ventura county medical center-santa paula hospital drug...

Ventura County Medical Center-Santa Paula Hospital

Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary

abacavir Ziagen oral tab 300 mg

abatacept Orencia IV soln 250 mg in NS 500mL

acetaminophen Ofirmev IV soln 10 mg/mL Restricted: patients with no oral or rectal route 3/31/2011

acetaminophen Children's Tylenol oral liq 80 mg/0.8 mL

acetaminophen Infants Tylenol Concentrated Drops oral liq 80 mg/0.8 mL

acetaminophen Tylenol oral liq80 mg/0.8 mL, 160 mg/5 mL, 650 mg/25

mL

acetaminophen Tylenol rectal supp 120 mg, 325 mg, 650 mg

acetaminophen Tylenol oral tab 325 mg

acetaminophen-codeine Tylenol #3 oral liq

acetaminophen-codeine Tylenol #3 oral tab 325 mg-30 mg, 300 mg-30 mg

acetaminophen-HYDROcodone Vicodin oral tab325 mg-10 mg, 325 mg-5 mg, 300 mg-5

mg7/1/2013

acetaminophen-HYDROcodone Norco oral tab325 mg-10 mg, 325 mg-5 mg, 300 mg-10

mg

acetaminophen-oxyCODONE Percocet 5/325 oral tab 325 mg-5 mg

acetaZOLAMIDE Diamox inj powder 500 mg

acetaZOLAMIDE Diamox oral tab 250 mg

acetaZOLAMIDE Diamox Sequels oral cap-XR 500 mg

acetic acid topical acetic acid irrigation irrigation soln 0.25%

acetylchloine opth Miochol intraocular powder 1.00%

acetylcysteine Acetadote IV soln 20.00%

acetylcysteine Mucomyst-10 inhalation soln 10.00%

acetylcysteine Mucomyst-20 inhalation soln 20.00%

acyclovir Zovirax oral cap 200 mg/5 mL

acyclovir Zovirax IV powder 500 mg

acyclovir Zovirax oral susp 200 mg/5 mL

acyclovir Zovirax oral tab 800 mg

acyclovir topical Zovirax top oint 5.00%

adenosine Adenocard, Adenoscan IV soln 3 mg/mL

ado-trastuzumab emtansine Kadcyla® IV soln 100 mg, 160 mg 8/29/2013

aerochamber N/A inhalation device n/a

aerochamber w/mask Large N/A inhalation device n/a

aerochamber w/mask small N/A inhalation device n/a

Al hydroxide/Mg hydroxide/simethicone Maalox Antacid Antigas Regular Strength oral susp 200 mg-200 mg-20 mg/5 mL

albendazole Albenza oral tab 200 mg

albumin human Albumar-5 IV soln 5%, 25%

albumin human Human Albumin Grifols IV soln 25.00%

albumin human Plasbumin-25 IV soln 25.00%

albumin human Plasbumin-5 IV soln 5.00%

albuterol Proventil oral syrup 2 mg/5 mL Therapeutic Interchange

albuterol Proventil HFA inhalation aerosol with adapter CFC free 90 mcg/inh Therapeutic Interchange

albuterol N/A inhalation aerosol 90 mcg/inh

albuterol N/A inhalation soln0.5%, 1.25mg/3 mL (0.042%), 2.5 mg/3 mL

(0.083%)

albuterol N/A oral syrup 2 mg/5 mL

albuterol Ventolin HFA inhalation aerosol with adapter CFC free 90 mcg/inh

aldesleukin Proleukin IV powder 22000000 intl units

alemtuxumab Campath 5/24/2012

allopurinol Zyloprim IV powder 500 mg

allopurinol Zyloprim oral tab 100 mg, 300 mg

ALPRAZolam Xanax oral tab 0.25 mg, 0.5 mg

alprostadil Prostin VR inj soln 0.5 mg/mL

alteplaseCathflo

Activaseinj powder 2 mg

Restricted: 1. Treatment of acute nonhemorrhagic strock (as per VCMC protocol) 2.

Massive pulmonary embolus with hemodynamic compromise (pulmonary consult

required) 3. Thrombolysis of clot-occluded catheters

aluminum chloride hexahydrate topical Drysol top soln 20.00%


Drug Formulary


aluminum hydroxide Alternagel oral susp 320 mg/5 mL

aluminum sulfate-calcium acetate topical Domeboro top powder -

amantadine Symmetrel oral cap 100 mg

amikacin Amikin IV soln 50 mg/mL, 250 mg/mLRestricted: Use limited to treatment of infections due to Gram Negative Rods

documented or suspected to be resistant to Gentamicin and Tobramycin

aMILoride Midamor oral tab 5 mg

aminocaproic acid Amicar IV soln 250 mg/mL

aminophylline Phyllocontin IV soln 25 mg/mL

amiodarone Cordarone oral tab 200 mg

amiodarone Cordarone IV IV soln 50 mg/mL

amitriptyline Elavil oral tab 10 mg, 25 mg, 50 mg, 75 mg

amLODIPine Norvasc oral tab 5 mg, 10 mg

amLODIPine-atorvastatin Caduet oral tab 2.5 mg-1 mg, 5 mg-10 mg 2/28/2008

ammonia inhalant N/A inhalation amp -

ammonium chloride N/A IV soln 5 mEq/mL

amoxicillin Amoxil oral cap 250 mg, 500 mg

amoxicillin Amoxil oral powder 125 mg/5 mL, 250 mg/5 mL

amoxicillin-clavulanate Augmentin oral powder200 mg-28.5 mg/5 mL, 400 mg-57 mg/5

mL

amoxicillin-clavulanate Augmentin oral tab 250 mg-125 mg, 875 mg-125 mg

amphetamine-dextroamphetamine Adderall oral tab 5 mg

Amphotericin Amphotericin IV inj 0.5 mg/mL

amphotericin B Amphotericin IV powder 50 mg

amphotericin B liposomal AmBisome IV powder 50 mg

ampicillin Ampicillin inj powder 1 g, 2 g, 125 mg, 250 mg, 500 mg

ampicillin Principen oral cap 1 g, 2 g, 125 mg, 250 mg, 500 mg

ampicillin-sulbactam Unasyn inj powder 1 g-0.5 g, 2 g-1 g

amyl nitrite amyl nitrite inhalation soln 0.3 mL

amyl nitrite/Na nitrite/Na thiosulfate Cyanide Antidote Kit inj kit 0.3 mL-30 mg-25 mg

anagrelide Agrylin oral cap 0.5 mg

anastrazole Arimidex oral tab 1 mg

antazoline-naphazoline ophth Naphcon-A opthalmic soln 0.5%-0.05%

antihemophilic factor Advate rAHF-PFM IV powder recombinant albumin-free

antihemophilic factor IV kit recombinant albumin-free

antihemophilic factor IV powder recombinant

antihemophilic factor-von Willebrand Factor Humate-P, Wilate IV powder -

antipyrine-benzocaine otic Aurodex otic soln 54 mg-14 mg/mL

antivenin (crotalidae) polyvalent antivenin polyvalent inj soln

APAP/dichloralphenazone/isometheptene Midrin oral cap 325 mg-100 mg-65 mg

aprepitant Emend Restricted: Oncology Infusion Center ONLY

argatroban argatroban IV soln 100 mg/mL

ARIPiprazole Abilify oral tab 5 mg, 10 mg, 15 mg, 30 mg

ARIPiprazole for extended release inj Abilify Maintena IM susp 300 mg, 400 mg

arsenic trioxide Trisenox IV soln 1 mg/mL

ascorbic acid Vitamin C inj soln 500 mg/mL

ascorbic acid Vitamin C oral tab 500 mg

asenapine Saphris sublingual tab 5 mg, 10 mgRestricted: Patients must have failed generically available atypical antipsychotic

therapy12/19/2013

aspirin Ecotrin oral tab-EC 325 mg

aspirin rectal supp 300 mg

aspirin oral tab 325 mg

aspirin oral tab-chew 81 mg, 325 mg

aspirin oral tab-EC 81 mg, 325 mg

aspirin-dipyridamole Aggrenox oral cap-XR 25 mg-200 mg

atazanavir Reyataz oral cap 200 mg, 300 mg Restricted

atenolol Tenormin oral tab 25 mg, 50 mg, 100 mg

atomoxetine Strattera oral tab 10 mg, 25 mg, 40 mg 6/23/2015

atorvastatin Lipitor oral tab 10 mg, 20 mg, 40 mg, 80 mg


Drug Formulary


atovaquone Mepron oral susp 750 mg/5 mL

atropine Atropine inj soln 0.1 mg/mL, 0.4 mg/mL, 1 mg/mL

atropine opth Atropine opthalmic oint 1.00%

atropine/hyoscyamine/PB/scopalamine Antispasmodic oral elixir0.0194 mg-0.1037 mg-16.2 mg-0.0065

mg/5 mLTherapeutic Interchange

atropine/hyoscyamine/PB/scopalamine Donnatal oral tab 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg

atropine-diphenoxylate Lomotil oral liq 0.025 mg-2.5 mg/5 mL

atropine-diphenoxylate Lomotil oral tab 0.025 mg-2.5 mg

azacitidine Vidaza subQ

azathioprine Imuran oral tab 50 mg

azithromycin Zithromax IV powder 500 mg

azithromycin Zithromax oral powder 200 mg/5 mL

azithromycin Zithromax oral tab 250 mg, 600 mg

aztreonam Azactam inj powder 1 gRestricted: Use limited to treatment of Gram Negative Rods in Urinary Tract

Infections. Concurrent use of an aminoglycoside is strongly suggested to cover

Pseudomonas aeruginosa infections

bacitracin BacIM IM powder 50000 units

bacitracin opthalmic Ak-Tracin opthalmic oint 500 units/g

bacitracin topical Baciguent top oint 500 units/g

bacitracin/HC/neomycin/polymyxin B opth Cortisporin Opthalmic opthalmic oint 400 units-10 mg-3.5 mg-10000 units/g

bacitracin/neomycin/polymyxin B opth Cortisporin Opthalmic Suspension opthalmic oint 400 units-3.5 mg-10000 units/g

bacitracin/neomycin/polymyxin B topical Neosporin/Triple Antibiotic top oint 400 units-3.5 mg-5000 units/g

bacitracin-polymyxin B opth Polysporin Ophthalmic opthalmic oint 500 units-10000 units/g

bacitracin-polymyxin B topical Polysporin top oint 500 units-10000 units/g

baclofen Lioresal oral tab 10 mg

baf Zyvox IV soln 2 mg/mL

Restricted: Infectious Diseases Consult Required

1. Restricted to documented vancomycin resistant entercoccus.

2. Unknown source of infection causing septic shock.

3. Pneumonia with septic shock with MDRO

BCG BCG intravesical powder 81 mg, 325 mg

BCG TheraCys intravesical powder 81 mg

belimumab Benlysta Rx: Add TB Screen to Order -

belladonna-opium belladonna-opium rectal supp 16.2 mg-60 mg

benazepril Lotensin oral tab 5 mg, 10 mg, 20 mg

bendamustine Treanda Restricted: Oncology Infusion Center ONLY 6/24/2008

benzocaine topical Dermoplast top spray -

benzocaine/butamben/tetracaine topical Cetacainmucous

membraneaerosol 14%-2%-2%

benzoin topical tincture of benzoin top tincture -

benzoyl peroxide topical various top gel 5.00%

benztropine Cogentin inj soln 1 mg/mL

benztropine Cogentin oral tab 0.5 mg, 1 mg, 2 mg

beractant Survanta Intrathecal intrathecal susp 25 mg/mL

betamethasone Celestone Soluspan inj susp 6 mg/mL

betamethasone topical Diprolene top ointdipropionate 0.05%, dipropionate,

augmented 0.05%Therapeutic Interchange

betamethasone topical N/A top creamdipropionate 0.05%, dipropionate,

augmented 0.05%Therapeutic Interchange

betaxolol Betoptic S opthalmic susp 0.25%

bethanechol Urecholine subQ soln 5 mg/mL

bethanechol Urecholine oral tab 25 mg

bevacizumab Avastin IV soln 25 mg/mL

bicalutamide Casodex oral tab 50 mg

bimatoprost opth Lumigan opthalmic soln 0.03% Restricted

bisacodyl Dulcolax rectal supp 10 mg

bisacodyl Dulcolax oral tab-EC 5 mg

bismuth subsalicylate Pepto Bismol oral susp 262 mg/5 mL

bismuth subsalicylate Pepto Bismol oral tab-chew 262 mg

bivalirudin Angiomax IV powder 250 mg Restricted: Patient unable to use Heparin 2/28/2008


Drug Formulary


black widow spider antivenin inj powder 6000 units

bleomycin Blenoxane inj powder 15 units

bortezomib Velcade IV powder 3.5 mg Restricted

bosentan Tracleer oral tab 62.5 mg Restricted

botulinum toxin type A Botox inj powder 100 units

brentuximab vedotin Adcetris Rx: Add TB Screen to Order 9/22/2011

brimonidine opth Alphagan P opthalmic soln 0.15%

bromocriptine Parlodel oral tab 2.5 mg

budesonide Entocort EC oral cap-XR 3 mg

budesonide Pulmicort inhalation susp 0.5 mg/2 mL

budesonide Pulmicort Respules inhalation susp 0.5 mg/2 mL

Budesonide/Formoterol Symbicort inhalation 2/26/2009

bumetanide Bumex inj soln 0.25 mg/mL

bumetanide Bumex oral tab 1 mg

bupivacaine Sensorcaine inj soln 0.25%, 0.5%, 0.75%

bupivacaine-EPINEPHrine Sensorcaine with Epinephrine inj soln0.25%-1:200,000, 0.5%-1:200,000, 0.75%-

1:200,000

bupivacaine-fentaNYL N/A inj soln 0.1%-2mcg/mL-0.9%

buPROPion Wellbutrin oral tab 75 mg, 100 mg

buPROPion Wellbutrin XL oral tab-XR 100 mg/12 hours, 150 mg/12 hours

busPIRone BuSpar oral tab 5 mg

busulfan Myleran oral tab 2 mg

butorphanol Stadol inj soln 1 mg/mL, 2 mg/mL

cabazitaxel Jevtana IV soln 60 mg/1.5 mL Restricted: Infusion Patients with pre-approval

caffeine Cafcit oral liq citrate 20 mg/mL

caffeine Cafcit IV soln citrate 20 mg/mL

calamine topical calamine top lotion -

calcitonin Miacalcin inj soln 200 intl units/mL

calcitonin Miacalcin Nasal nasal spray 200 intl units/mL

calcitriol Rocaltrol oral cap 0.25 mcg

calcitriol Rocaltrol oral liq 1 mcg/mL

calcium acetate PhosLo oral tab 667 mg

calcium carbonate Tums oral tab-chew 500 mg

calcium chloride various inj soln 100 mg/mL

calcium glubionate glubionate calcium oral syrup 1.8 g/5 mL

calcium gluconate calcium gluconate inj soln 100 mg/mL

calcium-vitamin D Oscal-D oral tab 500 mg-200 intl units

candida albicans extract Candida Skin Test intradermal soln

capecitabine Xeloda oral tab 500 mg

capreomycin Capastate Sulfate IM powder 1 g

capsaicin topical Capzasin top cream 0.025%, 0.75%

captopril Capoten oral tab 12.5 mg, 25 mg

carbachol opth Isopto Carbachol opthalmic soln 3.00%

carBAMazepine Tegretol oral susp 100 mg/5 mL

carBAMazepine Tegretol oral tab 200 mg

carBAMazepine Tegretol oral tab-chew 100 mg

carbamide peroxide otic Carbamoxide otic soln 6.50%

carbidopa-levodopa Sinemet oral tab10 mg-100 mg, 25 mg-100 mg, 25 mg-250

mg

CARBOplatin Paraplatin IV powder 50 mg

carboprost Hemabate inj soln 250 mcg/mL

carfilzomib Kyprolis

carmustine BiCNU IV powder 100 mg

carvedilol Coreg oral tab 3.125 mg, 6.25 mg, 12.5 mg, 25 mg

Carvedilol Phosphate Coreg CR oral 7/26/2007

ceFAZolin Ancef inj powder 1 g, 500 mg

ceFAZolin Ancef IV soln 1 g/50 mL

cefepime Maxipime inj powder 1 g, 2 g

cefotaxime Claforan inj powder 1 g, 2 g, 500 mg Restricted to Neonatal Population 6/23/2015

cefotTEtan Cefotan inj powder 1 g, 2 g

cefOXitin Mefoxin inj powder 1 g, 2 g


Drug Formulary


cefOXitin Mefoxin IV soln 1 g/50 mL, 2 g/50 mL

cefTAZidime Fortaz, Tazicef inj powder 1 g, 2 g

Restricted: 1. Treatment of infections due to Pseudomonas aeruginosa or other gram

negative rods resistant to other cephalosporins, in conjunction with an

aminoglycoside (or in place of AG when their use is contra-indicated).

2. Empirical treatment of infections presumed due to Pseudomonas aeruginosa.

3. Empirical treatment of febrile neutropenia, ± an AG.

4. Empirical treatment of meningitis in neonates

cefTRIAXone Rocephin inj powder 1 g, 2 g, 250 mg, 500 mg

cefuroxime Ceftin inj powder 1.5 g, 750 mg

cefuroxime Ceftin oral powder 250 mg/5 mL

cefuroxime Ceftin, Zinacef oral tab 250 mg

cefuroxime Kefurox inj powder 1.5 g

celecoxib CeleBREX oral cap 100 mg

cephalexin Keflex oral cap 250 mg, 500 mg

cephalexin Keflex oral powder 125 mg/5 mL, 250 mg/5 mL

cetuximab Erbitux IV soln 2 mg/mL Restricted

chloral hydrate Aquachloral Supprettes rectal supp 325 mg

chloral hydrate Somnote oral syrup 500 mg/5 mL

chlorambucil Leukeran oral tab 2 mg

chlordiazePOXIDE Librium oral cap 10 mg, 25 mg

chlorhexidine topical Peridexmucous

membraneliq 0.12%

chlormabucil Leukeran oral 2 mg

chloroprocaine Nesacaine inj soln 3.00%

chloroquine Arelan oral tab 500 mg

chlorothiazide Diuril oral susp 250 mg/5 mL

chlorothiazide Diuril oral tab 500 mg

chlorothiazide Diuril Sodium IV powder 0.5 g

chlorpheniramine Chlor Phen oral tab 4 mg

chlorproMAZINE Thorazine oral concentrate 30 mg/mL

chlorproMAZINE Thorazine inj soln 25 mg/mL

chlorproMAZINE Thorazine oral tab 25 mg, 100 mg, 200 mg

chlorthalidone Thalitone oral tab 50 mg

chlorzoxazone Lorzone oral tab 500 mg

cholestyramine Questran oral powder 4 g/5 g

chorionic gonadotropin (HCG) Pregnyl IM powder 10,000 units

chromic chloride hexahydrate chromium III chloride inj soln 4 mcg/mL

cidofovir Vistide IV soln 75 mg/mL

cinacalcet Sensipar oral tab 30 mg Restricted

ciprofloxacin Cipro oral tab 250 mg, 500 mg, 750 mg Restricted: Use limited to suspected of proven Pseudomonas aeruginosa infections

ciprofloxacin Cipro IV IV soln 200 mg/100 mL-5%, 400 mg/200mL-5% Restricted: Use limited to suspected of proven Pseudomonas aeruginosa infections

ciprofloxacin opth Ciloxan opthalmic soln 0.30%

cisatracurium Nimbex IV soln 2 mg/mL

CISplatin Platinol-AQ IV soln 1 mg/mL

citalopram CeleXA oral tab 20 mg

citric acid/K citrate/Na citrate Polycitra oral liq 334 mg-550 mg-500 mg/5 mL

citric acid-sodium citrate Bicitra oral soln 334 mg-500 mg/5 mL

cladribine Cladribine Novaplus IV soln 1 mg/mL

clarithromycin Biaxin oral powder 125 mg/5 mL

clarithromycin Biaxin oral tab 500 mg

clindamycin Cleocin Phosphate oral cap 150 mg

clindamycin Cleocin Phosphate inj soln 150 mg/mL

clomiPRAMINE Anafranil oral cap 25 mg

clonazePAM Klonopin oral tab 0.5 mg, 1 mg, 2 mg

cloNIDine Catapres, Kapvay transdermal film 0.1 mg/24 hr, 0.2 mg/24 hr, 0.3 mg/24 hr

cloNIDine Catapres, Kapvay oral tab 0.1 mg, 0.2 mg

cloNIDine Catapres-TTS-1 transdermal film 0.1 mg/24 hr



Drug Formulary



clopidogrel Plavix oral tab 75 mg

clotrimazole Mycelex Troche oral lozenge 10 mg

clotrimazole topical Gyne-Lotrimin vaginal cream w applicator 1.00%

clotrimazole topical Lotrimin top cream 1.00%

clove oil clove oil oral oil -

cloZAPine Clozaril oral tab 25 mg, 100 mgRestricted: Treatment of refractory schizophrenic or schizoaffective disorders

following patient enrollment in the Clozapine Patient Management System.

cloZAPine FazaClo oral tab-ODT 25 mg, 100 mgRestricted: Treatment of refractory schizophrenic or schizoaffective disorders

following patient enrollment in the Clozapine Patient Management System.

coagulation factor IX BeneFIX IV powder - 9/23/2010

coagulation factor VIIa NovoSeven RT IV powder1000 mcg (1 mg), 2000 mcg (2 mg), 5000

mcg (5 mg)

cocaine topical cocaine topical top soln 4%, 10%

codeine codeine inj soln 15 mg/mL, 60 mg/mL

codeine codeine oral tab sulfate 30 mg

codeine-promethazine Phenergan w Codeine oral syrup 10 mg-6.25 mg/5 mL

colchicine Colcrys oral tab 0.6 mg 12/9/2010

colistimethate Colistin IV powder 150 mg Restricted: Infectious Diseases Consult Required

colistimethate Colistin inhalation powder 150 mg Restricted: Infectious Diseases Consult Required

conjugated estrogens Premarin oral tab 0.3 mg, 0.625 mg, 1.25 mg

conjugated estrogens Premarin IV inj powder 25 mg

conjugated estrogens topical Premarin Vaginal vaginal cream w applicator 0.625 mg/g

copper chloride cupric chloride inj soln 1.07 mg/mL

cortisone Cortone oral tab 25 mg

cosyntropin Cortrosyn inj powder 0.25 mg

cromolyn Gastrocrom oral soln 20 mg/mL

cromolyn Intal inhalation soln 10 mg/mL

cromolyn Intal oral soln 20 mg/mL

cromolyn Intal inhaler inhalation aerosol with adapter 0.8 mg/inh

cyclobenzaprine Flexiril oral tab 5 mg, 10 mg

cyclopentolate otphalmic Cyclogyl opthalmic soln 1.00%

cyclophosphamide Cytoxan IV powderlyophilized 1g, lyophilized 100 mg,

lyophilized 500 mg

cyclophosphamide Cytoxan oral tab 25 mg, 50 mg

cycloSPORINE Neoral oral cap modified 25 mg, 100 mg

cycloSPORINE Neoral inj soln 50 mg/mL

cyproheptadine cyproheptadine oral tab 4 mg

cysteine cysteine inj soln 50 mg/mL

cytarabine Cytorsar inj soln 100 mg/mL

cytarabine Cytosar inj powder 100 mg

D5W D5W IV soln dextrose 5% water

dabigatran Pradaxa oral cap 75 mg, 150 mg Restricted: patient admitted and taking dabigatran for chronic basis

dacarbazine DTIC IV powder 200 mg

Dacriose Dacriose opthalmic soln -

DACTINomycin Cosmegen IV powder 0.5 mg

danazol Danocrine oral cap 200 mg

dantrolene Dantrium oral cap 25 mg

dantrolene Dantrium IV IV powder 20 mg

dapsone Dapsone oral tab 100 mg

DAPTOmycin Cubicin IV powder 500 mg Restricted: Infectious Diseases Consult Required

darbepoetin alfa Aranesp inj soln

25 mcg/0.42 mL, 50 mcg/0.3 mL, 200

mcg/0.4 mL, 25 mcg/mL, 100 mcg/0.5 mL,

100 mcg/mL, 150/0.75 mL, 300 mcg/0.5

mL, 500 mcg/mL

Restricted

darunavir Prezista oral tab 600mg, 800mg Restricted

dasatinib Sprycel oral tab 70 mg Restricted

DAUNOrubicin Cerubidine IV powder 20 mg


Drug Formulary


DAUNOrubicin liposomal Daunoxome IV dispersion 2 mg/mL

decitabine Dacogen

deferoxamine Desferal inj powder 500 mg

delavirdine Rescriptor oral tab 200 mg

demeclocycline Declomycin oral tab 150 mg

denosumab Prolia, Xgeva SQ solnProlia: 60 mg/1 mL

Xgeva: 120 mg/1.7 mLRestricted: Oncology Infusion Center ONLY 1/7/2015

desflurane Suprane inhalation liq 100.00%

desipramine Norpramin oral tab 25 mg

desmopressin DDAVP inj soln 4 mcg/mL

desogestrel-ethinyl estradiol Ortho-Cept oral tab 0.15 mg-0.03 mg

dexamethasone dexamethasone oral elixir 0.5 mg/5 mL

dexamethasone dextamethasone inj soln 4 mg/mL, 10 mg/mL

dexamethasone dextamethasone oral tab 0.5 mg, 0.75 mg, 4 mg

dexamethasone/neomycin/polymyxin B opth Maxitrol opthalmic oint 1 mg-3.5 mg-10000 units

dexamethasone/neomycin/polymyxin B opth Maxitrol opthalmic susp 1 mg-3.5 mg-10000 units/mL

dexamethasone-tobramycin opth Tobradex opthalmic oint 0.1%-0.3%

dexamethasone-tobramycin opth Tobradex opthalmic susp 0.1%-0.3%

dexmedetomidine Precedex IV soln 100 mcg/mL Restricted

dexrazoxane Zinecard IV powder 250 mg 11/29/2007

dextran, high molecular weight Hyskon intrauteral soln 32%-10%

dextran, low molecular weight dextran, low molecular weight IV soln 10%-0.9%

dextroamphetamine Dexedrine oral tab 5 mg

dextromethorphan-guaiFENesin guaiFENesin-dextromethorphan oral liq 10 mg-100 mg/5 mL

diazepam Valium inj soln 5 mg/mL

diazepam Valium oral soln 5 mg/5 mL

diazepam Valium oral tab 2 mg, 5 mg

dibucaine topical Dibucaine top oint 1.00%

dicloxacillin Dycil oral cap 250 mg

dicyclomine Bentyl oral cap 10 mg

didanosine Videx EC oral cap-DR 250 mg, 400 mg

digoxin Lanoxin, Digitek oral elixir 50 mcg/mL (0.05 mg/mL)

digoxin Lanoxin, Digitek inj soln100 mcg/mL (0.1 mg/mL), 250 mcg/mL

(0.25 mg/mL)

digoxin Lanoxin, Digitek inj soln100 mcg/mL (0.1 mg/mL), 250 mcg/mL

(0.25 mg/mL)

digoxin Lanoxin, Digitek oral tab 125 mcg (0.125 mg), 250 mcg (0.25 mg)

digoxin immune FAB Digibind inj powder 38 mg

dihydrotachysterol DHT oral tab 0.125 mg

diltiazem Tiazac oral cap-XR120 mg/24 houts, 180 mg/24 hours, 240

mg/24 hours

diltiazem various IV powder 100 mg

diltiazem various IV soln 5 mg/mL

diltiazem various oral tab 30 mg, 60 mg

dimenhyDRINATE Dramamine oral tab 50 mg

dimethyl sulfoxide Rimso-50 irrigation soln 50.00%

dinoprostone topical Cervidil vaginal insert 10 mg

diphenhydrAMINE Benadryl inj soln 50 mg/mL

diphenhydrAMINE Benadryl Child Dye Free oral liq 12.5 mg/5 mL

diphenhydrAMINE Bendaryl DF oral cap 25 mg, 50 mg

diphenhydrAMINE Genahist oral liq 12.5 mg/5 mL

diphenhydramine/lidocaine/maalox Magic Mouth WashDiphenhydramine 12.5mg/5mL (30mL), Lidocaine viscous 2% (30mL), Maalox

(30mL)5/24/2012

dipivefrin opth Propine opthalmic soln 0.10%

diptheria/hepB/pertussis, acel/polio/tetanus Pediarix IM susp - Restricted

diptheria-tetanus toxoids (obsolete) IM susp 12.5 units-5 units/0.5 mL


Drug Formulary


diptheria-tetanus toxoids, pediatric

(obsolete)IM susp 12.5 units-5 units/0.5 mL

dipyridamole Persantine oral tab 50 mg

disopyramide Norpace CR oral cap-XR 100 mg

disulfiram Antabuse oral tab 250 mg

divalproex sodium Depakote oral tab-EC 250 mg, 500 mg

divalproex sodium Depakote ER oral tab-XR 250 mg, 500 mg

divalproex sodium Depakote Sprinkles oral cap-DR 125 mg

DOBUTamine Dobutrex IV soln 12.5 mg/mL

DOCEtaxel Taxotere IV soln 40 mg/mL

docusate Dulcolax oral cap sodium 100 mg, sodium 200 mg

docusate Dulcolax oral syrup sodium 100 mg/30 mL

dolutegravir Tivicay oral tab 7/29/2014

donepezil Aricept oral tab 5 mg

DOPamine Intropin IV soln1.6 mg/mL-D5%, 3.2 mg/mL-D5%, 40

mg/mL

dornase alfa Pulmozyme inhalation soln 2.5 mg/2.5 mL

dorzolamide-timolol opth Cosopt opthalmic soln 2%-0.5% 4/22/2010

doxazosin Cardura oral tab 1 mg, 4 mg

doxepin SINEquan oral cap 25 mg, 50 mg

doxepin SINEquan oral concentrate 10 mg/mL

DOXOrubicin Adriamycin IV soln 2 mg/mL

DOXOrubicin liposomal Doxil IV dispersion 2 mg/mL

doxycycline Vibramycin oral cap hyclate 100 mg, monohydrate 100 mg

doxycycline Vibramycin inj powder 100 mg

dronabinol Marinol oral cap 2.5 mg, 5 mg

DULoxetine Cymbalta oral cap-DR 20 mg, 30 mg Restricted: Diabetic neuropathy unresponsive to other medications 1/25/2007

econazole topical Spectazole top cream 1.00%

edetate calcium disodium Calcium EDTA inj soln 200 mg/mL

edrophonium Tensilon inj soln 10 mg/mL

efavirenz Sustiva oral cap 50 mg Restricted

eletriptan Relpax oral tab 40 mg Restricted

Elvitegravir/cobicistat/tneofovir/emtricitabin

eStribild

oral tab7/29/2014

emollients, topical Aquaphor top oint -

emollients, topical Eucerin top cream -

emollients, topical various top lotion -

emtricitabine Emtriva oral cap 200 mg Restricted

emtricitabine-tenofovir Truvada oral tab 200 mg-300 mg Restricted

enalapril Vasotec IV soln 1.25 mg/mL

enalapril Vasotec oral tab 5 mg, 10 mg

enfuvirtide Fuzeon subQ kit 90 mg Restricted

enoxaparin Lovenox subQ soln

30 mg/0.3 mL, 40 mg/0.4 mL, 60 mg/0.6

mL, 80 mg/0.8 mL, 10 mg/mL, 120 mg/0.8

mL, 150 mg/mL

entanercept Enbrel subQ soln 50mg/mL Restricted: Treatment of refractory rheumatoid arthritis, as per VCMC P&T.

ePHEDrine ePHEDrine inj soln 50 mg/mL

EPINEPHrine Adrenalin inhalation soln 2.25%

EPINEPHrine Adrenalin inj soln 0.1 mg/mL, 1 mg/mL

EPINEPHrine-lidocaine Xylocaine with EPINEPHrine inj soln1:100000-1%, 1:100000-2%, 1:200000-

0.5%, 1:200000-1%

epirubicin Ellence IV soln 2 mg/mL

eplerenone Inspra oral tab 25 mg

epoetin alfa Procrit inj soln

2000 units/mL, 3000 units/mL, 4000

units/mL, 10000 units/mL, 20000

units/mL, 40000 units/mL

epoprostenol Flolan IV powder 0.5 mg Restricted


Drug Formulary


epotein alfa Epogen, Procrit inj soln

2000 units/mL, 3000 units/mL, 4000

units/mL, 10000 units, mL, 20000


eptifibatide Integrelin IV soln 0.75 mg/mL

eptifibatide Integrelin IV soln 0.75 mg/mL

ergocalciferol Drisdol oral cap 50,000 intl units

ergocalciferol Drisdol oral soln 8000 intl units/mL

ergocalciferol, vitamin D2 Calciferol oral soln 8000 intl units/mL

ergocalciferol, vitamin D2 Calciferol oral tab 50,000 intl units

ergocalciferol, vitamin D2 Calciferol oral tab 400 intl units

eribulin Halaven Restricted: Oncology Infusion Center ONLY

ertapenem Invanz inj powder 1 gRestricted: Infectious Diseases Consult Required

Prophylactic one-time doses do NOT require an ID consult. All other scheduled

regimens must be approved

2/22/2007

erythromycin Ery-Tab oral tab-EC 250 mg, 500 mg

erythromycin Erythrocin, EES, various oral suspestolate 125 mg/5 mL, ethylsuccinate 400

mg/5 mL

erythromycin Erythrocin, various inj powder lactobionate 1g, lactobionate 500 mg

erythromycin opth E-mycin, various opthalmic oint 0.50%

erythromycin-sulfiSOXAZOLE Pediazole oralgranule for

reconstitution200 mg-600 mg/5 mL

escitalopram Lexapro oral tab 10 mg, 20 mg

esmolol Brevibloc IV soln 10 mg/mL

esomeprazole NexIUM IV IV powder 40 mg Preferred

esomeprazole NexIUM oral cap-DR 20 mg, 40 mg

estradiol Delestrogen IM soln valerate 40 mg/mL

estradiol Estrace oral tab 1 mg

ethacrynic acid Edecrin oral tab 25 mg

ethacrynic acid Edecrine Sodium IV powder 50 mg

ethambutol Myambutol oral tab 100 mg, 400 mg

ethanol Ethyl Alcohol inj soln 98.00%

ethanol topical Denatured Alcohol top liq 70.00%

ethanolamine oleate Ethamolin inj soln 50 mg/mL

ethinyl estradiol-norethindrone Nortrel 1/35 oral tab 35 mcg-1 mg

ethinyl estradiol-nortehindrone norethindrone-ethinyl estradiol oral tab35 mcg-1 mg, triphasic 0.5 mg-0.75 mg-1

mg

ethinyl estradiol-nortehindrone Nortrel 7/7/7 oral tab triphasic 0.5 mg-0.75 mg-1 mg

ethyl chloride topical Ethyl Chloride top spray 100.00%

etidronate Didronel oral tab 200 mg

etomidate Amidate IV soln 2 mg/mL

Etonogestrel Implant Implanon Restricted: Only trained physicians (Dr. Brecht-Doscher, C.Howe) 1/24/2008

etoposide Vepesid IV powder 100 mg

etoposide Vepesid IV soln 20 mg/mL

factor IX complex Profilnine SD IV powder human

famotidine Pepcid IV soln 10 mg/mL

famotidine Pepcid oral tab 20 mg

fat emulsion, intravenous Intralipid IV emulsion 20.00%

fat supplement, oral fat supplement, oil oral oil -

fenoldopam Corlopam IV soln 10 mg/mL Restricted

fentaNYL Duragesic transdermal film25 mcg/hr, 50 mcg/hr, 75 mcg/hr, 100

mcg/hr

fentaNYL Sublimaze inj soln 50 mcg/mL (0.05 mg/mL)

ferric subsulfate ferric subsulfate top soln -

ferric subsulfate ferric subsulfate top stick -

ferrous sulfate various oral liq 75 mg/0.6 mL, 300 mg/5 mL

ferrous sulfate various oral tab 325 mg

filgrastim Neupogen inj soln 300 mcg/mL, 480 mcg/1.6 mL

finasteride Proscar oral tab 5 mg

flecainide Tambocor oral tab 50 mg Restricted: Treatment of refractory life-threatening ventricular arrhythmia

floxuridine FUDR inj powder 0.5 g


Drug Formulary


fluconazole Diflucan IV soln 400 mg/200 mL-5%, 200 mg/100 mL-0.9%

fluconazole Diflucan oral tab 100 mg, 200 mg

flucytosine Ancobon oral cap 250 mg, 500 mg

fludarabine Fludara IV powder 50 mg

fludrocortisone Florinef Acetate oral tab 0.1 mg

flumazenil Romazicon IV soln 0.1 mg/mL

fluocinonide topical Lidex top cream 0.05%

fluocinonide topical Lidex top oint 0.05%

fluorescein opthalmic Ful-Glo opthalmic soln 2.00%

fluorescein opthalmic Ful-Glo opthalmic test 0.6 mg

fluoromethane topical Fluori-Methane top spray 15%-85%

fluorouracil 5-FU, Adrucil IV soln 50 mg/mL

FLUoxetine PROzac oral cap 10 mg, 20 mg

FLUoxetine Prozac oral soln 20 mg/5 mL

fluPHENAZine Prolixin oral concentrate 5 mg/mL

fluPHENAZine Prolixin oral tab 1 mg, 2.5 mg, 5 mg

fluPHENAZine Prolixin, Prolixin Decanoate inj soln 2.5 mg/mL, decanoate 25 mg/mL

flutamide Eulexin oral cap 125 mg

fluticasone Flovent inhalation aerosol with adapter 44 mcg/inh, 110 mcg/inh, 220 mcg/inh Restricted

fluticasone-salmeterol Advair Diskus inhalation powder 250 mcg-50 mcg/puff Restricted: Patients who are already on it 4/8/2015

fluticasone-salmeterol Advair Diskus inhalation powder 500 mcg-50 mcg/puff 4/8/2015

fluvoxaMINE Luvox oral tab 25 mg, 100 mg

folic acid folic acid inj soln 5 mg/mL

folic acid folic acid oral tab 1 mg

folic acid/vit b1/vit b6/MVI folic acid/vit b1/vit b6/mvi IV inj 1 mg/100 mg/100 mg/10 mL

fomepizole Antizol IV soln 1 g/mL

fondaparinux Arixtra subQ soln 2.5 mg/0.5 mL, 7.5 mg/0.5 mL Restricted: Patients with Heparin induced thrombocytopenia 12/4/2014

fosamprenavir Lexiva oral tab 700 mg Restricted

foscarnet Foscavir IV soln 24 mg/mL

fosfomycin Monurol oral powder 3 gm/sachet Restricted: Infectious Diseases consult required. 2/4/2014

fosinopril Monopril oral tab 10 mg, 20 mg

fosphenytoin Cerebyx inj soln 50 mg/mL

fulvestrant Faslodex IM soln 50 mg/mL

furosemide Lasix inj soln 10 mg/mL

furosemide Lasix oral soln 40 mg/5 mL

furosemide Lasix oral tab 20 mg, 40 mg, 80 mg

gabapentin Neurontin oral cap, soln 100 mg, 300 mg, 400 mg, 200 mg/5 mL

galsulfase Naglazyme Restricted: Peds Chemo/Infusion 1/24/2008

ganciclovir Cytovene oral cap 250 mg

ganciclovir Cytovene IV powder 500 mg

gemcitabine Gemzar IV powder 200 mg

gemfibrozil Lopid oral tab 600 mg

gentamicin Garamycin inj soln 10 mg/mL, 40 mg/mL

gentamicin opth Gentak opthalmic oint 0.30%

gentamicin opth Gentak opthalmic soln 0.30%

gentamicin topical Gentak top cream 0.10%

gentian violet topical gentian violet topical top soln 2.00%

glipizide Glucotrol oral tab 5 mg, 10 mg Restricted: not for NPO patient, hypoglycemic 7/29/2014

glucagon glucagon inj powder recombinant 1 mg

glucose dextrose compounding aerosol 5% 250 mL

glucose dextrose IV soln 5.00%

glucose dextrose IV soln 10%, 50%

glyBURIDE Diabeta oral tab 5 mg Restricted: To OB patients, studies suggest that lower concentrations cross placenta

glycerin glycerin, various compounding liq -

glycerin glycerin, various oral soln 50.00%

glycerin glycerin, various rectal supp adult, pediatric

glycopyrrolate Robinul inj soln 0.2 mg/mL


Drug Formulary


gonadorelin Factrel IV powder 0.1 mg

goserelin Zoladex subQ implant 3.6 mg, 10.8 mg Restricted

griseofulvin Fulvicin oral tab ultramicrocystalline 125 mg

guaiFENesin Mucinex oral liq 100 mg/5 mL

haemophilus b conjugate (HbOC) vaccine haemophilus b conjugate (HbOC) vaccine IM soln 25 mcg-10 mcg/0.5 mL

haemophilus b-hepatitis B vaccine Comvax IM susp -

haloperidol Haldol oral concentrate 2 mg/mL

haloperidol Haldol inj soln 5 mg/mL

haloperidol Haldol oral tab 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg

haloperidol Haldol Decanoate IM solndecanoate 50 mg/mL, decanoate 100

mg/mL

halothane Fluothane inhalation liq 100.00%

heparin heparin inj soln10 units/mL, 100 units/mL, 1000


heparin heparin IV soln 50 units/mL-D5%, 2 units/mL-NaCl 0.9%

heparin flush Heparin Lock Flush IV soln 10 units/mL, 100 units/mL

hepatitis A adult vaccine Havrix IM susp 1440 units/mL

hepatitis A pediatric vaccine Havrix Pediatric IM susp 720 units/0.5 mL

hepatitis B immune globulin H-BIG IM soln -

hepatitis B vaccine (obsolete) IM adult 20 mcg/mL, pediatric 10 mcg/0.5 mL

heptatitis B immune globulin Bayhep B IM soln -

hetastarch Hextend IV soln 60 mg/mL-LR

homatropine opth Isopto Homatropine opthalmic soln 5.00%

horse antithymocyte globulin Atgam

human papillomavirus vaccine Gardasil IM susp type 6, 11, 16, 18

hydrALAzine Apresoline inj soln 20 mg/mL

hydrALAzine Apresoline oral tab 10 mg, 25 mg, 50 mg

hydrochlorothiazide HCTZ oral tab 25 tab

hydrochlorothiazide-triamterene Dyazide oral cap 25 mg-37.5 mg

hydrocortisone hydrocortisone rectal susp 100 mg/60 mL

hydrocortisone Hydrocortone oral tab 10 mg, 20 mg

hydrocortisone Solu-CORTEF inj powder 100 mg, 250 mg, 500 mg

hydrocortisone topical Westcort top cream valerate 0.2%, 0.5%, 1%

hydrocortisone topical Westcort top oint 0.5%, 1%

hydrocortisone/neomycin/polymyxin B opthhydrocortisone/neomycin/polymyxin B

opthopthalmic susp 1%-0.35%-10000 units/mL

hydrocortisone/neomycin/polymyxin B otic Cortisporin Otic otic soln 1%-0.35%-10000 units/mL

hydrocortisone/neomycin/polymyxin B otic Cortisporin Otic otic susp 1%-0.35%-10000 units/mL

hydrocortisone-pramoxine topical Pramosone top lotion 2.5%-1%

HYDROmorphone Dilaudid IV inj 12.5 mg/50 mL

HYDROmorphone Dilaudid inj soln 1 mg/mL, 2 mg/mL, 4 mg/mL, 10 mg/mL

HYDROmorphone Dilaudid oral tab 2 mg, 4 mg

hydroxychloroquine Plaquenil Sulfate oral tab 200 mg

hydroxycobalamin hydroxycobalamin inj soln 1000 mcg/mL

hydroxyprogesterone Makena IM soln 250 mg/mL Use as Multi-Dose vial

hydroxypropyl methylcellulose GenTeal Gel opthalmic gel 0.30% 6/23/2015

hydroxyurea Hydrea oral cap 500 mg

hydrOXYzine Vistaril oral cap pamoate 25 mg, pamoate 50 mg

hydrOXYzine Vistaril oral syrup 10 mg/5 mL

hydrOXYzine Vistaril IM IM soln hydrochloride 50 mg/mL

hylan G-F 20 Synvisc intraarticular soln 8 mg/mL

hyoscamine Levsin SL sublingual tab 0.125 mg Restricted: Oncology Infusion Center ONLY

ibuprofen Motrin oral tab 400 mg, 600 mg, 800 mg

ibuprofen Motrin Children's oral susp 100 mg/5 mL

ibuprofen Motrin Migraine Pain oral tab 200 mg, 400 mg, 600 mg, 800 mg


Drug Formulary


Ibuprofen Lysine NeoProfen IV soln 10 mg/mL 2/28/2008

idarucizumab PraxBind IV soln 50 mg/mL 11/4/2015

idursulfase Elaprase IV soln 2 mg/mL Restricted 12/9/2010

ifosfamide Ifex IV powder 1 g

iloperidone Fanapt oral tab1 mg, 2 mg, 4 mg, 6 mg, 8 mg, 10 mg, 12

mg

Restricted: Patients must have failed generically available atypical antipsychotic

therapy

imatinib Gleevec oral tab 100 mg Restricted

imipenem-cilastatin Primaxin IV inj powder 250 mg-250 mg, 500 mg-500 mg


Use limited to therapy of nosocomial infections where pathogens are resistant to

aminoglycosides, extended-spectrum penicillins, and cephalosporins are

documented. Empirical use should be avoided. 1. Use of imipenem is limited to

therapy of hospital (or nursing home) acquired poly-microbial infections (i.e. gram

positive/negative, aerobic/anaerobic) where pathogens resistant to

aminologycosides, extended-spectrum penicillins, and cephalosporins are

documented; empirical use should be avoided. 2. Plays an important role in the

treatment of ESBL-producing strains. 3. Imipenem should NOT be used for community-

acquired infections, monotherapy of serious enterococcal, MRSA, MRSE,

Pseudomonas, or “Pseudomonad” infections, or as surgical prophylaxis. 4.

Pneumonia with shock, MDRO (Multi Drug Resistant Organism) in the ICU setting. 5.

Intra-abdominal infection with shock, MDRO/no MDRO risk.

imipramine Tofranil oral tab 10 mg, 25 mg

immune globluin (IVIG) Gammagard-SD

immune globulin (IVIG) Carimune

immune globulin (IVIG) Privigen

immune globulin intramuscular (IVIG) Baygam IM soln -

immune globulin intravenous (IVIG) Polygam S/D IV powder 5 g

immune globulin intravenous (IVIG) Venoglobulin-S 10% IV soln 10.00%

indigo carmine indigo carmine inj soln 8 mg/mL

indinavir Crixivan oral cap 400 mg

indocyanine green IC-Green inj powder 25 mg

indomethacin Indocin oral cap 25 mg

indomethacin Indocin IV powder 1 mg

inFLIXimab Remicade IV powder 100 mgRestricted: 1. Treatment of refractory Crohn’s Disease, as per VCMC Protocol. 2.

Treatment of refractory rheumatoid arthritis, as per VCMC Protocol

influenza virus vaccine, inactivate Fluarix IM susp -

influenza virus vaccine, inactivated Fluzone SV IM susp -

influenza virus vaccine, live, trivalent FluMist nasal spray -

insulin glargine Lantus subQ soln 100 units/mL

insulin glulisine Apidra subQ soln 100 units/mL Restricted 1/24/2008

insulin isophane NovoLIN N subQ susp human recombinant 100 units/mL

insulin lispro HumaLOG subQ soln 100 units/mL

insulin regular NovoLIN R inj soln human recombinant 100 units/mL Restricted: Only to IV use, NOT SubQ. 7/29/2014

interferon alfa-2a Roferon-A inj soln3000000 units/0.5 mL, 9000000 units/0.9

mL

interferon alfa-2b Intron A inj powder 50000000 intl units

interferon alfacon-1 Infergen inj soln 15 mcg/0.5 mL

interferon gamma-1b Actimmune subQ soln 2,000,000 intl units/0.5 mL

intravenous electrolyte solution LypholyteII/Nutrilyte II/TPN/Electrolytes IV soln LypholyteII/Nutrilyte II/TPN/Electrolytes

iodine topical top soln 5%-10%

iodoquinol Yodoxin oral tab 210 mg

ipecac ipecac oral syrup 7.00%

ipilimumab Yervoy

ipratropium Atrovent inhalation aerosol 18 mcg/inh

ipratropium Atrovent inhalation soln 0.02%

ipratropium bromide and albuterol Combivent® Respimat® inhalation spray 20 mcg/100 mcg 8/29/2013

irinotecan Camptosar IV soln 20 mg/mL

iron sucrose Venofer IV soln 20 mg/mL

isoflurane Forane inhalation liq 100.00%

isoniazid INH oral syrup 50 mg/5 mL

isoniazid Nydrazid IM soln 100 mg/mL

isoniazid Nydrazid oral tab 100 mg, 300 mg


Drug Formulary


isosorbide dinitrate Isordil oral tab 10 mg

isosorbide mononitrate Imdur oral tab-XR 30 mg, 60 mg

isosulfan blue Lymphazurin inj soln 10 mg/mL

itraconazole Sporanox oral cap 100 mg

itraconazole Sporanox IV kit 250 mg

ivermectin Stromectol oral tab 3 mg

ixabepilone Ixempra Restricted: Oncology Infusion Center ONLY 1/24/2008

kaolin-pectin kaolin-pectin oral susp 5.8 g-130 mg/30 mL

ketamine ketamine inj soln 50 mg/mL

ketoconazole Nizoral oral tab 200 mg

ketoconazole topical Nizoral topical top cream 2.00%

ketorolac Toradol inj soln 15 mg/mL, 30 mg/mL

ketorolac opth Acular opthalmic soln 0.50%

labetalol Trandate IV soln 5 mg/mL

labetalol Trandate oral tab 100 mg, 200 mg

lacosamide Vimpat IV soln 200 mg/20 mL Restricted: Patients who come from home with this medication

lacosamide Vimpat oral tab 50 mg, 100 mg, 200 mg

lactated ringer's lactated ringer's IV soln lactated ringers

lactulose Cephulac oral syrup 10 g/15 mL

lamiVUDine Epivir oral tab 150 mg

lamiVUDine-zidovudine Combivir oral tab 150 mg-300 mg

lamoTRIgine LaMICtal oral tab 25 mg, 100 mg

lamoTRIgine LaMICtal oral tab-disperse 5 mg

lansoprazole Prevacid SoluTab oral tab-ODT 30 mg

lanthanum carbonate Fosrenol oral tab 500 mg Restricted: patients on dialysis 1/26/2012

L-E-T Injection L-E-T Injection vaginal soln 0.8%-1:2000-0.5%

leucovorin Folinic Acid IV powder 50 mg

leucovorin Folinic Acid oral tab 5 mg, 10 mg

leuprolide Lupron Depot IM powder-XR3.75 mg/month, 7 mg/month, 22.5 mg/3

months

leuprolide Lupron Depot IM powder-XR3.75 mg/month, 7 mg/month, 11.25

mg/month, 22.5 mg/3 months

leuprolide Lupron Depot-Ped IM powder-XR 11.25 mg/month

levalbuterol Xopenex inhalation soln 0.63 mg/3 mL, 1.25 mg/3 mLRestricted: 1. Documented intolerance/side effects to albuterol in adult and pediatric

patients. 2. Documented decrease in side effects when given albuterol. 3. Patient

with corrected or uncorrected cardiac disease.

levETIRAcetam Keppra IV soln 100 mg/mL

levETIRAcetam Keppra oral soln 100 mg/mL

levETIRAcetam Keppra oral tab 250 mg, 500 mg, 750 mg

levOCARNitine Carnitor oral soln 100 mg/mL

levOCARNitine Carnitor inj soln 200 mg/mL

levofloxacin Levaquin IV soln 250 mg/50 mL, 500 mg/100 mL

levofloxacin Levaquin oral tab 250 mg, 500 mg

levonorgestrel levonorgestrel intrauteral device 52 mg

levonorgestrel Mirena intrauteral device 52 mg

levonorgestrel Plan B oral tab 0.75 mg

levothyroxine Synthroid, Levothroid inj powder 200 mcg

levothyroxine Synthroid, Levothroid oral tab100 mcg, 125 mcg, 150 mcg, 200 mcg, 25

mcg, 300 mcg, 50 mcg, 75 mcg

lidocaine Xylocaine HCl, Xylocaine HCl for Spinal inj soln 0.5%, 1%, 1.5%, 2%, 5%-0.4%, 7.5%-5%

lidocaine ophthalmic gel Akten ophthalmic gel 3.50% 10/24/2013

lidocaine topical lidocaine topical top film 5.00% Restricted

lidocaine topical Ela-Max top cream 4.00%

lidocaine topical Ela-Max 5 top cream 5.00%

lidocaine topical lidocaine topicalmucous

membranesoln 2%, 4%

lidocaine topical lidocaine topical top soln 4.00%

lidocaine topical LMX 4, LMX Plus top cream 4.00%


Drug Formulary


linezolid Zyvox oral tab 600 mg


1. Restricted to documented vancomycin resistant entercoccus.

2. Unknown source of infection causing septic shock.

3. Pneumonia with septic shock with MDRO

liothyronine Cytomel oral tab 25 mcg

lisinopril Prinivil, Zestril oral tab 5 mg, 10 mg, 20 mg

lithium lithium oral cap 300 mg, 600 mg

lithium lithium oral syrup 300 mg/5 mL

lithium Lithobid oral tab-XR 300 mg

loperamide Imodium oral cap 2 mg

loperamide Imodium oral liq 1 mg/5 mL

lopinavir-ritonavir Kaletra oral liq 400 mg-100 mg/5 mL

lopinavir-ritonavir Kaletra oral tab 200 mg-50 mg

loratadine Claritin oral syrup 5 mg/5 mL

loratadine Claritin oral tab 10 mg

LORazepam Ativan inj soln 2 mg/mL, 4 mg/mL

LORazepam Ativan oral tab 0.5 mg, 1 mg, 2 mg

losartan Cozaar oral tab 25 mg, 50 mg

loxapine Loxitane oral cap 5 mg, 10 mg, 25 mg

lurasidone Latuda oral tab 20 mg, 40 mg, 60 mg, 80 mg, 120 mgRestricted: Patients must have failed generically available atypical antipsychotic

therapy12/19/2013

LVP soln sodium chloride IV IV solnSodium Chloride 0.45%, Sodium Chloride

0.9%

LVP soln w hypertonic saline sodium chloride with hypertonic saline IV soln sodium chloride 3%

LVP solution LVP solution IV soln

Sodium Chloride 0.45%, Sodium Chloride

0.9%, Dextrose 5% in Water, Dextrose 5% with

0.2% NaCl, Dextrose 5% with 0.45% NaCl,

Dextrose 5% with 0.9% NaCl, Dextrose 5% in

Lactated Ringers Injection, Lactated Ringers

Injection

LVP solution with potassium LVP solution with potassium IV soln

Dextrose 5% in Water with KCl 20 mEq/L,

Dextrose 5% with 0.2% NaCl and KCl 10

mEq/L, Dextrose 5% with 0.2% NaCl and KCl

20 mEq/L, Dextrose 5% with 0.45% NaCl and

KCl 10 mEq/L, Dextrose 5% with 0.45% NaCl

and KCl 20 mEq/L, Dextrose 5% with 0.45%

NaCl and KCl 40 mEq/L, Dextrose 5% with

0.9% NaCl and KCl 20 mEq/L, Sodium Chloride

0.45% with KCl 20 mEq/L, Sodium Chloride

0.9% with KCl 20 mEq/L

LVP with hypertonic saline LVP with hypertonic saline IV soln Sodium Chloride 3%

LVP-dextrose Dextrose in water IV soln dextrose 5% in water

LVP-dextrose with NaCl Dextrose and NaCl IV soln

Dextrose 5% with 0.2% NaCl, Dextrose 55

with 0.45% NaCl, Dextrose 5% with 0.9%

NaCl

lymphocyte immune globulin, anti-thy (obs) IV soln equine 50 mg/mL

magnesium chloride Mag-Delay oral tab-XR 64 mg

magnesium gluconate Magonate oral liq 1000 mg/5 mL

magnesium hydroxide Milk of Magnesia oral susp 8.00%

magnesium oxide Mag-Ox 400 oral tab 400 mg 4/24/2008

magnesium sulfate magnesium sulfate intravesical inj 2 mg/250 mL normal saline

magnesium sulfate magnesium sulfate inj soln 50%-40 mg/mL

magnesium sulfate magnesium sulfate IV soln 40 mg/mL-D5%

malathion topical Ovide top lotion 0.50%

mannitol mannitol IV soln 20%, 25%

measles virus vaccine Attenuvax subQ powder -

measles/mumps/rubella virus vaccine MMR subQ powder -

mebendazole Vermox oral tab-chew 100 mg

mechlorethamine Mustargen inj powder 10 mg

meclizine Antivert, Bonine oral tab 12.5 mg

medroxyPROGESTERone Depo-Provera Contraceptive IM susp 150 mg/mL


Drug Formulary


medroxyPROGESTERone Provera oral tab 5 mg

megestrol megace oral susp 40 mg/mL

melphalan Alkeran oral tab 2 mg

memantine Namenda oral tab 10 mg

meningococcal conjugate vaccine Menveo IM soln - 7/29/2010

meningococcal polysaccharide vaccine Menomune ACYW-135 subQ powder single dose

menthol topicalCepacol Sore Throat from Post Nasal Drip

Menthol

mucous

membranelozenge -

menthol topical menthol topical top gel 2.00%

meperidine Demerol HCl inj soln25 mg/mL, 50 mg/mL, 75 mg/mL, 100

mg/mL

Restricted: 1. Prevention or treatment of drug induced or blood product-induced

rigors or post-anesthesia shivering. 2. Pre- and post-analgesia where fast onset and

short duration improve patient care. 3. Acute episodes of moderate to severe pain in

patients with adverse reactions, allergies, or unsuccessful pain management with first

line opiods in equi-analgesic dosesmepivacaine Carbocaine HCl inj soln 1.50%

mercaptopurine Purinethol oral tab 50 mg

meropenem Merrem IV powder 1 g, 500 mg Restricted: Infectious Diseases Consult Required

mesalamine Asacol oral tab-EC 400 mg

mesalamine Pentasa oral cap-XR 250 mg

mesalamine Rowasa rectal enema 4 g/60 mL

mesna Mesnex inj soln 100 mg/mL

mesoridazine Serentil inj soln 25 mg/mL

metFORMIN Glucophage oral tab 500 mg, 850 mg Restricted: Scr, contrast, comorbidities 7/29/2014

metFORMIN Glucophage XR oral tab-XR 500 mg Restricted: Scr, contrast, comorbidities 7/29/2014

methadone Dolophine oral concentrate 1 mg/mL 10 mg/mL removed, 1 mg/mL is replacement 11/4/2015

methadone Dolophine oral tab 5 mg, 10 mg

methimazole Tapazole oral tab 5 mg, 10 mg

methocarbamol Robaxin oral tab 750 mg

methotrexate Trexall, Rheumatrex inj soln 25 mg/mL

methotrexate Trexall, Rheumatrex oral tab 2.5 mg

methylcellulose methylcellulose oral powder 2 g/19 g

methyldopa Aldomet IV soln 50 mg/mL

methyldopa Aldomet oral tab 250 mg, 500 mg

methylene blue methylene blue inj soln 10 mg/mL

methylergonovine Methergine inj soln 0.2 mg/mL

methylergonovine Methergine oral tab 0.2 mg

methylphenidate Ritalin oral tab 5 mg, 10 mg

methylPREDNISolone Depo-Medrol inj susp 40 mg/mL

methylPREDNISolone Solu-MEDROL inj powder 1 g, 2 g, 40 mg, 125 mg, 500 mg

metoclopramide Reglan inj soln 5 mg/mL

metoclopramide Reglan oral syrup 5 mg/5 mL

metoclopramide Reglan oral tab 10 mg

metolazone Zaroxlyn oral tab 5 mg

metoprolol Lopressor inj soln 1 mg/mL

metoprolol Lopressor oral tab 12.5 mg, 25 mg, 50 mg, 100 mg

metoprolol Toprol-XL oral tab-XR 25 mg, 50 mg

metroNIDAZOLE Flagyl IV soln 500 mg/100 mL

metroNIDAZOLE Flagyl oral tab 250 mg, 500 mg

metyrapone Metopirone oral cap 250 mg

micafungin Mycamine IV powder 50 mg, 100 mg


1. Treatment of invasive Aspergillus infection in patients refractory to or intolerant of

other antifungal treatment.

2. Treatment of Candida resistant to fluconazole

2/25/2010

miconazole topical Monistat 3 vaginal supp 200 mg

midazolam Versed inj soln 1 mg/mL PF, 5 mg/mL

midazolam Versed oral syrup 2 mg/mL

midodrine ProAmatine oral tab 2.5 mg

mineral oil mineral oil oral liq 100.00%

minoxidil minoxidil oral tab 10 mg

mirtazapine Remeron oral tab 15 mg, 30 mg

mirtazapine Remeron SolTab oral tab-ODT 30 mg

misoprostol Cytotec oral tab 100 mcg, 200 mcg


Drug Formulary


mitoMYcin Mutamycin IV powder 5 mg, 20 mg

Mitotane Lysodern oral 500 mg Restricted: Oncology Only 11/19/2009

mitoXANTRONE Novantrone IV soln 2 mg/mL

modafinil Provigil oral tab 100 mg

mometasone nasal Nasonex nasal spray 50 mcg/inh

montelukast Singulair oral tab 10 mg

morphine Duramorph PF inj soln 0.5 mg/mL preservative-free

morphine morphine IV inj 50 mg/50 mL

morphine morphine inj soln

0.5 mg/mL PF, 2 mg/mL, 4 mg/mL, 10

mg/mL, 25 mg/mL, 25 mg/mL PF, 50

mg/mL

morphine morphine oral soln 10 mg/5 mL

morphine morphine oral tab 10 mg, 30 mg

morphine MSIR oral cap 15 mg

morphine Oramorph SR oral tab-XR 15 mg/12 hr, 30 mg/12 hr, 100 mg/12 hr

moxifloxacin opthalmic Vigamox opthalmic soln 0.50%Restricted: Treatment of serious ophthalmic infections in ED. Limited to

opthalmologist use

multivitamin MVI Pediatric IV powder Pediatric Multiple Vitamins

multivitamin MVI-12 IV soln multivitamins

multivitamin Nephrocaps oral cap Vitamin B complex with C and folic acid

multivitamin various oral cap Vitamin B complex with C and folic acid

multivitamin various oral liqmultiple vitamins, pediatric multiple

vitamins

multivitamin various IV solnmultiple vitamins, pediatric multiple

vitamins

multivitamin various oral tab multiple vitamins

multivitamin Vi-Daylin oral liq multiple vitamins

multivitamin with minerals various oral liq multiple vitamins with zinc

multivitamin with minerals various oral tabtherapeutic multiple vitamins with

minerals

multivitamin with minerals various oral tab-chew multiple vitamins with zinc

multivitamin, prenatal Prenatal vitamins oral tab prenatal vitamins

multivitamins w minerals ADEKs oral liq multiple vitamins with zinc

multivitamins w minerals ADEKs oral tab-chew multiple vitamins with zinc

mumps skin test antigen MSTA Mumps Skin Test Antigen intradermal soln -

mumps virus vaccine mumps virus vaccine subQ powder -

mupirocin topical Bactroban top oint 2.00%

mycophenolate mofetil CellCept oral tab 500 mg

nafcillin Nafcil inj powder 1 g, 2 g

naloxone Narcan inj soln 0.4 mg/mL, 1 mg/mL

naltrexone ReVia oral tab 50 mg

naltrexone (IM) Vivitrol inj susp 380 mg Restricted to Behavioral Health use only 6/23/2015

nandrolone Deca-Durabolin IM soln decanoate 200 mg/mL

naproxen Naprosyn oral tab 250 mg

natalizumab Tysabri inj soln 300 mg/ 15 mL Restricted: Oncology Infusion Center/Anacapa Neuroscience Center ONLY 3/4/2015

nelfinavir Viracept oral tab 250 mg

neomycin neomycin oral tab 500 mg

neomycin-polymyxin B sulfate opthalmic Neosporin opthalmic ointment opthalmic oint 400 units-3.5 mg-10000 units/g

neomycin-polymyxin B sulfate topical neomycin-polymyxin B sulfate topical irrigation soln 40 mg-200000 units/mL

neostigmine Prostigmin, Vagostigmin inj 1 mg/mL

nesiritide Natrecor IV powder 1.5 mgRestricted: 1. Restricted to use in patients with Class IV heart failure of moderate to

severe intensity. 2. Heart failure resistant to loop diuretics and nitroglycerin, with

clinical signs of volume overload. 3. Attending physician order required

nevirapine Viramune oral susp 50 mg/mL

nevirapine Viramune oral tab 200 mg


Drug Formulary


niCARdipine Cardene IV inj soln 2.5 mg/mL, decanoate 25 mg/mL

nicotine various oral lozenge 6/29/2014

nicotine various transdermal film 7 mg/24 hr, 14 mg/24 hr, 21 mg/24 hr

NIFEdipine Procardia oral cap 10 mg Restricted

NIFEdipine Procardia XL oral tab-XR 30 mg, 60 mg Restricted

NIFEdipine Adalat oral tab-XR 30 mg

niMODipine Nimotop oral cap 30 mg Restricted: Use limited to treatment of patients with subarachnoid hemorrhage

nitrofurantoin Furadantin oral susp 25 mg/5 mL

nitrofurantoin Macrobid oral cap macrocrystals-monohydrate 100 mg

nitroglycerin Nitro-Bid transdermal oint 2.00%

nitroglycerin Nitro-Dur transdermal film0.1 mg/hr, 0.2 mg/hr, 0.3 mg/hr, 0.4

mg/hr

nitroglycerinNitroquick (0.3 mg), Nitrostat (0.3 mg, 0.4

mg)sublingual tab 0.3 mg, 0.4 mg

nitroglycerin NTG IV soln 200 mcg/mL-D5%, 5 mg/mL

nitroprusside Nitropress IV powder 50 mg

norepinephrine Levophed Bitartrate IV soln 1 mg/mL

nortriptyline Pamelor oral cap 10 mg, 25 mg

nystatin Mycostatin oral susp 100000 units/mL

nystatin topical nystatin topical top cream 100000 units/g

nystatin topical nystatin topical top oint 100000 units/g

nystatin topical Nystop top powder 100000 units/g

octreotide SandoSTATIN inj soln 100 mcg/mL, 200 mcg/mL

ocular lubricant Artificial Tears opthalmic soln preserved

ocular lubricant Lacri-Lube SOP opthalmic oint -

ofloxacin otic Floxin Otic otic soln 0.30%

oLANZapine Zyprexa IM powder 10 mg

oLANZapine Zyprexa oral tab2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20

mg

oLANZapine Zyprexa Zydis oral tab-ODT 5 mg, 10 mg

omalizumab Xolair

ondansetron Zofran inj soln 2 mg/mL

ondansetron Zofran oral tab 4 mg

ondansetron Zofran oral tab-ODT 4 mg 12/19/2013

opium opium oral tincture 10% (equivalent to morphine 10 mg/mL)

oprelvekin Neumega subQ powder 5 mg

opthalmic irrigation, intraocular BSS opthalmic soln Balanced Salt Soln

opthalmic irrigation, intraocular BSS Plus opthalmic soln Balanced Salt Soln Plus

oseltamivir Tamiflu oral cap 75 mg

oxaliplatin Eloxatin IV powder 50 mg, 100 mg

oxandrolone Oxandrin oral tab 2.5 mg

Oxcarbazepine Trileptal oral tab 150 mg, 300 mg

oxybutynin Ditropan oral syrup 5 mg/5 mL

oxybutynin Ditropan oral tab 5 mg

oxyCODONE OxyCONTIN oral tab-XR 10 mg, 20 mg, 40 mg, 80 mg

oxymetazoline nasal Afrin nasal spray 0.05%

oxytocin Pitocin inj soln 10 units/mL

PACLitaxel Taxol IV soln 6 mg/mL

PACLitaxel protein-bound Abraxane IV powder 100 mg Restricted

palivizumab Synagis IM powder 50 mg

palonosetron Aloxi IV soln 0.25 mg/5 mL 1/7/2015

pamidronate Aredia IV powder 90 mg

pancrelipase Zenpep oral cap-DR

5000 units-17000 units-27,000 units

10000 units-34000 units-55000 units

15000 units-51000 units-82000 units

Restricted: Cystic fibrosis patients only 12/19/2013

pancrelipase Creon 10 oral cap-XR 33200 units-10000 units-3750 units

pancrelipase Creon 20 oral cap-XR 66400 units-20000 units-75000 units

pancrelipase Pancrease oral cap-DR 20000 units-4500 units-25000 units

pancrelipase Pancrease MT 10 oral cap-DR 30000 units-10000 units-30000 units


Drug Formulary




pancuronium Pavulon IV soln 1 mg/mL, 2 mg/mL

panitumumab Vectibix

pantoprazole Protonix IV IV powder 40 mg Restricted

papain-urea topical Accuzyme top oint 830,000 units/g-10%

papaverine papaverine inj soln 30 mg/mL

parenteral nutrition soln Amino Acids IV soln 6% (Trophamine)

parenteral nutrition soln Aminosyn II IV soln 10% (Aminosyn II)

parenteral nutrition soln parenteral nutrition soln IV soln

Dextrose 70% in water, amino acids 6%

(Trophamine), Amino Acids 10%

(Aminosyn II)

paricalcitol Zemplar IV soln 5 mcg/mL

paromomycin Humatin oral cap 250 mg

PARoxetine Paxil oral tab 10 mg, 20 mg, 30 mg

PEGaspargase Oncaspar

pegfilgrastim Neulasta subQ soln 6 mg/0.6 mL

peginterferon alfa-2b Pegasys subQ powder 160 mcg/mL

pegLOTicase Krystexxa

PEMEtrexed Alimta IV powder 500 mg

penicillamine Depen oral tab 250 mg

penicillin Bicillin L-A (obsolete) IM susp

G benzathine 600000 units/mL, G

benzathine 1,200,000 units/2 mL, G

benzathine 2,400,000 units/4 mL

penicillin penicillin inj powder

G potassium 5000000 units, G sodium

5000000 units, G potassium 20000000

untis

penicillin penicillin oral powderV potassium 125 mg/5 mL, V potassium

250 mg/5 mL

penicillin penicillin IM susp

G benzathine-procaine 300000 units-

300000 units/mL, G benzathine 600000

units/mL, G benzathine-procaine 900000

units-300000 units/2 mL, Gbenzathine

1,200,000 units/2 mL, G benzathine

2,400,000 units/4 mL

penicillin penicillin oral tab V potassium 250 mg

penicillin Pfizerpen (obsolete) inj powder G potassium 2000000 units

penicillin Veetids (obsolete) oral powder V potassium 250 mg/5 mL

pentamidine Nebupent inj powder 300 mg

pentostatin Nipent

pentoxifylline Trental oral tab-XR 400 mg

permethrin topical Elimite top cream 5.00%

permethrin topical Nix Cream Rinse top soln 1.00%

perphenazine Trilafon oral tab 4 mg, 8 mg

pertuzumab Perjeta 6/28/2012

petrolatum topical Vaseline top oint 100.00%

phenazopyridine Pyridium oral tab 100 mg, 200 mg

PHENobarbital Luminal oral elixir 20 mg/5 mL

PHENobarbital Luminal inj soln 60 mg/mL, 130 mg/mL

PHENobarbital Luminal oral tab 15 mg, 30 mg, 64.8 mg, 97.2 mg

phenol topical phenol topical compounding liq 99.00%

phenol topical Phenasep Cherry top spray 1.40%

phentolamine OraVerse inj soln all strengths 11/4/2015

phenylephrine Neo-Synephrine inj soln 10 mg/mL

phenylephrine nasal Neo-Synephrine Nasal nasal spray 0.25%

phenylephrine opthalmic Neo-Synephrine Opthalmic opthalmic soln 2.50%

phenylephrine topical Hemorrhoidal Ointment rectal oint 0.25%-3%

phenylephrine topical Preparation H rectal oint 0.25%-3%

phenytoin Dilantin inj soln 50 mg/mL


Drug Formulary


phenytoin Dilantin Infatabs oral tab-chew 50 mg

phenytoin Dilantin Kapseals oral cap-XR 100 mg

phenytoin Dilantin-125 oral susp 25 mg/mL

physostigmine Antilirium inj soln 1 mg/mL

physostigmine opthalmic physostigmine opthalmic opthalmic oint 0.25%

phytonadione Vitamin K1, Mephyton inj soln 1 mg/0.5 mL, 10 mg/mL

phytonadione Vitamin K1, Mephyton oral tab 5 mg

pilocarpine opthalmic Salagen opthalmic soln 0.5%, 1%, 2%, 4%

pioglitazone Actos oral tab 15 mg, 30 mg, 45 mg 9/27/2007

piperacillin-tazobactam Zosyn IV powder 2 g-0.25 g, 3 g-0.375 g, 4 g-0.5 g

pneumococcal 13-valent conjugate vaccine Prevnar-13 IM susp - 4/22/2010

pneumococcal 23-polyvalent vaccine Pneumovax 23 inj soln -

pneumococcal 23-valent vaccine (obsolete) Pnu-Imune 23 inj soln -

podophyllum resin topical Podocon-25 top soln 25.00%

poliovirus vaccine, inactivated poliovirus vaccine, inactivated inj susp -

polyethylene glycol 3350 MiraLax oral powder -

polyethylene glycol 3350 with electrolytes GoLYTELY oral powder -

poractant alfa Curosurf intratracheal susp 80 mg/mL

potassium acetate potassium acetate IV soln 2 mEq/mL

potassium chloride K-Dur 20 oral tab-XR 20 mEq

potassium chloride Klor-Con 10 oral tab-XR 10 mEq

potassium chloride Klor-Con M10 oral tab-XR 10 mEq

potassium chloride Klor-Con M20 oral tab-XR 20 mEq

potassium chloride potassium chloride IV inj 40 mEq/500 mL NS

potassium chloride potassium chloride oral liq 20 mEq/15 mL

potassium chloride potassium chloride IV soln20 mEq/100 mL, 2 mEq/mL, 40 mEq/100

mL

potassium chloride in dextroseDEXTROSE 5% IN WATER WITH KCLE 20

Meq/L 1000 mLIV soln KCl 20 mEq/L

potassium chloride in dextrose and half NSDEXTROSE 5% WITH 0.45% NS w KCL 30

mEq/L PREMIXEDIV soln KCl 30 mEq/L

potassium citrate Urocit-K oral tab-XR 10 mEq

potassium citrate-citric acid Cytra-K oral soln 334 mg/1100 mg/5 mL 3/4/2015

potassium iodide potassium iodide oral soln 1 g/mL

potassium phosphate Neutra-Phos-K oral powder 250 mg-555 mg

potassium phosphate potassium phosphate IV soln 3 mmol/mL

potassium phosphate-sodium phosphate K-Phos Neutral oral tab 250 mg-45 mg-298 mg

pramipexole Mirapex oral tab 0.125 mg, 1 mg

pravastatin Pravachol oral tab 10 mg, 20 mg, 40 mg

praziquantel Biltricide oral tab 600 mg

prazosin Minipress oral cap 1 mg

prednisoLONE prednisoLONE oral syrup 15 mg/5 mL

prednisoLONE opthalmic Pred Forte opthalmic soln sodium phosphate 1%

predniSONE predniSONE oral tab 1 mg, 5 mg, 10 mg, 20 mg

pregabalin Lyrica oral cap 75 mg Restricted

primidone Mysoline oral susp 250 mg/5 mL

primidone Mysoline oral tab 50 mg, 250 mg

probenecid Benemid oral tab 500 mg

procainamide Pronestyl oral cap 250 mg

procainamide Pronestyl inj soln 500 mg/mL

prochlorperazine Compazine inj soln 5 mg/mL

prochlorperazine Compazine rectal supp 25 mg

prochlorperazine Compazine oral tab 5 mg, 10 mg

promethazine Phenergan inj soln 25 mg/mL

promethazine Phenergan rectal supp 12.5 mg, 25 mg, 50 mg

promethazine Phenergan oral tab 12.5 mg, 25 mg

promethazine-codeine Phenergan with Codeine oral syrup 10 mg-6.25 mg/5 mL


Drug Formulary


propafenone Rhytmol oral tab 150 mg, 300 mg

proparacaine ophthalmic Alcaine opthalmic soln 0.50%

propofol Diprivan IV emulsion 10 mg/mL

propranolol propranolol IV soln 1 mg/mL

propranolol propranolol oral soln 20 mg/5 mL

propranolol propranolol oral tab 10 mg, 20 mg, 40 mg

propylthiouracil PTU oral tab 50 mg

protamine protamine inj soln 10 mg/mL

prothrombin complex concentrate (human) Kcentra™ inj powder 500 units (400-620 units Factor IX) Restricted: Ordering restricted to attending level providers 10/24/2013

protirelin Thyrel Trh IV soln 500 mcg/mL

pryridostigmine Mestinon oral tab 60 mg

pseudoephedrine Sudafed oral tab 60 mg

pseudoephedrine-triprolidine Actifed oral tab 60 mg-2.5 mg

psyllium Metamucil oral wafers 6/29/2014

psyllium Metamucil oral powder 3.4 g/3.7 g

pyrazinamide pyrazinamide oral tab 500 mg

pyridostigmine Mestinon oral tab 60 mg

pyridoxine Vitamin B6 inj soln 100 mg/mL

pyridoxine Vitamin B6 oral tab 100 mg

pyrimethamine Daraprim oral tab 25 mg

QUEtiapine Seroquel oral tab25 mg, 50 mg, 100 mg, 200 mg, 300 mg,

400 mg

quiNIDine quiNIDine oral tab 200 mg

quiNIDine quiNIDine oral tab-XR 324 mg

quiNINE quiNINE oral cap 200 mg

quinupristin/dalfopristin Synercid IV soln 500 mg Restricted: Infectious Diseases Consult Required

rabies immune globulin, human Bayrab IM soln 150 intl units/mL

rabies vaccine (obsolete) IM powder -

raltegravir Isentress oral tab 400 mg Restricted

ranitidine Zantac inj soln 25 mg/mL

ranitidine Zantac oral syrup 15 mg/mL

ranitidine Zantac oral tab 150 mg

rasburicase Elitek

Restricted: Restricted to pediatric hematology/oncology patients with cancer known

to cause tumor lysis syndrome with heavy tumor burden at diagnosis, uric acid >

7mcg/dl, SCr > 7 times baseline, decreased urine output and/or metabolic

abnormalities

11/19/2009

regradenoson Lexiscan 6/28/2012

remifentanil Ultiva IV powder 1 mg, 2 mg

reteplase Retavase IV kit 10 units Restricted: Thrombolytic therapy for acute Q-wave MI, as per VCMC Protocol

Rho (D) immune globulin WinRho SDF inj powder 300 mcg, 1000 mcg

rifabutin Mycobutin oral cap 150 mg

rifampin Rifadin oral cap 150 mg, 300 mg

rifampin Rifadin IV IV powder 600 mg

risperiDONE RisperDAL oral soln 1 mg/mL

risperiDONE RisperDAL Consta IM powder 25 mg/2 weeks

ritonavir Norvir oral cap 100 mg

ritonavir Norvir oral soln 80 mg/mL

ritonavir Retrovir oral cap 100 mg

ritonavir Retrovir oral soln 80 mg/mL

ritonavir-lopinavir Kaletra oral liq 400 mg-100 mg/5 mL

ritonavir-lopinavir Kaletra oral tab 200 mg-50 mg

riTUXimab Rituxan IV soln 10 mg/mL 12/11/2008

rivaroxaban Xarelto oral tab 10 mg Restricted: Education of contra-indications

rocuronium Zemuron IV soln 10 mg/mL

roflumilast Daliresp PO tab 500 mcg

romiDEPsin Istodax Restricted: Outpatient Oncology Dept ONLY. On demand only

romiPLOStim NplateRestricted: Patients, Prescribers & Medical center must be registered with the

program 8/28/2008

Ropivacaine Naropin 11/29/2007

rosiglitazone Avandia oral tab 4 mg


Drug Formulary


rosuvastatin Crestor oral tab 5 mg, 10 mg 9/27/2007

Rotavirus Vaccine RotaTeq 1/25/2001

rubella virus vaccine Meruvax II subQ powder -

salicylic acid topical Mediplast top pad 40.00%

saquinavir Invirase oral cap mesylate 200 mg

sargramostim Leukine inj soln 500 mcg/mL Restricted

scopalamine scopalamine inj soln 0.4 mg/mL

scopalamine Transderm-Scop transdermal film 1.5 mg

selenium selenium IV soln 40 mcg/mL

selenium selenium oral tab 50 mcg

selenium sulfide topical selenium sulfide topical top lotion 2.50%

senna Senokot oral tab 8.6 mg

sertraline Zoloft oral tab 50 mg, 100 mg

sevelamer Renagel, Renvela oral tab 400 mg, carbonate 800 mg

sevoflurane Ultane inhalation liq -

sildanfil Revatio, Viagra oral tab 20 mg, 25 mg, 50 mg

silver nitrate topical silver nitrate topical top stick -

silver sulfADIAZINE topical Silvadene top cream 1.00%

simethicone Genasyme oral liq 40 mg/0.6 mL

simethicone Mylicon oral tab-chew 80 mg

simple syrup simple syrup oral syrup -

simvastatin Zocor oral tab 10 mg, 20 mg, 40 mg 2/22/2007

sincalide Kinevac IV powder 5 mcg

sodium acetate sodium acetate IV soln 2 mEq/mL

sodium bicarbonate Neut IV soln 4.00%

sodium bicarbonate sodium bicarbonate IV soln 4%, 4.2%, 8.4%

sodium bisphophate-sodium phosphate Fleet Phospho Soda oral soln 18%-48%

sodium chloride SALINE FLUSH inj soln 0.9% NS 2.5 mL

sodium chloride sodium chloride inj soln 0.9% NS 2.5 mL, 0.45%, 0.9%

sodium chloride sodium chloride irrigation soln 0.90%

sodium chloride sodium chloride IV soln 14.60%

sodium chloride sodium chloride injection inj soln 0.45%, 0.9%

sodium chloride sodium chloride injection IV soln 14.60%

sodium chloride sodium chloride inhalation soln 0.9%, 3%, 7%

sodium chloride sodium chloride inhalation inhalation soln 0.9%, 3%

sodium chloride 0.9% KCL 20 mEq/L 1000 mL

premix IV

sodium chloride 0.9% KCL 20 mEq/L 1000

mL premix IVIV soln KCl 20 mEq/L

sodium chloride nasal sodium chloride nasal nasal soln 0.65%

sodium chondroitin-hyaluronate opthalmic Viscoat intraocular soln 40 mg-30 mg/mL

sodium citrate N/A catheter lock soln 4.00% Restricted: For hemodialysis catheter lock use only 10/24/2013

sodium hyaluronate opthalmic Amvisc Plus intraocular liq 1.60% 4/8/2015

sodium hyaluronate opthalmic Healon intraocular liq 10 mg/mL

sodium hypochlorite topical Dakins Full Strength top soln 0.50%

sodium hypochlorite topical Dakins Half Strenth top soln 0.25%

sodium hypochlorite topical Dakin's Solution top soln 0.25%

sodium phosphate sodium phosphate inj soln 3 mmol/mL

sodium polystyrene sulfonate Kayexylate oral susp 15 g/60 mL

sodium thiosulfate sodium thiosulfate IV soln 10%, 25%

sorbitol sorbitol oral liq 70.00%

sotalol Betapace oral tab 80 mg

spironolactone Aldactone oral tab 25 mg, 50 mg, 100 mg

starch topical Anusol suppositories rectal supp 51.00%

sterile talc sterile talc intrapleural aerosol -

sterile water Flolan Sterile Diluent IV soln diluent

sterile water sterile water inj soln -

sterile water sterile water irrigation soln -

stomahesive powder stomahesive powder top powder n/a

streptozocin Zanosar IV powder 1 g

succinylcholine Quelicin Chloride inj soln 20 mg/mL


Drug Formulary


sucralfate Carafate oral tab 1 g

SUFentanil Sufenta IV soln 50 mcg/mL

sulfacetamide sodium opthalmic Sulf-10 opthalmic soln 10.00%

sulfacetamide sodium opthalmic sulfacetamide sodium opthalmic opthalmic oint 10.00%

sulfaDIAZENE sulfaDIAZENE oral tab 500 mg

sulfamethoxazole-trimethoprim Bactrim oral susp 200-40 mg/5 mL

sulfamethoxazole-trimethoprim Bactrim DS oral tab 800 mg-160 mg

sulfamethoxazole-trimethoprim Bactrim IV IV soln 80 mg-15 mg/mL

sulfamethoxazole-trimethoprim Cotrim DS oral tab 800 mg-160 mg

sulfamethoxazole-trimethoprim Septra DS oral tab 800-160 mg

sulfamethoxazole-trimethoprim Septra IV IV soln 80 mg-16 mg/mL

sulfanilamide topical AVC vaginal cream 15.00%

sulfasalazine Azulfidine oral tab 500 mg

sulfiSOXAZOLE Gantrisin oral tab 500 mg

SUMAtriptan Imitrex subQ soln 6 mg/0.5 mL

sunblock cream sunblock cream top cream SPF 30

tacrolimus Prograf oral cap 1 mg

tamoxifen Arimidex oral tab 10 mg

tamsulosin Novaldex oral cap 0.4 mg

tapentadol Nucynta Restricted: Prescriber must be a physician on the Palliative Care Team 5/24/2012

Tdap Adacel IM susp 5 units-2 units-15.5 mcg/0.5 mL

tdap Boostrix IM susp 5 units-2.5 units-18.5 mcg/0.5 mL

temazepam Restoril oral cap 7.5 mg, 15 mg, 30 mg

temsirolimus Torisel IV soln 25 mg/mL

tenofovir Viread oral tab 300 mg

terazosin Hytrin oral cap 5 mg

terbinafine LamISIL oral tab 250 mg

terbutaline Brethine inj soln 1 mg/mL

terbutaline Brethine oral tab 2.5 mg, 5 mg

testosterone Depo-Testosterone IM soln cypionate 200 mg/mL

tetanus immune globulin BayTet IM soln 250 units

tetanus toxoid Tetanus Toxoid IM soln 5 units/0.5 mL

tetanus toxoid Tetanus Toxoid IM susp 5 unit/0.5 mL

tetanus toxoid Tetanus Toxoid Adsorbed IM susp 5 units/0.5 mL

tetanus/dipth/pertuss Tdap adult/adol IM susp 2.5 units-18.5 mcg-5 units/0.5 mL

tetanus-dipth toxoids Td adult/adol IM susp 6 units-2 units/0.5 mL

tetracaine Pontocaine HCl inj soln 1.00%

tetracaine opthalmic tetracaine opthalmic opthalmic soln 0.50%

tetracaine topical Pontocaine top soln 2.00%

tetracycline tetracycline oral cap 250 mg

theophylline Slo-Phyllin 80 oral syrup 80 mg/15 mL

theophylline Theo-Dur oral tab-XR 100 mg, 200 mg

theophylline theophylline oral cap-XR 125 mg, 200 mg

thiamine Vitamin B1 inj soln 100 mg/mL

thiamine Vitamin B1 oral tab 100 mg

thioguanine thioguanine oral tab 40 mg

thiopental Pentothal IV powder 5 g, 250 mg

thioridazine Mellaril oral tab 10 mg, 25 mg, 50 mg, 100 mg

thiothixene Navane oral cap 1 mg, 2 mg, 5 mg

thrombin topical thrombin topical top powder 5000 units

thyroid dessicated Armour Thyroid oral tab 60 mg

thyrotropin alpha thyrotropin alpha IM powder 1.1 mg

ticlopidine Ticlid oral tab 250 mg Restricted

tigecycline Tygacil IV powder 50 mg Restricted: Infectious Diseases Consult Required

timolol opthalmic Timoptic opthalmic soln 0.25%, 0.5%

timolol-dorzolamide opthalmic Cosopt opthalmic soln 2%-0.5%

Tiotropium bromide monohydrate Spiriva HandiHaler inhalation powder Restricted: For patients who are already taking this medication as an outpatient 6/29/2014

tobramycin Nebcin inj soln 40 mg/mL

tobramycin Nebcin Pediatric inj soln 10 mg/mL

tobramycin tobramycin inj powder 1.2 g


Drug Formulary


tobramycin Tobi inhalation soln 60 mg/mL

tocilizumab Actemra IV soln 20 mg/mL Restricted: Oncology Infusion Center ONLY 1/27/2011

tolnaftate Lamisil top soln 1.00%

tolnaftate Tinactin top cream 1.00%

topiramate Topamax oral tab 25 mg, 50 mg, 100 mg, 200 mg

topotecan Hycamtin IV powder 4 mg

Torsemide Demadex oral IV form not approved 1/25/2007

TPN-dextrose Dextrose in water IV soln dextrose 70% in water

trace elements Neotrace-4 IV soln 0.85 mcg-0.1 mg-0.025 mg-1.5 mg/mL

trace elements with selenium Multritrace-5 IV soln 4 mcg-0.4 mg-0.1 mg-20 mcg-1 mg/mL

traMADol Ultram oral tab 50 mg

tranexamic acid Cyklokapron 6/28/2012

trastuzumab Herceptin 9/23/2010

traZODone Desyrel oral tab 50 mg, 100 mg

triamcinolone Kenalog-10 inj susp 10 mg/mL

triamcinolone Kenalog-40 inj susp acetonide 40 mg/mL

triamcinolone Azmacort inhalation aerosol with adapter 100 mcg/inh

triamcinolone topical triamcinolone topical top cream 0.10%

triamcinolone topical triamcinolone topical top lotion 0.10%

triamcinolone topical triamcinolone topicalmucous

membranepaste 0.10%

trichloroacetic acid topical Tri-Chlor top liq 80.00%

trifluoperazine Stelazine oral tab 2 mg, 5 mg

trifluridine opthalmic Viroptic opthalmic soln 1.00%

trihexyphenidyl Artane oral tab 2 mg, 5 mg

trimethobenzamide Tigan oral cap 250 mg

trimethobenzamide Tigan IM soln 100 mg/mL

trimethoprim Proloprim oral tab 100 mg

triple dye topical Triple Dye top soln 2.29 mg-2.29 mg-1.14 mg/mL

tromethamine Tham IV soln 3.6 g/100 mL

tropicamide opth Mydriacyl opthalmic soln 1.00%

tuberculin PPD Aplisol intradermal soln 5 tuberculin units/0.1 mL

typhoid vaccine, inactivated typhoid vaccine, inactivated IM soln -

urokinase Abbokinase Open Cath IV powder 5000 intl units

ursodiol Actigall oral cap 300 mg

valGANciclovir Valcyte oral tab 450 mg Restricted

valproic acid Depacon inj soln 100 mg/mL

valproic acid Depakene oral syrup 250 mg/5 mL

valproic acid valproic acid oral cap-DR 250 mg, 500 mg

vancomycin vancomycin oral soln 5 gm/200 mLRestricted: (oral) Use limited to Metronidazole refractory or life-threatening C.

difficile enterocolitis. All Vancomycin Oral therapy needs to be initiated by an

attending physician

vancomycin vancomycin IV powder 1 g, 500 mg

varicella virus vaccine Varivax subQ powder -

varicella zoster immune globulin varicella zoster immune globulin IM soln 125 unit, 625 units

vasopressin Pitressin inj soln 20 units/mL

vecuronium Norcuron IV powder 10 mg

venlafaxine Effexor oral tab 25 mg, 100 mg

venlafaxine Effexor XR oral cap-XR 37.5 mg, 75 mg, 150 mg

verapamil Calan oral tab 80 mg, 120 mg

verapamil Calan SR oral tab-XR 120 mg/12 hours

verapamil verapamil oral cap-XR 180 mg/24 hrs, 240 mg/24 hrs

verapamil verapamil IV soln 2.5 mg/mL

vinBLAStine Velban IV powder 10 mg

vinCRIStine Oncovin IV soln 1 mg/mL

vinorelbine Navelbine IV soln 10 mg/mL

vitamin A Aquasol IM soln 50000 units/mL

vitamin A vitamin A oral cap 10000 units

vitamin A and D vitamin A and D top oint -


Drug Formulary


vitamin A and D w Zn Oxide vitamin A and D w Zn Oxide top oint -

vitamin E vitamin E oral cap 400 intl units

voriconazole VFEND IV powder 200 mg Restricted: Infectious Diseases Consult Required

voriconazole VFEND oral powder 40 mg/mL Restricted: Infectious Diseases Consult Required

voriconazole VFEND oral tab 200 mg Restricted: Infectious Diseases Consult Required

warfarin Coumadin oral tab 1 mg, 2 mg, 2.5 mg, 5 mg, 7.5 mg

zidovudine Retrovir oral cap 100 mg

zidovudine Retrovir IV soln 10 mg/mL

zidovudine Retrovir oral syrup 50 mg/5 mL

zidovudine Retrovir oral tab 300 mg

zinc sulfate zinc sulfate IV soln 1 mg/mL

zinc sulfate Zinc-220 oral cap 220 mg

ziprasidone Geodon oral cap 20 mg, 40 mg, 80 mg 11/30/2006

ziprasidone Geodon IM powder 20 mg

ziv-aflibercept Zaltrap IV soln 25 mg/mL Restricted: stage IV Colon CA unresponsive to FULFIRI & Oxaliplatin based regimen 11/15/2012

zoledronic acid Reclast IV soln 5 mg/100 mL

zoledronic acid Zometa IV soln 4 mg/5 mL

zolpidem Ambien oral tab 5 mg, 10 mg

zoster vaccine live Zostavax For prevention of Shingles in patients 50 years and older -

ventura county medical center-santa paula hospital drug...

Documents