Formulary Drug Listing Sorted by Generic NameEffective June 2009 |
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Generic Name |
Brand Name |
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A (top) |
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ACETAMINOPHEN all forms * |
TYLENOL |
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Acetaminophen/Caffeine/Butalbital |
Fioricet |
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ACETAZOLAMIDE, tablet only |
DIAMOX |
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ACETIC ACID |
VOSOL |
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ACETIC ACID/ALUMINUM ACETATE all forms * |
BUROW’S OTIC |
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ACETIC ACID/HYDRCORTISONE |
VOSOL HC |
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ACETYLCYSTEINE |
MUCOMYST |
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ACYCLOVIR all forms |
ZOVIRAX |
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ALBUTEROL |
VENTOLIN HFA, PROAIR HFA |
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ALCOHOL SWABS |
B-D SWABS |
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ALENDRONATE, all |
FOSAMAX |
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ALLOPURINOL |
ZYLOPRIM |
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ALPHA-TOCOPHERYL |
VITAMIN E |
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Aluminum Acetate |
Burrow’s Solution |
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ALUMINUM HYDROXIDE * |
AMPHOJEL |
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AMIODARONE |
CORDARONE |
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AMITRIPTYLINE |
ELAVIL |
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AMLODIPINE |
NORVASC |
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AMOXAPINE Code 1 psych |
ASENDIN |
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AMOXICILLIN |
AMOXIL |
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AMOXICILLIN/CLAVULANATE all forms except XR |
AUGMENTIN |
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AMPHETAMINES/DEXTROAMPHETAMINES |
ADDERALL & |
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AMPHOTERICIN B INJ |
FUNGIZONE |
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AMPICILLIN SODIUM injection only |
OMNIPEN-N |
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AMYLASE/LIPASE/PROTEASE |
PANCREASE |
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AMYLASE/LIPASE/PROTEASE/PANCREATIN |
CREON |
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ANTHRALIN |
DRITHOCREME |
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ANTIPYRINE/BENZOCAINE |
AURALGAN |
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Apraclonidine |
Iopidine |
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Artificial Tears |
Systane |
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ASPIRIN * |
BAYER |
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ASPIRIN/ACETAMINOPHEN/CAFFEINE * |
EXCEDRIN MIGRAINE |
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ATENOLOL |
TENORMIN |
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ATOMEXETINE ql of 1 tablet per day |
STRATTERA |
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Atorvastatin 80mg only, QL use ½ tablet per day when appropriate |
Lipitor |
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ATOVAQUONE Code 1 restricted to use for treatment
of mild to moderate |
MEPRON |
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ATROPINE SULFATE all forms |
ATROPINE |
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AUROTHIOGLUCOSE |
SOLGANAL |
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AZATHIOPRINE |
IMURAN |
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AZITHROMYCIN |
ZITHROMAX |
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B (top) |
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BACITRACIN * |
BACIGUENT |
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BACLOFEN Code 1 restricted to use in spasticity resulting from MS or spinal cord injury |
LIORESAL |
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BACTERIOSTATIC WATER FOR INJECTION |
BACTERIOSTATIC WATER |
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BECLOMETHASONE all forms of inhalers |
QVAR, VANCERIL, VANCENASE |
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BELLADONNA ALKALOIDS/PHENOBARBITAL |
DONNATAL |
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BENAZEPRIL |
LOTENSIN |
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BENAZEPRIL/HYDROCHLOROTHIAZIDE |
LOTENSIN HCT |
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BENZOYL PEROXIDE |
BENZAC |
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BENZTROPINE |
COGENTIN |
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BETAMETHASONE DIPROPIONATE all forms |
DIPROSONE |
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BETAMETHASONE VALERATE all forms |
VALISONE |
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BETAXOLOL |
BETOPTIC |
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BETHANECHOL CHLORIDE |
URECHOLINE |
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BISACODYL all forms * |
DULCOLAX |
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BISMUTH SUBSALICYLATE * |
PEPTO-BISMOL |
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BREATH FLOW METER * |
ASSESS |
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BRIMONIDINE TARTRATE |
ALPHAGAN |
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BROMOCRIPTINE MESYLATE |
PARLODEL |
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BUDESONIDE |
PULMICORT TAR for nebs if 6 YO or older |
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BUDESONIDE/FORMOTEROL |
SYMBICORT INHALER |
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BUMETANIDE |
BUMEX |
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BUPROPION all forms, Zyban maximum 12 weeks per year and smoking cessation class certificate |
WELLBUTRIN /ZYBAN |
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BUSPIRONE psych exempt |
BUSPAR |
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BUTOCONAZOLE |
FEMSTAT |
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C (top) |
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CALAMINE * |
CALAMINE |
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CALCITONIN all forms |
CALCIMAR |
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CALCITRIOL |
ROCALTROL |
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CALCIUM all forms that have a generic available * |
OSCAL |
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CALCIUM ACETATE |
PHOSLO |
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CALCIUM ACETATE/ALUMINUM SULFATE all forms * |
DOMEBORO |
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CALCIUM/VITAMIN D all forms that have a generic available * |
OSCAL-D |
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CAPSAICIN * |
ZOSTRIX |
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CAPTOPRIL |
CAPOTEN |
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CARBACHOL |
ISOPTO CARBACHOL |
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CARBAMAZEPINE |
CARBATROL, TEGRETOL, TEGRETOL XR |
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CARBIDOPA/LEVODOPA |
SINEMET |
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CARMUSTINE |
BICNU |
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CARVEDILOL (notCR) Code 1 restricted to treatment of CHF |
COREG |
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Cefaclor |
Ceclor |
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CEFAZOLIN |
ANCEF, KEFZOL |
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CEFIXIME Code 1 for otitis media when first line cannot be used or intolerant to Augmentin (suspension only); GC (tablets) |
SUPRAX |
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CEFDINIR, suspension only |
OMNICEF |
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CEFTRIAXONE |
ROCEPHIN |
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CEFUROXINE Code 1 restricted to 2nd line for sinusitis, otitis media and CAP up to a maximum of 250 mg per dose |
CEFTIN |
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CEPHALEXIN |
KEFLEX |
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CETIRIZINE |
ZYRTEC OTC |
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CHLORAL HYDRATE syrup, for pediatric use only |
NOCTEC |
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CHLOROQUINE HCL |
ARALEN |
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CHLORPHENIRAMINE * |
CHLOR-TRIMETON |
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CHLORPROPAMIDE |
DIABENESE |
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CHOLESTYRAMINE/SUCROSE bulk powder only |
QUESTRAN |
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CIMETIDINE |
TAGAMET |
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CIPROFLOXACIN |
CIPRO |
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CIPROFLOXACIN ophthalmic AND otic |
CILOXAN, CIPRO-HC |
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CIPROFLOXACIN/DEXAMETHASONE OTIC |
CIPRO-DEX |
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CITALOPRAM |
CELEXA |
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CLARITHROMYCIN |
BIAXIN |
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CLEMASTINE FUMARATE * |
TAVIST-1 |
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CLINDAMYCIN HYDROCHLORIDE |
CLEOCIN |
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CLINDAMYCIN PHOSPHATE |
CLEOCIN |
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CLINDAMYCIN TOPICAL SOLUTION |
CLEOCIN |
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CLOFAZIMINE |
LAMPRENE |
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CLOMIPRAMINE |
ANAFRANIL |
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CLONAZEPAM |
KLONOPIN |
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CLONIDINE all forms |
CATAPRES |
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CLOPIDOGREL Code 1 for stent replacement or intolerance or failure to aspirin |
PLAVIX |
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CLOTRIMAZOLE * |
LOTRIMIN |
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COAL TAR SOLUTION |
COAL TAR |
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CODEINE all forms |
CODEINE |
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CODEINE PHOSPHATE/ACETAMINOPHEN 15 mg & 30 mg only, QL maximum 120 tablets per 30 days |
TYLENOL W/CODEINE |
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COLCHICINE |
COLCHICINE |
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COLCHICINE/PROBENECID |
COLBENEMID |
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COLESTIPOL bulk |
COLESTID |
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COLLAGENASE |
SANTYL |
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CONDOMS, MALE * |
TROJAN |
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CORTISONE |
CORTONE |
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CROMOLYN all forms |
INTAL,CROLOM |
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CROTAMITON |
EURAX |
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CYANCOCOBALAMIN * |
VITAMIN B-12 |
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CYCLOBENZAPRINE |
FLEXERIL |
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CYCLOPENTOLATE |
CYCLOGYL |
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D (top) |
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DAPSONE |
DAPSONE |
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DESIPRAMINE |
NORPRAMIN |
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DESMOPRESSIN ACETATE |
DDAVP |
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DESONIDE |
DESOWEN |
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DEXAMETHASONE |
DECADRON |
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DEXAMETHASONE SODIUM PHOSPHATE |
DECADRON PHOSPHATE |
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DEXTROAMPHETAMINE SULFATE |
DEXEDRINE |
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DEXTROSE SOLUTION |
DEXTROSE |
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DIABETIC SUPPLIES |
ONE TOUCH, B-D |
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DIAPHRAGM |
ORTHO-DIAPHRAGM |
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DIAZEPAM |
VALIUM |
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DICLOFENAC/MISOPROSTOL |
ARTHROTEC |
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DICLOFENAC SODIUM |
VOLTAREN |
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DICLOXACILLIN |
DYNAPEN |
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DICYCLOMINE |
BENTYL |
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Didanosine |
Videx |
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DIETHYLSTILBESTROL |
STILPHOSTROL |
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DIGOXIN |
LANOXIN |
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DIHYDROTACHYSTEROL |
DHT |
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DILTIAZEM all forms |
CARDIZEM |
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DIMENHYDRINATE * |
DRAMAMINE |
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DIPHENHYDRAMINE |
BENADRYL |
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DIPHENOXYLATE/ATROPINE SULFATE |
LOMOTIL |
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Dipivefrin |
Propine |
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DIPYRIDAMOLE |
PERSANTINE |
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DISOPYRAMIDE |
NORPACE |
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DISULFIRAM |
ANTABUSE |
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DIVALPROEX SODIUM (notER) |
DEPAKOTE |
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DOCUSATE CALCIUM * |
SURFAK |
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DOCUSATE SODIUM * |
COLACE |
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DOLASETRON MESYLATE |
ANZEMET |
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DORZOLAMIDE |
TRUSOPT |
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DORZOLAMIDE/TIMOLOL |
COSOPT |
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DOXEPIN |
SINEQUAN |
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DOXYCYCLINE HYCLATE |
VIBRAMYCIN |
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E (top) |
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ECHOTHIOPHATE IODIDE |
PHOSPHOLINE |
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ECONAZOLE NITRATE 1% CREAM |
SPECTAZOLE 1% CREAM |
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ENALAPRIL |
VASOTEC |
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ENALAPRIL/HYDROCHLOROTHIAZIDE |
VASERETIC |
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ENOXAPARIN QL maximum 14 days |
LOVENOX |
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ENTACAPONE |
COMTAN |
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Epinephrine |
Epipen |
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ERGOCALCIFEROL * |
VITAMIN D |
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ERGOLOID MESYLATES |
HYDERGINE |
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ERGONOVINE |
ERGOTRATE |
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ERGOTAMINE |
ERGOSTAT |
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ERGOTAMINE TARTRATE/CAFFEINE |
CAFERGOT |
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ERGOTAMINE/CAFFEINE/BELLADONNA/PHENOBARBITAL |
CAFERGOT PB |
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ERYTHROMYCIN BASE |
ERY-TAB |
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ERYTHROMYCIN ETHYLSUCCINATE |
E.E.S |
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ERYTHROMYCIN OPHTHALMIC |
ILOTYCIN |
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ERYTHROMYCIN STEARATE |
ERYTHROCIN STEARATE |
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ERYTHROMYCIN/ethylsuccinate/SULFISOXAZOLE |
PEDIAZOLE |
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ESTRADIOL CYPIONATE |
DEPO-ESTRADIOL |
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ESTRADIOL |
ESTRACE |
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ETHAMBUTOL |
MYAMBUTOL |
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ETHIONANIDE |
TRECATOR-SC |
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ETHOSUXIMIDE |
ZARONTIN |
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ETIDRONATE |
DIDRONEL |
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ETODOLAC |
LODINE |
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ETONOGESTREL/ETHINYL ESTRADIOL |
NUVARING |
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FAMOTIDINE |
PEPCID |
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FERROUS GLUCONATE * |
FERGON |
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FERROUS SULFATE * |
FER-IN-SOL |
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FINASTERIDE 5 mg only |
PROSCAR |
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FLECAINIDE ACETATE |
TAMBOCOR |
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FLUCONAZOLE |
DIFLUCAN |
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FLUCYTOSINE |
ANCOBON |
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FLUDROCORTISONE |
FLORINEF |
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FLUNISOLIDE |
AEROBID |
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FLUNISOLIDE |
NASAREL |
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FLUOCINONIDE |
LIDEX |
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FLUOCINOLONE ACETONIDE |
SYNALAR |
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FLUOROMETHOLONE |
FML |
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FLUOROURACIL |
EFUDEX |
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FLUOXETINE |
PROZAC |
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FLURAZEPAM |
DALMANE |
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FLUTICASONE |
FLOVENT |
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FLUTICASONE PROPIONATE |
FLONASE |
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FLUTICASONE/SALMETEROL |
ADVAIR |
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FOLIC ACID * |
FOLIC ACID |
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FOSINOPRIL |
MONOPRIL |
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FURAZOLIDONE |
FUROXONE |
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FUROSEMIDE |
LASIX |
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G (top) |
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GABAPENTIN |
NEURONTIN |
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GEMFIBROZIL |
LOPID |
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GENTAMICIN all forms |
GARAMYCIN |
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GLIMEPIRIDE |
AMARYL |
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GLIPIZIDE XL requires TAR |
GLUCOTROL |
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GLUCAGON 1 mg emergency kit |
GLUCAGON |
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GLUCOSE MONITORS $100.00 maximum |
TRUETRACK or TrueTest |
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GLUCOSE TESTING STRIPS (BLOOD) |
TRUETRACK or TrueTest |
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GLUCOSE TESTING STRIPS (URINE) |
CLINISTIX |
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GLUCOSE/KETONE TEST COMBO (URINE) |
KETO-DIASTIX |
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GLYBURIDE |
MICRONASE |
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GLYCERIN/HYDROXYETHYLCELLULOSE * |
K-Y JELLY |
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GLYCERIN SUPPOSITORIES * |
GLYCERIN |
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GLYCOPYRROLATE |
ROBINUL |
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GOLD SODIUM THIOMALATE |
MYOCHRYSINE |
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GRANISETRON QL 6 per Rx |
KYTRIL |
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GRISEOFULVIN |
FULVICIN |
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GUAIFENESIN * |
ROBITUSSIN |
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GUAIFENESIN/CODEINE * |
ROBITUSSIN A-C |
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GUAIFENESIN/DEXTROMETHORPHAN * |
ROBITUSSIN DM |
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GUANFACINE |
TENEX |
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H (top) |
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HEPARIN SODIUM |
HEPARIN |
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HOMATROPINE HBR |
ISOPTO HOMATROPINE |
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HYDRALAZINE |
APRESOLINE |
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HYDROCHLOROTHIAZIDE tablets only |
HYDRODIURIL |
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HYDROCODONE BITARTRATE/ACETAMINOPHEN 5/500 & 7.5 750, QL maximum 120 tablets per 30 days |
VICODIN & VICODIN ES |
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HYDROCODONE BITARTRATE/ACETAMINOPHEN 10/325, QL maximum 120 tablets per 30 days |
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HYDROCODONE BITARTRATE/ACETAMINOPHEN 10/650 & 10/500, QL maximum 120 tablets per 30 days |
LORCET & LORTAB |
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HYDROCORTISONE all forms |
HYDROCORTISONE |
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Hydrocortisone/Polymyxin/Neomycin, ear and eye only |
Cortisporin |
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HYDROMORPHONE all forms |
DILAUDID |
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HYDROXYCHLOROQUINE |
PLAQUENIL |
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HYDROXYPROPYLMETHYLCELLULOSE |
ISOPTO ALKALINE |
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HYDROXYZINE all forms |
ATARAX, VISTARIL |
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I (top) |
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IBUPROFEN all forms |
MOTRIN |
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IMIPRAMINE HCL |
TOFRANIL |
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IMIQUIMOD |
ALDARA |
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INDOMETHACIN Code 1 intractable spondylitis; severe acute inflammatory process |
INDOCIN |
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INHALER DEVICE * |
AEROCHAMBER |
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INSULIN all forms, vials only |
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INSULIN SYRINGES/NEEDLES |
B-D SYRINGES, NEEDLES |
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IPRATROPIUM |
ATROVENT |
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IPRATROPIUM/ALBUTEROL |
COMBIVENT |
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IPRATROPIUM NASAL SPRAY |
ATROVENT NASAL SPRAY |
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IRON DEXTRAN COMPLEX |
INFED |
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ISONIAZID |
INH |
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ISOMETHEPTENE/DICHL0RALPHENAZONE/ACETAMINOPHEN |
MIDRIN |
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ISOSORBIDE DINITRATE |
ISORDIL |
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IVERMECTIN Code 1 restricted to treatment of resistant lice / scabies |
STROMECTOL |
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K (top) |
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Kaolin/Pectin |
Kaopectolin |
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KETOCONAZOLE all forms except 2% shampoo |
NIZORAL |
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KETONE TESTING PRODUCTS |
ACETEST |
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KETOPROFEN |
ORUDIS |
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KETOROLAC TROMETHAMINE, ophthalmic solution only |
ACULAR |
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KETOTIFEN, OTC |
ZADITOR, OTC |
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L (top) |
|
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LABETOLOL Code 1 restricted to use during pregnancy |
TRANDATE & NORMODYNE |
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LACTULOSE |
CEPHULAC |
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LAMOTRIGINE QL of ½ scored tablet per dose when appropriate |
LAMICTAL |
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LATANOPROST |
XALATAN |
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LEUCOVORIN |
LEUCOVORIN |
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LEVAMISOLE |
ERGAMISOL |
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LEVETIRACETAM |
KEPPRA |
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LEVOBUNOLOL |
BETAGAN |
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LEVOCARNITINE |
CARNITOR |
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LEVODOPA |
LARODOPA |
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LEVOFLOXACIN Code 1 age > 50 years. and lower respiratory infection |
LEVAQUIN |
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LEVONORGESTREL |
PLAN B |
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LEVONORGESTREL long acting |
NORPLANT |
|
LEVONORGESTREL/ETHINYL ESTRADIOL |
PREVEN |
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LEVOTHYROXINE SODIUM |
SYNTHROID |
|
LIDOCAINE all forms except transdermal patch |
XYLOCAINE |
|
LIOTHYRONINE |
CYTOMEL |
|
LISINOPRIL |
PRINIVIL, ZESTRIL |
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LISINOPRIL/HYDROCHLOROTHIAZIDE |
PRINIZIDE, ZESTORETIC |
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LOPERAMIDE * |
IMODIUM |
|
LORATIDINE * |
CLARITIN |
|
LORAZEPAM * |
ATIVAN |
|
Losartan ST T/F or intolerance to ACE inhibitor |
Cozaar |
|
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Hyzaar |
|
LOVASTATIN |
MEVACOR |
|
M (top) |
|
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MAGALDRATE/SIMETHICONE * |
RIOPAN |
|
MAGNESIUM HYDROXIDE * |
MILK OF MAGNESIA |
|
MAGNESIUM HYDROXIDE/ALUMINUM HYDROXIDE * |
MAALOX |
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MAGNESIUM OXIDE Code 1 restricted to renal failure * |
MAG-OXIDE |
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MALATHION |
OVIDE |
|
MAPROTILINE psych exempt |
LUDIOMIL |
|
MEBENDAZOLE |
VERMOX |
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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 |
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METIPRANOLOL |
OPTIPRANOLOL |
|
METOCLOPRAMIDE |
REGLAN |
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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 |
|
N (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 |
|
O (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 |
|
P (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 |
|
Q (top) |
|
|
QUINAPRIL |
ACCUPRIL |
|
QUINIDINE GLUCONATE |
QUINAGLUTE |
|
QUINIDINE SULFATE |
QUINIDIN |
|
R (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 |
|
S (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 |
|
U (top) |
|
|
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 |
|
W (top) |
|
|
WARFARIN SODIUM |
COUMADIN |
|
|
|
|
Z (top) |
|
|
Zanamivir QL 5 day course x 2 |
Relenza |
|
ZIDOVUDINE |
RETROVIR |
|
ZOLPIDEM (not CR) |
AMBIEN (generic) |
|
ZONISAMIDE |
ZONEGRAN |