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 magnesium stearate Lidocaine (Lidoderm) patch Qualitest No Contains gelatin which is bovine derived Lidocaine 100 mg/5ml emerg. Abboject Fresenius Kabi Yes Lidocaine 4% -5ml PF Hospira Yes Lisinopril tablet (all strengths) Major No Contains magnesium stearate Lorazepam 2 mg/mL injection Akorn, Westward Yes Lorazepam tablet McKesson No Magnesium hydroxide solution Pharmaceutical Assoc. No Contains glycerin Magnesium oxide Unknown Magnesium sulfate 4 mEq/mL injection Fresenius Kabi Yes Mannitol 25% injection Hospira Yes Meperidine 50 mg/mL injection Hospira Yes Methadone 5 mg, 10 mg tablet Westward, Roxane No Methadone 5 mg/5 mL oral solution No Contains glycerin Methadone 10 mg/mL injection DCF Yes Methocarbamol 500 mg tablet McKesson Unknown Methohexital 500 mg injection Par Yes Methylergonovine 0.2 mg tablet Lupin No Metoclopramide 5 mg/mL injection Hospira Yes Metoclopramide 1 gm/mL oral solution Vistapharm No Glycerin - may be animal derived Metoclopramide 5 mg orally disintegrating tablet Lupin No Magnesium stearate - animal derived Metoclopramide 10 mg tablet Impax, Mylan No Magnesium stearate - animal derived Metoprolol 1 mg/mL injection Frasenius Kabi Yes Metoprolol tartrate tablets (all strengths) Major No Midazolam injection Hospira Yes Misoprostol 100 mcg, 200 mcg tablet Gavis Yes Montelukast 10 mg tablet Various No Moxifloxacin 0.5% ophthalmic solution Alcon Yes Mycophenolate 500 mg tablet Mylan No Mycophenolate 180mg EC tablet (Myfortic) Mylan No Morphine injection WestWard, hospira Yes Morphine PCA DCF Yes Morphine ER tablet (MS Contin) Mallinckrodt No Morphine 15 mg, 30 mg IR tablet Westward, Roxane No Morphine PF (intrathecal) WestWard, hospira Yes Morphine oral solution No Contains glycerin Multihance Bracco Yes No animal byproducts or gluten. No final product testing for either. Naproxen 500mg tablet McKesson No Neostigmine 1 mg/mL injection DCF Yes Nicardipine injection West-Ward Yes Nitroglycerin 0.4 mg tablet Pfizer No Norepinephrine infusion Hospira Yes Nystatin oral suspension Unknown *couldn't find in the pharmacy Omeprazole-sodium bicarbonate suspension Par Yes Ondansetron injection Hospira Yes Ondansetron 4mg, 8mg orally disintegrating tablet Mylan Yes Oxybutynin tablet American health No Contains magnesium stearate Oxybutynin 5 mg/5 mL solution Morton Grove Yes Oxycodone 5 mg tablet Hospira, mallinkroft No Contains animal derived stearic acid Oxycodone oral solution Lehigh Valley Yes Oxycodone oral solution Vista No contains glycerin Oxycontin tablet Purdue No contains magnesium stearate Oxycodone-acetaminophen 5mg-325mg tablet Mallinckrodt No Pantoprazole 20 mg, 40 mg DR tablet Mylan Unknown Contains no gluten. Pantoprazole 40 mg DR tablet Aurobindo Yes Pantoprazole 40 mg DR tablet Major Yes Pantoprazole 40 mg injection Pfizer Yes No final testing for animal by-products Phenazopyridine 100 mg, 200 mg tablet ECI & Gemini No Contains magnesium stearate Phenylephrine in NS Eclat Yes Potassium chloride ER 10 mEq tablet Zydus Yes Potassium chloride oral solution (10%, 20%) Par Yes Pregabalin capsule (all strengths) Pfizer No Gelatin of animal origin; lot-specific ingredient sourcing Promethazine 25 mg/mL injection West-Ward Unknown Company not able to confirm or deny the presence of alpha-galactose in the raw materials Promethazine 25 mg/mL injection X-Gen Yes Promethazine 6.25 mg/5 mL oral solution Hi-Tech Pharmacal/Akorn Yes Promethazine 6.25 mg/5 mL oral solution PAR/Qualitest Yes Propofol 10 mg/mL injection Fresenius Kabi Yes Ok per manufacturer. Glycerol in product is plant-based Protamine 10 mg/mL injection Fresenius Kabi Yes Prothrombin complex concentrate (Kcentra) CSL Behring No Heparin porcine Remifentanil injection (Ultiva) Mylan Yes Rifampin capsule Eon Labs, Mylan No Gelatin - Porcine, bovine derived Rocuronium 10 mg/mL injection Mylan Yes Scopolamine Patch Yes Senna tablet Major Yes Sennokot S tablet Major No Contains bovine Sevoflurane Baxter Yes Sodium bicarbonate 1mEq/ml injection Hospira/DCF Yes Sotalol 80 mg tablet Teva No Sotalol 5 mg/mL solution Arbor Yes Spironolactone 25 mg tablet Amneal No Succinylcholine Hospira Yes Sufentanil 50 mcg/mL injection Akorn Yes Sugammadex 200 mg, 500 mg injection Merck Yes Sumatriptan 25 mg, 50 mg, 100 mg tablet Mylan, Sun Pharma No Magnesium stearate - animal derived Sumatriptan 5 mg, 20 mg nasal spray Lannett Yes Sumatriptan 4 mg, 6 mg injection Sandoz (Novartis) Yes Sumatriptan 6 mg injection Teva Yes Surgicel Original Ethicon Yes Plant-based oxidized regenerated cellulose Surgicel Fibrillar Ethicon Yes Plant-based oxidized regenerated cellulose Surgicel Nu-Knit Ethicon Yes Plant-based oxidized regenerated cellulose Surgifoam powder Ethicon No Contains porcine gelatin Surgifoam Absorbable Gelatin Sponge Ethicon No Contains porcine gelatin Tamsulosin capsule 0.4 mg capsule Boehringer Ingelheim No Bovine and porcine derivatives Thrombin No Tisseel fibrin sealant Baxter Yes Derived from human plasma Tranexamic acid 100 mg/mL injection Acella Yes Vancomycin injection Fresenius Kabi Yes Vasopressin infusion Fresenius Kabi Yes Vecuronium 10 mg injection Sun Yes Verapamil ER 100 mg capsule Mylan No Visipaque GE Healthcare Unknown No information available from manufacturer Zofran 4 mg orally disintegrating tablet Novartis No Contains gelatin; company does not perform tests to determine if ingredients are animal sourced

References: 1) Alpha-gal basics. Alpha-Gal Allergy Awareness website. http://alpha-gal.org. Accessed: October 10, 2017; 2) Kar I, et al. Alpha-gal allergy: Implications for pharmacists. Pharmacy Times May 2015.