RAFAEL LAZATIN MEMORIAL MEDICAL CENTER

(Ospital Ning Angeles)

“PHIC Accredited Health Care Provider”
Visitacion Street corner Pampang Road
Pampang, Angeles City, Philippines 2009
Tel. Nos.: (045) 322-1222, (045) 322-4495, (045) 887-4133
e-mail: ona_rlmmc@yahoo.com

January 13, 2023

To All concerned,

Subject: Drug Selection for the Hospital Formulary System

The Pharmacy and Therapeutics Committee (PTC) is a special committee

created to ensure that all drug products to be used in a hospital are safe, effective,
quality, and affordable. The creation of PTC is in accordance with the DOH
Administrative Order (AO) No. 51 series of 1988, also known as the “Implementing
Guidelines in Compliance with R.A 6675 (Generics Act of 1988)02.” In year 2000, DOH
AO No. 107 was issued amending DOH AO no. 51 s. 1988 which states that technical
experts from different major clinical departments and pharmacy who will be the regular
members with voting privileges.

Functions of the Pharmacy and Therapeutics Committee includes Implementing Hospital

Formulary System. With that said, may we request all department heads on their outputs
for addition and removal of drug products in the Hospital Formulary.

Attached is the list of current Drugs in the Hospital Formulary

Mariper D. Santos, RPh, MPA

PTC Secretary
 RAFAEL LAZATIN MEMORIAL MEDICAL CENTER
(Ospital Ning Angeles)
“PHIC Accredited Health Care Provider”
Visitacion Street corner Pampang Road
Pampang, Angeles City, Philippines 2009
Tel. Nos.: (045) 322-1222, (045) 322-4495, (045) 887-4133
e-mail: ona_rlmmc@yahoo.com

ALLERGY AND IMMUNE SYSTEM

ANTIHISTAMINE
Diphenhydramine (as HCl) Inj.: 50 mg/mL, 1mL ampule (IM, IV)
Cetirizine Oral: 10 mg tablet
2.5 mg/mL syrup (oral drops), 10 mL
1 mg/mL solution, 60 mL
Loratadine Oral: 10 mg tablet
STEROIDS
Hydrocortisone Inj.: 100 mg vial and 250 mg vial (IV) (as sodium succinate)
ANTIDOTES
Activated Charcoal, USP Oral: Powder, USP grade given as slurry
Atropine Inj.: 1 mg/mL, 1mL ampule (IM, IV, SC)
ANTI-INFECTIVES (SYSTEMIC)
ANTIBACTERIALS (Oral and Parenteral)
Amikacin (as sulfate) Inj.: 250 mg/mL, 2 mL vial (IM, IV)
Amoxicillin (as trihydrate) Oral: 500 mg capsule
Ampicillin Inj.: 500 mg vial (IM, IV)
Ampicillin + Sulbactam Inj.: 500 mg ampicillin + 250mg sulbactam (as sodium salt) vial
(IM/IV)
Azithromycin (as Dihydrate) Oral: 500 mg tablet
200 mg/5 mL powder for suspension, 15 mL
Cefalexin Oral.: 500 mg capsule
Cefazolin Inj.: 1 g vial (IM, IV)
Cefixime Oral.: 200 mg capsule
Cefotaxime Inj.:1 g vial (IM, IV)
Ceftazidime Inj.: 1 g vial (IM, IV)
Ceftriaxone Inj.: 1 g vial (IV)
Cefuroxime Inj.: 750 mg vial (IM, IV) (as axetil)
Oral.: 250 mg tablet and 500 mg tablet (as axetil)
Ciprofloxacin Inj.: 2 mg/mL, 100ml vial (IV infusion)
Oral.: 500 mg tablet
Clarithromycin Oral.:500 mg tablet
Clindamycin Inj.: 150 mg/mL, ampule 2 mL and 4 mL (IM, IV) (as phosphate)
Oral.: 300 mg capsule (as hydrochloride)
Co-Amoxiclav (amoxicillin + Oral.: 500 mg amoxicillin (as trihydrate) + 125 mg potassium
potassium clavulanate) clavulanate tablet
Cotrimoxazole Oral: 800 mg sulfamethoxazole + 160 mg trimethoprim tablet (B)
Erythromycin Eye Ointment: 0.5%, 5 g tube
Gentamicin (as sulfate) Inj.: 40 mg/mL, 2mL ampule (IM, IV)
Metronidazole Inj.: 500 mg vial (IV infusion)
 RAFAEL LAZATIN MEMORIAL MEDICAL CENTER
(Ospital Ning Angeles)
“PHIC Accredited Health Care Provider”
Visitacion Street corner Pampang Road
Pampang, Angeles City, Philippines 2009
Tel. Nos.: (045) 322-1222, (045) 322-4495, (045) 887-4133
e-mail: ona_rlmmc@yahoo.com

Oral: 500 mg tablet

Oxacillin (as sodium salt) Inj.: 500mg vial (IM, IV)
Silver Sulfadiazine Cream: 1%, 25 g tube
CARDIOVASCULAR SYSTEM
ADRENERGICS
Dobutamine Inj.: 12.5 mg/mL, 20 mL vial (IV infusion)
Dopamine Inj.: 40 mg/mL, 5mL ampule (IV)
Epinephrine Inj.: 1 mg/mL, 1mL ampule (IM, SC)
Norepinephrine (as bitartrate) Inj.: 1 mg/ml, 4 mL ampule (IV infusion)
ANTI-ANGINALS
Isosorbide Dinitrate Sublingual: 5 mg tablet
Oral: 5 mg tablet
Isosorbide-5-Mononitrate Oral: 30 mg MR tablet
Trimetazidine (as Oral: 35mg tablet
hydrochloride)
ANTIARRHYTHMIC DRUGS
Adenosine Inj.: 3mg/mL, 2mL
Amiodarone (as Hydrochloride) Inj.: 150 mg/3 mL ampule (IV)
Verapamil (as hydrochloride) Inj.: 2.5 mg/mL, 2mL ampule
ANTIDYSLIPIDEMIA
Atorvastatin Oral: 40 mg tablet
ANTIHYPERTENSIVES
Amlodipine Oral: 5 mg tablet and 10 mg tablet
Captopril Oral: 25 mg tablet
Carvedilol Oral.: 6.25mg tablet and 25mg tablet
Clonidine (as hydrochloride) Inj.: 150 mcg/mL ampule (IV)
Oral: 75 mcg tablet
Hydralazine (as hydrochloride) Inj.: 20 mg/mL, 1mL ampule (IM, IV)
Losartan (as potassium salt) Oral: 50 mg tablet
Methyldopa Oral: 250 mg tablet
Metoprolol (as tartate) Oral: 50 mg tablet
Nicardipine (as hydrochloride) Inj.: 1mg/mL, 2 mL and 10mLampule (IV)
Sacubitril/Valsartan Oral: 100 mg tablet
Telmisartan Oral: 40 mg and 80 mg tablet
ANTITHROMBOTICS
Aspirin Oral: 80 mg tablet
Clopidogrel Oral: 75 mg tablet
CARDIOACTIVE
Digoxin Inj.: 250 mcg/mL, 2mL ampule (IM, IV)
Oral: 250 mcg tablet
 RAFAEL LAZATIN MEMORIAL MEDICAL CENTER
(Ospital Ning Angeles)
“PHIC Accredited Health Care Provider”
Visitacion Street corner Pampang Road
Pampang, Angeles City, Philippines 2009
Tel. Nos.: (045) 322-1222, (045) 322-4495, (045) 887-4133
e-mail: ona_rlmmc@yahoo.com

ENDOCRINE SYSTEM and STERIODS

ANTIDIABETIC AGENTS
Metformin (as hydrochloride) Oral: 500 mg tablet
Regular Insulin Inj.: 100IU/ml, 10ml vial
CORTICOSTEROIDS
Dexamethasone Inj.: 4 mg/mL ampule, 2mL (IM, IV) (as sodium phosphate)
Hydrocortisone Inj.: 100 mg vial and 250 mg vial (IV) (as sodium succinate)
Methylprednisolone Oral: 4 mg tablet and 16 mg tab
Prednisolone Oral: 15 mg/5 mL syrup, 60 mL (as sodium phosphate)
Prednisone Oral: 5 mg, 10 mg and 20 mg tablet
10 mg/5 mL suspension, 60 mL
GASTROINTESTINAL SYSTEM
ANTACIDS
Calcium Carbonate Oral: 500 mg tablet
Ranitidine (as hydrochloride) Inj.: 25 mg/mL ampule (IM, IV, IV infusion)
Sodium Bicarbonate Inj.: 8.4%, 50ml vial
Oral: 650mg tablet
ANTIEMETICS
Domperidone Oral: 10mg tablet
Metoclopramide Inj.: 5 mg/mL, 2 mL ampule (IM, IV) (as hydrochloride)
Ondansetron Hydrochloride Inj.: 2 mg/mL, 2 mL ampule (IM, IV)
PROTON PUMP INHIBITOR
Omeprazole Inj.: 40 mg vial (IV)
Oral: 40mg capsule
ANTISPASMODICS
Hyoscine (as N-Butylbromide) Inj.: 20 mg/mL, 1 mL ampule (IM, IV, SC)
Oral: 10mg tablet
LAXATIVES
Bisacodyl Rectal: 5 mg and 10 mg suppository
Glycerol Rectal: 1.9 g and 2.5 g suppository
Lactulose Oral.: 3.35 g/5 mL, 120mL suspension
GENITO-URIARY SYSTEM
DIURETICS
Furosemide Inj.: 10 mg/mL, 2mL ampule (IM, IV)
Oral: 40mg tablet
Mannitol Inj.: 20%, 500 ml bottle (IV)
Spironolactone Oral: 25mg tablet
FOR BENIGN PROSTATIC HYPERTROPHY
Finasteride Oral: 5 mg tablet
Tamsulosin Oral: 200 mcg and 400 mcg tablet
 RAFAEL LAZATIN MEMORIAL MEDICAL CENTER
(Ospital Ning Angeles)
“PHIC Accredited Health Care Provider”
Visitacion Street corner Pampang Road
Pampang, Angeles City, Philippines 2009
Tel. Nos.: (045) 322-1222, (045) 322-4495, (045) 887-4133
e-mail: ona_rlmmc@yahoo.com

GYNECOLOGY AND OBSTRETICS

FOR ECLAMPSIA
Magnesium Sulfate (as Inj.: 250 mg/mL, 20ml vial (IM, IV)
heptahydrate)
OXYTOCIC
Carboprost (as Trometamol) Inj.: 125 mcg /0.5mL ampule and 250 mcg /mL ampule (IM)
Methylergometrine Inj.: 200 micrograms/mL, 1 mL ampul (IM, IV)
Oxytocin Inj.: 10 IU/mL, 1 mL ampule (IM, IV)
TOCOLYTIC
Isoxsuprine HCl Inj.: 5 mg/mL, 2 mL ampul (IM, IV infusion)
Oral: 10mg tablet
HEMATOLOGIC SYSTEM
ANTIANEMIC
Epoetin Alfa Inj.: 4000 IU/mL solution for injection (IV, SC)
Ferrous Sulfate Oral: 325 mg tablet
Ferrous Sulfate + Folic Acid Oral: 300 mg ferrous sulfate + 250 mcg folic acid tablet
Iron Sucrose Inj.: 20 mg/mL, 5ml ampule
ANTICOAGULANT
Enoxaparin Inj.: 4000 IU (equivalent to 40 mg/ 0.4mL) and (equivalent to 60
mg/ 0.6 mL) Pre-filled syringe (IV, SC)
ANTIFIBRINOLYTIC
Tranexamic Acid Inj.: 100 mg/mL, 5ml ampule
Oral: 500 mg capsule
BLOOD PLASMA EXPANDER
Hydroxyethyl Starch Inj.: 500 mL bottle (IV infusion)
COAGULANT
Phytomenadione Inj.: 10 mg/mL, 1 mL ampule (IM, IV, SC)
NERVOUS SYSTEM AND MUSCULOSKELETAL SYSTEM
ANTIVERTIGO
Betahistine Oral: 16 mg and 24 mg tablet
Cinnarizine Oral: 25 mg tablet
ANALGESICS/ANTIPYRETICS
Fentanyl Inj.: 50 mcg/ml, 2ml ampule
Ketorolac (trometamol) Inj.: 30 mg/mL, 1 mL ampule (IM, IV)
Morphine (as sulfate) Inj.: 10mg/mL, 1mL ampule (IM, IV, SC)
Nalbuphine (as hydrochloride) Inj.: 10 mg/mL, 1mL ampule (IM, IV, SC)
Paracetamol Inj.: 150 mg/mL, 2 ml ampule (IM, IV)
Oral: 500mg tablet
100 mg/mL drops, 15mL
120 mg/5 mL suspension, 60 mL
250 mg/5 mL suspension, 60 mL
 RAFAEL LAZATIN MEMORIAL MEDICAL CENTER
(Ospital Ning Angeles)
“PHIC Accredited Health Care Provider”
Visitacion Street corner Pampang Road
Pampang, Angeles City, Philippines 2009
Tel. Nos.: (045) 322-1222, (045) 322-4495, (045) 887-4133
e-mail: ona_rlmmc@yahoo.com

Rectal: 125 mg and 250 mg suppository

Phetidine HCl (as Inj.: 50 mg/mL, 2 mL ampule (IM, IV, SC)
hydrochloride)
Tramadol (as hydrochloride) Inj.: 50 mg/mL, 2 mL ampule (IM, IV, SC)
Oral: 50 mg capsule
ANESTHETIC
Ephedrine Inj.: 50 mg/mL 1 mL ampule (IM, IV) (as sulfate)
Isoflurane Inhalation:100ml bottle
Ketamine HCl Inj.: 50mg/mL, 10 mL vial (IM, IV)
Midazolam Inj.: 5 mg/mL, 1 ml ampule (IM, IV)
Neostigmine Inj.: 500 mcg/mL solution for injection (IM/IV/SC), 1 mL ampule
Propofol Inj.: 10 mg/mL, 20 mL ampule
Rocuronium (as bromide) Inj.: 10 mg/mL, 50mL (IV)
Sevoflurane Inhalation: 250 mL
Succinylcholine Chloride Inj.: 20 mg/mL, 10 mL vial
Bupivacaine (as Hydrochloride) Inj.: 5 mg/mL, 4mL ampule
5 mg/mL, 10mL polyamp
Lidocaine HCl Inj.: 20 mg/mL,5ml polyamp (IM/IV)
20 mg/mL, 50 ml vial (IM/IV)
Spray: 10 mg/mL, 50ml vial
ANTICONVULSANTS
Diazepam Inj.: 5 mg/mL, 2 mL ampule (IM, IV)
Midazolam Inj.: 5 mg/mL, 1 ml ampule (IM, IV)
Phenytoin (as sodium salt) Inj.: 50 mg/ml, 2 ml ampule
ANTI-INFLAMMATORY
Celecoxib Oral: 200 mg capsule
ANTIGOUT
Allopurinol Oral: 100 mg tablet
Colchicine Oral: 500 microgram tablet
Mefenamic Acid Oral: 500 mg tab/capsule
Methylprednisolone Oral: 4 mg tablet and 16 mg tab
ANTIPSYCHOSIS
Haloperidol Inj.: 50mg/mL, 1 mL ampule (IM)
RESPIRATORY SYSTEM
Salbutamol (as sulfate) Resp. Soln.: (for nebulization)
2.5mg/mL, 2.5ml (unit dose)
Metered Dose Inhaler (MDI):
100 micrograms/dose x 200 actuations
Butamirate Oral: 50 mg MR tablet
Budesonide Resp. Soln.: (for nebulization)
250 mcg/mL, 2 mL (unit dose)
Ipratropium +Salbutamol Resp. Soln.: (for nebulization)
 RAFAEL LAZATIN MEMORIAL MEDICAL CENTER
(Ospital Ning Angeles)
“PHIC Accredited Health Care Provider”
Visitacion Street corner Pampang Road
Pampang, Angeles City, Philippines 2009
Tel. Nos.: (045) 322-1222, (045) 322-4495, (045) 887-4133
e-mail: ona_rlmmc@yahoo.com

500 mcg ipratropium (as bromide) + 2.5 mg salbutamol (as sulfate)

Montelukast (as sodium salt)
Terbutaline
Acetylcysteine
VITAMINS AND MINERALS
Ascorbic Acid (vitamin C)
Calcium Gluconate
Multivitamins
Vitamin B Complex
Zinc
0.9% Sodium Chloride (PNSS)
5% Dextrose in Water (D5W)
10% Dextrose in Water (D10W)
5% Dextrose in 0.9% Sodium
Chloride (D5NSS)
5% Dextrose in Lactated
Ringers (D5LRS)
5% Dextrose in 0.3% Sodium
Chloride (D50.3NaCl)
50% Dextrose
Balanced Multiple
Maintenance Solution (IMB
/D5NM)
Lactated Ringer's Solution
(PLRS)
Sterile Water for Injection
Oral Rehydration Salt sachet
(ORS Solution)
Potassium Chloride
VACCINES AND IMMUNOLOGICALS
Anti-Tetanus Serum
BCG Vaccine
HEPATITIS B VACCINE
Tetanus Toxoid
x 2.5mL (unit dose)
Oral: 5 mg chewable tablet and 10 mg tablet
Inj.: 500 micrograms/mL, 1 mL ampule (IM, IV, SC)
MUCOLYTIC
Oral: 600mg effervescent tablet
Oral: 500 mg tablet
Inj.: 100 mg/mL, 10mL ampule (IV)
Oral: tab
Oral: 100 mg B1 + 5 mg B6 + 50 microgram B12 per tablet/capsule
Inj.: 100 mg B1 + 100 mg B6 + 1 mg B12 per 3 mL ampule (IV)
Oral: solution, (equiv. to 10 mg elemental zinc/mL) drops, 15 mL,
(as sulfate monohydrate) solution, (equiv. to 20 mg elemental
zinc/5 mL) syrup, 60 mL (as sulfate monohydrate)
FLUIDS AND ELECTROLYTES
Inj.: 50 mL, 500 mL and 1L bottle/bag (IV infusion)
Inj.: 500 mL bottle (IV infusion and as vehicle for IV medications)
Inj.: 500 mL bottle (IV infusion)
Inj.: 500 mL and 1 L bottle/bag (IV infusion)
Inj.: 1 L bottle (IV infusion)
Inj.: 500 mL and 1 L bottle/bag (IV infusion)
Inj.: 50 mL vial (IV)
Inj.: with 5% dextrose 500mL (infants) and 1L (children and adults)
bottle (IV infusion
Inj.: 500 mL and 1 L bottle/bag (IV infusion)
Inj.: 50 mL vial (IV)
Oral: Composition of reduced osmolarity ORS per liter of water
(WHO recommended):
Inj.: 40mEq, 20 ml vial
Oral: 600mg tablet
Inj.: 1500 IU/mL, 1 mL ampule (IM)
Inj.: freeze-dried powder, 250 mcg ampule
Inj.: 10 micrograms/0.5 mL monodose vial
(IM) (pediatric)
Inj.: 0.5 mL ampule (IM)
RAFAEL LAZATIN MEMORIAL MEDICAL CENTER
(Ospital Ning Angeles)
“PHIC Accredited Health Care Provider”
Visitacion Street corner Pampang Road
Pampang, Angeles City, Philippines 2009
Tel. Nos.: (045) 322-1222, (045) 322-4495, (045) 887-4133
e-mail: ona_rlmmc@yahoo.com

Additional drugs to be added

DRUG PNF NON- PNF