Alpha-gal Content for Select Medications Per Manufacturer Updated January 2019 Galactose-alpha-1,3-galactose (Alpha-Gal), is a delayed allergy to mammal meat (e.g., beef, pork). This allergy is caused by a lone star tick bite. Many animal by-products may contain the alpha-gal epitope. Patients with this allergy should avoid any medications, supplements, or foods that may contain alpha-gal. Certain inactive ingredients in medications, such as gelatin, glycerin, glycerol, lactic acid, stearic acid, and magnesium stearate; may be animal derived. A *Disclaimer: Information is subject to change based on lot number of medication. There may also be comprehensive list of medications containing alpha-gal or animal by-products is unavailable at this time. The list cases where risk vs benefit needs to be assessed in deciding whether to use alpha gal medications. below outlines select medications that DUH Pharmacy has contacted the manufacturers for to determine alpha-gal Please contact Pharmacy for review of medications prior to ordering and/or to determine if there are content. potential alternatives that should be considered as part of this assessment. Drug Name Manufacturer OK to Use? Notes Acetaminophen 325 mg tablet McNeill, McKesson No Contains magnesium stearate and gelatin Acetaminophen 325 mg tablet Major Yes Acetaminophen 10 mg/mL injection Mallinckrodt Yes Acetaminophen 160 mg/5 mL liquid Pharmaceutical Associates No Contains glycerin Acetaminophen suppository G&W, Perrigo No Acetaminophen-butalbital-caffeine (Fiorcet) tablet American Health No Acetaminophen-codeine 300mg-30mg tablet Mallinckrodt No Acetaminophen-codeine 120mg-12mg elixir Pharmaceutical Associates No Contains glycerin Adult cardioplegia (induction) DCF Yes Adult cardioplegia (maintenance) DCF Yes Albumin 5% and 25% Grifols Yes Contains no animal or mammalian by-products Alprazolam tablet (all strengths) Major, Mylan, Mckesson No Alvimopan 12 mg capsule Cubist No Contains gelatin (bovine and porcine) Aminocaproic acid 500 mg tablet Hospira No Contains magnesium stearate and stearic acid Aminocaproic acid 250 mg/mL injection Yes Amiodarone 50 mg/mL injection Baxter Yes Amlodipine 5 mg tablet AvKARE Yes Amlodipine 5 mg tablet Major Yes Ampicillin injection Fresenius Kabi Yes No animal byproducts or gluten. No final product testing for either. Aprepitant 40 mg capsule Merck, Sandoz No Contains gelatin (bovine and porcine) Aspirin 81 mg chewable tablet Hospak Yes Aspirin 81 mg EC tablet GeriCare No Aspirin 325 mg EC tablet McKesson No Contains anhydrous lactose (Phone: 855-625-4677) Atorvastatin 40 mg tablet Major, Mylan Yes Bacitracin 50,000 unit injection X-Gen No May contain milk and milk-derivatives (bovine) Bacitracin 50,000 unit injection Fresenius Yes No animal byproducts or gluten. No final product testing for either. Baclofen 10 mg tablet McKesson & American Health No Contains magnesium stearate Belladonna-opium suppository Perrigo Yes No addition of animal by-products, but no final confirmatory testing Balanced Salt Solution (BSS) 15ml Alcon Yes Beclomethasone (QVAR) 80 mcg inhaler Teva Yes BSS Bag 500ml Alcon Yes BSS Plus Bottle 500ml Alcon Yes Bisacodyl 10 mg suppository G&W Yes Bisacodyl 5 mg tablet Major, Rugby No Bivalirudin 250 mg injection The Medicines Company Yes Budesonide (Nasocort) nasal spray AstraZeneca Yes Bupivacaine liposome injection (Exparel) Pacira No Glycerol is of animal origin (could not specify bovine or porcine) Bupivacaine 0.25% injection Hospira Yes Bupivacaine 0.5% injection Hospira Yes Bupivacaine 0.0625% - hydromorphone 10mcg/ml epidural DCF Yes Bupivacaine 0.125% - Hydromorphone 10mcg/ml epidural DCF Yes Bupivacaine 0.125% - Hydromorphone 10mcg/ml - clonidine 1mcg/ml epidural DCF Yes Bupivacaine 0.125% - Hydromorphone 25mcg/ml epidural DCF Yes Bupivacaine 0.25% - Hydromorphone 10mcg/ml epidural DCF Yes Calcium chloride 100 mg/mL injection DCF Yes Carbidopa-levodopa 25mg-100mg tablet McKesson No Contains magnesium stearate Carbidopa-levodopa 25mg-100mg ER tablet Mylan No Contains magnesium stearate Carisoprodol 350mg tablet American Health No Cefazolin injection Sandoz Yes No excipients added to cefazolin products Cefazolin 1 gm injection Hikma (Westward) Yes No animal byproducts Cefazolin 2 gm injection B Braun Yes Cefuroxime injection West-Ward Yes Cefuroxime 1.5 gm injection Sagent Yes Per manufacturer: No animal products are used in production Celecoxib 100 mg, 200 mg capsule Mylan, Major No Contains gelatin (bovine and porcine) Chlorhexidine (Peridex) 3M ESPE Yes Ciprofloxacin injection Claris Yes No animal byproducts or gluten. No final product testing for either. Cisatracurium injection Fresenius Kabi/Sandoz Yes Clevidipine 0.5 mg/mL injection Fresenius Kabi Yes Glycerin is plant-derived per manufacturer. No final product testing done Clindamycin injection Hospira Unknown Product divested Clonazepam tablet Mckesson No Clonidine 100 mcg/mL injection X-Gen Yes Clonidine 0.1mg tablet Mylan No Cyclobenzaprine tablet McKesson, Major, Mylan No Cyclosporine 25mg, 100mg capsule Novartis No Contains gelatin Cystografin Bracco Yes No animal byproducts or gluten. No final product testing for either. Desflurane Baxter Yes Dexamethasone injection Fresenius Kabi Yes No animal byproducts or gluten. No final product testing for either. Dexmedetomidine 4 mcg/mL injection Hospira Yes Dextrose 50% in water 12.5g DCF & Hospira Yes Diazepam 5 mg, 10 mg tablet McKesson, Mylan No Diazepam 1mg/ml 5ml soln Precision Dose Yes Diazepam 5mg/ml 2ml tubex IV Hospira Yes Diphenhydramine injection Fresenius Yes No animal byproducts or gluten. No final product testing for either. Diphenhydramine tablet Contract Pharm & Major No Need specific lot number; ingredient sources lot-specific (Lactose, Mg stearate, gelatin listed) Duke Eye Mix (Adult #2) DCF Yes Duke Eye Mix (Pediatric) DCF Yes Electrolyte-A (Plasma-Lyte A) Yes Ephedrine 50 mg IV Par Yes Epinephrine inj. 1:1,000 PF BPI Labs Yes Epinephrine drip JHP Yes Ertapenem 1 gm injection Merck Yes No ruminant animals (e.g. cows) products are used in manufacturing; no final testing for alpha-gal Esomeprazole oral suspension AstraZeneca Yes Ezetimibe 10 mg tablet Sun Pharma, Avkare No Famotidine 10 mg/mL injection Fresenius Kabi Yes Fentanyl injection Hospira, Akorn, DCF Yes Fentanyl PCA syringe DCF Yes Fentanyl patch (all strengths) Mylan Yes Floseal hemostatic matrix Baxter No Bovine gelatin Furosemide 20 mg tablet Sandoz No Furosemide 10 mg/mL oral solution West-Ward Yes Gabapentin capsule (all strengths) Amneal & McKesson No Contains gelatin (bovine and porcine) Gabapentin capsule (all strengths) AvKARE No Contains gelatin (bovine, porcine) & gluten (not gliaden gluten - type responsible for celiac sprue) Gabapentin capsule (all strengths) Mylan & American Health No Contains gelatin (bovine and porcine) Gabapentin capsule (all strengths) Ascend No Gelatin - bovine Gabapentin capsule (all strengths) Pfizer No Gelatin Gabapentin (Neurontin) 250 mg/5 mL oral solution Pfizer No Gabapentin 250 mg/5 mL oral solution Amneal Yes Gabapentin 250 mg/5 mL oral solution Greenstone No Animal source gelatin Gelflim 25 mm-50 mm/125 mm-100 mm Pfizer No Contains porcine gelatin Gentamicin injection Baxter, Fresenius Kabi Yes Glucagon injection Bedford No Contains lactose monohydrate (may be animal derived) Glycopyrrolate West-Ward yes Haloperidol 5 mg/mL injection Fresenius Kabi No Lactic Acid may be animal derived Heparin All (porcine) No Porcine derived Hydralazine 20 mg/mL injection Frasenius Kabi Yes Magnesium stearate; typically gluten-free, but due to sourcing there may be cross-contamination. Final testing is Hydrocodone-acetaminophen tablet Mallinckrodt No done for this. Hydrocortisone 100 mg injection Pharmacia & Upjohn (Pfizer) Yes No animal byproducts listed or used in manufacture Hydromorphone injection Hospira No Lactic Acid may be animal derived Hydromorphone 1 mg/mL injection (pre-filled syringe) Fresenius Kabi Yes Hydromorphone 1 mg/mL injection (Compounded) DCF Yes Hydromorphone 2mg, 4mg tablet Westward, Rhodes No Hydromorphone ER tablet Paddock No Hydromorphone 10mcg/ml Epidural DCF Yes Hydromorphone 25mcg/ml Epidural DCF Yes Hydromorphone PCA syringe DCF Yes Ibuprofen tablet (all strengths) LNK; Major & McKesson No Contains lactose (bovine) Ibuprofen 100 mg/5 mL suspension Precision Dose No Contains glycerin IC Green Akorn Yes No animal byproducts or gluten. No final testing for either. Imitrex 100 mg tablet GSK No Magnesium stearate - animal derived Imitrex 20 mg nasal spray GSK Yes Imitrex 4 mg, 6 mg injection GSK Yes Influenza vaccine (Fluzone High Dose) Sanofi Yes Influenza vaccine (Flulaval) GSK No Sodium deoxycholate may of animal origin - ovine or bovine Influenza vaccine (Flublok) Sanofi Yes No animal byproducts Instat Microfibrillar Collagen Hemostat Ethicon No Contains bovine collagen Insulin glargine (Lantus) Sanofi Yes Insulin human Lilly (Humulin R) Yes Per manufacturer: Glycerin is product is plant derived Isoflurane Baxter Yes Isosorbide Dinitrate 5 mg tablet Sandoz No Isovue M-200 Bracco Yes No animal byproducts or gluten. No final product testing for either. Ketamine injection Par, Mylan, Hospira Yes Labetolol 100mg/20ml injection Hospira/Akorn Yes Labetolol 5 mg/mL injection (Carpuject) Hospira Yes Lacosamide injection (all strengths) UCB Yes Lacosamide 10 mg/mL oral solution UCB No Contains glycerin Lacosamide tablet (all strengths) UCB No Levetiracetam 500 mg/5 mL injection Sagent Yes No animal byproducts used in manufacture Levetiracetam tablet American Health No Contains