-term use for terminally ill patients for palliative care ( e.g. hospice patients) 07. Adjunct to neuroleptic therapy to stabilize psychosis 08. Second line therapy for anti-mania 09. Psychotic syndromes presenting with catatonia ( refer to BOP Schizophrenia Clinical Practice Guideline)