OUTPATIENT FORMULARY Alphabetical Listing by Name

Transcription

1 KIRTLAND AIR FORCE BASE OUTPATIENT FORMULARY Alphabetical Listing by Name This document is current as of May 24, The availability of formulary items is subject to change.

2 Alphabetical Drug Listing Available Dosage Forms Abacavir, Lamivudine, and Zidovudine Trizivir: Abacavir sulfate 300 mg, lamivudine 150 mg, and zidovudine 300 mg Acetaminophen Solution, Oral: Pain & Fever Childrens: 160 mg/5 ml (118 ml) [alcohol free, aspirin free, sugar free; contains polyethylene glycol, propylene glycol, sodium benzoate; cherry flavor] Suppository, Rectal: Acephen: 120 mg (12 ea) Generic: 650 mg (12s) Generic: 325 mg, 500 mg Acetaminophen and Codeine Solution, Oral [C-V]: Generic: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 ml (118 ml) [BCF] Tablet, Oral [C-III]: Generic: Acetaminophen 300 mg and codeine phosphate 30 mg [BCF] Generic: Acetaminophen 300 mg and codeine phosphate 60 mg AcetaZOLAMIDE Generic: 250 mg Acetic Acid (Otic) Solution, Otic: Generic: 2% (15 ml) Acetic Acid, Propylene Glycol Diacetate, and Hydrocortisone Solution, otic [drops]: VoSol HC: Acetic acid 2%, propylene glycol diacetate 3%, and hydrocortisone 1% (10 ml) [contains benzethonium chloride] Acyclovir (Systemic) Capsule, Oral: Generic: 200 mg [BCF] Suspension, Oral: Generic: 200 mg/5 ml (473 ml) [BCF] Generic: 400 mg [BCF], 800 mg [BCF] Acyclovir (Topical) Cream, External: Zovirax: 5% (5 g) [contains cetostearyl alcohol, propylene glycol] Ointment, External: Generic: 5% (15 g) Adalimumab Pen-injector Kit, Subcutaneous [preservative free]: Humira Pen: 40 mg/0.8 ml (1 ea) [contains polysorbate 80] [BCF] Prefilled Syringe Kit, Subcutaneous [preservative free]: Humira: 10 mg/0.2 ml (1 ea) [BCF]; 20 mg/0.4 ml (1 ea) [BCF]; 40 mg/0.8 ml (1 ea) [BCF] [contains polysorbate 80] Adapalene Cream, External: Differin: 0.1% (45 g) Albendazole Albenza: 200 mg [contains saccharin sodium] Albiglutide Pen-injector, Subcutaneous [preservative free]: Tanzeum: 30 mg (1 ea); 50 mg (1 ea) [contains polysorbate 80] Albuterol Aerosol Solution, Inhalation: ProAir HFA: 108 (90 Base) mcg/actuation (8.5 g) [BCF] Nebulization Solution, Inhalation: Generic: 0.083% [2.5 mg/3 ml] (30s) [BCF] Generic: 0.5% (5 mg/ml) (20 ml) Alcohol (Isopropyl) Pad: BD Swab Single Use: 100/box Alendronate Generic: 5 mg [BCF], 10 mg [BCF], 35 mg [BCF], 70 mg [BCF] 1

3 Alfuzosin Tablet Extended Release 24 Hour, Oral, as hydrochloride: Generic: 10 mg [BCF] Allopurinol Tablet, Oral, as sodium: Generic: 100 mg [BCF], 300 mg [BCF] ALPRAZolam Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg Aluminum Chloride Hexahydrate Solution, External: Hypercare: 20% (35 ml) Aluminum Hydroxide, Magnesium Hydroxide, and Simethicone Suspension, Oral: Generic: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 ml (355 ml) Amantadine Capsule, Oral, as hydrochloride: Generic: 100 mg [BCF] Syrup, Oral, as hydrochloride: Generic: 50 mg/5 ml (473 ml) [BCF] Amiodarone Tablet, Oral, as hydrochloride: Pacerone: 200 mg [scored] [BCF] Amitriptyline Tablet, Oral, as hydrochloride: Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF] AmLODIPine Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF] Amlodipine and Benazepril Capsule, Oral: Lotrel: 2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF] Lotrel: 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF] Generic: 2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF] 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF] 5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF] 5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF] 10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF] 10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF] Amoxicillin Capsule, Oral: Generic: 250 mg [BCF], 500 mg [BCF] Suspension Reconstituted, Oral: Generic: 125 mg/5 ml (100 ml); 250 mg/5 ml (150 ml) [BCF]; 400 mg/5 ml (50 ml) [BCF] Generic: 875 mg Amoxicillin and Clavulanate Powder for suspension, Oral: Augmentin: 125: Amoxicillin 125 mg and clavulanate potassium mg per 5 ml (75 ml) [contains potassium 0.16 meq/5 ml] [BCF] Generic: 200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 ml (100 ml) [BCF] 250: Amoxicillin 250 mg and clavulanate potassium 62.5 mg per 5 ml (75 ml) [BCF] 400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 ml (100 ml) [BCF] ES-600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 ml (125 ml) [BCF] Generic: 250: Amoxicillin 250 mg and clavulanate potassium 125 mg [BCF] 500: Amoxicillin 500 mg and clavulanate potassium 125 mg [BCF] 875: Amoxicillin 875 mg and clavulanate potassium 125 mg [BCF] Ampicillin Capsule, Oral: Generic: 250 mg 2

4 Anastrozole Generic: 1 mg Apixaban Eliquis: 2.5 mg, 5 mg ARIPiprazole Abilify: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg Artificial Tears Ointment, Ophthalmic [preservative free]: Artificial Tears: % (3.5 g) Solution, Ophthalmic: Artificial Tears: 1.4% (15 ml) [contains benzalkonium chloride, edetate disodium] Aspirin Tablet Delayed Release, Oral: Aspirin EC Low Dose: 81 mg Generic: 325 mg Aspirin and Dipyridamole Capsule, variable release: Aggrenox : Aspirin 25 mg [immediate release] and dipyridamole 200 mg [extended release] [contains lactose, sucrose] Atenolol Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] AtoMOXetine Capsule, Oral: Strattera: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg AtorvaSTATin Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Atovaquone and Proguanil Generic: Atovaquone 250 mg and proguanil hydrochloride 100 mg Atropine (Ophthalmic) Ointment, Ophthalmic, as sulfate: Generic: 1% (3.5 g) Solution, Ophthalmic, as sulfate: Generic: 1% (5 ml) AzaTHIOprine Generic: 50 mg Azelastine (Nasal) Solution, Nasal, as hydrochloride: Generic: 137 mcg/spray (30 ml) Azelastine (Ophthalmic) Solution, Ophthalmic, as hydrochloride: Generic: 0.05% (6 ml) Azithromycin (Systemic) Packet, Oral, as dihydrate [strength expressed as base]: Generic: 1 g [BCF] Suspension Reconstituted, Oral, as dihydrate [strength expressed as base]: Generic: 100 mg/5 ml (15 ml) [BCF]; 200 mg/5 ml (15 ml) Tablet, Oral, as dihydrate [strength expressed as base]: ZPak: 250 mg [BCF] Tablet, Oral, as monohydrate [strength expressed as base]: Generic: 250 mg [BCF], 500 mg [BCF] Bacitracin and Polymyxin B Ointment, ophthalmic: (Ophthalmic) Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) Generic: Bacitracin 500 units and polymyxin B 10,000 units per g (3.5 g) Ointment, Ophthalmic: Generic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units per g (3.5 g) [BCF] Baclofen Generic: 10 mg, 20 mg Benazepril Tablet, Oral, as hydrochloride: Generic: 5 mg, 10 mg, 20 mg, 40 mg Benzonatate Capsule, Oral: Generic: 100 mg, 200 mg 3

5 Benzoyl Peroxide Gel, External: Acne-Clear: 10% (42.5 g) Generic: 5% (60 g) Liquid, External: Benzoyl Peroxide Wash: 5% (148 g) [contains cetyl alcohol, edetate disodium, propylene glycol] Benzoyl Peroxide Wash: 10% (227 g) [contains edetate disodium] Benztropine Tablet, Oral, as mesylate: Generic: 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF] Betamethasone and Cream, External: Clotrimazole Generic: Betamethasone dipropionate 0.05% (base) and clotrimazole 1% (15 g) Betamethasone (Topical) Cream, External, as dipropionate [strength expressed as base]: Generic: 0.05% (15 g) Cream, External, as dipropionate augmented [strength expressed as base]: Generic: 0.05% (15 g) Betaxolol (Ophthalmic) Suspension, Ophthalmic: Betoptic-S: 0.25% (10 ml) Bicalutamide Generic: 50 mg [BCF] Bimatoprost Solution, Ophthalmic: Lumigan: 0.01% (5 ml) [contains benzalkonium chloride] Bisacodyl Suppository, Rectal: Biscolax: 10 mg (12 ea) Tablet Delayed Release, Oral: Bisacodyl EC: 5 mg Bismuth Subsalicylate Tablet Chewable, Oral, as subsalicylate: Bismatrol: 262 mg [contains aspartame] Bisoprolol and Hydrochlorothiazide Generic: 2.5/6.25: Bisoprolol fumarate 2.5 mg and hydrochlorothiazide 6.25 mg 5/6.25: Bisoprolol fumarate 5 mg and hydrochlorothiazide 6.25 mg 10/6.25: Bisoprolol fumarate 10 mg and hydrochlorothiazide 6.25 mg Brimonidine and Timolol Solution, Ophthalmic: Combigan: Brimonidine tartrate 0.2% and timolol 0.5% (10 ml) [contains benzalkonium chloride] Brimonidine (Ophthalmic) Solution, Ophthalmic, as tartrate: Generic: 0.15% (5 ml) [BCF]; 0.2% (5 ml, 10 ml) [BCF] Bromfenac Solution, Ophthalmic: Generic: 0.09% (1.7 ml) Brompheniramine, Dextromethorphan, and Phenylephrine Syrup, oral: Generic: Brompheniramine maleate 1 mg, dextromethorphan hydrobromide 5 mg, and phenylephrine hydrochloride 2.5 mg per 5 ml Budesonide (Oral Inhalation) Suspension, Inhalation: Pulmicort: 0.25 mg/2 ml (2 ml); 0.5 mg/2 ml (2 ml) [contains disodium edta, polysorbate 80] Budesonide (Systemic) Capsule Extended Release 24 Hour, Oral: Generic: 3 mg BuPROPion Tablet, Oral, as hydrochloride: Generic: 75 mg [BCF], 100 mg [BCF] Tablet Extended Release 12 Hour, Oral, as hydrochloride: Generic: 100 mg [BCF], 150 mg [BCF], 200 mg Tablet Extended Release 24 Hour, Oral, as hydrochloride: Generic: 150 mg [BCF], 300 mg [BCF] BusPIRone Tablet, Oral, as hydrochloride: Generic: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF] 4

6 Butalbital, Acetaminophen, and Caffeine Generic: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg [BCF] Butalbital, Aspirin, and Caffeine Generic: Butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg Calcipotriene Cream, External: Generic: 0.005% (60 g) Calcitriol (Systemic) Capsule, Oral: Generic: 0.25 mcg Calcium and Vitamin D Generic: Calcium 500 mg and vitamin D 200 units Generic: Oyster Shell Calcium 500 mg and D3 400 units Candesartan Tablet, Oral, as cilexetil: Atacand: 4 mg, 8 mg, 16 mg, 32 mg [scored] Capecitabine Xeloda: 500 mg Captopril Generic: 12.5 mg [BCF], 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] CarBAMazepine Suspension, Oral: Generic: 100 mg/5 ml (450 ml) [BCF] Generic: 200 mg [BCF] Tablet, Chewable, Oral: Generic: 100 mg [BCF] Tablet Extended Release 12 Hour, Oral: TEGretol-XR: 400 mg [BCF] Generic: 100 mg, 200 mg Carbamide Peroxide Solution, Otic: Ear Drops Earwax Aid: 6.5% (15 ml) [contains propylene glycol, trolamine (triethanolamine)] Carbidopa and Levodopa Generic: 10/100: Carbidopa 10 mg and levodopa 100 mg [BCF] 25/100: Carbidopa 25 mg and levodopa 100 mg [BCF] 25/250: Carbidopa 25 mg and levodopa 250 mg [BCF] Tablet Extended Release, Oral: Generic: 25/100: Carbidopa 25 mg and levodopa 100 mg Generic: 50/200: Carbidopa 50 mg and levodopa 200 mg Carboxymethylcellulose Solution, Ophthalmic, as sodium: Refresh Plus: 0.5% (30 ea) Carvedilol Generic: mg [BCF], 6.25 mg [BCF], 12.5 mg [BCF], 25 mg [BCF] Cefdinir Suspension Reconstituted, Oral: Generic: 125 mg/5 ml (60 ml) Cefpodoxime Generic: 100 mg Cefprozil Suspension Reconstituted, Oral: Generic: 125 mg/5 ml (100 ml); 250 mg/5 ml (50 ml) Generic: 250 mg Cefuroxime Tablet, Oral, as axetil [strength expressed as base]: Generic: 250 mg, 500 mg Celecoxib Capsule, Oral: CeleBREX: 100 mg, 200 mg 5

7 Cephalexin Capsule, Oral: Generic: 250 mg [BCF], 500 mg [BCF] Suspension Reconstituted, Oral: Generic: 250 mg/5 ml (100 ml) [BCF] Cetirizine Syrup, Oral, as hydrochloride: Cetirizine HCl Childrens Allergy: 1 mg/ml (118 ml) [contains methylparaben, propylene glycol, propylparaben; grape flavor] Tablet, Oral, as hydrochloride: Generic: 5 mg, 10 mg Cetirizine and Pseudoephedrine Tablet, extended release: Generic: Cetirizine hydrochloride 5 mg and pseudoephedrine hydrochloride 120 mg Chlorhexidine Gluconate Solution, Mouth/Throat: Generic: 0.12% (473 ml) [BCF] Chloroquine Tablet, Oral, as phosphate: Generic: 500 mg [equivalent to chloroquine base 300 mg] Chlorpheniramine Syrup, Oral, as maleate: Aller-Chlor: 2 mg/5 ml (118 ml) [contains alcohol, usp, menthol, methylparaben, propylene glycol, propylparaben; fruit flavor] Tablet, Oral, as maleate: Aller-Chlor: 4 mg [scored] Chlorthalidone Generic: 25 mg [BCF], 50 mg [BCF] Cholecalciferol Liquid, Oral: D-Vi-Sol: 400 units/ml (50 ml) [gluten free, lactose free, sugar free; contains polysorbate 80] Cholestyramine Resin Packet, Oral: Generic: 4 g (60 ea) Ciclopirox Solution, External: Generic: 8% (6.6 ml) Cimetidine Solution, Oral, as hydrochloride [strength expressed as base]: Generic: 300 mg/5 ml (237 ml) Ciprofloxacin and Dexamethasone Suspension, Otic: Ciprodex: Ciprofloxacin 0.3% and dexamethasone 0.1% (7.5 ml) [contains benzalkonium chloride, edetate disodium, tyloxapol] Ciprofloxacin (Ophthalmic) Ointment, Ophthalmic, as hydrochloride: Ciloxan: 0.3% (3.5 g) Solution, Ophthalmic, as hydrochloride: Ciloxan: 0.3% (5 ml) [contains benzalkonium chloride, edetate disodium] Ciprofloxacin (Systemic) Suspension Reconstituted, Oral: Cipro: 250 mg/5 ml (100 ml) [BCF] Tablet, Oral, as hydrochloride [strength expressed as base]: Generic: 100 mg [BCF], 250 mg [BCF], 500 mg [BCF], 750 mg [BCF] Citalopram Solution, Oral: Generic: 10 mg/5 ml (240 ml) [BCF] Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF] Clarithromycin Generic: 250 mg, 500 mg Tablet Extended Release 24 Hour, Oral: Biaxin XL Pac: 500 mg Generic: 250 mg Clindamycin and Benzoyl Peroxide Gel, External: BenzaClin: Clindamycin phosphate 1% and benzoyl peroxide 5% (25 g) 6

8 Clindamycin (Systemic) Capsule, Oral, as hydrochloride [strength expressed as base]: Cleocin HCl: 300 mg Generic: 150 mg [BCF] Solution Reconstituted, Oral, as palmitate hydrochloride [strength expressed as base]: Generic: 75 mg/5 ml (100 ml) Clindamycin (Topical) Cream, Vaginal, as phosphate [strength expressed as base]: Generic: 2% (40 g) [BCF] Gel, External, as phosphate [strength expressed as base]: Generic: 1% (30 g) Solution, External, as phosphate [strength expressed as base]: Cleocin T: 1% (60 ml) [contains isopropyl alcohol 50%] [BCF] Clobetasol Cream, External, as propionate: Generic: 0.05% (15 g) [BCF] Foam, External, as propionate: Generic: 0.05% (50 g, 100 g) Gel, External, as propionate: Generic: 0.05% (15 g) Ointment, External, as propionate: Generic: 0.05% (15 g) [BCF] ClomiPHENE Tablet, Oral, as citrate: Generic: 50 mg ClomiPRAMINE Capsule, Oral, as hydrochloride: Generic: 50 mg ClonazePAM Generic: 0.5 mg [BCF], 1 mg, 2 mg CloNIDine Patch Weekly, Transdermal: Generic: 0.1 mg/24 hr (4 ea); 0.2 mg/24 hr (4 ea); 0.3 mg/24 hr (4 ea) Tablet, Oral, as hydrochloride: Generic: 0.1 mg [BCF], 0.2 mg [BCF], 0.3 mg [BCF] Clopidogrel Generic: 75 mg [BCF] Clotrimazole (Oral) Lozenge, Mouth/Throat: Generic: 10 mg (70 ea) Troche, Mouth/Throat: Generic: 10 mg Clotrimazole (Topical) Cream, External: Clotrimazole Anti-Fungal: 1% (28.35 g) [contains benzyl alcohol] Solution, External: Generic: 1% (30 ml) [BCF] Codeine Tablet, Oral, as sulfate: Generic: 30 mg Colchicine Colcrys: 0.6 mg [scored] Colestipol Tablet, Oral, as hydrochloride: Colestid: 1 g Cyanocobalamin Solution, Injection: Generic: 1000 mcg/ml (1 ml) Cyclobenzaprine Tablet, Oral, as hydrochloride: Generic: 5 mg, 10 mg [BCF] Cyclopentolate Solution, Ophthalmic, as hydrochloride: Cyclogyl: 1% (5 ml); 2% (5 ml) CycloSPORINE (Ophthalmic) Emulsion, Ophthalmic [preservative free]: Restasis: 0.05% (1 ea) [contains polysorbate 80] 7

9 CycloSPORINE (Systemic) Capsule, Oral: Gengraf: 25 mg, 100 mg [contains cremophor el] Neoral: 25 mg, 100 mg [contains alcohol, usp] SandIMMUNE: 25 mg [contains alcohol, usp] SandIMMUNE: 100 mg Cyproheptadine Syrup, Oral, as hydrochloride: Generic: 2 mg/5 ml (473 ml) [BCF] Tablet, Oral, as hydrochloride: Generic: 4 mg [BCF] Dabigatran Etexilate Capsule, Oral: Pradaxa: 75 mg, 150 mg Desmopressin Solution, Nasal, as acetate: DDAVP: 0.01% (5 ml) Tablet, Oral, as acetate: DDAVP: 0.1 mg [scored] Desonide Cream, External: Generic: 0.05% (15 g) Dexamethasone (Systemic) Elixir, Oral: Generic: 0.5 mg/5 ml (237 ml) Generic: 0.5 mg, 0.75 mg, 1 mg, 4 mg Dextroamphetamine Tablet, Oral, as sulfate: Generic: 5 mg Dextroamphetamine and Amphetamine Capsule, Extended release, Oral: Adderall XR: 5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate 1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sulfate 1.25 mg (equivalent to amphetamine base 3.1 mg)] [BCF] Adderall XR: 10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate 2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate 2.5 mg (equivalent to amphetamine base 6.3 mg)] [BCF] Adderall XR: 15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccharate 3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine sulfate 3.75 mg (equivalent to amphetamine base 9.4 mg)] [BCF] Adderall XR: 20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate 5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate 5 mg (equivalent to amphetamine base 12.5 mg)] [BCF] Adderall XR: 25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine saccharate 6.25 mg, amphetamine aspartate monohydrate 6.25 mg, amphetamine sulfate 6.25 mg (equivalent to amphetamine base 15.6 mg)] [BCF] Adderall XR: 30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate 7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sulfate 7.5 mg (equivalent to amphetamine base 18.8 mg)] [BCF] Tablet, oral: 10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate 2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate 2.5 mg (equivalent to amphetamine base 6.3 mg)] 15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccharate 3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine sulfate 3.75 mg (equivalent to amphetamine base 9.4 mg)] 20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate 5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate 5 mg (equivalent to amphetamine base 12.6 mg)] 30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate 7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sulfate 7.5 mg (equivalent to amphetamine base 18.8 mg)] 8

10 Diabetic Supplies Glucose meter: Freestyle Freedom Lite Monitor [BCF] Precision Xtra Blood Glucose Monitoring System Lancet: Accu-Chek Soft Touch (100s) Syringe and needle: BD Insulin Syringe Ultrafine: 30 G x 1/2" (0.3 ml): 100s BD Insulin Syringe Ultrafine: 30 G x 1/2" (0.5 ml): 100s BD Insulin Syringe Ultrafine: 30 G x 1/2" (1 ml): 100s NovoFine Pen Needle (30 gauge - 8 mm) Test Strips/Kit: Freestyle Lite Test Strips [BCF] Precision Xtra Blood Glucose Test Strips [BCF] Diazepam Gel, Rectal: Diastat AcuDial: 10 mg (1 ea); 20 mg (1 ea) [contains alcohol, usp, benzoic acid, sodium benzoate] Generic: 2 mg, 5 mg [BCF], 10 mg Dibucaine Ointment, External: Generic: 1% (28 g) Diclofenac (Ophthalmic) Solution, Ophthalmic, as sodium: Generic: 0.1% (5 ml) Diclofenac (Systemic) Tablet Delayed Release, Oral, as sodium: Generic: 50 mg, 75 mg Diclofenac (Topical) Gel, Transdermal, as sodium: Voltaren: 1% (100 g) [contains isopropyl alcohol, propylene glycol] Dicloxacillin Capsule, Oral: Generic: 250 mg [BCF], 500 mg [BCF] Dicyclomine Capsule, Oral, as hydrochloride: Generic: 10 mg [BCF] Solution, Oral, as hydrochloride: Generic: 10 mg/5 ml (473 ml) [BCF] Tablet, Oral, as hydrochloride: Generic: 20 mg [BCF] Digoxin Lanoxin: mg [BCF], 0.25 mg [BCF] [scored] Generic: mg [BCF], 0.25 mg [BCF] Diltiazem Capsule Extended Release 24 Hour, Oral, as hydrochloride: Tiazac: 180 mg [BCF], 420 mg [BCF] Generic: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF], 300 mg [BCF], 360 mg [BCF], 420 mg [BCF] Tablet, Oral, as hydrochloride: Generic: 60 mg DiphenhydrAMINE (Systemic) Capsule, Oral, as hydrochloride: Generic: 25 mg Liquid, Oral, as hydrochloride: Q-Dryl: 12.5 mg/5 ml (118 ml) [alcohol free; contains saccharin sodium, sodium benzoate; cherry flavor] Diphenoxylate and Atropine Generic: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate mg Disulfiram Generic: 250 mg Docusate Capsule, Oral, as sodium: Stool Softener: 100 mg 9

11 Donepezil Tablet, Oral, as hydrochloride: Generic: 5 mg, 10 mg Dorzolamide Solution, Ophthalmic: Generic: 2% (10 ml) Dorzolamide and Timolol Solution, Ophthalmic: Generic: Dorzolamide 2% and timolol 0.5% (10 ml) Doxazosin Generic: 2 mg, 4 mg, 8 mg Doxepin (Systemic) Capsule, Oral: Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF] Concentrate, Oral: Generic: 10 mg/ml (118 ml) [BCF] Doxycycline Capsule, Oral, as hyclate [strength expressed as base]: Generic: 50 mg, 100 mg [BCF] Capsule Delayed Release, Oral, as monohydrate [strength expressed as base]: Oracea: 40 mg Tablet, Oral, as hyclate [strength expressed as base]: Generic: 100 mg [BCF] Tablet, Oral, as monohydrate [strength expressed as base]: Generic: 100 mg DULoxetine Capsule Delayed Release Particles, Oral: Generic: 20 mg, 30 mg, 60 mg Econazole Cream, External, as nitrate: Generic: 1% (15 g, 30 g) Efavirenz Capsule, Oral: Sustiva: 50 mg, 200 mg Sustiva: 600 mg Efavirenz, Emtricitabine, and Tenofovir Tablet, oral: Atripla : Efavirenz 600 mg, emtricitabine 200 mg, and tenofovir disoproxil fumarate 300 mg Eletriptan Relpax: 20 mg, 40 mg Emollients Cream, External: Hydrocerin: (454 g) Vanicream: (453 g) Lotion, External: Hydrocerin: (472 ml) Ointment, External: Aquaphor: (396 g) Empagliflozin Jardiance: 10 mg, 25 mg Emtricitabine and Tenofovir Tablet: Truvada: Emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg Enalapril Tablet, Oral, as maleate: Generic: 2.5 mg, 10 mg, 20 mg Enoxaparin Solution, Subcutaneous, as sodium [preservative free]: Generic: 30 mg/0.3 ml (0.3 ml) [BCF]; 40 mg/0.4 ml (0.4 ml) [BCF]; 60 mg/0.6 ml (0.6 ml) [BCF]; 80 mg/0.8 ml (0.8 ml) [BCF]; 100 mg/ml (1 ml) [BCF]; 120 mg/0.8 ml (0.8 ml) [BCF]; 150 mg/ml (1 ml) [BCF] Entecavir Generic: 0.5 mg EPINEPHrine (Systemic) Device, Injection: EpiPen 2-Pak: 0.3 mg/0.3 ml (2 ea) [latex free; contains sodium metabisulfite] EpiPen Jr 2-Pak: 0.15 mg/0.3 ml (2 ea) [contains sodium metabisulfite] 10

12 Epoetin Alfa Solution, Injection: Epogen: 20,000 units/ml (1 ml) [contains benzyl alcohol] Procrit: 20,000 units/ml (1 ml) [contains benzyl alcohol] Solution, Injection [preservative free]: Epogen: 2000 units/ml (1 ml); 3000 units/ml (1 ml); 4000 units/ml (1 ml); 10,000 units/ml (1 ml) Procrit: 2000 units/ml (1 ml); 3000 units/ml (1 ml); 4000 units/ml (1 ml); 10,000 units/ml (1 ml); 40,000 units/ml (1 ml) Ergocalciferol Capsule, Oral: Generic: 50,000 units Erlotinib Tarceva: 25 mg, 100 mg, 150 mg Erythromycin and Benzoyl Gel, External: Peroxide Generic: Erythromycin 30 mg and benzoyl peroxide 50 mg per g (23.3 g) Erythromycin and Sulfisoxazole Suspension Reconstituted, Oral: E.S.P.: Erythromycin ethylsuccinate 200 mg and sulfisoxazole acetyl 600 mg per 5 ml (100 ml) [contains methylparaben, polysorbate 80; cherry flavor] Erythromycin (Ophthalmic) Ointment, Ophthalmic: Generic: 0.5% (3.5 g) [BCF] Erythromycin (Systemic) Suspension Reconstituted, Oral, as ethylsuccinate: E.E.S. Granules: 200 mg/5 ml (100 ml) [BCF] Tablet, Oral, as stearate: Erythrocin Stearate: 250 mg [BCF] Tablet Delayed Release, Oral, as base: Ery-Tab: 250 mg [BCF] PCE: 333 mg Erythromycin (Topical) Gel, External: Generic: 2% (30 g) [BCF] Solution, External: Generic: 2% (60 ml) [BCF] Escitalopram Generic: 10 mg, 20 mg Esomeprazole Capsule Delayed Release, Oral, as magnesium [strength expressed as base]: NexIUM: 20 mg [BCF], 40 mg [BCF] Estradiol (Systemic) Patch Weekly, Transdermal: Vivelle-Dot: mg/24 hr (8 ea); mg/24 hr (8 ea); 0.05 mg/24 hr (8 ea); mg/24 hr (8 ea); 0.1 mg/24 hr (8 ea) Generic: mg/24 hours (4s) [BCF]; mg/24 hours (4s) [BCF]; 0.05 mg/24 hours (4s) [BCF]; 0.06 mg/24 hours (4s) [BCF]; mg/24 hours (4s) [BCF]; 0.1 mg/24 hours (4s) [BCF] Generic: 1 mg, 2 mg Estradiol (Topical) Cream, Vaginal: Estrace: 0.1 mg/g (42.5 g) Tablet, Vaginal, as base: Vagifem: 10 mcg Estrogens (Conjugated/Equine) and Medroxyprogesterone Prempro: 0.3/1.5: Conjugated estrogens 0.3 mg and medroxyprogesterone acetate 1.5 mg [BCF] Prempro: 0.45/1.5: Conjugated estrogens 0.45 mg and medroxyprogesterone acetate 1.5 mg [BCF] Prempro: 0.625/2.5: Conjugated estrogens mg and medroxyprogesterone acetate 2.5 mg [BCF] Prempro: 0.625/5: Conjugated estrogens mg and medroxyprogesterone acetate 5 mg [BCF] 11

13 Estrogens (Conjugated/Equine, Systemic) Premarin: 0.3 mg [BCF], 0.45 mg [BCF], mg [BCF], 0.9 mg, 1.25 mg [BCF] Estrogens (Conjugated/Equine, Topical) Estrogens (Esterified) and Methyltestosterone Cream, Vaginal: Premarin: mg/g (30 g) [BCF] Covaryx: Esterified estrogen 1.25 mg and methyltestosterone 2.5 mg Covaryx HS: Esterified estrogen mg and methyltestosterone 1.25 mg Eszopiclone Lunesta: 1 mg, 2 mg, 3 mg Ethambutol Tablet, Oral, as hydrochloride: Myambutol: 400 mg [scored] [BCF] Generic: 100 mg [BCF], 400 mg [BCF] Ethinyl Estradiol and Desogestrel Ethinyl Estradiol and Drospirenone Ethinyl Estradiol and Ethynodiol Diacetate Ethinyl Estradiol and Etonogestrel Ethinyl Estradiol and Levonorgestrel Tablet, oral [low dose formulation]: Mircette: Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 white tablets] Day 22-23: 2 inactive green tablets Day 24-28: Ethinyl estradiol 0.01 mg [5 yellow tablets] (28s) Tablet, oral [monophasic formulation]: Ortho-Cept 28: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 light orange tablets and 7 green inactive tablets] (28s) Tablet, oral [triphasic formulation]: Cyclessa: Day 1-7: Ethinyl estradiol mg and desogestrel 0.1 mg [7 light yellow tablets] Day 8-14: Ethinyl estradiol mg and desogestrel mg [7 orange tablets] Day 15-21: Ethinyl estradiol mg and desogestrel 0.15 mg [7 red tablets] Day 22-28: 7 green inactive tablets (28s) Yasmin: Ethinyl estradiol 0.03 mg and drospirenone 3 mg [21 yellow active tablets and 7 white inactive tablets] (28s) [BCF] Yaz: Ethinyl estradiol 0.02 mg and drospirenone 3 mg [24 light pink active tablets and 4 white inactive tablets] (28s) [BCF] Tablet, oral [monophasic formulation]: Zovia 1/35-28: Ethinyl estradiol mg and ethynodiol diacetate 1 mg [21 light pink tablets and 7 white inactive tablets] (28s) Ring, vaginal: NuvaRing : Ethinyl estradiol mg/day and etonogestrel 0.12 mg/day (3s) [3-week duration] Tablet, Oral [low dose formulation]: Sronyx: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 white tablets and 7 peach inactive tablets] [BCF] Tablet, Oral [monophasic formulation]: Levora: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (28s) [21 white tablets and 7 peach inactive tablets] [BCF] Tablet, Oral [extended cycle regimen]: Jolessa: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 pink tablets and 7 white inactive tablets] (91s) [BCF] Tablet, oral [triphasic formulation]: Trivora: Day 1-6: Ethinyl estradiol 0.03 mg and levonorgestrel 0.05 mg [6 blue tablets] Day 7-11: Ethinyl estradiol 0.04 mg and levonorgestrel mg [5 white tablets] Day 12-21: Ethinyl estradiol 0.03 mg and levonorgestrel mg [10 pink tablets] Day 22-28: 7 peach inactive tablets (28s) 12

14 Ethinyl Estradiol and Norelgestromin Ethinyl Estradiol and Norethindrone Ethinyl Estradiol and Norgestimate Patch Weekly, Transdermal: Ortho Evra : Ethinyl estradiol 0.75 mg and norelgestromin 6 mg [releases ethinyl estradiol 20 mcg and norelgestromin 150 mcg per day] (1s) Tablet, Oral [monophasic formulation]: Loestrin 21 1/20: Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg [light yellow tablets] (21s) Loestrin Fe 1.5/30: Ethinyl estradiol 0.03 mg and norethindrone acetate 1.5 mg [21 pink tablets] and ferrous fumarate 75 mg [7 brown tablets] (28s) Necon 1/35: Ethinyl estradiol mg and norethindrone 1 mg (28s) [21 dark yellow tablets and 7 white inactive tablets] [BCF] Tablet, oral [biphasic formulation]: Cyclafem 7/7/7: Day 1-7: Ethinyl estradiol mg and norethindrone 0.5 mg [7 white tablets] Day 8-14: Ethinyl estradiol mg and norethindrone 0.75 mg [7 light pink tablets] Day 15-21: Ethinyl estradiol mg and norethindrone 1 mg [7 pink tablets] Day 22-28: 7 light green inactive tablets (28s) Tablet, Oral [monophasic formulation]: MonoNessa: Ethinyl estradiol mg and norgestimate 0.25 mg [21 blue tablets and 7 green inactive tablets] [BCF] Tablet, Oral [triphasic formulation]: Ortho Tri-Cyclen Lo [BCF]: Day 1-7: Ethinyl estradiol mg and norgestimate 0.18 mg [7 white tablets] Day 8-14: Ethinyl estradiol mg and norgestimate mg [7 light blue tablets] Day 15-21: Ethinyl estradiol mg and norgestimate 0.25 mg [7 dark blue tablets] Day 22-28: 7 dark green inactive tablets TriNessa [BCF]: Day 1-7: Ethinyl estradiol mg and norgestimate 0.18 mg [7 white tablets] Day 8-14: Ethinyl estradiol mg and norgestimate mg [7 light blue tablets] Day 15-21: Ethinyl estradiol mg and norgestimate 0.25 mg [7 blue tablets] Day 22-28: 7 green inactive tablets Ethinyl Estradiol and Norgestrel Low-Ogestrel: Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [21 white tablets and 7 peach inactive tablets] (28s) Etodolac Generic: 400 mg Exenatide Solution, Subcutaneous: Byetta 10 MCG Pen: 10 mcg/0.04 ml (2.4 ml) [contains metacresol] Byetta 5 MCG Pen: 5 mcg/0.02 ml (1.2 ml) [contains metacresol] Ezetimibe Zetia: 10 mg Famciclovir Generic: 250 mg, 500 mg Famotidine Generic: 20 mg, 40 mg Felodipine Tablet Extended Release 24 Hour, Oral: Generic: 2.5 mg, 5 mg, 10 mg Fenofibrate and Derivatives Tablet, Oral, as fenofibrate: Tricor: 145 mg [BCF] [contains soybean lecithin] Generic: 48 mg [BCF], 145 mg [BCF], 160 mg Ferrous Sulfate Solution, Oral: Fer-Iron: 75 (15 Fe) MG/ML (50 ml) [contains sodium metabisulfite] Generic: 325 (65 Fe) MG 13

15 Fexofenadine Suspension, Oral, as hydrochloride: Allegra Allergy Childrens: 30 mg/5 ml (120 ml) Tablet, Oral, as hydrochloride: Generic: 60 mg, 180 mg Filgrastim Solution, Injection: Neupogen: 300 mcg/ml (1 ml); 480 mcg/1.6 ml (1.6 ml) [contains polysorbate 80] Solution, Injection [preservative free]: Neupogen: 300 mcg/0.5 ml (0.5 ml); 480 mcg/0.8 ml (0.8 ml) [contains polysorbate 80] Finasteride Generic: 5 mg [BCF] Flecainide Tablet, Oral, as acetate: Generic: 50 mg, 100 mg Fluconazole Suspension Reconstituted, Oral: Generic: 10 mg/ml (35 ml) Diflucan: 150 mg [BCF], 200 mg Generic: 100 mg, 150 mg [BCF] Flunisolide (Nasal) Solution, Nasal: Generic: 25 MCG/ACT (0.025%) (25 ml) Fluocinonide Cream, External: Generic: 0.05% (15 g, 30 g) [BCF] Gel, External: Generic: 0.05% (15 g) Ointment, External: Generic: 0.05% (15 g) [BCF] Solution, External: Generic: 0.05% (60 ml) Fluoride Cream, Dental, as sodium: PreviDent 5000 Plus: 1.1% (51 g) [spearmint flavor] Gel, Dental, as sodium: PreviDent: 1.1% (56 g) [berry flavor] Paste, Dental, as sodium: Clinpro 5000: 1.1% (113 g) [contains saccharin sodium; vanilla mint flavor] Solution, oral, as sodium [drops]: Generic: 1.1 mg/ml (50 ml) [equivalent to fluoride 0.5 mg/ml] Fluorometholone Ointment, Ophthalmic, as base: FML: 0.1% (3.5 g) [contains phenylmercuric acetate] Suspension, Ophthalmic, as base: Generic: 0.1% (5 ml) Fluorouracil (Topical) Cream, External: Generic: 5% (40 g) FLUoxetine Capsule, Oral: Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF] Solution, Oral: Generic: 20 mg/5 ml (120 ml) [BCF] Generic: 60 mg Flutamide Capsule, Oral: Generic: 125 mg 14

16 Fluticasone and Salmeterol Aerosol, for Oral Inhalation: Advair HFA: 45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg per inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF] Advair HFA: 115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcg per inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF] Advair HFA: 230/21: Fluticasone propionate 230 mcg and salmeterol 21 mcg per inhalation (8 g) [chlorofluorocarbon free; 60 metered actuations] [BCF] Powder, for Oral Inhalation: Advair Diskus: 100/50: Fluticasone propionate 100 mcg and salmeterol 50 mcg (60s) [contains lactose] [BCF] Advair Diskus: 250/50: Fluticasone propionate 250 mcg and salmeterol 50 mcg (60s) [contains lactose] [BCF] Advair Diskus: 500/50: Fluticasone propionate 500 mcg and salmeterol 50 mcg (60s) [contains lactose] [BCF] Fluticasone (Nasal) Suspension, Nasal, as propionate: Generic: 50 mcg/inhalation (16 g) [BCF] Fluticasone (Oral Inhalation) Aerosol, Inhalation, as propionate: Flovent HFA: 44 mcg/inhalation (10.6 g) [chlorofluorocarbon free; 120 metered actuations] [BCF] Flovent HFA: 110 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF] Flovent HFA: 220 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF] Aerosol Powder Breath Activated, Inhalation, as propionate: Flovent Diskus: 50 mcg (60s) [contains lactose] [BCF] Flovent Diskus: 100 mcg (60s) [contains lactose] [BCF] Flovent Diskus: 250 mcg (60s) [contains lactose] [BCF] Folic Acid Generic: 1 mg [BCF] Fosinopril Tablet, Oral, as sodium: Generic: 10 mg, 20 mg, 40 mg Furosemide Solution, Oral: Generic: 10 mg/ml (60 ml) [BCF] Generic: 20 mg [BCF], 40 mg [BCF] Gabapentin Capsule, Oral: Generic: 100 mg [BCF], 300 mg [BCF], 400 mg [BCF] Generic: 600 mg [BCF], 800 mg [BCF] Gatifloxacin Solution, Ophthalmic: Generic: 0.5% (2.5 ml) Gemfibrozil Generic: 600 mg [BCF] Gentamicin (Ophthalmic) Ointment, Ophthalmic: Gentak : 0.3% (3.5 g) [BCF] Solution, Ophthalmic [drops]: Generic: 0.3% (5 ml) [BCF] Glatiramer Acetate Kit, Subcutaneous: Copaxone: 20 mg/ml [contains mannitol] Solution Prefilled Syringe, Subcutaneous: Copaxone: 40 mg/ml (1 ml) Glimepiride Generic: 2 mg, 4 mg 15

17 GlipiZIDE Generic: 5 mg [BCF], 10 mg [BCF] Tablet Extended Release 24 Hour, Oral: Generic: 2.5 mg, 5 mg, 10 mg Glucagon Kit, Injection: Glucagon Emergency: 1 mg GlyBURIDE Glynase: 1.5 mg [BCF], 3 mg [BCF], 6 mg [BCF] [scored] Generic: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF], 6 mg Glyburide and Metformin Tablet, oral: Generic: 1.25 mg/250 mg: Glyburide 1.25 mg and metformin hydrochloride 250 mg 2.5 mg/500 mg: Glyburide 2.5 mg and metformin hydrochloride 500 mg 5 mg/500 mg: Glyburide 5 mg and metformin hydrochloride 500 mg Goserelin Implant, Subcutaneous: Zoladex: 3.6 mg (1s) [1 month implant] [BCF] Zoladex: 10.8 mg (1s) [3 month implant] [BCF] Griseofulvin Suspension, Oral: Generic: 125 mg/5 ml (120 ml) [BCF] Generic: 125 mg [BCF], 250 mg [BCF] GuaiFENesin Generic: 200 mg Tablet Extended Release 12 Hour, Oral: Generic: 600 mg Guaifenesin and Codeine Solution, Oral: Generic: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 ml (118 ml) Guaifenesin and Dextromethorphan Syrup, Oral: Generic: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 ml (118 ml) [cherry flavor] GuanFACINE Generic: 1 mg Tablet Extended Release 24 Hour, Oral: Generic: 1 mg, 2 mg, 3 mg, 4 mg Homatropine Solution, Ophthalmic, as hydrobromide: Homatropaire: 5% (5 ml) HydrALAZINE Tablet, Oral, as hydrochloride: Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] Hydrochlorothiazide Capsule, Oral: Generic: 12.5 mg [BCF] Generic: 25 mg [BCF], 50 mg [BCF] Hydrochlorothiazide and Triamterene Hydrocodone and Acetaminophen Hydrocortisone (Systemic) Tablet, Oral, as base: Generic: 10 mg Capsule, Oral: Generic: Hydrochlorothiazide 25 mg and triamterene 37.5 mg Generic: Hydrochlorothiazide 25 mg and triamterene 37.5 mg [BCF] Hydrochlorothiazide 50 mg and triamterene 75 mg [BCF] Generic: Hydrocodone bitartrate 5 mg and acetaminophen 325 mg Hydrocodone bitartrate 7.5 mg and acetaminophen 325 mg Hydrocodone bitartrate 10 mg and acetaminophen 325 mg 16

18 Hydrocortisone (Topical) Cream, External, as base: Proctozone-HC 2.5% : 2.5% (30 g) [BCF] Generic: 1% (28.35 g) Cream, External, as valerate: Generic: 0.2% (15 g) Ointment, External, as valerate: Generic: 0.2% (15 g) Suppository, Rectal, as acetate: Anucort-HC: 25 mg (24s) [BCF] HYDROmorphone Tablet, Oral, as hydrochloride: Generic: 2 mg Hydroxychloroquine Tablet, Oral, as sulfate: Generic: 200 mg HydrOXYzine Capsule, Oral, as pamoate: Generic: 25 mg, 50 mg Syrup, Oral, as hydrochloride: Generic: 10 mg/5 ml (118 ml) [BCF] Tablet, Oral, as hydrochloride: Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] Hyoscyamine Tablet Dispersible, Oral, as sulfate: Generic: mg Tablet Extended Release 12 Hour, Oral, as sulfate: Symax-SR: mg [scored] Hyoscyamine, Atropine, Scopolamine, and Phenobarbital Donnatal: 16.2 mg Ibandronate Generic: 150 mg Ibuprofen Suspension, Oral: Generic: 100 mg/5 ml (120 ml) Generic: 400 mg [BCF], 600 mg [BCF], 800 mg [BCF] Imatinib Gleevec: 100 mg, 400 mg [scored] Imipramine Capsule, Oral, as pamoate: Generic: 75 mg [BCF] Tablet, Oral, as hydrochloride: Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] Imiquimod Cream, External: Generic: 5% (12 ea) Indomethacin Capsule, Oral: Generic: 25 mg [BCF], 50 mg [BCF] Capsule Extended Release, Oral: Generic: 75 mg Inhalation Devices Holding chamber: AeroChamber Plus Holding chamber with mask: AeroChamber Plus Flo-Vu: Small, Medium, Large Insulin Aspart Solution, Subcutaneous: NovoLOG: 100 units/ml (10 ml) [contains metacresol, phenol] [BCF] Solution Cartridge, Subcutaneous: NovoLOG Penfill: 100 units/ml (3 ml) [contains metacresol, phenol] [BCF] Solution Pen-injector, Subcutaneous: NovoLOG FlexPen: 100 units/ml (3 ml) [contains metacresol, phenol] [BCF] 17

19 Insulin Aspart Protamine and Insulin Aspart Suspension, Subcutaneous: NovoLOG Mix 70/30: Insulin aspart protamine suspension 70% [intermediate acting] and insulin aspart solution 30% [rapid acting]: 100 units/ml (10 ml) [BCF] NovoLOG Mix 70/30 FlexPen: Insulin aspart protamine suspension 70% [intermediate acting] and insulin aspart solution 30% [rapid-acting]: 100 units/ml (3 ml) [contains metacresol, phenol] [BCF] Insulin Detemir Solution, Subcutaneous: Levemir: 100 units/ml (10 ml) [contains metacresol, phenol] Insulin Glargine Solution, Subcutaneous: Lantus: 100 units/ml (10 ml) [contains metacresol] [BCF] Lantus Solostar: 100 units/ml (3 ml) [prefilled pen] [BCF] Insulin NPH Suspension, Subcutaneous: NovoLIN N: 100 units/ml (10 ml) [contains metacresol, phenol] [BCF] Insulin NPH and Insulin Regular Suspension, Subcutaneous: NovoLIN 70/30: Insulin NPH suspension 70% [intermediate acting] and insulin regular solution 30% [short acting]: 100 units/ml (10 ml) [contains metacresol, phenol] [BCF] Insulin Regular Solution, Injection: NovoLIN R: 100 units/ml (10 ml) [contains metacresol] [BCF] Interferon Beta-1a Kit, Intramuscular: Avonex Prefilled: 30 mcg/0.5 ml Solution, Subcutaneous [preservative free]: Rebif: 22 mcg/0.5 ml (0.5 ml); 44 mcg/0.5 ml (0.5 ml) [contains albumin human] Interferon Beta-1b Kit, Subcutaneous: Betaseron: 0.3 mg [contains albumin human] Ipratropium and Albuterol Aerosol Solution, Inhalation: Combivent Respimat: Ipratropium bromide 20 mcg and albuterol (base) 100 mcg per inhalation (4 g) [contains benzalkonium chloride, edetate disodium] Solution, for nebulization: Generic: Ipratropium bromide 0.5 mg and albuterol (base) 2.5 mg per 3 ml (30s) [BCF] Ipratropium (Nasal) Solution, Nasal, as bromide: Atrovent: 0.03% (30 ml); 0.06% (15 ml) Ipratropium (Oral Inhalation) Aerosol Solution, Inhalation, as bromide: Atrovent HFA: 17 mcg/actuation (12.9 g) [chlorofluorocarbon free; 200 metered actuations] [BCF] Solution, Inhalation, as bromide [preservative free]: Generic: 0.02% (2.5 ml) Isoniazid Syrup, Oral: Generic: 50 mg/5 ml (473 ml) Generic: 100 mg [BCF], 300 mg [BCF] Isosorbide Dinitrate Capsule Extended Release, Oral: Dilatrate-SR: 40 mg Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg [BCF] Isosorbide Mononitrate Tablet Extended Release 24 Hour, Oral: Generic: 30 mg [BCF], 60 mg [BCF], 120 mg [BCF] Ketoconazole (Systemic) Generic: 200 mg Ketoconazole (Topical) Cream, External: Generic: 2% (15 g) Shampoo, External: Generic: 2% (120 ml) Ketorolac (Ophthalmic) Solution, Ophthalmic, as tromethamine: Generic: 0.4% (5 ml) 18

20 Labetalol Tablet, Oral, as hydrochloride: Generic: 200 mg, 300 mg Lactic Acid and Ammonium Lotion, External: Hydroxide AmLactin: Lactic acid 12% with ammonium hydroxide (225 g) Lactobacillus Solution, Oral Gerber Soothe: Lactobacillus reuteri 100 million cell/5 drops Lactulose Solution, Oral: Generic: 10 g/15 ml (237 ml) [BCF] Lamivudine and Zidovudine Combivir: Lamivudine 150 mg and zidovudine 300 mg [scored] LamoTRIgine Generic: 25 mg, 100 mg, 150 mg, 200 mg Tablet Chewable, Oral: Generic: 5 mg Tablet Extended Release 24 Hour, Oral: LaMICtal XR: 50 mg, 100 mg, 200 mg, 300 mg [contains polysorbate 80] Lansoprazole Tablet Dispersible, Oral: Prevacid SoluTab: 15 mg, 30 mg Lapatinib Tykerb: 250 mg Latanoprost Solution, Ophthalmic: Generic: 0.005% (2.5 ml) [BCF] Leflunomide Generic: 10 mg, 20 mg Letrozole Generic: 2.5 mg Leuprolide Kit, Intramuscular, as acetate [preservative free]: Lupron Depot: 3.75 mg [latex free; contains polysorbate 80] LevETIRAcetam Solution, Oral: Generic: 100 mg/ml (473 ml) Generic: 500 mg, 750 mg Levofloxacin (Systemic) Solution, Oral: Generic: 25 mg/ml (100 ml) [BCF] Generic: 250 mg [BCF], 500 mg [BCF], 750 mg [BCF] Levonorgestrel (Systemic) Plan B One-Step: 1.5 mg Levothyroxine Tablet, Oral, as sodium: Generic: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg [BCF], 100 mcg [BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150 mcg [BCF], 175 mcg [BCF], 200 mcg [BCF], 300 mcg [BCF] Lidocaine and Prilocaine Cream, External [preservative free]: Generic: Lidocaine 2.5% and prilocaine 2.5% (30 g) Lidocaine (Topical) Gel, External, as hydrochloride: Generic: 2% (30 ml) Ointment, External: Generic: 5% (50 g) Patch, External: Lidoderm: 5% (30 ea) [contains disodium edta, methylparaben, propylene glycol, propylparaben] Viscous Solution, Mouth/Throat, as hydrochloride: Generic: 2% (100 ml) Lindane Shampoo, External: Generic: 1% (60 ml) 19

21 Liothyronine Generic: 5 mcg, 25 mcg Liraglutide Solution Pen-injector, Subcutaneous: Victoza: 18 mg/3 ml (3 ml) [contains phenol, propylene glycol] Lisinopril Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg [BCF], 40 mg [BCF] Lisinopril and Hydrochlorothiazide Generic: 10/12.5: Lisinopril 10 mg and hydrochlorothiazide 12.5 mg [BCF] 20/12.5: Lisinopril 20 mg and hydrochlorothiazide 12.5 mg [BCF] 20/25: Lisinopril 20 mg and hydrochlorothiazide 25 mg [BCF] Lithium Capsule, Oral, as carbonate: Generic: 150 mg [BCF], 300 mg [BCF] Solution, Oral, as citrate: Generic: 8 meq/5 ml (500 ml) [BCF] Tablet Extended Release, Oral, as carbonate: Lithobid: 300 mg Loperamide Capsule, Oral, as hydrochloride: Generic: 2 mg [BCF] Loratadine Syrup, Oral: Childrens Loratadine: 5 mg/5 ml (120 ml) [fruit flavor] Generic: 10 mg Loratadine and Pseudoephedrine LORazepam Generic: 0.5 mg, 1 mg, 2 mg Losartan Tablet, Oral, as potassium: Losartan and Hydrochlorothiazide Tablet Extended Release 12 Hour, Oral: Claritin-D 12 Hour: Loratadine 5 mg and pseudoephedrine sulfate 120 mg Tablet Extended Release 24 Hour, Oral: Claritin-D 24 Hour: Loratadine 10 mg and pseudoephedrine sulfate 240 mg Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Hyzaar 50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg [contains potassium 4.24 mg (0.108 meq)] [BCF] Hyzaar 100/12.5: Losartan potassium 100 mg and hydrochlorothiazide 12.5 mg [contains potassium 8.48 mg (0.216 meq)] [BCF] Hyzaar 100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg [contains potassium 8.48 mg (0.216 meq)] [BCF] Loteprednol Gel, Ophthalmic, as etabonate: Lotemax: 0.5% (5 g) [contains benzalkonium chloride, edetate disodium dihydrate, propylene glycol] Suspension, Ophthalmic, as etabonate: Lotemax: 0.5% (5 ml) Lovastatin Generic: 10 mg, 20 mg, 40 mg Magnesium Citrate Solution, Oral: Generic: g/30 ml (296 ml) Mebendazole Capsule, Oral, as hydrochloride: Generic: 100 mg Meclizine Tablet Chewable, Oral, as hydrochloride: Travel Sickness: 25 mg [scored; contains aspartame; raspberry flavor] MedroxyPROGESTERone Tablet, Oral, as acetate: Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF] 20

22 Mefloquine Tablet, Oral, as hydrochloride: Generic: 250 mg Megestrol Tablet, Oral, as acetate: Generic: 40 mg Meloxicam Generic: 7.5 mg [BCF], 15 mg [BCF] Memantine Capsule Extended Release 24 Hour, Oral, as hydrochloride: Namenda XR: 28 mg Tablet, Oral, as hydrochloride: Namenda: 5 mg,10 mg Namenda Titration Pak: 5 mg (28 ea) and 10 mg (21 ea) Meperidine Tablet, Oral, as hydrochloride: Generic: 50 mg Mesalamine Capsule Delayed Release, Oral: Delzicol: 400 mg Kit, Rectal: Generic: 4 g Tablet Delayed Release, Oral: Lialda: 1.2 g [BCF] Metaxalone Generic: 800 mg MetFORMIN Tablet, Oral, as hydrochloride: Generic: 500 mg [BCF], 850 mg [BCF], 1000 mg [BCF] Methadone Tablet, Oral, as hydrochloride: Generic: 10 mg Methazolamide Generic: 50 mg Methimazole Generic: 5 mg, 10 mg Methocarbamol Generic: 500 mg [BCF], 750 mg Methotrexate Generic: 2.5 mg [BCF] Methylergonovine Tablet, Oral, as maleate: Generic: 0.2 mg Methylphenidate Capsule Extended Release 24 Hour, Oral, as hydrochloride: Ritalin LA: 10 mg [BCF], 40 mg [BCF] Generic: 20 mg [BCF], 30 mg [BCF], 40 mg [BCF] Tablet, Oral, as hydrochloride: Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF] Tablet Extended Release, Oral, as hydrochloride: Generic: 18 mg [BCF], 27 mg [BCF], 36 mg [BCF], 54 mg [BCF] MethylPREDNISolone Medrol (Pak): 4 mg [scored] Generic: 4 mg Metoclopramide Solution, Oral: Generic: 5 mg/5 ml (473 ml) [BCF] Generic: 10 mg [BCF] Metolazone Generic: 2.5 mg, 5 mg Metoprolol Tablet, Oral, as tartrate: Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Tablet Extended Release 24 Hour, Oral, as succinate: Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF] 21

23 MetroNIDAZOLE (Systemic) Generic: 250 mg [BCF], 500 mg [BCF] MetroNIDAZOLE (Topical) Gel, External: Metrogel: 1% (60 g) [contains methylparaben, propylparaben] Gel, Vaginal: Generic: 0.75% (70 g) [BCF] Miconazole (Topical) Cream, External, as nitrate: Antifungal: 2% (28 g) [contains benzoic acid] Cream, Vaginal, as nitrate: Generic: 2% (45 g) Mineral Oil Oil, Oral: Generic: (473 ml) Minocycline Capsule, Oral: Generic: 50 mg, 100 mg Mirtazapine Generic: 15 mg, 30 mg Misoprostol Generic: 100 mcg, 200 mcg Modafinil Generic: 100 mg, 200 mg Mometasone (Oral Inhalation) This medication is nonformulary. For formulary alternatives, refer to Therapeutic Category. Montelukast Packet, Oral: Singulair: 4 mg/packet (30s) [BCF] Generic: 10 mg [BCF] Tablet Chewable, Oral: Generic: 4 mg [BCF], 5 mg [BCF] Morphine (Systemic) Tablet, Oral, as sulfate: Generic: 15 mg Tablet Extended Release, Oral, as sulfate: Generic: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF] Mouthwash, Magic Solution: Extemporaneously prepared by pharmacy Suspension, mouth/throat: First Mouthwash BLM Kit: Diphenhydramine-Lidocaine-Aluminum Hydroxide-Magnesium Hydroxide-Simethicone Moxifloxacin (Ophthalmic) Solution, Ophthalmic: Vigamox: 0.5% (3 ml) Moxifloxacin (Systemic) Avelox: 400 mg Mupirocin Cream, External, as calcium [strength expressed as base]: Generic: 2% (15 g) Ointment, External: Generic: 2% (22 g) [BCF] Mycophenolate Capsule, Oral, as mofetil: Generic: 250 mg Tablet, Oral, as mofetil: CellCept: 500 mg Tablet Delayed Release, Oral, as mycophenolic acid: Myfortic: 180 mg, 360 mg Nabumetone Generic: 500 mg, 750 mg Naltrexone Tablet, Oral, as hydrochloride: Generic: 50 mg 22

24 Naphazoline and Pheniramine Solution, Ophthalmic: Naphcon-A: Naphazoline hydrochloride 0.025% and pheniramine maleate 0.3% (5 ml) [contains benzalkonium chloride] Naproxen Suspension, Oral: Generic: 125 mg/5 ml (500 ml) [BCF] Generic: 250 mg [BCF], 375 mg, 500 mg [BCF] Nefazodone Tablet, Oral, as hydrochloride: Generic: 150 mg Neomycin Tablet, Oral, as sulfate: Generic: 500 mg Neomycin, Polymyxin B, and Dexamethasone Neomycin, Polymyxin B, and Gramicidin Neomycin, Polymyxin B, and Hydrocortisone (Otic) Ointment, Ophthalmic: Maxitrol: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexamethasone 0.1% per g (3.5 g) [contains methylparaben, propylparaben] Suspension, ophthalmic [drops]: Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexamethasone 0.1% per 1 ml (5 ml) Solution, Ophthalmic [drops]: Generic: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin mg per 1 ml (10 ml) [BCF] Solution, Otic: Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone 10 mg per 1 ml (10 ml) Suspension, Otic: Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone 10 mg per 1 ml (10 ml) [BCF] Nepafenac Suspension, Ophthalmic: Nevanac: 0.1% (3 ml) [contains edentate disodium benzalkonium chloride] Niacin Generic: 250 mg, 500 mg Tablet Extended Release, Oral: Niaspan: 500 mg [BCF], 750 mg [BCF], 1000 mg [BCF] Nicotine Gum, Mouth/Throat, as polacrilex: Generic: 2 mg (110 ea) [BCF]; 4 mg (110 ea) [BCF] Patch 24 Hour, Transdermal: Generic: 7 mg/24 hr (14 ea) [BCF]; 14 mg/24 hr (14 ea) [BCF]; 21 mg/24 hr (14 ea) [BCF] NIFEdipine Capsule, Oral: Generic: 10 mg Tablet Extended Release 24 Hour, Oral: Generic: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF] Nitrofurantoin Capsule, Oral: Macrodantin: 50 mg [BCF] Generic: 50 mg [BCF] Macrobid: 100 mg [BCF] Generic: 100 mg [BCF] Suspension, Oral: Generic: 25 mg/5 ml (230 ml) 23

25 Nitroglycerin Ointment, Rectal: Rectiv: 0.4% (30 g) [contains propylene glycol] Patch 24 Hour, Transdermal: Nitro-Dur: 0.3 mg/hour (30s) [BCF]; 0.8 mg/hour (30s) [BCF] Generic: 0.1 mg/hour (30s) [BCF]; 0.2 mg/hour (30s) [BCF]; 0.4 mg/hour (30s) [BCF]; 0.6 mg/hour (30s) [BCF] Solution, Translingual: Generic: 0.4 mg/spray (4.9 g) [BCF] Tablet, Sublingual: Nitrostat: 0.4 mg [BCF] Norethindrone Nor-QD: 0.35 mg [BCF] Generic: 0.35 mg [BCF] Tablet, Oral, as acetate: Generic: 5 mg Norethindrone and Mestranol Norinyl 1+50 (28): Norethindrone 1 mg and mestranol 0.05 mg [21 white tablets and 7 orange inactive tablets] Nortriptyline Capsule, Oral: Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] Nystatin and Triamcinolone Cream, External: Generic: Nystatin 100,000 units and triamcinolone acetonide 0.1% (30 g) Nystatin (Oral) Suspension, Mouth/Throat: Generic: 100,000 units/ml (60 ml) [BCF] Generic: 500,000 units Nystatin (Topical) Cream, External: Generic: 100,000 units/g (30 g) [BCF] Ointment, External: Generic: 100,000 units/g (30 g) [BCF] Powder, External: Nystop: 100,000 units/g (15 g) Ofloxacin (Ophthalmic) Solution, Ophthalmic: Generic: 0.3% (5 ml) Ofloxacin (Otic) Solution, Otic: Generic: 0.3% (10 ml) OLANZapine Generic: 2.5 mg, 5 mg, 10 mg Olopatadine (Ophthalmic) Solution, Ophthalmic: Pataday: 0.2% (2.5 ml) [contains benzalkonium chloride, edetate disodium] Patanol: 0.1% (5 ml) [contains benzalkonium chloride] [BCF] Omeprazole Capsule Delayed Release, Oral: Generic: 10 mg [BCF], 20 mg [BCF], 40 mg Ondansetron Generic: 4 mg, 8 mg Tablet Dispersible, Oral: Generic: 4 mg, 8 mg Orphenadrine Tablet Extended Release 12 Hour, Oral, as citrate: Generic: 100 mg Oseltamivir Capsule, Oral, as phosphate: Tamiflu: 75 mg Suspension Reconstituted, Oral, as base: Tamiflu: 6 mg/ml (60 ml) [contains saccharin sodium, sodium benzoate; tutti-frutti flavor] 24