2014 DSHS-DADS Drug Formulary

TEXAS HEALTH AND HUMAN SERVICES COMMISSION

DEPARTMENT OF STATE HEALTH SERVICESDEPARTMENT OF AGING AND DISABILITY SERVICES

DRUG FORMULARY2014

http://www.dshs.state.tx.us/mhprograms/Formulary.shtm

Approved October 2013

http://www.dshs.state.tx.us/mhprograms/Formulary.shtm

The Texas Department of State Health Services (DSHS)/Department of Aging and Disability Services (DADS) Drug Formulary is the publication that outlines the medications that have been approved for use in Community Mental Health Centers, Mental Health State Hospitals and the State Supported Living Centers. The formulary is published annually around the beginning of the calendar year. This document is divided into three sections (Alphabetical Listing, Therapeutic Classification/Cost Index, and Alphabetical Index) to facilitate usage.

1. ALPHABETICAL LISTING:This section lists all the medications alphabetically by generic (nonproprietary) name. Trade (proprietary) names and abbreviations are listed in parenthesis after the generic name. In this section, all approved dosage forms and strengths are also listed.

L o raz ep a m (A tiv a n ) C - IVIn je c t io n : 2 m g /m L , 4 m g /m LS o lu t io n , o ra l: 2 m g /m LT a b le t: 0 .5 m g , 1 m g , 2 m g

Generic Name Trade Name ScheduledDrug

{ }Dosage

Strengths &Concentrations

DosageForms

2. THERAPEUTIC CLASSIFICATION/COST INDEX:This section groups the medications by therapeutic usage and lists them alphabetically by generic (nonproprietary) name. Medications may be listed in multiple categories. For trade names, consult the alphabetical index. Also in this section is a relative cost index so that medications used in similar situations can be evaluated keeping cost of care in mind. Relative cost is based on cost per day of the average dose. The cost of bulk items is listed per unit.

Mood StabilizersCarbamazepine (Tegretol) $ - $$$Divalproex (Depakote) $$ - $$$Lithium Carbonate (Eskalith, Lithonate,

Lithobid)

$

Lithium Citrate (Cibalith-S) $$ - $$Valproate (Depakene) $$ - $$

TherapeuticClass

RelativeCost

Index** Index = $ < $$ < $ < $$ < $$$ < $$$$ < $$$$$ < $$$$$$ < $$$$$$$

3. ALPHABETICAL INDEX:This section lists all the medications alphabetically by trade name, generic name, and abbreviations. Page numbers for each of the listings is provided.

INTRODUCTION

The purpose of the DSHS/DADS Executive Formulary Committee is to maintain and update the Formulary and to recommend standards for drug use within the Community Mental Health Centers, Mental Health State Hospital and the State Supported Living Centers. The Committee is concerned with maintaining the highest standards for drug use. To assist the clinician in prescribing the most cost effective agents a Therapeutic Classification with relative cost data is provided. Because of their frequency of use, the highest level of concern and vigilance centers on the psychotropic medications. For the clinician's reference, the Formulary provides tables summarizing the recommended dosage ranges for the psychotropic drugs; however, these guidelines are not intended to replace other references or the clinician's clinical judgment. The clinician is urged to check with other references, including the Department of State Health Services rule governing prescribing of psychoactive medications (Texas Administrative Code, Title 25, Part 1, Chapter 415, Subchapter A), The American Hospital Formulary Service Drug Information, Facts & Comparisons, and The AMA Drug Evaluations among other reliable sources.

This Formulary, is not intended to be a reference for drug use. Rather it is to serve the clinician as a listing of drugs, which are approved for use within the Department. Approval of a drug entity for inclusion in the Formulary does not imply approval of all formulations containing that entity. The Executive Formulary Committee will decide which formulations are approved for use within the department. Not all drugs listed in the Formulary will be stocked at each facility's pharmacy. If a physician, dentist, nurse or pharmacist desires to have a drug added to the Formulary, he or she should complete and submit the appropriate form (New Drug Application, DF-1, see Appendix 1) to the facility’s Pharmacy and Therapeutics Committee. If it is approved at the facility level but is not included in the Departmental Formulary, the facility’s Director of Pharmacy must then forward the request to the DSHS/DADS Executive Formulary Committee in care of the Texas Department of State Health Services, State Hospital Section. Requests received at least 30 days prior to the quarterly meeting will be considered at that meeting. Requests received less than 30 days before the meeting will not be considered until the following meeting. Clinicians and facilities are encouraged to submit supporting documents with their formulary request. The Executive Formulary Committee will evaluate the submission's appropriateness based upon the efficacy and safety of the proposed drug compared with existing formulary items and cost effectiveness of the new agent. When appropriate, the Executive Formulary committee will add the new drug or replace old agents in the same pharmacological/therapeutic category with the new agent. The DSHS/DADS Formulary and Interim Formulary Updates are available at http://www.dshs.state.tx.us/mhprograms/Formulary.shtm

The DSHS/DADS Formulary consists of routine and reserve drugs. Drugs in the reserve class have specific guidelines for use printed in the Formulary. These guidelines will be used to audit the appropriate use of reserve drugs. Based on the audit results, continuing education will be developed and targeted as needed. The purpose of reserve status is to stimulate thought and promote care in prescribing. Discussions about the use of reserve status drugs with peers are encouraged. Use of reserve status drugs requires documentation of justification in the patient’s progress notes.

As a means of preventing medication errors, the Formulary has incorporated TALL MAN characters to assist in distinguishing look-alike drug names. TALL MAN characters are being implemented in various parts of the pharmaceutical industry in order to prevent medication errors. Even though the Formulary may not play a major role in preventing medication errors, hopefully this change will stimulate the awareness of TALL MAN characters and assist in implementing this print style in other areas of our medication use process.

The Texas Department of State Health Services and The Texas Department of Aging and Disability Services utilize a closed formulary system. Only drugs listed in the Formulary are to be stocked, prescribed and dispensed in DSHS/DADS facilities including pharmaceutical products recommended by consultants for specialized treatments. When a patient's condition requires a drug not listed in the Formulary, limited quantities can be obtained for use in that particular patient. However, documentation (Non-Formulary Drug Justification Form, DF-2, see Appendix 2) or other appropriate pharmacy software generated report should be submitted to the facility Clinical Director and the Office of the Medical Director where it will be reviewed by the Executive Formulary Committee to assure reasonable compliance with the Formulary.

When requested by the Commissioner, the Executive Formulary Committee will make other recommendations regarding drug use. If facility clinicians have topics for committee consideration, these requests should be sent to the Chairperson, DSHS/DADS Executive Formulary Committee in care of the Texas Department of State Health Services, State Hospital Section (mail code 2023). The Committee also appreciates your comments concerning the printing of the Formulary and Committee deliberations and decisions. Please feel free to provide input.

Jennifer Wright, M.D.ChairpersonExecutive Formulary Committee

October 18, 2013 Date

MEMBERS OF THE DSHS/DADS EXECUTIVE FORMULARY COMMITTEE

Victoria Morgan, M.D.Brenham State Supported Living Center

Vacant DADS Physician

Mary Bowers, RN, BSNLufkin State Supported Living Center

Catherine S. Hall, Pharm.D., BCPPSan Antonio State Hospital

Robert L. Ward, DOHill Country Community MHMR Center

Connie Millhollon, RNTerrell State Hospital

Marla Knight, Pharm.D., CGP, FASCPAbilene State Supported Living Center

James Baker, M.D.DSHS Medical Director

Jeanna Heidel, PharmDRusk State Hospital

Ann L. Richards, PharmD, BCPPDSHS Pharmacy Services DirectorSan Antonio State Hospital

Jennifer Wright, M.D., ChairKerrville State Hospital

Kenda Pittman, Pharm.D.Austin State Supported Living Center

Jeff Matthews, M.D.UT Health Northeast

Phillip Balfanz, M.D.Hill Country Community MHMR Center

Ex-Officio MembersPeggy PerryDirector, State Mental Health Facilities (DSHS)Kerry RaymondAssistant Director, State Mental Health Facilities (DSHS)Scott SchalchlinInterim Assistant Commissioner(DADS)Mike MaplesDeputy Commissioner MH/SA Program Services (DSHS)Lilani Muthali, MDMedical Director – State Supported Living Centers (DADS)Nina Jo Muse, MDPsychiatric Advisory for Mental Health, State Hospitals Section (DSHS)Jay Norwood, MSN, RNNursing Director, State Hospitals Sections (DSHS)Valerie Kipfer, MSN, RNNursing Services Coordinator, State Supported Living Centers (DADS)

DSHS/DADS DRUG FORMULARY EDITORSharon M. Tramonte, PharmD

San Antonio State Supported Living Center

Debra Gregg, RPh, MBASan Antonio State Hospital

Table of Contents Texas Health and Human Services Commission.....................................................1

Procedure for Addition of Drugs to the Formulary 10

Psychotropic Dosage Guidelines 11 Children and Adolescent Treatment of Behavioral Emergencies Intramuscular Short-Acting Agents.........................................................................................................12Adult Treatment of Behavioral Emergencies Intramuscular Short-Acting Agents. .13Antipsychotics........................................................................................................14Antidepressants.....................................................................................................16Mood Stabilizers....................................................................................................18Stimulants..............................................................................................................19Miscellaneous Drugs Used for Psychotropic Purposes.........................................19Anxiolytics..............................................................................................................21Sedatives and Hypnotics.......................................................................................22

Reserve Drugs 23

Therapeutic Serum Concentrations of Some Anticonvulsants 25

Alphabetical Listing 26

Therapeutic Classification/Cost Index 79

Antidiabetic Agents 79 Insulins, Human.........................................................................................79Sulfonylureas.............................................................................................79Miscellaneous Antidiabetics.......................................................................79Glucose Elevating Agents..........................................................................79

Antidotes/Deterrents/Poison Control Agents 80

Antihistamines 80

Antineoplastic Agents 81

Blood Modifying Agents 81 Antiplatelet.................................................................................................81Anticoagulant.............................................................................................81Anticoagulation Antagonist........................................................................81Miscellaneous Blood Modifying Agents.....................................................81

Cardiovascular Agents 81 Diuretics.....................................................................................................81Cardiac Glycosides....................................................................................82Antianginals...............................................................................................82

DSHS/DADS Drug Formulary 2014 page 6Procedure for Addition of Drugs to the Formulary

Antiarrhythmics..........................................................................................82Calcium Channel Blockers.........................................................................82Beta-Adrenergic Blockers..........................................................................83Antihyperlipidemics....................................................................................83Angiotensin Converting Enzyme Inhibitors................................................83Vasopressors.............................................................................................83Miscellaneous Antihypertensives...............................................................83Miscellaneous Cardiovasculars.................................................................84

Central Nervous System Agents 84 Analgesics.................................................................................................84Antiemetic/Antivertigo Agents....................................................................84Miscellaneous Agents................................................................................85Psychotropic Agents..................................................................................85Sedatives and Hypnotics...........................................................................87Anticonvulsants..........................................................................................88Muscle Relaxants......................................................................................88AntiParkinson Agents................................................................................89Agents for Migraine....................................................................................89Dementia Agents.......................................................................................89

Endocrine Agents 90 Estrogens...................................................................................................90Progesterones...........................................................................................90Combination Products...............................................................................90Androgens.................................................................................................90Adrenal Cortical Steroids...........................................................................90Thyroid Agents...........................................................................................90Miscellaneous Endocrine Agents...............................................................91

Gastrointestinal Agents 91 Antacids.....................................................................................................91Antispasmodics/Anticholinergic Agents.....................................................91Histamine (H2) Antagonists........................................................................91Proton Pump Inhibitors..............................................................................92Antiflatulents..............................................................................................92Stimulants..................................................................................................92Laxatives....................................................................................................92Antidiarrheals.............................................................................................93Rectal Agents............................................................................................93Miscellaneous Gastrointestinal Agents......................................................93

Genitourinary Agents 93 Interstitial Cystitis Agents...........................................................................93Genitourinary Irrigants...............................................................................93Medications for BPH..................................................................................94Urinary Alkalinizers....................................................................................94Urinary Anticholinergics.............................................................................94


Urinary Cholinergics..................................................................................94Vaginal Antifungals....................................................................................94Miscellaneous Genitourinary Agents.........................................................94

Immunological Agents 94 Immune Serums........................................................................................94Bacterial Vaccines.....................................................................................95Viral Vaccines............................................................................................95Toxoids......................................................................................................95In-Vivo Diagnostic Biologicals....................................................................95

Infectious Disease Agents 95 Antibiotics..................................................................................................95Antifungals.................................................................................................96Antituberculars...........................................................................................97Antivirals....................................................................................................97Antihelmintics.............................................................................................97Urinary Anti-Infectives................................................................................97Miscellaneous Anti-Infectives.....................................................................97

Intravenous Solutions and Additives 98 Intravenous Solutions................................................................................98Electrolyte Replacement Additives............................................................98

Nutritional Agents 99 Vitamins.....................................................................................................99Minerals, Trace Elements, and Electrolytes...............................................99Combination Products...............................................................................99

Osteoporosis Agents 100

Respiratory Agents 100 Bronchodilators..........................................................................................100Bronchodilators, Combination/Short Acting...............................................100Bronchodilators, Combination Steroid + Long Acting Beta-2 agonists......100Cough, Cold and Decongestant Preparations...........................................101Expectorants..............................................................................................101Steroids......................................................................................................101Miscellaneous Respiratory Drugs..............................................................101

Topical Agents 102 Ophthalmics...............................................................................................102Otics...........................................................................................................103Nasal, Mouth and Throat Agents...............................................................103Dermatologicals.........................................................................................104Irrigation Solutions.....................................................................................107


Nutritional Supplements* 108

Alphabetical Index 109

Appendix 1: New Drug Application Form 121

Appendix 2: Executive Formulary Committee Conflict of Interest Policy 123

Appendix 3: Non-Formulary Drug Justification Form 126

Appendix 4: Adverse Drug Reaction Reporting (MedWatch) Form 127

Appendix 5: Foods Containing Tyramine 129


PROCEDURE FOR ADDITION OF DRUGS TO THE FORMULARY

A physician, dentist, nurse or pharmacist desiring that a new drug be added to the Formulary should submit a new drug application (Form DF-1) to the facility's formulary committee. If approved, the new drug application should be forwarded to the Executive Formulary Committee. The following information should accompany the application:

(1) published articles in the biomedical literature that substantiate the efficacy and safety of the proposed new drug;

(2) advantages of the proposed new drug compared with similar therapeutic agents presently in the Formulary;

(3) drugs in the Formulary which the proposed agent will replace or supplement;

(4) cost effectiveness data.

New drug applications should be received by the secretary of the committee thirty days prior to the committee's scheduled meeting date. Applications received after this time will be considered at the next meeting.

The chairperson will assign a committee member to present an objective treatise and recommendations concerning the proposed to new drug to the Executive Formulary Committee. The committee may decide to approve or deny the drug's inclusion, approve the drug on a trial basis, or postpone a decision until the following meeting of the committee. The committee, at its discretion, may approve a drug's inclusion in the Formulary subject to specific limitations (e.g., recommendation by qualified specialists or consultants) or as a reserve drug.

The specific limitations or guidelines for use of a reserve drug are stated in the formulary. A credentialed clinician may prescribe reserve drugs outside Formulary guidelines; however, such exceptions must be justified in the patient record and must be reviewed in routine facility audits of reserve drug utilization.


PSYCHOTROPIC DOSAGE GUIDELINES

The following is a list of psychotropic drug dosages. These guidelines are not intended to establish rigid standards of treatment but to assist in monitoring the pharmacotherapy of the patient. Furthermore, guidelines for special patient populations are not intended to be absolute. For those medications that have a well-established therapeutic serum range, the dosage should be based upon the desired serum range and response rather than a specific maximum administered daily dosage. These guidelines should be used in conjunction with sound clinical judgment and the prescriber’s experience.

In children and adolescents, metabolic and physiologic differences from adults should be considered when prescribing. Dosing based on body weight may be more accurate when treating these patients.

Different dosage requirements are usually necessary in the geriatric population. Since there is no standard definition for “geriatric”, the arbitrary age of 65 has been chosen to identify geriatric patients. In general, geriatric patient dosing guidelines should reflect a “go low, go slow” approach. Standard reference books should be consulted if needed for appropriate dosages when treating this population.

In general, when treating patients with developmental disabilities, a “go low, go slow” approach is recommended when increasing or decreasing psychotropic medication. The use of psychotropic medication can be therapeutic and empowering for a person with both developmental disabilities and mental illness. The primary goal is to obtain an accurate diagnosis of behavioral and psychiatric symptoms so that the patients’ treatment is appropriate. A functional analysis by a psychologist is vital prior to starting any psychotropic medication except in an emergency.

Prescribing psychotropic medication should be based on the following resources:

The Department of State Health Services rule governing prescribing of psychoactive medications (Texas Administrative Code, Title 25, Part 1, Chapter 415, Subchapter A)

Other useful resources that reflect current Standards of Care for the mentally ill include but are not limited to the following:

APA Practice Guidelines

Texas Dept of Family and Protective Services: Psychotropic Medication Utilization Parameters for Foster Children

Revised 18 October 2013

DSHS/DADS Drug Formulary 2014 page 11Psychotropic Dosage Guidelines

CHILDREN AND ADOLESCENT TREATMENT OF BEHAVIORAL EMERGENCIES

INTRAMUSCULAR SHORT-ACTING AGENTS

The following doses are for recommendation only and were obtained from a survey of use that was completed by practitioners that treat this population within our agency. These doses are not based on any literature support unless otherwise indicated and are to be used for general guidelines.

Children (< 12 y/o)

Drug Maximum Single dose (mg)

Minimum Interval (hrs)

Maximum Total Dose per day

(mg)Aripiprazole 4.875 - 9.75

(older)4 to 8 19.5

Chlorpromazine 25 – 50 6 to 8 75^*Diphenhydramine 25 – 50 4 to 6 50-150Haloperidol 2.5 – 5 4 to 6 10Hydroxyzine 25 – 50 4 to 6 150LORazepam 1 – 2 4 to 8 4 -6OLANZapine 5 – 10 4 to 6 15Ziprasidone 10 4 to 6 20

Adolescent (12 y/o to < 18 y/o)

Drug Maximum Single dose (mg)

Minimum Interval (hrs)

Maximum Total Dose per day

(mg)Aripiprazole 9.75 4 to 8 19.5Chlorpromazine 25 – 50 4 to 6 150*Diphenhydramine 50 – 100 4 to 6 200Fluphenazine 2 6 to 8 10Haloperidol 5 4 to 6 20Hydroxyzine 50 – 100 4 to 6 200LORazepam 2 4 to 8 8OLANZapine 10 4 to 6 20Ziprasidone 10 – 20 4 to 6 40

^ Lexicomp® Online (accessed 10-8-13)* Diphenhydramine use in behavioral emergencies is not supported in the literature

and there is a high rate of paradoxical reactions in this population

Tables added 5 February 2009Reviewed 18 October 2013


ADULT TREATMENT OF BEHAVIORAL EMERGENCIES INTRAMUSCULAR SHORT-ACTING

AGENTS

DRUGMAXIMUM

SINGLE DOSE (MG)

MINIMUM INTERVAL (HRS)

MAXIMUM TOTAL DOSE

PER DAY (MG)IM Aripiprazole1 15 2 30IM Chlorpromazine2 100* 2 400IM Diphenhydramine3-4 100 1 400IM Fluphenazine4-5 10 1 10^IM Haloperidol2 10 1 40IM Hydroxyzine3 100 1 400IM LORazepam2,6 4 1 12IM OLANZapine7 10 2 30IM Ziprasidone8 10 2 40

20 4 40*Initial dose is not recommended to be greater than 50mg if tolerability is unknown^ Use doses exceeding 10 mg daily with caution

1. Product Information: Abilify®, aripiprazole injection. Bristol-Myers Squibb, Princeton, NJ, 2013.

2. Allen MH, Currier GW, Carpenter D, et al. Treatment of Behavioral Emergencies Expert Consensus Guideline Series. Journal of Psychiatric Practice 2005;11 [Suppl 1]:1-108.

3. Lexicomp® Online (accessed 10-8-13)4. Micro-Medex® [intranet database]. Version 2.0. Thomson Reuters.5. Product Information: Fluphenazine hydrochloride injection. App Pharmaceuticals

LCC, Schaumburg, IL, 2010.6. Lukens TW, Wolf SJ, Edlow JA, et al. Clinical Policy: Critical Issues in the

Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department. From the American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department. Ann Emerg Med 2006;47:79-99.

7. Product Information: Zyprexa®, olanzapine intramuscular injection. Eli Lilly and Company, Indianapolis, IN, USA, 2010.

8. Product Information: GEODON® ziprasidone mesylate IM injection. Pfizer,Inc, New York, NY, 2013.

Table updated 18 October 2013


ANTIPSYCHOTICS

Suggested Maximum Dose (mg/day)*

Drug Adult Child (< 12 y/o)


ARIPiprazole (Abilify)

ARIPiprazole Maintena (Abilify Maintena)

30

400

15 30

Asenapine (Saphris) 20 ID ID

chlorproMAZINE (Thorazine) 2,000 500 (≤ 45.5 kg) 800 (>45.5kg)

cloZAPine5 (Clozaril, Fazaclo) - RESERVE USE

900 300 (Lit) 600 (Lit)

fluPHENAZine1 (oral) (Prolixin)

fluPHENAZine Decanoate1 (Prolixin Decanoate)

60

400 per 4 weeks

Haloperidol2 (oral) (Haldol)

Haloperidol Decanoate2 (Haldol Decanoate)

40

450 per month

0.15 mg/kg (Lit) 15 (Lit)

Iloperidone (Fanapt) RESERVE USE 24 ID IDLoxapine (Loxitane) 250Lurasidone (Latuda) 160 ID IDOLANZapine (zyPREXA) 30 12.5 (Lit) 20 (Lit)

OLANZapine pamoate (zyPREXA Relprevv) RESERVE USE

300 per 2 weeks

405 per 4 weeks

Paliperidone (Invega)

Paliperidone palmitate (Invega Sustenna)

12

234 per 4 weeks

ID 6 (<51kg)12 (≥51kg)

(Lit)

Perphenazine (Trilafon) 64 ID 64 (Lit)

QUEtiapine (SEROquel) 800400 (≤ 9 y/o)800 (10-12)

(Lit)800 (Lit)

risperiDONE (RisperDAL, RisperDAL M-Tab)RisperDAL Consta

84

50 per 2 weeks

3 (Lit) 6

Thioridazine (Mellaril)3- RESERVE USE(ABSOLUTE)

800Thiothixene (Navane) 60Trifluoperazine (Stelazine) 40

Ziprasidone (Geodon) 240806 (≤45kg)

407

(Lit)

1606 (>45kg)407

(Lit)*except where noted. If therapeutic concentrations are not listed, then those drugs do not have an established range.1 Fluphenazine Therapeutic Concentration = 1 - 3 ng/mL 6Bipolar Disorder


2 Haloperidol Therapeutic Concentration = 3 - 15 ng/mL 7Tourette’s Disorder3 A boxed warning has been added to advise clinicians of prolongation of the QTc interval

ID – insufficient data

4 Risperidone doses >6 mg/day have increased risk of EPS Lit – Literature Support5 Clozapine Therapeutic Concentration > 350ng/ml Revised 18 Oct 2013


ANTIDEPRESSANTSSuggested Maximum Dose (mg/day)

Drug Adult Child (< 12 y/o) Adolescent (12 y/o to < 18 y/o)

Amitriptyline (Elavil) 3006

Amoxapine (Asendin) 600buPROPion (Wellbutrin)

buPROPion SR (Wellbutrin SR)

buPROPion XL (Wellbutrin XL)

450(with no single dose > 150)

400(with no single dose > 200)

450

Lesser of 6 mg/kg or 300 (Lit) 4

Lesser of 6 mg/kg or 300 (Lit) 4

400 (Lit) 4

450 (Lit) 4

Citalopram** (celeXA) 40 40 (Lit) 40 (Lit)clomiPRAMINE (Anafranil) 250Desipramine (Norpramin) 300*1

Doxepin (SINEquan) 3007

DULoxetine (Cymbalta) 120 ID 60 (Lit)Escitalopram (Lexapro) 20 20 (Lit) 30 (Lit)FLUoxetine** (PROzac) 80 60 (Lit) 60fluvoxaMINE (Luvox) 300 200 300Imipramine (Tofranil) 300*2 Lesser of 4 mg/kg or

200 (Lit) 4Lesser of 4 mg/kg or

200 (Lit) 4

Maprotiline (Ludiomil) 225Mirtazapine (Remeron) 45Nortriptyline (Pamelor, Aventyl) 150*3 Lesser of 2 mg/kg or

100 (Lit) 4Lesser of 2 mg/kg or

100 (Lit) 4

PARoxetine (Paxil) 60 Not recommended 40 (Lit)Phenelzine (Nardil) 90Protriptyline (Vivactil) - Non-formulary 60Sertraline** (Zoloft) 200 200 (Lit) 200Tranylcypromine (Parnate) 60traZODone (Desyrel) 600 ID 100 (Lit) 5

Trimipramine (Surmontil) 300Venlafaxine (Effexor)Venlafaxine XR (Effexor XR)

375 150 (Lit) 375 (Lit)

*Plasma concentration monitoring is recommended if these doses are exceeded.**Dose varies with diagnosis.1Desipramine Therapeutic = 100-300 ng/mL 5 For sedative hypnotic2Imipramine Therapeutic Concentration = 150-250 ng/mL

6Amitriptyline Therapeutic Conc. = 120-250 ng/mL

3Nortriptyline Therapeutic Concentration = 50-150 ng/mL 7Doxepin Therapeutic Concentration = 150 ng/mL

4 For ADHD Lit – Literature Support


ID = Insufficient data to suggest support regarding its efficacy or to provide maximum dose guidelines in this patient group. Revised 18 October 2013


MOOD STABILIZERSSuggested Maximum Dose (mg/day)*

Drug Therapeutic Serum

ConcentrationAdult

Child (< 12 y/o)


carBAMazepine (TEGretol, TEGretol XR, Carbatrol)

4 - 12 mcg/mLAdol – Max 12 mcg/ml

1,600

35 mg/kg (<6)

800 mg (6-12 mcg/ml)

#1,000 (12-15)1,200 (>15)

lamoTRIgine (laMICtal) nd

With VPA 100

Mono-therapy 200

With EIAED 400

With VPA 1-3 mg/kg

With VPA & EIAED 1-5 mg/kg

Mono-therapy 4.5 – 7.5 mg/kg

With EIAED 5 – 15 mg/kg

With VPA 200 With VPA &

EIAED 400 Monotherapy

375 With EIAED 500

Lithium (Lithobid, Eskalith)

Adult – 0.6-1.5 mEq/L

Elderly – 0.6-1.0 mEq/L

Child – 0.6 mEq/L

Adol – Max 1.2 mEq/L

3,600 (<65 years old)

1,800 (65 years old)

#(0.6–1.2 mEq/L)

(Lit)

#1800

(0.6-1.2 mEq/L)(Lit)

OXcarbazepine (Trileptal) nd 2,400

60 mg/kg or 1500(Lit)

60 mg/kg or 2100(Lit)

Valproic Acid/Valproate (Depakene), Divalproex (Depakote) Divalproex ER

50 - 125 mcg/mL

Adol – Max 125 mcg/ml (Lit)

Depakote ER85-125

60 mg/kg

20 mg/kg(<10 years

old)

60mg/kg (≥10 years

old) #

60mg/kg#

* Plasma concentration monitoring is recommended if these doses are exceedednd = not yet determined# - Maximum daily dose typically determined by drug serum concentration and individual patient tolerability.Lit – Literature supportEIAED – Enzyme inducing anti-epileptic drugs (e.g., carbamazepine, phenobarbital, phenytoin, primidone)VPA – valproic acid/valproateRevised 18 October 2013


STIMULANTSSuggested Maximum Dose

(mg/day)Drug Adult Child (< 12 y/o) Adolescent (12

y/o to < 18 y/o)Amphetamine Mixture (Adderall, Adderall XR) 60 40

30 (XR)40

30 (XR)Dextroamphetamine (Dexedrine) 60 40 40

Methylphenidate) Methylphenidate, immediate release (Ritalin, Methylin, MetadateMethylphenidate, sustained release (Ritalin SR, Concerta, Metadate CD

60

72 (Concerta)

60Concerta – 2 mg/kg (not to

exceed 54 mg/day)

60Concerta – 2 mg/kg (not to exceed 108

mg/day)(Lit)


MISCELLANEOUS DRUGS USED FOR PSYCHOTROPIC PURPOSES

Suggested Maximum Dose(mg/day)

Drug Adult Child (< 12 y/o) Adolescent (12 y/o to < 18 y/o)

Atomoxetine (Strattera) 1001.4mg/kg (≤70kg)

100 (>70kg)

1.4mg/kg (≤70kg)

100 (>70kg)

cloNIDine (Catapres) 0.40.2 (27-40.5kg)0.3 (40.5-45kg)

# (Lit)

0.4 (>45kg)# (Lit)

cloNIDine Extended Release (Kapvay) NON-FORMULARY

0.4 0.4* 0.4

guanFACINE (Tenex) 42 (27-40.5kg)3 (40.5-45kg)

# (Lit)

4 (>45kg)# (Lit)

guanFACINE Extended Release (Intuniv) NON-FORMULARY

44* 4

Naltrexone (ReVia) 200

Propranolol (Inderal) 160 (anxiety)***

*** Maximum dose has not been determined for aggression or self-injurious behavior (SIB).# For ADHD* Not studied in children < 6 years oldLit – Literature support


ANXIOLYTICSSuggested Maximum Dose

(mg/day)Drug Under 65 years

(mg/day)Over 65 years

(mg/day)

ALPRAZolam (Xanax)

(exception: for panic disorder)

4

10

2

N/A

busPIRone (BuSpar) 60 60

ChlordiazePOXIDE1 (Librium) 100* 40*

clonazePAM (KlonoPIN) 4^ 4^

Clorazepate1 (Tranxene) 60 30

Diazepam1 (Valium) 60 20

LORazepam (Ativan) 10* 3*

Oxazepam (Serax) 90 60*Larger doses may be necessary in some cases of alcohol/substance withdrawal.1 Long acting benzodiazepines are not recommended in the geriatric population.^ doses up to 20 mg have been used to treat seizure disordersReviewed 18 October 2013


SEDATIVES AND HYPNOTICSSuggested Maximum Dose

(mg/day)Drug Under 65

years(mg/day)

Over 65 years

(mg/day)

Child (< 12 y/o) Adolescent (12 y/o to < 18

y/o)

Chloral Hydrate (Noctec) 1,500* 1,500* #Lesser of 100 mg/kg or 2 g

#Lesser of 100 mg/kg or 2 g

diphenhydrAMINE (Benadryl) 300 300

1 mg/kg up to max of 50

50 mg per dose up to a max 300 mg/day

hydrOXYzine (Atarax, Vistaril) 400 300

25 (3-6 y/o)50 (6-12 y/o)

(Lit)

100 (>12 y/o)(Lit)

Temazepam (Restoril) 30 15traZODone (Desyrel) 200 150 ID 100 (Lit)

Triazolam (Halcion)(Conscious sedation dosing)

0.25

(0.5)

0.125

(0.25)Zaleplon (Sonata) 10 5 NR NR

Zolpidem (Ambien)10 (Males)

5 (Females)5

NRNR

* Individual dose usually 500 mg but doses up to 1 gram may be used to produce conscious sedation for certain procedures

# For pre-procedure sedation onlyNR – Not RecommendedND – No Maximum Dose Established

Reviewed 18 October 2013


RESERVE DRUGS

The purpose of the reserve drug class is to stimulate thought and promote care in prescribing. Discussions and interaction with other prescribers is strongly encouraged. When reserve status drugs are utilized, documentation of justification in the patient’s progress notes is mandated. To assist the prescriber, specific guidelines have been developed by the Executive Formulary Committee for use of each drug so classified. The guidelines will be used to audit the appropriate use of reserve drugs. Based on the audit results, continuing education will be developed and targeted as needed.

Drug Guidelines for UseAtovaquone (Mepron) Patients needing PCP treatment/prophylaxis that cannot

tolerate cotrimoxazole or dapsone.Betamethasone dipropionate, augmented (Diprolene A/F)

To be used under the direction of a dermatologist

Clobetasol (Temovate) To be used under the direction of a dermatologistClopidogrel (Plavix) Documented sensitivity to aspirincloZAPine (Clozaril, Fazaclo) 1) For use in patients with refractory schizophrenia or

schizoaffective disorder [defined as failure on two antipsychotics from two different chemical families given for sufficient time (6-12 weeks) at a sufficient dose (1,000 mg/day of chlorpromazine equivalents); or

2) For use in schizophrenic or schizoaffective patients who cannot tolerate other antipsychotics; or

3) Psychosis associated with other organic conditions who have failed two antipsychotics or who cannot tolerate other antipsychotics; or

4) Manic disorders with psychosis in patients who have failed two antipsychotics

5) Reduction in the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective

cycloSERINE (Seromycin) When recommended by a consultant physician or prescribed by an infectious disease specialist at TCID.

Drug Guidelines for UseEpoetin alfa (Epogen, Procrit) When recommended by a consultant physician or prescribed

by an infectious disease specialist at TCID.Esomeprazole (NexIUM) Patients who have Medicare Part D coverage for

esomeprazoleFelbamate (Felbatol) Weekly progress note by physician monitoring for response

and adverse effects for at least two weeks following initiation of therapy

Iloperidone (Fanapt) 1) For use in patients that have failed on two antipsychotics given for a sufficient time; or

For patients who cannot tolerate other antipsychotics due to akathisia

Linezolid (Zyvox) Patients at TCID or in consultation with an expert in infectious disease.

Lisdexamfetamine 1) Continued therapy on admission; or

DSHS/DADS Drug Formulary 2014 page 23Reserve Drugs

dimesylate (Vyvanse) 2) Failed other stimulants.Nabumetone (Relafen) For the treatment of chronic osteoarthritis or chronic

rheumatoid arthritisOLANZapine pamoate (zyPREXA Relprevv)

1) Written approval by the Hospital Clinical Director and the local mental health authority clinical director prior to initiation of therapy with olanzapine pamoate2) Compliance with the Risk Evaluation and Mitigation Strategy (REMS)

Olmesartan (Benicar) Prior failure to ACE inhibitor therapy due to intolerable side effects

Ophthalmic agents containing a steroid

Consultation with an Ophthalmologist or Therapeutic Optometrist prior to initiation.

Pentamidine (Pentam) 1) Prophylaxis post-treatment of documented Pneumocystis carinii pneumonia; or

2) Prophylaxis of Pneumocystis carinii in patients with CD 4 counts of less than 200

Thioridazine (Mellaril) 1) Indicated only for patients with refractory schizophrenia (failed other classes of antipsychotics)

2) EKG prior to initiating therapy: 7 – 14 days after dose change; 7 – 14 days after other medication changes that could significantly alter the cardiac effects of Thioridazine; every six months; and as clinically indicated

3) Potassium level prior to initiating therapy; every six months; and as clinically indicated

4) Magnesium level prior to initiating therapy; and as clinically indicated (especially if potassium level is low)

TiZANidine (Zanaflex) 1) Documented failure or intolerance to baclofen2) Liver enzymes obtained at baseline, 1, 3, and 6 months

and at least annually3) Documentation of efficacy after one month of therapy4) The dose should be decreased in severe renal dysfunction

(CrCl <25 mL/min)Valsartan (Diovan) Prior failure to ACE inhibitor therapy due to intolerable side

effects

DSHS/DADS Drug Formulary 2014 page 24Reserve Drugs

THERAPEUTIC SERUM CONCENTRATIONS OF SOME ANTICONVULSANTS

Drug (mcg/mL)carBAMazepine (TEGretol, TEGretol XR,

Carbatrol 4-12

Ethosuximide (Zarontin) 40-100PHENobarbital (Luminal) 15-40

Phenytoin (Dilantin) 10-20

Valproic Acid, Valproate, Divalproex (Depakene, Depakote) Divalproex ER

Seizure Disorder: 50-100Bipolar Disorder: 50-125

Aggression: not established

Depakote ERSeizure Disorder: 50-100Bipolar Disorder: 85-125

Serum concentrations are useful in the evaluation of therapy. However, they should only be considered as a guide to treatment, not the sole criterion for determination of dosage regimens.

The following anticonvulsants do not have an established therapeutic serum concentration range. Routine monitoring of these anticonvulsants is not warranted as serum concentrations cannot be correlated with clinical efficacy.

BenzodiazepinesGabapentinLamotrigineleVETIRAcetamOxcarbazepineTiagabineTopiramateZonisamide

*Source: Lexicomp® Online (accessed 10-16-13)

Reviewed 18 October 2013

DSHS/DADS Drug Formulary 2014 page 25Anticonvulsant Serum Concentrations

ALPHABETICAL LISTING

Abrasive Cleanser (Brasivol, Pernox, Salac, Seba-Nil)Cleanser:Lotion:

Acamprosate (Campral)Tablet, delayed release: 333 mg

(Tylenol)Capsule: 500 mgLiquid: 160 mg/5 mLSuppository, rectal: 120 mg, 125 mg, 325 mg, 650 mgTablet: 325 mg, 500 mgTablet, chewable: 80 mg

Acetaminophen/Codeine C-IIILiquid, oral: Acetaminophen 120 mg/Codeine 12 mg per 5 mL (C-V)Tablet: #2: Acetaminophen 300 mg/Codeine 15 mg

#3: Acetaminophen 300 mg/Codeine 30 mg

Acetaminophen/Hydrocodone (Lortab, Vicodin, Vicodin ES) C-IIIElixir: Acetaminophen 167 mg/Hydrocodone 2.5 mg per 5 mL with 7% alcohol Tablet: Acetaminophen 300 mg/Hydrocodone 5 mg

Acetaminophen 300 mg/Hydrocodone 7.5 mgAcetaminophen 300 mg/Hydrocodone 10mgAcetaminophen 325 mg/Hydrocodone 5 mg

Acetaminophen 325 mg/Hydrocodone 10 mg Acetaminophen 500 mg/Hydrocodone 2.5 mg Acetaminophen 500 mg/Hydrocodone 5 mg Acetaminophen 500 mg/Hydrocodone 7.5 mg Acetaminophen 500 mg/Hydrocodone 10 mg Acetaminophen 750 mg/Hydrocodone 7.5 mg

acetaZOLAMIDE (Diamox)Capsule, sustained release: 500 mgTablet: 125 mg, 250 mg

Acetic Acid (Acetasol, VoSol)Solution, otic: 2%

Acetic Acid/Aluminum Acetate (Domeboro Otic)Solution, otic: 2% acetic acid in aluminum acetate

DSHS/DADS Drug Formulary 2014 page 26Alphabetical Listing

Acetic Acid/Hydrocortisone/Propylene Glycol/Sodium Acetate/Benzethonium (VoSol HC)

Solution, otic: 1% Hydrocortisone, 2% Acetic Acid, 3% Propylene Glycol, 0.015% Sodium Acetate, and 0.02% Benzethonium

Acetylcysteine (Mucomyst)Solution, inhalation: 10% [100 mg/mL], 20% [200 mg/mL]

Activated CharcoalCapsules: 200 mg, 260 mgLiquid, oral, activated, with sorbitol: 25 g, 30 g, 50 gPowder for oral suspension, activated: 15 g, 30 g, 40 g, 120 g, 240 g Tablet: 260mg

Acyclovir (Zovirax)Capsule: 200 mgCream: 0.5%Powder for injection: 500 mg, 1000 mgOintment, topical 5% [50 mg/g]: 3 gm, 15 gmSuspension, oral: 200 mg/5 mLTablet: 400 mg, 800 mg

Adapalene (Differin)Cream: 0.1%Gel, topical: 0.1%

Adenosine (Adenocard)Injection: 3 mg/mL

Albuterol (Proventil, Ventolin, Vospire ER)Aerosol, inhalation, chlorofluorocarbon free: 90 mcg/dose (17g) [200 doses]Solution, inhalation: 0.083% [2.5mg/3mL], 0.5% [5 mg/mL]Syrup: 2 mg/5 mL Tablet: 2 mg, 4 mgTablet, extended release: 4 mg, 8 mg

Albuterol/Ipratropium (Combivent, DuoNeb)Inhaler, oral: Albuterol 103 mcg/Ipratropium 18 mcgSolution, inhalation: 2.5mg-0.5mg/3ml

Alendronate (Fosamax)Solution, oral: 70 mg/5 mLTablet: 5 mg, 10 mg, 35 mg, 40 mg, 70 mg

Allopurinol (Zyloprim)Tablet: 100 mg, 300 mg


ALPRAZolam (Xanax, Xanax XR) C-IVTablet: 0.25 mg, 0.5 mg, 1 mg, 2 mgTablet, sustained release: 0.5 mg, 1 mg, 2 mg, 3 mg

Aluminum Chloride Hexahydrate (Drysol)Liquid

Aluminum Hydroxide (Amphojel)Capsule: 400 mgSuspension, oral: 320 mg/5 mL, 600 mg/5 mLTablet: 300 mg, 400 mg, 500 mg, 600 mg

Aluminum Hydroxide/Magnesium Trisilicate (Gaviscon)Tablet, chewable: each tablet contains Aluminum Hydroxide/Magnesium Trisilicate

Aluminum Hydroxide/Magnesium Hydroxide (Maalox)Suspension, oral: containing Aluminum Hydroxide/Magnesium Hydroxide Tablet: each tablet contains Aluminum Hydroxide/Magnesium Hydroxide

Aluminum Hydroxide/Magnesium Hydroxide/Simethicone (Mylanta, Aludrox)Liquid, oral: containing Aluminum Hydroxide/Magnesium Hydroxide/Simethicone Tablet: each tablet contains Aluminum Hydroxide/Magnesium

Hydroxide/Simethicone

Amantadine (Symmetrel)Capsule: 100 mgSyrup: 50 mg/5 mL

Amikacin (Amikin)Injection: 50 mg/mL, 250 mg/mL

Amino Acid Injection (Aminosyn)Infusion: 3.5%, 5%, 7%, 8.5%, 10%, 15%

Amino Acid Injection/Dextrose/Electrolytes (Clinimix E)Infusion: 2.75%, 4.25%, 5%

Aminophylline (79% Theophylline)Injection: 25 mg/mLSuppository, rectal: 250 mgTablet: 200 mg

Amiodarone (Pacerone, Cordarone)Tablet: 100 mg, 200 mg, 400 mg

Amitriptyline (Elavil)


Tablet: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg

Amlodipine (Norvasc)Tablet, extended release: 2.5 mg, 5 mg, 10 mg

Amoxapine (Asendin)Tablet: 25 mg, 50 mg, 100 mg, 150 mg

Amoxicillin (Amoxil, Polymox)Capsule: 250 mg, 500 mgPowder for oral suspension: 50 mg/mL, 125 mg/5 mL, 250 mg/5 mLTablet: 500 mg, 875 mgTablet, chewable: 125 mg, 250 mg

Amoxicillin/Clavulanate (Augmentin)Suspension, oral: 400mg (contains 57mg Clavulanate) per 5ml, 600mg (contains 42.9mg Clavulanate) per 5mlTablet: 200 mg (contains 28.5 mg Clavulanate)

250 mg (contains 125 mg Clavulanate) 400 mg (contains 57 mg Clavulanate) 500 mg (contains 125 mg Clavulanate) 875 mg (contains 125 mg Clavulanate)

Tablet, chewable: 125 mg (contains 31.25 mg Clavulanate) 250 mg (contains 62.5 mg Clavulanate)Tablet, extended release: 1000 mg

Amphetamine Mixture (Adderall, Adderall XR) CIICapsule, extended release: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mgTablet: 2.5 mg, 5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg

Ampicillin (Polycillin, Omnipen)Capsule, as anhydrous: 250 mg, 500 mgCapsule, as trihydrate: 250 mg, 500 mgPowder for injection: 125 mg, 250 mg, 500 mg, 1 g, 2 g, 10 gPowder for oral suspension, as trihydrate: 125 mg/5 mL, 250 mg/5 mL

Antineoplastic AgentsIn consultation with the oncologist

Antipyrine/Benzocaine (Allergen, Auralgan)Solution, otic

Antiviral AgentsUsed to treat AIDS/HIV


ARIPiprazole (Abilify, Abilify discmelt, Abilify Maintena)Injection: 9.75 mgInjection, long acting: 300 mg, 400 mgSolution, oral: 1 mg/mLTablet: 2mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mgTablet, rapid dissolving: 10 mg, 15 mg

Ascorbic Acid (Vitamin C)Solution, oral: 100 mg/mL Tablet: 250 mg, 500 mg, 1000mgTablet, chewable: 250 mg, 500 mg

Asenapine (Saphris)Tablet, sublingual: 5 mg, 10 mg

AspirinSuppository, rectal: 300 mg, 600 mgTablet: 325 mgTablet, buffered: 325 mg with buffering agentsTablet, chewable: 81 mgTablet, enteric coated: 81 mg, 162 mg, 325 mg, 500 mg, 650 mg

Aspirin/Acetaminophen/Caffeine (Excedrine Migraine)Tablet: Aspirin 250 mg/Acetaminophen 250 mg/Caffeine 65 mg

Atenolol (Tenormin)Tablet: 25 mg, 50 mg, 100 mg

Atomoxetine (Strattera)Capsule: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg

Atorvastatin (Lipitor)Tablet: 10 mg, 20 mg, 40 mg, 80 mg

Atropine Sulfate (Isopto Atropine)Ointment, ophthalmic: 1%Solution, ophthalmic: 1%

Atovaquone Mepron RESERVE USESuspension: 750 mg/5 mL

Azelastine (AstelinNasal spray: 0.1% (137 mcg/spray)


Azithromycin (Zithromax)Powder for oral solution: 200 mg/5 mL, 400 mg/5 mLTablet: 250 mg, 500 mg, 600 mg

Bacitracin (Baciguent)Injection: 50,000 unitsOintment, ophthalmic: 500 units/gOintment, topical: 500 units/g

Bacitracin/Polymyxin B (Polysporin)Ointment, ophthalmic: Bacitracin 500 units/Polymyxin B 10,000 units/gOintment, topical: Bacitracin 500 units/Polymyxin B 10,000 units/gPowder, topical: Bacitracin 500 units/Polymyxin B 10,000 units/g

Baclofen (Lioresal)Tablet: 10 mg, 20 mg

Beclomethasone, (Beconase, QVAR)Inhaler, oral: 40mcg [100 actuations], 80mcg [100 actuations]Spray, nasal: 0.084% (19 g) [120 metered doses]Spray, nasal: 40mcg/actuationSpray, nasal, aqueous: 42 mcg/inhalation (25 g) [200 metered doses], 84

mcg/inhalation (25 g) [200 metered doses]

Benazepril (Lotensin)Tablet: 5 mg, 10 mg, 20 mg, 40 mg

Benzocaine (Lanacaine, Cepacol, Oragel)Topical, for mucous membranes:

Gel: 6%, 20%Liquid: 20%

Topical, dermatalogic:Cream, topical: 5%, 6% Ointment: 5%Spray: 5%, 20%

Mouth/Throat preparations:Gel: 6.3%, 7.5%, 10%, 15%, 20%Liquid: 5%, 6.3%, 10%, 20%

Benzoin, Compound TinctureTincture, topical (also contains aloe, storax, tolu balsam, 74% to 80% alcohol): 30

mL, 60 mL, 120 mL, 480 mL, 4000 mL

Benzonatate (Tessalon Perle)Capsule: 100 mg, 200 mg


Benzoyl PeroxideBar: 5%Cream, topical: 10%Gel, topical: 2.5%, 5%, 10%Liquid, topical: 5%, 10%Lotion: 10%Pads: 9%Wash, topical: 2.5%, 4%, 5%, 10%

Benzoyl Peroxide/Clindamycin (BenzaClin)Gel, topical: Benzoyl Peroxide 5%/Clindamycin 1%

Benztropine (Cogentin)Injection: 1 mg/mLTablet: 0.5 mg, 1 mg, 2 mg

Betamethasone dipropionate (Diprolene)Cream: 0.05%Gel: 0.05%Lotion: 0.05%Ointment 0.05%

Betamethasone dipropionate, augmented (Diprolene A/F) RESERVE USECream: 0.05%Gel: 0.05%Lotion: 0.05%Ointment: 0.05%

Betamethasone Valerate (Valisone)Cream, topical: 0.01%, 0.1%Lotion: 0.1%Ointment, topical: 0.1%

Betaxolol (Betoptic S)Solution, ophthalmic: 0.5%Suspension, ophthalmic: 0.25%

Bethanechol (Urecholine)Injection: 5 mg/mLTablet: 5 mg, 10 mg, 25 mg, 50 mg

Bimatoprost (Lumigan)Solution, ophthalmic: 0.01%, 0.03%

Birth Control AgentsAny commercially available


Bisacodyl (Dulcolax)Suppository, rectal: 10 mgTablet, enteric coated: 5 mg

Bismuth Subsalicylate (Pepto-Bismol, Bismatrol, Kaopectate)Liquid, oral: 262mg/15 mLTablet, chewable: 262 mg

Brimonidine (Alphagan)Solution, ophthalmic: 0.1% 0.15%, 0.2%

Bromocriptine (Parlodel)Capsule: 5 mgTablet: 2.5 mg

Brompheniramine/Phenylephrine (Dimetapp Cold and Allergy)Liquid: 1mg Brompheniramine/2.5mg Phenylephrine per 5mL

Brompheniramine/Pseudoephedrine (Bromfed)Capsule: 12 mg Brompheniramine/120 mg PseudoephedrineElixir: 4 mg Brompheniramine/30 mg PseudoephedrineLiquid: 15mg Brompheniramine/1mg Psuedoephedrine per 5mL, 12mg

Brompheniramine/1mg Psuedoephedrine per 5mLSyrup: 2 mg Brompheniramine/30 mg PseudoephedrineTablet: 4 mg Brompheniramine/60 mg PseudoephedrineTablet, sustained release: 8mg Brompheniramine/120mg Psuedoephedrine

Budesonide (Pulmicort)Solution, inhalation: 0.25 mg, 0.5 mg, 1 mg

Budesonide/Formoterol (Symbicort)Aerosol, inhalation, oral: 160 mcg/4.5 mcg, 80 mcg/4.5 mcg

buPROPion (Budeprion, Budeprion ER Budeprion SR Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban)

Tablet: 75 mg, 100 mgTablet, sustained release: 100 mg, 150 mg, 200 mgTablet, extended release: 150 mg, 300 mg

busPIRone (BuSpar)Tablet: 5 mg, 10 mg, 15 mg, 30 mg

Calamine/Zinc Oxide/Glycerin (Calamine Lotion)Lotion, topical: 120 mL, 240 mL, 480 mL


Calamine/Pramoxine (Caladryl)Lotion, topical: 180 mL

Calcipotriene (Dovonex)Cream, topical: 0.005%Ointment, topical: 0.005%Solution, topical: 0.005%

Calcitonin-Salmon (Miacalcin)Nasal spray: 200 IU/activation

Calcium Carbonate (Os-Cal, Titralac) [40% elemental calcium]Liquid, oral: 500 mg/5 mL, 1000 mg/5 mL Tablet: 600 mg, 1250 mg, 1500 mgTablet, chewable: 350 mg, 500 mg, 550 mg, 750 mg, 850 mg, 1000 mg

Calcium Carbonate/Vitamin D (Os-Cal + D, Os-Cal chewable)Tablet: Calcium 250 mg/Vitamin D 125 IU

Calcium 315mg/Vitamin D 200IU Calcium 500 mg/Vitamin D 125 IU Calcium 600mg/Vitamin D 200IU

Tablet,chewable: Calcium 500mg/Vitamin D 600iu

Calcium Citrate (Citracal) [21% elemental calcium]Tablet: 200 mg, 250 mg, 315 mg, 950 mg

Calcium Citrate/Vitamin D (Citrical+D)Tablet: Calcium 315mg/Vitamin D 200IU Calcium 600mg/Vitamin D 200IU

Calcium Glubionate (Neo-Calglucon) [6% elemental calcium]Syrup: 1.8 g/5 mL

Calcium Gluconate [9% elemental calcium]Injection: 10% [100 mg/mL]Tablet: 500 mg, 650 mg, 975 mg, 1g

Camphor-Phenol (Campho-Phenique)Liquid, topical: 10.8% Camphor/4.7% phenol [with eucalyptus oil and mineral oil]

Captopril (Capoten)Tablet: 12.5 mg, 25 mg, 50 mg, 100 mg


carBAMazepine (TEGretol, TEGretol XR, Carbatrol)Capsule, extended release: 100 mg, 200 mg, 300 mgSuspension, oral: 100 mg/5 mLTablet: 200 mgTablet, chewable: 100 mgTablet, extended release: 100 mg, 200 mg, 400 mg

Carbamide Peroxide/Glycerin/Propylene Glycol/Sodium Stannate (Debrox, Gly-Oxide)

Gel, oral: 10% Solution, oral: 10%, 15%Solution, otic: 6.5%

Carbidopa/Levodopa (Sinemet)Tablet: Carbidopa 10 mg/Levodopa 100 mg

Carbidopa 25 mg/Levodopa 100mg Carbidopa 25 mg/Levodopa 250 mg

Tablet, Sustained release: Carbidopa 25 mg/Levodopa 100 mg Carbidopa 50 mg/Levodopa 200 mg

Carboxymethylcellulose/Electrolytes (Saliva Substitute, Moi-Stir, Salivart, MouthKote, Salix)

Solution, oral

Carvedilol (Coreg)Tablet: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg

ceFAZolin (Kefzol, Ancef)Injection: 500 mg, 1 gPowder for injection: 250 mg, 500 mg, 1 g, 5 g, 10 g, 20 g

Cefepime (Maxipime)Injection: 500 mg, 1 g, 2 g

cefTRIAxone (Rocephin)Infusion, premixed in dextrose: 1 g, 2 gPowder for injection: 250 mg, 500 mg, 1 g, 2 g, 10 g

Cefuroxime Axetil (Ceftin) - Oral form only - RESERVE USEPowder for oral suspension: 125 mg/5 mL, 250 mg/5 mLTablet: 125 mg, 250 mg, 500 mg

Cellulose (Unifiber)Powder, oral: 150 g, 270 g, 480 g


Cephalexin (Keflex)Capsule: 250 mg, 500 mgPowder for oral suspension: 100 mg/mL, 125 mg/5 mL, 250 mg/5 mL Tablet: 250 mg, 500 mg, 1 gTablet: 500 mg

Cetirizine (zyrTEC)Syrup: 1 mg/mlTablet: 5 mg, 10 mgTablet, chew: 5 mg, 10 mg

Cetirizine/Pseudoephedrine (zyrTEC D)Tablet, 12hr: 5 mg/120 mg

Chloral Hydrate (Noctec) C-IVCapsule: 500 mgSyrup: 500 mg/5 mL

ChlordiazePOXIDE (Librium) - oral form only - C-IVCapsule: 5 mg, 10 mg, 25 mg

Chlorhexidine (Peridex, Hibiclens, Bactoshield )Liquid, topical, with 4% isopropyl alcohol: 4%Rinse, oral, with 12% alcohol: 0.12%

Chlorpheniramine (Chlor-Trimeton, Teldrin)Capsule: 12 mgSyrup: 2 mg/5 mLTablet: 4 mg, 8 mg, 12 mgTablet, chewable: 2 mgTablet, timed release: 8 mg, 12 mg

chlorproMAZINE (Thorazine)Injection: 25 mg/mLTablet: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg

Chlorthalidone (Hygroton)Tablet: 15 mg, 25 mg, 50 mg, 100 mg

Cholestyramine (Questran)Powder, oral: 4 gm resin/9 gm powderPowder for oral suspension (with aspartame): 4 gm resin/5 gm powder Powder for oral suspension (with phenyalanine): 4 gm resin/5.5 gm powderTablet: 1 gm

Ciclopirox (Loprox, Penlac)Shampoo: 1%


Solution, Topical: 8%

Ciprofloxacin (Cipro, Ciloxan)Injection: 200 mg, 400 mgOintment, ophthalmic: 0.3%Solution, ophthalmic: 0.3%Suspension, oral: 5 gm/100 mL, 10 gm/100 mLTablet: 100 mg, 250 mg, 500 mg, 750 mg

Ciprofloxacin/Hydrocortisone (Cipro Otic)Solution, otic: Ciprofloxacin 2 mg/Hydrocortisone 10 mg per mL

Citalopram (celeXA)Solution, oral: 10 mg/5 mLTablet: 10 mg, 20 mg, 40 mg

Clarithromycin (Biaxin)Granules for oral suspension: 125 mg/5 mL, 250 mg/5 mLTablet, film coated: 250 mg, 500 mg

Clindamycin (Cleocin, Cleocin T)Capsule: 75 mg, 150 mg, 300 mgGel, topical: 1% [10 mg/g]Granules for oral solution: 75 mg/5 mLInjection: 150 mg/mLLotion: 1% [10 mg/mL]Solution, topical: 1% [10 mg/mL]

Clobazam (Onfi)Suspension: 2.5 mg/mLTablet: 5 mg, 10 mg, 20 mg

Clobetasol (Temovate, Cormax, Clobex) - RESERVE USECream, topical: 0.05% Cream, topical, in emollient base: 0.05%Gel, topical: 0.05%Lotion, topical: 0.05%Ointment, topical: 0.05% Solution, topical scalp application: 0.05%

clomiPRAMINE (Anafranil) Capsule: 25 mg, 50 mg, 75 mg

clonazePAM (KlonoPIN) C-IVTablet: 0.5 mg, 1 mg, 2 mgTablet, oral disintegrating: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg


cloNIDine (Catapres)Patch, transdermal: 1, 2, and 3 (0.1, 0.2, 0.3 mg/day, 7 day duration)Tablet: 0.1 mg, 0.2 mg, 0.3 mg

`Clopidogrel (Plavix) - RESERVE USE

Tablet: 75 mg

Clorazepate (Tranxene, Tranxene SD) C-IVTablet: 3.75 mg, 7.5 mg, 15 mgTablet, sustained release: 11.25 mg, 22.5 mg

Clotrimazole (Lotrimin, Mycelex, Gyne-Lotrimin, Fungoid)Cream, topical: 1%Cream, vaginal: 1%, 2%Lotion: 1%Solution, topical: 1%Suppository, vaginal: 100 mg, 200 mgTablet, vaginal: 100 mg, 500 mgTroche: 10 mg

cloZAPine (Clozaril, Fazaclo) - RESERVE USETablet: 25 mg, 50mg, 100 mg, 200mgTablet, oral disintegrating: 12.5 mg, 25 mg, 100 mg, 150 mg, 200 mg

Coal Tar (Ionil-T, Tegrin, Pentrax, Polytar)Cream, topical: 2%Liquid, topical: 30%Shampoo: 1%, 2%, 2.5%, 5%Solution, topical: 120 mL, 480 mL

Cod Liver Oil/Zinc Oxide/Talc (Desitin)Ointment, topical: 40% Zinc Oxide [with Cod Liver Oil, Talc, Petrolatum, Lanolin, and

Methylparaben]

ColchicineTablet: 0.5 mg, 0.6 mg

Collagenase (Santyl)Ointment, topical: 0.03%, 0.1%

Cromolyn (Intal)Solution, nebulizing: 10 mg/mL Solution, nasal: 40 mg/mLSolution, ophthalmic: 4%


Cyanocobalamin (Vitamin B12)Injection: 1000 mcg/mLTablet: 100 mcg, 250 mcg, 500 mcg, 1000 mcg

Cyclobenzaprine (Flexeril)Tablet: 5 mg, 10 mg

cycloSERINE (Seromycin) -`RESERVE USECapsule: 250mg

Cyproheptadine (Periactin)Syrup: 2 mg/5 mL with 5% alcoholTablet: 4 mg

Dantrolene (Dantrium)Capsule: 25 mg, 50 mg, 100 mgPowder for injection: 20 mg

DapsoneTablet: 25 mg, 100 mg

Darifenacin (Enablex)Tablet: 7.5 mg, 15mg

Deferoxamine (Desferal)Powder for injection: 500 mg

Denosumab (Prolia)Injection: 60mg

Desipramine (Norpramin,)Tablet: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg

Desmopressin (DDAVP, Stimate)Injection: 4mcg/mlSolution, nasal: 100 mcg/mL, 1.5 mg/mLTablet: 0.1 mg, 0.2 mg

Desonide (Desowen, Lokara, Tridesilon)Cream: 0.05%Lotion: 0.05%`Ointment: 0.05%


Dexamethasone (Decadron)Injection, as sodium phosphate: 4 mg/mL, 10 mg/mL, 20 mg/mL, 24 mg/mLSolution, oral: 0.5 mg/5 mLSuspension, ophthalmic: 0.1% with methylcellulose 0.5% - RESERVE USETablet: 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg

Dextroamphetamine (Dexedrine, Dexedrine spansules, Dextrostat)Capsule, sustained release: 5 mg, 10 mg, 15 mgTablet: 5 mg, 10 mg (5 mg tablet contain tartrazine)

DextromethorphanCapsule: 15 mg, 30 mgLiquid, oral: 3.5 mg/5 mL, 7.5 mg/5 mL, 10 mg/15 mL, 15 mg/5 mLLiquid, oral, sustained release: 30 mg/5 mLLozenges: 2.5 mg, 5 mg, 7.5 mg

Dextrose/Sodium Chloride Intravenous SolutionInfusion: Dextrose 5% in 0.2% Sodium ChlorideInfusion: Dextrose 5% in 0.45% Sodium ChlorideInfusion: Dextrose 5% in 0.9% Sodium Chloride

Dextrose 5%/Sodium Chloride/Potassium Chloride Intravenous SolutionInfusion: Dextrose 5%/Sodium Chloride 0.2%/Potassium Chloride

with Potassium Chloride: 10 mEq, 20 mEqInfusion: Dextrose 5%/Sodium Chloride 0.45%/Potassium Chloride

with Potassium Chloride: 10 mEq, 20 mEq, 40 mEqInfusion: Dextrose 5%/Sodium Chloride 0.9%/Potassium Chloride

with Potassium Chloride: 20 mEq, 40 mEq

Dextrose 5% in WaterInfusion

Dextrose 5% in Ringer's LactateInfusion

Dextrose 5% with Multiple Electrolytes (D5 E75, Baxter)Infusion

Dextrose 50% in WaterInfusionSyringeVials


Diaper Rash Ointment (Desitin, Diaperene, Vitamin A&D)see Cod Liver Oil/Zinc Oxide/Talc (Desitin)see Vitamin A&D Topical see Zinc Oxide/Petrolatum/Imidazolidinyl Urea (Diaperene)

Diaper Rash Powder (Mexsana)Powder: contains kaolin, eucalyptus oil, camphor, corn starch, lemon oil, zinc oxide

Diazepam (Valium, Diastat) C-IVGel, rectal: 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mgInjection: 5 mg/mLSolution, oral: 1 mg/mL, 5 mg/mL Tablet: 2 mg, 5 mg, 10 mg

Dicyclomine (Bentyl)Capsule: 10 mg, 20 mgInjection: 10 mg/mLSyrup: 10 mg/5 mLTablet: 10 mg

Digoxin (Lanoxin)Capsule: 50 mcg, 100 mcg, 200 mcgElixir: 50 mcg/mL with 10% alcohol Injection: 100 mcg/mL, 250 mcg/mLTablet: 125 mcg, 250 mcg, 500 mcg

Diltiazem (Cardizem)Capsule, sustained release:

Cardizem CD: 120 mg, 180 mg, 240 mg, 300 mgCardizem SR: 60 mg, 90 mg, 120 mgDilacor XR: 180 mg, 240 mgTiazac: 120 mg, 180 mg, 240 mg, 300 mg, 360 mg

Tablet: 30 mg, 60 mg, 90 mg, 120 mgTablet, sustained release: 120 mg, 180 mg, 240 mg

Dimercaprol (B.A.L.)Injection: 100 mg/mL

diphenhydrAMINE (Benadryl)Capsule: 25 mg, 50 mgCream, topical: 2%Injection: 50 mg/mLLiquid, oral: 12.5 mg/5 mLLotion: 1% Tablet: 25 mg, 50 mg


Diphtheria & Tetanus Toxoids Adsorbed (DT)Injection, single dose

Diphtheria & Tetanus Toxoids Adsorbed for Adult Use (Td)Injection, single dose

Diphtheria, Tetanus, & Acellular Pertussis (Tdap, Boostrix, Adacel)Injection, single dose

Disulfiram (Antabuse)Tablet: 250 mg, 500 mg

Divalproex (Depakote, Depakote ER, Divalproex ER)Capsule, sprinkles: 125 mgTablet, delayed release: 125 mg, 250 mg, 500 mgTablet, extended release: 250 mg, 500 mg - RESERVE USE

Docusate Calcium (Surfak)Capsule: 240 mg

Docusate Sodium (Colace, Doxinate)Capsule: 100 mg, 250 mgLiquid, oral: 150 mg/15 mLSyrup: 60 mg/15 mLTablet: 100 mg

Docusate Sodium/Sennosides (Peri-Colace)Tablet: Docusate 50 mg/Sennosides 8.6 mg

Donepezil (Aricept)Tablet: 5 mg, 10 mg, 23 mgTablet, oral disintegrating: 5 mg, 10 mg

DOPamine (Intropin)Infusion in D5W: 0.8 mg/mL, 1.6 mg/mL, 3.2 mg/mLInjection: 40 mg/mL, 80 mg/mL, 160 mg/mL

Doxepin (SINEquan, Zonalon)Capsule: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mgConcentrate, oral: 10 mg/mL Cream: 5%

Doxycycline (Vibramycin, Periostat)Capsule: 50 mg, 100 mgPowder for oral suspension: 25 mg/5 mL Tablet: 20 mg, 50 mg, 100 mg


DULoxetine (Cymbalta)Capsule, delayed release: 20 mg, 30 mg, 60 mg

Emollient Lotion/Cream/Gel (Lubriderm, Allercreme, Keri Lotion, Cetaphil, Lac-Hydrin, Eucerin, Nutraderm, Clinac O.C.

Cream, topicalGel, topicalLotion, topical

Emollient Ointment (Lanolin, Aquaphor)Ointment, topical

Enalapril (Vasotec)Tablet: 2.5 mg, 5 mg, 10 mg, 20 mg

Enoxaparin (Lovenox)Injection: 30 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg, 150 mg

Entacapone (Comtan)Tablet: 200 mg

EPINEPHrine (Adrenalin)Auto-injector: 1:2000 [0.15 mg], 1:1000 [0.3 mg]Injection: 1:100,000 [0.01 mg/mL], 1:10,000 [0.1 mg/mL], 1:1000 [1 mg/mL]

Epoetin alfa (Epogen, Procrit)- RESERVE USEInjection: 2,000 units/mL, 3,000 units/mL, 4,000 units/mL, 10,000 units/mL, 20,000 units/mL, 40,000 units/mL

Ergocalciferol (Calciferol, Drisdol)See Vitamin D

Erythromycin (Erythrocin)Erythromycin base(Eryc, E-Mycin, Ery-Tab, E-Base, PCE):

Capsule, delayed release: 250 mgTablet, enteric coated: 250 mg, 333 mg, 500 mgTablet, film coated: 250 mg, 500 mgTablet, polymer coated particles: 333 mg, 500 mg

Erythromycin Ethylsuccinate (EryPed, E.E.S.):Granules/Powder for oral suspension: 200 mg/5 mL, 400 mg/5 mL Suspension, oral: 200 mg/5 mL, 400 mg/5 mLSuspension, oral (drops): 100 mg/2.5 mLTablet: 400 mgTablet, chewable: 200 mg

Ointment, ophthalmic: 5%


Erythromycin/Benzoyl Peroxide (Benzamycin)Gel, topical: Erythromycin 30 mg/Benzoyl Peroxide 50 mg per gram (with 16%

alcohol)

Escitalopram (Lexapro)Solution: 5mg/5mlTablet: 5 mg, 10 mg, 20 mg

Esomeprazole (NexIUM) RESERVE USECapsule: 20 mg, 40 mgSuspension packet: 10 mg, 20 mg, 40 mg

Estradiol (Estrace, Vivelle, Alora, Climara, Estraderm, Vagifem)Cream, vaginal: 43 gmSystems, transdermal: 0.025 mg, 0.0375 mg, 0.05 mg, 0.075 mg, 0.1 mg per 24 hrTablet: 0.5 mg, 1 mg, 2 mgTablet, vaginal: 25 mg

Estrogen/medroxyPROGESTERone (PremPro, Premphase)Tablet: Conjugated estrogen 0.3 mg/medroxyPROGESTERone 1.5 mgTablet: Conjugated estrogen 0.45 mg/medroxyPROGESTERone 1.5 mgTablet: Conjugated estrogen 0.625 mg/medroxyPROGESTERone 2.5 mgTablet: Conjugated estrogen 0.625 mg/medroxyPROGESTERone 5 mg

Estrogens, Conjugated (Premarin)Cream, vaginal: 0.625 mg/gInjection: 25 mgTablet: 0.3 mg, 0.625 mg, 0.9 mg, 1.25 mg, 2.5 mg

Ethambutol (Myambutol)Tablet: 100 mg, 400 mg

Ethinyl Estradiol/Norethindrone (Loestrin, , Ortho-Novum 777)Loestrin:

1/20: Ethinyl Estradiol 0.02 mg/Norethindrone 1 mg1.5/30: Ethinyl Estradiol 0.03 mg/Norethindrone 1.5 mg

Ortho-Novum 777: Phase 1(Ethinyl Estradiol 0.035 mg/Norethindrone 0.5 mg), Phase 2 (Ethinyl Estradiol 0.035 mg/Norethindrone 0.75 mg), Phase 3 (Ethinyl Estradiol 0.035 mg/Norethindrone 1 mg)

Ethinyl Estradiol/Norgestrel (Ovral, Lo-Ovral)Lo-Ovral: Ethinyl Estradiol 0.03 mg/Norgestrel 0.3 mgOvral: Ethinyl Estradiol 0.05 mg/Norgestrel 0.5 mg

EthionamideTablet, sugar coated: 250 mg


Ethosuximide (Zarontin)Capsule: 250 mgSyrup: 250 mg/5 mL

Ethyl ChlorideSpray: 100 g, 105 mL, 120 mL, 270 mL

Famotidine (Pepcid)Injection: 10 mg/mLPowder for oral suspension: 40 mg/5 mLTablet: 10 mg, 20 mg, 40 mg

Felbamate (Felbatol) - RESERVE USESuspension, oral: 600 mg/5 mLTablet: 400 mg, 600 mg

Felodipine (Plendil)Tablet, extended release: 2.5 mg, 5 mg, 10 mg

Fenofibrate (Antara, Lofibra, Tricor, Triglide)Capsule: 50 mg, 150 mg, 160 mgCapsule, micronized: 43 mg, 67 mg, 130 mg, 134 mg, 200 mgTablet: 40 mg, 54 mg, 120 mg, 160 mgTablet: nanocrystallized: 48 mg, 50 mg, 145 mg, 160 mg

fentaNYL (Duragesic) C-IILozenge: 200 mcg, 400 mcg, 600 mcg, 800 mcgPatch, transdermal: 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr, 100 mcg/hr

Ferrous Fumarate/Docusate Sodium (Ferro-Sequels)[contains 33% elemental iron]

Tablet, timed released: Ferrous fumarate 150 mg [50 mg]/Docusate Sodium 100 mg Ferrous Sulfate (Feosol, Fer-In-Sol) [contains 20% elemental iron]

Elixir with 5% alcohol: 220 mg/5 mL [18 mg/5 mL]Tablet: 160 mg [32mg], 300 mg [60 mg], 325 mg [65 mg]

Fexofenadine (Allegra)Tablet: 30 mg, 60 mg, 180 mg

Fexofenadine/Pseudoephedrine (Allegra-D)Tablet, extended release: 60 mg Fexofenadine/120 mg Pseudoephedrine

Finasteride (Proscar)Tablet: 5 mg


Fish Oil (Nature Made Fish Oil NUTRITIONAL SUPPLEMENT)Capsules: 225 mg, 500 mg, 1000 mg 1200 mg, 1400 mg

Flavoxate (Urispas)Tablet, film coated: 100 mg

Fluconazole (Diflucan)Suspension: 40 mg/mLTablet: 100 mg, 150 mg, 200 mg, 250 mg, 500 mg

Fludrocortisone (Florinef)Tablet: 0.1 mg

Fluocinolone (Capex, Derma-Smooth/FS, Synalar)Cream, topical: 0.01%, 0.025%Oil: 0.01%Ointment, topical: 0.025%Shampoo: 0.01%Solution, topical: 0.01%

Fluocinonide (Lidex)Cream, topical: 0.05% Gel, topical: 0.05%Ointment, topical: 0.05%Solution, topical: 0.05%

Fluorescein SodiumInjection: 10%Strip, ophthalmic: 0.6 mg, 1 mg

FLUoxetine (PROzac)Capsule: 10 mg, 20 mgLiquid, oral: 20 mg/5 mLTablet: 10 mg, 20 mg

fluPHENAZine (Prolixin)Concentrate: 5 mg/mL with 14% alcoholElixir: 2.5 mg/5 mL with 14% alcohol Injection, as decanoate: 25 mg/mLInjection, as hydrochloride: 2.5 mg/mL Tablet: 1 mg, 2.5 mg, 5 mg, 10 mg

Fluticasone (Flonase, Flovent)Aerosol, inhalation, oral: 44 mcg/actuation, 110 mcg/actuation, 220 mcg/actuationInhalation, nasal: 50 mcg/actuation


Fluticasone/Salmeterol (Advair)Powder, inhalation: 100mcg fluticasone/50mcg salmeterol, 250mcg fluticasone/50mcg salmeterol, 500mcg fluticasone/50mcg salmeterol

Fluvastatin (Lescol)Capsule: 20 mg, 40 mg

fluvoxaMINE (Luvox)Tablet: 25 mg, 50 mg, 100 mg

Folic Acid (Folvite)Tablet: 0.4 mg, 0.8 mg, 1 mg

Fondaparinux (Arixtra)Injection: 2.5 mg, 5 mg, 7.5 mg, 10 mg

Fosphenytoin (Cerebyx)Injection: 100 Phenytoin Equivalents [PE]/2 mL, 500 PE/10 mL

Furosemide (Lasix)Injection: 10 mg/mLSolution, oral: 10 mg/mL, 40 mg/5 mLTablet: 20 mg, 40 mg, 80 mg

Gabapentin (Neurontin)Capsule: 100 mg, 300 mg, 400 mgSolution, oral: 250 mg/5 mLTablet: 400 mg, 600 mg, 800 mg

Galantamine (Razadyne)Capsule, 24hr: 8 mg, 16 mg, 24 mgSolution, oral: 4 mg/mLTablet, film coated: 4 mg, 8 mg, 12 mg

Gemfibrozil (Lopid)Tablet, film coated: 600 mg

Gentamicin (Garamycin)Cream, topical: 0.1%Infusion, premixed in D5W: 60 mg, 80 mg, 100 mgInfusion, premixed in NS: 40 mg, 60 mg, 80 gm, 90 mg, 100 mg, 120 mgInjection: 10 mg/mL, 40 mg/mLInjection, intrathecal (preservative free): 2 mg/mLOintment, ophthalmic: 0.3% [3 mg/g]Ointment, topical: 0.1%Solution, ophthalmic: 0.3% [3 mg/mL]


glipiZIDE (Glucotrol)Tablet: 5 mg, 10 mgTablet, extended release: 2.5 mg, 5 mg, 10 mg

Glucosamine NUTRITIONAL SUPPLEMENTCapsule: 500 mg, 1000 mgTablet: 500 mg, 1000 mg, 1500 mg

GlucagonPowder for injection: 1 mg

GlucoseGel, oralTablet

glyBURIDE (Micronase, DiaBeta)Tablet: 1.25 mg, 2.5 mg, 5 mgTablet, micronized: 1.5 mg, 3 mg, 6 mg

Glycerin (Sani-Supp)Suppository, rectal

Glycopyrrolate (Robinul)Tablet: 1 mg

Griseofulvin (Fulvicin)Microsize:

Capsule: 125 mg, 250 mgSuspension, oral: 125 mg/5 mL with 0.2% alcohol Tablet: 250 mg, 500 mg

Ultramicrosize:Tablet: 125 mg, 165 mg, 250 mg, 330 mg

guaiFENesin (Robitussin Mucinex)Caplet, sustained release: 600 mgLiquid, oral: 100 mg/5 mL, 200 mg/5 mLTablet: 100 mg, 200 mg, 400mgTablet, sustained release: 600 mg

guaiFENesin/Codeine (Robitussin AC) C-VSyrup: 100mg guaiFENesin/10mg codeine per 5mL


guaiFENesin/Dextromethorphan (Robitussin DM)Liquid, oral: guaiFENesin 100 mg/Dextromethorphan 10 mg per 5 mL,

guaiFENesin 100mg/Dextromethorphan 15mg per 5mL, guaiFENesin 66.7mg/Dextromethorphan 6.7mg per 5mL

Tablet, sustained release: guaiFENesin 300 mg/Dextromethorphan 30 mg

guaiFENesin/Pseudoephedrine (Mucinex D)Tablet: guaiFENesin 600 mg/Pseudoephedrine 60 mg

guanFACINE (Tenex)Tablet: 1 mg, 2 mg

Haloperidol (Haldol)Concentrate, oral: 2 mg/mLInjection, as decanoate: 50 mg/mL, 100 mg/mLInjection, as lactate: 5 mg/mLTablet: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg

Heparin Injection: 10 units/mL, 100 units/mL, 1,000 units/mL, 5,000 units/mL, 10,000

units/mL, 20,000 units/mL

Hepatitis A Vaccine (Vaqta, Havrix)Injection, single dose

Hepatitis A/Hepatitis B Vaccine (Twinrix)Injection, single dose

Hepatitis B Immune Globulin (HBIG)Injection, single dose

Hepatitis B Virus Vaccine, Recombinant (Recombivax HB, Engerix-B)Injection: 5 mcg/mL, 10 mcg/mL, 20 mcg/mL

Hexachlorophene (pHisoHex)Liquid, topical: 3%

Homatropine (Isopto Homatropine)Solution, ophthalmic: 2%, 5%

hydrALAZINE (Apresoline)Tablet: 10 mg, 25 mg, 50 mg, 100 mg


Hydrochlorothiazide (HydroDIURIL, Esidrix)Capsule: 12.5 mgSolution, oral: 50 mg/5 mLTablet: 12.5 mg, 25 mg, 50 mg, 100 mg

Hydrocodone/Guaifenesin (Hycotuss, Kwelcof) C-IIILiquid, oral: Hydrocodone 5 mg/Guaifenesin 100 mg per 5 mL

Hydrocortisone Injection, as sodium succinate: 100 mg, 250 mg, 500 mg, 1000 mgSuppositories, rectal, as acetate: 10 mg, 25 mgSuspension, oral, as cypionate: 10 mg/5 mL

Hydrocortisone base:Cream, rectal: 1%, 2.5%Tablet, oral: 5 mg, 10 mg, 20 mg

Hydrocortisone, topical (Lanacort, Corticaine):Cream, topical: 0.5%, 1%, 2.5%Lotion, topical: 0.5%, 1%, 2%, 2.5% Ointment, topical: 0.5%, 1%, 2.5%

Hydrogen PeroxideSolution, topical: 3%

hydrOXYzine (Atarax, Vistaril)Capsule: 25 mg, 50 mg, 100 mgInjection, as hydrochloride: 25 mg/mL, 50 mg/mLSuspension: 25 mg/5 mLSyrup, as hydrochloride: 10 mg/5 mLTablet: 10 mg, 25 mg, 50 mg, 100 mg

Ibandronate (Boniva)Tab: 2.5 mg, 150 mgInjection: 3 mg/3 mL

Ibuprofen (Motrin)Suspension, oral: 40 mg/mL, 100 mg/5 mLTablet: 200 mg, 400 mg, 600 mg, 800 mgTablet, chewable: 100mg

Iloperidone (Fanapt) RESERVE USETablet: 1 mg, 2 mg, 4 mg, 6 mg, 8 mg, 10 mg, 12 mg

Imipramine (Tofranil)Tablet: 10 mg, 25 mg, 50 mg


Influenza Virus Vaccine (Fluzone, Fluviron)Injection, single dose

Insulin, Aspart (NovoLog)Injection: 100 units/mL

Insulin, Combination (70/30)Injection: 100 units/mL

Insulin, Glargine (Lantus)Injection: 100 units/mL

Insulin, LenteInjection: 100 units/mL

Insulin, Lispro (humaLOG)Injection: 100 units/mL

Insulin, Lispro/Insulin, Lispro Protamine (humaLOG Mix 75/25)Injection: 100 units/mL

Insulin, NPHInjection: 100 units/mL

Insulin, RegularInjection: 100 units/mL

Insulin, UltralenteInjection: 100 units/mL

Ipratropium (Atrovent)Inhalation: 18 mcg/actuationSolution, nasal: 0.03%, 0.06%Solution, nebulizing: 0.02%

Iron salts with or without vitamins and/or minerals (Hemocyte Plus, Niferex, Niferex-150, Niferex-150 Forte)

CapsuleSolution, oralTablet

Isoniazid (INH)Injection: 100 mg/mLSyrup: 50 mg/5 mLTablet: 50 mg, 100 mg, 300 mg


Isosorbide Dinitrate (Isordil, Sorbitrate)Capsule, sustained release: 40 mgTablet, chewable: 5 mg, 10 mgTablet, oral: 5 mg, 10 mg, 20 mg, 30 mg, 40 mgTablet, sublingual: 2.5 mg, 5 mg, 10 mgTablet, sustained release: 40 mg

Isosorbide Mononitrate (Imdur, ISMO, Monoket)Tablet: 10 mg, 20 mgTablet, extended release: 30 mg, 60 mg, 120 mg

Ivermectin (Stromectol)Tablet: 3 mg

Kaolin-PectinSuspension: 30 mL, 120 mL, 180 mL, 240 mL

Ketoconazole (Nizoral)Cream, topical: 2%Shampoo: 2%Tablet: 200 mg

Ketorolac (Toradol)Injection: 15 mg/mL, 30 mg/mL

Ketotifen (Zaditor)Solution, ophthalmic: 0.025%

Labetalol (Normodyne)Tablet: 100 mg, 200 mg, 300 mg

Lacosamide (Vimpat)Oral Solution: 10 mg/mLInjection: 10 mg/mLTablet: 50 mg, 100 mg, 150 mg, 200mg

Lactobacillus Acidophilus (Lactinex, Bacid)CapsuleGranules: 1 g/packetTablet, chewable

Lactulose (Cephulac)Syrup: 10 g/15 mL


lamoTRIgine (laMICtal)Tablet: 25 mg, 100 mg, 150 mg, 200 mgTablet, dispersible/chewable: 2 mg, 5 mg, 25 mg

Lansoprazole (Prevacid)Capsule, enteric coated granules: 15 mg, 30 mgGranules for oral suspension: 15 mg, 30 mg

Latanoprost (Xalatan)Solution, ophthalmic: 0.005%

Leucovorin (Wellcovorin)Injection: 3 mg/mLPowder for injection: 25 mg, 50 mg, 100 mg, 350 mgTablet: 5 mg, 10 mg, 15 mg, 25 mg

Levarterenol (Levophed) see Norepinephrine

leVETIRAcetam (Keppra)Solution, oral: 100 mg/mLTablets: 100mg, 250 mg, 500 mg, 750 mg, 1,000mg

Levofloxacin (Levaquin)Infusion: 250 mg, 500 mg, 750 mgSolution: 250mg/10mLTablet: 250 mg, 500 mg, 750 mg

Levonorgestrel/Ethinyl Estradiol (Tri-Levlen, Triphasil)Tablet: Phase I (Levonorgestrel 0.05 mg/Ethinyl Estradiol 30 mcg), Phase 2

(Levonorgestrel 0.075 mg/Ethinyl Estradiol 40 mg), Phase 3 (Levonorgestrel 0.125 mg/ Ethinyl Estradiol 30 mg)

Levothyroxine (Synthroid, Levoxyl)Powder for injection: 200 mcg/mL, 500 mcg/mLTablet: 25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125 mcg, 150 mcg,

175 mcg, 200 mcg, 300 mcg

Lidocaine (Lidoderm, Xylocaine)Injection: 0.4%, 1%, 2%, 4%, 10%Gel, topical: 2%, 2.5% Liquid, topical: 2.5%, 4%Liquid, viscous: 2%Ointment, topical: 2.5%, 5%Patch: 5%Solution, topical: 2%, 4%


Lidocaine/Prilocaine (EMLA)Cream: Lidocaine 2.5%/Prilocaine 2.5%

Linezolid (Zyvox) RESERVE USESuspension: 100 mg/5mlTablet: 600 mg

Lisdexamfetamine dimesylate (Vyvanse) RESERVE USECapsule: 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg

Lisinopril (Prinivil, Zestril)Tablet: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg 40 mg

Lithium Carbonate (Eskalith, Lithonate, Lithobid)Capsule: 150 mg, 300 mg, 600 mgTablet: 300 mgTablet, controlled release: 450 mgTablet, slow release: 300 mg

Lithium CitrateSyrup: 300 mg/5 mL

Loperamide (Imodium)Capsule: 2 mgLiquid, oral: 1 mg/5 mLTablet: 2 mg

Loratadine (Claritin)Liquid, oral: 5mg/5mLTablet: 10 mg

Loratadine/Pseudoephedrine (Claritin D)Tablet, sustained release: 12hr, 24hr

LORazepam (Ativan) C-IVInjection: 2 mg/mL, 4 mg/mLSolution, oral: 2 mg/mLTablet: 0.5 mg, 1 mg, 2 mg

Loxapine (Loxitane)Capsule: 5 mg, 10 mg, 25 mg, 50 mg

Lurasidone (Latuda)Tablet: 20 mg 40 mg, 80 mg, 60 mg, 120 mg


Magnesium CitrateSolution, oral: 300 mL

Magnesium Hydroxide (Milk of Magnesia)Liquid, oral: 400 mg/5 mLLiquid, oral, concentrate: 800 mg/5 mLTablet, chewable: 311 mg

Magnesium L-lactate dihydrate (Mag-Tab SR) NUTRITIONAL SUPPLEMENTTablet

Magnesium Sulfate (Epsom Salt)Granules: ~40 mEq magnesium/5 gInjection: 100 mg/mL, 125 mg/mL, 250 mg/mL, 500 mg/mL

Maprotiline (Ludiomil)Tablet: 25 mg, 50 mg, 75 mg

Measles, Mumps and Rubella Virus Vaccine, Live (MMR II)Injection, single dose

Meclizine (Antivert, Bonine)Tablet: 12.5 mg, 25 mg, 50 mg

medroxyPROGESTERone (Provera)Injection, suspension: 100 mg/mL, 150 mg/mL, 400 mg/mLTablet: 2.5 mg, 5 mg, 10 mg

Megestrol (Megace, Megace ES)Suspension: 200mg/5ml, 625mg/5mlTablet: 20mg, 40mg

Melatonin NUTRITIONAL SUPPLEMENTCapsule: 10 mgTablet: 1 mg, 3 mg, 5 mg, 10 mgTablet, sublingual: 5 mgTablet, sustained release: 3 mg

Meloxicam (Mobic)Tablet: 7.5 mg, 15 mg

Memantine (Namenda)Tablet: 5 mg, 10 mg


MentholCreamLiquidOintmentPatchSpray

Menthol/Zinc Oxide (Calmoseptine, Risamine)Ointment

Mesalamine (Asacol, Pentasa, Rowasa)Capsule, controlled release: 250 mgSuppository: 500 mg, 1,000 mgSuspension, rectal: 4 gm/60 mLTablet, delayed release: 400 mg

metFORMIN (Glucophage, Glucophage XR)Tablet: 500 mg, 850 mg, 1000 mgTablet, extended release: 500 mg, 750 mg

Methadone (Dolophine) C-IISolution, oral: 1 mg/mLTablet: 5 mg, 10 mg, 40 mg

Methimazole (Tapazole)Tablet: 5 mg, 10 mg

Methocarbamol (Robaxin)Tablet: 500 mg, 750 mg

Methylcellulose (Citrucel)Powder: Methylcellulose 2 g per tbsp [with sucrose]Powder, sugar free: Methylcellulose 2 g per tbsp [with phylalanine]

Methyldopa (Aldomet)Injection: 50 mg/mLSuspension, oral: 250 mg/5 mLTablet: 125 mg, 250 mg, 500 mg

Methylphenidate, immediate release (Ritalin, Methylin, Metadate) C-IITablet: 5 mg, 10 mg, 20 mg

Methylphenidate, sustained release (Ritalin SR, Concerta, Metadate CD C-IITablet, extended release: 18 mg, 36 mg, 27 mg, 54 mgTablet, sustained release: 20 mg


methylPREDNISolone (Medrol, Depo-Medrol)Injection, as acetate: 20 mg/mL, 40 mg/mL, 80 mg/mLInjection, as sodium succinate: 40 mg, 125 mg, 500 mg, 1000 mg, 2000 mgTablet: 2 mg, 4 mg, 8 mg, 16 mg, 24 mg, 32 mg

Menthol/Methyl Salicylate (Ben-Gay)Cream, topical: 30%

Metoclopramide (Reglan) Injection: 5 mg/mLLiquid, oral, sugar free: 5 mg/5 mLTablet: 5 mg, 10 mg

Metoprolol (Lopressor, Toprol XL)Tablet: 25 mg, 50 mg, 100 mgTablet, extended release: 25 mg, 50 mg, 100 mg, 200 mg

metroNIDAZOLE (Flagyl, Noritate, MetroGel)Capsule: 375 mgCream, topical: 0.75%, 1%Gel, topical: 0.75% [7.5 mg/mL]Gel, vaginal: 0.75%Injection: 5 mg/mLPowder for injection: 500 mgTablet: 250 mg, 500 mg

Miconazole (Monistat)Cream, topical: 2%Cream, vaginal: 2%Injection: 10 mg/mLLotion: 2%Powder, topical: 2%Spray, topical: 2%Suppository, vaginal: 100 mg, 200 mg

Midazolam (Versed) C-IVInjection: 1 mg/mL, 5 mg/mL

Mineral Oil - for topical use onlyOil

MinocyclineCapsule: 50 mg, 75 mg, 100 mgCapsule, pellet filled: 50 mg, 100 mg


Mirtazapine (Remeron, Remeron SolTab)Tablet: 7.5mg, 15 mg, 30 mg, 45 mgTablet, rapid dissolving: 15 mg, 30 mg, 45 mg

Misoprostol (Cytotec)Tablet: 100 mcg, 200 mcg

Mometasone (Nasonex)Inhalation, nasal: 50 mcg/actuation

Montelukast (Singulair)Tablet, chewable: 4 mg, 5mgTablet: 10 mg

Morphine C-IIInjection: 1 mg/mL, 2 mg/mL, 4 mg/mL, 10 mg/mLSolution, oral: 20 mg/mLSuppository, rectal: 20 mg, 30 mgTablet, controlled release: 15 mg, 30 mg, 60 mgTablet, sublingual: 10 mg

Moxifloxacin (Avelox)Infusion: 400 mg/250 mLTablet: 400 mg

Multivitamin (Unicap, Hexavitamins)Liquid, oral: each solution contains a minimum of USDA requirementsTablet: each tablet contains a minimum of USDA requirementsTablet, chew: each tablet contains a minimum of USDA requirements

Multivitamin, Prenatal (Filibon)Tablet: each tablet contains a minimum of USDA requirements

Multivitamin/MineralsLiquid, oral: each solution contains a minimum of USDA requirementsTablet: each tablet contains a minimum of USDA requirementsTablet, chew: each tablet contains a minimum of USDA requirements

Multivitamins, Pediatric (Poly-Vi-Sol)Liquid, oral: each solution contains a minimum of USDA requirements

Mupirocin (Bactroban)Cream, topical: 2%Ointment, intranasal: 2%Ointment, topical: 2%


Nabumetone (Relafen) - RESERVE USETablet: 500 mg, 750 mg

Nafcillin (Unipen)Capsule: 250 mgPowder for injection: 500 mg, 1 g, 2 g, 4 g, 10 gSolution: 250 mg/5 mLTablet: 500 mg

Naloxone (Narcan)Injection: 0.4 mg/mL, 1 mg/mL

Naltrexone (Trexan, ReVia)Tablet: 50 mg

Naphazoline (Naphcon, AK-Con)Solution, ophthalmic: 0.012%, 0.1%

Naproxen (Naprosyn)Tablet: 220 mg, 250 mg, 275 mg, 375 mg, 500 mg, 550 mgTablet, controlled release: 500 mg

Neomycin (Mycifradin)Tablet: 500 mg

Neomycin/Polymyxin B/Bacitracin (Triple Antibiotic Ointment)Ointment, topical: Neomycin 3.5 mg/Polymyxin B 5000 units/Bacitracin 400 units

Neomycin/Polymyxin B/Hydrocortisone (Cortisporin)Solution, otic: Neomycin/Polymyxin B/Hydrocortisone Suspension, otic: Neomycin/Polymyxin B/Hydrocortisone

Niacin/Nicotinamide (Nicobid)Capsule, extended release: 250 mg, 500 mgTablet: 50 mg, 100 mg, 250 mg, 500 mgTablet, extended release: 250 mg, 500 mg, 750 mg, 1000 mg

Nicotine (Nicoderm, Habitrol, ProStep, Nicotrol, Nicorette)Patch, transdermal:

Habitrol: 21 mg/day, 14 mg/day, 7 mg/dayNicoderm: 21 mg/day, 14 mg/day, 7 mg/dayNicotrol: 15 mg/day (gradual release over 16 hours)

Pieces, chewing gum, as polacrilex: 2 mg/square, 4 mg/square


NIFEdipine (Procardia)Capsule, liquid-filled: 10 mg, 20 mgTablet, sustained release: 30 mg, 60 mg, 90 mg

Nitrofurantoin (Macrodantin)Capsule: 50 mg, 100 mgCapsule, extended release: 100 mgCapsule, macrocrystal: 25 mg, 50 mg, 100 mgCapsule, macrocrystal/monohydrate: 100 mgSuspension, oral: 25 mg/mL

NitroglycerinCapsule, sustained release: 2.5 mg, 6.5 mg, 9 mg, 13 mgOintment, topical 2%: 30 gm, 60 gmPatch, transdermal, topical: systems designed to deliver 2.5 mg, 5 mg, 7.5 mg, 10 mg,

or 15 mg over 24 hoursSpray, translinqual: 0.4 mg/metered sprayTablet, buccal, controlled release: 2 mg, 3 mgTablet, sublingual: 0.3 mg, 0.4 mg, 0.6 mgTablet, sustained release: 2.6 mg, 6.5 mg, 9 mg

Non-Soap Cleanser (Cetaphil)BarLotion

Norepinephrine or Levarterenol (Levophed)Injection: 1 mg/mL

Norgestimate/Ethinyl Estradiol (Ortho Tri-Cyclen)Tablet: 21 day, 28 day

Nortriptyline (Aventyl, Pamelor)Capsule: 10 mg, 25 mg, 50 mg, 75 mgSolution: 10 mg/5 mL

Nystatin (Mycostatin)Cream, topical: 100,000 units/gOintment, topical: 100,000 units/gPowder for oral suspension: 50 million units, 1 billion units, 2 billion units, 5 billion

unitsPowder, topical: 100,000 units/gSuspension, oral: 100,000 units/mL Tablet, oral: 500,000 unitsTroche: 200,000 units


OLANZapine (zyPREXA, zyPREXA Relprevv zyPREXA Zydis)Injection: 10 mg/2 mLInjection as pamoate: 210 mg, 300 mg, 405 mg RESERVE USETablet: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mgTablet, rapid dissolving: 5 mg, 10 mg, 15 mg, 20 mg

Olmesartan (Benicar - RESERVE USETablet: 5 mg, 20 mg, 40 mg

Olopatadine (Patanol)Solution, ophthalmic: 0.1%

Omeprazole (PriLOSEC)Capsule, delayed release: 10 mg, 20 mg, 40 mg

Ondansetron (Zofran, Zofran ODT)Tablet: 4mg, 8mgTablet, oral disintegrating: 4mg, 8mg

Ophthalmic Irrigating Solution (BSS, Eye Stream, AK-Rinse)Solution, ophthalmic

Ophthalmic Lubricant (HypoTears, HypoTears PF Artifical Tears, Liquitears)Ointment, ophthalmicSolution, ophthalmicSolution, ophthalmic 1.4%

Oseltamivir (Tamiflu)Capsule: 75 mg

Oxazepam (Serax) C-IVCapsule: 10 mg, 15 mg, 30 mgTablet: 15 mg

OXcarbazepine (Trileptal)Suspension, oral: 300 mg/5 mLTablet: 150 mg, 300 mg, 600 mg

Oxybenzone/PDO/Pet Hy-Phl (Vaseline Lip Therapy)Ointment

Oxybutynin (Ditropan, Ditropan XL)Syrup: 5 mg/5 mLTablet: 5 mgTablet, extended release: 5 mg, 10 mg, 15 mg


oxyCODONE (oxyCONTIN) C-IITablet: 15mg, 30mgTablet, controlled release: 5 mg,10 mg, 15 mg, 20 mg, 40 mg, 80 mg, 160 mg

Oxymetazoline (Afrin)Solution, nasal, drops: 0.025%, 0.05%Solution, nasal, spray: 0.05%

Paliperidone (Invega, Invega Sustenna)Injection, long acting: 39 mg, 78 mg, 117 mg, 156 mg, 234 mgTablet, extended release: 1.5 mg 3 mg, 6 mg, 9 mg

Pancrelipase (Pancrease, Creon)Capsule: contains lipase, protease and amylaseTablet: contains lipase, protease and amylase

Pantoprazole (Protonix)Suspension Packets; 40mgTablet: 40 mg, 20 mg

Papin/Urea (Accuzyme, Ethezyme, Gladase, Kovia)Ointment

Papin/Urea/Chlorophyllin (Gladase C, Panafil)Ointment

PARoxetine (Paxil)Suspension, 10 mg/5 mlTablet: 10 mg, 20 mg, 30 mg, 40 mgTablet: controlled release: 12.5 mg, 25 mg, 37.5 mg, 50 mg

Penicillamine (Cuprimine)Capsule: 125 mg, 250 mgTablet: 250 mg

Penicillin G Benzathine (Bicillin)Injection: 300,000 units/mL, 600,000 units/mL

Penicillin G Benzathine/Penicillin G Procaine (Bicillin C-R)Injection: Penicillin G Benzathine 150,000 units/Penicillin G Procaine 150,000 units,

Penicillin G Benzathine 900,000 units/Penicillin G Procaine 300,000 units

Penicillin G Procaine (Wycillin)Injection (suspension): 300,000 units/mL, 500,000 units/mL, 600,000 units/mL


Penicillin G SodiumInjection: 5 million units

Penicillin V Potassium (Pen-Vee K, V-Cillin K)Powder for oral solution: 125 mg/5 mL, 250 mg/5 mLTablet: 125 mg, 250 mg, 500 mg

Pentamidine (Pentam) - RESERVE USEInhalation: 300 mgPowder for injection: 300 mg

Permethrin (Acticin, Elimite, NIX)Cream, topical: 5%Lotion: 1%Shampoo: 1%

Perphenazine (Trilafon)Tablet: 2 mg, 4 mg, 8 mg, 16 mg

Petrolatum, White (Vaseline)Ointment, topical: 430 g

Phenazopyridine (Pyridium)Tablet: 95 mg, 100 mg, 200 mg

Phenelzine (Nardil)Tablet: 15 mg

PHENobarbital (Luminal) C-IVElixir: 20 mg/5 mLInjection: 65 mg/mL, 130 mg/mLTablet: 8 mg, 15 mg, 16 mg, 30 mg, 32 mg, 60 mg, 65 mg, 100 mg

Phenol (Chloraseptic)Mouthwash/GargleThroat Spray

Phenylephrine (Neo-Synephrine)Solution, nasal, drops: 0.125%, 0.25%, 0.5%Solution, nasal, spray: 0.25%, 0.5%, 1%Solution, ophthalmic: 2.5%, 10%


Phenytoin (Dilantin)Capsule, extended release: 30 mg, 100 mgCapsule, immediate release: 100 mg, 200 mg, 300 mgInjection: 50 mg/mLSuspension, oral: 125 mg/5 mLTablet, chewable: 50 mg

Physostigmine (Antilirium)Injection: 1 mg/mL

Phytonadione (Vitamin K1, Mephyton, Konakion)Injection, aqueous colloidal: 2 mg/mL, 10 mg/mLInjection, aqueous (IM only): 2 mg/mL, 10 mg/mLTablet: 5 mg

Pilocarpine (Isopto Carpine)Solution, ophthalmic, as hydrochloride: 1%, 2%, 4%

Pimecrolimus (Elidel)Cream: 1%

Pioglitazone (Actos)Tablet: 15 mg, 30 mg, 45 mg

Piperacillin/Tazobactam (Zosyn)Injection: 2.25 g, 3.375 g and 4.5 g

Pneumococcal Vaccine, Polyvalent (Pneumovax)Injection, single dose

Podophyllum Resin (Podocon-25)Liquid, topical: 25% in benzoin

Polycarbophil (Fibercon, Fiber-Lax)Tablet: 500 mg, 600 mg, 625 mg, 650 mg

Polyethylene Glycol (MiraLax)Powder for oral solution

Polymyxin B/Bacitracin (Polysporin)Ointment, ophthalmic: Polymyxin B 10,000 units/Bacitracin 500 unitsOintment, topical: Polymyxin B 10,000 units/Bacitracin 500 unitsPowder, topical: Polymyxin B 10,000 units/Bacitracin 500 units

Polymyxin B/Neomycin (Neosporin)Cream: Polymyxin B 10,000 units/Neomycin 3.5 mg


Polymyxin B/Trimethoprim (Polytrim)Solution, ophthalmic: Polymyxin B 10,000 units/Trimethoprim 1 mg/mL

Potassium ChlorideCapsule: 8 mEq, 10 mEqCapsule, sustained release: 10 mEqCrystals for oral suspension, extended release: 20 mEq/packetLiquid, oral: 10% [20 mEq/15 mL], 15% [30 mEq/15 mL], 20% [40 mEq/15 mL]Powder for oral suspension(per packet): 15 mEq, 20 mEq, 25 mEqInjection, concentrate: 2 mEq/mLTablet, controlled release (microencapsulated): 750 mg [10 mEq], 1500 mg [20 mEq]Tablet, controlled release (wax matrix): 500 mg [6.7 mEq], 600 mg [8 mEq], 750 mg

[10 mEq]

Potassium Citrate (Urocit K)Tablet: 5 mEq, 10 mEq

Potassium Citrate Combinations (Polycitra, Polycitra-LC, Polycitra K, Citrolith)Solution, oral: containing Sodium Citrate /Potassium Citrate/Citric AcidSolution, oral: containing Sodium Citrate/Potassium Citrate

Potassium Iodide (SSKI)Solution, oral: 100 mg/mL,1 g/mL

Potassium Phosphate (Neutra-Phos-K)Powder for oral solution: 250 mg elemental phosphours/14.2 mEq potassium per packet

Povidone-Iodine (Betadine)Cleanser, topical: 60 mL, 240 mLOintment, topical: 10%Solution, prep: 30 mL, 60 mL, 240 mL, 473 mL, 1000 mL, 4000 mLSolution, topical: 10%

Pramipexole (Mirapex)Tablet: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 1.5 mg

Pramoxine (Tronothane)Cream, topical: 1%Gel, topical: 1%Lotion: 1%Ointment, topical: 1%Spray: 1%

Pramoxine/Zinc (Caladryl Clear)Lotion, topical: 1% pramoxine/0.1% zinc acetate


Pravastatin (Pravachol)Tablet: 10 mg, 20 mg, 40 mg, 80 mg

Prazosin (Minipress)Capsule: 1 mg, 2 mg, 5 mg

prednisoLONE (Delta-Cortef, Pred Mild, Pred Forte)Solution, oral: 5mg/5mlSyrup: 15 mg/5 mLTablet: 5 mgSolution, ophthalmic: 0.12%, 1% RESERVE USE

predniSONE (Meticorten, Deltasone)Syrup: 5 mg/5 mLTablet: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg

Pregabalin (Lyrica)Capsule: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg

Primidone (Mysoline)Suspension, oral: 250 mg/5 mLTablet: 50 mg, 250 mg

Procainamide (Pronestyl)Capsule: 250 mg, 375 mg, 500 mgTablet: 250 mg, 375 mg, 500 mgTablet, sustained release: 250 mg, 500 mg, 750 mg, 1000 mg

Prochlorperazine (Compazine)Injection: 5 mg/mLSuppository, rectal: 25 mgTablet: 5 mg, 10 mg, 25 mg

Promethazine (Phenergan)Injection: 25 mg/mL, 50 mg/mLSuppository, rectal: 12.5 mg, 25 mg, 50 mgSyrup: 6.25 mg/5 mLTablet: 12.5 mg, 25 mg, 50 mg

Propantheline (Pro-Banthine)Tablet: 7.5 mg, 15 mg

Proparacaine (Alcaine)Solution, ophthalmic: 0.5%


Propranolol (Inderal)Capsule, sustained release: 60 mg, 80 mg, 120 mg, 160 mgInjection: 1 mg/mLSolution, oral: 4 mg/mL, 8 mg/mL, 80 mg/mLTablet: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg

Propylethylene Glycol Electrolyte Solution (PEG, Co-Lyte, GoLYTELY, OCL)Powder for oral solution: 2000 mL, 4000 mL, 4800 mL, 6000 mL

PropylthiouracilTablet: 50 mg

ProtamineInjection: 10 mg/mL

Pseudoephedrine (Sudafed)Liquid, oral: 15 mg/5 mL, 30 mg/mLTablet, immediate release: 30 mg, 60 mgTablet, timed release: 120 mgTablet, extended release: 120 mg, 240 mg

PyrazinamideTablet: 500 mg

Pyrethins 0.33%/Piperonyl Butoxide 4% (Pronto, RID)Liquid, topical: 0.18%, 0.3%Shampoo: 0.3%, 0.33%

Pyridoxine (Vitamin B6)Injection: 100 mg/mLTablet: 25 mg, 50 mg, 100 mg

QUEtiapine (SEROquel)Tablet: 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg

Raloxifene (Evista)Tablet: 60 mg

Ranitidine (Zantac)Injection: 25 mg/mLGranules, effervescent: 150 mgSyrup: 15 mg/mL Tablet: 75 mg, 150 mg, 300 mgTablet, effervescent: 150 mg


Rasagiline (Azilect)Tablet: 0.5 mg, 1 mg

Rectal Hemorrhoidal Cream with Hydrocortisone Cream: see Hydrocortisone

Rectal Hemorrhoidal Ointment (Anusol)Ointment

Rectal Hemorrhoidal Suppositories (Wyanoids, Anusol)

Suppository, rectal:

Rectal Hemorrhoidal Suppositories with Hydrocortisone (Anusol-HC)Suppository, rectal: see Hydrocortisone

Repaglinide (Prandin)Tablet: 0.5 mg, 1 mg, 2 mg

Rifabutin (Mycobutin)Capsule: 150 mg

Rifampin (Rifadin)Capsule: 150 mg, 300 mgInjection: 600 mg

Rifampin/Isoniazid (Rifamate)Capsule: Rifampin 300 mg/Isoniazid 150 mg

Ringer’s Lactate Solution (Hartmann's Solution)Infusion

Risedronate (Actonel)Tablet: 5 mg, 30 mg, 35 mg

risperiDONE (RisperDAL, RisperDAL M-Tab, RisperDAL Consta)Injection, long acting: 12.5 mg/2 mL, 25 mg/2 mL, 37.5 mg/2 mL, 50 mg/2 mLSolution, oral: 1 mg/mLTablet: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mgTablet, orally disintegrating: 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg

Rivastigmine (Exelon, Exelon Patches)Capsule: 1.5 mg, 3 mg, 4.5 mg, 6 mgPatch, transdermal: 4.6 mg/24 hours, 9.5 mg/24 hours

Rufinamide (Banzel)Tablet: 200 mg, 400 mg


Salicylic Acid (Compound W, DuoFilm, Mediplast, Salex, Neutrogena)Cleaning PadsCleanserGel, topical: 6%, 17%Liquid, topical: 17%Lotion: 3%Plaster: 40%ShampooSoap: 2%Wash

Salicyclic Acid/SulfurBar:CleanserCreamGelLotionShampoo:

Salmeterol (Serevent)Aerosol, inhalation: 25 mcg/dosePowder, inhalation: 50 mcg

Scopolamine (Isopto Hyoscine)Solution, ophthalmic: 0.25%

Selenium Sulfide (Selsun)Shampoo: 1%, 2.5%

Senna (Senokot)Tablet: 8.6 mg, 25 mg

Sertraline (Zoloft)Concentrate, oral: 20 mg/mLTablet: 25 mg, 50 mg, 100 mg

Sevelamer (Renagel)Tablet: 400 mg, 800 mg

Silver NitrateApplicator sticks

Silver Sulfadiazine (Silvadene)Cream, topical: 1%


Simethicone (Mylicon)Drops, oral: 40 mg/0.6 mLTablet, chewable: 40 mg, 80 mg, 125 mg

Simvastatin (Zocor)Tablet: 5 mg, 10 mg, 20 mg, 40 mg, 80 mg

Sodium BicarbonateInjection: 4.2% [5 mEq/10 mL], 8.4% [10 mEq/10 mL]

Sodium ChlorideDrops, nasal: 0.9%Infusion: 0.2%, 0.45%, 0.9%, 3%, 5%, 20%, 23.4%Injection, bacteriostatic: 0.9%Injection, for admixtures: 50 mEq, 100 mEq, 635 mEqOintment, ophthalmic: 5%Solution, irrigation: 0.45%, 0.9%Solution, nasal: 0.4%, 0.6%, 0.65%Solution, nebulizing: 0.9%Solution, ophthalmic: 2%, 5% Tablet: 650 mg, 1 gTablet, enteric coated: 1 gTablet, slow release: 600 mg

Sodium Chloride Intravenous SolutionInfusion: 0.2%, 0.45%, 0.9%

Sodium Citrate/Citric Acid (Bicitra, Oracit)Solution, oral:

Bicitra: Sodium Citrate 500 mg/Citric Acid 334 mg per 5 mLOracit: Sodium Citrate 400 mg/Citric Acid 640 mg per 5 mL

Sodium FluorideLiquid, oral: 360 mL, 480 mL, 540 mLTablet, chewable: 0.25 mg, 0.5 mg, 1 mg, 1.1 mg, 2.2 mg

Sodium LactateInjection: Sodium 167 mEq/Lactate 168 mEq per liter

Sodium Polystyrene Sulfonate (Kayexalate)Powder for suspension: 454 gmSuspension, oral: 1.25 gm/5 mL (with sorbitol and alcohol)

SorbitolSolution, oral: 70%


Spironolactone (Aldactone)Tablet: 25 mg, 50 mg, 100 mg

Spironolactone/Hydrochlorothiazide (Aldactazide)Tablet: Spironolactone 25 mg/Hydrochlorothiazide 25 mg, Spironolactone 50 mg/

Hydrochlorothiazide 50 mg

Stannous Fluoride (OmniMed, PerioMed)Solution, oral: 0.4%, 0.63%

Sucralfate (Carafate)Suspension, oral: 1 g/10 mLTablet: 1 g

Sulfacetamide Sodium (Sulamyd, Sebizon)Gel: 10%Lotion: 10%Ointment, ophthalmic: 10% Solution, ophthalmic: 10%

sulfaSALAzine (Azulfidine)Tablet: 500 mgTablet, delayed release: 500 mg

Sulindac (Clinoril)Tablet: 150 mg, 200 mg

SUMAtriptan (Imitrex)Injection: 12 mg/mLNasal Spray: 5 mg, 20 mgTablet: 25 mg, 50 mg, 100 mg

Sunscreen/blockCream/Lotion: contains a minimum SPF of 15

Tacrolimus (Protopic)Ointment: 0.03%, 0.1%

Tamoxifen (Nolvadex)Tablet: 10 mg, 20 mg

Tamsulosin (Flomax)Capsule, sustained release: 0.4 mg


Tazarotene (Tazorac, Avage)Cream, topical: 0.05%, 0.1%Gel, topical: 0.05%, 0.1%

Temazepam (Restoril) C-IVCapsule: 7.5 mg, 15 mg, 30 mg

Terbinafine (Lamisil)Cream, topical: 1%Tablet: 250 mg

Terbutaline (Brethine)Aerosol, oral: 0.2 mg/actuation Injection: 1 mg/mLTablet: 2.5 mg, 5 mg

Testosterone (Androlan) C-IVInjection, in oil, as cypionate: 100 mg/mL, 200 mg/mL

Tetracycline (Achromycin, Panmycin)Capsule: 100 mg, 250 mg, 500 mgSuspension, oral: 125 mg/5 mLTablet: 250 mg, 500 mg

Tetrahydrozoline (Visine Allergy Relief, Visine Moisturizing)Solution, ophthalmic: 0.05%

Theophylline (Elixophyllin)Capsule, timed release (12 hour): 130 mg, 260 mgCapsule, timed release (24 hour): 100 mg, 200 mg, 300 mgSolution, oral: 80 mg/15 mL, 150 mg/15 mLTablet, immediate release [Slo-phyllin]: 100 mg, 125 mg, 200 mg, 250 mg, 300 mgTablet, timed release:

Theolair SR (8-12 hour): 100 mg, 200 mg, 250 mg, 300 mg, 500 mgTheo-Dur (8-24 hour): 100 mg, 200 mg, 300 mg, 450 mgTheophylline SR (12-24 hour): 100 mg, 200 mg, 300 mgUniphyl (24 hour): 400 mg

Tablet, timed release (12 hour): 100 mg, 200 mg, 300 mg

Thiabendazole (Mintezol)Suspension, oral: 500 mg/5 mLTablet, chewable: 500 mg

Thiamine (Vitamin B1)Injection: 100 mg/mL, 200 mg/mLTablet: 50 mg, 100 mg, 250 mg, 500 mg


Thioridazine (Mellaril) - RESERVE USETablet: 10 mg, 15 mg, 25 mg, 50 mg, 100 mg, 150 mg, 200 mg

Thiothixene (Navane)Capsule: 1 mg, 2 mg, 5 mg, 10 mg, 20 mg

Thyroid, Desiccated (Thyroid)Capsule (pork source): 60 mg, 120 mg, 180 mg, 300 mgTablet:

Armour: 15 mg, 30 mg, 60 mg, 90 mg, 120 mg, 180 mg, 240 mg, 300 mgThyrolar (bovine source): 30 mg, 60 mg, 120 mgThyroid Strong (60 mg is equivalent to 90 mg thyroid, USP)Thyroid, USP: 15 mg, 30 mg, 60 mg, 120 mg, 180 mg, 300 mg

Tiagabine (Gabatril)Tablet: 2 mg, 4 mg, 12 mg, 16 mg, 20 mg

Timolol (Timoptic)Gel, ophthalmic: 0.25%, 0.5% Solution, as maleate, ophthalmic: 0.25%, 0.5% Solution, as maleate, ophthalmic, preservative free, single use: 0.25%, 0.5%

Timolol/Dorzolamide (Cosopt)Solution, ophthalmic: Timolol 0.5%/Dorzolamide 2%

Tioconazole (Vagistat-1)Ointment, vaginal: 6.5%

Tiotropium (Spriva)Cap: 18mcg (with device)

TiZANidine (Zanaflex) - RESERVE USECapsule: 2mg, 4mg, 6mgTablet: 2 mg, 4 mg

Tobramycin (Nebcin, Tobrex)Injection: 10 mg/mL, 40 mg/mLOintment, ophthalmic: 0.3%Powder for injection: 40 mg/mLSolution, ophthalmic: 0.3%

Tobramycin/Dexamethasone (TobraDex) [contains Benzalkonium] - RESERVE USEOintment, ophthalmic: Tobramycin 0.3%/Dexamethasone 0.1%Suspension, ophthalmic: Tobramycin 0.3%/ Dexamethasone 0.1%


TOLBUTamide (Orinase)Tablet: 250 mg, 500 mg

Tolnaftate (Tinactin)Aerosol, topical, liquid: 1%Aerosol, topical, powder: 1%Cream, topical: 1%Powder, topical: 1%Solution, topical: 1%

Tolterodine (Detrol, Detrol LA)Capsule, extended release: 2 mg, 4 mgTablet: 1 mg, 2 mg

Topiramate (Topamax)Capsule, sprinkle: 15 mg, 25 mgTablet: 25 mg, 50 mg, 100 mg, 200 mg

traMADol (Ultram)Tablet: 50 mg

Tranylcypromine (Parnate)Tablet: 10 mg

Travoprost (Travatan)Solution, ophthalmic: 0.004%

traZODone (Desyrel)Tablet: 50 mg, 100 mg, 150 mg, 300 mg

Tretinoin Gel (Retin-A)Cream, topical: 0.025%, 0.05%, 0.1%Gel, topical: 0.01%, 0.025%, 0.1%Liquid, topical: 0.05%

Triamcinolone (Aristocort, Kenacort, Azmacort, Nasacort)Aerosol, oral, inhalation: 100 mcg/metered spray Aerosol, topical: 0.2 mg/2 second sprayCream, topical: 0.025%, 0.1%, 0.5%Lotion, topical: 0.025%, 0.1%Ointment, topical: 0.025%, 0.1%, 0.5%Spray, intranasal: 55 mcg/actuation [100 sprays/canister]

Triamterene (Dyrenium)Capsule: 50 mg, 100 mg


Triamterene/Hydrochlorothiazide (Dyazide, Maxzide)Capsule (Dyazide): 37.5 mg Triamterene/25 mg Hydrochlorothiazide. 50 mg

Triamterene/25 mg HydrochlorothiazideTablet (Maxzide): 37.5 mg Triamterene/25 mg Hydrochlorothiazide, 75 mg

Triamterene/50 mg Hydrochlorothiazide

Triazolam (Halcion) C-IVTablet: 0.125 mg, 0.25 mg

Trifluoperazine (Stelazine)Tablet: 1 mg, 2 mg, 5 mg, 10 mg

Trihexyphenidyl (Artane)Elixir: 2 mg/5 mLTablet: 2 mg, 5 mg

Trimethobenzamide (Tigan)Capsule: 250 mg, 300 mgInjection: 100 mg/mLSuppository, rectal: 200 mg

Trimethoprim/Sulfamethoxazole (Co-Trimoxazole, Bactrim, Septra)The 5:1 ratio of Sulfamethoxazole (SMX) to Trimethoprim (TMP) is constant in all dosage forms

Injection: 80 mg SMX/16 mg TMP per mLSuspension, oral: 200 mg SMX/40 mg TMP per 5 mL Tablet: 400 mg SMX/80 mg TMP, 800 mg SMX/160 mg TMP

Trimipramine (Surmontil)Capsule: 25 mg, 50 mg, 100 mg

Triprolidine/Pseudoephedrine (Actifed)Capsule, extended release: Triprolidine 5 mg/Pseudoephedrine 120 mgSyrup: Triprolidine 1.25 mg/Pseudoephedrine 30 mg per 10 mLTablet: Triprolidine 2.5 mg/Pseudoephedrine 60 mg

Tropicamide (Mydriacyl)Solution, ophthalmic: 0.5%, 1%

Trospium (Sanctura)Tablet: 20 mg

Trypsin/Balsam Peru/Castor Oil (Granulex GranuloDerm, Revina, TBC, Xenaderm, Vasolex)

Aerosol: Trypsin 0.1 mg/Balsam Peru 72.5 mg/Castor Oil 650 mg per 0.82 mL Ointment: Trypsin 90 units/Balsam Peru 87 mg/Castor Oil 788 mg per gram


Tuberculin, Purified Protein Derivative (P.P.D.)Intermediate test strength: 5 TU/0.1 mL

UreaCream: 10%, 20, 40%Lotion: 10%, 40%Shampoo: 10%

valACYclovir (Valtrex)Caplets: 500 mg, 1 g

Valproic Acid/Valproate (Depakene)Capsule: 250 mgSyrup: 250 mg/5 mL

Valsartan (Diovan) RESERVE USETablet: 40 mg, 80 mg, 160 mg, 320 mg

Vancomycin (Vancocin)Capsule: 125 mg, 250 mgPowder for oral solution: 1 g, 10 gPowder for injection: 500 mg, 1 g, 2 g, 5 g, 10 g

Varicella Virus Vaccine, Live (Varivax)Injection, single dose

Venlafaxine (Effexor)Capsule, sustained release: 37.5 mg, 75 mg, 150 mgTablet: 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mgTablet, extended release: 37.5 mg, 75 mg, 150 mg, 225 mg

Verapamil (Calan, Isoptin)Capsule, sustained release: 100mg, 120 mg, 180 mg, 240 mg, 360 mgInjection: 2.5 mg/mLTablet: 40 mg, 80 mg, 120 mgTablet, sustained release: 120 mg, 180 mg, 240 mg

Vitamin A (Aquasol A)Capsule: 8,000 units, 10,000 units, 25,000 units, 50,000 unitsInjection: 50,000 units/mLTablet: 5000 units

Vitamin A&D TopicalCreamOintment


Vitamin B ComplexTablet: each tablet contains a minimum of USDA requirements

Vitamin B Complex/Vitamin C (Stresscaps, Allbee with CNephrocaps, Nephro-viteCapsule: each capsule contains a minimum of USDA requirementsTablet: each tablet contains a minimum of USDA requirements

Vitamin B Complex/Vitamin C/ZincTablet: each tablet contains a minimum of USDA requirements

Vitamin D (Ergocalciferol, Calciferol, Drisdol)Capsule: 0.25 mcg, 0.5 mcg, 400 units, 2,000 units, 10,000 units, 50,000 unitsDrops, oral: 200 units/dropTablet: 400 units, 2,000 units

Vitamin E (Aquasol E)Capsule: 100 units, 200 units, 400 units, 1,000 unitsTablet: 200 units, 400 units, 2,000 units

Warfarin (Coumadin)Tablet: 1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6mg, 7.5 mg, 10 mg

Water for InjectionInfusion

Water for IrrigationSolution, irrigation

Wound Cleanser (CarraKlenz)Topical, spray

Zafirlukast (Accolate)Tablet: 10 mg, 20 mg

Zaleplon (Sonata) C-IVCapsule: 5 mg, 10 mg

Zanamivir (Relenza)Powder for Inhalation: 5 mg

Zinc OxideOintment, topical: 20% in white ointment Paste, topical: 25% in white petrolatum

Zinc Oxide/Petrolatum/Imidazolidinyl Urea (Diaperene)Ointment, topical


Zinc SulfateCapsule: 220 mg [50 mg zinc]Injection: 1 mg/mL, 5 mg/mLTablet: 220mg

Ziprasidone (Geodon)Capsule: 20 mg, 40 mg, 60 mg, 80 mgInjection: 20 mg

Zoledronic Acid (Reclast, Zometa)Injection: 5 mg/100 mL

Zolpidem (Ambien) C-IVTablet: 5 mg, 10 mg

Zonisamide (Zonegran)Capsule: 25 mg, 50 mg, 100 mg


THERAPEUTIC CLASSIFICATION/COST INDEX

ANTIDIABETIC AGENTS

INSULINS, HUMANInsulin, Aspart (NovoLog) $$$$$$$Insulin, Combination (70/30) $$$$Insulin, Glargine (Lantus) $$$$$$$Insulin, Lente $$$$Insulin, Lispro (humaLOG) $$$$$$$Insulin, Lispro/Insulin, Lispro Protamine (humaLOG Mix 75/25) $$$$$$$Insulin, NPH $$$$Insulin, Regular $$$$Insulin, Ultralente $$$$$

SULFONYLUREASglipiZIDE (Glucotrol) $

glyBURIDE (Micronase, DiaBeta) $$

TOLBUTamide (Orinase) $$

MISCELLANEOUS ANTIDIABETICSmetFORMIN (Glucophage, Glucophage XR $

Pioglitazone (Actos) $$-$$$Repaglinide (Prandin) $$ - $$$$

GLUCOSE ELEVATING AGENTSDextrose 50% in Water $$Glucagon $$$$$$$Glucose $ - $$$

DSHS/DADS Drug Formulary 2014 page 79Therapeutic Classification/Cost Index

ANTIDOTES/DETERRENTS/POISON CONTROL AGENTS

Acetylcysteine (Mucomyst)Activated CharcoalDeferoxamine (Desferal)Dimercaprol (B.A.L.)Disulfiram (Antabuse)GlucagonGlucose, oralLeucovorin (Wellcovorin)Naloxone (Narcan) $$ - $$Naltrexone (Trexan, ReVia) $$$Nicotine Polacrilex (Nicorette) $$ - $$$$$Nicotine Transdermal Patch (Nicoderm, Habitrol, ProStep,

Nicotrol)$$$

Penicillamine (Cuprimine)Physostigmine (Antilirium)Phytonadione (Vitamin K1, Mephyton) $$ - $$$Protamine $

ANTIHISTAMINES

Cetirizine (zyrTEC) $

Chlorpheniramine (Chlor-Trimeton, Teldrin) $ - $Cyproheptadine (Periactin) $

diphenhydrAMINE (Benadryl) $

Fexofenadine (Allegra) $$hydrOXYzine (Atarax, Vistaril) $ - $$Loratadine (Claritin) $$


ANTINEOPLASTIC AGENTSAll commercially available oncologic agents used in the treatment of cancer are considered to be formulary agents, if prescribed by an oncologist for the active treatment of cancer.

Tamoxifen (Nolvadex) $$

BLOOD MODIFYING AGENTS

ANTIPLATELETAspirin $

Clopidogrel (Plavix) – RESERVE USE $$$

ANTICOAGULANTFondaparinux (Arixtra) $$$$$$$Heparin $$Enoxaparin (Lovenox) $$$$$$$Warfarin (Coumadin) $

ANTICOAGULATION ANTAGONISTPhytonadione (Vitamin K1, Mephyton) $$ - $$$Protamine $

MISCELLANEOUS BLOOD MODIFYING AGENTSEpoetin alfa (Epogen, Procrit) RESERVE USE $$$$$$$Ferrous Fumarate/Docusate Sodium (Ferro-Sequels) [33%

elemental iron]$$

Ferrous Sulfate (Feosol, Fer-In-Sol) [20% elemental iron] $

CARDIOVASCULAR AGENTS

DIURETICSThiazides & Related Diuretics

Chlorthalidone (Hygroton) $

Hydrochlorothiazide (HydroDIURIL, Esidrix) $


Loop DiureticsFurosemide (Lasix) $

Potassium-Sparing DiureticsSpironolactone (Aldactone) $

Triamterene (Dyrenium) $ - $

Carbonic Anhydrase InhibitorsacetaZOLAMIDE (Diamox) $

Combination DiureticsSpironolactone/Hydrochlorothiazide (Aldactazide) $ - $$

Triamterene/Hydrochlorothiazide (Dyazide, Maxzide) $ - $

CARDIAC GLYCOSIDESDigoxin (Lanoxin) $

ANTIANGINALSIsosorbide Dinitrate (Isordil, Sorbitrate) $Isosorbide Mononitrate (Imdur, ISMO, Monoket) $Nitroglycerin $ - $

ANTIARRHYTHMICSAdenosine (Adenocard) $$$$$$$Amiodarone (Pacerone, Cordarone) $ - $Procainamide (Pronestyl) $ - $

CALCIUM CHANNEL BLOCKERSAmlodipine (Norvasc) $$

Diltiazem (Cardizem) $ - $$Felodipine (Plendil) $ - $$NIFEdipine (Procardia) $ - $$$Verapamil (Calan, Isoptin) $ - $$


BETA-ADRENERGIC BLOCKERSAtenolol (Tenormin) $Carvedilol (Coreg) $-$$Labetalol (Normodyne) $ - $$Metoprolol (Lopressor, Toprol XL) $ - $$Propranolol (Inderal) $ - $$$

ANTIHYPERLIPIDEMICSAtorvastatin (Lipitor) $-$$$$Cholestyramine (Questran) $ - $$$Fenofibrate (Antara, Lofibra, Tricor, Triglide) $-$$$$Fluvastatin (Lescol) $$Gemfibrozil (Lopid) $

Niacin/Nicotinamide (Nicobid) $ - $Pravastatin (Pravachol) $$

Simvastatin (Zocor)

ANGIOTENSIN CONVERTING ENZYME INHIBITORSBenazepril (Lotensin) $

Captopril (Capoten) $

Enalapril (Vasotec) $

Lisinopril (Prinivil, Zestril) $

VASOPRESSORSDOPamine (Intropin) $$$ - $$$$EPINEPHrine (Adrenalin) $ - $$$$$$$Norepinephrine or Levarterenol (Levophed) $$$ - $$$$$$$

MISCELLANEOUS ANTIHYPERTENSIVEScloNIDine (Catapres) $ - $$$$$$hydrALAZINE (Apresoline) $

Methyldopa (Aldomet) $ - $$$$$$$Olmesartan (Benicar RESERVE USE $$Prazosin (Minipress) $ - $$

Valsartan (Diovan) RESERVE USE $$


MISCELLANEOUS CARDIOVASCULARSSodium Polystyrene Sulfonate (Kayexalate) $$ - $$$$

CENTRAL NERVOUS SYSTEM AGENTS

ANALGESICSNonsteroidal Anti-Inflammatory Agents

Aspirin $ - $Ibuprofen (Motrin) $ - $$Ketorolac (Toradol) $$$$ - $$$$$$$Meloxicam (Mobic) $

Nabumetone (Relafen) - RESERVE USE $$Naproxen (Naprosyn) $$

Sulindac (Clinoril) $ - $$

Opiate AgonistsfentaNYL (Duragesic) C-II $$$-$$$$$Methadone (Dolophine) C-II $ - $$$$Morphine C-II $ - $$$oxyCODONE (oxyCONTIN) C-II

$$ - $$$$$

Miscellaneous Analgesics & AntipyreticsAcetaminophen (Tylenol) $ - $$Acetaminophen/Codeine C-III $ - $Acetaminophen/Hydrocodone (Lortab, Vicodin, Vicodin ES) C-III $$ - $$traMADol (Ultram) $ - $$$$

ANTIEMETIC/ANTIVERTIGO AGENTSdiphenhydrAMINE (Benadryl) $

hydrOXYzine (Atarax, Vistaril) $ - $$Meclizine (Antivert, Bonine) $

Metoclopramide (Reglan) $ - $$$Ondansetron (Zofran, Zofran ODT) $ - $$$Prochlorperazine (Compazine)Promethazine (Phenergan) $ - $$$$$Trimethobenzamide (Tigan) $$


MISCELLANEOUS AGENTSMegestrol (Megace, Megace ES) $ - $$$$$$$

PSYCHOTROPIC AGENTSBenzodiazepines

ALPRAZolam (Xanax, Xanax XR) C-IV $ - $ChlordiazePOXIDE (Librium) oral only C-IV $

clonazePAM (KlonoPIN) C-IV $$ - $$$$Clorazepate (Tranxene) C-IV $ - $$

Diazepam (Valium) C-IV $

LORazepam (Ativan) C-IV $ - $$$Oxazepam (Serax) C-IV $ - $$

Temazepam (Restoril) C-IV $

Triazolam (Halcion) C-IV $ - $

AntidepressantsMonoamine Oxidase Inhibitors

Phenelzine (Nardil) $$ - $Tranylcypromine (Parnate) $$

Serotonin Selective Reuptake Inhibitors (SSRIs)Citalopram (celeXA) $

Escitalopram (Lexapro) $ - $$$FLUoxetine (PROzac) $

fluvoxaMINE (Luvox) $$- $PARoxetine (Paxil) $ - $$$Sertraline (Zoloft) $

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)DULoxetine (Cymbalta) $$$ - $$$$Venlafaxine (Effexor) $$- $$$$

Tricyclic AgentsAmitriptyline (Elavil) $$ - $clomiPRAMINE (Anafranil) - for OCD $ - $$$Desipramine (Norpramin) $ - $Doxepin (SINEquan) $ - $$

Imipramine (Tofranil) $

Nortriptyline (Aventyl, Pamelor) $ - $$Trimipramine (Surmontil) $ - $$$


Miscellaneous AgentsAmoxapine (Asendin) $ - $$buPROPion (Budeprion, Budeprion SR, Budeprion ER, Wellbutrin,

Wellbutrin SR Wellbutrin XL, Zyban)$ - $

Maprotiline (Ludiomil) $ - $Mirtazapine (Remeron, Remeron SolTab) $ - $$traZODone (Desyrel) $ - $

AntipsychoticsARIPiprazole (Abilify, Abilify discmelt, Abilify Maintena) $$$$ - $$$$$$$Asenapine (Saphris) $$$$$$ChlorproMAZINE (Thorazine) $

cloZAPine (Clozaril, Fazaclo) - RESERVE USE $$ - $$$$$$$fluPHENAZine(Prolixin) $ - $$$fluPHENAZine Decanoate (Prolixin Decanoate) $$ - $$$$Haloperidol (Haldol) $

Haloperidol Decanoate (Haldol Decanoate) $$ - $$$$Iloperidone (Fanapt) RESERVE USE $$$$$Loxapine (Loxitane) $ - $$$Lurasidone (Latuda) $$$$$$-$$$$$$$OLANZapine (zyPREXA, zyPREXA Zydis) $ - $$$$OLANZapine pamoate (zyPREXA Relprevv)RESERVE USE $$$$$$-$$$$$$$Paliperidone (Invega, Invega Sustenna) $$$$ - $$$$$$$Perphenazine (Trilafon) $$ - $$QUEtiapine (SEROquel) $ - $$$$$risperiDONE (RisperDAL, RisperDAL M-Tab, RisperDAL Consta) $- $$$$$$Thioridazine (Mellaril) - RESERVE USE $ - $Thiothixene (Navane) $ - $Trifluoperazine (Stelazine) $$ - $Ziprasidone (Geodon) $$-$$$

Mood StabilizerscarBAMazepine (TEGretol, TEGretol XR, Carbatrol)Divalproex (Depakote) Depakote ER, Divalproex ER $- $$lamoTRIgine (laMICtal ) $$ - $$$Lithium Carbonate (Eskalith, Lithonate, Lithobid) $

Lithium Citrate $$ - $$Valproate (Depakene) $$ - $$


StimulantsAmphetamine Mixture (Adderall, Adderall XR) CII $$ - $$Atomoxetine (Strattera) $$ - $$$$

Dextroamphetamine (Dexedrine Dextrostat) C-II (Rarely used in adults)

$ - $$

Lisdexamfetamine dimesylate (Vyvanse) RESERVE USE $$$$Methylphenidate C-II (Rarely used in adults)Methylphenidate, immediate release (Ritalin, Methylin, Metadate)Methylphenidate, sustained release (Ritalin SR, Concerta,

Metadate CD

$ - $$

Chemical Dependency AdjunctsAcamprosate (Campral $$$$$Disulfuram (Antabuse) $$$-$$$$Naltrexone (Trexan, ReVia $$$Topiramate (Topamax $$- $$$$

Miscellaneous Psychotropic AgentsbusPIRone (BuSpar) $$ - $$$$guanFACINE (Tenex) $-$$$hydrOXYzine (Atarax, Vistaril) $

Naloxone (Narcan) $ - $$Naltrexone (Trexan, ReVia) $$$ - $$$$$

SEDATIVES AND HYPNOTICSBenzodiazepines

ALPRAZolam (Xanax, Xanax XR) C-IV $ - $clonazePAM (KlonoPIN) C-IV $ - $$Diazepam (Valium) C-IV $

LORazepam (Ativan) C-IV $ - $$$Midazolam (Versed) C-IV $$$ - $$$$$$Oxazepam (Serax) C-IV $

Temazepam (Restoril) C-IV $

Triazolam (Halcion) C-IV $ - $

Miscellaneous Sedative and HypnoticsChloral Hydrate (Noctec) C-IV $ - $$


traZODone (Desyrel) $ - $Zaleplon (Sonata) C-IV $ - $$Zolpidem (Ambien) C-IV $


ANTICONVULSANTSBarbiturates

PHENobarbital (Luminal) C-IV $ - $$Primidone (Mysoline) $$ - $$

BenzodiazepinesclonazePAM (KlonoPIN) C-IV $$ - $$Clorazepate (Tranxene, Tranxene SD) C-IV $ - $$

Diazepam (Valium, Diastat) C-IV $ - $$$$$$$LORazepam (Ativan) C-IV $ - $$$Clobazam (Onfi) $$$$$ - $$$$$$

HydantoinsFosphenytoin (Cerebyx) $$$Phenytoin (Dilantin) $$ - $$

SuccinimidesEthosuximide (Zarontin) $ - $$$

Miscellaneous AnticonvulsantscarBAMazepine (TEGretol, TEGretol XR, Carbatrol) $$ - $$$$Divalproex (Depakote) Depakote ER, Divalproex ER) $$ - $$$$Felbamate (Felbatol) - RESERVE USE $$ - $$$$Gabapentin (Neurontin) $$ - $$$Lacosamide (Vimpat) $$$$ - $$$$$lamoTRIgine (laMICtal) $$ - $$$leVETIRAcetam (Keppra) $$$-$$$$OXcarbazepine (Trileptal) $$-$$$$Pregabalin (Lyrica) $$-$$$Rufinamide (Banzel) $$$$ - $$$$$$$Tiagabine (Gabatril) $$$$ - $$$$Topiramate (Topamax) $$- $$$$Valproate (Depakene) $ - $$$$Zonisamide (Zonegran) $$ - $$$$

MUSCLE RELAXANTSAntispasticity Agnets

Baclofen (Lioresal) $$ - $Dantrolene (Dantrium) $$ - $$$$Diazepam (Valium) C-IV $ - $$TiZANidine (Zanaflex) - RESERVE USE $$


AntispasmodicsCyclobenzaprine (Flexeril) $

Diazepam (Valium) C-IV $ - $$Methocarbamol (Robaxin) $ - $$$TiZANidine (Zanaflex) - RESERVE USE $$

ANTIPARKINSON AGENTSAmantadine (Symmetrel) $$

Benztropine (Cogentin) $ - $$$$Bromocriptine (Parlodel) $$ - $$$$$$$Entacapone (Comtan) $$ - CCarbidopa/Levodopa (Sinemet) $$ - $$$$Pergolide (Permax) $$ - $$$Pramipexole (Mirapex) $$ - $$$Rasagiline (Azilect) $$$$$Trihexyphenidyl (Artane) $ - $$

AGENTS FOR MIGRAINEAspirin/Acetaminophen/Caffeine (Excedrine Migraine) $

Atenolol (Tenormin) $Divalproex (Divalproex ER, Depakote, Depakote ER- RESERVE USE ) $$ - $$$$FLUoxetine (PROzac) $

Metoprolol (Lopressor, Toprol XL) $ - $$

Naproxen (Naprosyn) $$

Propranolol (Inderal) $ - $$$SUMAtriptan (Imitrex) $$$$$ - $$$$$$$Topiramate (Topamax) $

Valproate (Depakene) $ - $$$$Verapamil (Calan, Isoptin) $ - $$

DEMENTIA AGENTSDonepezil (Aricept) $$$-$$$$Galantamine (Razadyne) $$ - $$$Memantine (Namenda) $$ - $$$Rivastigmine (Exelon, Exelon Patches) $$$-$$$$


ENDOCRINE AGENTS

ESTROGENSEstradiol (Estrace, Vivelle, Alora, Climara, Estraderm) $ - $$$$$$$Estrogens, Conjugated (Premarin) $$

PROGESTERONESmedroxyPROGESTERone (Provera) $ - $$

COMBINATION PRODUCTSAll commercially available Birth Control Agents are considered to be formulary agents

Estrogen/medroxyPROGESTERone (PremPro Premphase) $$ -$$Ethinyl Estradiol/Norethindrone (Loestrin, , Ortho-Novum 777) $$$$$$$Ethinyl Estradiol/Norgestrel (Ovral, Lo-Ovral) $$$$$$$Levonorgestrel/Ethinyl Estradiol (Tri-Levlen, Triphasil) $$$$$$$Norgestimate/Ethinyl Estradiol (Ortho Tri-Cyclen) $$$$$$$

ANDROGENSTestosterone (Androlan) C-IV $$ - $$$

ADRENAL CORTICAL STEROIDSDexamethasone (Decadron) $ - $$Fludrocortisone (Florinef) $ -$$Hydrocortisone $$ - $$$$$methylPREDNISolone (Medrol, Depo-Medrol) $ - $$$$prednisoLONE (Delta-Cortef) $ - $$predniSONE (Meticorten, Deltasone) $ - $$$$Triamcinolone (Aristocort, Kenacort) $ - $$$$$

THYROID AGENTSLevothyroxine (Synthroid, Levoxyl) $

Methimazole (Tapazole) $$ - $$Propylthiouracil $

Thyroid, Desiccated (Thyroid) $


MISCELLANEOUS ENDOCRINE AGENTSAllopurinol (Zyloprim) $

Colchicine $

Desmopressin (DDAVP, Stimate) $$$ - $$$$

GASTROINTESTINAL AGENTS

ANTACIDSAluminum Hydroxide (Amphojel) $ - $$Aluminum Hydroxide/Magnesium Trisilicate (Gaviscon) $ - $$Aluminum Hydroxide/Magnesium Hydroxide (Maalox) $ - $Aluminum Hydroxide/Magnesium Hydroxide/ Simethicone (Mylanta,

Aludrox)$ - $

Calcium Carbonate (Os-Cal, Titralac) - 40% elemental calcium $

ANTISPASMODICS/ANTICHOLINERGIC AGENTSDicyclomine (Bentyl) $ - $$Glycopyrrolate (Robinul) $$

Propantheline (Pro-Banthine) $ - $$

HISTAMINE (H2) ANTAGONISTSPreferred Agent:

Famotidine (Pepcid) $ - $$$$

Others:Ranitidine (Zantac) $ - $$$$


PROTON PUMP INHIBITORSPreferred Agent:

Lansoprazole (Prevacid) $$$Pantoprazole (Protonix) – price based on market share $$ - $$$

Others:Esomeprazole (NexIUM) RESERVE USE $$$$

Omeprazole (PriLOSEC) $ - $$$

ANTIFLATULENTSSimethicone (Mylicon) $ - $$

STIMULANTSMetoclopramide (Reglan) $ - $$

LAXATIVESSaline Laxatives

Magnesium Citrate $Magnesium Hydroxide (Milk of Magnesia) $

Magnesium Sulfate (Epsom Salt) $$

Irritant/Stimulant Laxatives

Bisacodyl (Dulcolax) $

Senna (Senokot) $ - $

Bulk LaxativesCellulose (Unifiber) $Methylcellulose (Citrucel) $

Polycarbophil (Fibercon, Fiber-Lax) $ - $$$$$$$

Osmotic LaxativesLactulose (Cephulac) $ - $$Polyethylene Glycol (MiraLax) $

Propylethylene Glycol Electrolyte Solution (PEG, Co-Lyte, GoLYTELY, OCL)

$

Sorbitol $ - $

Combination LaxativesDocusate Sodium/Sennosides (Peri-Colace) $


SurfactantsDocusate Calcium (Surfak) $

Docusate Sodium (Colace, Doxinate) $

Miscellaneous LaxativesGlycerin Suppository (Sani-Supp) $

ANTIDIARRHEALSBismuth Subsalicylate (Pepto-Bismol, Bismatrol, Kaopectate) $ - $Kaolin-Pectin $$ - $$Lactobacillus Acidophilus (Lactinex, Bacid) $$ - $$Loperamide (Imodium) $ - $$

RECTAL AGENTSPramoxine (Tronothane) $ - $$Rectal Hemorrhoidal Cream with Hydrocortisone $$$Rectal Hemorrhoidal Ointment (Anusol) $$Rectal Hemorrhoidal Suppositories (Wyanoids, Anusol) $

Rectal Hemorrhoidal Suppositories with Hydrocortisone (Anusol-HC) $ - $$

MISCELLANEOUS GASTROINTESTINAL AGENTSActivated CharcoalBismuth Subsalicylate (Pepto-Bismol, Bismatrol) $ - $Mesalamine (Asacol, Pentasa, Rowasa) $$$ - $$$$$Misoprostol (Cytotec) $$Pancrelipase (Pancrease, Creon) $$ - $$$$Sucralfate (Carafate) $ - $$$$sulfaSALAzine (Azulfidine) $$

GENITOURINARY AGENTS

INTERSTITIAL CYSTITIS AGENTSPhenazopyridine (Pyridium) $ - $$

GENITOURINARY IRRIGANTSSodium Chloride $$$Water for Irrigation $ - $$


MEDICATIONS FOR BPHFinasteride (Proscar) $$

Tamsulosin (Flomax) $$

URINARY ALKALINIZERSPotassium Citrate (Urocit K) $ - $$$$Potassium Citrate Combinations (Polycitra, Polycitra-LC, Polycitra K, Citrolith)

$$ - $$

Sodium Bicarbonate $ - $$Sodium Citrate/Citric Acid (Bicitra, Oracit) $$ - $$$

URINARY ANTICHOLINERGICSDarifenacin (Enablex) $$$Flavoxate (Urispas) $$$Oxybutynin (Ditropan, Ditropan XL) $$ - $$Trospium (Sanctura $$$Tolterodine (Detrol, Detrol LA) $$ - $$$

URINARY CHOLINERGICSBethanechol (Urecholine) $ - $$$

VAGINAL ANTIFUNGALSClotrimazole (Gyne-Lotrimin, Mycelex) $$$$ - $$$$$Miconazole (Monistat) $$$$ - $$$$$Tioconazole (Vagistat-1) $$$$

MISCELLANEOUS GENITOURINARY AGENTSEstradiol (Estrace) $$ - $$$$$$$Estrogens, Conjugated (Premarin) $$$$$$$Nitrofurantoin (Macrodantin) $$ - $$$$Sevelamer (Renagel) $$$ - $$$$

IMMUNOLOGICAL AGENTS

IMMUNE SERUMSHepatitis B Immune Globulin (HBIG) $$$$$$$


BACTERIAL VACCINESPneumococcal Vaccine, Polyvalent (Pneumovax) $$$$$

VIRAL VACCINESHepatitis A Vaccine (Vaqta) Havrix) $$$$$$$Hepatitis A/Hepatitis B Vaccine (Twinrix) $$$$$$$Hepatitis B Virus Vaccine, Recombinant (Recombivax HB, Engerix-B ) $$$$$$$Influenza Virus Vaccine (Fluzone, Fluviron) $$Measles, Mumps and Rubella Virus Vaccine, Live (MMR II) $$$$$$$Varicella Virus Vaccine, Live (Varivax) $$$$$$$

TOXOIDSDiphtheria & Tetanus Toxoids Adsorbed (DT) $$$$Diphtheria & Tetanus Toxoids Adsorbed for Adult Use (Td) $$$Diphtheria, Tetanus, & Acellular Pertussis (Tdap) (Boostrix, Adacel) $$$$$$$

IN-VIVO DIAGNOSTIC BIOLOGICALSTuberculin, Purified Protein Derivative (P.P.D.) $$ - $$$$$$$

INFECTIOUS DISEASE AGENTS

ANTIBIOTICSPenicillins

Amoxicillin (Amoxil, Polymox) $ - $$$$Amoxicillin/Clavulanate (Augmentin) $$Ampicillin (Polycillin, Omnipen) $ - $$$$Nafcillin (Unipen) $$$$$$$Penicillin G Benzathine (Bicillin) $$$ - $$$$$$$Penicillin G Benzathine/Penicillin G Procaine (Bicillin C-R) $$$$Penicillin G Procaine (Wycillin) $$ - $$$$$$Penicillin G Sodium $$ - $$$$Penicillin V Potassium (Pen-Vee K, V-Cillin K) $ - $$

Piperacillin/Tazobactam (Zosyn) $$$$$$$


CephalosporinsceFAZolin (Kefzol, Ancef) $$$$ - $$$$$Cefepime (Maxipime) $$$$$$ - $$$$$$

$cefTRIAxone (Rocephin) $$$$$$$Cefuroxime Axetil (Ceftin) - Oral form only - RESERVE USE $$$ - $$$$$Cephalexin (Keflex) $ - $

MacrolidesAzithromycin (Zithromax) $$$$Clarithromycin (Biaxin) $Erythromycin (Erythrocin) $ - $

TetracyclinesDoxycycline (Vibramycin) $ - $$$$$Minocycline $$ - $$$$Tetracycline (Achromycin, Panmycin) $ - $$

QuinolonesCiprofloxacin (Cipro) $- $$$$$$$Levofloxacin (Levaquin) $ - $$$$$$$Moxifloxacin (Avelox) $$$$ - $$$$$$$

AminoglycosidesAmikacin (Amikin) $$$$$Gentamicin (Garamycin) $$Neomycin (Mycifradin) $$ - $$$$Tobramycin (Nebcin) $$$ - $$$$

Miscellaneous AntibioticsClindamycin (Cleocin) $ - $$$$$$$cycloSERINE (Seromycin) RESERVE USE $$$$Linezolid (Zyvox) RESERVE USE $$$$$$$metroNIDAZOLE (Flagyl) $ - $$$$$$$Trimethoprim/Sulfamethoxazole (Co-Trimoxazole, Bactrim, Septra) $ - $$$$$$$Vancomycin (Vancocin) $$$$ - $$$$$$$

ANTIFUNGALSFluconazole (Diflucan) $- $$$$$Griseofulvin (Fulvicin) $Ketoconazole (Nizoral) $$ - $$$Nystatin (Mycostatin) $$ - $$Terbinafine (Lamisil) $$$$


ANTITUBERCULARScycloSERINE (Seromycin) $$$$Ethambutol (Myambutol) $$ - $$$$Ethionamide $$$Isoniazid (INH) $

Pyrazinamide $ - $$$Rifabutin (Mycobutin) $$$$$Rifampin (Rifadin) $$ - $$$$$$$Rifampin/Isoniazid (Rifamate) $$

ANTIVIRALSAll commercially available Antiviral Agents used in the treatment of AIDS/HIV are

considered to be formulary agentsAcyclovir (Zovirax) $$ - $$$$Amantadine (Symmetrel) $$ - $$Oseltamivir (Tamiflu) $$$$$$$valACYclovir (Valtrex) $$$$ - $$$$$$$Zanamivir (Relenza) $$$$$$$

ANTIHELMINTICSIvermectin (Stromectol) $$$ - $$$$$$$Thiabendazole (Mintezol) $$$$

URINARY ANTI-INFECTIVESNitrofurantoin (Macrodantin) $$ - $$$$

MISCELLANEOUS ANTI-INFECTIVESAtovaquone (Mepron) - RESERVE USE $$$$$$$Dapsone $$Pentamidine (Pentam) - RESERVE USE $$$$$$


INTRAVENOUS SOLUTIONS AND ADDITIVES

INTRAVENOUS SOLUTIONSAmino Acid Injection (Aminosyn) $$$$ - $$$$$$$Amino Acid Injection/Dextrose/Electrolytes (Clinimix E) $$$$$$$Dextrose/Sodium Chloride Intravenous Solution $$$$

Dextrose 5% in 0.2% Sodium ChlorideDextrose 5% in 0.45% Sodium ChlorideDextrose 5% in 0.9% Sodium Chloride

Dextrose 5% in Water $ - $$Dextrose 5% in Ringer's Lactate $Dextrose 5% with Multiple Electrolytes (D5 E75, Baxter) $$$Dextrose 5%/Sodium Chloride/Potassium Chloride Intravenous Solution $$$$$$ - $$$$$$

$Dextrose 5%/Sodium Chloride 0.2%/Potassium ChlorideDextrose 5%/Sodium Chloride 0.45%/Potassium ChlorideDextrose 5%/Sodium Chloride 0.9%/Potassium Chloride

Dextrose 50% in Water $$$$ - $$$$$Ringer’s Lactate Solution (Hartmann's Solution) $$Sodium Chloride Intravenous Solution $$$$ - $$$$$

Sodium Chloride 0.2%Sodium Chloride 0.45%Sodium Chloride 0.9%

$ - $$$

Water for Injection $$ - $$$$

ELECTROLYTE REPLACEMENT ADDITIVESCalcium Gluconate $$

Magnesium Sulfate $ - $Potassium Chloride $ - $$Sodium Bicarbonate $ - $$Sodium Chloride $ - $$Sodium Lactate $$$$Zinc Sulfate $ - $$


NUTRITIONAL AGENTS

VITAMINSAscorbic Acid (Vitamin C) $ - $Cyanocobalamin ( Vitamin B12) $ - $$$$$$$Folic Acid (Folvite) $ - $$$$Leucovorin (Wellcovorin) $$ - $$$$Niacin/Nicotinamide (Nicobid) $

Phytonadione (Vitamin K1, Mephyton, Konakion) $$ - $$$Pyridoxine (Vitamin B6) $ - $$Thiamine (Vitamin B1) $ - $Vitamin A (Aquasol A) $ - $$$$$$$Vitamin D (Ergocalciferol, Calciferol, Drisdol) $-$Vitamin E (Aquasol E) $ - $$$$$$$

MINERALS, TRACE ELEMENTS, AND ELECTROLYTESCalcium Carbonate (Os-Cal, Os-Cal Chewable Titralac) - 40% elemental

calcium$

Calcium (Citracal) $

Calcium Glubionate (Neo-Calglucon) - 6% elemental calcium $ - $$Calcium Gluconate - 9% elemental calcium $$

Ferrous Fumarate/Docusate Sodium (Ferro-Sequels) - 33% elemental iron $$

Ferrous Sulfate (Feosol, Fer-In-Sol) -20% elemental iron $

Potassium Chloride $$

Potassium Phosphate (Neutra-Phos-K) $$ - $$$Zinc Sulfate $ - $$

COMBINATION PRODUCTSCalcium Carbonate/Vitamin D (Os-Cal + D) $

Calcium Citrate/Vitamin D (Citrical+D) $

Iron salts with or without vitamins and/or minerals (Hemocyte Plus, Niferex, Niferex-150, Niferex-150 Forte)

$ - $$$$

Multivitamin (Unicap, Hexavitamins) $ - $Multivitamin/Minerals $ - $Multivitamins, Pediatric (Poly-Vi-Sol) $$Multivitamins, Prenatal (Filibon) $

Vitamin B ComplexVitamin B Complex/Vitamin C (Stresscaps, Allbee with C Nephrocaps,

Nephro-vite)$ -$$

Vitamin B Complex/Vitamin C/Zinc $


OSTEOPOROSIS AGENTS

Alendronate (Fosamax) $ - $$Calcitonin-Salmon (Miacalcin) $$$Denosumab (Prolia) $$$$$$$Ibandronate (Boniva) $$$$$$$Raloxifene (Evista) $$Risedronate (Actonel) $$$$$Zoledronic Acid (Reclast Zometa) $$$$$$$

RESPIRATORY AGENTS

BRONCHODILATORSAlbuterol (Proventil, Ventolin Vospire ER) $ - $$$

Aminophylline $$ - $$Ipratropium (Atrovent Inhaler) $$$$$$$Salmeterol (Serevent) $$$$$$$Terbutaline (Brethine) $ - $$$$$$Theophylline (Elixophyllin) $ - $$Tiotropium (Spriva) $$$$$$$

BRONCHODILATORS, COMBINATION/SHORT ACTINGAlbuterol/Ipratropium (Combivent, DuoNeb) $$ - $$$$$$$

BRONCHODILATORS, COMBINATION STEROID + LONG ACTING BETA-2 AGONISTSBudesonide/Formoterol (Symbicort) $$$$$$$Fluticasone/Salmeterol (Advair) $$$ - $$$$$


COUGH, COLD AND DECONGESTANT PREPARATIONSBenzonatate (Tessalon Perle) Antitussive $$$Brompheniramine/Phenylephrine (Dimetapp Cold and Allergy) $

Brompheniramine/Pseudoephedrine (Bromfed) $$

Chlorpheniramine (Chlor-Trimeton, Teldrin) $ - $$Cetirizine/Pseudoephedrine (zyrTEC D) $DextromethorphanAntitussive $ - $$


Fexofenadine (Allegra) $ - $$Fexofenadine/Pseudoephedrine (Allegra-D) $$guaiFENesin/Codeine (Robitussin AC) C-V $$guaiFENesin/Dextromethorphan (Robitussin DM) $ - $$guaiFENesin/Pseudoephedrine (Mucinex D) $$

Hydrocodone/Guaifenesin (Hycotuss, Kwelcof) C-III $$Loratadine (Claritin) $$

Loratadine/Pseudoephedrine (Claritin D) $$ - $$Phenylephrine (Neo-Synephrine) Decongestant $$$Pseudoephedrine (Sudafed) Decongestant $ - $$

Triprolidine/Pseudoephedrine (Actifed) $

EXPECTORANTSguaiFENesin (Robitussin, Mucinex) $ - $$

Potassium Iodide (SSKI) $ - $

STEROIDSBeclomethasone (Beconase QVAR) $$$$$$$Budesonide (Pulmicort) $$$$ - $$$$$Fluticasone (Flonase, Flovent) $$$$$$$Fluticasone/Salmeterol (Advair) $$$ - $$$$$Mometasone (Nasonex) $$$$$$$Triamcinolone (Azmacort, Nasacort) $$$$$$$

MISCELLANEOUS RESPIRATORY DRUGSAcetylcysteine (Mucomyst) $$$$ - $$$$$$Cromolyn (Intal) $$$$$$$Montelukast (Singulair) $$Sodium Chloride $ - $Zafirlukast (Accolate) $$


TOPICAL AGENTS

OPHTHALMICSAgents for Glaucoma

Betaxolol (Betoptic S) $$$$Bimatoprost (Lumigan) $$$$$$$Brimonidine (Alphagan) $$$$$$$Latanoprost (Xalatan) $$$$$$$Pilocarpine (Isopto Carpine) $ - $$$$$$$Timolol (Timoptic) $$ - $$$$$$$Timolol/Dorzolamide (Cosopt) $$$$$$$Travoprost (Travatan) $$$$$$$

AntibioticsBacitracin (Baciguent) $Ciprofloxacin (Ciloxan) $$$$$ - $$$$$$$Erythromycin $$Gentamicin (Garamycin) $$Polymyxin B/Bacitracin (Polysporin) $$$$$$Polymyxin B/Trimethoprim (Polytrim) $$$Sulfacetamide Sodium (Sulamyd) $ - $$$$$$$Tobramycin (Tobrex) $$ - $$$$$$$

MydriaticsAtropine Sulfate (Isopto Atropine) $$Homatropine (Isopto Homatropine) $$ - $$$$Phenylephrine (Neo-Synephrine) $$ - $$$$Scopolamine (Isopto Hyoscine) $$ - $$$Tropicamide (Mydriacyl) $$ - $$$$

LubricantsOphthalmic Lubricant (Artifical Tears, Liquitears, HypoTears, HypoTears

PF)$$-$$$$

Decongestant/AntiallergyKetotifen (Zaditor) $$$$Naphazoline (Naphcon, AK-Con) $$Olopatadine (Patanol) $$$$$$$Tetrahydrozoline (Visine Allergy Relief, Visine Moisturizing) $$$


Miscellaneous OphthalmicsCromolyn (Intal $$$-$$$$Dexamethasone (Decadron) - RESERVE USE $$Fluorescein Sodium $ - $$$Ophthalmic Irrigating Solution (BSS, Eye Stream, AK-Rinse) $$prednisoLONEPred Mild, Pred Forte Reserve Use

$$$$$$ - $$$$$$$

Proparacaine (Alcaine) $$Sodium Chloride $$ - $$$$Tobramycin/Dexamethasone (TobraDex)- RESERVE USE $$$$$$ - $$$$$$

$

OTICSAcetic Acid (Acetasol, VoSol) $$Acetic Acid/Aluminum Acetate (Domeboro Otic) $Acetic Acid/Hydrocortisone/Propylene Glycol/ Sodium

Acetate/Benzethonium (VoSol HC)$$

Antipyrine/Benzocaine (Allergen, Auralgan) $ - $$Carbamide Peroxide/Glycerin/Propylene Glycol/ Sodium Stannate (Debrox) $Ciprofloxacin/Hydrocortisone (Cipro HC Otic) $$$$$$$Hydrogen Peroxide $$

Mineral Oil $$Neomycin/Polymyxin B/Hydrocortisone (Cortisporin - ear drops only) $$$

NASAL, MOUTH AND THROAT AGENTSAzelastine (Astelin) 0.1% nasal spray 137 mcg/spray $$$$$$$Benzocaine (Oragel Cepacol) $$ - $$$Carbamide Peroxide/Glycerin/Propylene Glycol/ Sodium Stannate (Gly-

Oxide)$$$

Carboxymethylcellulose/Electrolytes (Saliva Substitute, Moi-Stir, Salivart, MouthKote, Salix)

$ - $$$

Chlorhexidine (Peridex) $$Clotrimazole (Mycelex, Fungoid) $$Doxycycline (Periostat) $$$Fluticasone (Flonase, Flovent) $$$$ - $$$$$$$Nystatin (Mycostatin) $$ - $$$Oxymetazoline (Afrin) $

Phenol (Chloraseptic) $$Phenylephrine (Neo-Synephrine) $$Sodium Chloride $$

Sodium Fluoride $

Stannous Fluoride (OmniMed, PerioMed) $$$$


DERMATOLOGICALSAcne Agents

Adapalene (Differin) $$$$$$$Benzoyl Peroxide $ - $$Benzoyl Peroxide/Clindamycin (BenzaClin) $$$$$$$Clindamycin (Cleocin T) $$$ - $$$$$$Erythromycin/Benzoyl Peroxide (Benzamycin) $$$$$$$metroNIDAZOLE (Noritate, MetroGel) $$$$$$$Salicyclic Acid/Sulfur $-$$$$Sulfacetamide Sodium (Sebizon) $$$$$$$Tazarotene (Tazorac, Avage) $$$$$$$Tretinoin Gel (Retin-A) $$$$$$ - $$$$$$

$

Anesthetics, LocalBenzocaine (Lanacaine) $$ - $$$Ethyl Chloride $$$$$$$Lidocaine (Xylocaine) $$ - $$$$$$Lidocaine/Prilocaine (EMLA, Lidoderm) $$$ - $$$$Pramoxine (Tronothane) $$$ - $$$$$$$

Anti-Histamine AgentsCalamine/Zinc Oxide/Glycerin (Calamine Lotion) $Calamine/Pramoxine (Caladryl) $$$diphenhydrAMINE (Benadryl) $Doxepin (Zonalon) $$$$$$$Pramoxine/Zinc (Caladryl Clear) $$

Anti-InfectivesAntibiotics

Bacitracin (Baciguent) $Bacitracin/Polymyxin B (Polysporin) $$$ - $$$$Clindamycin (Cleocin T) $$$ - $$$$$$Gentamicin (Garamycin) $$$metroNIDAZOLE (Noritate, MetroGel) $$$$$$$Mupirocin (Bactroban) $$$$$$$Neomycin/Polymyxin B/Bacitracin (Triple Antibiotic Ointment) $Polymyxin B/Neomycin (Neosporin) $$ - $$$$$$$

AntiviralAcyclovir (Zovirax) $$$$$$$


AntifungalsCiclopirox (Loprox Penlac) $$$$-$$$$$$$Clotrimazole (Lotrimin, Fungoid) $$$$$$Ketoconazole (Nizoral) $$$$$$ - $$$$$$

$Miconazole (Monistat) $$$ - $$$$$$Nystatin (Mycostatin) $$ - $$$$$Terbinafine (Lamisil) $$$$$$$Tolnaftate (Tinactin) $$ - $$$

AntipsoriaticsCalcipotriene (Dovonex) $$$$$$$Coal Tar (Ionil-T, Tegrin, Pentrax, Polytar) $$$Selenium Sulfide (Selsun) $$ - $$$$Tazarotene (Tazorac, Avage) $$$$$$$

Antiseborrheic AgentsCoal Tar (Ionil-T, Tegrin, Pentrax, Polytar) $$$Salicyclic Acid/Sulfur $-$$$$Selenium Sulfide (Selsun) $$ - $$$$Sulfacetamide Sodium (Sebizon) $$$$$$$

Antiseptics & GermacidesChlorhexidine (Hibiclens, Bactoshield) $$ - $$$Hexachlorophene (pHisoHex) $$$ - $$$$$$$Povidone-Iodine (Betadine) $ - $$$$$

Burn AgentsBacitracin (Baciguent) $Silver Sulfadiazine (Silvadene) $$ - $$$$$$$


CorticosteroidsUltra High Potency

Betamethasone dipropionate, augmented (Diprolene A/F) - RESERVE USE $$$$$$$Clobetasol (Clobex, Cormax,Temovate) - RESERVE USE $$ - $$$$$$$

High PotencyBetamethasone dipropionate (Diprolene) $$ - $$$$$$Fluocinonide (Lidex) $ - $$$

Medium PotencyBetamethasone Valerate (Valisone) $$ - $$$$Fluocinolone (Capex, Derma-Smooth/FS, Synalar) $$$$ - $$$$$$$Triamcinolone (Aristocort, Kenacort) $ - $$$$$

Low PotencyDesonide (Desowen, Lokara, Tridesilon) $$ - $$$$$$$Hydrocortisone (Lanacort, Corticaine) $ - $$

Diaper Rash AgentsDiaper Rash Ointment (Desitin, Vitamin A&D Topical, Diaperene ) $ - $$Diaper Rash Powder (Mexsana) $$Zinc Oxide $$$ - $$$$$$

EmollientsEmollient Gel (Clinac O.C.) $$$$Emollient Lotion/Cream (Lubriderm, Allercreme, Keri Lotion, Cetaphil, Lac-

Hydrin, Eucerin, Nutraderm)$$ - $$$$

Emollient Ointment (Lanolin, Aquaphor) $ - $$$

KeratolyticsPodophyllum Resin (Podocon-25) $$$$$$$Salicylic Acid(Compound W, DuoFilm, Mediplast, Salex, Neutrogena) $$ - $$$$$$$Urea $$$$ - $$$$$$$

Ointment & Lotion BasesPetrolatum, White (Vaseline) $ - $$Oxybenzone/PDO/Pet Hy-Phl (Vaseline Lip Therapy) $

Rubs and LinimentsMenthol $$ - $$$$Menthol/Methyl Salicylate (Ben-Gay) $$ - $$$$


Skin CleansersAbrasive Cleanser (Brasivol, Pernox, Salac, Seba-Nil) $$$$Non-Soap Cleanser (Cetaphil) $$$ - $$$$Salicyclic Acid/Sulfur $-$$$$

Scabicides & PediculicidesPermethrin 1% Liquid (NIX) $$$Permethrin 5% Cream (Acticin), Elimite) $$$ - $$$$$Pyrethins 0.33%/Piperonyl Butoxide 4% (Pronto, RID)

Skin ProtectantsBenzoin, Compound Tincture $$Menthol/Zinc Oxide (Calmoseptine, Risamine) $$ - $$$Silver Sulfadiazine (Silvadene) $$ - $$$$$$$Zinc Oxide $$$ - $$$$$$

SunscreensCream/Lotion: contains a minimum SPF of 15 $$$$

Tar-Containing AgentsCoal Tar (Ionil-T, Tegrin, Pentrax, Polytar) $$$ - $$$$$$

Wound AgentsCollagenase (Santyl) $$$$$$$Papin/Urea (Accuzyme, Gladase, Kovia, Ethezyme) $$$$$ - $$$$$$$Papin/Urea/Chlorophyllin (Gladase C, Panafil) $$$$$ - $$$$$$$Trypsin/Balsam Peru/Castor Oil (Granulex, GranuloDerm, Revina, TBC, Vasolex, Xenaderm)

$$$$$$$

Wound Cleanser , CarraKlenz)

$$$$-$$$$$

Miscellaneous DermatologicalsAluminum Chloride Hexahydrate (Drysol) $$$$Camphor-Phenol (Campho-Phenique) $$Hydrogen Peroxide $Pimecrolimus (Elidel) $$$$$$$Silver Nitrate $$

Tacrolimus (Protopic) $$$$$$$Trypsin/Balsam Peru/Castor Oil (Granulex) $$$$ - $$$$$

IRRIGATION SOLUTIONSSodium Chloride $$$Water for Injection $$ - $$$$


NUTRITIONAL SUPPLEMENTS*Fish Oil (Nature Made Fish Oil) $

Glucosamine $$

Magnesium L-lactate dihydrate (Mag-Tab SR) $Melatonin $

*The following certification processes and product lines certifiedGood Manufacturer Practices (GMP) Nature’s Way

Country LifeTwin

Consumer Labs (CL) Good Neighbor PharmacySundown

United States Pharmacopoeia (USP) Nature MadeNational Sanitation Foundation (NSF) GNC Nutritional Supplements


Alphabetical IndexAbilify................................................................14, 30, 86Abilify discmelt........................................................30, 86Abilify Maintena................................................14, 30, 86Abrasive Cleanser................................................26, 107Acamprosate..........................................................26, 87Accolate................................................................77, 101Accuzyme.............................................................62, 107Acetaminophen.......................................................26, 84Acetaminophen/Codeine........................................26, 84Acetaminophen/Hydrocodone................................26, 84Acetasol................................................................26, 103acetaZOLAMIDE....................................................26, 82Acetic Acid............................................................26, 103Acetic Acid/Aluminum Acetate..............................26, 103Acetic Acid/Hydrocortisone/Propylene Glycol/Sodium

Acetate/Benzethonium......................................27, 103Acetylcysteine.................................................27, 80, 101Achromycin.............................................................72, 96Acticin...................................................................63, 107Actifed...................................................................75, 101Activated Charcoal...........................................27, 80, 93Actonel..................................................................68, 100Actos......................................................................64, 79Acyclovir.........................................................27, 97, 104Adacel....................................................................42, 95Adapalene............................................................27, 104Adderall............................................................19, 29, 87Adderall XR......................................................19, 29, 87Adenocard..............................................................27, 82Adenosine...............................................................27, 82Adrenalin................................................................43, 83Advair...........................................................47, 100, 101Afrin......................................................................62, 103AK-Con.................................................................59, 102AK-Rinse..............................................................61, 103Albuterol...............................................................27, 100Albuterol/Ipratropium............................................27, 100Alcaine..................................................................66, 103Aldactazide.............................................................71, 82Aldactone................................................................71, 82Aldomet..................................................................56, 83Alendronate..........................................................27, 100Allbee with C...........................................................77, 99Allegra............................................................45, 80, 101Allegra-D...............................................................45, 101Allercreme............................................................43, 106Allergen................................................................29, 103Allopurinol...............................................................27, 91Alora.......................................................................44, 90Alphagan..............................................................33, 102ALPRAZolam..............................................21, 28, 85, 87Aludrox...................................................................28, 91Aluminum Chloride Hexahydrate..........................28, 107Aluminum Hydroxide..............................................28, 91Aluminum Hydroxide/Magnesium Hydroxide..........28, 91Aluminum Hydroxide/Magnesium

Hydroxide/Simethicone.......................................28, 91

Aluminum Hydroxide/Magnesium Trisilicate...........28, 91Amantadine......................................................28, 89, 97Ambien.............................................................22, 78, 87Amikacin.................................................................28, 96Amikin.....................................................................28, 96Amino Acid Injection...............................................28, 98Amino Acid Injection/Dextrose/Electrolytes............28, 98Aminophylline.......................................................28, 100Aminosyn................................................................28, 98Amiodarone............................................................28, 82Amitriptyline......................................................16, 28, 85Amlodipine..............................................................29, 82Amoxapine........................................................16, 29, 86Amoxicillin...............................................................29, 95Amoxicillin/Clavulanate...........................................29, 95Amoxil.....................................................................29, 95Amphetamine Mixture.......................................19, 29, 87Amphojel.................................................................28, 91Ampicillin................................................................29, 95Anafranil...........................................................16, 37, 85Ancef......................................................................35, 96Androlan.................................................................72, 90Antabuse................................................................42, 80Antara.....................................................................45, 83Antilirium.................................................................64, 80Antipyrine/Benzocaine..........................................29, 103Antivert...................................................................55, 84Antiviral Agents.......................................................29, 97Anusol....................................................................68, 93Anusol-HC..............................................................68, 93Apresoline...............................................................49, 83Aquaphor..............................................................43, 106Aquasol A...............................................................76, 99Aquasol E...............................................................77, 99Aricept....................................................................42, 89ARIPiprazole.....................................................14, 30, 86ARIPiprazole Maintena.................................................14Aristocort........................................................74, 90, 106Arixtra.....................................................................47, 81Artane.....................................................................75, 89Artifical Tears........................................................61, 102Asacol.....................................................................56, 93Ascorbic Acid..........................................................30, 99Asenapine.........................................................14, 30, 86Asendin.............................................................16, 29, 86Aspirin...............................................................30, 81, 84Aspirin/Acetaminophen/Caffeine............................30, 89Astelin...................................................................30, 103Atarax...................................................22, 50, 80, 84, 87Atenolol.............................................................30, 83, 89Ativan....................................................21, 54, 85, 87, 88Atomoxetine......................................................19, 30, 87Atorvastatin.............................................................30, 83Atovaquone......................................................23, 30, 97Atropine Sulfate....................................................30, 102Atrovent................................................................51, 100Augmentin..............................................................29, 95

Auralgan...............................................................29, 103Avage...........................................................72, 104, 105Avelox.....................................................................58, 96Aventyl..............................................................16, 60, 85Azelastine.............................................................30, 103Azilect.....................................................................68, 89Azithromycin...........................................................31, 96Azmacort..............................................................74, 101Azulfidine................................................................71, 93B.A.L.......................................................................41, 80Bacid......................................................................52, 93Baciguent..............................................31, 102, 104, 105Bacitracin..............................................31, 102, 104, 105Bacitracin/Polymyxin B.........................................31, 104Baclofen..................................................................31, 88Bactoshield...........................................................36, 105Bactrim...................................................................75, 96Bactroban.............................................................58, 104Banzel....................................................................68, 88Beclomethasone...................................................31, 101Beconase..............................................................31, 101Benadryl................................22, 41, 80, 84, 87, 101, 104Benazepril...............................................................31, 83Ben-Gay...............................................................57, 106Benicar.............................................................24, 61, 83Bentyl.....................................................................41, 91BenzaClin.............................................................32, 104Benzamycin..........................................................44, 104Benzocaine...................................................31, 103, 104Benzoin, Compound Tincture...............................31, 107Benzonatate.........................................................31, 101Benzoyl Peroxide..................................................32, 104Benzoyl Peroxide/Clindamycin.............................32, 104Benztropine............................................................32, 89Betadine...............................................................65, 105Betamethasone dipropionate................................32, 106Betamethasone dipropionate, augmented..............23, 32Betamethasone Valerate......................................32, 106Betaxolol...............................................................32, 102Bethanechol............................................................32, 94Betoptic S.............................................................32, 102Biaxin......................................................................37, 96Bicillin.....................................................................62, 95Bicillin C-R..............................................................62, 95Bicitra.....................................................................70, 94Bimatoprost..........................................................32, 102Birth Control Agents...............................................32, 90Bisacodyl................................................................33, 92Bismatrol.................................................................33, 93Bismuth Subsalicylate............................................33, 93Bonine....................................................................55, 84Boniva...................................................................50, 100Boostrix...................................................................42, 95Brasivol.................................................................26, 107Brethine................................................................72, 100Brimonidine...........................................................33, 102Bromfed................................................................33, 101Bromocriptine.........................................................33, 89

Brompheniramine/Phenylephrine.........................33, 101Brompheniramine/Pseudoephedrine....................33, 101BSS......................................................................61, 103Budeprion...............................................................33, 86Budeprion ER.........................................................33, 86Budeprion SR.........................................................33, 86Budesonide...........................................................33, 101Budesonide/Formoterol........................................33, 100buPROPion.......................................................16, 33, 86buPROPion SR.............................................................16buPROPion XL.............................................................16BuSpar..............................................................21, 33, 87busPIRone........................................................21, 33, 87Caladryl................................................................34, 104Caladryl Clear.......................................................65, 104Calamine Lotion....................................................33, 104Calamine/Pramoxine............................................34, 104Calamine/Zinc Oxide/Glycerin..............................33, 104Calan................................................................76, 82, 89Calciferol...........................................................43, 77, 99Calcipotriene.........................................................34, 105Calcitonin-Salmon................................................34, 100Calcium Carbonate...........................................34, 91, 99Calcium Carbonate/Vitamin D................................34, 99Calcium Citrate.......................................................34, 99Calcium Citrate/Vitamin D.......................................34, 99Calcium Glubionate................................................34, 99Calcium Gluconate...........................................34, 98, 99Calmoseptine........................................................56, 107Campho-Phenique................................................34, 107Camphor-Phenol..................................................34, 107Campral..................................................................26, 87Capex...................................................................46, 106Capoten..................................................................34, 83Captopril.................................................................34, 83Carafate..................................................................71, 93carBAMazepine....................................18, 25, 35, 86, 88Carbamide Peroxide/Glycerin/Propylene Glycol/Sodium

Stannate............................................................35, 103Carbatrol...............................................18, 25, 35, 86, 88Carbidopa/Levodopa..............................................35, 89Carboxymethylcellulose/Electrolytes....................35, 103Cardizem................................................................41, 82CarraKlenz............................................................77, 107Carvedilol................................................................35, 83Catapres...........................................................19, 38, 83ceFAZolin...............................................................35, 96Cefepime................................................................35, 96Ceftin......................................................................35, 96cefTRIAxone...........................................................35, 96Cefuroxime Axetil...................................................35, 96celeXA..............................................................16, 37, 85Cellulose.................................................................35, 92Cepacol................................................................31, 103Cephalexin..............................................................36, 96Cephulac................................................................52, 92Cerebyx..................................................................47, 88Cetaphil..................................................43, 60, 106, 107

Cetirizine.................................................................36, 80Cetirizine/Pseudoephedrine..................................36, 101Chloral Hydrate.................................................22, 36, 87Chloraseptic..........................................................63, 103ChlordiazePOXIDE...........................................21, 36, 85Chlorhexidine................................................36, 103, 105Chlorpheniramine...........................................36, 80, 101chlorproMAZINE...............................................14, 36, 86Chlorthalidone........................................................36, 81Chlor-Trimeton................................................36, 80, 101Cholestyramine.......................................................36, 83Ciclopirox..............................................................36, 105Ciloxan..................................................................37, 102Cipro.......................................................................37, 96Cipro HC Otic.......................................................37, 103Ciprofloxacin...................................................37, 96, 102Ciprofloxacin/Hydrocortisone................................37, 103Citalopram........................................................16, 37, 85Citracal...................................................................34, 99Citrical+D................................................................34, 99Citrolith...................................................................65, 94Citrucel...................................................................56, 92Clarithromycin.........................................................37, 96Claritin............................................................54, 80, 101Claritin D...............................................................54, 101Cleocin...................................................................37, 96Cleocin T..............................................................37, 104Climara...................................................................44, 90Clinac O.C............................................................43, 106Clindamycin....................................................37, 96, 104Clinimix E................................................................28, 98Clinoril....................................................................71, 84Clobazam...............................................................37, 88Clobetasol.......................................................23, 37, 106Clobex..................................................................37, 106clomiPRAMINE.................................................16, 37, 85clonazePAM.........................................21, 37, 85, 87, 88cloNIDine..........................................................19, 38, 83cloNIDine Extended Release........................................19Clopidogrel.......................................................23, 38, 81Clorazepate................................................21, 38, 85, 88Clotrimazole............................................38, 94, 103, 105cloZAPine...................................................14, 23, 38, 86Clozaril........................................................14, 23, 38, 86Coal Tar........................................................38, 105, 107Cod Liver Oil/Zinc Oxide/Talc.................................38, 41Cogentin.................................................................32, 89Colace....................................................................42, 93Colchicine...............................................................38, 91Collagenase..........................................................38, 107Co-Lyte...................................................................67, 92Combivent............................................................27, 100Compazine.............................................................66, 84Compound W........................................................69, 106Comtan...................................................................43, 89Concerta...........................................................19, 56, 87Cordarone...............................................................28, 82Coreg......................................................................35, 83

Cormax.................................................................37, 106Corticaine.............................................................50, 106Cortisporin............................................................59, 103Cosopt..................................................................73, 102Co-Trimoxazole......................................................75, 96Coumadin...............................................................77, 81Creon......................................................................62, 93Cromolyn......................................................38, 101, 103Cuprimine...............................................................62, 80Cyanocobalamin.....................................................39, 99Cyclobenzaprine.....................................................39, 89cycloSERINE..............................................23, 39, 96, 97Cymbalta..........................................................16, 43, 85Cyproheptadine......................................................39, 80Cytotec...................................................................58, 93D5 E75...................................................................40, 98Dantrium.................................................................39, 88Dantrolene..............................................................39, 88Dapsone.................................................................39, 97Darifenacin.............................................................39, 94DDAVP...................................................................39, 91Debrox..................................................................35, 103Decadron........................................................40, 90, 103Deferoxamine.........................................................39, 80Delta-Cortef............................................................66, 90Deltasone...............................................................66, 90Denosumab..........................................................39, 100Depakene.......................................18, 25, 76, 86, 88, 89Depakote..............................................18, 25, 42, 86, 89Depakote ER..............................................42, 86, 88, 89Depo-Medrol...........................................................57, 90Derma-Smooth/FS................................................46, 106Desferal..................................................................39, 80Desipramine.....................................................16, 39, 85Desitin.............................................................38, 41, 106Desmopressin.........................................................39, 91Desonide..............................................................39, 106Desowen...............................................................39, 106Desyrel.................................................16, 22, 74, 86, 87Detrol......................................................................74, 94Detrol LA.................................................................74, 94Dexamethasone.............................................40, 90, 103Dexedrine.........................................................19, 40, 87Dexedrine spansules....................................................40Dextroamphetamine.........................................19, 40, 87Dextromethorphan................................................40, 101Dextrose 5% in 0.2% Sodium Chloride...................40, 98Dextrose 5% in 0.45% Sodium Chloride.................40, 98Dextrose 5% in 0.9% Sodium Chloride...................40, 98Dextrose 5% in Ringer's Lactate.............................40, 98Dextrose 5% in Water.............................................40, 98Dextrose 5% with Multiple Electrolytes...................40, 98Dextrose 5%/Sodium Chloride 0.2%/Potassium Chloride

............................................................................40, 98Dextrose 5%/Sodium Chloride 0.45%/Potassium

Chloride..............................................................40, 98Dextrose 5%/Sodium Chloride 0.9%/Potassium Chloride

............................................................................40, 98

Dextrose 5%/Sodium Chloride/Potassium Chloride Intravenous Solution...........................................40, 98

Dextrose 50% in Water.....................................40, 79, 98Dextrose/Sodium Chloride Intravenous Solution....40, 98Dextrostat...............................................................40, 87DiaBeta...................................................................48, 79Diamox...................................................................26, 82Diaper Rash Powder............................................41, 106Diaperene.......................................................41, 77, 106Diastat....................................................................41, 88Diazepam........................................21, 41, 85, 87, 88, 89Dicyclomine............................................................41, 91Differin..................................................................27, 104Diflucan..................................................................46, 96Digoxin...................................................................41, 82Dilantin..............................................................25, 64, 88Diltiazem.................................................................41, 82Dimercaprol............................................................41, 80Dimetapp Cold and Allergy...................................33, 101Diovan..............................................................24, 76, 83diphenhydrAMINE.................22, 41, 80, 84, 87, 101, 104Diphtheria & Tetanus Toxoids Adsorbed................42, 95Diphtheria & Tetanus Toxoids Adsorbed for Adult Use42,

95Diphtheria, Tetanus, & Acellular Pertussis..............42, 95Diprolene..............................................................32, 106Diprolene A/F..................................................23, 32, 106Disulfiram................................................................42, 80Ditropan..................................................................61, 94Ditropan XL.............................................................61, 94Divalproex.......................................18, 25, 42, 86, 88, 89Divalproex ER.................................18, 25, 42, 86, 88, 89Docusate Calcium..................................................42, 93Docusate Sodium...................................................42, 93Docusate Sodium/Sennosides................................42, 92Dolophine...............................................................56, 84Domeboro Otic.....................................................26, 103Donepezil................................................................42, 89DOPamine..............................................................42, 83Dovonex...............................................................34, 105Doxepin....................................................16, 42, 85, 104Doxinate.................................................................42, 93Doxycycline....................................................42, 96, 103Drisdol..............................................................43, 77, 99Drysol...................................................................28, 107DT...........................................................................42, 95Dulcolax..................................................................33, 92DULoxetine.......................................................16, 43, 85DuoFilm................................................................69, 106DuoNeb................................................................27, 100Duragesic...............................................................45, 84Dyazide..................................................................75, 82Dyrenium................................................................74, 82Effexor..............................................................16, 76, 85Elavil.................................................................16, 28, 85Elidel.....................................................................64, 107Elimite...................................................................63, 107Elixophyllin............................................................72, 100

EMLA....................................................................54, 104Emollient Gel..............................................................106Emollient Lotion/Cream..............................................106Emollient Lotion/Cream/Gel..........................................43Emollient Ointment...............................................43, 106Enablex..................................................................39, 94Enalapril..................................................................43, 83Engerix-B................................................................49, 95Enoxaparin.............................................................43, 81Entacapone............................................................43, 89EPINEPHrine..........................................................43, 83Epoetin alfa.......................................................24, 43, 81Epogen.............................................................24, 43, 81Epsom Salt.............................................................55, 92Ergocalciferol....................................................43, 77, 99Erythrocin...............................................................43, 96Erythromycin...................................................43, 96, 102Erythromycin/Benzoyl Peroxide............................44, 104Escitalopram.....................................................16, 44, 85Esidrix.....................................................................50, 81Eskalith.............................................................18, 54, 86Esomeprazole...................................................24, 44, 92Estrace.............................................................44, 90, 94Estraderm...............................................................44, 90Estradiol............................................................44, 90, 94Estrogen/medroxyPROGESTERone......................44, 90Estrogens, Conjugated.....................................44, 90, 94Ethambutol.............................................................44, 97Ethezyme..............................................................62, 107Ethinyl Estradiol/Norethindrone..............................44, 90Ethinyl Estradiol/Norgestrel....................................44, 90Ethionamide............................................................44, 97Ethosuximide....................................................25, 45, 88Ethyl Chloride.......................................................45, 104Eucerin.................................................................43, 106Evista....................................................................67, 100Excedrine Migraine.................................................30, 89Exelon....................................................................68, 89Exelon Patches.......................................................68, 89Eye Stream...........................................................61, 103Famotidine..............................................................45, 91Fanapt........................................................14, 24, 50, 86Fazaclo.......................................................14, 23, 38, 86Felbamate.........................................................24, 45, 88Felbatol.............................................................24, 45, 88Felodipine...............................................................45, 82Fenofibrate.............................................................45, 83fentaNYL.................................................................45, 84Feosol...............................................................45, 81, 99Fer-In-Sol..........................................................45, 81, 99Ferro-Sequels...................................................45, 81, 99Ferrous Fumarate/Docusate Sodium................45, 81, 99Ferrous Sulfate.................................................45, 81, 99Fexofenadine..................................................45, 80, 101Fexofenadine/Pseudoephedrine...........................45, 101Fibercon..................................................................64, 92Fiber-Lax................................................................64, 92Filibon.....................................................................58, 99

Finasteride..............................................................45, 94Fish Oil.................................................................46, 108Flagyl......................................................................57, 96Flavoxate................................................................46, 94Flexeril....................................................................39, 89Flomax....................................................................71, 94Flonase.........................................................46, 101, 103Florinef...................................................................46, 90Flovent..........................................................46, 101, 103Fluconazole............................................................46, 96Fludrocortisone.......................................................46, 90Fluocinolone.........................................................46, 106Fluocinonide.........................................................46, 106Fluorescein Sodium..............................................46, 103FLUoxetine.................................................16, 46, 85, 89fluPHENAZine..................................................14, 46, 86fluPHENAZine Decanoate......................................14, 86Fluticasone...................................................46, 101, 103Fluticasone/Salmeterol.................................47, 100, 101Fluvastatin..............................................................47, 83Fluviron...................................................................51, 95fluvoxaMINE.....................................................16, 47, 85Fluzone...................................................................51, 95Folic Acid................................................................47, 99Folvite.....................................................................47, 99Fondaparinux..........................................................47, 81Fosamax...............................................................27, 100Fosphenytoin..........................................................47, 88Fulvicin...................................................................48, 96Fungoid.........................................................38, 103, 105Furosemide.............................................................47, 82Gabapentin.............................................................47, 88Gabatril...................................................................73, 88Galantamine...........................................................47, 89Garamycin..............................................47, 96, 102, 104Gaviscon.................................................................28, 91Gemfibrozil.............................................................47, 83Gentamicin.............................................47, 96, 102, 104Geodon.............................................................14, 78, 86Gladase................................................................62, 107Gladase C.............................................................62, 107glipiZIDE.................................................................48, 79Glucagon..........................................................48, 79, 80Glucophage............................................................56, 79Glucophage XR......................................................56, 79Glucosamine.........................................................48, 108Glucose..................................................................48, 79Glucotrol.................................................................48, 79glyBURIDE.............................................................48, 79Glycerin..................................................................48, 93Glycopyrrolate........................................................48, 91Gly-Oxide..............................................................35, 103GoLYTELY.............................................................67, 92Granulex...............................................................75, 107GranuloDerm........................................................75, 107Griseofulvin.............................................................48, 96guaiFENesin.........................................................48, 101guaiFENesin/Codeine...........................................48, 101

guaiFENesin/Dextromethorphan..........................49, 101guaiFENesin/Pseudoephedrine............................49, 101guanFACINE....................................................19, 49, 87guanFACINE Extended Release..................................19Gyne-Lotrimin.........................................................38, 94Habitrol...................................................................59, 80Halcion........................................................22, 75, 85, 87Haldol...............................................................14, 49, 86Haldol Decanoate.........................................................14Haloperidol.......................................................14, 49, 86Haloperidol Decanoate.................................................14Hartmann's Solution...............................................68, 98Havrix.....................................................................49, 95HBIG.......................................................................49, 94Hemocyte Plus.......................................................51, 99Heparin...................................................................49, 81Hepatitis A Vaccine................................................49, 95Hepatitis A/Hepatitis B Vaccine..............................49, 95Hepatitis B Immune Globulin..................................49, 94Hepatitis B Virus Vaccine, Recombinant................49, 95Hexachlorophene.................................................49, 105Hexavitamins..........................................................58, 99Hibiclens...............................................................36, 105Homatropine.........................................................49, 102humaLOG...............................................................51, 79humaLOG Mix 75/25..............................................51, 79Hycotuss...............................................................50, 101hydrALAZINE..........................................................49, 83Hydrochlorothiazide................................................50, 81Hydrocodone/Guaifenesin....................................50, 101Hydrocortisone...............................................50, 90, 106HydroDIURIL..........................................................50, 81Hydrogen Peroxide.......................................50, 103, 107hydrOXYzine.........................................22, 50, 80, 84, 87Hygroton.................................................................36, 81HypoTears............................................................61, 102HypoTears PF......................................................61, 102Ibandronate..........................................................50, 100Ibuprofen................................................................50, 84Iloperidone..................................................14, 24, 50, 86Imdur......................................................................52, 82Imipramine........................................................16, 50, 85Imitrex.....................................................................71, 89Imodium..................................................................54, 93Inderal.........................................................19, 67, 83, 89Influenza Virus Vaccine..........................................51, 95INH.........................................................................51, 97Insulin, Aspart.........................................................51, 79Insulin, Combination (70/30)...................................51, 79Insulin, Glargine......................................................51, 79Insulin, Lente..........................................................51, 79Insulin, Lispro.........................................................51, 79Insulin, Lispro/Insulin, Lispro Protamine.................51, 79Insulin, NPH............................................................51, 79Insulin, Regular.......................................................51, 79Insulin, Ultralente....................................................51, 79Intal...............................................................38, 101, 103Intropin...................................................................42, 83

Intuniv...........................................................................19Invega...............................................................14, 62, 86Invega Sustenna...............................................14, 62, 86Ionil-T............................................................38, 105, 107Ipratropium...........................................................51, 100Iron salts with or without vitamins and/or minerals. 51, 99ISMO......................................................................52, 82Isoniazid.................................................................51, 97Isoptin...............................................................76, 82, 89Isopto Atropine.....................................................30, 102Isopto Carpine......................................................64, 102Isopto Homatropine..............................................49, 102Isopto Hyoscine....................................................69, 102Isordil......................................................................52, 82Isosorbide Dinitrate.................................................52, 82Isosorbide Mononitrate...........................................52, 82Ivermectin...............................................................52, 97Kaolin-Pectin..........................................................52, 93Kaopectate.............................................................33, 93Kapvay.........................................................................19Kayexalate..............................................................70, 84Keflex.....................................................................36, 96Kefzol.....................................................................35, 96Kenacort.........................................................74, 90, 106Keppra....................................................................53, 88Keri Lotion............................................................43, 106Ketoconazole..................................................52, 96, 105Ketorolac................................................................52, 84Ketotifen...............................................................52, 102KlonoPIN..............................................21, 37, 85, 87, 88Konakion.................................................................64, 99Kovia....................................................................62, 107Kwelcof.................................................................50, 101Labetalol.................................................................52, 83Lac-Hydrin............................................................43, 106Lacosamide............................................................52, 88Lactinex..................................................................52, 93Lactobacillus Acidophilus........................................52, 93Lactulose................................................................52, 92laMICtal......................................................18, 53, 86, 88Lamisil............................................................72, 96, 105lamoTRIgine...............................................18, 53, 86, 88Lanacaine.............................................................31, 104Lanacort................................................................50, 106Lanolin..................................................................43, 106Lanoxin...................................................................41, 82Lansoprazole..........................................................53, 92Lantus.....................................................................51, 79Lasix.......................................................................47, 82Latanoprost...........................................................53, 102Latuda...............................................................14, 54, 86Lescol.....................................................................47, 83Leucovorin........................................................53, 80, 99Levaquin.................................................................53, 96Levarterenol......................................................53, 60, 83leVETIRAcetam......................................................53, 88Levofloxacin............................................................53, 96Levonorgestrel/Ethinyl Estradiol.............................53, 90

Levophed..........................................................53, 60, 83Levothyroxine.........................................................53, 90Levoxyl...................................................................53, 90Lexapro.............................................................16, 44, 85Librium..............................................................21, 36, 85Lidex.....................................................................46, 106Lidocaine..............................................................53, 104Lidocaine/Prilocaine.............................................54, 104Lidoderm...............................................................53, 104Linezolid...........................................................24, 54, 96Lioresal...................................................................31, 88Lipitor......................................................................30, 83Liquitears..............................................................61, 102Lisdexamfetamine dimesylate..........................24, 54, 87Lisinopril.................................................................54, 83Lithium..............................................................18, 54, 86Lithobid.............................................................18, 54, 86Lithonate.................................................................54, 86Loestrin...................................................................44, 90Lofibra....................................................................45, 83Lokara...................................................................39, 106Lo-Ovral..................................................................44, 90Loperamide.............................................................54, 93Lopid.......................................................................47, 83Lopressor..........................................................57, 83, 89Loprox...................................................................36, 105Loratadine.......................................................54, 80, 101Loratadine/Pseudoephedrine................................54, 101LORazepam.........................................21, 54, 85, 87, 88Lortab.....................................................................26, 84Lotensin..................................................................31, 83Lotrimin.................................................................38, 105Lovenox..................................................................43, 81Loxapine...........................................................14, 54, 86Loxitane............................................................14, 54, 86Lubriderm.............................................................43, 106Ludiomil............................................................16, 55, 86Lumigan................................................................32, 102Luminal.............................................................25, 63, 88Lurasidone........................................................14, 54, 86Luvox................................................................16, 47, 85Lyrica......................................................................66, 88Maalox....................................................................28, 91Macrodantin......................................................60, 94, 97Magnesium Citrate.................................................55, 92Magnesium Hydroxide............................................55, 92Magnesium L-lactate dihydrate.............................55, 108Magnesium Sulfate...........................................55, 92, 98Mag-Tab SR.........................................................55, 108Maprotiline........................................................16, 55, 86Maxipime................................................................35, 96Maxzide..................................................................75, 82Measles, Mumps and Rubella Virus Vaccine, Live. 55, 95Meclizine.................................................................55, 84Mediplast..............................................................69, 106Medrol....................................................................57, 90medroxyPROGESTERone.....................................55, 90Megace...................................................................55, 85

Megace ES.............................................................55, 85Megestrol................................................................55, 85Melatonin..............................................................55, 108Mellaril........................................................14, 24, 73, 86Meloxicam..............................................................55, 84Memantine..............................................................55, 89Menthol.................................................................56, 106Menthol/Methyl Salicylate.....................................57, 106Menthol/Zinc Oxide...............................................56, 107Mephyton....................................................64, 80, 81, 99Mepron.............................................................23, 30, 97Mesalamine............................................................56, 93Metadate...........................................................19, 56, 87Metadate CD....................................................19, 56, 87metFORMIN...........................................................56, 79Methadone..............................................................56, 84Methimazole...........................................................56, 90Methocarbamol.......................................................56, 89Methylcellulose.......................................................56, 92Methyldopa.............................................................56, 83Methylin............................................................19, 56, 87Methylphenidate.....................................................19, 87Methylphenidate, sustained release.................19, 56, 87Methylphenidate,immediate release.................19, 56, 87methylPREDNISolone............................................57, 90Meticorten...............................................................66, 90Metoclopramide................................................57, 84, 92Metoprolol.........................................................57, 83, 89MetroGel...............................................................57, 104metroNIDAZOLE............................................57, 96, 104Mexsana...............................................................41, 106Miacalcin...............................................................34, 100Miconazole.....................................................57, 94, 105Micronase...............................................................48, 79Midazolam..............................................................57, 87Milk of Magnesia.....................................................55, 92Mineral Oil............................................................57, 103Minipress................................................................66, 83Minocycline.............................................................57, 96Mintezol..................................................................72, 97MiraLax...................................................................64, 92Mirapex...................................................................65, 89Mirtazapine.......................................................16, 58, 86Misoprostol.............................................................58, 93MMR II....................................................................55, 95Mobic......................................................................55, 84Moi-Stir.................................................................35, 103Mometasone.........................................................58, 101Monistat..........................................................57, 94, 105Monoket..................................................................52, 82Montelukast..........................................................58, 101Morphine.................................................................58, 84Motrin.....................................................................50, 84MouthKote............................................................35, 103Moxifloxacin............................................................58, 96Mucinex................................................................48, 101Mucinex D.............................................................49, 101Mucomyst.......................................................27, 80, 101

Multivitamin.............................................................58, 99Multivitamin, Prenatal.............................................58, 99Multivitamin/Minerals..............................................58, 99Multivitamins, Pediatric...........................................58, 99Mupirocin..............................................................58, 104Myambutol..............................................................44, 97Mycelex..........................................................38, 94, 103Mycifradin...............................................................59, 96Mycobutin...............................................................68, 97Mycostatin..............................................60, 96, 103, 105Mydriacyl..............................................................75, 102Mylanta...................................................................28, 91Mylicon...................................................................70, 92Mysoline.................................................................66, 88Nabumetone.....................................................24, 59, 84Nafcillin...................................................................59, 95Naloxone..........................................................59, 80, 87Naltrexone..................................................19, 59, 80, 87Namenda................................................................55, 89Naphazoline..........................................................59, 102Naphcon...............................................................59, 102Naprosyn..........................................................59, 84, 89Naproxen..........................................................59, 84, 89Narcan..............................................................59, 80, 87Nardil................................................................16, 63, 85Nasacort...............................................................74, 101Nasonex...............................................................58, 101Nature Made Fish Oil............................................46, 108Navane.............................................................14, 73, 86Nebcin....................................................................73, 96Neo-Calglucon........................................................34, 99Neomycin................................................................59, 96Neomycin/Polymyxin B/Bacitracin........................59, 104Neomycin/Polymyxin B/Hydrocortisone................59, 103Neosporin.............................................................64, 104Neo-Synephrine....................................63, 101, 102, 103Nephrocaps............................................................77, 99Nephro-vite.............................................................77, 99Neurontin................................................................47, 88Neutra-Phos-K........................................................65, 99Neutrogena...........................................................69, 106NexIUM.............................................................24, 44, 92Niacin/Nicotinamide..........................................59, 83, 99Nicobid..............................................................59, 83, 99Nicoderm................................................................59, 80Nicorette.................................................................59, 80Nicotine..................................................................59, 80Nicotine Polacrilex..................................................59, 80Nicotine Transdermal Patch...................................59, 80Nicotrol...................................................................59, 80NIFEdipine..............................................................60, 82Niferex....................................................................51, 99Niferex-150.............................................................51, 99Niferex-150 Forte....................................................51, 99Nitrofurantoin....................................................60, 94, 97Nitroglycerin............................................................60, 82NIX.......................................................................63, 107Nizoral............................................................52, 96, 105

Noctec..............................................................22, 36, 87Nolvadex.................................................................71, 81Non-Soap Cleanser..............................................60, 107Norepinephrine.......................................................60, 83Norgestimate/Ethinyl Estradiol................................60, 90Noritate.................................................................57, 104Normodyne.............................................................52, 83Norpramin.........................................................16, 39, 85Nortriptyline......................................................16, 60, 85Norvasc..................................................................29, 82NovoLog.................................................................51, 79Nutraderm.............................................................43, 106Nystatin...................................................60, 96, 103, 105OCL........................................................................67, 92OLANZapine.....................................................14, 61, 86OLANZapine pamoate......................................14, 24, 86Olmesartan.......................................................24, 61, 83Olopatadine..........................................................61, 102Omeprazole............................................................61, 92OmniMed..............................................................71, 103Omnipen.................................................................29, 95Ondansetron...........................................................61, 84Onfi.........................................................................37, 88Ophthalmic Irrigating Solution...............................61, 103Ophthalmic Lubricant............................................61, 102Oracit......................................................................70, 94Oragel...................................................................31, 103Orinase...................................................................74, 79Ortho Tri-Cyclen.....................................................60, 90Ortho-Novum 777...................................................44, 90Os-Cal..............................................................34, 91, 99Os-Cal + D..............................................................34, 99Os-Cal chewable..........................................................34Os-Cal Chewable.........................................................99Oseltamivir..............................................................61, 97Ovral.......................................................................44, 90Oxazepam..................................................21, 61, 85, 87OXcarbazepine.................................................18, 61, 88Oxybenzone/PDO/Pet Hy-Phl...............................61, 106Oxybutynin..............................................................61, 94oxyCODONE..........................................................62, 84oxyCONTIN............................................................62, 84Oxymetazoline......................................................62, 103P.P.D......................................................................76, 95Pacerone................................................................28, 82Paliperidone......................................................14, 62, 86Paliperidone palmitate..................................................14Pamelor............................................................16, 60, 85Panafil...................................................................62, 107Pancrease..............................................................62, 93Pancrelipase...........................................................62, 93Panmycin................................................................72, 96Pantoprazole..........................................................62, 92Papin/Urea............................................................62, 107Papin/Urea/Chlorophyllin......................................62, 107Parlodel..................................................................33, 89Parnate.............................................................16, 74, 85PARoxetine.......................................................16, 62, 85

Patanol.................................................................61, 102Paxil..................................................................16, 62, 85PEG........................................................................67, 92Penicillamine..........................................................62, 80Penicillin G Benzathine...........................................62, 95Penicillin G Benzathine/Penicillin G Procaine.........62, 95Penicillin G Procaine..............................................62, 95Penicillin G Sodium................................................63, 95Penicillin V Potassium............................................63, 95Penlac...................................................................36, 105Pentam.............................................................24, 63, 97Pentamidine......................................................24, 63, 97Pentasa..................................................................56, 93Pentrax.........................................................38, 105, 107Pen-Vee K..............................................................63, 95Pepcid....................................................................45, 91Pepto-Bismol..........................................................33, 93Pergolide......................................................................89Periactin..................................................................39, 80Peri-Colace.............................................................42, 92Peridex.................................................................36, 103PerioMed..............................................................71, 103Periostat...............................................................42, 103Permax.........................................................................89Permethrin............................................................63, 107Pernox..................................................................26, 107Perphenazine...................................................14, 63, 86Petrolatum, White.................................................63, 106Phenazopyridine.....................................................63, 93Phenelzine........................................................16, 63, 85Phenergan..............................................................66, 84PHENobarbital..................................................25, 63, 88Phenol..................................................................63, 103Phenylephrine.......................................63, 101, 102, 103Phenytoin..........................................................25, 64, 88pHisoHex..............................................................49, 105Physostigmine........................................................64, 80Phytonadione..............................................64, 80, 81, 99Pilocarpine............................................................64, 102Pimecrolimus........................................................64, 107Pioglitazone............................................................64, 79Piperacillin/Tazobactam.........................................64, 95Plavix................................................................23, 38, 81Plendil.....................................................................45, 82Pneumococcal Vaccine, Polyvalent........................64, 95Pneumovax.............................................................64, 95Podocon-25..........................................................64, 106Podophyllum Resin...............................................64, 106Polycarbophil..........................................................64, 92Polycillin..................................................................29, 95Polycitra..................................................................65, 94Polycitra K..............................................................65, 94Polycitra-LC............................................................65, 94Polyethylene Glycol................................................64, 92Polymox..................................................................29, 95Polymyxin B/Bacitracin.........................................64, 102Polymyxin B/Neomycin.........................................64, 104Polymyxin B/Trimethoprim....................................65, 102

Polysporin...............................................31, 64, 102, 104Polytar..........................................................38, 105, 107Polytrim.................................................................65, 102Poly-Vi-Sol..............................................................58, 99Potassium Chloride..........................................65, 98, 99Potassium Citrate...................................................65, 94Potassium Citrate Combinations............................65, 94Potassium Iodide..................................................65, 101Potassium Phosphate.............................................65, 99Povidone-Iodine....................................................65, 105Pramipexole............................................................65, 89Pramoxine......................................................65, 93, 104Pramoxine/Zinc.....................................................65, 104Prandin...................................................................68, 79Pravachol................................................................66, 83Pravastatin..............................................................66, 83Prazosin..................................................................66, 83Pred Forte.............................................................66, 103Pred Mild..............................................................66, 103prednisoLONE................................................66, 90, 103predniSONE...........................................................66, 90Pregabalin..............................................................66, 88Premarin...........................................................44, 90, 94Premphase.............................................................44, 90PremPro.................................................................44, 90Prevacid..................................................................53, 92PriLOSEC...............................................................61, 92Primidone...............................................................66, 88Prinivil.....................................................................54, 83Pro-Banthine...........................................................66, 91Procainamide..........................................................66, 82Procardia................................................................60, 82Prochlorperazine....................................................66, 84Procrit...............................................................24, 43, 81Prolia....................................................................39, 100Prolixin..............................................................14, 46, 86Prolixin Deconate.........................................................14Promethazine.........................................................66, 84Pronestyl.................................................................66, 82Pronto...................................................................67, 107Propantheline.........................................................66, 91Proparacaine........................................................66, 103Propranolol.................................................19, 67, 83, 89Propylethylene Glycol Electrolyte Solution.............67, 92Propylthiouracil.......................................................67, 90Proscar...................................................................45, 94ProStep...................................................................59, 80Protamine.........................................................67, 80, 81Protonix..................................................................62, 92Protopic................................................................71, 107Protriptyline...................................................................16Proventil................................................................27, 100Provera...................................................................55, 90PROzac......................................................16, 46, 85, 89Pseudoephedrine.................................................67, 101Pulmicort...............................................................33, 101Pyrazinamide..........................................................67, 97Pyrethins 0.33%/Piperonyl Butoxide 4%...............67, 107

Pyridium..................................................................63, 93Pyridoxine...............................................................67, 99Questran.................................................................36, 83QUEtiapine.......................................................14, 67, 86QVAR...................................................................31, 101Raloxifene.............................................................67, 100Ranitidine................................................................67, 91Rasagiline...............................................................68, 89Razadyne...............................................................47, 89Reclast..................................................................78, 100Recombivax HB......................................................49, 95Rectal Hemorrhoidal Cream with Hydrocortisone...68, 93Rectal Hemorrhoidal Ointment...............................68, 93Rectal Hemorrhoidal Suppositories........................68, 93Rectal Hemorrhoidal Suppositories with Hydrocortisone

............................................................................68, 93Reglan..............................................................57, 84, 92Relafen.............................................................24, 59, 84Relenza..................................................................77, 97Remeron...........................................................16, 58, 86Remeron SolTab....................................................58, 86Renagel..................................................................69, 94Repaglinide.............................................................68, 79Restoril.......................................................22, 72, 85, 87Retin-A..................................................................74, 104ReVia..........................................................19, 59, 80, 87Revina..................................................................75, 107RID.......................................................................67, 107Rifabutin.................................................................68, 97Rifadin....................................................................68, 97Rifamate.................................................................68, 97Rifampin.................................................................68, 97Rifampin/Isoniazid..................................................68, 97Ringer’s Lactate Solution........................................68, 98Risamine...............................................................56, 107Risedronate..........................................................68, 100RisperDAL........................................................14, 68, 86RisperDAL Consta............................................14, 68, 86RisperDAL M-Tab.............................................14, 68, 86risperiDONE.....................................................14, 68, 86Ritalin................................................................19, 56, 87Ritalin SR..........................................................19, 56, 87Rivastigmine...........................................................68, 89Robaxin..................................................................56, 89Robinul...................................................................48, 91Robitussin.............................................................48, 101Robitussin AC.......................................................48, 101Robitussin DM......................................................49, 101Rocephin................................................................35, 96Rowasa..................................................................56, 93Rufinamide.............................................................68, 88Salac....................................................................26, 107Salex....................................................................69, 106Salicyclic Acid/Sulfur.............................69, 104, 105, 107Salicylic Acid.........................................................69, 106Saliva Substitute...................................................35, 103Salivart..................................................................35, 103Salix......................................................................35, 103

Salmeterol............................................................69, 100Sanctura.................................................................75, 94Sani-Supp...............................................................48, 93Santyl...................................................................38, 107Saphris.............................................................14, 30, 86Scopolamine.........................................................69, 102Seba-Nil................................................................26, 107Sebizon.........................................................71, 104, 105Selenium Sulfide...................................................69, 105Selsun...................................................................69, 105Senna.....................................................................69, 92Senokot..................................................................69, 92Septra.....................................................................75, 96Serax..........................................................21, 61, 85, 87Serevent...............................................................69, 100Seromycin...................................................23, 39, 96, 97SEROquel.........................................................14, 67, 86Sertraline..........................................................16, 69, 85Sevelamer..............................................................69, 94Silvadene......................................................69, 105, 107Silver Nitrate.........................................................69, 107Silver Sulfadiazine........................................69, 105, 107Simethicone............................................................70, 92Simvastatin.............................................................70, 83Sinemet..................................................................35, 89SINEquan.........................................................16, 42, 85Singulair................................................................58, 101Sodium Bicarbonate.........................................70, 94, 98Sodium Chloride.......................70, 93, 98, 101, 103, 107Sodium Chloride 0.2%............................................70, 98Sodium Chloride 0.45%..........................................70, 98Sodium Chloride 0.9%............................................70, 98Sodium Chloride Intravenous Solution...................70, 98Sodium Citrate/Citric Acid.......................................70, 94Sodium Fluoride...................................................70, 103Sodium Lactate.......................................................70, 98Sodium Polystyrene Sulfonate................................70, 84Sonata..............................................................22, 77, 87Sorbitol...................................................................70, 92Sorbitrate................................................................52, 82Spironolactone........................................................71, 82Spironolactone/Hydrochlorothiazide.......................71, 82Spriva...................................................................73, 100SSKI.....................................................................65, 101Stanous Fluoride..................................................71, 103Stelazine...........................................................14, 75, 86Stimate...................................................................39, 91Strattera............................................................19, 30, 87Stresscaps..............................................................77, 99Stromectol..............................................................52, 97Sucralfate...............................................................71, 93Sudafed................................................................67, 101Sulamyd................................................................71, 102Sulfacetamide Sodium..........................71, 102, 104, 105sulfaSALAzine........................................................71, 93Sulindac..................................................................71, 84SUMAtriptan...........................................................71, 89Sunscreen/block...................................................71, 107

Surfak.....................................................................42, 93Surmontil..........................................................16, 75, 85Symbicort..............................................................33, 100Symmetrel........................................................28, 89, 97Synalar.................................................................46, 106Synthroid................................................................53, 90Tacrolimus............................................................71, 107Tamiflu....................................................................61, 97Tamoxifen...............................................................71, 81Tamsulosin.............................................................71, 94Tapazole.................................................................56, 90Tazarotene...................................................72, 104, 105Tazorac.........................................................72, 104, 105TBC......................................................................75, 107Td...........................................................................42, 95Tdap.......................................................................42, 95TEGretol...............................................18, 25, 35, 86, 88TEGretol XR.........................................18, 25, 35, 86, 88Tegrin...........................................................38, 105, 107Teldrin.............................................................36, 80, 101Temazepam................................................22, 72, 85, 87Temovate........................................................23, 37, 106Tenex................................................................19, 49, 87Tenormin..........................................................30, 83, 89Terbinafine......................................................72, 96, 105Terbutaline............................................................72, 100Tessalon Perle......................................................31, 101Testosterone...........................................................72, 90Tetracycline............................................................72, 96Tetrahydrozoline...................................................72, 102Theophylline.........................................................72, 100Thiabendazole........................................................72, 97Thiamine.................................................................72, 99Thioridazine................................................14, 24, 73, 86Thiothixene.......................................................14, 73, 86Thorazine..........................................................14, 36, 86Thyroid...................................................................73, 90Thyroid, Desiccated................................................73, 90Tiagabine................................................................73, 88Tigan......................................................................75, 84Timolol..................................................................73, 102Timolol/Dorzolamide.............................................73, 102Timoptic................................................................73, 102Tinactin.................................................................74, 105Tioconazole............................................................73, 94Tiotropium.............................................................73, 100Titralac..............................................................34, 91, 99TiZANidine..................................................24, 73, 88, 89TobraDex..............................................................73, 103Tobramycin.....................................................73, 96, 102Tobramycin/Dexamethasone................................73, 103Tobrex..................................................................73, 102Tofranil..............................................................16, 50, 85TOLBUTamide........................................................74, 79Tolnaftate..............................................................74, 105Tolterodine..............................................................74, 94Topamax.....................................................74, 87, 88, 89Topiramate.................................................74, 87, 88, 89

Toprol XL..........................................................57, 83, 89Toradol...................................................................52, 84traMADol.................................................................74, 84Tranxene....................................................21, 38, 85, 88Tranxene SD..........................................................38, 88Tranylcypromine...............................................16, 74, 85Travatan...............................................................74, 102Travoprost............................................................74, 102traZODone............................................16, 22, 74, 86, 87Tretinoin................................................................74, 104Trexan..............................................................59, 80, 87Triamcinolone.........................................74, 90, 101, 106Triamterene............................................................74, 82Triamterene/Hydrochlorothiazide............................75, 82Triazolam....................................................22, 75, 85, 87Tricor......................................................................45, 83Tridesilon..............................................................39, 106Trifluoperazine..................................................14, 75, 86Triglide....................................................................45, 83Trihexyphenidyl......................................................75, 89Trilafon..............................................................14, 63, 86Trileptal.............................................................18, 61, 88Tri-Levlen................................................................53, 90Trimethobenzamide................................................75, 84Trimethoprim/Sulfamethoxazole.............................75, 96Trimipramine.....................................................16, 75, 85Triphasil..................................................................53, 90Triple Antibiotic Ointment......................................59, 104Triprolidine/Pseudoephedrine...............................75, 101Tronothane.....................................................65, 93, 104Tropicamide..........................................................75, 102Trospium.................................................................75, 94Trypsin/Balsam Peru/Castor Oil...........................75, 107Tuberculin, Purified Protein Derivative...................76, 95Twinrix....................................................................49, 95Tylenol....................................................................26, 84Ultram.....................................................................74, 84Unicap....................................................................58, 99Unifiber...................................................................35, 92Unipen....................................................................59, 95Urea......................................................................76, 106Urecholine..............................................................32, 94Urispas...................................................................46, 94Urocit K...................................................................65, 94Vagistat-1...............................................................73, 94valACYclovir...........................................................76, 97Valisone................................................................32, 106Valium.............................................21, 41, 85, 87, 88, 89Valproate........................................18, 25, 76, 86, 88, 89Valproic Acid.....................................................18, 25, 76Valsartan..........................................................24, 76, 83Valtrex....................................................................76, 97Vancocin.................................................................76, 96Vancomycin............................................................76, 96Vaqta......................................................................49, 95Varicella Virus Vaccine, Live..................................76, 95Varivax...................................................................76, 95Vaseline................................................................63, 106

Vaseline Lip Therapy............................................61, 106Vasolex.................................................................75, 107Vasotec...................................................................43, 83V-Cillin K.................................................................63, 95Venlafaxine.......................................................16, 76, 85Ventolin.................................................................27, 100Verapamil.........................................................76, 82, 89Versed....................................................................57, 87Vibramycin..............................................................42, 96Vicodin....................................................................26, 84Vicodin ES..............................................................26, 84Vimpat....................................................................52, 88Visine Allergy Relief..............................................72, 102Visine Moisturizing................................................72, 102Vistaril...................................................22, 50, 80, 84, 87Vitamin A................................................................76, 99Vitamin A&D Topical.......................................41, 76, 106Vitamin B Complex.................................................77, 99Vitamin B Complex/Vitamin C.................................77, 99Vitamin B Complex/Vitamin C/Zinc.........................77, 99Vitamin B1...............................................................72, 99Vitamin B12..............................................................39, 99Vitamin B6...............................................................67, 99Vitamin C................................................................30, 99Vitamin D................................................................77, 99Vitamin E................................................................77, 99Vitamin K1...................................................64, 80, 81, 99Vivactil..........................................................................16Vivelle.....................................................................44, 90VoSol....................................................................26, 103VoSol HC..............................................................27, 103Vospire ER...........................................................27, 100Vyvanse............................................................24, 54, 87Warfarin..................................................................77, 81Water for Injection...........................................77, 98, 107Water for Irrigation..................................................77, 93Wellbutrin..........................................................16, 33, 86Wellbutrin SR....................................................16, 33, 86Wellbutrin XL....................................................16, 33, 86Wellcovorin.......................................................53, 80, 99Wound Cleanser...................................................77, 107Wyanoids................................................................68, 93Wycillin...................................................................62, 95Xalatan.................................................................53, 102Xanax.........................................................21, 28, 85, 87Xanax XR.........................................................28, 85, 87Xenaderm.............................................................75, 107Xylocaine..............................................................53, 104Zaditor..................................................................52, 102Zafirlukast.............................................................77, 101Zaleplon............................................................22, 77, 87Zanaflex......................................................24, 73, 88, 89Zanamivir................................................................77, 97Zantac....................................................................67, 91Zarontin............................................................25, 45, 88Zestril......................................................................54, 83Zinc Oxide....................................................77, 106, 107Zinc Oxide/Petrolatum/Imidazolidinyl Urea.............41, 77

Zinc Sulfate.......................................................78, 98, 99Ziprasidone.......................................................14, 78, 86Zithromax................................................................31, 96Zocor......................................................................70, 83Zofran.....................................................................61, 84Zofran ODT.............................................................61, 84Zoledronic Acid.....................................................78, 100Zoloft.................................................................16, 69, 85Zolpidem...........................................................22, 78, 87Zometa.................................................................78, 100Zonalon.................................................................42, 104Zonegran................................................................78, 88

Zonisamide.............................................................78, 88Zosyn......................................................................64, 95Zovirax............................................................27, 97, 104Zyban.....................................................................33, 86Zyloprim..................................................................27, 91zyPREXA..........................................................14, 61, 86zyPREXA Relprevv.....................................14, 24, 61, 86zyPREXA Zydis......................................................61, 86zyrTEC...................................................................36, 80zyrTEC D..............................................................36, 101Zyvox................................................................24, 54, 96

APPENDIX 1: NEW DRUG APPLICATION FORM415 — C

EXHIBIT ADSHS/DADS

(Formerly: Texas Department of Mental Health and Mental Retardation)NEW DRUG APPLICATION

(for inclusion in the DSHS/DADS Drug Formulary)

** (THE NEW DRUG APPLICATION PROCESS IS DESCRIBED ON THE BACK OF THIS FORM.) **

Date: Name of practitioner submitting the application: Name of entity with which the practitioner is associated by employment or contract (i.e., state hospital, state supported living center, state center, or local authority (state-operated community services (SOCS) or community MHMR center)):

Information regarding new drug:Therapeutic ClassificationGeneric NameTrade Name(s)Manufacturer(s)Dosage Form(s)

Explain the pharmacological action or use of this drug:

Explain the advantages of this drug over those listed in the formulary:

State which drugs this new drug would replace or supplement:

************************************************************************************

application is approved signature of chairman of facility pharmacy and therapeutics

committeeORapplication is appropriate and complete

signature of clinical/medical director or designee

Section 415.108 of TDMHMR rules governing the use and maintenance of the THHSC Drug Formulary (25 TAC, Chapter 415, Subchapter C) describes the procedures for applying to have a drug added to the formulary, which are:

§415.108. Applying to Have a Drug Added to the Formulary.

(a) Any member of the Executive Formulary Committee, any service system component* practitioner, or any contract practitioner may apply to have a drug added to the THHSC Drug Formulary by completing the New Drug Application Form DF-1, referenced as Exhibit A in §415.112 of this title (relating to Exhibit) and including:(1) published articles in biomedical literature that substantiate the efficacy and safety

of the proposed drug;(2) information on the advantages of the proposed drug compared with similar

formulary drugs;(3) a list of formulary drugs that the proposed drug would replace or supplement; and(4) cost effectiveness data.

(b) Submitting the application.(1) If the person submitting the application is a facility** practitioner or a facility

contract practitioner, then that practitioner submits the application to the facility’s pharmacy and therapeutics committee for approval. If the committee approves the application, then it forwards the application to the Executive Formulary Committee.

(2) If the person submitting the application is a non-facility service system component practitioner or a non-facility service system component contract practitioner, then that practitioner submits the application to the component’s clinical/medical director or designee who determines if the application is appropriate and complete, and if so, forwards the application to the Executive Formulary Committee.

(3) If the person completing the application is a member of the Executive Formulary Committee, then that person submits the application directly to Executive Formulary Committee.

(c) The Executive Formulary Committee considers the drug application and recommends:

(1) approving the proposed drug’s inclusion and, if appropriate, approving audit criteria and recommending dosage guidelines;

(2) denying the proposed drug’s inclusion;(3) approving the proposed drug on a trial basis for a specified period of time;(4) approving the proposed drug as a reserve drug, with guidelines; or(5) postponing the decision until a later meeting.

* The term “service system component” means a state hospital, state supported living center, state center, or local authority (state-operated community services (SOCS) or community MHMR center).

** The term “facility” means a state hospital, state supported living center, or state center.

APPENDIX 2: EXECUTIVE FORMULARY COMMITTEE CONFLICT OF INTEREST POLICY

PolicyThe Executive Formulary Committee (EFC) must ensure balance, independence, objectivity and scientific rigor in determining which drugs should be on the formulary. It is the policy of the Executive Formulary Committee to prohibit any apparent or actual conflict of interest. As such, each member of the Executive Formulary Committee and each requesting practitioner shall abide by this policy and submit a Conflict of Interest Disclosure Statement. The intent of this disclosure is not to prevent those with a significant financial interest or other relationship from participating in the formulary process, but rather to provide information to committee members and to the public so that conflicts can be resolved prior to the decision making process. It remains for the members of the Committee to determine whether the individual’s interests or relationships may influence them with regard to exposition or conclusions. A conflict of interest for these purposes includes any situation in which a Committee member or individual submitting a request to the EFC has a private or personal interest sufficient to appear to influence the objective exercise of his/her duties for the agency. An apparent conflict of interest is one in which a reasonable person would think that the person’s judgment is potentially compromised.

All committee members, individuals submitting drug monographs and individuals requesting drugs for addition to the formulary are expected to disclose any significant financial interest or other relationship with (a) the manufacturer(s) of any commercial product and/or provider of commercial services for drugs on the formulary or being considered for the formulary (b) any commercial support for these drugs. (Significant financial interest or other relationship can include such things as grants or research support, employee, consultant, major stockholder, member of speaker’s bureau, etc.).

Procedure1. Committee members shall submit Disclosure Statements at least annually and as

needed as their situation changes. See Attachment A for the “Executive Formulary Committee Disclosure Form.”

2. Individuals submitting requests for addition to the Formulary or completing drug monographs shall submit the “Executive Formulary Committee Disclosure Form” along with the New Drug Application or drug monograph, respectively.

3. A review of Committee members’ conflict of interest shall be completed for all individuals present at each meeting. This information shall be documented in the minutes of each meeting.

4. Each facility Pharmacy and Therapeutics Committee or similarly functioning committee is encouraged to adopt a similar policy.

5. The following definitions are applicable to this policy“Companies” – include pharmaceutical and biotechnology companies.

“Compensation” - includes direct and indirect remuneration or royalties, and may also include, among other things, items and services at reduced prices, or with discounts or rebates.

“Controlling Interest” - a direct or indirect ownership or beneficial interest, individually or in conjunction with members of your family, which permits election or selection of a majority of the governing body of a Company and/or which permits the exercise of control over the affairs of such Company.

“Gifts” or “Gratuities” include, among other things, entertainment or recreational items, subsidies given directly to a healthcare professional for continuing medical education (CME), educational (i.e. anatomical models) and non-educational and practice-related items (i.e. items that do not advance disease or treatment education).

“Financial Interest” – a direct or indirect, through business, investment or family:(a) Ownership Interest or investment interest in a Company;(b) Compensation arrangement with a Company or any of its affiliates; or(c) Ownership Interest or investment interest in, or Compensation arrangement

with, any Company or individual with which that Company or any of its affiliates is negotiating a transaction or arrangement.

“Ownership Interest” - owns or controls directly, indirectly, or beneficially through such person’s family, in excess of five percent (5%) of the total value of all securities of a Company.

“Significant Relationship” - a person or a member of such person’s family serves as an officer, general or limited partner, board member, employee, speaker or consultant to a company.

Executive Formulary Committee Disclosure Form

Name:Date:Facility:

Member of Executive Formulary Committee? Yes No

Submitting a New Drug Application? Yes No

Preparing the Drug Monograph? Yes No

I have read the Executive Formulary Committee policy on conflicts of interest. In agreement with this policy, I hereby disclose the following:

I have no conflicts of interest to disclose.-or-

* The following is a list of my potential conflicts of interest:

Company Consultant Grant Research

Speaker’s Bureau

Major Stockholder

Other (e.g., meals, gifts, travel, etc.)

* Attach an additional sheet describing your potential conflict of interest.

I have made all of the required disclosures. I understand that it is my continuing obligation to provide disclosure of potential conflicts of interest. If I become aware of any specific conflicts, or if there is a change in my professional activities, financial interests, or employment, I will submit an additional disclosure form in accordance with Executive Formulary Committee policies.

Signature Date

Reviewed by Executive Formulary Committee:Date

APPENDIX 3: NON-FORMULARY DRUG JUSTIFICATION FORM

DSHS/DADS

Non-Formulary Drug Justification

Facility/Component

Drug Name(Generic) (Trade) (Strength) (AHFS Therapeutic Class)

The purpose of the Formulary is to ensure that the treatments available to THHSC consumers are consistent with need, effectiveness, risk, and cost. Exceptions to the Formulary are limited to the three categories listed below.

This request is for: an individual patient treatment course. Is this chronic or acute therapy?

more than one patient/course of therapy. It is estimated that _________ patients will be treated with this drug. Is this chronic or acute therapy?

Reason for request: An illness for which no Formulary drug is as safe or effective. A trial supply in anticipation of application to Formulary. To prevent interruption of course of therapy established prior to admission.

Quantity Ordered

Cost/Unit

TotalPurchase Cost

*Estimate CourseChronic Cost Per Month

*Estimate CourseAcute Cost

Alternative drugs are available on the DSHS/DADS Formulary.

Attending Physician (signature) Date

Was the drug ordered yes or no?

AGREE DISAGREE

Pharmacy Director or designee (signature) Date

APPROVED DISAPPROVED EMERGENCYFacility clinical/medical director’s approval must be obtained within three working days.

Facility clinical/medical director or designee (signature) Date

APPENDIX 4: ADVERSE DRUG REACTION REPORTING (MEDWATCH) FORM

APPENDIX 5: FOODS CONTAINING TYRAMINE

*High Amounts of TyramineSmoked, aged or pickled meat or fish

SauerkrautAged Cheeses such as Swiss and Cheddar

Yeast extractsFava beans

**Moderate Amounts of TyramineBeer

AvocadosMeat extracts

Read wines such as Chianti

***Low Amounts of TyramineCaffeine-containing beverages

Distilled spiritsChocolateSoy sauce

Cottage and cream cheesesYogurt and sour cream

*May not consume**May consume in moderation

***May consume

Adapted from Shulman KI, et al. Dietary restriction, tyramine, and the use of monoamine oxidase inhibitors. J Clin Psychopharmacol. 1989; 9: 397.

2014 DSHS-DADS Drug Formulary

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Transcript of 2014 DSHS-DADS Drug Formulary