Product Details
Phenytoin Sodium Injection USP
Phenytoin (Diphenylhydantoin) Sodium50 mg/mL
Solution for Injection (Preservative-Free)
DIN/PIN/NPN
00780626
Manufacturer
Sandoz Canada Inc.
Formulary Listing Date
2017-02-28
Unit Price
6.0785
Amount MOH Pays
6.0785
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N03AB02
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 481 | 1 year | For the management of patients receiving palliative care*. *Note: The patient must have a progressive life-limiting illness and require this medication for palliative purposes. |
| 657 | 1 year | For the treatment of patients receiving care at home* who have failed or are unable to tolerate oral alternatives, and who require an injectable option to manage their condition. *Note: e.g., home care recipients, long-term care home residents. |