OTC DRUG LIST COUGH, COLD & ALLERGY
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- Francis Frederick Porter
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1 OTC DRUG LIST Effective May 2012 The following is a partial listing of NDCs for OTCs covered by Passport Health Plan. There may be other NDCs covered, such as store COUGH, COLD & ALLERGY Common Brand Name** Brand/Generic NDC Manufacturer Antihistamine Diphenhydramine 25mg caps Benadryl, Q-DRYL Generic RUGBY Generic QUALITEST Generic EON LABS Generic EON LABS Diphenhydramine 50mg caps Benadryl Generic EON LABS Generic QUALITEST Generic AKYMA PHARMACEU Diphenhydramine 12.5mg/5ml elixir Benadryl Generic IVAX PHARMACEUT Chlorpheniramine 4mg tablet Chlor-trimeton Generic IVAX PHARMACEUT Chlorpheniramine 2mg/5ml syrup Aller-chlor Generic EDWARDS PHARMACY Loratidine tablet Claritin, Allergy Relief Generic PERRIGO CO. Generic LEADER Loratadine rapid disintegrting tablet Alavert Brand WYETH CONSUMER Loratidine syrup Claritin, Allergy Relief Generic BERGEN BRUNSWIG Generic TARO PHARM USA Generic BERGEN BRUNSWIG Cetirizine tablet Zyrtec Generic MYLAN Generic PERRIGO CO. Generic APOTEX CORP Cetirizine syrup Zyrtec Generic PERRIGO CO. Generic TARO PHARM USA **Generics preferred when available. Unit dose only long-term care setting. 1
2 Antihistamine-Decongestant Combinations Pseudoephedrine Hcl/Brompheniramine Dimetapp, Q-Tapp Elixir Generic QUALITEST Bromaline Solution Generic RUGBY Pseudoephedrine Hcl/Triprolidine Hcl Aprodine Generic MAJOR PHARM. Phenylephrine/Brompheniramine Dimetapp Solution Generic MAJOR PHARM. Loratadine/Pseudoephedrine Claritin D Generic BERGEN BRUNSWIG Generic OHM LABS. Cetirizine/Pseudoephedrine Zyrtec D Generic PERRIGO CO. Generic PERRIGO CO. Decongestant Pseudoephedrine Hcl Tablet, Syrup Sudafed Generic PHARMACEU ASSOC Generic RUGBY Pseudoephedrine Hcl Syrup Children s Sudafed Generic SILARX PHARM Decongestant-Expectorant Combinations Guaifenesin/Pseudoephedrine Hcl Mucinex D Brand ADAMS LABS Expectorant Guaifenesin tab CR 600 mg Mucinex Brand ADAMS LABS Guaifenesin 100mg/5ml Robitussin, Guiatuss, Q-Tussin Generic RUGBY Generic PERRIGO Generic QUALITEST Nasal - Decongestant Oxymetazoline Afrin Generic MAJOR PHARM. Generic TARO PHARM USA Generic SUNMARK Nasal - Misc Sodium Chloride Spray 0.65% Sea Soft/Deep Sea Generic QUALITEST Generic GOOD NEIGHBOR Generic IVAX **Generics preferred when available. Unit dose only long-term care setting. 2
3 Opthalmic Antihistamine Ketotifen Fumarate Zaditor/Alaway Generic AKORN INC. Brand NOVARTIS Opthalmic - Vasoconstrictors Naphazoline Hcl/Pheniramine Naphcon-A Brand J & J Naphazoline Hcl Naphcon Brand ALCON LABS. Opthalmic - Misc Polyvinyl Alcohol Drops Akwa Tears Generic RUGBY Generic MAJOR PHARM. Mineral Oil/ White Petrolatum ointment Lacri-Lube S.O.P. Brand ALLERGAN INC. Antitussives (Non-Narcotic) Dextromethorphan Polistirex Delsym susp Brand RECKITT BENCKIS Dextromethorphan HBR (pediatric) Robitussin Pediatric, Pediacare Brand WYETH CONSUMER Brand PFIZER CONS.HLT Antitussive-1st Gen. Antihistamine-Decongestant (Non-Narcotic) Dextromethorphan/pseudoephedrine/ Dimetapp DM/Q-Tapp DM Elixir Generic RUGBY brompheniramine Generic QUALITEST Pyrilamine/Phenylephrine/ Dextromethorphan Codituss DM Syrup Generic CYPRESS PHARM. Antitussive and Expectorant Combination (Non-Narcotic) Guaifenesin/Dextromethorphan Robitussin DM Syrup Generic RUGBY Generic QUALITEST Diabetic Tussin DM Brand HI-TECH CARE Mucinex DM Tablets Brand ADAMS LABS Generic ADAMS LABS Guaifenesin/Dextromethorphan/ Robitussin Cough & Brand WYETH Phenylephrine Cold CF Antitussive-Expectorant Combination (Narcotic) Guaifenesin/codeine phos Cheratussin AC Brand QUALITEST **Generics preferred when available. Unit dose only long-term care setting. 3
4 Common Brand Name** Brand/Generic NDC Manufacturer Antitussive-Decongestant-Expectorant Comb (Narcotic) Pseudoephedrine Hcl/Codeine/Guaifenesin Cheratussin DAC Brand QUALITEST GASTROINTESTINAL (STOMACH) AGENTS Acid reducers - Antacids Aluminum Hydroxide Alternagel Brand RIJ PHARM Aluminum/Magnesium Hydroxide/simethicone Mylanta/Maalox Generic PERRIGO CO. Generic MAJOR PHARM. Magnesium Hydroxide MOM Generic RUGBY Generic IVAX PHARMACEUT Calcium Carbonate tabs Tums Generic MAJOR PHARM. Generic IVAX PHARMACEUT Acid reducers - H2blockers & PPIs Cimetidine 200mg tablet Tagamet HB Generic PERRIGO CO. Famotidine 10mg Pepcid AC Generic PERRIGO CO. Generic IVAX PHARMACEUT Famotidine 20mg Pepcid AC Generic IVAX PHARMACEUT Ranitidine 75mg Zantac Generic MAJOR PHARM. Ranitidine 150mg Generic LEADER Generic IVAX PHARMACEUT Omeprazole 20mg Prilosec OTC Generic SUNMARK Generic LEADER Generic PERRIGO CO. Antidiarrheals Loperamide Hcl caplet Imodium A-D Generic SUNMARK Loperamide Hcl 1mg/5ml liquid Generic PERRIGO CO. Bismuth Subsalicylate chew tabs Pepto-Bismol Generic QUALITEST Bismuth Subsalicylate suspension Pepto-Bismol Generic IVAX PHARMACEUT Antiflatulents Simethicone Drops Mylicon Generic QUALITEST Generic MAJOR PHARM. **Generics preferred when available. Unit dose only long-term care setting. 4
5 Simethicone Chew tabs Gas-X Generic AKYMA PHARMACEU Generic RUGBY Laxatives Polyethylene glycol 3350 oral powder Miralax Generic PADDOCK LABS Docusate sodium cap 100mg Colace Generic QUALITEST Generic RUGBY Sennosides Senokot Generic QUALITEST Generic IVAX PHARMACEUT Sennosides/Docusate Sodium Senna-S Generic IVAX PHARMACEUT Generic IVAX PHARMACEUT Bisacodyl tabs Dulcolax Generic PERRIGO CO. Generic QUALITEST Calcium Polycarbophil Fiber-Lax Generic SUNMARK Generic QUALITEST Psyllium Seed Metamucil/Natural fiber Generic MAJOR PHARM. Generic RUGBY Magnesium Citrate Citrate of Magnesia Generic VI JON INC Generic BERGEN BRUNSWIG Laxatives, Local/Rectal Bisacodyl Supp Bisac-Evac Generic RUGBY Generic PERRIGO Glycerin Pediatric Supp Fleet Babylax Brand FLEET,C.B. CO. Na biphosphate/sodium phosphate Fleet Enema Brand FLEET,C.B. CO. Generic BERGEN BRUNSWIG PAIN RELIEVERS Aspirin 81mg EC Ecotrin Generic QUALITEST Generic IVAX PHARMACEUT Aspirin 81mg Chewable Bayer Children s Aspirin Generic MAJOR PHARM. Generic IVAX PHARMACEUT **Generics preferred when available. Unit dose only long-term care setting. 5
6 Aspirin EC 325mg Tablet Ecotrin Generic RUGBY Generic QUALITEST APAP 100mg/ml Drops Q-PAP Drops Generic QUALITEST Generic ACTAVIS MID ATL APAP 160mg/5ml Solution Q-Pap Solution Generic QUALITEST Generic IVAX PHARMACEUT APAP 325mg Tablet Tylenol Generic QUALITEST Generic MAJOR PHARM. APAP 500mg Tablet Tylenol Extra Strength Generic MARLEX PHARM. Generic QUALITEST APAP 80mg Chewable Tablet Children s Tylenol Generic RUGBY Generic RUGBY APAP 120mg Supp Feverall, Acephen Generic ACTAVIS MID ATL Generic IVAX PHARMACEUT APAP 325mg Supp Feverall, Acephen Generic G & W LABS. Generic RUGBY Aspirin/APAP/Caffeine Excedrin Migraine Brand NOVARTIS CONSUM Generic MAJOR PHARM. Ibuprofen 200m Tablet Motrin Generic IVAX PHARMACEUT Generic MAJOR PHARM. Ibuprofen 100mg/5ml Suspension Children s Motrin Generic BERGEN BRUNSWIG Generic PERRIGO CO. Naproxen 220mg Tablet Aleve Generic MAJOR PHARM. Generic PERRIGO CO. TOPICALS Topical Anti-infective viral Docosanol Abreva Brand GSK CONSUMER Terbinafine Lamisil AT Generic AMERISOURCEBERGEN Generic TARO PHARM USA **Generics preferred when available. Unit dose only long-term care setting. 6
7 Topical - Anti-Infective Polymyxin B, neomycin, bacitracin Triple Antibiotic Ointment Generic QUALITEST Generic TARO PHARM USA Generic FOUGERA Topical-Anti-Parasites Permethrin 1% Nix Generic ACTAVIS MID ATL Generic SUNMARK Topical Steroid Low Potency Hydrocortisone 0.5% cream Dermolate Generic FOUGERA Generic SUNMARK Hydrocortisone 0.5% ointment Cortizone-5 Generic FOUGERA Hydrocortisone 1% cream Cortaid Generic PERRIGO CO. Generic FOUGERA Hydrocortisone 1% lotion HydroSkin Generic RUGBY Generic PERRIGO CO. Hydrocortisone 1% ointment Cortizone-10 Generic ACTAVIS MID ATL Generic FOUGERA Hydrocortisone acetate 0.5% cream Lanacort-5 Creme Generic BERGEN BRUNSWIG Hydrocortisone acetate 1.0% cream Lanacort 10 Creme Generic BERGEN BRUNSWIG Generic QUALITEST Hydrocortisone acetate 1.0% ointment Max strength Cortaid Generic PERRIGO CO. Topical Antifungal Clotrimazole cream 1% Lotrimin-AF Generic PERRIGO CO. Generic TARO PHARM USA Miconazole Nitrate 2% Cream Baza Antifungal Generic ACTAVIS MID ATL Generic ACTAVIS MID ATL Ketoconazole 1% Shampoo Nizoral A-D Brand MC NEIL CONS. **Generics preferred when available. Unit dose only long-term care setting. 7
8 Topical Protectives Zinc oxide 20% Zinc Oxide Generic FOUGERA Zinc oxide 40% Generic Vitamin A&D Vitamin A&D Generic SCHERING PLOUGH Vaginal Clotrimazole vaginal cream 1% Gyne-lotrimin Generic TARO PHARM USA Generic ACTAVIS MID ATL Miconazole nitrate vaginal cream 2% Monistat 7 Generic PERRIGO CO. Generic ACTAVIS MID ATL Miconazole nitrate 100mg vaginal supp Monistat 7 supp Generic G & W LABS. Generic ACTAVIS MID ATL Miconazole 200mg-2% Combo Pack Monistat 3 Combo pack Generic MAJOR PHARM. Benzoyl Peroxide 10% Gel Benzac AC 10% Generic RUGBY Benzoyl Peroxide 5% Gel Benzac AC 5& Generic RUGBY VITAMINS/MINERALS Calcium Replacement Calcium Carbonate/Vitamin D Oysco 500+D Generic RUGBY Oyst-Cal-D 500 Generic IVAX PHARMACEUT Calcium Carbonate/Vitamin D Calcarb 600 with Vitamin D Generic IVAX PHARMACEUT Generic MAJOR PHARM. Calcium Carbonate/Vitamin D Generic LEADER Calcium Carbonate 500mg Oyst-Cal-500 Generic IVAX PHARMACEUT Oysco-500 Generic RUGBY Calcium Carb 1250mg/5 ml Suspension Generic PHARMACEU ASSOC Generic ROXANNE LAB Calcium Citrate 200mg Calcitrate Generic MAJOR Calcium Citrate/Vitamin D Citrus Calcium with Vit D Generic RUGBY **Generics preferred when available. Unit dose only long-term care setting. 8
9 Magnesium Salts Replacement Magnesium Oxide 400mg Mag-ox Generic CYPRESS PHARM. Generic BLAINE PHARMACE Generic RISING PHARM Iron Replacement Ferrous Sulfate 325mg tabs Generic AMNEAL PHARMACEU Generic URL PHARMA Generic IVAX PHARMACEUT Ferrous Sulfate 324mg tabs Generic PADDOCK LABS Ferrous Sulfate 15mg/0.6 ml drop Generic SILARX Generic RUGBY Generic QUALITEST Ferrous Sulfate 220mg/5ml elixir Generic RUGBY Poly-Iron 150mg Capsule Poly-iron Generic CYPRESS PHARM. Pediatric Vitamin Preparations (up to age 5) Multivitamin drops Poly-vitamin Generic HI-TECH PHARM. Generic RUGBY Multivitamin chew tabs Flinstone chewable Generic IVAX PHARMACEUT Generic MAJOR PHARM. Multivitamins with iron drops Poly-vi-sol with iron Generic HI-TECH PHARM. Generic RUGBY Multivitamins W-Iron chew tabs Flintstones with Iron Generic IVAX PHARMACEUT MAJOR PHARM. Vitamin D drops D-Vi-Sol Brand MJ NUTRITIONAL Generic SILARX Multivitamin Preparations Multivitamins Vigran Generic RUGBY Generic IVAX PHARMACEUT Multivitamins, therapeutic Thera Generic IVAX PHARMACEUT Generic MAJOR PHARM. **Generics preferred when available. Unit dose only long-term care setting. 9
10 Multivitamins, therapeutic with minerals Thera-M Generic MCKESSON Generic LEADER **Generics preferred when available. Unit dose only long-term care setting. 10
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NDC ANALGESICS Label Name Generic Drug Name Drug Strength Dosage Form 00713011801 ACEPHEN 120 MG SUPPOSITORY ACETAMINOPHEN 120 MG SUPP.RECT 45802073233 ACETAMINOPHEN 120 MG SUPPOSITORY ACETAMINOPHEN 120
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