Formulary Drug Listing Sorted by Generic Name

Effective June 2009

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 Generic Name

Brand Name

(top)

ACETAMINOPHEN all forms *

TYLENOL

Acetaminophen/Caffeine/Butalbital

Fioricet

ACETAZOLAMIDE, tablet only

DIAMOX

ACETIC ACID

VOSOL

ACETIC ACID/ALUMINUM ACETATE all forms *

BUROW’S OTIC

ACETIC ACID/HYDRCORTISONE

VOSOL HC

ACETYLCYSTEINE

MUCOMYST

ACYCLOVIR all forms

ZOVIRAX

ALBUTEROL

VENTOLIN HFA, PROAIR HFA

ALCOHOL SWABS 

B-D SWABS

ALENDRONATE, all

FOSAMAX

ALLOPURINOL

ZYLOPRIM

ALPHA-TOCOPHERYL

VITAMIN E

Aluminum Acetate

Burrow’s Solution

ALUMINUM HYDROXIDE  *

AMPHOJEL

AMIODARONE

CORDARONE

AMITRIPTYLINE 

ELAVIL

AMLODIPINE

NORVASC

AMOXAPINE Code 1 psych 

ASENDIN

AMOXICILLIN

AMOXIL

AMOXICILLIN/CLAVULANATE all forms except XR

AUGMENTIN

AMPHETAMINES/DEXTROAMPHETAMINES  

ADDERALL &
ADDERALL XR

AMPHOTERICIN B INJ

FUNGIZONE

AMPICILLIN SODIUM injection only

OMNIPEN-N

AMYLASE/LIPASE/PROTEASE  

PANCREASE

AMYLASE/LIPASE/PROTEASE/PANCREATIN

CREON

ANTHRALIN

DRITHOCREME

ANTIPYRINE/BENZOCAINE

AURALGAN

Apraclonidine

Iopidine

Artificial Tears

Systane

ASPIRIN  *

BAYER

ASPIRIN/ACETAMINOPHEN/CAFFEINE *

EXCEDRIN MIGRAINE

ATENOLOL

TENORMIN

ATOMEXETINE ql of 1 tablet per day

STRATTERA

Atorvastatin 80mg only, QL use ½ tablet per day when appropriate

Lipitor

ATOVAQUONE Code 1 restricted to use for treatment of mild to moderate
P. carinii pneumonia in patients who are intolerant to TMP/SMX

MEPRON

ATROPINE SULFATE all forms

ATROPINE

AUROTHIOGLUCOSE

SOLGANAL

AZATHIOPRINE

IMURAN

AZITHROMYCIN

ZITHROMAX

 

(top)

BACITRACIN *

BACIGUENT

BACLOFEN Code 1 restricted to use in spasticity resulting from MS or spinal cord injury

LIORESAL

BACTERIOSTATIC WATER FOR INJECTION

BACTERIOSTATIC WATER

BECLOMETHASONE all forms of inhalers

QVAR, VANCERIL, VANCENASE

BELLADONNA ALKALOIDS/PHENOBARBITAL

DONNATAL

BENAZEPRIL

LOTENSIN

BENAZEPRIL/HYDROCHLOROTHIAZIDE

LOTENSIN HCT

BENZOYL PEROXIDE

BENZAC

BENZTROPINE

COGENTIN

BETAMETHASONE DIPROPIONATE all forms

DIPROSONE

BETAMETHASONE VALERATE all forms

VALISONE

BETAXOLOL

BETOPTIC

BETHANECHOL CHLORIDE

URECHOLINE

BISACODYL all forms *

DULCOLAX

BISMUTH SUBSALICYLATE *

PEPTO-BISMOL

BREATH FLOW METER  *

ASSESS

BRIMONIDINE TARTRATE

ALPHAGAN

BROMOCRIPTINE MESYLATE

PARLODEL

BUDESONIDE

PULMICORT TAR for nebs if 6 YO or older

BUDESONIDE/FORMOTEROL

SYMBICORT INHALER

BUMETANIDE

BUMEX

BUPROPION  all forms, Zyban maximum 12 weeks per year and smoking cessation class certificate

WELLBUTRIN /ZYBAN

BUSPIRONE psych exempt

BUSPAR

BUTOCONAZOLE

FEMSTAT

(top)

CALAMINE *

CALAMINE

CALCITONIN all forms

CALCIMAR

CALCITRIOL

ROCALTROL

CALCIUM all forms that have a generic available *

OSCAL

CALCIUM ACETATE

PHOSLO

CALCIUM ACETATE/ALUMINUM SULFATE all forms  *

DOMEBORO

CALCIUM/VITAMIN D all forms that have a generic available *

OSCAL-D

CAPSAICIN *

ZOSTRIX

CAPTOPRIL

CAPOTEN

CARBACHOL 

ISOPTO CARBACHOL

CARBAMAZEPINE

CARBATROL, TEGRETOL, TEGRETOL XR

CARBIDOPA/LEVODOPA

SINEMET

CARMUSTINE

BICNU

CARVEDILOL (notCR) Code 1 restricted to treatment of CHF

COREG

Cefaclor

Ceclor

CEFAZOLIN

ANCEF, KEFZOL

CEFIXIME Code 1 for otitis media when first line cannot be used or intolerant to Augmentin (suspension only); GC (tablets)

SUPRAX

CEFDINIR, suspension only

OMNICEF

CEFTRIAXONE

ROCEPHIN

CEFUROXINE Code 1 restricted to 2nd line for sinusitis, otitis media and CAP up to a maximum of 250 mg per dose

CEFTIN

CEPHALEXIN

KEFLEX

CETIRIZINE

ZYRTEC OTC

CHLORAL HYDRATE syrup, for pediatric use only

NOCTEC

CHLOROQUINE HCL

ARALEN

CHLORPHENIRAMINE *

CHLOR-TRIMETON

CHLORPROPAMIDE

DIABENESE

CHOLESTYRAMINE/SUCROSE bulk powder only

QUESTRAN

CIMETIDINE

TAGAMET

CIPROFLOXACIN

CIPRO

CIPROFLOXACIN ophthalmic AND otic

CILOXAN, CIPRO-HC

CIPROFLOXACIN/DEXAMETHASONE OTIC

CIPRO-DEX

CITALOPRAM

CELEXA

CLARITHROMYCIN

BIAXIN

CLEMASTINE FUMARATE *

TAVIST-1

CLINDAMYCIN HYDROCHLORIDE

CLEOCIN

CLINDAMYCIN PHOSPHATE

CLEOCIN

CLINDAMYCIN TOPICAL SOLUTION

CLEOCIN

CLOFAZIMINE

LAMPRENE

CLOMIPRAMINE

ANAFRANIL

CLONAZEPAM

KLONOPIN

CLONIDINE all forms

CATAPRES

CLOPIDOGREL Code 1 for stent replacement or intolerance or failure to aspirin

PLAVIX

CLOTRIMAZOLE *

LOTRIMIN

COAL TAR SOLUTION

COAL TAR

CODEINE all forms

CODEINE

CODEINE PHOSPHATE/ACETAMINOPHEN 15 mg & 30 mg only, QL maximum 120 tablets per 30 days

TYLENOL W/CODEINE

COLCHICINE

COLCHICINE

COLCHICINE/PROBENECID 

COLBENEMID

COLESTIPOL bulk

COLESTID

COLLAGENASE

SANTYL

CONDOMS, MALE *

TROJAN

CORTISONE

CORTONE

CROMOLYN all forms

INTAL,CROLOM

CROTAMITON

EURAX

CYANCOCOBALAMIN *

VITAMIN B-12

CYCLOBENZAPRINE

FLEXERIL

CYCLOPENTOLATE

CYCLOGYL

(top)

 

DAPSONE

DAPSONE

DESIPRAMINE

NORPRAMIN

DESMOPRESSIN ACETATE

DDAVP

DESONIDE

DESOWEN

DEXAMETHASONE

DECADRON

DEXAMETHASONE SODIUM PHOSPHATE

DECADRON PHOSPHATE

DEXTROAMPHETAMINE SULFATE

DEXEDRINE

DEXTROSE SOLUTION

DEXTROSE

DIABETIC SUPPLIES

ONE TOUCH, B-D

DIAPHRAGM

ORTHO-DIAPHRAGM

DIAZEPAM

VALIUM

DICLOFENAC/MISOPROSTOL

ARTHROTEC

DICLOFENAC SODIUM

VOLTAREN

DICLOXACILLIN

DYNAPEN

DICYCLOMINE

BENTYL

Didanosine

Videx

DIETHYLSTILBESTROL

STILPHOSTROL

DIGOXIN

LANOXIN

DIHYDROTACHYSTEROL

DHT

DILTIAZEM all forms

CARDIZEM

DIMENHYDRINATE *

DRAMAMINE

DIPHENHYDRAMINE

BENADRYL

DIPHENOXYLATE/ATROPINE SULFATE

LOMOTIL

Dipivefrin

Propine

DIPYRIDAMOLE

PERSANTINE

DISOPYRAMIDE

NORPACE

DISULFIRAM

ANTABUSE

DIVALPROEX SODIUM (notER)

DEPAKOTE

DOCUSATE CALCIUM *

SURFAK

DOCUSATE SODIUM *

COLACE

DOLASETRON MESYLATE

ANZEMET

DORZOLAMIDE

TRUSOPT

DORZOLAMIDE/TIMOLOL

COSOPT

DOXEPIN

SINEQUAN

DOXYCYCLINE HYCLATE

VIBRAMYCIN

(top)

ECHOTHIOPHATE IODIDE

PHOSPHOLINE

ECONAZOLE NITRATE 1% CREAM

SPECTAZOLE 1% CREAM

ENALAPRIL

VASOTEC

ENALAPRIL/HYDROCHLOROTHIAZIDE

VASERETIC

ENOXAPARIN QL maximum 14 days

LOVENOX

ENTACAPONE

COMTAN

Epinephrine

Epipen

ERGOCALCIFEROL *

VITAMIN D

ERGOLOID MESYLATES

HYDERGINE

ERGONOVINE

ERGOTRATE

ERGOTAMINE

ERGOSTAT

ERGOTAMINE TARTRATE/CAFFEINE

CAFERGOT

ERGOTAMINE/CAFFEINE/BELLADONNA/PHENOBARBITAL  

CAFERGOT PB

ERYTHROMYCIN BASE

ERY-TAB

ERYTHROMYCIN ETHYLSUCCINATE

E.E.S

ERYTHROMYCIN OPHTHALMIC

ILOTYCIN

ERYTHROMYCIN STEARATE

ERYTHROCIN STEARATE

ERYTHROMYCIN/ethylsuccinate/SULFISOXAZOLE 

PEDIAZOLE

ESTRADIOL CYPIONATE

DEPO-ESTRADIOL

ESTRADIOL

ESTRACE

ETHAMBUTOL

MYAMBUTOL

ETHIONANIDE

TRECATOR-SC

ETHOSUXIMIDE

ZARONTIN

ETIDRONATE

DIDRONEL

ETODOLAC

LODINE

ETONOGESTREL/ETHINYL ESTRADIOL

NUVARING

 

 

 

 

F  (top)

FAMOTIDINE

PEPCID

FERROUS GLUCONATE *

FERGON

FERROUS SULFATE *

FER-IN-SOL

FINASTERIDE 5 mg only

PROSCAR

FLECAINIDE ACETATE

TAMBOCOR

FLUCONAZOLE  

DIFLUCAN

FLUCYTOSINE

ANCOBON

FLUDROCORTISONE

FLORINEF

FLUNISOLIDE

AEROBID

FLUNISOLIDE

NASAREL

FLUOCINONIDE

LIDEX

FLUOCINOLONE ACETONIDE

SYNALAR

FLUOROMETHOLONE

FML

FLUOROURACIL

EFUDEX

FLUOXETINE

PROZAC

FLURAZEPAM

DALMANE

FLUTICASONE

FLOVENT

FLUTICASONE PROPIONATE

FLONASE

FLUTICASONE/SALMETEROL

ADVAIR

FOLIC ACID  *

FOLIC ACID

FOSINOPRIL

MONOPRIL

FURAZOLIDONE

FUROXONE

FUROSEMIDE

LASIX

(top) 

GABAPENTIN

NEURONTIN

GEMFIBROZIL

LOPID

GENTAMICIN all forms

GARAMYCIN

GLIMEPIRIDE

AMARYL

GLIPIZIDE XL requires TAR

GLUCOTROL

GLUCAGON 1 mg emergency kit

GLUCAGON

GLUCOSE MONITORS $100.00 maximum 

TRUETRACK or TrueTest

GLUCOSE TESTING STRIPS (BLOOD)

TRUETRACK or TrueTest

GLUCOSE TESTING STRIPS (URINE)

CLINISTIX

GLUCOSE/KETONE TEST COMBO (URINE)

KETO-DIASTIX

GLYBURIDE

MICRONASE

GLYCERIN/HYDROXYETHYLCELLULOSE  *

K-Y JELLY

GLYCERIN SUPPOSITORIES  *

GLYCERIN

GLYCOPYRROLATE

ROBINUL

GOLD SODIUM THIOMALATE

MYOCHRYSINE

GRANISETRON QL 6 per Rx

KYTRIL

GRISEOFULVIN

FULVICIN

GUAIFENESIN *

ROBITUSSIN

GUAIFENESIN/CODEINE *

ROBITUSSIN A-C

GUAIFENESIN/DEXTROMETHORPHAN  *

ROBITUSSIN DM

GUANFACINE 

TENEX

(top)

HEPARIN SODIUM

HEPARIN

HOMATROPINE HBR

ISOPTO HOMATROPINE

HYDRALAZINE

APRESOLINE

HYDROCHLOROTHIAZIDE tablets only

HYDRODIURIL

HYDROCODONE BITARTRATE/ACETAMINOPHEN 5/500 & 7.5 750, QL maximum 120 tablets per 30 days

VICODIN & VICODIN ES

HYDROCODONE BITARTRATE/ACETAMINOPHEN 10/325, QL maximum 120 tablets per 30 days

NORCO

HYDROCODONE BITARTRATE/ACETAMINOPHEN 10/650 & 10/500, QL maximum 120 tablets per 30 days

LORCET & LORTAB

HYDROCORTISONE all forms

HYDROCORTISONE

Hydrocortisone/Polymyxin/Neomycin, ear and eye only

Cortisporin

HYDROMORPHONE all forms

DILAUDID

HYDROXYCHLOROQUINE

PLAQUENIL

HYDROXYPROPYLMETHYLCELLULOSE

ISOPTO ALKALINE

HYDROXYZINE all forms

ATARAX, VISTARIL

(top)

IBUPROFEN all forms

MOTRIN

IMIPRAMINE HCL

TOFRANIL

IMIQUIMOD

ALDARA

INDOMETHACIN Code 1 intractable spondylitis; severe acute inflammatory process

INDOCIN

INHALER DEVICE *

AEROCHAMBER

INSULIN all forms, vials only

 

INSULIN SYRINGES/NEEDLES

B-D SYRINGES, NEEDLES

IPRATROPIUM

ATROVENT

IPRATROPIUM/ALBUTEROL

COMBIVENT

IPRATROPIUM NASAL SPRAY

ATROVENT NASAL SPRAY

IRON DEXTRAN COMPLEX

INFED

ISONIAZID

INH

ISOMETHEPTENE/DICHL0RALPHENAZONE/ACETAMINOPHEN

MIDRIN

ISOSORBIDE DINITRATE

ISORDIL

IVERMECTIN Code 1 restricted to treatment of resistant lice / scabies

STROMECTOL

(top)

Kaolin/Pectin

Kaopectolin

KETOCONAZOLE all forms except 2% shampoo

NIZORAL

KETONE TESTING PRODUCTS

ACETEST

KETOPROFEN

ORUDIS

KETOROLAC TROMETHAMINE, ophthalmic solution only

ACULAR

KETOTIFEN, OTC

ZADITOR, OTC

L   (top)

LABETOLOL Code 1 restricted to use during pregnancy

TRANDATE & NORMODYNE

LACTULOSE

CEPHULAC

LAMOTRIGINE QL of ½ scored tablet per dose when appropriate

LAMICTAL

LATANOPROST

XALATAN

LEUCOVORIN

LEUCOVORIN

LEVAMISOLE

ERGAMISOL

LEVETIRACETAM

KEPPRA

LEVOBUNOLOL

BETAGAN

LEVOCARNITINE

CARNITOR

LEVODOPA

LARODOPA

LEVOFLOXACIN Code 1 age > 50 years. and lower respiratory infection

LEVAQUIN

LEVONORGESTREL

PLAN B

LEVONORGESTREL long acting

NORPLANT

LEVONORGESTREL/ETHINYL ESTRADIOL

PREVEN

LEVOTHYROXINE SODIUM

SYNTHROID

LIDOCAINE  all forms except transdermal patch

XYLOCAINE

LIOTHYRONINE

CYTOMEL

LISINOPRIL

PRINIVIL, ZESTRIL

LISINOPRIL/HYDROCHLOROTHIAZIDE

PRINIZIDE, ZESTORETIC

LOPERAMIDE *

IMODIUM

LORATIDINE *

CLARITIN

LORAZEPAM *

ATIVAN

Losartan ST T/F or intolerance to ACE inhibitor

Cozaar

Losartan/hydrochlorothiazide ST T/F or intolerance to ACE inhibitor 

Hyzaar

LOVASTATIN

MEVACOR

(top)

MAGALDRATE/SIMETHICONE  *

RIOPAN

MAGNESIUM HYDROXIDE *

MILK OF MAGNESIA

MAGNESIUM HYDROXIDE/ALUMINUM HYDROXIDE *

MAALOX

MAGNESIUM OXIDE Code 1 restricted to renal failure *

MAG-OXIDE

MALATHION

OVIDE

MAPROTILINE psych exempt   

LUDIOMIL

MEBENDAZOLE

VERMOX

MECLIZINE *

ANTIVERT

MEDROXYPROGESTERONE

DEPO-PROVERA, PROVERA

MEDROXYPROGESTERONE/ESTRADIOL CYPIONATE

LUNELLE

MELOXICAM

MOBIC

MEPERIDINE

DEMEROL

MESALAMINE Code 1 restricted to intolerance or unresponsive to sulfasalzine

ASACOL

METAPROTERENOL

ALUPENT

METFORMIN 

GLUCOPHAGE

METHADONE QL maximum 90 day supply per fill

DOLOPHINE

METHENAMINE HIPPURATE

HIPREX

METHENAMINE MANDELATE

MANDELAMINE

METHIMAZOLE

TAPAZOLE

METHOCARBAMOL QL maximum 50 tablets per 30 days

ROBAXIN

METHOTREXATE

METHOTREXATE

METHSUXIMIDE

CELONTIN

METHYLDOPA

ALDOMET

METHYLERGONOVINE

METHERGINE

METHYLPHENIDATE all forms

RITALIN

METHYLPHENIDATE all sustained release forms, limited to 1 daily

CONCERTA, METADATE

METHYLPREDNISOLONE all forms

MEDROL

METHYLPREDNISOLONE SODIUM SUCCINATE

SOLU-MEDROL

METHYLTESTOSTERONE

ANDROID

METIPRANOLOL

OPTIPRANOLOL

METOCLOPRAMIDE

REGLAN

METOLAZONE

ZAROXOLYN

METOPROLOL TARTRATE

LOPRESSOR

METRONIDAZOLE    

FLAGYL

METRONIDAZOLE

METROGEL

MEXILETINE

MEXITIL

MICONAZOLE NITRATE *

MONISTAT

MINOCYCLINE

MINOCIN

MINOXIDIL   

LONITEN

MIRTAZAPINE

REMERON

MISOPROSTOL

CYTOTEC

MOEXIPRIL 

UNIVASC

MOEXIPRIL/HYDROCHLOROTHIAZIDE

UNIRETIC

MOMETASONE FUROATE, for children under 4 YO only

ASMANEX, NASONEX

Montelukast ST dx asthma in pts already on ICS or Advair;  dx allergic rhinitis with T/F of NSA + nasal steroid

Singulair

MORPHINE SULFATE all forms of generic

ROXANOL, MS CONTIN

MOXIFLOXACIN, ophthalmic only

VIGAMOX

MULTIVITAMINS W/FLUORIDE

POLY-VI-FLOR

MUPIROCIN  OINTMENT ONLY

BACTROBAN

(top)

Nabumetone

Relafen

Naphazoline

Ak-Con

NAPHAZOLINE HYDROCHLORIDE/ANTAZOLINE  *

VASOCON-A

NAPHAZOLINE HYDROCHLORIDE/PHENIRAMINE  *

NAPHCON-A

NAPROXEN

NAPROSYN

NAPROXEN SODIUM

ANAPROX

NATAMYCIN

NATACYN

NEFAZODONE maximum 2 tablets per day lower strengths

SERZONE

Neomycin/polymyxin/bacitracin

Neosporin

NEOMYCIN/POLYMYXIN/PREDNISOLONE

POLY-PRED

NEOSTIGMINE BROMIDE

PROSTIGMIN

NIACIN all forms

NIACIN, NIASPAN

NICLOSAMIDE

NICLOCIDE

NICOTINE PATCH QL 12 weeks per 365 days and smoking cessation class certificate *

NICOTROL

NICOTINE POLACRILEX QL 12 weeks per 365 days and smoking cessation class certificate*e

NICORETTE

NIFEDIPINE SR

ADALAT CC

NITROFURANTOIN all forms

FURADANTIN

NITROFURANTOIN/NITROFURAN MACROCRYSTALS

MACROBID

NITROGLYCERIN all tablets, capsules, and ointment

NITROGLYCERIN

NONOXYNOL 9   *

CONCEPTROL

NORELGESTROMIN/ETHINYL ESTRADIOL

ORTHO EVRA

NORTRIPTYLINE

PAMELOR

NYSTATIN

MYCOSTATIN

NYSTATIN/TRIAMCINOLONE

MYCOLOG II

(top)

OCTOXYNOL 9 *

ORTHO-GYNOL

OFLOXACIN OTIC & tablets Code 1 restricted to use in the treatment of PID, GC, UTI, polymicrobial skin and  febrile GI or blood infections when other first line antibiotics cannot be used

FLOXIN

OMERPRAZOLE 10 & 20 mg QL 2 TABLETS/DAY *

PRILOSEC

ONDANSETRON QL 12 / Rx

ZOFRAN

Oseltamivir QL 5 day course x 2

Tamiflu

OXCARBAZEPINE

TRILEPTAL

OXYBUTYNIN

DITROPAN

Oxybutynin XL Code 1 specialist

Ditropan XL

OXYCODONE

ROXICODONE

OXYCODONE/ACETAMINOPHEN QL maximum 100 per 30 days

PERCOCET

OXYCODONE/ASPIRIN QL maximum 100 per 30 days

PERCODAN

(top)

PAROXETINE

PAXIL

PENICILLIN G PROCAINE & BENZATHINE

WYCILLIN

PENICILLIN V POTASSIUM

PEN VK

PENTAMIDINE Code1 HIV history of PCP or with CD4(T4) lymphocycte count < 200 cells/mm3

PENTAM 300

PENTOXIFYLLINE Code1 restricted to use over 65years of age diagnosed with intermittent claudication, or diabetics of any age diagnosed with intermittent claudication

TRENTAL

 

MIRALAX POWDER

PEG 3350/ELECTROLYTES

COLYTE/GOLYTELY

PERMETHRIN

ELIMITE

PHENAZOPYRIDINE

PYRIDIUM

PHENOBARBITAL all forms *

PHENOBARBITAL

PHENYTOIN SODIUM

DILANTIN

PHYTONADIONE *

MEPHYTON

PILOCARPINE HYDROCHLORIDE

ISOPTO CARPINE

PIOGLITAZONE ST T/F of metformin or sulfonylurea

ACTOS

PIPERONYL BUTOXIDE/PYRETHRINS *

RID

PIRBUTEROL

MAXAIR

PIROXICAM

FELDENE

PODOFILOX gel only

CONDYLOX

POLYMYXIN B SULFATE/BACITRACIN drops and ointment *

POLYSPORIN

Polymyxin/TMP

Polytrim

POTASSIUM CHLORIDE all forms

K-DUR

POTASSIUM IODIDE

SSKI

POVIDONE-IODINE 10% solution only *

BETADINE

PRAMIPREXOLE

MIRAPEX

PRAMIPEXOLE DIHYDROCHLORIDE

MIRAPEX

Pravastatin

Pravachol

PRAZOSIN

MINIPRESS

PREDNICARBATE all forms

DERMATOP

PREDNISOLONE

PRELONE

PREDNISOLONE ACETATE

PRED FORTE, PRED MILD

PREDNISONE

PREDNISONE

PRENATAL VITAMINS

PRENAVITE

PRIMAQUINE

PRIMAQUINE

PRIMIDONE

MYSOLINE

PROBENECID

BENEMID

PROCAINAMIDE

PRONESTYL

PROCHLORPERAZINE MALEATE all forms

COMPAZINE

PROGESTERONE inj

PROGESTERONE INJ

PROMETHAZINE all forms except cough and cold combinations

PHENERGAN

PROPAFENONE

RYTHMOL

PROPOXYPHENE NAPSYLATE/ACETAMINOPHEN QL maximum 50 tablets per 30 days

DARVOCET-N 100

PROPRANOLOL all forms

INDERAL, INDERAL LA

PROPYLTHIOURACIL, PTU

PROPYLTHIOURACIL  

PROTRIPTYLINE

VIVACTIL

PSEDUOEPHEDRINE/BROMPHENIRAMINE *

DIMETAPP

PSEUDOEPHEDRINE HYDROCHLORIDE all forms *

SUDAFED

PSEUDOEPHEDRINE /TRIPROLIDINE *

ACTIFED

PYRANTEL

ANTIMINTH

PYRAZINAMIDE

PYRAZINAMIDE

PYRIDOSTIGMINE

MESTINON

PYRIDOXINE *

VITAMIN B-6

PYRIMETHAMINE

DARAPRIM

(top)

QUINAPRIL

ACCUPRIL

QUINIDINE GLUCONATE

QUINAGLUTE

QUINIDINE SULFATE

QUINIDIN

(top)

RALOXIFENE

EVISTA

RAMIPRIL

ALTACE

RANITIDINE

ZANTAC

RIFABUTIN Code 1 for use in prevention of MAC disease in advanced HIV infection

MYCOBUTIN

RIFAMPIN

RIFADIN

RIFAMPIN/ISONIAZID

RIFAMATE

RIFAMPIN/ISONIAZID /PYRAZINAMIDE

RIFATER

RILUZOLE Code 1 treatment of ALS only

RILUTEK

ROPINIROLE

REQUIP not XL

ROSIGLITAZONE

AVANDIA

(top)

SALMETEROL

SEREVENT

SALSALATE

DISALCID

SELEGILINE

ELDEPRYL

SELENIUM SULFIDE

SELSUN

SENNA *

SENOKOT

SERTRALINE

ZOLOFT

SEVELAMER Code 1 treatment failure to Phoslo

RENAGEL

SILVER SULFADIAZINE

SILVADENE

SIMVASTATIN

ZOCOR

SODIUM FLUORIDE

LURIDE

SODIUM PHOSPHATE/SODIUM BIPHOSPHATE *

FLEET’S ENEMA

SODIUM POLYSTYRENE SULFONATE

KAYEXALATE

SOTALOL

BETAPACE

SPIRONOLACTONE

ALDACTONE

SPIRONOLACTONE/HYDROCHLOROTHIAZIDE

ALDACTAZIDE

STREPTOMYCIN

STREPTOMYCIN

SUCRALFATE

CARAFATE

SULFAMETHOXAZOLE/TRIMETHOPRIM all forms

SEPTRA, SEPTRA DS

SULFACETAMIDE/PREDNISOLONE ACETATE

BLEPHAMIDE

SULFACETAMIDE SODIUM all forms

SULAMYD

SULFATHIAZINE/SULFACETAMIDE/SULFABENZAMIDE

SULTRIN

SULFASALAZINE

AZULFIDINE

SULFISOXAZOLE

GANTRISIN

SULINDAC

CLINORIL

SUMATRIPTAN QL maximum 2 syringes per 30 days - 9 tablets per 30 days - 2 spray cartons per 30 days

IMITREX

T (top)

TAMOXIFEN

NOLVADEX

TAMSULOSIN

FLOMAX

TEMAZEPAM (not 7.5MG) 15mg and 30 mg strengths only

RESTORIL

TERAZOSIN

HYTRIN

TERBINAFINE 250MG tab and 1% cream

LAMASIL AT

TERBUTALINE SULFATE

BRETHINE, BRICANYL

TERCONAZOLE *

TERAZOL

TESTOSTERONE all forms of injections

DEPO-TESTOSTERONE

TETRACYCLINE

SUMYCIN

THEOPHYLLINE all forms

THEO-DUR

THIABENDAZOLE

MINTEZOL

THIAMINE *

VITAMIN B-1

Thyroid, dessicated

Armour

TIMOLOL 

TIMOPTIC

TIOTROPIUM

SPIRIVA

TOBRAMYCIN 

NEBCIN

TOBRAMYCIN SULFATE/DEXAMETHASONE

TOBRADEX

Tolnaftate

Tinactin

TOLTERODINE TARTRATE (not LA)

DETROL

TOPIRAMATE; use higher strength tablets as appropriate

TOPAMAX

TORSEMIDE

DEMADEX

TRANDOLAPRIL

MAVIK

TRAZODONE

DESYREL

TRIAMCINOLONE ACETONIDE all forms

KENALOG

TRIAMCINOLONE ACETONIDE

AZMACORT

TRIAMCINOLONE DIACETATE

ARISTOCORT

TRIAMTERENE

DYRENIUM

Triamterene/hydrochlorothiazide (all forms)

Dyazide

TRIFLURIDINE

VIROPTIC

TRIMETHOBENZAMIDE

TIGAN

TRIMETHOPRIM

PROLOPRIM

TRIPLE VITAMINS W/FLUORIDE Code 1 for children under 8 years old

TRI-VI-FLOR

TRIPLE VITS W/FLUORIDE & IRON Code 1 for children under 8 years old

TRI-VI-FLOR/IRON

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URSODIOL

ACTIGALL

V  (top)

VALPROIC ACID

DEPAKENE

VANCOMYCIN all forms Code 1 failure to first line antibiotics or intolerance

VANCOCIN

VARENICLINE up to 6 months without TAR

CHANTIX

VENLAFAXINE, TABLETS ONLY (XR requires TAR)

EFFEXOR

VERAPAMIL

CALAN

VITAMIN B COMBINATION/VITAMIN C/FOLIC ACID Code 1 restricted to renal failure *

NEPHRO-VITE

(top)

WARFARIN SODIUM

COUMADIN

 

 

(top)

Zanamivir QL 5 day course x 2

Relenza

ZIDOVUDINE

RETROVIR

ZOLPIDEM (not CR)

AMBIEN (generic)

ZONISAMIDE

ZONEGRAN