Effective January 2011
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Brand Name |
Generic Name |
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A (top) |
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ACCUPRIL |
QUINAPRIL |
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ACETEST |
KETONE TESTING PRODUCTS |
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ACTIFED |
PSEUDOEPHEDRINE/TRI PROLIDINE |
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ACTIGALL |
URSODIOL |
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ACTOS |
PIOGLITAZONE |
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ACULAR |
KETOROLAC TROMETHAMINE, ophthalmic solution only |
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ADALAT CC |
NIFEDIPINE |
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ADDERALL |
AMPHETAMINES/DEXTROAMPHETAMINES |
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ADDERALL XR |
AMPHETAMINES/DEXTROAMPHETAMINES |
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ADVAIR |
FLUTICASONE/SALMETEROL |
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AEROBID |
FLUNISOLIDE |
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AEROCHAMBER * |
INHALER DEVICE |
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ALDACTAZIDE |
SPIRONOLACTONE/HYDROCHLOROTHIAZIDE |
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ALDACTONE |
SPIRONOLACTONE |
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ALDARA |
IMIQUIMOD |
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ALDOMET |
METHYLDOPA |
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ALPHAGAN |
BRIMONIDINE TARTRATE |
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ALTACE |
RAMIPRIL |
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ALUPENT |
METAPROTERENOL |
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AMARYL |
GLIMEPIRIDE |
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AMBIEN |
ZOLPIDEM |
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AMOXIL |
AMOXICILLIN |
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AMPHOJEL * |
ALUMINUM HYDROXIDE |
|
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AMPICILLIN INJ |
AMPICILLIN |
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ANAPROX |
NAPROXEN SODIUM |
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ANCEF, KEFZOL |
CEFAZOLIN |
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ANCOBON |
FLUCYTOSINE |
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ANDROID |
METHYLTESTOSTERONE |
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ANTABUSE |
DISULFIRAM |
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ANTIMINTH |
PYRANTEL |
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ANTIVERT |
MECLIZINE |
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ANTURANE |
SULFINPYRAZONE |
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ANZEMET |
DOLASETRON MESYLATE |
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APRESOLINE |
HYDRALAZINE |
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ARALEN |
CHLOROQUINE HCL |
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ARISTOCORT |
TRIAMCINOLONE DIACETATE |
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ARTHROTEC |
DICLOFENAC/MISOPROSTOL |
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ASACOL |
MESALAMINE Code 1 restricted to intolerance or unresponsive to sulfasalazine |
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ASENDIN |
AMOXAPINE |
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ASMANEX |
MOMETASONE |
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ASSESS * |
PEAK AIR FLOW METER |
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ATIVAN * |
LORAZEPAM |
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ATROPINE |
ATROPINE SULFATE all forms |
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ATROVENT |
IPRATROPIUM |
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ATROVENT NASAL SPRAY |
IPRATROPIUM NASAL SPRAY |
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AUGMENTIN |
AMOXICILLIN/CLAVULANATE all forms except XR |
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AURALGAN |
ANTIPYRINE/BENZOCAINE |
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AZMACORT |
TRIAMCINOLONE ACETONIDE |
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AZULFIDINE |
SULFASALAZINE |
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B (top) |
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BACIGUENT * |
BACITRACIN |
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BACTROBAN OINTMENT |
MUPIROCIN |
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BAYER ASPIRIN * |
ASPIRIN all forms |
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B-D SWABS |
ALCOHOL SWABS |
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B-D SYRINGES, NEEDLES |
INSULIN SYRINGES, NEEDLES |
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BENADRYL * |
DIPHENHYDRAMINE |
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BENEMID |
PROBENECID |
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BENTYL |
DICYCLOMINE |
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BENZAC |
BENZOYL PEROXIDE |
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BETADINE |
POVIDONE-IODINE 10% solution only |
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BETAGAN |
LEVOBUNOLOL |
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BETAPACE |
SOTALOL |
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BETASERON |
INTERFERON BETA-1B |
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BETOPTIC |
BETAXOLOL |
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BIAXIN |
CLARITHROMYCIN in individuals with HIV infection, for otitis media when other first line antibiotics cannot be used or treatment of H. pylori (maximum 2 weeks) |
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BICILLIN L-A |
PENICILLIN G BENZATHINE |
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BLEPHAMIDE |
SULFACETAMIDE/PREDNISOLONE AC |
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BRETHINE |
TERBUTALINE SULFATE |
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BUMEX |
BUMETANIDE |
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BUROW’S OTIC |
ACETIC ACID/ALUMINUM ACETATE 2% ear solution only |
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BUSPAR |
BUSPIRONE psych exempt |
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C (top) |
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CAFERGOT |
ERGOTAMINE TARTRATE/CAFFEINE |
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CAFERGOT PB |
ERGOTAMINE/CAFFEINE/BELLADONNA/PHENOBARBITAL |
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CALAMINE * |
CALAMINE |
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CALAN |
VERAPAMIL |
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CALCIMAR |
CALCITONIN all forms |
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CAPOTEN |
CAPTOPRIL |
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CAPOZIDE |
CAPTOPRIL/HYDROCHLOROTHIAZIDE |
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CARAFATE |
SUCRALFATE |
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CARBATROL |
CARBAMAZEPINE |
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CARDIZEM |
DILTIAZEM all forms |
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CARNITOR |
LEVOCARNITINE |
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CATAPRES |
CLONIDINE all forms |
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CEFIZOX |
CEFTIZOXIME |
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CEFTIN |
CEFUROXINE Code 1 restricted to 2nd line for sinusitis, otitis media and CAP up to a maximum of 250mg dose |
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CELEXA |
CITALOPRAM |
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CEPHULAC |
LACTULOSE |
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CHANTIX |
VARENICLINE |
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CHLOR-TRIMETON * |
CHLORPHENIRAMINE |
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CILOXAN |
CIPROFLOXACIN |
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CIPRO |
CIPROFLOXACIN |
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CIPRO-DEX OTIC |
CIPROFLOXACIN/DEXAMETHASONE |
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CIPRO HC OTIC |
CIPROFLOXACIN HYDROCORTISONE OTIC |
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CLARITIN * |
LORATIDINE |
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CLEOCIN |
CLINDAMYCIN HCL |
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CLEOCIN |
CLINDAMYCIN PHOSPHATE |
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CLEOCIN |
CLINDAMYCIN TOPICAL |
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CLINISTIX |
GLUCOSE TESTING (URINE) |
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CLINORIL |
SULINDAC |
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COAL TAR |
COAL TAR SOLUTION |
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CODEINE |
CODEINE all forms |
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COGENTIN |
BENZTROPINE |
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COLACE * |
DOCUSATE SODIUM |
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COLBENEMID |
COLCHICINE/PROBENECID |
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COLCRYS |
COLCHICINE |
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COLESTID |
COLESTIPOL bulk |
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COLYTE |
PEG 3350/ELECTROLYTE SOLUTION |
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COMBIVENT |
IPRATROPIUM/ALBUTEROL |
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COMPAZINE |
PROCHLORPERAZINE MALEATE all forms |
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COMTAN |
ENTACAPONE |
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CONCEPTROL * |
NONOXYNOL 9 |
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CONCERTA |
METHYLPHENIDATE restricted to QD |
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CONDYLOX |
PODOFILOX gel only |
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COPAXONE |
GLATIRAMER ACETATE |
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COREG |
CARVEDILOL Code 1 restricted to treatment of CHF |
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CORDARONE |
AMIODARONE |
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CORTONE |
CORTISONE |
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COSOPT |
DORZOLAMIDE/TIMOLOL |
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COUMADIN |
WARFARIN SODIUM |
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COZAAR |
LOSARTAN **treatment failure to ACEI |
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CREON |
AMYLASE/LIPASE/PROTEASE/PANCREATIN |
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CYCLOGYL |
CYCLOPENTOLATE |
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CYTOMEL |
LIOTHYRONINE |
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CYTOTEC |
MISOPROSTOL |
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D (top) |
||
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DALMANE * |
FLURAZEPAM |
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DAPSONE |
DAPSONE |
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DARAPRIM |
PYRIMETHAMINE |
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DARVOCET-N 100 |
PROPOXYPHENE NAPSYLATE/ACETAMINOPHEN QL maximum 50 tablets per 30 days |
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DDAVP |
DESMOPRESSIN ACETATE |
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DECADRON |
DEXAMETHASONE |
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DECADRON PHOSPHATE |
DEXAMETHASONE SODIUM PHOSPHATE |
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DELTASONE |
PREDNISONE |
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DEMADEX |
TORSEMIDE |
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DEMEROL |
MEPERIDINE |
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DEPAKENE |
VALPROIC ACID |
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DEPAKOTE |
DIVALPROEX SODIUM |
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DEPO-ESTRADIOL |
ESTRADIOL CYPIONATE |
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DEPO-PROVERA |
MEDROXYPROGESTERONE |
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DEPO-TESTOSTERONE |
TESTOSTERONE all forms of injections |
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DERMATOP |
PREDNICARBATE all forms |
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DESOWEN |
DESONIDE |
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DESYREL |
TRAZODONE |
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DETROL/DETROL LA |
TOLTERODINE TARTRATE |
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|
DEXEDRINE |
D-AMPHETAMINE all forms |
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DEXTROSE SOLUTION |
DEXTROSE/WATER |
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DHT |
DIHYDROTACHYSTEROL |
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DIABINESE |
CHLORPROPAMIDE |
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DIAMOX |
ACETAZOLAMIDE |
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DIDRONEL |
ETIDRONATE |
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DIENESTROL |
DIENESTROL |
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DIFLUCAN |
FLUCONAZOLE |
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DILANTIN |
PHENYTOIN SODIUM |
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DILAUDID |
HYDROMORPHONE all forms |
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DIMETAPP * |
PSEUDOEPHEDRINE/BROMPHENIRAMINE |
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DIPROSONE |
BETAMETHASONE DIPROPIONATE all forms |
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DISALCID |
SALSALATE |
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DITROPAN |
OXYBUTYNIN |
|
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DITROPAN XL |
OXYBUTYNIN SR, code 1 urologist |
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DOLOPHINE |
METHADONE, ql maximum 90 day supply per fill |
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DOMEBORO |
CALCIUM ACETATE/ALUMINUM SULFATE |
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DONNATAL |
BELLADONA ALK/PB |
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DRAMAMINE * |
DIMENHYDRINATE |
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DRITHOCREME |
ANTHRALIN |
|
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DULERA |
MOMETASONE FUROATE/FORMOTEROL FUMARATE |
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DULCOLAX * |
BISACODYL |
|
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DYNAPEN |
DICLOXACILLIN |
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DYAZIDE/DYRENIUM |
TRIAMTERENE/HCTZ |
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E (top) |
||
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E.E.S |
ERYTHROMYCIN ETHYLSUCCINATE |
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EDECRIN |
ETHACRYNIC ACID |
|
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EFFEXOR |
VENLAFAXINE QL one per day for ER, two per day for IR |
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EFUDEX |
FLUOROURACIL |
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ELAVIL |
AMITRIPTYLINE |
|
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ELDEPRYL |
SELEGILINE |
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ELESTAT |
SELEGILINE |
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ELIMITE |
EPINASTINE |
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EPINEPHRINE |
EPINEPHRINE HYDROCHLORIDE |
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ERGAMISOL |
LEVAMISOLE |
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ERGOSTAT |
ERGOTAMINE |
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ERGOTRATE |
ERGONOVINE |
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ERY-TAB |
ERYTHROMYCIN BASE |
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ERYTHROMYCIN ST |
ERYTHROMYCIN STEARATE |
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ESTRACE |
ESTRADIOL |
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EURAX |
CROTAMITON |
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EVISTA |
RALOXIFENE |
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EXCERDIN * |
ASPIRIN/ACETAMINOPHEN/CAFFEINE |
|
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F (top) |
||
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FELDENE |
PIROXICAM |
|
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FEMSTAT * |
BUTOCONAZOLE |
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FERGON |
FERROUS GLUCONATE |
|
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FER-IN-SOL * |
FERROUS SULFATE |
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FLAGYL |
METRONIDAZOLE |
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FLEET’S ENEMA * |
SODIUM PHOSPHATE/SODIUM BIPHOSPHATE |
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FLEXERIL |
CYCLOBENZAPRINE |
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FLOMAX |
TAMSULOSIN |
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FLONASE |
FLUTICASONE PROPIONATE |
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FLORINEF |
FLUDROCORTISONE |
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FLOVENT |
FLUTICASONE 110 mcg strength should be reserved for doses that cannot be delivered by the 220 mcg strength |
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FLOXIN |
OFLOXACIN |
|
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FLOXIN EAR DROPS |
OFLOXACIN otic |
|
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FML |
FLUOROMETHOLONE |
|
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FOLIC ACID * |
FOLIC ACID |
|
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FOSAMAX |
ALENDRONATE |
|
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FOSCAVIR |
FOSCARNET Code 1 restricted to use in patients with AIDS or AIDS related conditions |
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FULVICIN |
GRISEOFULVIN |
|
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FUNGIZONE |
AMPHOTERICIN B INJ |
|
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FURADANTIN |
NITROFURANTOIN all forms |
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FUROXONE |
FURAZOLIDONE |
|
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G (top) |
||
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GANTRISIN |
SULFISOXAZOLE |
|
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GARAMYCIN |
GENTAMICIN all forms |
|
|
GAVISCON * |
SODIUM BICARBONATE/MAGNESIUM TRISILICATE/ALUMINUM HYRDROXIDE/ALGINIC ACID |
|
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GLUCAGON |
GLUCAGON 1mg emergency kit |
|
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GLUCOPHAGE |
METFORMIN |
|
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GLUCOTROL |
GLIPIZIDE |
|
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GLYCERIN * |
GLYCERIN suppositories |
|
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GOLYTELY/COLYTE |
PEG 3350/ELECTROLYTE SOLUTION |
|
|
H (top) |
||
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HALOTESTIN |
FLUOXYMESTERONE |
|
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HEPARIN |
HEPARIN SODIUM |
|
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HIBICLENS * |
CHLORHEXIDINE GLUCONATE |
|
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HIPREX |
METHENAMINE HIPPURATE |
|
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HIVID |
ZALCITABINE |
|
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HUMALOG |
INSULIN all forms, vials only |
|
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HUMULIN |
INSULIN all forms, vials only |
|
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HYDERGINE |
ERGOLOID MESYLATES |
|
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HYDROCORTISONE * |
HYDROCORTISONE all forms |
|
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HYDRODIURIL |
HYDROCHLOROTHIAZIDE |
|
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HYTRIN |
TERAZOSIN |
|
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HYZAAR |
LOSARTAN/HCTZ **treatment failure to ACEI |
|
|
I (top) |
||
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ILETIN |
INSULIN all forms, vials only |
|
|
ILOTYCIN |
ERYTHROMYCIN OPHTHALMIC |
|
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IMITREX |
SUMATRIPTAN QL 2 syringes/30days - 9 tablets per 30 days - 2 spray cartons per 30 days |
|
|
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|
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IMODIUM * |
LOPERAMIDE |
|
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IMURAN |
AZATHIOPRINE |
|
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INDERAL, INDERAL LA |
PROPRANOLOL all forms |
|
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INDOCIN |
INDOMETHACIN |
|
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INFED |
IRON DEXTRAN COMPLEX |
|
|
INH |
ISONIAZID |
|
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INTAL |
CROMOLYN all forms |
|
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IOPIDINE |
APRACLONIDINE |
|
|
ISOPTO ALKALINE |
HYDROXYPROPYLMETHYLCELLULOSE |
|
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ISOPTO CARBACHOL |
CARBACHOL |
|
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ISOPTO CARPINE |
PILOCARPINE HYDROCHLORIDE |
|
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ISOPTO HOMATROPINE |
HOMATROPINE HYDROBROMIDE |
|
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ISORDIL |
ISOSORBIDE DINITRATE |
|
|
K (top) |
||
|
KAYEXALATE |
SODIUM POLYSTYRENE SULFONATE |
|
|
K-DUR |
POTASSIUM CHLORIDE all forms |
|
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KEFLEX |
CEPHALEXIN |
|
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KENALOG |
TRIAMCINOLONE ACETONIDE all forms |
|
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KEPPRA |
LEVETIRACETAM |
|
|
KETO-DIASTIX |
GLUCOSE/KETONE TEST COMBO (URINE) |
|
|
KLONOPIN * |
CLONAZEPAM |
|
|
K-Y JELLY * |
GLYCERIN/HYDROXYETHYLCELLULOSE |
|
|
KYTRIL |
GRANISETRON QL 6 per Rx |
|
|
L (top) |
||
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LAMICTAL |
LAMOTRIGINE |
|
|
LAMISIL AT * |
TERBINAFINE tabs & cream |
|
|
LAMPRENE |
CLOFAZIMINE |
|
|
LANOXIN |
DIGOXIN |
|
|
LANTUS |
INSULIN all forms, vials only |
|
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LARODOPA |
LEVODOPA |
|
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LASIX |
FUROSEMIDE |
|
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LEUCOVORIN CALCIUM |
LEUCOVORIN |
|
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LEVAQUIN |
LEVOFLOXACIN |
|
|
LEVOXYL |
LEVOTHROXINE SODIUM |
|
|
LIDEX |
FLUOCINONIDE |
|
|
LIORESAL |
BACLOFEN Code 1 restricted to use in spasticity resulting from MS or spinal cord injury |
|
|
LODINE |
ETODOLAC Code 1 intolerance to 1st or 2nd line NSAIDS |
|
|
LOFIBRA |
FENOFIBRATE, micronized |
|
|
LOMOTIL |
DIPHENOXYLATE/ATROPINE SULFATE |
|
|
LONITEN |
MINOXIDIL |
|
|
LOPID |
GEMFIBROZIL |
|
|
LOPRESSOR |
METOPROLOL TARTRATE |
|
|
LORCET |
HYDROCODONE BITARTRATE/ACETAMINOPHEN 10/650, QL maximum 120 tablets per 30 days |
|
|
LORTAB 10/500 |
HYDROCODONE/APAP 10/500 |
|
|
LOTENSIN HCT/LOTENSIN |
BENAZEPRIL/HYDROCHLOROTHIAZIDE & BENAZEPRIL |
|
|
LOTRIMIN * |
CLOTRIMAZOLE |
|
|
LOVENOX |
ENOXAPARIN QL maximum 7 days |
|
|
LUDIOMIL |
MAPROTILINE psych exempt |
|
|
LUNELLE |
MEDROXYPROGESTERONE/ESTRADIOL CYPIONATE |
|
|
|
|
|
|
LURIDE |
SODIUM FLUORIDE |
|
|
M (top) |
||
|
MAALOX * |
MAGNESIUM HYDROXIDE/ALUMINUM HYDROXIDE |
|
|
MACROBID |
NITROFURANTOIN/NITROFURAN MACROCRYSTALS |
|
|
MAG-OXIDE * |
MAGNESIUM OXIDE Code 1 restricted to renal failure |
|
|
MANDELAMINE |
METHENAMINE MANDELATE |
|
|
MAVIK |
TRANDOLAPRIL |
|
|
MAXAIR |
PIRBUTEROL |
|
|
MEDROL |
METHYLPREDNISOLONE all forms |
|
|
|
|
|
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MEPHYTON * |
PHYTONADIONE |
|
|
MEPRON |
ATOVAQUONE Code 1 restricted to use for treatment of mild to moderate P. carinii pneumonia in patients who are intolerant to TMP/SMX |
|
|
MESANTOIN |
MEPHENYTOIN |
|
|
MESTINON |
PYRIDOSTIGMINE |
|
|
METADATE CD |
METHYLPHENIDATE |
|
|
METHERGINE |
METHYLERGONOVINE |
|
|
METHOTREXATE |
METHOTREXATE |
|
|
METROGEL |
METRONIZOLE topical only |
|
|
MEVACOR |
LOVASTATIN |
|
|
MEXITIL |
MEXILETINE |
|
|
MICRONASE |
GLYBURIDE |
|
|
MIDRIN * |
ISOMETHEPTENE/DICHL0RALPHENAZONE/ACETAMINOPHEN |
|
|
MILK OF MAGNESIA * |
MAGNESIUM HYDROXIDE |
|
|
MILONTIN |
PHENSUXIMIDE |
|
|
MINIPRESS |
PRAZOSIN |
|
|
MINOCIN |
MINOCYCLINE |
|
|
MINTEZOL |
THIABENDAZOLE |
|
|
MIRALAX POWDER |
PEG 3350 |
|
|
MIRAPEX |
PRIMIPEXOLE DIHYDROCHLORIDE |
|
|
MOBIC |
MELOXICAM |
|
|
MONISTAT |
MICONAZOLE NITRATE |
|
|
MONOPRIL |
FOSINOPRIL |
|
|
MOTRIN |
IBUPROFEN all forms |
|
|
MS CONTIN |
MORPHINE EXTENDED RELEASE all forms |
|
|
MUCOMYST |
ACETYLCYSTEINE |
|
|
MYAMBUTOL |
ETHAMBUTOL |
|
|
MYCOBUTIN |
RIFABUTIN Code 1 for use in prevention of MAC disease in advanced HIV infection |
|
|
MYCOLOG II |
NYSTATIN/TRIAMCINOLONE |
|
|
MYCOSTATIN |
NYSTATIN |
|
|
MYOCHRYSINE |
GOLD SODIUM THIOMALATE |
|
|
MYSOLINE |
PRIMIDONE |
|
|
N (top) |
||
|
NAPHCON-A * |
NAPHAZOLINE HYDROCHLORIDE/PHENIRAMINE |
|
|
NAPROSYN |
NAPROXEN |
|
|
NASAREL |
FLUNISOLIDE |
|
|
NASONEX |
MOMETASONE FUROATE For children under 4 YO only |
|
|
NATACYN |
NATAMYCIN |
|
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NEBCIN |
TOBRAMYCIN |
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NEPHRO-VITE * |
NEPHRO-VITE Code 1 restricted to renal failure |
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NEURONTIN |
GABAPENTIN |
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NEUTREXIN |
TRIMETREXATE Code1 immuno-compromised patients intolerant to TMP/SMX |
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NIACIN * |
NIACIN all forms |
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NICLOCIDE |
NICLOSAMIDE |
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NICORETTE * |
NICOTINE POLACRILEX QL 12 weeks / 365 days and smoking cessation class certificate |
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NICOTROL * |
NICOTINE PATCH QL 12 weeks / 365 days and smoking cessation class certificate |
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NITROGLYCERIN |
NITROGLYCERIN all tablets, capsules, and ointment |
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NIZORAL |
KETOCONAZOLE |
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NOLVADEX |
TAMOXIFEN |
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HYDROCODONE/APAP 10/325 |
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NORPACE |
DISOPYRAMIDE |
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NORPLANT |
LEVONORGESTREL long acting |
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NORPRAMIN |
DESIPRAMINE |
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NORVASC |
AMLODIPINE |
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NUVARING |
ETONOGESTREL/ETHINYL ESTRADIOL |
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O (top) |
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OMNICEF, susp only |
CEFDINIR |
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OMNIPEN-N |
AMPICILLIN SODIUM injection only |
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OPTIPRANOLOL |
METIPRANOLOL |
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ORTHO-DIAPHRAGM |
DIAPHRAGM |
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ORTHO EVRA |
NORELGESTROMIN/ETHINYL ESTRADIOL |
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ORTHO-GYNOL * |
OCTOXYNOL 9 |
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ORUDIS |
KETOPROFEN |
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OSCAL * |
CALCIUM all forms that have a generic available |
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OSCAL-D * |
CALCIUM/VITAMIN D all forms that have a generic available |
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OVIDE |
MALATHION |
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P (top) |
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PAMELOR |
NORTRIPTYLINE |
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PANCREASE |
AMYLASE/LIPASE/PROTEASE |
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PAXIL |
PAROXETINE, generic only |
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PEDIAZOLE |
ERYTHROMYCIN/SULFISOXAZOLE |
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PEN VK |
PENICILLIN V POTASSIUM |
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PEPCID |
FAMOTIDINE |
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PEPTO-BISMOL * |
BISMUTH SUBSALICYLATE |
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PERCOCET |
OXYCODONE/ACETAMINOPHEN QL maximum 100 per 30 days |
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PERCODAN |
OXYCODONE/ASPIRIN QL maximum 100 per 30 days |
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PERMAX |
PERGOLIDE MESYLATE |
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PERSANTINE |
DIPYRIDAMOLE |
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PHENERGAN |
PROMETHAZINE all forms except cough and cold combinations |
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PHENOBARBITAL * |
PHENOBARBITAL all forms |
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PHOSLO |
CALCIUM ACETATE |
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PHOSPHOLINE |
ECHOTHIOPHATE IODIDE |
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PIPERAZINE |
PIPERAZINE CITRATE |
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PIPRACIL |
PIPERACILLIN |
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PLAQUENIL |
HYDROXYCHLOROQUINE |
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PLAN B |
LEVONORGESTREL |
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PLAVIX |
CLOPIDOGREL Code 1 for stent replacement or intolerance or failure to aspirin |
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POLY-PRED |
NEOMYCIN/POLYMYXIN/PREDNISOLONE |
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POLYSPORIN OPHT |
POLYMYXIN B SULFATE/BACITRACIN drops and ointment |
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POLY-VI-FLOR |
MULTIVITAMINS W/FLUORIDE restricted to children 8 yrs old and younger |
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PRANDIN |
REPAGLINIDE |
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PRAVACHOL |
PRAVASTATIN |
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PRED FORTE, PRED MILD |
PREDNISOLONE ACETATE |
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PRELONE |
PREDNISOLONE |
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PRENAVITE |
PRENATAL VITAMINS |
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PREVACID |
LANSOPRAZOLE |
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PREVEN |
LEVONORGESTREL/ETHINYL ESTRADIOL |
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PRILOSEC 10 & 20mg * |
OMEPRAZOLE QL maximum 2 TABLETS PER DAY |
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PRIMAQUINE |
PRIMAQUINE |
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PRINIVIL |
LISINOPRIL |
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PRINIZIDE |
LISINOPRIL/HYDROCHLOROTHIAZIDE |
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PROCARDIA XL |
NIFEDIPINE XL |
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PROGESTERONE INJ |
PROGESTERONE |
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PROLOPRIM |
TRIMETHOPRIM |
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PRONESTYL |
PROCAINAMIDE |
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PROPYLTHIOURACIL |
PROPYLTHIOURACIL, PTU |
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PROSCAR |
FINASTERIDE 5 mg |
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PROSTIGMIN |
NEOSTIGMINE BROMIDE |
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PROTAMINE |
PROTAMINE SULFATE |
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PROTONIX |
PANTOPRAZOLE |
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PROVENTIL |
ALBUTEROL all generic forms |
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PROVERA |
MEDROXYPROGESTERONE |
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PROZAC |
FLUOXETINE restricted to 10mg & 20mg capsules only |
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PULMICORT |
BUDESONIDE TAR for nebs if 6 YO or older |
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PYRAZINAMIDE |
PYRAZINAMIDE |
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PYRIDIUM |
PHENAZOPYRIDINE |
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Q (top) |
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QUESTRAN |
CHOLESTYRAMINE/SUCROSE bulk only |
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QUINAGLUTE |
QUINIDINE GLUCONATE |
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QUINAMM |
QUININE SULFATE |
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QUINIDIN |
QUINIDINE SULFATE |
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QVAR |
BECLOMETHASONE DIPROPIONATE |
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R (top) |
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REGLAN |
METOCLOPRAMIDE |
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RELAFEN |
NABUMETONE |
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REMERON |
MIRTAZAPINE |
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RENVELA |
SEVELAMER Code 1 restriction failure/intolerance with Phoslo |
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REQUIP |
ROPINIROLE Not XL |
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RESTORIL * |
TEMAZEPAM 15mg and 30mg strengths only |
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RETROVIR |
ZIDOVUDINE |
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RHINOCORT, |
BUDESONIDE |
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RID * |
PIPERONYL BUTOXIDE/PYRETHRINS |
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RIFADIN |
RIFAMPIN |
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RIFAMATE |
RIFAMPIN/ISONIAZID |
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RIFATER |
RIFAMPIN/ ISONIAZID/PYRAZINAMIDE |
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RILUTEK |
RILUZOLE Code1 treatment of ALS only |
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RIOPAN * |
MAGALDRATE/SIMETHICONE |
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RITALIN |
METHYLPHENIDATE all forms |
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ROBAXIN |
METHOCARBAMOL QL maximum of 50 tabs in 30 days |
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ROBINUL |
GLYCOPYRROLATE |
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ROBITUSSIN * |
GUAIFENESIN |
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ROBITUSSIN DM * |
GUAIFENESIN/DEXTROMETHORPHAN |
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ROBITUSSIN A-C * |
GUAIFENESIN/CODEINE |
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ROCALTROL |
CALCITRIOL |
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ROCEPHIN |
CEFTRIAXONE |
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ROXANOL |
MORPHINE all forms |
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ROXICODONE |
OXYCODONE |
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RYTHMOL |
PROPAFENONE |
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S (top) |
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SANTYL |
COLLAGENASE |
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SELSUN |
SELENIUM SULFIDE |
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SENOKOT * |
SENNA |
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SEPTRA, SEPTRA DS |
SULFAMETHOXAZOLE/TRIMETHOPRIM all forms |
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SEREVENT |
SALMETEROL |
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SERZONE |
NEFAZODONE |
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SILVADENE |
SILVER SULFADIAZINE |
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SINEMET |
CARBIDOPA/LEVODOPA |
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SINEQUAN |
DOXEPIN |
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SODIUM CHLORIDE |
SODIUM CHLORIDE all forms |
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SOLGANAL |
AUROTHIOGLUCOSE |
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SOLU-MEDROL |
METHYLPREDNISOLONE SODIUM SUCCINATE |
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SPECTAZOLE 1% CREAM |
ECONAZOLE NITRATE 1% CREAM |
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SSKI |
POTASSIUM IODIDE |
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STRATTERA |
ATOMEXETINE, ql one capsule per day |
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STREPTOMYCIN |
STREPTOMYCIN |
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STROMECTOL |
IVERMECTIN Code 1 restricted to treatment of resistant lice / scabies |
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SUDAFED * |
PSEUDOEPHEDRINE HCL all forms |
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SULAMYD |
SULFACETAMIDE SODIUM all forms |
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SULTRIN |
SULFATHIAZINE/SULFACETAMIDE/SULFABENZAMIDE |
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SUMYCIN |
TETRACYCLINE |
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SUPRAX |
CEFIXIME Code 1 for otitis media when first line cannot be used or intolerant to Augmentin (suspension only); GC (tablets) |
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SURFAK * |
DOCUSATE CALCIUM |
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SYMBICORT INHALER |
BUDESONIDE/FORMOTEROL |
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SYNALAR |
FLUOCINOLONE ACETONIDE |
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SYNTHROID |
LEVOTHYROXINE |
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T (top) |
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TAGAMET |
CIMETIDINE |
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TAMBOCOR |
FLECAINIDE ACETATE |
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TAPAZOLE |
METHIMAZOLE |
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TAVIST-1 * |
CLEMASTINE FUMARATE |
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TEGRETOL, TEGRETOL XR |
CARBAMAZEPINE |
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TEMOVATE |
CLOBETASOL all forms |
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TENEX |
GUANFACINE |
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TENORMIN |
ATENOLOL |
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TERAZOL * |
TERCONAZOLE |
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THEO-DUR |
THEOPHYLLINE all forms |
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TIGAN |
TRIMETHOBENZAMIDE |
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TIMOPTIC |
TIMOLOL |
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TOBRADEX |
TOBRAMYCIN SULFATE/DEXAMETHASONE |
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TOFRANIL |
IMIPRAMINE HYDROCHLORIDE |
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TOPAMAX |
TOPIRAMATE; use higher strength tablets as appropriate |
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TRANDATE |
LABETOLOL Code 1 restricted to use in pregnancy |
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TRENTAL |
PENTOXIFYLLINE Code 1 restricted to use over 65 years of age diagnosed with intermittent claudication, or diabetics of any age diagnosed with intermittent claudication |
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TRIAVIL |
AMITRIPTYLINE HYDROCHLORIDE/PERPHENAZINE psych exempt |
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TRILEPTAL |
OXCARBAZEPINE |
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TRI-VI-FLOR |
TRIPLE VITAMINS W/FLUORIDE restricted to children 8 yrs old and younger |
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TRI-VI-FLOR/IRON |
TRIPLE VITS W/FLUORIDE & IRON restricted to children 8 yrs old and younger |
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TROJAN * |
CONDOMS, MALE |
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TRUETRACK MONITORS |
GLUCOSE MONITORS |
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TRUETRACK TEST STRIPS |
GLUCOSE TEST STRIPS |
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TRUSOPT |
DORZOLAMIDE |
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TYLENOL * |
ACETAMINOPHEN all forms |
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TYLENOL W/CODEINE |
CODEINE PHOSPHATE/ACETAMINOPHEN 15 & 30 mg codeine only; QL maximum 120 tablets per 30 days |
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U (top) |
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ULTRAM |
TRAMADOL |
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UNIPEN |
NAFCILLIN |
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UNIRETIC |
MOEXIPRIL/HYDROCHLOROTHIAZIDE |
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UNIVASC |
MOEXIPRIL |
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URECHOLINE |
BETHANECHOL CHLORIDE |
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V (top) |
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VALISONE |
BETAMETHASONE VALERATE all forms |
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VALIUM * |
DIAZEPAM |
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VANCENASE |
BECLOMETHASONE all forms of inhalers |
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VANCERIL |
BECLOMETHASONE all forms of inhalers |
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VANCOCIN |
VANCOMYCIN all forms Code 1 failure to first line antibiotics or intolerance |
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VASERETIC |
ENALAPRIL/HYDROCHLOROTHIAZIDE |
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VASOCON-A * |
NAPHAZOLINE HYDROCHLORIDE/ANTAZOLINE |
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VASOTEC |
ENALAPRIL |
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VENTOLIN HFA |
ALBUTEROL HFA |
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VERMOX |
MEBENDAZOLE |
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VIBRAMYCIN |
DOXYCYCLINE HYCLATE |
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VICODIN & VICODIN ES |
HYDROCODONE BITARTRATE/ACETAMINOPHEN 5/500 & 7.5/750 QL maximum. 120 tabs per 30 days |
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VIGAMOX |
MOXIFLOXACIN, ophthalmic only |
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VIRA-A |
VIDARABINE |
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VIROPTIC |
TRIFLURIDINE |
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VISTARIL / ATARAX |
HYDROXYZINE all forms |
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VITAMIN B-1 * |
THIAMINE |
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VITAMIN B-6 * |
PYRIDOXINE |
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VITAMIN B-12 * |
CYANCOCOBALAMIN |
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VITAMIN D * |
ERGOCALCIFEROL |
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VITAMIN E * |
ALPHA-TOCOPHERYL |
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VIVACTIL |
PROTRIPTYLINE |
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VOLTAREN |
DICLOFENAC SODIUM |
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VOSOL |
ACETIC ACID |
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VOSOL HC |
ACETIC ACID/HYDROCORTISONE |
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W (top) |
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WATER |
BACTERIOSTATIC WATER |
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WATER FOR INJECTION |
WATER FOR INJECTION, WFI |
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WELLBUTRIN /SR |
BUPROPION |
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WYCILLIN |
PENICILLIN G PROCAINE |
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WYDASE |
HYALURONIDASE |
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X (top) |
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XALATAN |
LATANOPROST |
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XYLOCAINE |
LIDOCAINE except transdermal patch |
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Z (top) |
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ZADITOR, OTC |
KETOTIFEN, OTC |
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ZANTAC |
RANITIDINE |
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ZARONTIN |
ETHOSUXIMIDE |
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ZAROXOLYN |
METOLAZONE |
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ZERTEC OTC |
CETIRIZINE |
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ZESTRIL/ZESTORETIC |
LISINOPRIL & LISINOPRIL/HYDROCHLOROTHIAZIDE |
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ZITHROMAX |
AZITHROMYCIN |
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ZOCOR |
SIMVASTATIN |
|
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ZOFRAN |
ONDANSETRON QL 12 / Rx |
|
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ZOLOFT |
SERTRALINE |
|
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ZOSTRIX * |
CAPSAICIN |
|
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ZOVIRAX |
ACYCLOVIR all forms |
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ZYBAN |
BUPROPION QL 12 weeks per year and smoking cessation class certificate |
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ZYLOPRIM |
ALLOPURINOL |
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