Limited Use Note(s)

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PHENYTOIN (DIPHENYLHYDANTOIN) SODIUM50mg/mL Inj Sol (Preservative Free)
Reason For Use CodeClinical Criteria
481For the management of patients receiving palliative care*.
LU Authorization Period: 1 year
NOTE: *The patient must have a progressive life-limiting illness and require this medication for palliative purposes.
657For 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.
LU Authorization Period: 1 year
NOTE: *e.g., home care recipients, long-term care home residents.