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BLANCHFIELD ARMY COMMUNITY HOSPITAL

OUTPATIENT FORMULARY

Alphabetical Listing by

This document is current as of .

The availability of formulary items is subject to change.

Name

March 19, 2020

Abacavir, Dolutegravir, and LamivudineOutpatient Dosage FormsTablet, Oral:Triumeq: Abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg

AcetaminophenOutpatient Dosage FormsCaplet, Oral:Generic: 500 mg

Solution, Oral [drops]:Generic: 80 mg/0.8 mL (15 mL)

Suppository, Rectal:Generic: 120 mg (12s); 325 mg (12s); 650 mg (12s)

Suspension, Oral:Generic: 160 mg/5 mL (120 mL) [available through Self Care program]:

Tablet, Oral:Generic: 325 mg (bottle of 100 tablets) [available through Self Care pro-gram], 500 mg

Acetaminophen and CodeineOutpatient Dosage FormsSolution, Oral [C-V]:Generic: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 mL(120 mL, 473 mL) [contains alcohol 7%] [BCF]

Tablet, Oral [C-III] :Generic: Acetaminophen 300 mg and codeine phosphate 30 mg [BCF]

AcetaZOLAMIDEOutpatient Dosage FormsCapsule Extended Release 12 Hour, Oral:Generic: 500 mg

Tablet, Oral:Generic: 250 mg

Acetic Acid (Otic)Outpatient Dosage FormsSolution, Otic:Generic: 2% (60 mL)

Acetic Acid, Propylene Glycol Diacetate, and HydrocortisoneOutpatient Dosage FormsSolution, Otic:Generic: Acetic acid 2%, propylene glycol diacetate 3%, and hydrocortisone1% (10 mL)

Acetic Acid (Topical)Outpatient Dosage FormsSolution, Irrigation:Generic: 0.25% (1000 mL)

AcetylcysteineOutpatient Dosage FormsSolution, Inhalation [preservative free]:Generic: 20% [200 mg/mL] (4 mL, 10 mL, 30 mL)

Acyclovir (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 200 mg [BCF]

Suspension, Oral:Generic: 200 mg/5 mL (473 mL) [BCF]

Tablet, Oral:Generic: 400 mg [BCF], 800 mg [BCF]

Acyclovir (Topical)Outpatient Dosage FormsOintment, External:Generic: 5% (5 g, 15 g, 30 g)

AdalimumabOutpatient Formulary Brands Available HumiraOutpatient Dosage FormsKit, Subcutaneous [preservative free]:Humira: 40 mg/0.8 mL [contains polysorbate 80] [BCF]

AdapaleneOutpatient Dosage FormsCream, External:Generic: 0.1% (45 g)

AlbendazoleOutpatient Dosage FormsTablet, Oral:Generic: 200 mg

AlbuterolOutpatient Formulary Brands Available Ventolin® HFAOutpatient Dosage FormsAerosol Solution, Inhalation:Generic: 90 mcg/actuation (18 g)

Nebulization Solution, Inhalation:Generic: 0.083% [2.5 mg/3 mL] (25s, 30s, 60s) [BCF]; 0.5% [100 mg/20mL] (1s)

Nebulization Solution, Inhalation [preservative free]:Generic: 0.083% [2.5 mg/3 mL] (60s)

Syrup, Oral:Generic: 2 mg/5 mL (473 mL)

Alcohol (Ethyl)Outpatient Dosage FormsPad, External:Generic: 70% (100s)

AlendronateOutpatient Dosage FormsSolution, Oral:Generic: 70 mg/75 mL (75 mL) [BCF]

Tablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF], 35 mg [BCF], 70 mg [BCF]

Alendronate and CholecalciferolOutpatient Dosage FormsTablet, Oral:Fosamax Plus D: 70/5600: Alendronate 70 mg and cholecalciferol 5600 int.units

AlfuzosinOutpatient Formulary Brands Available UroxatralOutpatient Dosage FormsTablet Extended Release 24 Hour, Oral, as hydrochloride:Uroxatral: 10 mg [BCF]Generic: 10 mg [BCF]

AliskirenOutpatient Dosage FormsTablet, Oral:Generic: 150 mg, 300 mg

AllopurinolOutpatient Dosage FormsTablet, Oral:Generic: 100 mg [BCF], 300 mg [BCF]

ALPRAZolamOutpatient Dosage FormsTablet, Oral:Generic: 0.5 mg, 1 mg

Aluminum Chloride HexahydrateOutpatient Formulary Brands Available DrysolOutpatient Dosage FormsSolution, External:Drysol: 20% (37.5 mL)

Aluminum Hydroxide, Magnesium Hydroxide, and SimethiconeOutpatient Dosage FormsLiquid, Oral:Generic: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, andsimethicone 20 mg per 5 mL (360 mL); Aluminum hydroxide 400 mg,magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)

Tablet, Chewable, Oral:Generic: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, andsimethicone 25 mg

AmantadineOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 100 mg [BCF]

Capsule, Softgel, Oral, as hydrochloride:Generic: 100 mg [BCF]

Syrup, Oral, as hydrochloride:Generic: 50 mg/5 mL (10 mL) [BCF]

AmiodaroneOutpatient Formulary Brands Available PaceroneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Pacerone: 200 mg [scored] [BCF]Generic: 200 mg [BCF]

AmitriptylineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF]

AmLODIPineOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

ABACAVIR, DOLUTEGRAVIR, AND LAMIVUDINE

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Amlodipine and BenazeprilOutpatient Formulary Brands Available LotrelOutpatient Dosage FormsCapsule, Oral:Lotrel:2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF]5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF]5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF]5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF]10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF]10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF]

Generic:2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF]5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF]5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF]5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF]10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF]10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF]

Ammonia Spirit (Aromatic)Outpatient Dosage FormsSolution, for Inhalation:Generic: 1.7% to 2.1% (0.33 mL, 60 mL)

AmoxicillinOutpatient Dosage FormsCapsule, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

Suspension Reconstituted, Oral:Generic: 125 mg/5 mL (150 mL); 250 mg/5 mL (150 mL) [BCF]; 400 mg/5 mL(100 mL) [BCF]

Tablet, Chewable, Oral:Generic: 250 mg

Amoxicillin and ClavulanateOutpatient Formulary Brands Available Augmentin; Augmentin ES-600Outpatient Dosage FormsSuspension Reconstituted, Oral:Augmentin:125: Amoxicillin 125 mg and clavulanate potassium 31.25 mg per 5 mL (75mL, 100 mL, 150 mL) [contains potassium 0.16 mEq/5 mL; bananaflavor] [BCF]

250: Amoxicillin 250 mg and clavulanate potassium 62.5 mg per 5 mL (75mL) [contains potassium 0.32 mEq/5 mL; orange flavor] [BCF]

Augmentin ES-600: Amoxicillin 600 mg and clavulanate potassium 42.9 mgper 5 mL (125 mL, 200 mL) [contains phenylalanine 7 mg/5 mL andpotassium 0.23 mEq/5 mL; strawberry cream flavor]

Generic:200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (50mL, 75 mL, 100 mL) [BCF]

250: Amoxicillin 250 mg and clavulanate potassium 62.5 mg per 5 mL (75mL, 100 mL, 150 mL) [BCF]

400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (50 mL,75 mL, 100 mL) [BCF]

600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (75mL, 125 mL, 200 mL) [BCF]

Tablet, Oral:Generic:Amoxicillin 250 mg and clavulanate potassium 125 mg [BCF]Amoxicillin 500 mg and clavulanate potassium 125 mg [BCF]Amoxicillin 875 mg and clavulanate potassium 125 mg [BCF]

Tablet, Chewable, Oral:Generic:200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg400: Amoxicillin 400 mg and clavulanate potassium 57 mg

AnastrozoleOutpatient Dosage FormsTablet, Oral:Generic: 1 mg

ApixabanOutpatient Dosage FormsTablet, Oral:Eliquis: 2.5 mg, 5 mg

ApraclonidineOutpatient Dosage FormsSolution, Ophthalmic:Generic: 0.5% (10 mL)

ARIPiprazoleOutpatient Dosage FormsSolution, Oral:Generic: 1 mg/mL (150 mL)

Tablet, Oral:Generic: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg

ArmodafinilOutpatient Dosage FormsTablet, Oral:Generic: 50 mg, 150 mg, 200 mg, 250 mg

Artificial TearsOutpatient Formulary Brands Available Akwa Tears [OTC]; Tears NaturaleFree [OTC]Outpatient Dosage FormsOintment, Ophthalmic [preservative free]:Generic: 3.5 g

Solution, Ophthalmic [irrigation]:Generic: 120 mL

Solution, Ophthalmic:Akwa Tears: 15 mL [contains benzalkonium chloride]Tears Naturale Free: (36s)

AspirinOutpatient Dosage FormsTablet, Oral:Generic: 325 mg


Tablet, Enteric Coated, Oral:Generic: 81 mg, 325 mg

Aspirin and DipyridamoleOutpatient Dosage FormsCapsule Extended Release 12 Hour, Oral:Generic: Aspirin 25 mg [immediate release] and dipyridamole 200 mg[extended release]

AtenololOutpatient Dosage FormsTablet, Oral:Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

AtoMOXetineOutpatient Dosage FormsCapsule, Oral:Generic: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg

AtorvaSTATinOutpatient Formulary Brands Available LipitorOutpatient Dosage FormsTablet, Oral:Lipitor: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]

Atovaquone and ProguanilOutpatient Dosage FormsTablet, Oral:Generic: Atovaquone 250 mg and proguanil hydrochloride 100 mg

Tablet, Oral [pediatric]:Generic: Atovaquone 62.5 mg and proguanil hydrochloride 25 mg

AzaTHIOprineOutpatient Dosage FormsTablet, Oral:Generic: 50 mg

Azelaic AcidOutpatient Formulary Brands Available AzelexOutpatient Dosage FormsCream, External:Azelex: 20% (30 g) [contains benzoic acid]

Azelastine (Nasal)Outpatient Dosage FormsSolution, Nasal, as hydrochloride:Generic: 0.1% [137 mcg/spray] (30 mL)

Azithromycin (Systemic)Outpatient Formulary Brands Available ZithromaxOutpatient Dosage FormsPacket, Oral:Generic: 1 g (3 ea) [BCF]

Suspension Reconstituted, Oral:Zithromax: 100 mg/5 mL (15 mL) [cherry-vanilla-banana flavor] [BCF]Generic: 100 mg/5 mL (15 mL) [BCF]; 200 mg/5 mL (15 mL, 30 mL)

Tablet, Oral:Zithromax: 250 mg [BCF]Generic: 250 mg [BCF], 500 mg [BCF]

Bacitracin and Polymyxin B (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Generic: Bacitracin 500 units and polymyxin B 10,000 units per g (3.5 g)

BACITRACIN AND POLYMYXIN B (OPHTHALMIC)

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Bacitracin, Neomycin, and Polymyxin B (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Generic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 unitsper g (3.5 g) [BCF]

Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone(Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Generic: Bacitracin 400 units, neomycin 3.5 mg, polymyxin B 10,000 units,and hydrocortisone 10 mg per g (3.5 g)

Bacitracin (Topical)Outpatient Dosage FormsOintment, External, as zinc [strength expressed as base]:Generic: 500 units/g (15 g) [available through Self Care program]

BaclofenOutpatient Dosage FormsTablet, Oral:Generic: 10 mg

Balanced Salt SolutionOutpatient Formulary Brands Available Eye Stream [OTC]Outpatient Dosage FormsSolution, Ophthalmic [irrigation]:Eye Stream: Sodium chloride 0.64%, potassium chloride 0.075%, calciumchloride 0.048%, magnesium chloride 0.03%, sodium acetate 0.39%, sodiumcitrate 0.17% (30 mL, 120 mL)

Solution, Ophthalmic [irrigation; preservative free]:Generic: Sodium chloride 0.64%, potassium chloride 0.075%, calcium chloride0.048%, magnesium chloride 0.03%, sodium acetate 0.39%, sodium citrate0.17% (18 mL, 500 mL)

Belladonna and OpiumOutpatient Dosage FormsSuppository, Rectal:Generic: Belladonna extract 16.2 mg and opium 60 mg

BenazeprilOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg, 20 mg, 40 mg

BenzocaineOutpatient Formulary Brands Available Americaine [OTC]; Hurricaine[OTC]Outpatient Dosage FormsAerosol, Mouth/Throat:Hurricaine: 20% (60 mL) [dye free; wild cherry flavor]

Aerosol, Topical [spray]:Americaine: 20% (60 mL)

BenzonatateOutpatient Dosage FormsCapsule, Oral:Generic: 100 mg

BenztropineOutpatient Dosage FormsTablet, Oral, as mesylate:Generic: 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF]

Betamethasone (Topical)Outpatient Formulary Brands Available Beta-Val [DSC]Outpatient Dosage FormsCream, External, as valerate [strength expressed as base]:Beta-Val: 0.1% (15 g) [DSC]Generic: 0.1% (45 g)

Ointment, External, as dipropionate augmented [strength expressed as base]:Generic: 0.05% (15 g)

Betaxolol (Ophthalmic)Outpatient Formulary Brands Available Betoptic SOutpatient Dosage FormsSuspension, Ophthalmic:Betoptic S: 0.25% (10 mL) [contains benzalkonium chloride]

BethanecholOutpatient Dosage FormsTablet, Oral, as chloride:Generic: 10 mg, 25 mg

Bictegravir, Emtricitabine, and Tenofovir AlafenamideOutpatient Dosage FormsTablet, Oral:Biktarvy: Bictegravir 50 mg, emtricitabine 200 mg, and tenofovir alafena-mide 25 mg

BisacodylOutpatient Dosage FormsTablet, Enteric Coated, Oral:Generic: 5 mg

Bismuth Subcitrate, Metronidazole, and TetracyclineOutpatient Dosage FormsCapsule, Oral:Pylera: Bismuth subcitrate potassium 140 mg, metronidazole 125 mg, andtetracycline hydrochloride 125 mg

Bismuth SubsalicylateOutpatient Dosage FormsTablet Chewable, Oral, as subsalicylate:Generic: 262 mg

BisoprololOutpatient Dosage FormsTablet, Oral, as fumarate:Generic: 5 mg, 10 mg

Bisoprolol and HydrochlorothiazideOutpatient Dosage FormsTablet, Oral:Generic: 10/6.25: Bisoprolol fumarate 10 mg and hydrochlorothiazide6.25 mg, 2.5/6.25: Bisoprolol fumarate 2.5 mg and hydrochlorothiazide6.25 mg, 5/6.25: Bisoprolol fumarate 5 mg and hydrochlorothiazide 6.25 mg

Brimonidine (Ophthalmic)Outpatient Formulary Brands Available Alphagan POutpatient Dosage FormsSolution, Ophthalmic, as tartrate [drops]:Alphagan P: 0.15% (5 mL) [contains Purite] [BCF]Generic: 0.15% (5 mL) [BCF]; 0.2% (5 mL) [BCF]

BromocriptineOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg

Brompheniramine and PseudoephedrineOutpatient Formulary Brands Available Dimaphen [OTC] [DSC]Outpatient Dosage FormsElixir, Oral:Dimaphen: Brompheniramine maleate 1 mg and pseudoephedrine hydro-chloride 15 mg per 5 mL (120 mL) [DSC]

Budesonide (Oral Inhalation)Outpatient Dosage FormsSuspension, Inhalation:Generic: 0.25 mg/2 mL (2 mL); 0.5 mg/2 mL (2 mL)

Buprenorphine and NaloxoneOutpatient Dosage FormsFilm, Buccal:Bunavail: Buprenorphine 6.3 mg and naloxone 1 mg (1 ea, 30 ea); Buprenor-phine 2.1 mg and naloxone 0.3 mg (1 ea, 30 ea); Buprenorphine 4.2 mg andnaloxone 0.7 mg (1 ea, 30 ea) [contains brilliant blue fcf (fd&c blue #1),methylparaben, propylparaben, saccharin sodium, sodium benzoate]

Film, Sublingual:Suboxone: Buprenorphine 4 mg and naloxone 1 mg (1 ea, 30 ea); Buprenor-phine 8 mg and naloxone 2 mg (1 ea, 30 ea); Buprenorphine 12 mg andnaloxone 3 mg (1 ea, 30 ea); Buprenorphine 2 mg and naloxone 0.5 mg (1ea, 30 ea) [contains fd&c yellow #6 (sunset yellow); lime flavor]

Generic: Buprenorphine 12 mg and naloxone 3 mg (1 ea, 30 ea); Buprenor-phine 2 mg and naloxone 0.5 mg (1 ea, 30 ea); Buprenorphine 4 mg andnaloxone 1 mg (1 ea, 30 ea); Buprenorphine 8 mg and naloxone 2 mg (1 ea,30 ea)

Tablet Sublingual, Sublingual:Zubsolv: Buprenorphine 5.7 mg and naloxone 1.4 mg, Buprenorphine 8.6 mgand naloxone 2.1 mg, Buprenorphine 0.7 mg and naloxone 0.18 mg, Bupre-norphine 1.4 mg and naloxone 0.36 mg, Buprenorphine 11.4 mg and nalox-one 2.9 mg, Buprenorphine 2.9 mg and naloxone 0.71 mg [containsmenthol; menthol flavor]

Generic: Buprenorphine 2 mg and naloxone 0.5 mg, Buprenorphine 8 mg andnaloxone 2 mg

BuPROPionOutpatient Formulary Brands Available Wellbutrin SR; Wellbutrin XLOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 75 mg [BCF], 100 mg [BCF]

Tablet Extended Release 12 Hour, Oral, as hydrochloride:Wellbutrin SR: 100 mg [BCF]Generic: 100 mg [BCF], 150 mg [BCF]

Tablet Extended Release 24 Hour, Oral, as hydrochloride:Wellbutrin XL: 150 mg [BCF], 300 mg [BCF]Generic: 150 mg [BCF], 300 mg [BCF]

BACITRACIN, NEOMYCIN, AND POLYMYXIN B (OPHTHALMIC)

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BusPIRoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF]

Butalbital, Acetaminophen, and CaffeineOutpatient Dosage FormsTablet, Oral:Generic: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg [BCF]

Butalbital, Aspirin, and CaffeineOutpatient Dosage FormsTablet, Oral:Generic: Butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg

CabergolineOutpatient Dosage FormsTablet, Oral:Generic: 0.5 mg

CalcipotrieneOutpatient Dosage FormsCream, External:Generic: 0.005% (60 g)

Calcitriol (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 0.25 mcg

Calcium and Vitamin DOutpatient Formulary Brands Available Os-Cal 500+D [OTC]Outpatient Dosage FormsTablet, Oral:Generic: Calcium 315 mg and vitamin D 250 units

Tablet, Chewable, Oral:Os-Cal 500+D: Calcium 500 mg and vitamin D 400 int. units [sugar free;contains phenylalanine; light lemon flavor]

Calcium GlubionateOutpatient Formulary Brands Available Calcionate [OTC]Outpatient Dosage FormsSyrup, Oral:Calcionate: 1.8 g/5 mL (473 mL) [contains benzoic acid; caramel-orangeflavor; equivalent to elemental calcium 115 mg/5 mL]

CandesartanOutpatient Dosage FormsTablet, Oral, as cilexetil:Generic: 4 mg, 8 mg, 16 mg, 32 mg

Candesartan and HydrochlorothiazideOutpatient Dosage FormsTablet, Oral:Generic: 16/12.5: Candesartan cilexetil 16 mg and hydrochlorothiazide12.5 mg, 32/12.5: Candesartan cilexetil 32 mg and hydrochlorothiazide12.5 mg, 32/25: Candesartan cilexetil 32 mg and hydrochlorothiazide 25 mg

CapsaicinOutpatient Dosage FormsCream, External:Generic: 0.025% (60 g); 0.075% (60 g)

CaptoprilOutpatient Dosage FormsTablet, Oral:Generic: 12.5 mg [BCF], 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

CarBAMazepineOutpatient Formulary Brands Available TEGretol; TEGretol-XROutpatient Dosage FormsSuspension, Oral:TEGretol: 100 mg/5 mL (450 mL) [contains propylene glycol; citrus-vanillaflavor] [BCF]

Generic: 100 mg/5 mL (10 mL) [BCF]Tablet, Oral:Generic: 200 mg [BCF], 400 mg [BCF]

Tablet, Chewable, Oral:Generic: 100 mg [BCF]

Tablet Extended Release 12 Hour, Oral:TEGretol-XR: 100 mg, 200 mg, 400 mg [BCF]Generic: 100 mg, 200 mg, 400 mg [BCF]

Carbidopa and LevodopaOutpatient Formulary Brands Available SinemetOutpatient Dosage FormsTablet, Oral:Sinemet:10/100: Carbidopa 10 mg and levodopa 100 mg [BCF]25/100: Carbidopa 25 mg and levodopa 100 mg [BCF]

25/250: Carbidopa 25 mg and levodopa 250 mg [BCF]Generic:10/100: Carbidopa 10 mg and levodopa 100 mg [scored] [BCF]25/100: Carbidopa 25 mg and levodopa 100 mg [scored] [BCF]25/250: Carbidopa 25 mg and levodopa 250 mg [scored] [BCF]

Tablet Extended Release, Oral:Generic: Carbidopa 50 mg and levodopa 200 mg

CarisoprodolOutpatient Dosage FormsTablet, Oral:Generic: 350 mg

CarvedilolOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as phosphate:Generic: 10 mg, 20 mg, 40 mg, 80 mg

Tablet, Oral:Generic: 3.125 mg [BCF], 6.25 mg [BCF], 12.5 mg [BCF], 25 mg [BCF]

CefdinirOutpatient Dosage FormsCapsule, Oral:Generic: 300 mg

Suspension Reconstituted, Oral:Generic: 125 mg/5 mL (60 mL, 100 mL)

CelecoxibOutpatient Dosage FormsCapsule, Oral:Generic:100 mg, 200 mg

CephalexinOutpatient Formulary Brands Available KeflexOutpatient Dosage FormsCapsule, Oral:Keflex: 250 mg [BCF], 500 mg [BCF]Generic: 250 mg [BCF], 500 mg [BCF]

Suspension Reconstituted, Oral:Generic: 125 mg/5 mL (100 mL); 250 mg/5 mL (200 mL) [BCF]

Cetirizine (Systemic)Outpatient Dosage FormsSyrup, Oral, as hydrochloride:Generic: 5 mg/5 mL (118 mL)

Tablet, Oral, as hydrochloride:Generic: 10 mg

Chloral HydrateOutpatient Dosage FormsSyrup, Oral:Generic: 500 mg/5 mL (5 mL)

Chlorhexidine Gluconate (Oral)Outpatient Formulary Brands Available PeriogardOutpatient Dosage FormsSolution, Mouth/Throat:Generic: 0.12% (473 mL) [BCF]

ChloroquineOutpatient Dosage FormsTablet, Oral, as phosphate:Generic: 500 mg [equivalent to chloroquine base 300 mg]

ChlorthalidoneOutpatient Dosage FormsTablet, Oral:Generic: 25 mg [BCF], 50 mg [BCF]

ChlorzoxazoneOutpatient Dosage FormsTablet, Oral:Generic: 250 mg, 375 mg, 500 mg, 750 mg

CholecalciferolOutpatient Dosage FormsTablet, Oral:Generic: 1000 units, 5000 units

CilostazolOutpatient Dosage FormsTablet, Oral:Generic: 50 mg, 100 mg

Ciprofloxacin and DexamethasoneOutpatient Formulary Brands Available CiprodexOutpatient Dosage FormsSuspension, Otic:Ciprodex: Ciprofloxacin 0.3% and dexamethasone 0.1% (7.5 mL) [containsbenzalkonium chloride]

CIPROFLOXACIN AND DEXAMETHASONE

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Ciprofloxacin (Systemic)Outpatient Formulary Brands Available CiproOutpatient Dosage FormsSuspension Reconstituted, Oral:Cipro: 250 mg/5 mL (100 mL) [strawberry flavor] [BCF]; 500 mg/5 mL (100mL) [strawberry flavor]

Generic: 250 mg/5 mL (100 mL) [BCF]; 500 mg/5 mL (100 mL)Tablet, Oral, as hydrochloride [strength expressed as base]:Generic: 100 mg, 250 mg [BCF], 500 mg [BCF], 750 mg

CitalopramOutpatient Dosage FormsSolution, Oral:Generic: 10 mg/5 mL (240 mL) [BCF]

Tablet, Oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]

ClarithromycinOutpatient Dosage FormsSuspension Reconstituted, Oral:Generic: 125 mg/5 mL (100 mL); 250 mg/5 mL (100 mL)

Tablet, Oral:Generic: 250 mg, 500 mg

Tablet Extended Release 24 Hour, Oral:Generic: 500 mg

Clindamycin and Benzoyl PeroxideOutpatient Dosage FormsGel, External:Duac: Clindamycin phosphate 1.2% and benzoyl peroxide 5% (45 g)Generic: Clindamycin 1% and benzoyl peroxide 5% (25 g, 50 g)

Clindamycin (Systemic)Outpatient Dosage FormsCapsule, Oral, as hydrochloride [strength expressed as base]:Generic: 150 mg [BCF]

Solution Reconstituted, Oral, as palmitate hydrochloride [strength expressed asbase]:Generic: 75 mg/5 mL (100 mL)

Clindamycin (Topical)Outpatient Dosage FormsCream, Vaginal, as phosphate [strength expressed as base]:Cleocin: 2% (40 g) [contains benzyl alcohol, mineral oil] [BCF]Generic: 2% (40 g) [BCF]

Gel, External, as phosphate [strength expressed as base]:Generic: 1% (30 g)

Solution, External, as phosphate [strength expressed as base]:Generic: 1% (60 mL) [BCF]

ClobetasolOutpatient Dosage FormsCream, External, as propionate:Generic: 0.05% (30 g, 45 g)

Foam, External, as propionate:Generic: 0.05% (50 g, 100 g)

Ointment, External, as propionate:Generic: 0.05% (30 g, 45 g)

Solution, External, as propionate:Generic: 0.05% (25 mL)

ClomiPHENEOutpatient Dosage FormsTablet, Oral, as citrate:Generic: 50 mg

ClonazePAMOutpatient Dosage FormsTablet, Oral:Generic: 0.5 mg [BCF], 2 mg

CloNIDineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 0.1 mg [BCF], 0.2 mg [BCF], 0.3 mg [BCF]

Tablet Extended Release 12 Hour, Oral, as hydrochloride:Generic: 0.1 mg

ClopidogrelOutpatient Formulary Brands Available PlavixOutpatient Dosage FormsTablet, Oral:Plavix: 75 mg [BCF], 300 mg [BCF]Generic: 75 mg [BCF], 300 mg [BCF]

Clotrimazole (Topical)Outpatient Dosage FormsCream, External:Generic: 1% (30 g) [available through Self Care program]

Cream, Vaginal:Generic: 1% (45 g) [available through Self Care program]

Solution, External:Generic: 1% (30 mL) [BCF]

Coal TarOutpatient Dosage FormsSolution, External:Generic: 20% (473 mL)

CodeineOutpatient Dosage FormsTablet, Oral, as sulfate:Generic: 30 mg

ColchicineOutpatient Dosage FormsTablet, Oral:Generic: 0.6 mg

ColestipolOutpatient Dosage FormsGranules, Oral, as hydrochloride:Generic: 5 g/5 g scoop (500 g)

Tablet, Oral, as hydrochloride:Generic: 1 g

Collodion, FlexibleOutpatient Dosage FormsLiquid, External:Generic: (30 mL)

CondomOutpatient Dosage FormsCondom: 3s

Contraceptive DevicesOutpatient Dosage FormsDiaphragm: 65 mm, 70 mm, 75 mm, 80 mm, 85 mm, 90 mm

Cromolyn (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as sodium:Generic: 4% (10 mL)

CyanocobalaminOutpatient Dosage FormsTablet, Oral:Generic: 1000 mcg

CyclobenzaprineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg [BCF]

CyclopentolateOutpatient Dosage FormsSolution, Ophthalmic, as hydrochloride:Generic: 0.5% (15 mL); 1% (15 mL); 2% (5 mL)

Cyclopentolate and PhenylephrineOutpatient Formulary Brands Available CyclomydrilOutpatient Dosage FormsSolution, Ophthalmic:Cyclomydril: Cyclopentolate hydrochloride 0.2% and phenylephrine hydro-chloride 1% (5 mL) [contains benzalkonium chloride]

CycloSPORINE (Ophthalmic)Outpatient Formulary Brands Available RestasisOutpatient Dosage FormsEmulsion, Ophthalmic [preservative free]:Restasis: 0.05% (0.4 mL) [contains castor oil]

CycloSPORINE (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 25 mg, 50 mg, 100 mg

Solution, Oral:Generic: 100 mg/mL (50 mL)

CyproheptadineOutpatient Dosage FormsSyrup, Oral, as hydrochloride:Generic: 2 mg/5 mL (480 mL) [BCF]

Tablet, Oral, as hydrochloride:Generic: 4 mg [BCF]

Dabigatran EtexilateOutpatient Formulary Brands Available Pradaxa

CIPROFLOXACIN (SYSTEMIC)

6

Outpatient Dosage FormsCapsule, Oral:Pradaxa: 75 mg, 150 mg

Dapsone (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 25 mg

DesipramineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg

DesmopressinOutpatient Dosage FormsSolution, Nasal, as acetate:Generic: 0.01% (5 mL)

Tablet, Oral, as acetate:Generic: 0.2 mg

DesonideOutpatient Dosage FormsCream, External:Generic: 0.05% (60 g)

Ointment, External:Generic: 0.05% (15 g, 60 g)

DexAMETHasone (Systemic)Outpatient Dosage FormsElixir, Oral:Generic: 0.5 mg/5 mL (237 mL)

Tablet, Oral:Generic: 0.5 mg, 4 mg

DextroamphetamineOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as sulfate:Generic: 10 mg, 15 mg

Tablet, Oral, as sulfate:Generic: 5 mg

Dextroamphetamine and AmphetamineOutpatient Dosage FormsCapsule, Extended release, Oral:Adderall XR:5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetaminesulfate 1.25 mg (equivalent to amphetamine base 3.1 mg)] [BCF]

10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sul-fate 2.5 mg (equivalent to amphetamine base 6.3 mg)] [BCF]

15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccha-rate 3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphet-amine sulfate 3.75 mg (equivalent to amphetamine base 9.4 mg)] [BCF]

20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate5 mg (equivalent to amphetamine base 12.5 mg)] [BCF]

25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine saccha-rate 6.25 mg, amphetamine aspartate 6.25 mg, amphetamine sulfate6.25 mg (equivalent to amphetamine base 15.6 mg)] [BCF]


Generic:5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetaminesulfate 1.25 mg (equivalent to amphetamine base 3.1 mg)] [BCF]



20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate5 mg (equivalent to amphetamine base 12.5 mg)] [BCF]



Tablet, Oral:Generic:5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetaminesulfate 1.25 mg (equivalent to amphetamine base 3.13 mg)]

10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate2.5 mg, amphetamine aspartate 2.5 mg, amphetamine sulfate 2.5 mg(equivalent to amphetamine base 6.3 mg)]

20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate5 mg, amphetamine aspartate 5 mg, amphetamine sulfate 5 mg (equiva-lent to amphetamine base 12.6 mg)]

Diabetic SuppliesOutpatient Dosage FormsLancet: (200s)Meter:Precision Xtra [limit of one machine per patient]

Pen needle:BD Ultra-Fine Original Pen Needle (100s)BD Ultra-Fine Short Pen Needle (100s)BD Ultra-Fine Mini Pen Needle (100s)

Syringe and needle:BD Insulin Syringe 1 mL (Ultra-Fine) [BCF]BD Lo-Dose Insulin Syringe 0.5 mL (Ultra-Fine)[BCF]BD Lo-Dose Insulin Syringe 0.3 mL (Ultra-Fine)

Test Strips:Precision Xtra Blood Glucose Test Strips (100s)Precision Xtra Ketone Test Strips (10s)

DiazePAMOutpatient Dosage FormsSolution, Oral:Generic: 5 mg/5 mL (5 mL)

Tablet, Oral:Generic: 5 mg [BCF]

DibucaineOutpatient Dosage FormsOintment, External:Generic: 1% [10 mg/g] (30 g)

Diclofenac (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as sodium:Generic: 0.1% (5 mL)

Diclofenac (Systemic)Outpatient Dosage FormsTablet Delayed Release, Oral, as sodium:Generic: 50 mg, 75 mg

Diclofenac (Topical)Outpatient Formulary Brands Available VoltarenOutpatient Dosage FormsGel, Transdermal, as sodium:Voltaren: 1% (100 g) [contains isopropyl alcohol, propylene glycol]

DicloxacillinOutpatient Dosage FormsCapsule, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

DicyclomineOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 10 mg [BCF]

Solution, Oral, as hydrochloride:Generic: 10 mg/5 mL (473 mL)


DifluprednateOutpatient Formulary Brands Available DurezolOutpatient Dosage FormsEmulsion, Ophthalmic:Durezol: 0.05% (5 mL) [contains edetate sodium (tetrasodium), polysor-bate 80]

DigoxinOutpatient Formulary Brands Available LanoxinOutpatient Dosage FormsSolution, Oral:Generic: 0.05 mg/mL (60 mL)

Tablet, Oral:Lanoxin: 125 mcg [BCF], 250 mcg [BCF] [scored]Generic: 125 mcg [BCF], 250 mcg [BCF]

DilTIAZemOutpatient Formulary Brands Available TiazacOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as hydrochloride:Tiazac: 180 mg [BCF], 240 mg [BCF]Generic: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF], 300 mg [BCF],360 mg [BCF], 420 mg [BCF]

DILTIAZEM

7


Dimethyl SulfoxideOutpatient Formulary Brands Available Rimso-50Outpatient Dosage FormsSolution, Intravesical:Rimso-50: 50% (50 mL)

DinoprostoneOutpatient Dosage FormsInsert, Vaginal:Cervidil: 10 mg (1 ea)

DiphenhydrAMINE (Systemic)Outpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 25 mg, 50 mg

Solution, Oral, as hydrochloride:Generic: 12.5 mg/5 mL (5 mL)

Diphenoxylate and AtropineOutpatient Dosage FormsTablet, Oral:Generic: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate 0.025 mg

DipyridamoleOutpatient Dosage FormsTablet, Oral:Generic: 25 mg

DisulfiramOutpatient Dosage FormsTablet, Oral:Generic: 250 mg

DofetilideOutpatient Dosage FormsCapsule, Oral:Generic: 125 mcg, 250 mcg, 500 mcg

DonepezilOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg

Dornase AlfaOutpatient Dosage FormsSolution, Inhalation:Pulmozyme: 1 mg/mL (2.5 mL)

DorzolamideOutpatient Dosage FormsSolution, Ophthalmic:Generic: 2% (10 mL)

Dorzolamide and TimololOutpatient Dosage FormsSolution, Ophthalmic:Generic: Dorzolamide 2% [20 mg/mL] and timolol 0.5% [5 mg/mL] (10 mL)

DoxazosinOutpatient Dosage FormsTablet, Oral:Generic: 2 mg, 8 mg

Doxepin (Systemic)Outpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF]

Concentrate, Oral:Generic: 10 mg/mL (120 mL) [BCF]

Doxepin (Topical)Outpatient Dosage FormsCream, External, as hydrochloride:Generic: 5% (45 g)

DoxycyclineOutpatient Dosage FormsCapsule, Oral, as hyclate:Generic: 100 mg [strength expressed as base] [BCF]

Tablet, Oral, as hyclate:Generic: 100 mg [strength expressed as base] [BCF]

DULoxetineOutpatient Dosage FormsCapsule Delayed Release Particles, Oral:Generic: 20 mg, 30 mg, 60 mg

EmollientsOutpatient Formulary Brands Available Keri; VanicreamOutpatient Dosage FormsCream, External:Vanicream: (57 g, 113 g, 453 g) [dye free, fragrance free]

Lotion, External:Keri: (60 mL)

EmpagliflozinOutpatient Dosage FormsTablet, Oral:Jardiance: 10 mg, 25 mg

Emtricitabine and Tenofovir Disoproxil FumarateOutpatient Dosage FormsTablet, Oral:Truvada: Emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg

EnalaprilOutpatient Dosage FormsTablet, Oral, as maleate:Generic: 2.5 mg, 5 mg, 10 mg, 20 mg

EnoxaparinOutpatient Formulary Brands Available LovenoxOutpatient Dosage FormsSolution, Subcutaneous, as sodium [preservative free]:Lovenox: 30 mg/0.3 mL (0.3 mL) [BCF]; 40 mg/0.4 mL (0.4 mL) [BCF];60 mg/0.6 mL (0.6 mL) [BCF]; 80 mg/0.8 mL (0.8 mL) [BCF]; 100 mg/mL(1 mL) [BCF]; 120 mg/0.8 mL (0.8 mL) [BCF]; 150 mg/mL (1 mL) [BCF]

Generic: 30 mg/0.3 mL (0.3 mL) [BCF]; 40 mg/0.4 mL (0.4 mL) [BCF]; 60 mg/0.6 mL (0.6 mL) [BCF]; 80 mg/0.8 mL (0.8 mL) [BCF]; 100 mg/mL (1 mL)[BCF]; 120 mg/0.8 mL (0.8 mL) [BCF]; 150 mg/mL (1 mL) [BCF]

EPINEPHrine (Systemic)Outpatient Formulary Brands Available EpiPen; EpiPen Jr.Outpatient Dosage FormsSolution, Injection:Generic: 0.1 mg/mL (10 mL); 1 mg/mL (1 mL)

Solution Auto-injector, Injection:EpiPen 2-Pak: 0.3 mg/0.3 mL (2 mL) [contains sodium metabisulfite; 1:1000solution; delivers 0.3 mg per injection]

EpiPen Jr 2-Pak: 0.15 mg/0.3 mL (2 mL) [contains sodium metabisulfite;1:2000 solution; delivers 0.15 mg per injection]

Generic: 0.15 mg/0.15 mL (1 ea [DSC], 2 ea); 0.3 mg/0.3 mL (1 ea, 2 ea)

ErgocalciferolOutpatient Dosage FormsCapsule, Oral:Generic: 50,000 units

Ergotamine and CaffeineOutpatient Dosage FormsTablet, Oral:Generic: Ergotamine tartrate 1 mg and caffeine 100 mg

Erythromycin (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Generic: 5 mg/g (3.5 g) [BCF]

Erythromycin (Systemic)Outpatient Formulary Brands Available E.E.S. Granules; Ery-Tab; EryPed200; Erythrocin StearateOutpatient Dosage FormsSuspension Reconstituted, Oral, as ethylsuccinate:E.E.S. Granules: 200 mg/5 mL (100 mL, 200 mL) [cherry flavor] [BCF]EryPed: 200 mg/5 mL (100 mL) [fruit flavor] [BCF]Generic: 200 mg/5 mL (100 mL, 200 mL)

Tablet, Oral, as stearate:Erythrocin Stearate: 250 mg [BCF]

Tablet Delayed Release, Oral, as base:Ery-Tab: 250 mg [BCF]

Erythromycin (Topical)Outpatient Dosage FormsGel, External:Generic: 2% (30 g, 60 g) [BCF]

Solution, External:Generic: 2% (60 mL) [BCF]

EscitalopramOutpatient Dosage FormsSolution, Oral:Generic: 5 mg/5 mL (240 mL)

Tablet, Oral:Generic: 5 mg, 10 mg, 20 mg

DILTIAZEM

8

EsomeprazoleOutpatient Dosage FormsCapsule Delayed Release, Oral, as magnesium [strength expressed as base]:Generic: 20 mg, 40 mg

Estradiol (Systemic)Outpatient Formulary Brands Available ClimaraOutpatient Dosage FormsPatch Weekly, Transdermal:Climara:0.025 mg/24 hours (4s) [6.5 cm2, total estradiol 2.04 mg] [BCF]0.0375 mg/24 hours (4s) [9.375 cm2, total estradiol 2.85 mg] [BCF]0.05 mg/24 hours (4s) [12.5 cm2, total estradiol 3.8 mg] [BCF]0.06 mg/24 hours (4s) [15 cm2, total estradiol 4.55 mg] [BCF]0.075 mg/24 hours (4s) [18.75 cm2, total estradiol 5.7 mg] [BCF]0.1 mg/24 hours (4s) [25 cm2, total estradiol 7.6 mg] [BCF]

Generic: 0.025 mg/24 hours (4 ea) [BCF]; 0.0375 mg/24 hours (4 ea) [BCF];0.05 mg/24 hours (4 ea) [BCF]; 0.06 mg/24 hours (4 ea) [BCF]; 0.075 mg/24hours (4 ea) [BCF]; 0.1 mg/24 hours (4 ea) [BCF]

Tablet, Oral:Generic: 1 mg, 2 mg

Estrogens (Conjugated/Equine) and MedroxyprogesteroneOutpatient Formulary Brands Available PremproOutpatient Dosage FormsTablet, Oral:Prempro:0.3/1.5: Conjugated estrogens 0.3 mg and medroxyprogesterone acetate1.5 mg (28s) [BCF]

0.45/1.5: Conjugated estrogens 0.45 mg and medroxyprogesterone acetate1.5 mg (28s) [BCF]

0.625/2.5: Conjugated estrogens 0.625 mg and medroxyprogesterone ace-tate 2.5 mg (28s) [BCF]

0.625/5: Conjugated estrogens 0.625 mg and medroxyprogesterone acetate5 mg (28s) [BCF]

Estrogens (Conjugated/Equine, Systemic)Outpatient Formulary Brands Available PremarinOutpatient Dosage FormsTablet, Oral:Premarin: 0.3 mg [BCF], 0.45 mg [BCF], 0.625 mg [BCF], 1.25 mg [BCF]

Estrogens (Conjugated/Equine, Topical)Outpatient Formulary Brands Available PremarinOutpatient Dosage FormsCream, Vaginal:Premarin: 0.625 mg/g (30 g) [BCF]

Estrogens (Esterified) and MethyltestosteroneOutpatient Dosage FormsTablet, Oral:Generic: Esterified estrogen 0.625 mg and methyltestosterone 1.25 mg;esterified estrogens 1.25 mg and methyltestosterone 2.5 mg

EszopicloneOutpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2 mg, 3 mg

EthambutolOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 100 mg [BCF], 400 mg [BCF]

Ethinyl Estradiol and DesogestrelOutpatient Dosage FormsTablet, Oral:Generic: Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21tablets]; Day 22-23: 2 inactive tablets; Day 24-28: Ethinyl estradiol 0.01 mg[5 tablets], Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg

Ethinyl Estradiol and DrospirenoneOutpatient Formulary Brands Available Yasmin; YazOutpatient Dosage FormsTablet, Oral:Yasmin: Ethinyl estradiol 0.03 mg and drospirenone 3 mg (28s) [21 yellowactive tablets and 7 white inactive tablets] [BCF]

Yaz: Ethinyl estradiol 0.02 mg and drospirenone 3 mg (28s) [24 light pinktablets and 4 white inactive tablets] [BCF]

Generic: Ethinyl estradiol 0.02 mg and drospirenone 3 mg [21 active tabletsand 7 inactive tablets] (28s) [BCF]

Generic: Ethinyl estradiol 0.03 mg and drospirenone 3 mg [21 active tabletsand 7 inactive tablets] (28s) [BCF]

Ethinyl Estradiol and Ethynodiol DiacetateOutpatient Dosage FormsTablet, Oral:Generic: Ethinyl estradiol 0.035 mg and ethynodiol diacetate 1 mg [21 tabletsand 7 inactive tablets], Ethinyl estradiol 0.05 mg and ethynodiol diacetate1 mg [21 tablets and 7 inactive tablets]

Ethinyl Estradiol and EtonogestrelOutpatient Formulary Brands Available NuvaRingOutpatient Dosage FormsRing, Vaginal:NuvaRing: Ethinyl estradiol 0.015 mg/day and etonogestrel 0.12 mg/day (1s)[3-week duration]

Ethinyl Estradiol and LevonorgestrelOutpatient Formulary Brands Available Aviane; Lessina; Levora; SronyxOutpatient Dosage FormsTablet, Oral [low dose formulation]:Aviane 28: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21orange tablets and 7 light green inactive tablets] [BCF]

Lessina 28: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 pinktablets and 7 white inactive tablets] [BCF]

Sronyx: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 whitetablets and 7 peach inactive tablets] [BCF]

Generic: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg [21 tablets and 7inactive tablets] (28s) [BCF]

Tablet, Oral [monophasic formulation]:Levora 28: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (28s) [21white tablets and 7 peach inactive tablets] [BCF]

Generic: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [21 tablets and7 inactive tablets] (28s) [BCF]

Tablet, Oral [triphasic formulation]:Generic:Day 1-6: Ethinyl estradiol 0.03 mg and levonorgestrel 0.05 mg [6 tablets]Day 7-11: Ethinyl estradiol 0.04 mg and levonorgestrel 0.075 mg [5 tablets]Day 12-21: Ethinyl estradiol 0.03 mg and levonorgestrel 0.125 mg [10tablets]

Day 22-28: 7 inactive tablets

Ethinyl Estradiol and NorelgestrominOutpatient Formulary Brands Available Ortho Evra [DSC]Outpatient Dosage FormsPatch Weekly, Transdermal:Ortho Evra: Ethinyl estradiol 35 mcg and norelgestromin 150 mcg per day (1ea [DSC], 3 ea [DSC])

Ethinyl Estradiol and NorethindroneOutpatient Formulary Brands Available Loestrin Fe 1.5/30; Necon 7/7/7;Norinyl 1+35Outpatient Dosage FormsTablet, Oral:Loestrin Fe 1.5/30: Ethinyl estradiol 0.03 mg and norethindrone acetate1.5 mg [21 pink tablets] and ferrous fumarate 75 mg [7 brown tablets] (28s)

Norinyl 1+35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 yellowgreen tablets and 7 orange inactive tablets] (28s) [BCF]

Generic: Ethinyl estradiol 0.005 mg and norethindrone acetate 1 mg, Ethinylestradiol 0.02 mg and norethindrone acetate 1 mg [21 tablets] and ferrousfumarate 75 mg [7 tablets]

Tablet, Oral [triphasic formulation]:Necon 7/7/7:Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [7 whitetablets]

Day 8-14: Ethinyl estradiol 0.035 mg and norethindrone 0.75 mg [7 lightpeach tablets]

Day 15-21: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [7 peachtablets]

Day 22-28: 7 green inactive tablets

Ethinyl Estradiol and NorgestimateOutpatient Formulary Brands Available MonoNessa; Ortho Tri-Cyclen Lo;TriNessaOutpatient Dosage FormsTablet, Oral [monophasic formulation]:MonoNessa: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg (28s) [21blue tablets and 7 green inactive tablets] [BCF]

Tablet, Oral [triphasic formulation]:Ortho Tri-Cyclen Lo [BCF]:Day 1-7: Ethinyl estradiol 0.025 mg and norgestimate 0.18 mg [7 whitetablets]

Day 8-14: Ethinyl estradiol 0.025 mg and norgestimate 0.215 mg [7 light bluetablets]

Day 15-21: Ethinyl estradiol 0.025 mg and norgestimate 0.25 mg [7 darkblue tablets]

Day 22-28: 7 dark green inactive tabletsTriNessa [BCF]:Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 whitetablets]

Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light bluetablets]

ETHINYL ESTRADIOL AND NORGESTIMATE

9

Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 bluetablets]

Day 22-28: 7 green inactive tablets

Ethinyl Estradiol and NorgestrelOutpatient Formulary Brands Available Low-Ogestrel; OgestrelOutpatient Dosage FormsTablet, Oral:Ogestrel: Ethinyl estradiol 0.05 mg and norgestrel 0.5 mg

Tablet, Oral [monophasic formulation]:Low-Ogestrel: Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [21 whitetablets and 7 peach inactive tablets]

EthosuximideOutpatient Dosage FormsCapsule, Oral:Generic: 250 mg

Solution, Oral:Generic: 250 mg/5 mL (473 mL,474 mL)

EtodolacOutpatient Dosage FormsTablet, Oral:Generic: 400 mg

ExenatideOutpatient Formulary Brands Available BydureonOutpatient Dosage FormsPen-injector, Subcutaneous:Bydureon: 2 mg (1 ea)

Suspension Reconstituted, Subcutaneous:Bydureon: 2 mg (1 ea)

EzetimibeOutpatient Dosage FormsTablet, Oral:Generic: 10 mg

FamotidineOutpatient Dosage FormsTablet, Oral:Generic: 10 mg, 20 mg, 40 mg

Fenofibrate and DerivativesOutpatient Formulary Brands Available TriCorOutpatient Dosage FormsTablet, Oral:TriCor: 48 mg [BCF], 145 mg [BCF] [contains soybean lecithin]Generic: 48 mg [BCF], 145 mg [BCF]

FentaNYLOutpatient Dosage FormsPatch, Transdermal, as base:Generic: 25 mcg/hr (5s); 50 mcg/hr (5s); 75 mcg/hr (5s); 100 mcg/hr (5s)

Ferrous SulfateOutpatient Formulary Brands Available Fer-In-Sol [OTC]; Fer-iron [OTC]Outpatient Dosage FormsElixir, Oral:Generic: 220 mg/5 mL (473 mL) [elemental iron 44 mg/5 mL]

Liquid, Oral:Fer-In-Sol: 75 mg/mL (50 mL) [gluten free; contains ethanol 0.2%, sodiumbisulfite; elemental iron 15 mg/mL]

Fer-iron: 75 mg/mL (50 mL) [contains ethanol 0.2%, sodium bisulfite; lemonflavor; elemental iron 15 mg/mL]

Tablet, Oral:Generic: 325 mg [elemental iron 65 mg]

FexofenadineOutpatient Formulary Brands Available AllegraOutpatient Dosage FormsSuspension, Oral, as hydrochloride:Allegra Allergy Childrens: 30 mg/5 mL (120 mL) [alcohol free, dye free;contains butylparaben, edetate disodium, propylene glycol, propylparaben;raspberry creme flavor]

Tablet, Oral, as hydrochloride:Generic: 60 mg, 180 mg

FinasterideOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF]

FlecainideOutpatient Dosage FormsTablet, Oral, as acetate:Generic: 50 mg, 100 mg, 150 mg

FluconazoleOutpatient Formulary Brands Available Diflucan

Outpatient Dosage FormsSuspension Reconstituted, Oral:Generic: 10 mg/mL (35 mL); 40 mg/mL (35 mL)

Tablet, Oral:Generic: 100 mg, 150 mg [BCF], 200 mg

FludrocortisoneOutpatient Dosage FormsTablet, Oral, as acetate:Generic: 0.1 mg

Flunisolide (Nasal)Outpatient Dosage FormsSolution, Nasal:Generic: 25 mcg/actuation (0.025%) (25 mL)

Fluocinolone (Topical)Outpatient Dosage FormsOil, External, as acetonide:Generic: 0.01% (118.28 mL)

Solution, External, as acetonide:Generic: 0.01% (60 mL)

FluocinonideOutpatient Dosage FormsCream, External:Generic: 05% (30 g, 60 g) [BCF]

Gel, External:Generic: 0.05% (45 g)

Ointment, External:Generic: 0.05% (30 g, 60 g) [BCF]

FluorideOutpatient Formulary Brands Available Gel-Kam [OTC]; PreviDent 5000PlusOutpatient Dosage FormsCream, Oral, as sodium [toothpaste]:PreviDent 5000 Plus: 1.1% (51 g) [contains sodium benzoate; spearmintflavor; equivalent to fluoride 2.5 mg/dose]

Gel, Topical, as stannous flouride:Gel-Kam: 0.4% (129 g) [fruit & berry flavor]

Tablet, Chewable, Oral, as sodium:Generic: 2.2 mg [equivalent to fluoride 1 mg]

FluorometholoneOutpatient Dosage FormsSuspension, Ophthalmic, as base [drops]:Generic: 0.1% (10 mL)

Fluorouracil (Topical)Outpatient Dosage FormsCream, External:Generic: 0.5% (30 g); 5% (40 g)

FLUoxetineOutpatient Dosage FormsCapsule, Oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]

Solution, Oral:Generic: 20 mg/5 mL (5 mL, 120 mL) [BCF]

Tablet, Oral:Generic: 10 mg [scored] [BCF]

FlurandrenolideOutpatient Formulary Brands Available CordranOutpatient Dosage FormsTape, External:Cordran: 4 mcg/cm2 (1 ea)

FlutamideOutpatient Dosage FormsCapsule, Oral:Generic: 125 mg

Fluticasone and SalmeterolOutpatient Formulary Brands Available Advair Diskus; Advair HFAOutpatient Dosage FormsAerosol, for Oral Inhalation:Advair HFA:45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg per inhalation(12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]

115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcg per inhala-tion (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]

230/21: Fluticasone propionate 230 mcg and salmeterol 21 mcg per inhala-tion (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]

Powder, for Oral Inhalation:Advair Diskus:100/50: Fluticasone propionate 100 mcg and salmeterol 50 mcg (60s)[contains lactose] [BCF]

ETHINYL ESTRADIOL AND NORGESTIMATE

10

250/50: Fluticasone propionate 250 mcg and salmeterol 50 mcg (60s)[contains lactose] [BCF]

500/50: Fluticasone propionate 500 mcg and salmeterol 50 mcg (60s)[contains lactose] [BCF]

Fluticasone (Nasal)Outpatient Formulary Brands Available FlonaseOutpatient Dosage FormsSuspension, Nasal, as propionate:Flonase: 50 mcg/inhalation (16 g) [contains benzalkonium chloride; 120metered actuations] [BCF]

Generic: 50 mcg/inhalation (16 g) [BCF]

Fluticasone (Oral Inhalation)Outpatient Formulary Brands Available Flovent Diskus; Flovent HFAOutpatient Dosage FormsAerosol, Inhalation, as propionate:Flovent HFA:44 mcg/inhalation (10.6 g) [chlorofluorocarbon free; 120 metered actua-tions] [BCF]

110 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actua-tions] [BCF]

220 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actua-tions] [BCF]

Aerosol Powder Breath Activated, Inhalation, as propionate:Flovent Diskus:50 mcg (60s) [contains lactose] [BCF]100 mcg (60s) [contains lactose] [BCF]250 mcg (60s) [contains lactose] [BCF]

FluvoxaMINEOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as maleate:Generic: 100 mg, 150 mg

Tablet, Oral, as maleate:Generic: 25 mg, 50 mg, 100 mg

Folic AcidOutpatient Dosage FormsTablet, Oral:Generic: 1 mg [BCF]

FosfomycinOutpatient Dosage FormsPacket, Oral:Monurol: 3 g (1 ea) [orange flavor]

FosinoprilOutpatient Dosage FormsTablet, Oral, as sodium:Generic: 10 mg, 20 mg, 40 mg

FurosemideOutpatient Formulary Brands Available LasixOutpatient Dosage FormsSolution, Oral:Generic: 20 mg [BCF], 40 mg [BCF] 10 mg/mL (120 mL) [BCF]

Tablet, Oral:Lasix: 20 mg [scored] [BCF], 40 mg [scored] [BCF]Generic: 20 mg [BCF], 40 mg [BCF]

GabapentinOutpatient Dosage FormsCapsule, Oral:Generic: 100 mg [BCF], 300 mg [BCF], 400 mg [BCF]

Solution, Oral:Generic: 250 mg/5 mL (470 mL)


Ganciclovir (Ophthalmic)Outpatient Formulary Brands Available ZirganOutpatient Dosage FormsGel, Ophthalmic:Zirgan: 0.15% (5 g) [contains benzalkonium chloride]

GemfibrozilOutpatient Dosage FormsTablet, Oral:Generic: 600 mg [BCF]

Gentamicin (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Gentak: 0.3% (3.5 g) [BCF]Generic: 0.3% (3.5 g) [BCF]

Solution, Ophthalmic:Generic: 0.3% (5 mL, 15 mL) [BCF]

GlimepirideOutpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2 mg, 4 mg

GlipiZIDEOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF]

Tablet Extended Release 24 Hour, Oral:Generic: 2.5 mg, 5 mg, 10 mg

GlucagonOutpatient Formulary Brands Available Glucagon EmergencyOutpatient Dosage FormsKit, Injection:Glucagon Emergency: 1 mg [contains lactose]

GlyBURIDEOutpatient Dosage FormsTablet, Oral:Generic: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF]

Tablet, Micronized, Oral:Glynase: 1.5 mg [BCF], 3 mg [BCF], 6 mg [BCF] [scored]

Glyburide and MetforminOutpatient Dosage FormsTablet, Oral:Generic: 1.25 mg/250 mg: Glyburide 1.25 mg and metformin hydrochloride250 mg; 2.5 mg/500 mg: Glyburide 2.5 mg and metformin hydrochloride500 mg; 5 mg/500 mg: Glyburide 5 mg and metformin hydrochloride 500 mg

Glycopyrrolate (Systemic)Outpatient Formulary Brands Available RobinulOutpatient Dosage FormsTablet, Oral:Generic: 1 mg

GoserelinOutpatient Formulary Brands Available ZoladexOutpatient Dosage FormsImplant, Subcutaneous:Zoladex:3.6 mg (1s) [1 month implant] [BCF]10.8 mg (1s) [3 month implant] [BCF]

GriseofulvinOutpatient Formulary Brands Available Gris-PEGOutpatient Dosage FormsSuspension, Oral:Generic: 125 mg/5 mL (120 mL) [BCF]

Tablet, Oral:Gris-PEG: 125 mg [BCF], 250 mg [BCF] [scored]Generic: 125 mg [BCF], 250 mg [BCF]

Guaifenesin and CodeineOutpatient Dosage FormsSolution, Oral:Generic: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL(118 mL)

Guaifenesin and DextromethorphanOutpatient Dosage FormsLiquid, Oral:Generic: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per5 mL (480 mL)

GuanFACINEOutpatient Dosage FormsTablet, Oral:Generic: 1 mg

Tablet Extended Release 24 Hour, Oral:Generic: 1 mg, 2 mg, 3 mg, 4 mg

HaloperidolOutpatient Dosage FormsTablet, Oral:Generic: 0.5 mg, 2 mg

HomatropineOutpatient Dosage FormsSolution, Ophthalmic, as hydrobromide:Generic: 5% (5 mL)

HydrALAZINEOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

HYDRALAZINE

11

HydroCHLOROthiazideOutpatient Dosage FormsCapsule, Oral:Generic: 12.5 mg [BCF]


Hydrochlorothiazide and SpironolactoneOutpatient Dosage FormsTablet, Oral:Generic: Hydrochlorothiazide 25 mg and spironolactone 25 mg

Hydrochlorothiazide and TriamtereneOutpatient Dosage FormsTablet, Oral:Generic:Hydrochlorothiazide 25 mg and triamterene 37.5 mg [BCF]Hydrochlorothiazide 50 mg and triamterene 75 mg [BCF]

Hydrocodone and AcetaminophenOutpatient Dosage FormsSolution, Oral:Generic: Hydrocodone bitartrate 7.5 mg and acetaminophen 500 mg per 15mL (118 mL, 473 mL)

Tablet, Oral:Generic:Hydrocodone bitartrate 5 mg and acetaminophen 325 mgHydrocodone bitartrate 7.5 mg and acetaminophen 325 mg

Hydrocortisone (Systemic)Outpatient Dosage FormsTablet, Oral, as base:Generic: 5 mg, 20 mg

Hydrocortisone (Topical)Outpatient Formulary Brands Available Anucort-HC; Proctozone-HC 2.5%Outpatient Dosage FormsCream, External, as base:Proctozone-HC 2.5%: 2.5% (30 g) [BCF]Generic: 1% (30 g) [available through Self Care program]

Lotion, External, as base:Generic: 2.5% (59 mL, 118 mL)

Suspension, Rectal, as base:Generic: 100 mg/60 mL (60 mL)

HYDROmorphoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 2 mg

HydroquinoneOutpatient Formulary Brands Available MelanexOutpatient Dosage FormsCream, External:Generic: 4% (28.35 g)

Solution, External:Melanex: 3% (30 mL) [contains ethanol, sodium metabisulfite]

HydroxychloroquineOutpatient Dosage FormsTablet, Oral, as sulfate:Generic: 200 mg

HYDROXYprogesterone CaproateOutpatient Dosage FormsOil, Intramuscular:Generic: 250 mg/mL (5 mL)

HydroxyureaOutpatient Dosage FormsCapsule, Oral:Generic: 500 mg

HydrOXYzineOutpatient Dosage FormsCapsule, Oral, as pamoate:Generic: 50 mg

Solution, Oral, as hydrochloride:Generic: 10 mg/5 mL (473 mL) [BCF]

Syrup, Oral, as hydrochloride:Generic: 10 mg/5 mL (473 mL) [BCF]

Tablet, Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

HyoscyamineOutpatient Dosage FormsTablet, Oral, as sulfate:Generic: 0.125 mg

Tablet Disintegrating, Oral, as sulfate:Generic: 0.125 mg

Tablet Sublingual, Sublingual, as sulfate:Generic: 0.125 mg

Tablet Extended Release 12 Hour, Oral, as sulfate:Generic: 0.375 mg

Hyoscyamine, Atropine, Scopolamine, and PhenobarbitalOutpatient Dosage FormsElixir, Oral:Generic: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, scopol-amine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg per 5 mL(473 mL)

Tablet, Oral:Generic: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, scopol-amine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg

IbandronateOutpatient Dosage FormsTablet, Oral:Generic: 150 mg

IbuprofenOutpatient Formulary Brands Available Ibu-200 [OTC]Outpatient Dosage FormsSuspension, Oral:Generic: 100 mg/5 mL (120 mL) [available through Self Care program]

Tablet, Oral:Ibu-200: 200 mg [available through Self Care program]Generic: 200 mg [available through Self Care program], 400 mg [BCF],600 mg [BCF], 800 mg [BCF]

ImipramineOutpatient Dosage FormsCapsule, Oral, as pamoate:Generic: 75 mg [BCF]


ImiquimodOutpatient Dosage FormsCream, External:Generic: 5% (24 ea)

IndapamideOutpatient Dosage FormsTablet, Oral:Generic: 1.25 mg, 2.5 mg

IndomethacinOutpatient Dosage FormsCapsule, Oral:Generic: 25 mg [BCF], 50 mg [BCF]

Inhalation DevicesOutpatient Formulary Brands Available AeroChamber; OptiChamberOutpatient Dosage FormsHolding Chamber:OptiChamber

Mask:AeroChamber with mask (small, medium)

Insulin AspartOutpatient Formulary Brands Available NovoLOG; NovoLOG FlexPenOutpatient Dosage FormsSolution, Subcutaneous:NovoLOG: 100 units/mL (10 mL) [contains metacresol, phenol] [BCF]

Solution Pen-injector, Subcutaneous:NovoLOG FlexPen: 100 units/mL (3 mL) [contains metacresol, phenol] [BCF]

Insulin Aspart Protamine and Insulin AspartOutpatient Formulary Brands Available NovoLOG Mix 70/30; NovoLOGMix 70/30 FlexPenOutpatient Dosage FormsSuspension, Subcutaneous:NovoLOG Mix 70/30: Insulin aspart protamine suspension 70% [intermediateacting] and insulin aspart solution 30% [rapid-acting] (10 mL) [BCF]

NovoLOG Mix 70/30 FlexPen: 100 units/mL: Insulin aspart protamine suspen-sion 70% [intermediate acting] and insulin aspart solution 30% [rapid-acting](3 mL) [BCF]

Insulin DetemirOutpatient Formulary Brands Available LevemirOutpatient Dosage FormsSolution, Subcutaneous:Levemir: 100 units/mL (10 mL)

Insulin GlargineOutpatient Formulary Brands Available Lantus; Lantus SolostarOutpatient Dosage FormsSolution, Subcutaneous:Lantus: 100 units/mL (10 mL) [contains metacresol] [BCF]

HYDROCHLOROTHIAZIDE

12

Solution Pen-injector, Subcutaneous:Lantus Solostar: 100 units/mL (3 mL) [BCF]

Insulin NPHOutpatient Formulary Brands Available NovoLIN NOutpatient Dosage FormsSuspension, Subcutaneous:NovoLIN N: 100 units/mL (10 mL) [BCF]

Insulin NPH and Insulin RegularOutpatient Formulary Brands Available NovoLIN 70/30Outpatient Dosage FormsSuspension, Subcutaneous:NovoLIN 70/30: Insulin NPH suspension 70% [intermediate acting] and insulinregular solution 30% [short acting]: 100 units/mL (10 mL) [BCF]

Insulin RegularOutpatient Formulary Brands Available NovoLIN ROutpatient Dosage FormsSolution, Injection:NovoLIN R: 100 units/mL (10 mL) [BCF]

Ipratropium and AlbuterolOutpatient Formulary Brands Available Combivent RespimatOutpatient Dosage FormsSolution, for Nebulization:Generic: Ipratropium bromide 0.5 mg and albuterol (base) 2.5 mg per 3mL (30s)

Solution, for Oral Inhalation [spray]:Combivent Respimat: Ipratropium bromide 20 mcg and albuterol (base) 100mcg per inhalation (4 g) [contains benzalkonium chloride; 120 meteredactuations]

Ipratropium (Nasal)Outpatient Dosage FormsSolution, Nasal, as bromide:Generic: 0.03% (30 mL); 0.06% (15 mL)

Ipratropium (Oral Inhalation)Outpatient Formulary Brands Available Atrovent HFAOutpatient Dosage FormsAerosol Solution, Inhalation, as bromide:Atrovent HFA: 17 mcg/actuation (12.9 g) [chlorofluorocarbon free; 200metered actuations] [BCF]

Solution, Inhalation, as bromide [preservative free]:Generic: 0.02% (2.5 mL)

IrbesartanOutpatient Dosage FormsTablet, Oral:Generic: 75 mg, 150 mg, 300 mg

IsoniazidOutpatient Dosage FormsSolution, Oral:Generic: 50 mg/5 mL (473 mL)


Isosorbide DinitrateOutpatient Formulary Brands Available Dilatrate-SROutpatient Dosage FormsCapsule Extended Release, Oral:Dilatrate-SR: 40 mg

Tablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg [BCF]

Tablet Extended Release, Oral:Generic: 40 mg [BCF]

Tablet, Sublingual:Generic: 5 mg

Isosorbide MononitrateOutpatient Dosage FormsTablet Extended Release 24 Hour, Oral:Generic: 30 mg [BCF], 60 mg [BCF], 120 mg [BCF]

ISOtretinoin (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 10 mg

ItraconazoleOutpatient Dosage FormsCapsule, Oral:Generic: 100 mg

Ivermectin (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 3 mg

Ketoconazole (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 200 mg

Ketoconazole (Topical)Outpatient Dosage FormsCream, External:Generic: 2% (30 g)

Shampoo, External:Generic: 2% (120 mL)

Ketorolac (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as tromethamine:Generic: 0.4% (5 mL)

Ketorolac (Systemic)Outpatient Dosage FormsKit, Injection, as tromethamine:ReadySharp Ketorolac: 15 mg/mL [contains alcohol, usp]

Solution, Injection, as tromethamine:Generic: 15 mg/mL (1 mL); 30 mg/mL (1 mL)

Solution, Injection, as tromethamine [preservative free]:Generic: 15 mg/mL (1 mL); 30 mg/mL (1 mL)

Solution, Intramuscular, as tromethamine:Generic: 60 mg/2 mL (2 mL)

Solution, Intramuscular, as tromethamine [preservative free]:Generic: 60 mg/2 mL (2 mL)

Tablet, Oral, as tromethamine:Generic: 10 mg

Ketotifen (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic:Generic: 0.025% (5 mL)

LabetalolOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 100 mg, 200 mg

LactuloseOutpatient Dosage FormsSolution, Oral:Generic: 10 g/15 mL (473 mL) [BCF]

Solution, Oral/Rectal:Generic: 10 g/15 mL (473 mL) [BCF]

LamoTRIgineOutpatient Dosage FormsTablet, Oral:Generic: 25 mg, 100 mg, 150 mg, 200 mg

Tablet Chewable, Oral:Generic: 25 mg

LanolinOutpatient Formulary Brands Available Lansinoh [OTC]Outpatient Dosage FormsOintment, External:Lansinoh: 7.5 gGeneric: (454 g)

LatanoprostOutpatient Dosage FormsSolution, Ophthalmic:Generic: 0.005% (2.5 mL) [BCF]

LeflunomideOutpatient Dosage FormsTablet, Oral:Generic: 10 mg, 20 mg

LetrozoleOutpatient Dosage FormsTablet, Oral:Generic: 10 mg, 20 mg

LeuprolideOutpatient Formulary Brands Available Lupron Depot; Lupron Depot-3Month; Lupron Depot-4 MonthOutpatient Dosage FormsKit, Intramuscular, as acetate [preservative free]:Lupron Depot: 3.75 mg, 7.5 mg [contains polylactide-co-glycolide, polysorbate80; released over 1 month]

Lupron Depot-3 Month: 11.25 mg, 22.5 mg [contains polylactide-co-glycolide,polysorbate 80; released over 3 months]

Lupron Depot-4 Month: 30 mg [contains polylactide-co-glycolide, polysorbate80; released over 4 months]

LEUPROLIDE

13

LevalbuterolOutpatient Dosage FormsNebulization Solution, Inhalation, as hydrochloride [strength expressed as base,preservative free]:Generic: 0.31 mg/3 mL (3 mL); 0.63 mg/3 mL (3 mL); 1.25 mg/3 mL (3 mL)

LevETIRAcetamOutpatient Dosage FormsSolution, Oral:Generic: 100 mg/mL (473 mL)

Tablet, Oral:Generic: 250 mg, 500 mg, 750 mg, 1000 mg

LevoFLOXacin (Systemic)Outpatient Formulary Brands Available LevaquinOutpatient Dosage FormsSolution, Oral:Levaquin: 25 mg/mL (480 mL) [contains benzyl alcohol, propylene gly-col] [BCF]

Generic: 25 mg/mL (480 mL) [BCF]Tablet, Oral:Levaquin: 250 mg [BCF], 500 mg [BCF], 750 mg [BCF]Generic: 250 mg [BCF], 500 mg [BCF], 750 mg [BCF]

Levonorgestrel (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 0.75 mg [BCF]

LevothyroxineOutpatient Formulary Brands Available SynthroidOutpatient Dosage FormsTablet, Oral, as sodium:Synthroid: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg [BCF], 100mcg [BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150 mcg[BCF], 175 mcg [BCF], 200 mcg [BCF], 300 mcg [BCF]

Generic: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg [BCF], 100mcg [BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150 mcg[BCF], 175 mcg [BCF], 200 mcg [BCF], 300 mcg [BCF]

Lidocaine (Topical)Outpatient Formulary Brands Available XylocaineOutpatient Dosage FormsCream, External:Generic: 4% (5 g, 30 g)

Jelly, Topical, as hydrochloride:Xylocaine: 2% (30 mL)

Jelly, Topical, as hydrochloride [preservative free]:Generic: 2% (10 mL)

Patch, External:Generic: 5% (30 ea)

Solution, External, as hydrochloride:Generic: 4% [40 mg/mL] (50 mL)

Solution, Mouth/Throat, as hydrochloride:Generic: 2% (15 mL, 100 mL)

LifitegrastOutpatient Dosage FormsSolution, Ophthalmic:Xiidra: 5% (5 ea)

LinaCLOtideOutpatient Dosage FormsCapsule, Oral:Linzess: 72 mcg, 145 mcg, 290 mcg

LiothyronineOutpatient Dosage FormsTablet, Oral:Generic: 5 mcg, 25 mcg, 50 mcg

LisinoprilOutpatient Formulary Brands Available ZestrilOutpatient Dosage FormsTablet, Oral:Zestril: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg[BCF], 40 mg [BCF]

Lisinopril and HydrochlorothiazideOutpatient Dosage FormsTablet, Oral:Generic:10/12.5: Lisinopril 10 mg and hydrochlorothiazide 12.5 mg [BCF]20/12.5: Lisinopril 20 mg and hydrochlorothiazide 12.5 mg [BCF]20/25: Lisinopril 20 mg and hydrochlorothiazide 25 mg [BCF]

LithiumOutpatient Dosage FormsCapsule, Oral, as carbonate:Generic: 150 mg [BCF], 300 mg [BCF]

Solution, Oral, as citrate:Generic: 300 mg/5 mL (5 mL, 500 mL) [equivalent to amount of lithium inlithium carbonate] [BCF]

Tablet Extended Release, Oral, as carbonate:Generic: 450 mg

LoperamideOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 2 mg (pack of 12 capsules) [BCF] [available through Self Careprogram]

LoratadineOutpatient Dosage FormsSyrup, Oral:Generic: 5 mg/5 mL (120 mL)


Loratadine and PseudoephedrineOutpatient Dosage FormsTablet, Extended Release, Oral:Generic: Loratadine 10 mg and pseudoephedrine sulfate 240 mg

LORazepamOutpatient Dosage FormsTablet, Oral:Generic: 0.5 mg, 1 mg, 2 mg

LosartanOutpatient Formulary Brands Available CozaarOutpatient Dosage FormsTablet, Oral, as potassium:Cozaar: 25 mg [contains potassium 2.12 mg (0.054 mEq)] [BCF]Cozaar: 50 mg [contains potassium 4.24 mg (0.108 mEq)] [BCF]Cozaar: 100 mg [contains potassium 8.48 mg (0.216 mEq)] [BCF]Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Losartan and HydrochlorothiazideOutpatient Formulary Brands Available HyzaarOutpatient Dosage FormsTablet, Oral:Hyzaar 50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg[contains potassium 4.24 mg (0.108 mEq)] [BCF]

Hyzaar 100/12.5: Losartan potassium 100 mg and hydrochlorothiazide12.5 mg [contains potassium 8.48 mg (0.216 mEq)] [BCF]

Hyzaar 100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg[contains potassium 8.48 mg (0.216 mEq)] [BCF]

Generic:50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg [BCF]100/12.5: Losartan potassium 100 mg and hydrochlorothiazide12.5 mg [BCF]

100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg [BCF]

LoteprednolOutpatient Formulary Brands Available LotemaxOutpatient Dosage FormsGel, Ophthalmic, as etabonate:Lotemax: 0.5% (5 g) [contains benzalkonium chloride, edetate disodiumdihydrate, propylene glycol]

Ointment, Ophthalmic, as etabonate:Lotemax: 0.5% (3.5 g)

Suspension, Ophthalmic, as etabonate:Lotemax: 0.5% (5 mL, 10 mL, 15 mL)

LovastatinOutpatient Dosage FormsTablet, Oral:Generic: 10 mg, 20 mg, 40 mg

LubiprostoneOutpatient Formulary Brands Available AmitizaOutpatient Dosage FormsCapsule, Oral:Amitiza: 8 mcg, 24 mcg

LurasidoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Latuda: 20 mg, 40 mg, 60 mgLatuda: 80 mg [contains fd&c blue #2 aluminum lake]Latuda: 120 mg

LEVALBUTEROL

14

Magnesium CitrateOutpatient Dosage FormsSolution, Oral:Generic: 1.745 g/30 mL (296 mL)

MeclizineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 25 mg

MedroxyPROGESTERoneOutpatient Dosage FormsTablet, Oral, as acetate:Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

MefloquineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 250 mg

MegestrolOutpatient Dosage FormsSuspension, Oral, as acetate:Generic: 40 mg/mL (240 mL)

Tablet, Oral, as acetate:Generic: 40 mg

MeloxicamOutpatient Dosage FormsTablet, Oral:Generic: 7.5 mg [BCF], 15 mg [BCF]

MemantineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg

MeperidineOutpatient Dosage FormsSolution, Oral, as hydrochloride:Generic: 50 mg/5 mL (500 mL)


MercaptopurineOutpatient Dosage FormsTablet, Oral:Generic: 50 mg

MesalamineOutpatient Formulary Brands Available Apriso; Delzicol; LialdaOutpatient Dosage FormsCapsule Delayed Release, Oral:Delzicol: 400 mg

Capsule Extended Release 24 Hour, Oral:Apriso: 0.375 g [contains aspartame]

Suppository, Rectal:Generic: 1000 mg (30 ea)

Kit, Rectal:Generic: 4 g

Tablet Delayed Release, Oral:Lialda: 1.2 g [BCF]Generic: 1.2 g [BCF]

MetaxaloneOutpatient Dosage FormsTablet, Oral:Generic: 400 mg, 800 mg

MetFORMINOutpatient Formulary Brands Available Glucophage XROutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 500 mg [BCF], 850 mg [BCF], 1000 mg [BCF]

Tablet Extended Release 24 Hour, Oral, as hydrochloride:Glucophage® XR: 500 mg [BCF], 750 mg [BCF]Generic: 500 mg [BCF], 750 mg [BCF]

MethadoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg

MethazolAMIDEOutpatient Dosage FormsTablet, Oral:Generic: 50 mg

MethIMAzoleOutpatient Dosage FormsTablet, Oral:Generic: 5 mg, 10 mg

MethocarbamolOutpatient Dosage FormsTablet, Oral:Generic: 500 mg [BCF]

MethotrexateOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg [BCF]

MethylergonovineOutpatient Dosage FormsTablet, Oral, as maleate:Generic: 0.2 mg

MethylphenidateOutpatient Formulary Brands Available Concerta; Ritalin LAOutpatient Dosage FormsCapsule, Extended Release, Oral, as hydrochloride [bi-modal release]:Ritalin LA: 10 mg [5 mg immediate release, 5 mg extended release] [BCF]Generic: 20 mg [generic for Ritalin LA] [BCF], 30 mg [generic for Ritalin LA][BCF], 40 mg [generic for Ritalin LA] [BCF]


Tablet Extended Release, Oral, as hydrochloride:Generic: 20 mg

Tablet Extended Release 24 Hour, Oral, as hydrochloride:Concerta: 18 mg [BCF], 27 mg [BCF], 36 mg [BCF], 54 mg [BCF]Generic: 18 mg [BCF], 27 mg [BCF], 36 mg [BCF], 54 mg [BCF]

MethylPREDNISoloneOutpatient Dosage FormsSolution Reconstituted, Injection, as sodium succinate [strength expressed asbase]:Generic: 40 mg (1 ea); 125 mg (1 ea); 1000 mg (1 ea)

Solution Reconstituted, Injection, as sodium succinate [strength expressed asbase, preservative free]:SOLU-Medrol: 40 mg (1 ea) [contains lactose]SOLU-Medrol: 125 mg (1 ea); 1000 mg (1 ea)

Suspension, Injection, as acetate:Generic: 40 mg/mL (5 mL)

Suspension, Injection, as acetate [preservative free]:DEPO-Medrol: 40 mg/mL (1 mL)


MetipranololOutpatient Formulary Brands Available OptiPranololOutpatient Dosage FormsSolution, Ophthalmic:OptiPranolol: 0.3% (5 mL) [contains benzalkonium chloride]

MetoclopramideOutpatient Dosage FormsSolution, Oral:Generic: 5 mg/5 mL (473 mL) [BCF]


MetOLazoneOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg

MetoprololOutpatient Dosage FormsTablet, Oral, as tartrate:Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Tablet Extended Release 24 Hour, Oral, as succinate:Generic: 25 mg [expressed as mg equivalent to tartrate] [BCF], 50 mg[expressed as mg equivalent to tartrate] [BCF], 100 mg [expressed as mgequivalent to tartrate] [BCF], 200 mg [expressed as mg equivalent totartrate] [BCF]

MetroNIDAZOLE (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

MetroNIDAZOLE (Topical)Outpatient Formulary Brands Available MetroGel-VaginalOutpatient Dosage FormsCream, External:Generic: 0.75% (45 g)

METRONIDAZOLE (TOPICAL)

15

Gel, Vaginal:MetroGel-Vaginal: 0.75% (70 g) [BCF]Generic: 0.75% (70 g) [BCF]

Minocycline (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 50 mg, 100 mg

Minoxidil (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 2.5 mg

MirabegronOutpatient Formulary Brands Available MyrbetriqOutpatient Dosage FormsTablet Extended Release 24 Hour, Oral:Myrbetriq: 25 mg, 50 mg

MirtazapineOutpatient Dosage FormsTablet, Oral:Generic: 15 mg, 30 mg

MiSOPROStolOutpatient Dosage FormsTablet, Oral:Generic: 100 mcg, 200 mcg

ModafinilOutpatient Dosage FormsTablet, Oral:Generic: 100 mg, 200 mg

Mometasone (Nasal)Outpatient Dosage FormsSuspension, Nasal, as furoate:Generic: 50 mcg/actuation (17 g)

Mometasone (Oral Inhalation)Outpatient Formulary Brands Available Asmanex TwisthalerOutpatient Dosage FormsPowder, for oral inhalation, as furoate:Asmanex Twisthaler: 110 mcg (30 units) [contains lactose; delivers 100 mcg/actuation]

Asmanex Twisthaler: 1220 mcg (120 units) [contains lactose; delivers 200mcg/actuation]

MontelukastOutpatient Formulary Brands Available SingulairOutpatient Dosage FormsPacket, Oral:Singulair: 4 mg/packet (30s) [BCF]Generic: 4 mg/packet (30s) [BCF]

Tablet, Oral:Singulair: 10 mg [BCF]Generic: 10 mg [BCF]

Tablet, Chewable, Oral:Singulair:4 mg [contains phenylalanine 0.674 mg/tablet; cherry flavor] [BCF]5 mg [contains phenylalanine 0.842 mg/tablet; cherry flavor] [BCF]

Generic: 4 mg [BCF], 5 mg [BCF]

Morphine (Systemic)Outpatient Formulary Brands Available MS ContinOutpatient Dosage FormsSolution, Oral, as sulfate:Generic: 10 mg/5 mL (500 mL)

Tablet, Oral, as sulfate:Generic: 15 mg

Tablet Extended Release, Oral, as sulfate:MS Contin: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF],200 mg [BCF]

Generic: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF],200 mg [BCF]

Moxifloxacin (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic:Generic: 0.5% (3 mL)

Moxifloxacin (Systemic)Outpatient Formulary Brands Available Avelox ABC Pack [DSC]Outpatient Dosage FormsTablet, Oral:Avelox ABC Pack: 400 mg [DSC]Generic: 400 mg

MupirocinOutpatient Dosage FormsOintment, External:Generic: 2% (22 g) [BCF]

MycophenolateOutpatient Dosage FormsCapsule, Oral, as mofetil:Generic: 250 mg

Suspension Reconstituted, Oral, as mofetil:Generic: 200 mg/mL (160 mL)

Tablet, Oral, as mofetil:Generic: 500 mg

NadololOutpatient Dosage FormsTablet, Oral:Generic: 20 mg, 40 mg, 80 mg

NaftifineOutpatient Formulary Brands Available NaftinOutpatient Dosage FormsCream, External, as hydrochloride:Naftin: 1% (30 g) [contains benzyl alcohol]

NaldemedineOutpatient Dosage FormsTablet, Oral:Symproic: 0.2 mg

NaloxoneOutpatient Dosage FormsLiquid, Nasal:Narcan: 4 mg/0.1 mL (1 ea) [contains benzalkonium chloride, edetatedisodium]

NaltrexoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 50 mg

Naphazoline (Ophthalmic)Outpatient Formulary Brands Available Clear eyes Seasonal Relief [OTC]Outpatient Dosage FormsSolution, Ophthalmic, as hydrochloride:Clear eyes Seasonal Relief: 0.012% (15 mL) [contains benzalkonium chloride,glycerin, zinc sulfate]

NaproxenOutpatient Dosage FormsSuspension, Oral:Generic: 125 mg/5 mL (500 mL) [BCF]

Tablet, Oral:Generic: 250 mg [BCF], 375 mg, 500 mg [BCF]

Tablet, Oral, as sodium:Generic: 275 mg [equivalent to naproxen base 250 mg] [BCF], 550 mg[equivalent to naproxen base 500 mg] [BCF]

NeomycinOutpatient Dosage FormsTablet, Oral, as sulfate:Generic: 500 mg

Neomycin, Polymyxin B, and DexamethasoneOutpatient Dosage FormsOintment, Ophthalmic:Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame-thasone 0.1% per g (3.5 g)

Suspension, Ophthalmic:Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame-thasone 0.1% per 1 mL (5 mL)

Neomycin, Polymyxin B, and GramicidinOutpatient Formulary Brands Available NeosporinOutpatient Dosage FormsSolution, Ophthalmic:Neosporin: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin0.025 mg per 1 mL (10 mL) [BCF]

Generic: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin0.025 mg per 1 mL (10 mL) [BCF]

Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic)Outpatient Dosage FormsSuspension, Ophthalmic:Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone10 mg per 1 mL (7.5 mL)

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Neomycin, Polymyxin B, and Hydrocortisone (Otic)Outpatient Dosage FormsSolution, Otic:Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone10 mg per 1 mL (10 mL)

Suspension, Otic:Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone10 mg per 1 mL (10 mL) [BCF]

NepafenacOutpatient Formulary Brands Available NevanacOutpatient Dosage FormsSuspension, Ophthalmic:Nevanac: 0.1% (3 mL) [contains benzalkonium chloride]

NiacinOutpatient Formulary Brands Available NiaspanOutpatient Dosage FormsTablet, Oral:Generic: 50 mg, 500 mg

Tablet, Extended Release, Oral:Niaspan: 500 mg [BCF], 750 mg [BCF], 1000 mg [BCF]

NicotineOutpatient Dosage FormsGum, Mouth/Throat, as polacrilex:Generic: 2 mg (50 ea) [BCF]; 4 mg (50 ea, 110 ea) [BCF]

Patch 24 Hour, Transdermal:Generic: 7 mg/24 hours (7 ea) [BCF]; 14 mg/24 hours (14 ea) [BCF]; 21 mg/24 hours (7 ea) [BCF]

NIFEdipineOutpatient Formulary Brands Available Adalat CC; ProcardiaOutpatient Dosage FormsCapsule, Oral:Procardia: 10 mgGeneric: 10 mg

Tablet Extended Release 24 Hour, Oral:Adalat CC: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF]Generic: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF]

NitrofurantoinOutpatient Formulary Brands Available FuradantinOutpatient Dosage FormsCapsule, Oral [macrocrystal/monohydrate]:Generic: 100 mg [BCF]

Suspension, Oral:Furadantin: 25 mg/5 mL (230 mL)

NitroglycerinOutpatient Formulary Brands Available Nitro-Bid; Nitro-Dur; Nitrolingual;NitrostatOutpatient Dosage FormsOintment, Transdermal:Nitro-Bid: 2% (1 g) [20 mg/g]

Patch 24 Hour, Transdermal:Nitro-Dur: 0.1 mg/hr (30s) [BCF]; 0.2 mg/hr (30s) [BCF]; 0.3 mg/hr (30s)[BCF]; 0.4 mg/hr (30s) [BCF]; 0.6 mg/hr (30s) [BCF]; 0.8 mg/hr (30s) [BCF]

Generic: 0.1 mg/hour (30s) [BCF]; 0.2 mg/hour (30s) [BCF]; 0.4 mg/hour(30s) [BCF]; 0.6 mg/hour (30s) [BCF]

Solution, Translingual:Nitrolingual: 0.4 mg/spray (12 g) [contains ethanol 20%; 200 meteredsprays] [BCF]

Generic: 0.4 mg/spray (12 g) [BCF]Tablet, Sublingual:Nitrostat: 0.4 mg [BCF]

Nonoxynol 9Outpatient Formulary Brands Available Delfen [OTC]; Gynol II ExtraStrength [OTC]Outpatient Dosage FormsFoam, Vaginal:Delfen: 12.5% (18 g) [contains benzoic acid]

Gel, Vaginal:Gynol II Extra Strength: 3% (81 g)

NorethindroneOutpatient Formulary Brands Available Nor-QDOutpatient Dosage FormsTablet, Oral:Nor-QD: 0.35 mg [BCF]Generic: 0.35 mg [BCF]

Tablet, Oral, as acetate:Generic: 5 mg

Norethindrone and MestranolOutpatient Formulary Brands Available Norinyl 1+50

Outpatient Dosage FormsTablet, Oral:Norinyl 1+50: Norethindrone 1 mg and mestranol 0.05 mg [21 white tabletsand 7 orange inactive tablets] (28s)

NortriptylineOutpatient Formulary Brands Available PamelorOutpatient Dosage FormsCapsule, Oral:Pamelor: 10 mg [BCF], 25 mg [BCF]Pamelor: 50 mg [contains sodium bisulfite (may have trace amounts)] [BCF]Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

Nystatin and TriamcinoloneOutpatient Dosage FormsCream, External:Generic: Nystatin 100,000 units and triamcinolone acetonide 0.1% (30 g)

Nystatin (Oral)Outpatient Dosage FormsSuspension, Mouth/Throat:Generic: 100,000 units/mL (60 mL, 480 mL) [BCF]

Tablet, Oral:Generic: 500,000 units

Nystatin (Topical)Outpatient Dosage FormsCream, External:Generic: 100,000 units/g (15 g) [BCF]

Ointment, External:Generic: 100,000 units/g (30 g) [BCF]

Powder, External:Generic: 100,000 units/g (15 g)

Ofloxacin (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic:Generic: 0.3% (5 mL)

Ofloxacin (Otic)Outpatient Dosage FormsSolution, Otic:Generic: 0.3% (5 mL)

Olopatadine (Nasal)Outpatient Formulary Brands Available PatanaseOutpatient Dosage FormsSolution, Nasal:Patanase: 0.6% (30.5 g) [contains benzalkonium chloride, edetate disodium]

Olopatadine (Ophthalmic)Outpatient Formulary Brands Available Patanol; PazeoOutpatient Dosage FormsSolution, Ophthalmic [drops]:Patanol: 0.1% (5 mL) [contains benzalkonium chloride] [BCF]Pazeo: 0.7% (2.5 mL) [contains benzalkonium chloride]

OmalizumabOutpatient Dosage FormsSolution Reconstituted, Subcutaneous [preservative free]:Xolair: 150 mg (1 ea)

Omega-3 Fatty AcidsOutpatient Dosage FormsCapsule, Oral:Lovaza: 1 g [contains soybean oil, tocopherol, dl-alpha]

OmeprazoleOutpatient Dosage FormsCapsule Delayed Release, Oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg

OndansetronOutpatient Dosage FormsTablet, Oral:Generic: 4 mg, 8 mg

Tablet Disintegrating, Oral:Generic: 4 mg, 8 mg

OseltamivirOutpatient Formulary Brands Available TamifluOutpatient Dosage FormsCapsule, Oral, as phosphate:Tamiflu: 75 mg

Suspension Reconstituted, Oral, as base:Tamiflu: 12 mg/mL (25 mL) [contains sodium benzoate; tutti frutti flavor]

OXcarbazepineOutpatient Formulary Brands Available Trileptal

OXCARBAZEPINE

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Outpatient Dosage FormsSuspension, Oral:Trileptal: 300 mg/5 mL (250 mL) [contains ethanol, propylene glycol]

Tablet, Oral:Trileptal: 150 mg, 300 mg, 600 mg [scored]

OxybutyninOutpatient Dosage FormsSyrup, Oral, as chloride:Generic: 5 mg/5 mL (473 mL)

Tablet, Oral, as chloride:Generic: 5 mg

Tablet Extended Release 24 Hour, Oral, as chloride:Generic: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF]

OxyCODONEOutpatient Formulary Brands Available OxyCONTINOutpatient Dosage FormsSolution, Oral, as hydrochloride:Generic: 5 mg/5 mL (500 mL)


Tablet, Controlled Release, Oral, as hydrochloride:OxyCONTIN: 10 mg, 20 mg, 40 mg, 80 mg

Oxycodone and AcetaminophenOutpatient Dosage FormsTablet, Oral:Generic:5/325: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg [BCF]7.5/325: Oxycodone hydrochloride 7.5 mg and acetaminophen 325 mg10/325: Oxycodone hydrochloride 10 mg and acetaminophen 325 mg

Oxymetazoline (Nasal)Outpatient Dosage FormsSolution, Nasal, as hydrochloride:Generic: 0.05% (15 mL) [available through Self Care program]

PalivizumabOutpatient Dosage FormsSolution, Intramuscular [preservative free]:Synagis: 50 mg/0.5 mL (0.5 mL); 100 mg/mL (1 mL) [contains glycine,histidine]

PancrelipaseOutpatient Formulary Brands Available Creon; PancreazeOutpatient Dosage FormsCapsule, Delayed Release, Enteric Coated Microspheres, Oral [porcinederived]:Creon:Lipase 3000 USP units, protease 9500 USP units, and amylase 15,000 USPunits [BCF]

Lipase 6000 USP units, protease 19,000 USP units, and amylase 30,000USP units [BCF]

Lipase 12,000 USP units, protease 38,000 USP units, and amylase 60,000USP units [BCF]



Capsule, Delayed Release, Enteric Coated Microtablets, Oral [porcine derived]:Pancreaze:Lipase 4200 units, protease 10,000 units, and amylase 17,500 unitsLipase 10,500 units, protease 25,000 units, and amylase 43,750 unitsLipase 16,800 units, protease 40,000 units, and amylase 70,000 unitsLipase 21,000 units, protease 37,000 units, and amylase 61,000 units

PantoprazoleOutpatient Dosage FormsTablet Delayed Release, Oral:Generic: 20 mg, 40 mg

Papillomavirus (9-Valent) Vaccine (Human, Recombinant)Outpatient Dosage FormsSuspension, Intramuscular [preservative free]:Gardasil 9: (0.5 mL) [contains polysorbate 80, yeast extract]

PARoxetineOutpatient Dosage FormsTablet, Oral, as hydrochloride [strength expressed as base]:Generic: 20 mg, 30 mg, 40 mg

Penicillin V PotassiumOutpatient Dosage FormsSolution Reconstituted, Oral:Generic: 125 mg/5 mL (100 mL, 200 mL) [BCF]; 250 mg/5 mL (100 mL, 200mL) [BCF]


Penicillin G (Parenteral/Aqueous)Outpatient Formulary Brands Available PfizerpenOutpatient Dosage FormsSolution Reconstituted, Injection, as potassium [preservative free]:Pfizerpen: 20,000,000 units (1 ea)

Penicillin G ProcaineOutpatient Dosage FormsSuspension, Intramuscular:Generic: 600,000 units/mL (1 mL, 2 mL)

PentoxifyllineOutpatient Dosage FormsTablet Extended Release, Oral:Generic: 400 mg

PermethrinOutpatient Dosage FormsCream, External:Generic: 5% (60 g) [BCF]

Lotion, External:Generic: 1% (59 mL) [available through Self Care program]

PhenazopyridineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 100 mg [BCF], 200 mg [BCF]

PHENobarbitalOutpatient Dosage FormsElixir, Oral:Generic: 20 mg/5 mL (5 mL) [BCF]

Tablet, Oral:Generic: 16.2 mg, 32.4 mg, 64.8 mg, 97.2 mg

Phenylephrine (Ophthalmic)Outpatient Formulary Brands Available AK-DilateOutpatient Dosage FormsSolution, Ophthalmic, as hydrochloride [drops]:AK-Dilate: 10% (5 mL) [contains benzalkonium chloride]Generic: 2.5% (15 mL)

PhenytoinOutpatient Formulary Brands Available Dilantin; Dilantin-125Outpatient Dosage FormsCapsule, Oral, as sodium:Dilantin: 30 mgGeneric: 100 mg [BCF]

Suspension, Oral:Dilantin-125: 125 mg/5 mL (240 mL) [contains ethanol ≤0.6%, sodium ben-zoate; orange-vanilla flavor] [BCF]

Tablet, Chewable, Oral:Dilantin: 50 mg [scored] [BCF]

PhytonadioneOutpatient Formulary Brands Available MephytonOutpatient Dosage FormsTablet, Oral:Mephyton: 5 mg [scored]

Pilocarpine (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as hydrochloride [drops]:Generic: 0.5% (15 mL [DSC]); 1% (15 mL) [BCF]; 2% (15 mL) [BCF]

Pilocarpine (Systemic)Outpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 7.5 mg

PimecrolimusOutpatient Formulary Brands Available ElidelOutpatient Dosage FormsCream, External:Elidel: 1% (30 g) [BCF]

Piroxicam (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 10 mg, 20 mg

PodofiloxOutpatient Dosage FormsSolution, External:Generic: 0.5% (3.5 mL)

Polyethylene Glycol 3350Outpatient Formulary Brands Available GlycoLax [DSC]

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Outpatient Dosage FormsPowder for Solution, Oral:GlycoLax: PEG 3350 527 g (24 oz) [DSC]

Polyethylene Glycol-Electrolyte SolutionOutpatient Formulary Brands Available GoLYTELY; MoviPrep; NuLYTELYOutpatient Dosage FormsPowder for Solution, Oral:GoLYTELY: PEG 3350 236 g, sodium sulfate 22.74 g, sodium bicarbonate6.74 g, sodium chloride 5.86 g, and potassium chloride 2.97 g (4000 mL)[original flavor]

MoviPrep: Pouch A: PEG 3350 100 g, sodium sulfate 7.5 g, sodium chloride2.69 g, potassium chloride 1.015 g; Pouch B: Ascorbic acid 4.7 g, sodiumascorbate 5.9 g (1000 mL) [contains phenylalanine 2.33 mg/treatment;lemon flavor]

NuLYTELY: PEG 3350 420 g, sodium bicarbonate 5.72 g, sodium chloride11.2 g, and potassium chloride 1.48 g (4000 mL) [available with cherry,lemon-lime, orange and pineapple flavor packs]

Potassium ChlorideOutpatient Formulary Brands Available Epiklor; Klor-Con; Klor-Con 10;Klor-Con M20Outpatient Dosage FormsCapsule Extended Release, Oral:Generic: 10 mEq [BCF]

Packet, Oral:Epiklor: 20 mEq/packet (30s, 100s) [sugar free; orange flavor] [BCF]Klor-Con: 20 mEq/packet (30s, 100s) [sugar free; fruit flavor] [BCF]Generic: 20 mEq (30 ea, 100 ea) [BCF]

Solution, Oral:Generic: 20 mEq/15 mL (473 mL) [BCF]

Tablet Extended Release, Oral:Klor-Con 10: 10 mEq [750 mg] [BCF]Klor-Con M20: 20 mEq [scored; 1500 mg] [BCF]Generic: 10 mEq [BCF], 20 mEq [BCF]

Potassium CitrateOutpatient Formulary Brands Available Urocit-KOutpatient Dosage FormsTablet, Oral:Urocit-K: 1080 mg [10 mEq]

Potassium IodideOutpatient Formulary Brands Available SSKIOutpatient Dosage FormsSolution, Oral:SSKI: 1 g/mL (237 mL)

Potassium PhosphateOutpatient Formulary Brands Available K-PhosOutpatient Dosage FormsTablet, Oral:K-Phos Original: 500 mg [scored; phosphorus 114 mg and potassium 144 mg(3.7 mEq) per tablet]

Potassium Phosphate and Sodium PhosphateOutpatient Formulary Brands Available K-Phos Neutral; Neutra-Phos[OTC] [DSC]Outpatient Dosage FormsPowder for Solution, Oral:Neutra-Phos: Dibasic potassium phosphate, monobasic potassium phos-phate, dibasic sodium phosphate, and monobasic sodium phosphate perpacket (100s) [equivalent to elemental phosphorus 250 mg (14.25 mEq),sodium 164 mg (7.1 mEq), and potassium 278 mg (7.1 mEq) perpacket] [DSC]

Tablet, Oral:K-Phos Neutral: Monobasic potassium phosphate 155 mg, dibasic sodiumphosphate 852 mg, and monobasic sodium phosphate 130 mg [scored;equivalent to elemental phosphorus 250 mg, sodium 298 mg (13 mEq),and potassium 45 mg (1.1 mEq)]

Povidone-Iodine (Topical)Outpatient Formulary Brands Available Betadine [OTC]Outpatient Dosage FormsSolution, External:Betadine: 10% (237 mL)

PramipexoleOutpatient Dosage FormsTablet, Oral, as dihydrochloride monohydrate:Generic: 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg

Pramoxine and HydrocortisoneOutpatient Formulary Brands Available ProctoFoam HCOutpatient Dosage FormsAerosol, foam, rectal:ProctoFoam HC: Pramoxine hydrochloride 1% and hydrocortisone acetate1% (10 g)

PrasugrelOutpatient Dosage FormsTablet, Oral:Effient: 10 mg

PravastatinOutpatient Formulary Brands Available PravacholOutpatient Dosage FormsTablet, Oral, as sodium:Pravachol: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]

PrazosinOutpatient Formulary Brands Available MinipressOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Minipress: 1 mg, 2 mg, 5 mg

PrednisoLONE (Ophthalmic)Outpatient Formulary Brands Available Pred MildOutpatient Dosage FormsSuspension, Ophthalmic, as acetate:Pred Mild: 0.12% (5 mL) [contains benzalkonium chloride, sodium bisul-fite] [BCF]

Generic: 1% (10 mL) [BCF]

PrednisoLONE (Systemic)Outpatient Dosage FormsSolution, Oral, as sodium phosphate [strength expressed as base]:Generic: 15 mg/5 mL (237 mL) [BCF]

PredniSONEOutpatient Dosage FormsTablet, Oral:Generic: 1 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF]

Tablet Therapy Pack, Oral:Generic: 5 mg (21 ea)

PrimaquineOutpatient Dosage FormsTablet, Oral, as phosphate:Generic: 26.3 mg

PrimidoneOutpatient Dosage FormsTablet, Oral:Generic: 50 mg, 250 mg

ProbenecidOutpatient Dosage FormsTablet, Oral:Generic: 500 mg [BCF]

ProchlorperazineOutpatient Formulary Brands Available ComproOutpatient Dosage FormsSuppository, Rectal:Compro: 25 mg (12 ea) [contains coconut oil, palm oil]

Tablet, Oral, as maleate [strength expressed as base]:Generic: 5 mg

ProgesteroneOutpatient Formulary Brands Available First-Progesterone VGS 100; First-Progesterone VGS 200; PrometriumOutpatient Dosage FormsCapsule, Oral:Prometrium: 100 mg, 200 mg [contains peanut oil]

Suppository, Vaginal [compounding kit]:First-Progesterone VGS 100: 100 mg (30s)First-Progesterone VGS 200: 200 mg (30s)

PromethazineOutpatient Formulary Brands Available PrometheganOutpatient Dosage FormsSuppository, Rectal, as hydrochloride:Promethegan: 12.5 mg (12s) [BCF]; 25 mg (12s) [BCF]

Syrup, Oral, as hydrochloride:Generic: 6.25 mg/5 mL (473 mL) [BCF]


PropafenoneOutpatient Dosage FormsCapsule Extended Release 12 Hour, Oral, as hydrochloride:Generic: 225 mg, 325 mg, 425 mg

Tablet, Oral, as hydrochloride:Generic: 150 mg, 225 mg, 300 mg

PropranololOutpatient Formulary Brands Available Inderal LA

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Outpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as hydrochloride:Inderal LA: 80 mg, 120 mg, 160 mg


PropylthiouracilOutpatient Dosage FormsTablet, Oral:Generic: 50 mg [BCF]

Prothrombin Complex Concentrate (Human) [(Factors II, VII, IX,X), Protein C, and Protein S]Outpatient Dosage FormsKit, Intravenous [preservative free]:Kcentra: ~500 units, ~1000 units [pyrogen free; contains albumin human,heparin]

PseudoephedrineOutpatient Formulary Brands Available Sudafed 12 Hour [OTC]; SudoGest[OTC]Outpatient Dosage FormsSyrup, Oral, as hydrochloride:Generic: 30 mg/5 mL (118 mL)

Tablet, Oral, as hydrochloride:SudoGest: 30 mg

Tablet Extended Release 12 Hour, Oral, as hydrochloride:Sudafed 12 Hour: 120 mg

Pyrantel PamoateOutpatient Formulary Brands Available Pin-X [OTC]Outpatient Dosage FormsSuspension, Oral, as pamoate:Pin-X: 144 mg/mL (30 mL) [sugar free; contains sodium benzoate; caramelflavor; equivalent to pyrantel base 50 mg/mL]

PyrazinamideOutpatient Dosage FormsTablet, Oral:Generic: 500 mg [BCF]

PyridostigmineOutpatient Formulary Brands Available MestinonOutpatient Dosage FormsTablet, Oral, as bromide:Generic: 60 mg

Tablet Extended Release, Oral, as bromide:Mestinon: 180 mg [scored]

PyridoxineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 50 mg

QUEtiapineOutpatient Formulary Brands Available SEROquel; SEROquel XROutpatient Dosage FormsTablet, Oral:SEROquel: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF],300 mg [BCF], 400 mg [BCF]

Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF], 300 mg[BCF], 400 mg [BCF]

Tablet Extended Release 24 Hour, Oral:SEROquel XR: 50 mg [BCF], 150 mg [BCF], 200 mg [BCF], 300 mg [BCF],400 mg [BCF]

Generic: 50 mg [BCF], 150 mg [BCF], 200 mg [BCF], 300 mg [BCF],400 mg [BCF]

QuiNIDineOutpatient Dosage FormsTablet Extended Release, Oral, as gluconate:Generic: 324 mg

RaloxifeneOutpatient Formulary Brands Available EvistaOutpatient Dosage FormsTablet, Oral, as hydrochloride:Evista: 60 mg [BCF]Generic: 60 mg [BCF]

RaltegravirOutpatient Dosage FormsTablet, Oral:Isentress: 400 mg

RamiprilOutpatient Formulary Brands Available AltaceOutpatient Dosage FormsCapsule, Oral:Altace: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

Generic: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

RaNITIdineOutpatient Formulary Brands Available ZantacOutpatient Dosage FormsSyrup, Oral:Zantac: 15 mg/mL (480 mL) [contains ethanol 7.5%; peppermint flavor] [BCF]


RifAMPinOutpatient Dosage FormsCapsule, Oral:Generic: 300 mg [BCF]

RisedronateOutpatient Formulary Brands Available ActonelOutpatient Dosage FormsTablet, Oral, as sodium:Actonel: 35 mg, 150 mg

RisperiDONEOutpatient Formulary Brands Available RisperDALOutpatient Dosage FormsSolution, Oral:RisperDAL: 1 mg/mL (30 mL) [contains benzoic acid] [BCF]Generic: 1 mg/mL (30 mL) [BCF]

Tablet, Oral:RisperDAL: 0.25 mg [BCF], 0.5 mg [BCF], 1 mg [scored] [BCF], 2 mg [BCF],3 mg [BCF], 4 mg [BCF]

Generic: 0.25 mg [BCF], 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF], 3 mg[BCF], 4 mg [BCF]

RivaroxabanOutpatient Formulary Brands Available XareltoOutpatient Dosage FormsTablet, Oral:Xarelto: 10 mg, 15 mg, 20 mg

RivastigmineOutpatient Formulary Brands Available ExelonOutpatient Dosage FormsPatch 24 Hour, Transdermal:Exelon: 4.6 mg/24 hr (1 ea, 30 ea); 9.5 mg/24 hr (1 ea, 30 ea); 13.3 mg/24 hr(1 ea, 30 ea)

RizatriptanOutpatient Formulary Brands Available Maxalt; Maxalt-MLTOutpatient Dosage FormsTablet, Oral:Maxalt: 5 mg [BCF], 10 mg [BCF]Generic: 5 mg [BCF], 10 mg [BCF]

Tablet Dispersible, Oral:Maxalt-MLT:5 mg [contains phenylalanine 1.05 mg/tablet; peppermint flavor] [BCF]10 mg [contains phenylalanine 2.1 mg/tablet; peppermint flavor] [BCF]

Generic: 5 mg [BCF], 10 mg [BCF]

ROPINIRoleOutpatient Dosage FormsTablet, Oral:Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg

RosuvastatinOutpatient Dosage FormsTablet, Oral:Crestor: 5 mg, 10 mg, 20 mg, 40 mg

SalmeterolOutpatient Formulary Brands Available Serevent DiskusOutpatient Dosage FormsAerosol Powder Breath Activated, Inhalation:Serevent Diskus: 50 mcg (60s) [contains lactose] [BCF]

SalsalateOutpatient Dosage FormsTablet, Oral:Generic: 500 mg [BCF], 750 mg [BCF]

Selenium SulfideOutpatient Dosage FormsLotion, External:Generic: 2.5% (120 mL) [BCF]

SertralineOutpatient Dosage FormsConcentrate, Oral:Generic: 20 mg/mL (60 mL) [BCF]

Tablet, Oral:Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

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SildenafilOutpatient Formulary Brands Available ViagraOutpatient Dosage FormsTablet, Oral:Viagra: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]Generic: 20 mg [ECF] , 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Silver NitrateOutpatient Dosage FormsApplicator Sticks, External:Generic: Silver nitrate 75% and potassium nitrate 25% (100s) [6"]

Silver SulfadiazineOutpatient Dosage FormsCream, External:Generic: 1% (85 g) [BCF]

SimethiconeOutpatient Formulary Brands Available Infants Gas Relief Drops [OTC]Outpatient Dosage FormsSuspension, Oral:Infants Gas Relief Drops: 40 mg/0.6 mL (30 mL) [vanilla flavor]


SimvastatinOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 40 mg [BCF],80 mg [BCF]

SITagliptinOutpatient Formulary Brands Available JanuviaOutpatient Dosage FormsTablet, Oral:Januvia: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Sitagliptin and MetforminOutpatient Formulary Brands Available Janumet; Janumet XROutpatient Dosage FormsTablet, Oral:Janumet 50/500: Sitagliptin 50 mg and metformin hydrochloride500 mg [BCF]

Janumet 50/1000: Sitagliptin 50 mg and metformin hydrochloride1000 mg [BCF]

Tablet, Extended Release, Oral:Janumet XR: 50/500: Sitagliptin 50 mg and metformin hydrochloride500 mg [BCF]

Janumet XR: 50/1000: Sitagliptin 50 mg and metformin hydrochloride1000 mg [BCF]

Janumet XR: 100/1000: Sitagliptin 100 mg and metformin hydrochloride1000 mg [BCF]

Sodium ChlorideOutpatient Formulary Brands Available Muro 128 [OTC]Outpatient Dosage FormsOintment, Ophthalmic [preservative free]:Muro 128: 5% (3.5 g)

Solution, Nasal:Generic: 0.65% (45 mL) [available through Self Care program]

Solution, Ophthalmic:Muro 128: 5% (15 mL)

Sodium Citrate and Citric AcidOutpatient Dosage FormsSolution, Oral:Generic: Sodium citrate 500 mg and citric acid 334 mg per 5 mL (473 mL)[equivalent to bicarbonate 1 mEq/mL]

Sodium PhosphatesOutpatient Formulary Brands Available Fleet Enema [OTC]; OsmoPrepOutpatient Dosage FormsSolution, Rectal [enema]:Fleet Enema: Monobasic sodium phosphate monohydrate 19 g and dibasicsodium phosphate heptahydrate 7 g per 118 mL delivered dose (133 mL)[contains sodium 4.4 g/118 mL]

Tablet, Oral:OsmoPrep: Sodium phosphate monobasic monohydrate 1.102 g and sodiumphosphate dibasic anhydrous 0.398 g [scored; gluten free; sodium phos-phate 1.5 g per tablet]

Sodium Polystyrene SulfonateOutpatient Formulary Brands Available Kayexalate; Kionex; SPSOutpatient Dosage FormsPowder, Oral:Kayexalate: 454 g [contains sodium 100 mg (4.1 mEq)/g]

Suspension, Oral:Kionex: 15 g/60 mL (480 mL) [contains ethanol 0.2%, propylene glycol,sodium 1500 mg (65 mEq)/60 mL, sorbitol; raspberry flavor]

SPS: 15 g/60 mL (473 mL) [contains ethanol 0.3%, propylene glycol, sodium1500 mg (65 mEq)/60 mL, sorbitol; cherry flavor]

SolifenacinOutpatient Formulary Brands Available VESIcareOutpatient Dosage FormsTablet, Oral, as succinate:VESIcare: 5 mg, 10 mg

SorbitolOutpatient Dosage FormsSolution, Oral:Generic: 70% (480 mL)

SotalolOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 80 mg, 120 mg

SpironolactoneOutpatient Formulary Brands Available AldactoneOutpatient Dosage FormsTablet, Oral:Aldactone: 100 mg [scored]Generic: 25 mg [BCF]

SucralfateOutpatient Dosage FormsSuspension, Oral:Carafate: 1 g/10 mL (420 mL) [contains fd&c red #40, methylparaben; cherryflavor]

Tablet, Oral:Generic: 1 g

SugammadexOutpatient Formulary Brands Available BridionOutpatient Dosage FormsSolution, Intravenous:Bridion: 200 mg/2 mL (2 mL); 500 mg/5 mL (5 mL)

Sulfacetamide (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic, as sodium [drops]: 10% (15 mL) [BCF]

Sulfamethoxazole and TrimethoprimOutpatient Formulary Brands Available SulfatrimOutpatient Dosage FormsSuspension, Oral:Sulfatrim: Sulfamethoxazole 200 mg and trimethoprim 40 mg per 5 mL (480mL) [contains ethanol ≤0.5%, propylene glycol; cherry flavor] [BCF]

Generic: Sulfamethoxazole 200 mg and trimethoprim 40 mg per 5 mL (480mL) [BCF]

Tablet, Oral:Generic: Sulfamethoxazole 400 mg and trimethoprim 80 mg [BCF]; Sulfame-thoxazole 800 mg and trimethoprim 160 mg [BCF]

SulfaSALAzineOutpatient Formulary Brands Available Azulfidine EN-tabsOutpatient Dosage FormsTablet, Oral:Generic: 500 mg [BCF]Tablet Delayed Release, Oral:Azulfidine EN-tabs: 500 mg [BCF]Generic: 500 mg [BCF]

Sulfur and Salicylic AcidOutpatient Formulary Brands Available Sebex [OTC]Outpatient Dosage FormsShampoo, External:Sebex: Micropulverized sulfur 2% and salicylic acid 2% (120 mL)

Sulfur and SulfacetamideOutpatient Formulary Brands Available CleniaOutpatient Dosage FormsCream, Topical:Clenia: Sulfur 5% and sulfacetamide sodium 10% (28 g)

Wash, Topical:Clenia: Sulfur 5% and sulfacetamide sodium 10% (340 g)

SUMAtriptanOutpatient Formulary Brands Available ImitrexOutpatient Dosage FormsInjection, solution, as succinate [strength expressed as base]:Imitrex: 6 mg/0.5 mL (0.5 mL) [BCF]

Tablet, Oral, as succinate [strength expressed as base]:Imitrex: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Tacrolimus (Topical)Outpatient Formulary Brands Available Protopic

TACROLIMUS (TOPICAL)

21

Outpatient Dosage FormsOintment, External:Protopic: 0.03% (60 g); 0.1% (60 g)

TamoxifenOutpatient Dosage FormsTablet, Oral:Generic: 10 mg [BCF], 20 mg [BCF]

TamsulosinOutpatient Formulary Brands Available FlomaxOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Flomax: 0.4 mg [BCF]Generic: 0.4 mg [BCF]

Tablet, Oral, as hydrochloride:Generic: 0.4 mg

TelmisartanOutpatient Dosage FormsTablet, Oral:Generic: 20 mg, 40 mg, 80 mg

Telmisartan and HydrochlorothiazideOutpatient Formulary Brands Available Micardis HCTOutpatient Dosage FormsTablet, Oral:Micardis HCT: 40/12.5: Telmisartan 40 mg and hydrochlorothiazide 12.5 mgMicardis HCT: 80/12.5: Telmisartan 80 mg and hydrochlorothiazide 12.5 mgMicardis HCT: 80/25: Telmisartan 80 mg and hydrochlorothiazide 25 mg

TemazepamOutpatient Dosage FormsCapsule, Oral:Generic: 15 mg [BCF], 30 mg [BCF]

TerazosinOutpatient Dosage FormsCapsule, Oral:Generic: 1 mg [BCF], 2 mg [BCF], 5 mg [BCF], 10 mg [BCF]

Terbinafine (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 250 mg

Terbinafine (Topical)Outpatient Dosage FormsCream, External, as hydrochloride:Generic: 1% (15 g, 30 g)

TerbutalineOutpatient Dosage FormsTablet, Oral, as sulfate:Generic: 2.5 mg, 5 mg

TerconazoleOutpatient Dosage FormsCream, Vaginal:Generic: 0.4% (45 g)

TestosteroneOutpatient Formulary Brands Available Androderm; Depo-Testosterone;Fortesta; XyostedOutpatient Dosage FormsGel, Transdermal:Fortesta: 10 mg/actuation (2%) (60 g) [odorless; contains propylene glycol,trolamine (triethanolamine)] [BCF]

Generic: 10 mg/actuation (2%) (60 g) [BCF]Solution, Intramuscular, as cypionate:Depo-Testosterone: 100 mg/mL (10 mL); 200 mg/mL (1 mL) [contains benzylalcohol, benzyl benzoate]

Patch 24 Hour, Transdermal:Androderm: 2 mg/24 hr (60 ea); 4 mg/24 hr (30 ea)

Solution Auto-injector, Subcutaneous [preservative free]:Xyosted: 50 mg/0.5 mL (0.5 mL); 75 mg/0.5 mL (0.5 mL); 100 mg/0.5 mL (0.5mL) [contains sesame oil]

Tetracycline (Systemic)Outpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 250 mg [BCF], 500 mg [BCF]

TheophyllineOutpatient Formulary Brands Available Elixophyllin; Theo-24Outpatient Dosage FormsCapsule Extended Release 24 Hour, Oral:Theo-24: 300 mg [24 hours] [BCF], 400 mg [24 hours] [BCF]

Elixir, Oral:Elixophyllin: 80 mg/15 mL (473 mL) [mixed fruit flavor] [BCF]

Tablet Extended Release 12 Hour, Oral:Generic: 200 mg [BCF], 300 mg [BCF]

Tablet Extended Release 24 Hour, Oral:Generic: 400 mg [BCF]

Thyroid, DesiccatedOutpatient Dosage FormsTablet, Oral:Armour Thyroid: 15 mg, 30 mg, 60 mg, 90 mg, 120 mgArmour Thyroid: 180 mg [scored]Armour Thyroid: 240 mgArmour Thyroid: 300 mg [scored]

TicagrelorOutpatient Formulary Brands Available BrilintaOutpatient Dosage FormsTablet, Oral:Brilinta: 60 mg, 90 mg

Timolol (Ophthalmic)Outpatient Formulary Brands Available Timolol GFSOutpatient Dosage FormsGel Forming Solution, Ophthalmic, as maleate [strength expressed as base]:Timolol GFS: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF]

Solution, Ophthalmic, as maleate [strength expressed as base]:Generic: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF]

TiotropiumOutpatient Formulary Brands Available Spiriva® HandiHaler®Outpatient Dosage FormsAerosol Solution, Inhalation:Spiriva Respimat: 2.5 mcg/actuation (4 g) [contains benzalkonium chloride,disodium edta]

Capsule, Inhalation:Spiriva HandiHaler: 18 mcg [contains milk protein] [BCF]

TiZANidineOutpatient Dosage FormsTablet, Oral:Generic: 4 mg

Tobramycin and DexamethasoneOutpatient Formulary Brands Available TobraDexOutpatient Dosage FormsOintment, Ophthalmic:TobraDex: Tobramycin 0.3% and dexamethasone 0.1% (3.5 g) [containschlorobutanol]

Suspension, Ophthalmic:TobraDex: Tobramycin 0.3% and dexamethasone 0.1% (5 mL) [containsbenzalkonium chloride]

Generic: Tobramycin 0.3% and dexamethasone 0.1% (5 mL)

Tobramycin (Ophthalmic)Outpatient Formulary Brands Available TobrexOutpatient Dosage FormsSolution, Ophthalmic:Tobrex: 0.3% (5 mL)Generic: 0.3% (5 mL)

TolnaftateOutpatient Dosage FormsPowder, External:Generic: 1% (45 g)

TolterodineOutpatient Formulary Brands Available Detrol LAOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as tartrate:Detrol LA: 2 mg [BCF], 4 mg [BCF]Generic: 2 mg [BCF], 4 mg [BCF]

TopiramateOutpatient Formulary Brands Available TopamaxOutpatient Dosage FormsTablet, Oral:Generic: 25 mg, 50 mg, 100 mg, 200 mg

TorsemideOutpatient Dosage FormsTablet, Oral:Generic: 5 mg, 10 mg, 20 mg, 100 mg

TraMADolOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 50 mg [BCF]

TACROLIMUS (TOPICAL)

22

Tranexamic AcidOutpatient Dosage FormsTablet, Oral:Generic: 650 mg

TraZODoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 50 mg [BCF], 100 mg [BCF], 150 mg [BCF], 300 mg [BCF]

Tretinoin (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 10 mg

Tretinoin (Topical)Outpatient Formulary Brands Available AvitaOutpatient Dosage FormsCream, External:Avita: 0.025% (45 g) [BCF]Generic: 0.025% (20 g, 45 g) [BCF]; 0.05% (45 g) [BCF]; 0.1% (45 g)

Gel, External:Generic: 0.025% (45 g)

Triamcinolone (Topical)Outpatient Dosage FormsCream, External, as acetonide:Generic:0.1% (15 g, 80 g, 454 g) [BCF]; 0.5% (15 g)

Ointment, External, as acetonide:Generic: 0.1% (15 g, 80 g, 454 g) [BCF]

Paste, Mouth/Throat, as acetonide:Generic: 0.1% (5 g)

TrihexyphenidylOutpatient Dosage FormsElixir, Oral, as hydrochloride:Generic: 2 mg/5 mL (473 mL) [BCF]


TrimethoprimOutpatient Dosage FormsTablet, Oral:Generic: 100 mg

Trimethoprim and Polymyxin BOutpatient Dosage FormsSolution, Ophthalmic:Generic: Trimethoprim 1 mg and polymyxin B sulfate 10,000 units per 1 mL(10 mL) [BCF]

TropicamideOutpatient Formulary Brands Available MydriacylOutpatient Dosage FormsSolution, Ophthalmic:Mydriacyl: 1% (15 mL) [contains benzalkonium chloride]Generic: 1% (15 mL)

Typhoid VaccineOutpatient Formulary Brands Available VivotifOutpatient Dosage FormsCapsule, enteric coated [live]:Vivotif: Viable S. typhi Ty21a 2-6.8 x 109 colony-forming units and nonviable S.typhi Ty21a 5-50 x 109 bacterial cells [contains lactose 100-180 mg/capsuleand sucrose 26-130 mg/capsule]

Urea (Topical)Outpatient Formulary Brands Available Carmol 20; VanamideOutpatient Dosage FormsCream, External:Carmol 20: 20% (90 g)Vanamide: 40% (85 g) [DSC]

UrsodiolOutpatient Dosage FormsCapsule, Oral:Generic: 300 mg

ValACYclovirOutpatient Dosage FormsTablet, Oral:Generic: 1 g

Valproic Acid and DerivativesOutpatient Formulary Brands Available Depakene; Depakote; DepakoteER; Depakote SprinkleOutpatient Dosage FormsCapsule Sprinkle, Oral, as divalproex sodium:Depakote Sprinkle: 125 mg [BCF]Generic: 125 mg [BCF]

Syrup, Oral, as valproate sodium:Depakene: 250 mg/5 mL (473 mL) [strength expressed as valproic acid]

Tablet Delayed Release, Oral, as divalproex sodium:Depakote: 125 mg [BCF], 250 mg [BCF], 500 mg [BCF]Generic: 125 mg [BCF], 250 mg [BCF], 500 mg [BCF]

Tablet Extended Release 24 Hour, Oral, as divalproex sodium:Depakote ER: 250 mg [BCF], 500 mg [BCF]Generic: 250 mg [BCF], 500 mg [BCF]

ValsartanOutpatient Formulary Brands Available DiovanOutpatient Dosage FormsTablet, Oral:Diovan: 40 mg [scored] [BCF], 80 mg [BCF], 160 mg [BCF], 320 mg [BCF]Generic: 40 mg [BCF], 80 mg [BCF], 160 mg [BCF], 320 mg [BCF]

Valsartan and HydrochlorothiazideOutpatient Formulary Brands Available Diovan HCTOutpatient Dosage FormsTablet, Oral:Diovan HCT80 mg/12.5 mg: Valsartan 80 mg and hydrochlorothiazide 12.5 mg [BCF]160 mg/12.5 mg: Valsartan 160 mg and hydrochlorothiazide 12.5 mg [BCF]320 mg/12.5 mg: Valsartan 320 mg and hydrochlorothiazide 12.5 mg [BCF]160 mg/25 mg: Valsartan 160 mg and hydrochlorothiazide 25 mg [BCF]320 mg/25 mg: Valsartan 320 mg and hydrochlorothiazide 25 mg [BCF]

Generic:80 mg/12.5 mg: Valsartan 80 mg and hydrochlorothiazide 12.5 mg [BCF]160 mg/12.5 mg: Valsartan 160 mg and hydrochlorothiazide 12.5 mg [BCF]160 mg/25 mg: Valsartan 160 mg and hydrochlorothiazide 25 mg [BCF]320 mg/12.5 mg: Valsartan 320 mg and hydrochlorothiazide 12.5 mg [BCF]320 mg/25 mg: Valsartan 320 mg and hydrochlorothiazide 25 mg [BCF]

VenlafaxineOutpatient Formulary Brands Available Effexor XROutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral:Effexor XR: 37.5 mg [BCF], 75 mg [BCF], 150 mg [BCF]Generic: 37.5 mg [BCF], 75 mg [BCF], 150 mg [BCF]

Tablet, Oral:Generic: 25 mg [BCF], 37.5 mg [BCF], 50 mg [BCF], 75 mg [BCF],100 mg [BCF]

Tablet Extended Release 24 Hour, Oral:Generic: 225 mg [BCF]

VerapamilOutpatient Formulary Brands Available Calan; Calan SROutpatient Dosage FormsTablet, Oral, as hydrochloride:Calan: 80 mg [scored]

Tablet Extended Release, Oral, as hydrochloride:Calan SR: 120 mg [BCF], 180 mg [scored] [BCF], 240 mg [scored] [BCF]Generic: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF]

Vitamins (Multiple/Oral)Outpatient Formulary Brands Available CertaviteOutpatient Dosage FormsTablet, Oral:Certavite

Vitamins (Multiple/Pediatric)Outpatient Formulary Brands Available Cerovite JuniorOutpatient Dosage FormsLiquid, Oral [drops]:Generic: (50 mL)

Tablet, Oral:Cerovite Junior: 60s

Vitamins (Multiple/Prenatal)Outpatient Formulary Brands Available Prenatal PlusOutpatient Dosage FormsContent varies depending on product used.Tablet, Oral [only available to females under 46 years of age]:Prenatal Plus: 100s [BCF]

WarfarinOutpatient Dosage FormsTablet, Oral, as sodium:Generic: 1 mg [BCF], 2 mg [BCF], 2.5 mg [BCF], 3 mg [BCF], 4 mg [BCF],5 mg [BCF], 6 mg [BCF], 7.5 mg [BCF], 10 mg [BCF]

White PetrolatumOutpatient Dosage FormsOintment, External:Generic: 100% (30 g)

ZaleplonOutpatient Dosage FormsCapsule, Oral:Generic: 5 mg, 10 mg

ZALEPLON

23

ZiprasidoneOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 20 mg, 40 mg, 60 mg, 80 mg

ZolpidemOutpatient Dosage FormsTablet, Oral, as tartrate:Generic: 5 mg [BCF], 10 mg [BCF]

Tablet Extended Release, Oral, as tartrate:Generic: 6.25 mg, 12.5 mg

ZonisamideOutpatient Dosage FormsCapsule, Oral:Generic:25 mg, 50 mg, 100 mg

ZIPRASIDONE

24

Therapeutic Category Index

25

AbortifacientDinoprostone ............................................................................................ 8

Acetylcholinesterase InhibitorPyridostigmine ........................................................................................20

Acetylcholinesterase Inhibitor (Central)Donepezil ..................................................................................................8Rivastigmine ...........................................................................................20

Acne ProductsAdapalene ................................................................................................ 2Clindamycin and Benzoyl Peroxide ......................................................... 6Erythromycin (Topical) ..............................................................................8ISOtretinoin (Systemic) .......................................................................... 13Sulfur and Sulfacetamide .......................................................................21Tretinoin (Topical) ...................................................................................23

Adrenergic Agonist AgentOxymetazoline (Nasal) ...........................................................................18

Aldehyde Dehydrogenase InhibitorDisulfiram ..................................................................................................8

Alkalinizing Agent, OralPotassium Citrate ...................................................................................19Sodium Citrate and Citric Acid ...............................................................21

Alkylamine DerivativeBrompheniramine and Pseudoephedrine ................................................ 4

Alpha1 AgonistNaphazoline (Ophthalmic) ......................................................................16

Alpha1 BlockerAlfuzosin ...................................................................................................2Doxazosin .................................................................................................8Prazosin ..................................................................................................19Tamsulosin ............................................................................................. 22Terazosin ................................................................................................ 22

Alpha2-Adrenergic AgonistCloNIDine ................................................................................................. 6GuanFACINE ..........................................................................................11TiZANidine ..............................................................................................22

Alpha2 Agonist, OphthalmicApraclonidine ............................................................................................3Brimonidine (Ophthalmic) .........................................................................4

Alpha-Adrenergic AgonistPhenylephrine (Ophthalmic) ...................................................................18

Alpha/Beta AgonistBrompheniramine and Pseudoephedrine ................................................ 4EPINEPHrine (Systemic) ..........................................................................8Loratadine and Pseudoephedrine ..........................................................14Pseudoephedrine ................................................................................... 20

5 Alpha-Reductase InhibitorFinasteride ..............................................................................................10

AmebicideMetroNIDAZOLE (Systemic) .................................................................. 15

Aminoquinoline (Antimalarial)Chloroquine .............................................................................................. 5Hydroxychloroquine ................................................................................12Primaquine ............................................................................................. 19

5-Aminosalicylic Acid DerivativeMesalamine ............................................................................................ 15SulfaSALAzine ........................................................................................21

Ammonium DetoxicantLactulose ................................................................................................ 13Neomycin ................................................................................................16

Analgesic Combination (Opioid)Acetaminophen and Codeine ...................................................................2Belladonna and Opium ............................................................................ 4Hydrocodone and Acetaminophen .........................................................12Oxycodone and Acetaminophen ............................................................18

Analgesic, NonopioidAcetaminophen .........................................................................................2Aspirin .......................................................................................................3Butalbital, Acetaminophen, and Caffeine .................................................5Celecoxib ..................................................................................................5Diclofenac (Systemic) ...............................................................................7Etodolac ..................................................................................................10Ibuprofen ................................................................................................ 12Indomethacin ..........................................................................................12Ketorolac (Systemic) .............................................................................. 13

Meloxicam .............................................................................................. 15Naproxen ................................................................................................16Piroxicam (Systemic) ..............................................................................18

Analgesic, OpioidAcetaminophen and Codeine ...................................................................2Belladonna and Opium ............................................................................ 4Buprenorphine and Naloxone .................................................................. 4Codeine .................................................................................................... 6FentaNYL ............................................................................................... 10Hydrocodone and Acetaminophen .........................................................12HYDROmorphone .................................................................................. 12Meperidine ..............................................................................................15Methadone ..............................................................................................15Morphine (Systemic) .............................................................................. 16OxyCODONE ......................................................................................... 18Oxycodone and Acetaminophen ............................................................18TraMADol ............................................................................................... 22

Analgesic, Opioid Partial AgonistBuprenorphine and Naloxone .................................................................. 4

Analgesic, TopicalBenzocaine ...............................................................................................4Capsaicin ..................................................................................................5Lidocaine (Topical) ................................................................................. 14

Analgesic, UrinaryPhenazopyridine .....................................................................................18

AndrogenTestosterone ...........................................................................................22

Anesthetic/CorticosteroidPramoxine and Hydrocortisone ..............................................................19

Angiotensin II Receptor BlockerCandesartan .............................................................................................5Candesartan and Hydrochlorothiazide .....................................................5Irbesartan ............................................................................................... 13Losartan ..................................................................................................14Losartan and Hydrochlorothiazide ......................................................... 14Telmisartan ............................................................................................. 22Telmisartan and Hydrochlorothiazide .....................................................22Valsartan .................................................................................................23Valsartan and Hydrochlorothiazide ........................................................ 23

Angiotensin-Converting Enzyme (ACE) InhibitorAmlodipine and Benazepril ...................................................................... 3Benazepril .................................................................................................4Captopril ................................................................................................... 5Enalapril ....................................................................................................8Fosinopril ................................................................................................ 11Lisinopril ................................................................................................. 14Lisinopril and Hydrochlorothiazide ......................................................... 14Ramipril .................................................................................................. 20

Anilidopiperidine OpioidFentaNYL ............................................................................................... 10

AntacidAluminum Hydroxide, Magnesium Hydroxide, and Simethicone .............2

AnthelminticAlbendazole ..............................................................................................2Ivermectin (Systemic) .............................................................................13Pyrantel Pamoate ...................................................................................20

Antianginal AgentAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 3Atenolol .....................................................................................................3DilTIAZem .................................................................................................7Isosorbide Dinitrate ................................................................................ 13Isosorbide Mononitrate ...........................................................................13Metoprolol ...............................................................................................15Nadolol ................................................................................................... 16NIFEdipine ..............................................................................................17Nitroglycerin ............................................................................................17Propranolol ............................................................................................. 19Verapamil ............................................................................................... 23

Antianxiety Agent, MiscellaneousBusPIRone ............................................................................................... 5

Antiarrhythmic Agent, Class IaQuiNIDine ...............................................................................................20

Antiarrhythmic Agent, Class IcFlecainide ............................................................................................... 10Propafenone ...........................................................................................19

ABORTIFACIENT

26

Antiarrhythmic Agent, Class IIPropranolol ............................................................................................. 19Sotalol .....................................................................................................21

Antiarrhythmic Agent, Class IIIAmiodarone .............................................................................................. 2Dofetilide ...................................................................................................8Sotalol .....................................................................................................21

Antiarrhythmic Agent, Class IVDilTIAZem .................................................................................................7Verapamil ............................................................................................... 23

Antiarrhythmic Agent, MiscellaneousDigoxin ......................................................................................................7

Antibiotic, AminoglycosideGentamicin (Ophthalmic) ........................................................................11Neomycin ................................................................................................16Tobramycin (Ophthalmic) ....................................................................... 22

Antibiotic, Cephalosporin (First Generation)Cephalexin ................................................................................................5

Antibiotic, Cephalosporin (Third Generation)Cefdinir ..................................................................................................... 5

Antibiotic/Corticosteroid, OphthalmicNeomycin, Polymyxin B, and Dexamethasone ......................................16Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ..................16Tobramycin and Dexamethasone .......................................................... 22

Antibiotic/Corticosteroid, OticCiprofloxacin and Dexamethasone .......................................................... 5Neomycin, Polymyxin B, and Hydrocortisone (Otic) ..............................17

Antibiotic, FluoroquinoloneCiprofloxacin (Systemic) ...........................................................................6LevoFLOXacin (Systemic) ......................................................................14Moxifloxacin (Ophthalmic) ......................................................................16Moxifloxacin (Systemic) ..........................................................................16Ofloxacin (Ophthalmic) ...........................................................................17Ofloxacin (Otic) .......................................................................................17

Antibiotic, LincosamideClindamycin (Systemic) ............................................................................6Clindamycin (Topical) ............................................................................... 6

Antibiotic, MacrolideAzithromycin (Systemic) ...........................................................................3Clarithromycin ...........................................................................................6Erythromycin (Ophthalmic) .......................................................................8Erythromycin (Systemic) .......................................................................... 8Erythromycin (Topical) ..............................................................................8

Antibiotic, MiscellaneousBismuth Subcitrate, Metronidazole, and Tetracycline ..............................4Dapsone (Systemic) .................................................................................7Fosfomycin ............................................................................................. 11MetroNIDAZOLE (Systemic) .................................................................. 15Nitrofurantoin ..........................................................................................17Sulfamethoxazole and Trimethoprim ..................................................... 21Trimethoprim .......................................................................................... 23

Antibiotic, OphthalmicBacitracin and Polymyxin B (Ophthalmic) ................................................3Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) ............................ 4Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone(Ophthalmic) .......................................................................................... 4

Erythromycin (Ophthalmic) .......................................................................8Gentamicin (Ophthalmic) ........................................................................11Moxifloxacin (Ophthalmic) ......................................................................16Neomycin, Polymyxin B, and Gramicidin ...............................................16Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ..................16Ofloxacin (Ophthalmic) ...........................................................................17Sulfacetamide (Ophthalmic) ...................................................................21Tobramycin (Ophthalmic) ....................................................................... 22Trimethoprim and Polymyxin B .............................................................. 23

Antibiotic, Oral RinseChlorhexidine Gluconate (Oral) ............................................................... 5

Antibiotic, OticCiprofloxacin and Dexamethasone .......................................................... 5Neomycin, Polymyxin B, and Hydrocortisone (Otic) ..............................17Ofloxacin (Otic) .......................................................................................17

Antibiotic, PenicillinAmoxicillin .................................................................................................3Amoxicillin and Clavulanate ..................................................................... 3Dicloxacillin ...............................................................................................7Penicillin V Potassium ............................................................................18

Penicillin G (Parenteral/Aqueous) ..........................................................18Penicillin G Procaine ..............................................................................18

Antibiotic, Respiratory FluoroquinoloneLevoFLOXacin (Systemic) ......................................................................14Moxifloxacin (Systemic) ..........................................................................16

Antibiotic, Sulfonamide DerivativeSulfamethoxazole and Trimethoprim ..................................................... 21Sulfur and Sulfacetamide .......................................................................21

Antibiotic, Tetracycline DerivativeBismuth Subcitrate, Metronidazole, and Tetracycline ..............................4Doxycycline .............................................................................................. 8Minocycline (Systemic) ...........................................................................16Tetracycline (Systemic) .......................................................................... 22

Antibiotic, TopicalBacitracin (Topical) ...................................................................................4Erythromycin (Topical) ..............................................................................8MetroNIDAZOLE (Topical) ..................................................................... 15Mupirocin ................................................................................................16Silver Nitrate ...........................................................................................21Silver Sulfadiazine ..................................................................................21

Anticholinergic AgentBenztropine .............................................................................................. 4Dicyclomine .............................................................................................. 7Glycopyrrolate (Systemic) ...................................................................... 11Hyoscyamine ..........................................................................................12Hyoscyamine, Atropine, Scopolamine, and Phenobarbital ....................12Ipratropium and Albuterol .......................................................................13Ipratropium (Nasal) .................................................................................13Ipratropium (Oral Inhalation) .................................................................. 13Solifenacin ..............................................................................................21Tiotropium ...............................................................................................22Tolterodine ..............................................................................................22Trihexyphenidyl ...................................................................................... 23

Anticholinergic Agent, Long-ActingTiotropium ...............................................................................................22

Anticholinergic Agent, OphthalmicCyclopentolate ..........................................................................................6Homatropine ........................................................................................... 11

AnticoagulantApixaban ...................................................................................................3Dabigatran Etexilate .................................................................................6Enoxaparin ............................................................................................... 8Rivaroxaban ........................................................................................... 20Warfarin .................................................................................................. 23

Anticoagulant, Direct Thrombin InhibitorDabigatran Etexilate .................................................................................6

Anticoagulant, Factor Xa InhibitorApixaban ...................................................................................................3Rivaroxaban ........................................................................................... 20

Anticoagulant, Low Molecular Weight HeparinEnoxaparin ............................................................................................... 8

Anticoagulant, Vitamin K AntagonistWarfarin .................................................................................................. 23

Anticonvulsant, BarbituratePHENobarbital ........................................................................................18

Anticonvulsant, BenzodiazepineClonazePAM .............................................................................................6DiazePAM .................................................................................................7LORazepam ........................................................................................... 14

Anticonvulsant, HydantoinPhenytoin ................................................................................................18

Anticonvulsant, MiscellaneousAcetaZOLAMIDE ......................................................................................2CarBAMazepine ....................................................................................... 5Gabapentin ............................................................................................. 11LamoTRIgine ..........................................................................................13LevETIRAcetam ..................................................................................... 14OXcarbazepine .......................................................................................17Primidone ............................................................................................... 19Topiramate ..............................................................................................22Valproic Acid and Derivatives ................................................................ 23Zonisamide .............................................................................................24

Anticonvulsant, SuccinimideEthosuximide ..........................................................................................10

ANTICONVULSANT, SUCCINIMIDE

27

Antidepressant, Alpha-2 AntagonistMirtazapine .............................................................................................16

Antidepressant, Dopamine/Norepinephrine-Reuptake InhibitorBuPROPion .............................................................................................. 4

Antidepressant, Selective Serotonin Reuptake InhibitorCitalopram ................................................................................................ 6Escitalopram .............................................................................................8FLUoxetine ............................................................................................. 10FluvoxaMINE .......................................................................................... 11PARoxetine .............................................................................................18Sertraline ................................................................................................ 20

Antidepressant, Serotonin/Norepinephrine Reuptake InhibitorDULoxetine ...............................................................................................8Venlafaxine .............................................................................................23

Antidepressant, Serotonin Reuptake Inhibitor/AntagonistTraZODone .............................................................................................23

Antidepressant, Tricyclic (Secondary Amine)Desipramine ............................................................................................. 7Nortriptyline ............................................................................................ 17

Antidepressant, Tricyclic (Tertiary Amine)Amitriptyline ..............................................................................................2Doxepin (Systemic) .................................................................................. 8Imipramine ..............................................................................................12

Antidiabetic Agent, BiguanideGlyburide and Metformin ........................................................................11MetFORMIN ........................................................................................... 15Sitagliptin and Metformin ....................................................................... 21

Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) InhibitorSITagliptin ...............................................................................................21Sitagliptin and Metformin ....................................................................... 21

Antidiabetic Agent, Dopamine AgonistBromocriptine ........................................................................................... 4

Antidiabetic Agent, Glucagon-Like Peptide-1 (GLP-1) ReceptorAgonist

Exenatide ................................................................................................10

Antidiabetic Agent, Sodium-Glucose Cotransporter 2 (SGLT2)Inhibitor

Empagliflozin ............................................................................................ 8

Antidiabetic Agent, SulfonylureaGlimepiride ..............................................................................................11GlipiZIDE ................................................................................................ 11GlyBURIDE .............................................................................................11Glyburide and Metformin ........................................................................11

AntidiarrhealBismuth Subcitrate, Metronidazole, and Tetracycline ..............................4Bismuth Subsalicylate .............................................................................. 4Diphenoxylate and Atropine .....................................................................8Loperamide .............................................................................................14

AntidoteAcetylcysteine ...........................................................................................2Alcohol (Ethyl) .......................................................................................... 2Glucagon ................................................................................................ 11Naloxone ................................................................................................ 16Naltrexone .............................................................................................. 16Potassium Iodide ....................................................................................19Sodium Polystyrene Sulfonate ...............................................................21Sugammadex ......................................................................................... 21

Antidote, ExtravasationDimethyl Sulfoxide ....................................................................................8Nitroglycerin ............................................................................................17Terbutaline ..............................................................................................22

Antidote, HypoglycemiaGlucagon ................................................................................................ 11

AntiemeticDexAMETHasone (Systemic) ...................................................................7HydrOXYzine ..........................................................................................12Meclizine .................................................................................................15Metoclopramide ......................................................................................15Ondansetron ...........................................................................................17Prochlorperazine .................................................................................... 19Promethazine ......................................................................................... 19

Antifibrinolytic AgentTranexamic Acid .....................................................................................23

AntiflatulentAluminum Hydroxide, Magnesium Hydroxide, and Simethicone .............2Simethicone ............................................................................................21

Antifungal Agent, Azole DerivativeItraconazole ............................................................................................13Terconazole ............................................................................................ 22

Antifungal Agent, Imidazole DerivativeClotrimazole (Topical) ...............................................................................6Ketoconazole (Systemic) ........................................................................13Ketoconazole (Topical) ...........................................................................13

Antifungal Agent, OralFluconazole ............................................................................................ 10Griseofulvin .............................................................................................11Itraconazole ............................................................................................13Ketoconazole (Systemic) ........................................................................13Terbinafine (Systemic) ............................................................................22

Antifungal Agent, Oral Nonabsorbed/Partially AbsorbedClotrimazole (Topical) ...............................................................................6Nystatin (Oral) ........................................................................................ 17

Antifungal Agent, ParenteralFluconazole ............................................................................................ 10

Antifungal Agent, TopicalClotrimazole (Topical) ...............................................................................6Ketoconazole (Topical) ...........................................................................13Naftifine .................................................................................................. 16Nystatin and Triamcinolone ....................................................................17Nystatin (Topical) ....................................................................................17Terbinafine (Topical) ............................................................................... 22Tolnaftate ................................................................................................22

Antifungal Agent, VaginalClotrimazole (Topical) ...............................................................................6Terconazole ............................................................................................ 22

Antigout AgentAllopurinol .................................................................................................2Colchicine .................................................................................................6

Antihemophilic AgentDesmopressin ...........................................................................................7Tranexamic Acid .....................................................................................23

Antihemorrhoidal AgentDibucaine ..................................................................................................7Hydrocortisone (Topical) ........................................................................ 12

AntihypertensiveAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 3Atenolol .....................................................................................................3Benazepril .................................................................................................4Bisoprolol ..................................................................................................4Bisoprolol and Hydrochlorothiazide ......................................................... 4Candesartan .............................................................................................5Candesartan and Hydrochlorothiazide .....................................................5Captopril ................................................................................................... 5Carvedilol ..................................................................................................5Chlorthalidone .......................................................................................... 5CloNIDine ................................................................................................. 6DilTIAZem .................................................................................................7Doxazosin .................................................................................................8Enalapril ....................................................................................................8Fosinopril ................................................................................................ 11Furosemide .............................................................................................11GuanFACINE ..........................................................................................11HydrALAZINE ......................................................................................... 11HydroCHLOROthiazide .......................................................................... 12Hydrochlorothiazide and Spironolactone ............................................... 12Hydrochlorothiazide and Triamterene .................................................... 12Indapamide .............................................................................................12Irbesartan ............................................................................................... 13Labetalol .................................................................................................13Lisinopril ................................................................................................. 14Lisinopril and Hydrochlorothiazide ......................................................... 14Losartan ..................................................................................................14Losartan and Hydrochlorothiazide ......................................................... 14Metoprolol ...............................................................................................15Minoxidil (Systemic) ............................................................................... 16Nadolol ................................................................................................... 16NIFEdipine ..............................................................................................17Prazosin ..................................................................................................19Propranolol ............................................................................................. 19Ramipril .................................................................................................. 20Spironolactone ....................................................................................... 21Telmisartan ............................................................................................. 22

ANTIDEPRESSANT, ALPHA-2 ANTAGONIST

28

Telmisartan and Hydrochlorothiazide .....................................................22Terazosin ................................................................................................ 22Torsemide ...............................................................................................22Valsartan .................................................................................................23Valsartan and Hydrochlorothiazide ........................................................ 23Verapamil ............................................................................................... 23

Anti-inflammatory AgentDexAMETHasone (Systemic) ...................................................................7

Antilipemic Agent, 2-AzetidinoneEzetimibe ................................................................................................10

Antilipemic Agent, Bile Acid SequestrantColestipol ..................................................................................................6

Antilipemic Agent, Fibric AcidFenofibrate and Derivatives ................................................................... 10Gemfibrozil ..............................................................................................11

Antilipemic Agent, HMG-CoA Reductase InhibitorAtorvaSTATin ............................................................................................3Lovastatin ............................................................................................... 14Pravastatin ..............................................................................................19Rosuvastatin ...........................................................................................20Simvastatin .............................................................................................21

Antilipemic Agent, MiscellaneousNiacin ......................................................................................................17

Antilipemic Agent, Omega-3 Fatty AcidsOmega-3 Fatty Acids ............................................................................. 17

Antimalarial AgentAtovaquone and Proguanil .......................................................................3Chloroquine .............................................................................................. 5Hydroxychloroquine ................................................................................12Mefloquine ..............................................................................................15Primaquine ............................................................................................. 19QuiNIDine ...............................................................................................20

Antimanic AgentLithium ....................................................................................................14RisperiDONE ..........................................................................................20Valproic Acid and Derivatives ................................................................ 23

Antimigraine AgentErgotamine and Caffeine ......................................................................... 8Rizatriptan .............................................................................................. 20SUMAtriptan ........................................................................................... 21

Antineoplastic Agent, AntiandrogenFlutamide ................................................................................................10

Antineoplastic Agent, AntimetaboliteFluorouracil (Topical) ..............................................................................10Mercaptopurine .......................................................................................15

Antineoplastic Agent, Antimetabolite (Antifolate)Methotrexate ...........................................................................................15

Antineoplastic Agent, Antimetabolite (Purine Analog)Mercaptopurine .......................................................................................15

Antineoplastic Agent, Antimetabolite (Pyrimidine Analog)Fluorouracil (Topical) ..............................................................................10

Antineoplastic Agent, Aromatase InhibitorAnastrozole ...............................................................................................3Letrozole .................................................................................................13

Antineoplastic Agent, Estrogen Receptor AntagonistTamoxifen ............................................................................................... 22

Antineoplastic Agent, Gonadotropin-Releasing Hormone AgonistGoserelin ................................................................................................ 11Leuprolide ...............................................................................................13

Antineoplastic Agent, HormoneMegestrol ................................................................................................15

Antineoplastic Agent, MiscellaneousHydroxyurea ........................................................................................... 12

Antineoplastic Agent, Retinoic Acid DerivativeISOtretinoin (Systemic) .......................................................................... 13Tretinoin (Systemic) ............................................................................... 23

Antiparasitic Agent, TopicalPermethrin ..............................................................................................18

Anti-Parkinson Agent, AnticholinergicBenztropine .............................................................................................. 4Trihexyphenidyl ...................................................................................... 23

Anti-Parkinson Agent, Decarboxylase InhibitorCarbidopa and Levodopa .........................................................................5

Anti-Parkinson Agent, Dopamine AgonistAmantadine .............................................................................................. 2Bromocriptine ........................................................................................... 4Pramipexole ............................................................................................19ROPINIRole ............................................................................................20

Anti-Parkinson Agent, Dopamine PrecursorCarbidopa and Levodopa .........................................................................5

Antiplatelet AgentAspirin .......................................................................................................3Aspirin and Dipyridamole ......................................................................... 3Cilostazol ..................................................................................................5Clopidogrel ............................................................................................... 6Dipyridamole .............................................................................................8Prasugrel ................................................................................................ 19Ticagrelor ................................................................................................22

Antiplatelet Agent, Non-thienopyridineTicagrelor ................................................................................................22

Antiplatelet Agent, ThienopyridineClopidogrel ............................................................................................... 6Prasugrel ................................................................................................ 19

Antiprotozoal, NitroimidazoleMetroNIDAZOLE (Systemic) .................................................................. 15

Antiretroviral, Integrase Inhibitor (Anti-HIV)Abacavir, Dolutegravir, and Lamivudine .................................................. 2Bictegravir, Emtricitabine, and Tenofovir Alafenamide ............................ 4Raltegravir .............................................................................................. 20

Antiretroviral, Reverse Transcriptase Inhibitor, Nucleoside (Anti-HIV)

Abacavir, Dolutegravir, and Lamivudine .................................................. 2Bictegravir, Emtricitabine, and Tenofovir Alafenamide ............................ 4Emtricitabine and Tenofovir Disoproxil Fumarate .................................... 8

Antiretroviral, Reverse Transcriptase Inhibitor, Nucleotide (Anti-HIV)

Bictegravir, Emtricitabine, and Tenofovir Alafenamide ............................ 4Emtricitabine and Tenofovir Disoproxil Fumarate .................................... 8

Antirheumatic, Disease ModifyingAdalimumab ..............................................................................................2Leflunomide ............................................................................................13Methotrexate ...........................................................................................15

Antiseborrheic Agent, TopicalSelenium Sulfide .................................................................................... 20Sulfur and Salicylic Acid .........................................................................21Sulfur and Sulfacetamide .......................................................................21

Antiseptic, TopicalPovidone-Iodine (Topical) .......................................................................19

Antiseptic, VaginalPovidone-Iodine (Topical) .......................................................................19

Antispasmodic Agent, GastrointestinalHyoscyamine, Atropine, Scopolamine, and Phenobarbital ....................12

Antispasmodic Agent, UrinaryBelladonna and Opium ............................................................................ 4Oxybutynin ..............................................................................................18

Antithyroid AgentMethIMAzole ...........................................................................................15Potassium Iodide ....................................................................................19Propylthiouracil .......................................................................................20

Antitubercular AgentEthambutol ............................................................................................... 9Isoniazid ................................................................................................. 13Pyrazinamide ..........................................................................................20RifAMPin .................................................................................................20

AntitussiveBenzonatate ............................................................................................. 4Codeine .................................................................................................... 6Guaifenesin and Codeine .......................................................................11Guaifenesin and Dextromethorphan ...................................................... 11

Antiviral AgentAcyclovir (Systemic) .................................................................................2Amantadine .............................................................................................. 2Oseltamivir ..............................................................................................17ValACYclovir ...........................................................................................23

ANTIVIRAL AGENT

29

Antiviral Agent, AdamantaneAmantadine .............................................................................................. 2

Antiviral Agent, OphthalmicGanciclovir (Ophthalmic) ........................................................................ 11

Antiviral Agent, OralValACYclovir ...........................................................................................23

Antiviral Agent, TopicalAcyclovir (Topical) .................................................................................... 2

Appetite StimulantMegestrol ................................................................................................15

BarbiturateButalbital, Acetaminophen, and Caffeine .................................................5Butalbital, Aspirin, and Caffeine ...............................................................5PHENobarbital ........................................................................................18Primidone ............................................................................................... 19

BenzodiazepineALPRAZolam ............................................................................................2ClonazePAM .............................................................................................6DiazePAM .................................................................................................7LORazepam ........................................................................................... 14Temazepam ............................................................................................22

Beta2-Adrenergic AgonistIpratropium and Albuterol .......................................................................13

Beta2-Adrenergic Agonist, Long-ActingFluticasone and Salmeterol ................................................................... 10Salmeterol .............................................................................................. 20

Beta2 AgonistAlbuterol ................................................................................................... 2Fluticasone and Salmeterol ................................................................... 10Levalbuterol ............................................................................................14Salmeterol .............................................................................................. 20Terbutaline ..............................................................................................22

Beta3 AgonistMirabegron ............................................................................................. 16

Beta-Adrenergic Blocker, NonselectiveDorzolamide and Timolol ......................................................................... 8Propranolol ............................................................................................. 19Sotalol .....................................................................................................21

Beta-Blocker, Beta-1 SelectiveAtenolol .....................................................................................................3Bisoprolol ..................................................................................................4Bisoprolol and Hydrochlorothiazide ......................................................... 4Metoprolol ...............................................................................................15

Beta-Blocker, NonselectiveMetipranolol ............................................................................................15Nadolol ................................................................................................... 16Timolol (Ophthalmic) .............................................................................. 22

Beta-Blocker With Alpha-Blocking ActivityCarvedilol ..................................................................................................5Labetalol .................................................................................................13

Bisphosphonate DerivativeAlendronate .............................................................................................. 2Alendronate and Cholecalciferol .............................................................. 2Ibandronate ............................................................................................ 12Risedronate ............................................................................................ 20

Blood Product DerivativeProthrombin Complex Concentrate (Human) [(Factors II, VII, IX, X),Protein C, and Protein S] .................................................................... 20

Blood Viscosity Reducer AgentPentoxifylline .......................................................................................... 18

Calcineurin InhibitorCycloSPORINE (Ophthalmic) ...................................................................6CycloSPORINE (Systemic) ...................................................................... 6Pimecrolimus ..........................................................................................18Tacrolimus (Topical) ............................................................................... 21

Calcium Channel BlockerAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 3DilTIAZem .................................................................................................7NIFEdipine ..............................................................................................17Verapamil ............................................................................................... 23

Calcium Channel Blocker, DihydropyridineAmLODIPine .............................................................................................2

Amlodipine and Benazepril ...................................................................... 3NIFEdipine ..............................................................................................17

Calcium Channel Blocker, NondihydropyridineDilTIAZem .................................................................................................7Verapamil ............................................................................................... 23

Calcium SaltCalcium and Vitamin D ............................................................................ 5Calcium Glubionate ..................................................................................5

Carbonic Anhydrase InhibitorAcetaZOLAMIDE ......................................................................................2MethazolAMIDE ......................................................................................15

Carbonic Anhydrase Inhibitor (Ophthalmic)Dorzolamide ............................................................................................. 8Dorzolamide and Timolol ......................................................................... 8

Cardiac GlycosideDigoxin ......................................................................................................7

CatharticSodium Phosphates ............................................................................... 21

Cauterizing Agent, TopicalSilver Nitrate ...........................................................................................21

Central Nervous System StimulantArmodafinil ................................................................................................3Dextroamphetamine ................................................................................. 7Dextroamphetamine and Amphetamine .................................................. 7Ergotamine and Caffeine ......................................................................... 8Methylphenidate ..................................................................................... 15Modafinil ................................................................................................. 16

Chloride Channel ActivatorLubiprostone ...........................................................................................14

Cholinergic AgonistBethanechol ..............................................................................................4Pilocarpine (Systemic) ............................................................................18

ContraceptiveEthinyl Estradiol and Desogestrel ............................................................9Ethinyl Estradiol and Drospirenone ......................................................... 9Ethinyl Estradiol and Ethynodiol Diacetate ..............................................9Ethinyl Estradiol and Etonogestrel ...........................................................9Ethinyl Estradiol and Levonorgestrel ....................................................... 9Ethinyl Estradiol and Norelgestromin .......................................................9Ethinyl Estradiol and Norethindrone ........................................................ 9Ethinyl Estradiol and Norgestimate ..........................................................9Ethinyl Estradiol and Norgestrel ............................................................ 10Levonorgestrel (Systemic) ......................................................................14MedroxyPROGESTERone ..................................................................... 15Nonoxynol 9 ........................................................................................... 17Norethindrone .........................................................................................17Norethindrone and Mestranol ................................................................ 17

Contraceptive, BarrierContraceptive Devices ............................................................................. 6

Corticosteroid, Inhalant (Oral)Budesonide (Oral Inhalation) ................................................................... 4Fluticasone and Salmeterol ................................................................... 10Fluticasone (Oral Inhalation) .................................................................. 11Mometasone (Oral Inhalation) ............................................................... 16

Corticosteroid, NasalFlunisolide (Nasal) ..................................................................................10Fluticasone (Nasal) .................................................................................11Mometasone (Nasal) ..............................................................................16

Corticosteroid, OphthalmicBacitracin, Neomycin, Polymyxin B, and Hydrocortisone(Ophthalmic) .......................................................................................... 4

Difluprednate ............................................................................................ 7Fluorometholone .................................................................................... 10Loteprednol ............................................................................................ 14Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ..................16PrednisoLONE (Ophthalmic) ..................................................................19

Corticosteroid, OticCiprofloxacin and Dexamethasone .......................................................... 5Neomycin, Polymyxin B, and Hydrocortisone (Otic) ..............................17

Corticosteroid, RectalHydrocortisone (Topical) ........................................................................ 12

Corticosteroid, SystemicDexAMETHasone (Systemic) ...................................................................7Fludrocortisone .......................................................................................10Hydrocortisone (Systemic) ..................................................................... 12

ANTIVIRAL AGENT, ADAMANTANE

30

MethylPREDNISolone ............................................................................ 15PrednisoLONE (Systemic) ..................................................................... 19PredniSONE ...........................................................................................19

Corticosteroid, TopicalBetamethasone (Topical) ......................................................................... 4Clobetasol .................................................................................................6Desonide .................................................................................................. 7Fluocinolone (Topical) ............................................................................ 10Fluocinonide ........................................................................................... 10Flurandrenolide ...................................................................................... 10Hydrocortisone (Topical) ........................................................................ 12Nystatin and Triamcinolone ....................................................................17Triamcinolone (Topical) .......................................................................... 23

DecongestantBrompheniramine and Pseudoephedrine ................................................ 4Loratadine and Pseudoephedrine ..........................................................14Oxymetazoline (Nasal) ...........................................................................18Pseudoephedrine ................................................................................... 20

Depigmenting AgentHydroquinone ......................................................................................... 12

Diagnostic AgentGlucagon ................................................................................................ 11

Direct Oral Anticoagulant (DOAC)Apixaban ...................................................................................................3Dabigatran Etexilate .................................................................................6Rivaroxaban ........................................................................................... 20

Diuretic, Carbonic Anhydrase InhibitorAcetaZOLAMIDE ......................................................................................2MethazolAMIDE ......................................................................................15

Diuretic, LoopFurosemide .............................................................................................11Torsemide ...............................................................................................22

Diuretic, Potassium-SparingHydrochlorothiazide and Triamterene .................................................... 12Spironolactone ....................................................................................... 21

Diuretic, ThiazideBisoprolol and Hydrochlorothiazide ......................................................... 4Candesartan and Hydrochlorothiazide .....................................................5HydroCHLOROthiazide .......................................................................... 12Hydrochlorothiazide and Spironolactone ............................................... 12Hydrochlorothiazide and Triamterene .................................................... 12Lisinopril and Hydrochlorothiazide ......................................................... 14Losartan and Hydrochlorothiazide ......................................................... 14Telmisartan and Hydrochlorothiazide .....................................................22Valsartan and Hydrochlorothiazide ........................................................ 23

Diuretic, Thiazide-RelatedChlorthalidone .......................................................................................... 5Indapamide .............................................................................................12MetOLazone ...........................................................................................15

Dopamine AntagonistMetoclopramide ......................................................................................15

Electrolyte Supplement, OralCalcium and Vitamin D ............................................................................ 5Potassium Chloride ................................................................................ 19Potassium Phosphate and Sodium Phosphate ..................................... 19

Electrolyte Supplement, ParenteralPotassium Chloride ................................................................................ 19Potassium Phosphate ............................................................................ 19Sodium Chloride .....................................................................................21Sodium Phosphates ............................................................................... 21

EnzymeDornase Alfa .............................................................................................8Pancrelipase ...........................................................................................18

Ergot DerivativeBromocriptine ........................................................................................... 4Cabergoline .............................................................................................. 5Ergotamine and Caffeine ......................................................................... 8Methylergonovine ................................................................................... 15

Estrogen and Androgen CombinationEstrogens (Esterified) and Methyltestosterone ........................................9

Estrogen and Progestin CombinationEstrogens (Conjugated/Equine) and Medroxyprogesterone ....................9Ethinyl Estradiol and Desogestrel ............................................................9Ethinyl Estradiol and Drospirenone ......................................................... 9Ethinyl Estradiol and Ethynodiol Diacetate ..............................................9Ethinyl Estradiol and Etonogestrel ...........................................................9

Ethinyl Estradiol and Levonorgestrel ....................................................... 9Ethinyl Estradiol and Norelgestromin .......................................................9Ethinyl Estradiol and Norethindrone ........................................................ 9Ethinyl Estradiol and Norgestimate ..........................................................9Ethinyl Estradiol and Norgestrel ............................................................ 10Norethindrone and Mestranol ................................................................ 17

Estrogen DerivativeEstradiol (Systemic) ................................................................................. 9Estrogens (Conjugated/Equine, Systemic) .............................................. 9Estrogens (Conjugated/Equine, Topical) ..................................................9

Ethanolamine DerivativeDiphenhydrAMINE (Systemic) ..................................................................8

ExpectorantGuaifenesin and Codeine .......................................................................11Guaifenesin and Dextromethorphan ...................................................... 11Potassium Iodide ....................................................................................19

First Generation (Typical) AntipsychoticHaloperidol ..............................................................................................11Prochlorperazine .................................................................................... 19

GABA AnalogGabapentin ............................................................................................. 11

Gallstone Dissolution AgentUrsodiol .................................................................................................. 23

Gastrointestinal Agent, MiscellaneousAdalimumab ..............................................................................................2LinaCLOtide ............................................................................................14Lubiprostone ...........................................................................................14Naldemedine .......................................................................................... 16Sucralfate ............................................................................................... 21

Gastrointestinal Agent, ProkineticMetoclopramide ......................................................................................15

General AnestheticFentaNYL ............................................................................................... 10

Genitourinary IrrigantSodium Chloride .....................................................................................21Sorbitol ................................................................................................... 21

Gonadotropin Releasing Hormone AgonistGoserelin ................................................................................................ 11Leuprolide ...............................................................................................13

Guanylate Cyclase-C (GC-C) AgonistLinaCLOtide ............................................................................................14

Hemostatic AgentAluminum Chloride Hexahydrate ............................................................. 2Desmopressin ...........................................................................................7Prothrombin Complex Concentrate (Human) [(Factors II, VII, IX, X),Protein C, and Protein S] .................................................................... 20

Tranexamic Acid .....................................................................................23

Histamine H1 AntagonistAzelastine (Nasal) .................................................................................... 3Brompheniramine and Pseudoephedrine ................................................ 4Cetirizine (Systemic) ................................................................................ 5Cyproheptadine ........................................................................................ 6DiphenhydrAMINE (Systemic) ..................................................................8Fexofenadine ..........................................................................................10HydrOXYzine ..........................................................................................12Ketotifen (Ophthalmic) ............................................................................13Loratadine ...............................................................................................14Loratadine and Pseudoephedrine ..........................................................14Meclizine .................................................................................................15Olopatadine (Nasal) ............................................................................... 17Olopatadine (Ophthalmic) ...................................................................... 17Promethazine ......................................................................................... 19

Histamine H1 Antagonist, First GenerationBrompheniramine and Pseudoephedrine ................................................ 4Cyproheptadine ........................................................................................ 6DiphenhydrAMINE (Systemic) ..................................................................8HydrOXYzine ..........................................................................................12Meclizine .................................................................................................15Promethazine ......................................................................................... 19

Histamine H1 Antagonist, Second GenerationAzelastine (Nasal) .................................................................................... 3Cetirizine (Systemic) ................................................................................ 5Fexofenadine ..........................................................................................10Ketotifen (Ophthalmic) ............................................................................13Loratadine ...............................................................................................14Loratadine and Pseudoephedrine ..........................................................14

HISTAMINE H1 ANTAGONIST, SECOND GENERATION

31

Olopatadine (Nasal) ............................................................................... 17Olopatadine (Ophthalmic) ...................................................................... 17

Histamine H2 AntagonistFamotidine ..............................................................................................10RaNITIdine ............................................................................................. 20

Histone Deacetylase InhibitorValproic Acid and Derivatives ................................................................ 23

Hormone, Posterior PituitaryDesmopressin ...........................................................................................7

Hypnotic, MiscellaneousChloral Hydrate ........................................................................................ 5Eszopiclone .............................................................................................. 9Zaleplon ..................................................................................................23Zolpidem .................................................................................................24

Imidazoline DerivativeNaphazoline (Ophthalmic) ......................................................................16Oxymetazoline (Nasal) ...........................................................................18

Immunosuppressant AgentAzaTHIOprine ...........................................................................................3CycloSPORINE (Ophthalmic) ...................................................................6CycloSPORINE (Systemic) ...................................................................... 6Mercaptopurine .......................................................................................15Methotrexate ...........................................................................................15Mycophenolate ....................................................................................... 16Pimecrolimus ..........................................................................................18Tacrolimus (Topical) ............................................................................... 21

Inhalation, MiscellaneousInhalation Devices ..................................................................................12

Insulin, CombinationInsulin Aspart Protamine and Insulin Aspart ......................................... 12Insulin NPH and Insulin Regular ............................................................13

Insulin, Intermediate-ActingInsulin NPH ............................................................................................ 13

Insulin, Long-ActingInsulin Detemir ....................................................................................... 12Insulin Glargine ...................................................................................... 12

Insulin, Rapid-ActingInsulin Aspart ..........................................................................................12

Insulin, Short-ActingInsulin Regular ....................................................................................... 13

Iron PreparationsFerrous Sulfate .......................................................................................10

IrrigantSodium Chloride .....................................................................................21

Irrigating SolutionBalanced Salt Solution .............................................................................4

Keratolytic AgentPodofilox .................................................................................................18Urea (Topical) .........................................................................................23

Laxative, Bowel EvacuantSodium Phosphates ............................................................................... 21

Laxative, OsmoticLactulose ................................................................................................ 13Polyethylene Glycol 3350 ...................................................................... 18Polyethylene Glycol-Electrolyte Solution ............................................... 19Sorbitol ................................................................................................... 21

Laxative, SalineMagnesium Citrate ................................................................................. 15

Laxative, StimulantBisacodyl .................................................................................................. 4

Leukotriene-Receptor AntagonistMontelukast ............................................................................................ 16

Local AnestheticBenzocaine ...............................................................................................4Dibucaine ..................................................................................................7Lidocaine (Topical) ................................................................................. 14

Lubricant, OcularSodium Chloride .....................................................................................21

Lymphocyte Function-Associated Antigen 1 (LFA-1) AntagonistLifitegrast ................................................................................................14

Lysine AnalogTranexamic Acid .....................................................................................23

Magnesium SaltMagnesium Citrate ................................................................................. 15

Mast Cell StabilizerCromolyn (Ophthalmic) ............................................................................ 6Ketotifen (Ophthalmic) ............................................................................13

Mineralocorticoid (Aldosterone) Receptor AntagonistsHydrochlorothiazide and Spironolactone ............................................... 12Spironolactone ....................................................................................... 21

Miscellaneous ProductCondom ....................................................................................................6Diabetic Supplies ......................................................................................7

Monoclonal AntibodyAdalimumab ..............................................................................................2Palivizumab ............................................................................................ 18

Monoclonal Antibody, Anti-AsthmaticOmalizumab ........................................................................................... 17

Mucolytic AgentAcetylcysteine ...........................................................................................2Dornase Alfa .............................................................................................8

Neuraminidase InhibitorOseltamivir ..............................................................................................17

N-Methyl-D-Aspartate (NMDA) Receptor AntagonistMemantine ..............................................................................................15

Nonsteroidal Anti-inflammatory Drug (NSAID)Diclofenac (Ophthalmic) ...........................................................................7Diclofenac (Systemic) ...............................................................................7Diclofenac (Topical) ..................................................................................7

Nonsteroidal Anti-inflammatory Drug (NSAID), COX-2 SelectiveCelecoxib ..................................................................................................5

Nonsteroidal Anti-inflammatory Drug (NSAID), OphthalmicDiclofenac (Ophthalmic) ...........................................................................7Ketorolac (Ophthalmic) ...........................................................................13Nepafenac .............................................................................................. 17

Nonsteroidal Anti-inflammatory Drug (NSAID), OralAspirin .......................................................................................................3Diclofenac (Systemic) ...............................................................................7Etodolac ..................................................................................................10Ibuprofen ................................................................................................ 12Indomethacin ..........................................................................................12Ketorolac (Systemic) .............................................................................. 13Meloxicam .............................................................................................. 15Naproxen ................................................................................................16Piroxicam (Systemic) ..............................................................................18

Nonsteroidal Anti-inflammatory Drug (NSAID), ParenteralIbuprofen ................................................................................................ 12Indomethacin ..........................................................................................12Ketorolac (Systemic) .............................................................................. 13

Nonsteroidal Anti-inflammatory Drug (NSAID), TopicalDiclofenac (Topical) ..................................................................................7

Norepinephrine Reuptake Inhibitor, SelectiveAtoMOXetine ............................................................................................ 3

Nutritional SupplementFluoride ...................................................................................................10

Ophthalmic Agent, AntiglaucomaAcetaZOLAMIDE ......................................................................................2Betaxolol (Ophthalmic) .............................................................................4Brimonidine (Ophthalmic) .........................................................................4Dorzolamide ............................................................................................. 8Dorzolamide and Timolol ......................................................................... 8Latanoprost .............................................................................................13MethazolAMIDE ......................................................................................15Metipranolol ............................................................................................15Pilocarpine (Ophthalmic) ........................................................................18Timolol (Ophthalmic) .............................................................................. 22

Ophthalmic Agent, MioticPilocarpine (Ophthalmic) ........................................................................18

Ophthalmic Agent, MiscellaneousArtificial Tears ...........................................................................................3Balanced Salt Solution .............................................................................4

Ophthalmic Agent, MydriaticCyclopentolate and Phenylephrine .......................................................... 6

HISTAMINE H1 ANTAGONIST, SECOND GENERATION

32

Homatropine ........................................................................................... 11Phenylephrine (Ophthalmic) ...................................................................18Tropicamide ............................................................................................23

Ophthalmic Agent, VasoconstrictorNaphazoline (Ophthalmic) ......................................................................16

Opioid AntagonistNaloxone ................................................................................................ 16Naltrexone .............................................................................................. 16

Opioid Antagonist, Peripherally-ActingNaldemedine .......................................................................................... 16

Otic Agent, Anti-infectiveAcetic Acid (Otic) ......................................................................................2Acetic Acid, Propylene Glycol Diacetate, and Hydrocortisone ................2

Ovulation StimulatorClomiPHENE ............................................................................................6

P2Y12 AntagonistClopidogrel ............................................................................................... 6Prasugrel ................................................................................................ 19Ticagrelor ................................................................................................22

PediculocidePermethrin ..............................................................................................18

Pharmaceutical AidAlcohol (Ethyl) .......................................................................................... 2Collodion, Flexible ....................................................................................6White Petrolatum ....................................................................................23

Phenothiazine DerivativeProchlorperazine .................................................................................... 19Promethazine ......................................................................................... 19

Phosphodiesterase-3 Enzyme InhibitorCilostazol ..................................................................................................5

Phosphodiesterase-5 Enzyme InhibitorSildenafil .................................................................................................21

Phosphodiesterase Enzyme Inhibitor, NonselectiveTheophylline ........................................................................................... 22

Piperazine DerivativeCetirizine (Systemic) ................................................................................ 5HydrOXYzine ..........................................................................................12Meclizine .................................................................................................15

Piperidine DerivativeCyproheptadine ........................................................................................ 6Fexofenadine ..........................................................................................10Ketotifen (Ophthalmic) ............................................................................13Loratadine ...............................................................................................14Loratadine and Pseudoephedrine ..........................................................14Olopatadine (Nasal) ............................................................................... 17Olopatadine (Ophthalmic) ...................................................................... 17

Potassium BinderSodium Polystyrene Sulfonate ...............................................................21

ProgestinHYDROXYprogesterone Caproate .........................................................12Levonorgestrel (Systemic) ......................................................................14MedroxyPROGESTERone ..................................................................... 15Megestrol ................................................................................................15Norethindrone .........................................................................................17Progesterone ..........................................................................................19

ProstaglandinDinoprostone ............................................................................................ 8MiSOPROStol .........................................................................................16

Prostaglandin, OphthalmicLatanoprost .............................................................................................13

Prothrombin Complex Concentrate (PCC)Prothrombin Complex Concentrate (Human) [(Factors II, VII, IX, X),Protein C, and Protein S] .................................................................... 20

Proton Pump InhibitorEsomeprazole ...........................................................................................9Omeprazole ............................................................................................17Pantoprazole .......................................................................................... 18

Renin InhibitorAliskiren ....................................................................................................2

Respiratory StimulantAmmonia Spirit (Aromatic) ....................................................................... 3

Retinoic Acid DerivativeAdapalene ................................................................................................ 2ISOtretinoin (Systemic) .......................................................................... 13Tretinoin (Systemic) ............................................................................... 23Tretinoin (Topical) ...................................................................................23

RifamycinRifAMPin .................................................................................................20

SalicylateAspirin .......................................................................................................3Salsalate .................................................................................................20

Scabicidal AgentPermethrin ..............................................................................................18

Second Generation (Atypical) AntipsychoticARIPiprazole .............................................................................................3Lurasidone ..............................................................................................14QUEtiapine ............................................................................................. 20RisperiDONE ..........................................................................................20Ziprasidone .............................................................................................24

Selective 5-HT3 Receptor AntagonistOndansetron ...........................................................................................17

Selective Estrogen Receptor Modulator (SERM)ClomiPHENE ............................................................................................6Raloxifene ...............................................................................................20Tamoxifen ............................................................................................... 22

Selective Relaxant Binding AgentSugammadex ......................................................................................... 21

Serotonin 5-HT1B, 1D Receptor AgonistRizatriptan .............................................................................................. 20SUMAtriptan ........................................................................................... 21

Serotonin 5-HT4 Receptor AgonistMetoclopramide ......................................................................................15

Skeletal Muscle RelaxantBaclofen ....................................................................................................4Carisoprodol ............................................................................................. 5Chlorzoxazone ..........................................................................................5Cyclobenzaprine .......................................................................................6Metaxalone .............................................................................................15Methocarbamol .......................................................................................15

Skin and Mucous Membrane AgentImiquimod ...............................................................................................12

Skin and Mucous Membrane Agent, MiscellaneousEmollients .................................................................................................8

Smoking Cessation AidBuPROPion .............................................................................................. 4Nicotine ...................................................................................................17

Sodium-Glucose Cotransporter 2 (SGLT2) InhibitorEmpagliflozin ............................................................................................ 8

Sodium SaltSodium Chloride .....................................................................................21

SpermicideNonoxynol 9 ........................................................................................... 17

Substituted BenzimidazoleEsomeprazole ...........................................................................................9Omeprazole ............................................................................................17Pantoprazole .......................................................................................... 18

ThioamideMethIMAzole ...........................................................................................15Propylthiouracil .......................................................................................20

Thyroid ProductLevothyroxine ......................................................................................... 14Liothyronine ............................................................................................14Thyroid, Desiccated ................................................................................22

Topical Skin ProductAcetic Acid (Topical) .................................................................................2Aluminum Chloride Hexahydrate ............................................................. 2Calcipotriene .............................................................................................5Capsaicin ..................................................................................................5Clindamycin and Benzoyl Peroxide ......................................................... 6Coal Tar .................................................................................................... 6Collodion, Flexible ....................................................................................6Doxepin (Topical) ..................................................................................... 8Emollients .................................................................................................8Erythromycin (Topical) ..............................................................................8Fluorouracil (Topical) ..............................................................................10

TOPICAL SKIN PRODUCT

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Imiquimod ...............................................................................................12Lanolin ....................................................................................................13Pimecrolimus ..........................................................................................18Podofilox .................................................................................................18Povidone-Iodine (Topical) .......................................................................19Selenium Sulfide .................................................................................... 20Tacrolimus (Topical) ............................................................................... 21Urea (Topical) .........................................................................................23White Petrolatum ....................................................................................23

Topical Skin Product, AcneAdapalene ................................................................................................ 2Azelaic Acid ..............................................................................................3Clindamycin and Benzoyl Peroxide ......................................................... 6Clindamycin (Topical) ............................................................................... 6Erythromycin (Topical) ..............................................................................8Sulfur and Sulfacetamide .......................................................................21Tretinoin (Topical) ...................................................................................23

Topical Skin Product, AntibacterialSilver Nitrate ...........................................................................................21

Transient Receptor Potential Vanilloid 1 (TRPV1) AgonistCapsaicin ..................................................................................................5

Tumor Necrosis Factor (TNF) Blocking AgentAdalimumab ..............................................................................................2

Uricosuric AgentProbenecid ............................................................................................. 19

Urinary Acidifying AgentPotassium Phosphate ............................................................................ 19

Urinary Tract ProductDimethyl Sulfoxide ....................................................................................8

VaccinePapillomavirus (9-Valent) Vaccine (Human, Recombinant) ................... 18Typhoid Vaccine ..................................................................................... 23

Vaccine, Inactivated (Bacterial)Typhoid Vaccine ..................................................................................... 23

Vaccine, Inactivated (Viral)Papillomavirus (9-Valent) Vaccine (Human, Recombinant) ................... 18

Vaccine, Live (Bacterial)Typhoid Vaccine ..................................................................................... 23

VasodilatorCilostazol ..................................................................................................5Dipyridamole .............................................................................................8HydrALAZINE ......................................................................................... 11Isosorbide Dinitrate ................................................................................ 13Isosorbide Mononitrate ...........................................................................13Nitroglycerin ............................................................................................17

Vasodilator, Direct-ActingMinoxidil (Systemic) ............................................................................... 16

Vasopressin Analog, SyntheticDesmopressin ...........................................................................................7

VitaminVitamins (Multiple/Oral) ..........................................................................23Vitamins (Multiple/Pediatric) ...................................................................23Vitamins (Multiple/Prenatal) ................................................................... 23

Vitamin D AnalogAlendronate and Cholecalciferol .............................................................. 2Calcipotriene .............................................................................................5Calcitriol (Systemic) ..................................................................................5Cholecalciferol ..........................................................................................5Ergocalciferol ............................................................................................8

Vitamin, Fat SolubleCalcium and Vitamin D ............................................................................ 5Phytonadione ......................................................................................... 18

Vitamin, Water SolubleCyanocobalamin .......................................................................................6Folic Acid ................................................................................................11Niacin ......................................................................................................17Pyridoxine ...............................................................................................20

Xanthine Oxidase InhibitorAllopurinol .................................................................................................2

TOPICAL SKIN PRODUCT

34

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