Tadalafil entfaltet seine Wirkung über eine selektive Hemmung der PDE5, wodurch die Konzentration von cGMP im glatten Muskelgewebe stabil bleibt. Diese biochemische Modulation resultiert in einer langanhaltenden Relaxation der Gefäßwände. Der Wirkstoff wird nach oraler Einnahme effizient resorbiert, mit einer Bioverfügbarkeit von rund 80 %. Seine Halbwertszeit von bis zu 36 Stunden ist innerhalb dieser Substanzklasse außergewöhnlich. Abgebaut wird er in der Leber, hauptsächlich durch CYP3A4, mit anschließender biliärer Exkretion. Typische unerwünschte Wirkungen entstehen durch eine verstärkte Vasodilatation, etwa Kopfschmerzen oder Flush. Pharmakologisch wird cialis generika vor allem durch die verlängerte Wirkungsdauer charakterisiert.
Keesler_january 1.32
KEESLER AFB OUTPATIENT FORMULARY Alphabetical Listing by Name
This document is current as of January 10, 2014.
The availability of formulary items is subject to change. ABACAVIR AND LAMIVUDINE Abacavir and Lamivudine Outpatient Dosage Forms Outpatient Formulary Brands Available Epzicom® Outpatient Dosage Forms
Fosamax®: 70 mg/75 mL (75 mL) [raspberry flavor] [BCF]
Tablet, oral: 5 mg [BCF], 10 mg [BCF], 35 mg [BCF], 70 mg [BCF]
Epzicom®: 600/300: Abacavir 600 mg and lamivudine 300 mg
Alendronate and Cholecalciferol Acetaminophen Outpatient Formulary Brands Available Fosamax Plus D® Outpatient Dosage Forms Outpatient Dosage Forms
Solution, oral [drops]: 80 mg/0.8 mL (15 mL)
Fosamax Plus D®: 70/2800: Alendronate 70 mg and cholecalciferol 2800 int.
Suppository, rectal: 120 mg (12s); 650 mg (12s)
Fosamax Plus D®: 70/5600: Alendronate 70 mg and cholecalciferol 5600 int.
units [BCF] Acetaminophen and Codeine Alfuzosin Outpatient Formulary Brands Available Tylenol® with Codeine No. 3 Outpatient Formulary Brands Available Uroxatral® Outpatient Dosage Forms Outpatient Dosage Forms
Solution, oral [C-V]: Acetaminophen 120 mg and codeine phosphate 12 mg per
Tablet, extended release, oral, as hydrochloride:
5 mL (5 mL, 10 mL, 12.5 mL, 15 mL, 120 mL, 480 mL) [contains alcohol 7%]
Uroxatral®: 10 mg [BCF]
Tablet, oral [C-III]: Acetaminophen 300 mg and codeine phosphate 30 mg [BCF] Aliskiren Acetaminophen and Tramadol Outpatient Formulary Brands Available Tekturna® Outpatient Formulary Brands Available Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral: Acetaminophen 325 mg and tramadol hydrochloride 37.5 mg
Ultracet®: Acetaminophen 325 mg and tramadol hydrochloride 37.5 mg
Allopurinol Acetaminophen, Caffeine, and Isometheptene Mucate Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral: 100 mg [BCF], 300 mg [BCF]
Capsule, oral: Acetaminophen 500 mg, caffeine 20 mg, isometheptene mucate
ALPRAZolam Outpatient Formulary Brands Available Xanax® AcetaZOLAMIDE Outpatient Dosage Forms Outpatient Formulary Brands Available Diamox® Sequels® Outpatient Dosage Forms Alprostadil Outpatient Formulary Brands Available Edex®; Muse® Outpatient Dosage Forms Acetic Acid Outpatient Dosage Forms Acyclovir (Systemic) Outpatient Formulary Brands Available Zovirax® Aluminum Chloride Hexahydrate Outpatient Dosage Forms Outpatient Formulary Brands Available Drysol™
Capsule, oral: 200 mg [BCF] Outpatient Dosage Forms
Suspension, oral: 200 mg/5 mL (473 mL) [BCF]
Drysol™: 20% (37.5 mL) [contains ethanol 93%]
Tablet, oral: 400 mg [BCF], 800 mg [BCF] Amantadine Outpatient Dosage Forms Adalimumab
Capsule, oral, as hydrochloride: 100 mg [BCF] Syrup, oral, as hydrochloride: 50 mg/5 mL (10 mL, 473 mL, 480 mL) [BCF] Outpatient Formulary Brands Available Humira® Outpatient Dosage Forms Amcinonide Outpatient Dosage Forms
Humira®: 40 mg/0.8 mL (0.8 mL) [contains natural rubber/natural latex in
packaging, polysorbate 80] [ECF]
Injection, solution [pediatric, preservative free]:
Humira®: 20 mg/0.4 mL (0.4 mL) [contains natural rubber/natural latex in
AMILoride
packaging, polysorbate 80] [ECF] Outpatient Dosage Forms Adapalene Outpatient Formulary Brands Available Differin® Amiodarone Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 200 mg [BCF] Amitriptyline Outpatient Dosage Forms Albendazole
Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg Outpatient Formulary Brands Available Outpatient Dosage Forms AmLODIPine Outpatient Formulary Brands Available Norvasc® Outpatient Dosage Forms Albuterol
Tablet, oral: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF] Outpatient Formulary Brands Available Ventolin® HFA Outpatient Dosage Forms Amlodipine and Benazepril Outpatient Formulary Brands Available Lotrel®
Ventolin® HFA: 90 mcg/inhalation (18 g) [chlorofluorocarbon free; 200 metered
actuations] [BCF] Outpatient Dosage Forms
Solution, for nebulization: 0.083% [2.5 mg/3 mL] (25s, 30s, 60s) [BCF]; 0.5%
2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF] 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF] Alendronate
5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF] Outpatient Formulary Brands Available Fosamax®
10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF] Atenolol
2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF] Outpatient Dosage Forms
5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF]
Tablet, oral: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]
5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF] 5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF] AtoMOXetine
10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF] Outpatient Formulary Brands Available Strattera®
10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF] Outpatient Dosage Forms Amoxicillin
Strattera®: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg
Outpatient Dosage Forms
Capsule, oral: 250 mg [BCF], 500 mg [BCF] AtorvaSTATin
Powder for suspension, oral: 250 mg/5 mL (80 mL, 100 mL, 150 mL) [BCF]; Outpatient Formulary Brands Available Lipitor®
400 mg/5 mL (50 mL, 75 mL, 100 mL) [BCF] Outpatient Dosage Forms
Lipitor®: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Amoxicillin and Clavulanate Potassium Outpatient Formulary Brands Available Augmentin XR®; Augmentin® Atovaquone and Proguanil Outpatient Dosage Forms Outpatient Formulary Brands Available Malarone® Outpatient Dosage Forms
200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (50 mL,
75 mL, 100 mL) [contains phenylalanine] [BCF]
Malarone®: Atovaquone 250 mg and proguanil hydrochloride 100 mg
400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (50 mL, 75
Atropine
mL, 100 mL) [contains phenylalanine] [BCF]
600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (75 mL,
Outpatient Dosage Forms
125 mL, 200 mL) [BCF]
Solution, ophthalmic, as sulfate [drops]: 1% (15 mL)
AzaTHIOprine
125: Amoxicillin 125 mg and clavulanate potassium 31.25 mg per 5 mL (75
Outpatient Dosage Forms
mL, 100 mL, 150 mL) [contains potassium 0.16 mEq/5 mL; banana
flavor] [BCF]
200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (50
Azelaic Acid
mL, 75 mL, 100 mL) [contains phenylalanine 7 mg/5 mL and potassium 0.14
Outpatient Formulary Brands Available Azelex®; Finacea®
mEq/5 mL; orange flavor] [BCF] Outpatient Dosage Forms
250: Amoxicillin 250 mg and clavulanate potassium 62.5 mg per 5 mL (75
mL, 100 mL, 150 mL) [contains potassium 0.32 mEq/5 mL; orange fla-
Azelex®: 20% (30 g, 50 g) [contains benzoic acid]
vor] [BCF]
400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (50 mL,
Finacea®: 15% (50 g) [contains benzoic acid]
75 mL, 100 mL) [contains phenylalanine 7 mg/5 mL and potassium 0.29 mEq/5 mL; orange flavor] [BCF] Azelastine (Nasal) Outpatient Formulary Brands Available Astelin®
Amoxicillin 250 mg and clavulanate potassium 125 mg [BCF] Outpatient Dosage Forms
Amoxicillin 500 mg and clavulanate potassium 125 mg [BCF]
Solution, intranasal, as hydrochloride [spray]: 0.1% [137 mcg/spray] (30 mL)
Amoxicillin 875 mg and clavulanate potassium 125 mg [BCF]
Astelin®: 0.1% [137 mcg/spray] (30 mL) [contains benzalkonium chloride; 200
Augmentin XR®: 1000: Amoxicillin 1000 mg and clavulanate potassium
62.5 mg [scored; contains potassium 12.6 mg/tablet, sodium 29.3 mg/tablet]
Azithromycin (Ophthalmic) Anastrozole Outpatient Formulary Brands Available AzaSite® Outpatient Formulary Brands Available Arimidex® Outpatient Dosage Forms Outpatient Dosage Forms
AzaSite®: 1% (2.5 mL) [contains benzalkonium chloride]
Azithromycin (Systemic) Antipyrine and Benzocaine Outpatient Formulary Brands Available Zithromax®; Zithromax® Z-PAK® Outpatient Dosage Forms Outpatient Dosage Forms
Solution, otic [drops]: Antipyrine 5.4% and benzocaine 1.4% (10 mL, 15 mL)
Powder for suspension, oral, as dihydrate [strength expressed as base]:
100 mg/5 mL (15 mL) [BCF]; 1 g/packet (3s) [BCF] Zithromax®: 100 mg/5 mL (15 mL) [contains sodium 3.7 mg/5 mL; cherry- ARIPiprazole Outpatient Formulary Brands Available Abilify®
Zithromax®: 200 mg/5 mL (22.5 mL) [contains sodium 7.4 mg/5 mL; cherry-
Outpatient Dosage Forms
Zithromax®: 1 g/packet (10s) [contains sodium 37 mg/packet; banana-cherry
Abilify®: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg
Tablet, oral, as dihydrate [strength expressed as base]: 250 mg [BCF], Artificial Tears
500 mg [BCF] Outpatient Formulary Brands Available Systane® Ultra
Zithromax®: 250 mg [contains sodium 0.9 mg/tablet]
Outpatient Dosage Forms
Zithromax® Z-PAK®: 250 mg [contains sodium 0.9 mg/tablet]
Bacitracin
Systane® Ultra: Polyethylene glycol 400 0.4% and propylene glycol 0.3%
Outpatient Dosage Forms
Ointment, ophthalmic: 500 units/g (3.5 g])
Ointment, topical, as zinc [strength expressed as base]: 500 units/g (15 g)
Outpatient Dosage Forms Bacitracin, Neomycin, and Polymyxin B Outpatient Dosage Forms
Ointment, ophthalmic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B
10,000 units per g (3.5 g) [BCF] Aspirin and Dipyridamole Baclofen Outpatient Formulary Brands Available Aggrenox® Outpatient Dosage Forms Outpatient Dosage Forms
Aggrenox®: Aspirin 25 mg [immediate release] and dipyridamole 200 mg
Balsalazide Outpatient Formulary Brands Available Colazal® Outpatient Dosage Forms Atazanavir Outpatient Formulary Brands Available Reyataz®
Colazal®: 750 mg [contains sodium ~86 mg/capsule]
Outpatient Dosage Forms Outpatient Formulary Brands Available Readi-Cat® 2 Outpatient Dosage Forms Budesonide (Systemic, Oral Inhalation) Outpatient Formulary Brands Available Endocort® EC; Pulmicort
Readi-Cat® 2: 2.1% w/v (450 mL) [contains benzoic acid, sodium benzoate;
Outpatient Dosage Forms
Readi-Cat® 2: 2.1% w/v (250 mL, 450 mL) [contains benzoic acid, sodium
Readi-Cat® 2: 2.1% w/v (450 mL) [contains benzoic acid, sodium benzoate;
Belladonna and Opium Bupivacaine (Liposomal) Outpatient Dosage Forms Outpatient Dosage Forms
Suppository, rectal: Belladonna extract 16.2 mg and opium 60 mg (12s)
Benzonatate Outpatient Dosage Forms BuPROPion Outpatient Formulary Brands Available Wellbutrin SR®; Wellbutrin XL®; Benzoyl Peroxide Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 75 mg [BCF], 100 mg [BCF]
Tablet, extended release, oral, as hydrochloride: 100 mg [BCF], 150 mg [BCF]
Wellbutrin XL®: 300 mg [BCF]
Tablet, sustained release, oral, as hydrochloride:
Benztropine
Wellbutrin SR®: 100 mg [BCF], 150 mg [BCF] Outpatient Dosage Forms
Zyban®: 150 mg [BCF]
Tablet, oral, as mesylate: 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF] BusPIRone Betamethasone Outpatient Dosage Forms Outpatient Formulary Brands Available Luxíq®
Tablet, oral, as hydrochloride: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF] Outpatient Dosage Forms
Aerosol, topical, as valerate [strength expressed as base, foam]:
Butalbital, Acetaminophen, and Caffeine
Luxíq®: 0.12% (50 g) [contains ethanol 60.4%]
Outpatient Dosage Forms
Tablet, oral: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg
Betaxolol (Ophthalmic) Outpatient Formulary Brands Available Betoptic S® Outpatient Dosage Forms Butalbital, Aspirin, and Caffeine Outpatient Dosage Forms
Betoptic S®: 0.25% (15 mL) [contains benzalkonium chloride]
Tablet, oral: Butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg
Bicalutamide Calcipotriene Outpatient Formulary Brands Available Casodex® Outpatient Formulary Brands Available Dovonex® Outpatient Dosage Forms Outpatient Dosage Forms Bimatoprost Outpatient Formulary Brands Available Lumigan® Calcitriol Outpatient Dosage Forms Outpatient Dosage Forms
Lumigan®: 0.01% (5 mL) [contains benzalkonium chloride]
Bisacodyl Calcium Acetate Outpatient Dosage Forms Outpatient Formulary Brands Available PhosLo® Outpatient Dosage Forms
Suppository, rectal: 10 mg (50s)Tablet, enteric coated, oral: 5 mg
PhosLo®: 667 mg [equivalent to elemental calcium 169 mg (8.45 mEq)]
Calcium Carbonate Outpatient Formulary Brands Available Peptic Relief [OTC] Outpatient Formulary Brands Available Calcarb 600 [OTC] Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, chewable, oral, as subsalicylate:
Calcarb 600: 1500 mg [scored; sugar free; equivalent to elemental calcium
Brimonidine and Timolol Outpatient Formulary Brands Available Combigan™ Candesartan Outpatient Dosage Forms Outpatient Formulary Brands Available Atacand® Outpatient Dosage Forms
Combigan™: Brimonidine tartrate 0.2% and timolol maleate 0.5% (5 mL)
Atacand®: 4 mg, 8 mg, 16 mg, 32 mg [scored]
Brimonidine (Ophthalmic) Capecitabine Outpatient Formulary Brands Available Alphagan® P Outpatient Formulary Brands Available Xeloda® Outpatient Dosage Forms Outpatient Dosage Forms
Solution, ophthalmic, as tartrate [drops]: 0.15% (5 mL, 10 mL, 15 mL) [BCF];
0.2% (5 mL, 10 mL, 15 mL) [BCF]
Alphagan® P: 0.15% (10 mL) [contains Purite®]
Captopril Bromocriptine Outpatient Dosage Forms Outpatient Formulary Brands Available Parlodel® SnapTabs®
Tablet, oral: 12.5 mg [BCF], 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Outpatient Dosage Forms CarBAMazepine Outpatient Formulary Brands Available Carbatrol®; TEGretol® Outpatient Dosage Forms Budesonide and Formoterol Outpatient Formulary Brands Available Symbicort® Outpatient Dosage Forms
Suspension, oral: 100 mg/5 mL (5 mL, 10 mL, 450 mL) [BCF]
Tablet, oral: 200 mg [BCF]
Symbicort®: 80/4.5: Budesonide 80 mcg and formoterol fumarate dehydrate
Tablet, chewable, oral: 100 mg [BCF]
4.5 mcg per actuation (10.2 g); 160/4.5: Budesonide 160 mcg and formoterol
fumarate dehydrate 4.5 mcg per actuation (10.2 g) [120 metered inhalations]
Tablet, extended release, oral: 400 mg [BCF] CLINDAMYCIN (SYSTEMIC) Carbamide Peroxide Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral, as phosphate: 500 mg [equivalent to chloroquine base 300 mg]
Aralen®: 500 mg [equivalent to chloroquine base 300 mg]
Carbidopa and Levodopa Chlorpheniramine Outpatient Formulary Brands Available Sinemet® CR Outpatient Dosage Forms Outpatient Dosage Forms Chlorpheniramine and Phenylephrine
10/100: Carbidopa 10 mg and levodopa 100 mg [BCF] 25/100: Carbidopa 25 mg and levodopa 100 mg [BCF] Outpatient Formulary Brands Available C-Phen
25/250: Carbidopa 25 mg and levodopa 250 mg [BCF] Outpatient Dosage Forms
Sinemet® CR: 50/200: Carbidopa 50 mg and levodopa 200 mg [scored]
C-Phen: Chlorpheniramine maleate 4 mg and phenylephrine hydrochloride
12.5 mg per 5 mL (118 mL) [ethanol free, sugar free; contains sodium
Carboxymethylcellulose Outpatient Formulary Brands Available Optive™; Refresh Tears® ChlorproMAZINE Outpatient Dosage Forms Outpatient Dosage Forms
Optive™: 0.5% (15 mL, 30 mL) [contains glycerin]
Solution, ophthalmic, as sodium [drops, preservative free]:
Chlorthalidone Outpatient Dosage Forms Carteolol (Ophthalmic)
Tablet, oral: 25 mg [BCF], 50 mg [BCF] Outpatient Dosage Forms Cholestyramine Resin
Solution, ophthalmic, as hydrochloride [drops]: 1% (5 mL) [contains benzalko-
Outpatient Formulary Brands Available Questran® Light Outpatient Dosage Forms Carvedilol
Powder for suspension, oral: Cholestyramine resin 4 g/5 g of powder (210 g);
Outpatient Formulary Brands Available Coreg CR®; Coreg®
Cholestyramine resin 4 g/5.7 g of powder (239.4 g); Cholestyramine resin 4 g/
Outpatient Dosage Forms
9 g of powder (378 g); Cholestyramine resin 4 g/5 g packet (60s); Cholestyr-
Capsule, extended release, oral, as phosphate:
amine resin 4 g/5.7 g packet (60s); Cholestyramine resin 4 g/9 g packet (60s)
Questran® Light: Cholestyramine resin 4 g/5 g of powder (210 g); Cholestyr-
Tablet, oral: 3.125 mg [BCF], 6.25 mg [BCF], 12.5 mg [BCF], 25 mg [BCF]
amine resin 4 g/5 g packet (60s) [contains phenylalanine 14 mg/5 g; orange
Coreg®: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg
Cefadroxil Cilostazol Outpatient Dosage Forms Outpatient Formulary Brands Available Pletal®
Capsule, oral, as monohydrate [strength expressed as base]: 500 mg
Outpatient Dosage Forms Cefdinir Outpatient Formulary Brands Available Omnicef® Outpatient Dosage Forms Cimetidine Outpatient Dosage Forms
Omnicef®: 125 mg/5 mL (100 mL); 250 mg/5 mL (100 mL) [contains sodium
Cinacalcet
benzoate, sucrose 2.86 g/5 mL; strawberry flavor]
Outpatient Formulary Brands Available Sensipar® Cefprozil Outpatient Dosage Forms Outpatient Formulary Brands Available Cefzil® Outpatient Dosage Forms
Powder for suspension, oral, as anhydrous:
Ciprofloxacin and Dexamethasone
Cefzil®: 250 mg/5 mL (100 mL) [contains phenylalanine 28 mg/5 mL, sodium
Outpatient Formulary Brands Available Ciprodex® Outpatient Dosage Forms
Ciprodex®: Ciprofloxacin 0.3% and dexamethasone 0.1% (7.5 mL) [contains
Celecoxib Outpatient Formulary Brands Available CeleBREX® Ciprofloxacin (Systemic) Outpatient Dosage Forms Outpatient Formulary Brands Available Cipro® Outpatient Dosage Forms Cephalexin
Cipro®: 250 mg/5 mL (100 mL) [strawberry flavor] [BCF] Outpatient Dosage Forms
Tablet, oral, as hydrochloride [strength expressed as base]: 100 mg, 250 mg
Capsule, oral: 250 mg [BCF], 500 mg [BCF] [BCF], 500 mg [BCF], 750 mg
Powder for suspension, oral: 250 mg/5 mL (100 mL, 200 mL) [BCF] Citalopram Cetirizine Outpatient Dosage Forms Outpatient Formulary Brands Available ZyrTEC® Allergy; ZyrTEC® Child-
Solution, oral: 10 mg/5 mL (240 mL) [BCF]
Tablet, oral: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF] Outpatient Dosage Forms Clarithromycin
Syrup, oral, as hydrochloride: 5 mg/5 mL (120 mL)
ZyrTEC® Children's Allergy 5 mg/5 mL (120 mL) [contains propylene glycol;
Outpatient Formulary Brands Available Biaxin®; Biaxin® XL; Biaxin® XL
Tablet, oral, as hydrochloride: 5 mg, 10 mg
Outpatient Dosage Forms ChlordiazePOXIDE Outpatient Dosage Forms
Capsule, oral, as hydrochloride: 10 mg, 25 mg
Biaxin® XL Pac [7-day]: 500 mg (14 tablets)
Chlorhexidine Gluconate Clindamycin and Benzoyl Peroxide Outpatient Dosage Forms Outpatient Formulary Brands Available BenzaClin®
Liquid, oral [rinse]: 0.12% (473 mL, 480 mL) [BCF] Outpatient Dosage Forms
Hibiclens®: 4% (946 mL) [contains isopropyl alcohol 4%]
BenzaClin®: Clindamycin 1% and benzoyl peroxide 5% (25 g)
Chloroquine Clindamycin (Systemic) Outpatient Formulary Brands Available Aralen® Outpatient Formulary Brands Available Cleocin HCl®; Cleocin Pediatric® CLINDAMYCIN (SYSTEMIC) Outpatient Dosage Forms Outpatient Dosage Forms
Capsule, oral, as hydrochloride [strength expressed as base]: 150 mg [BCF]
Crolom®: 4% (10 mL) [contains benzalkonium chloride]
Granules for solution, oral, as palmitate hydrochloride [strength expressed as
Cyanocobalamin
Cleocin Pediatric®: 75 mg/5 mL (100 mL) [cherry flavor]
Outpatient Dosage Forms Clindamycin (Topical) Outpatient Formulary Brands Available Cleocin® Outpatient Dosage Forms Cyclobenzaprine
Cream, vaginal, as phosphate [strength expressed as base]: 2% (40 g) [BCF] Outpatient Formulary Brands Available Flexeril®
Cleocin®: 2% (40 g) [contains benzyl alcohol, mineral oil]
Outpatient Dosage Forms
Solution, topical, as phosphate [strength expressed as base]: 1% (30 mL, 60
Tablet, oral, as hydrochloride: 10 mg [BCF]
mL) [BCF] Clobetasol Cyclopentolate Outpatient Formulary Brands Available Olux®; Temovate E®; Temovate® Outpatient Formulary Brands Available AK-Pentolate™; Cyclogyl® Outpatient Dosage Forms Outpatient Dosage Forms
Solution, ophthalmic, as hydrochloride [drops]:
Olux®: 0.05% (100 g) [contains ethanol 60%; for scalp application]
AK-Pentolate™: 1% (15 mL) [contains benzalkonium chloride]
Cream, topical, as propionate [emollient-based]: 0.05% (30 g)
Cyclogyl®: 0.5% (15 mL) [contains benzalkonium chloride]
Ointment, topical, as propionate: 0.05% (45 g)
Cyclopentolate and Phenylephrine
Temovate®: 0.05% (15 g, 30 g, 45 g [DSC])
Outpatient Formulary Brands Available Cyclomydril®
Solution, topical, as propionate [for scalp application]: 0.05% (50 mL)
Outpatient Dosage Forms
Temovate®: 0.05% (50 mL) [contains isopropyl alcohol 39.3%]
ClomiPHENE
Cyclomydril®: Cyclopentolate hydrochloride 0.2% and phenylephrine hydro-
Outpatient Formulary Brands Available Clomid®
chloride 1% (2 mL) [contains benzalkonium chloride]
Outpatient Dosage Forms CycloSPORINE (Ophthalmic) Outpatient Formulary Brands Available Restasis® Outpatient Dosage Forms ClonazePAM
Emulsion, ophthalmic [drops, preservative free]:
Outpatient Dosage Forms
Restasis®: 0.05% (0.4 mL) [contains castor oil]
Tablet, oral: 0.5 mg [BCF], 2 mg CycloSPORINE (Systemic) CloNIDine Outpatient Formulary Brands Available Neoral® Outpatient Formulary Brands Available Catapres-TTS®-1; Catapres-TTS®- Outpatient Dosage Forms
Capsule, softgel, oral [modified]: 25 mg, 100 mg
Outpatient Dosage Forms
Neoral®: 25 mg, 100 mg [contains corn oil, dehydrated ethanol 11.9%]
Cyproheptadine Outpatient Dosage Forms
Syrup, oral, as hydrochloride: 2 mg/5 mL (473 mL, 480 mL) [BCF]
Tablet, oral, as hydrochloride: 0.1 mg [BCF], 0.2 mg [BCF], 0.3 mg [BCF]
Tablet, oral, as hydrochloride: 4 mg [BCF]
Tablet, extended release, oral, as hydrochloride:
Dabigatran Etexilate Outpatient Formulary Brands Available Pradaxa Clopidogrel Outpatient Dosage Forms Outpatient Formulary Brands Available Plavix® Outpatient Dosage Forms
Plavix®: 75 mg [BCF], 300 mg [BCF] Dantrolene
Generic: 75 mg [BCF], 300 mg [BCF] Outpatient Formulary Brands Available Dantrium® Clotrimazole (Oral) Outpatient Dosage Forms Outpatient Formulary Brands Available Mycelex® Outpatient Dosage Forms Dapsone (Systemic) Outpatient Dosage Forms Clotrimazole (Topical) Outpatient Dosage Forms Darbepoetin Alfa
Cream, topical: 1% (30 g) Solution, topical: 1% (10 mL, 30 mL) [BCF] Outpatient Formulary Brands Available Aranesp®; Aranesp® SingleJect® Outpatient Dosage Forms Outpatient Dosage Forms
Aranesp®: 60 mcg/0.3 mL (0.3 mL [DSC]); 200 mcg/0.4 mL (0.4 mL [DSC])
Aranesp® SingleJect®: 25 mcg/0.42 mL (0.42 mL); 60 mcg/0.3 mL (0.3 mL);
Colchicine
100 mcg/0.5 mL (0.5 mL); 200 mcg/0.4 mL (0.4 mL) [contains natural rubber/
Outpatient Dosage Forms
natural latex in packaging, polysorbate 80]
Darunavir Colestipol Outpatient Formulary Brands Available Prezista® Outpatient Formulary Brands Available Colestid® Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral, as hydrochloride [micronized]:
Collagenase (Topical) Desmopressin Outpatient Formulary Brands Available Outpatient Formulary Brands Available DDAVP® Outpatient Dosage Forms Outpatient Dosage Forms
Solution, intranasal, as acetate [spray]:
DDAVP®: 0.1 mg/mL (5 mL) [contains benzalkonium chloride; delivers 10 mcg/
Cromolyn (Ophthalmic) Outpatient Formulary Brands Available Crolom® DOCUSATE
20 mg [scored; dextroamphetamine sulfate 5 mg, dextroamphetamine sac-
charate 5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine
Desonide
sulfate 5 mg (equivalent to amphetamine base 12.6 mg)]
Outpatient Dosage Forms Diabetic Supplies
Cream, topical: 0.05% (60 g)Lotion, topical: 0.05% (60 mL)
Outpatient Formulary Brands Available Accu-Chek® Aviva; Accu-Chek® Outpatient Dosage Forms Outpatient Dosage Forms
Accu-Chek® Aviva Diabetes Monitoring Kit
Accu-Chek® Aviva Glucose Control Solution (2s)
Dexamethasone (Systemic) Outpatient Formulary Brands Available Decadron® [DSC]; Dexamethasone Outpatient Dosage Forms
BD Syringe 0.5 mL (Ultra-Fine II) 31 gauge x 5/16" [BCF]
Solution, oral: 0.5 mg/5 mL (240 mL, 500 mL)
BD Syringe 1 mL (Ultra-Fine II) 31 gauge x 5/16" [BCF]
Dexamethasone Intensol™: 1 mg/mL (30 mL) [dye free, sugar free; contains
benzoic acid, ethanol 30%, propylene glycol]
Diazepam Outpatient Formulary Brands Available Diastat®; Diastat® AcuDial™; Dextroamphetamine Outpatient Formulary Brands Available Dexedrine® Spansule® Outpatient Dosage Forms Outpatient Dosage Forms
Gel, rectal [pediatric rectal tip (4.4 cm)]:
Capsule, sustained release, oral, as sulfate:
Diastat®: 5 mg/mL (0.5 mL) [contains benzoic acid, benzyl alcohol, ethanol
Dexedrine® Spansule®: 5 mg [scored; contains tartrazine]
Gel, rectal [pediatric/adult rectal tip (4.4 cm)]:
Dextroamphetamine and Amphetamine
Diastat® AcuDial™: 10 mg (2 mL) [contains benzoic acid, benzyl alcohol,
Outpatient Formulary Brands Available Adderall XR®; Adderall®
ethanol 10%, propylene glycol, sodium benzoate; 5 mg/mL (delivers set
Outpatient Dosage Forms
Tablet, oral: 5 mg [BCF]
5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate
Diclofenac (Topical)
1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sul- fate 1.25 mg (equivalent to amphetamine base 3.1 mg)] [BCF] Outpatient Formulary Brands Available Voltaren
10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate
Outpatient Dosage Forms
2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate
2.5 mg (equivalent to amphetamine base 6.3 mg)] [BCF]
Voltaren: 1% (100 g) [contains isopropyl alcohol, propylene glycol]
15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccharate
Dicloxacillin
3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine sul- fate 3.75 mg (equivalent to amphetamine base 9.4 mg)] [BCF] Outpatient Dosage Forms
20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate
Capsule, oral: 250 mg [BCF], 500 mg [BCF]
5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate
Dicyclomine
5 mg (equivalent to amphetamine base 12.5 mg)] [BCF] Outpatient Dosage Forms
25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine saccharate
Capsule, oral, as hydrochloride: 10 mg [BCF]
6.25 mg, amphetamine aspartate monohydrate 6.25 mg, amphetamine sul-
Injection, solution, as hydrochloride: 10 mg/mL (2 mL) [BCF]
fate 6.25 mg (equivalent to amphetamine base 15.6 mg)] [BCF]
30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate
Bentyl®: 10 mg/5 mL (480 mL) [contains propylene glycol] [BCF]
7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sulfate
Tablet, oral, as hydrochloride: 20 mg [BCF]
7.5 mg (equivalent to amphetamine base 18.8 mg)] [BCF] Difluprednate
5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate
Outpatient Formulary Brands Available Durezol®
1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine
Outpatient Dosage Forms
sulfate 1.25 mg (equivalent to amphetamine base 3.1 mg)]
10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate
Durezol®: 0.05% (5 mL) [contains sorbic acid]
2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate2.5 mg (equivalent to amphetamine base 6.3 mg)]
15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccharate
Outpatient Formulary Brands Available Lanoxin®
3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine
Outpatient Dosage Forms
sulfate 3.75 mg (equivalent to amphetamine base 9.4 mg)]
Tablet, oral: 125 mcg [BCF], 250 mcg [BCF]
20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate
5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate
Diltiazem
5 mg (equivalent to amphetamine base 12.5 mg)]
Outpatient Formulary Brands Available Tiazac®
25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine saccharate
Outpatient Dosage Forms
6.25 mg, amphetamine aspartate monohydrate 6.25 mg, amphetamine
Capsule, extended release, oral, as hydrochloride [once-daily dosing]: 120 mg
sulfate 6.25 mg (equivalent to amphetamine base 15.6 mg)]
[BCF], 180 mg [BCF], 240 mg [BCF], 300 mg [BCF], 360 mg [BCF], 420 mg
30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate
7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sulfate
Tiazac®: 120 mg, 180 mg, 240 mg, 300 mg, 360 mg
7.5 mg (equivalent to amphetamine base 18.8 mg)]
DiphenhydrAMINE (Systemic)
5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate
Outpatient Formulary Brands Available Benadryl®; Diphenhist® [OTC]
1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sul-
Outpatient Dosage Forms
fate 1.25 mg (equivalent to amphetamine base 3.13 mg)]
Capsule, oral, as hydrochloride: 25 mg, 50 mg
10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate
Benadryl® Allergy: 25 mg [contains calcium 35 mg/capsule
2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate
Elixir, oral, as hydrochloride: 12.5 mg/5 mL
2.5 mg (equivalent to amphetamine base 6.3 mg)]
20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate
Diphenoxylate and Atropine
5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate
Outpatient Formulary Brands Available Lomotil®
5 mg (equivalent to amphetamine base 12.6 mg)]
Outpatient Dosage Forms
5 mg [scored; dextroamphetamine sulfate 1.25 mg, dextroamphetamine sac-
Lomotil®: 2.5/0.025: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate
charate 1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphet-
amine sulfate 1.25 mg (equivalent to amphetamine base 3.13 mg)]
10 mg [scored; dextroamphetamine sulfate 2.5 mg, dextroamphetamine sac-
Docusate
charate 2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphet-
Outpatient Formulary Brands Available Colace® [OTC]; Surfak® Liqui-
amine sulfate 2.5 mg (equivalent to amphetamine base 6.3 mg)]
DOCUSATE Outpatient Dosage Forms Outpatient Dosage Forms
Truvada®: Emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg
Capsule, softgel, oral, as calcium: 240 mg
[gluten free; equivalent to 245 mg tenofovir disoproxil]
Liquid, oral, as sodium: 50 mg/5 mL (473 mL)
Enoxaparin Outpatient Formulary Brands Available Lovenox® Docusate and Senna Outpatient Dosage Forms Outpatient Formulary Brands Available Senokot-S® [OTC]
Injection, solution, as sodium [preservative free]:
Outpatient Dosage Forms
Lovenox®: 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
Senokot-S®: Docusate sodium 50 mg and sennosides 8.6 mg [sugar free;
(1 mL) [BCF]; 120 mg/0.8 mL (0.8 mL) [BCF]; 150 mg/mL (1 mL) [BCF] Entacapone Donepezil Outpatient Formulary Brands Available Comtan® Outpatient Formulary Brands Available Aricept® Outpatient Dosage Forms Outpatient Dosage Forms
Aricept®: 5 mg [ECF], 10 mg [ECF] EPINEPHrine (Systemic, Oral Inhalation) Dorzolamide Outpatient Formulary Brands Available EpiPen®; EpiPen® Jr. Outpatient Formulary Brands Available Trusopt® Outpatient Dosage Forms Outpatient Dosage Forms
0.15 mg/0.15 mL (1.1 mL) [1:1000 solution; delivers 0.15 mg per injec-
Trusopt®: 2% (10 mL) [contains benzalkonium chloride]
tion] [BCF]
0.3 mg/0.3 mL (1.1 mL) [1:1000 solution; delivers 0.3 mg per injection] [BCF] Dorzolamide and Timolol
EpiPen®: 0.3 mg/0.3 mL (2 mL) [contains sodium metabisulfite; 1:1000 sol-
Outpatient Formulary Brands Available Cosopt® Outpatient Dosage Forms
EpiPen® Jr.: 0.15 mg/0.3 mL (2 mL) [contains sodium metabisulfite; 1:2000
solution; delivers 0.15 mg per injection]
Cosopt®: Dorzolamide hydrochloride 2% [strength expressed as base] and
timolol maleate 0.5% mg [strength expressed as base] (10 mL) [contains
Epoetin Alfa Outpatient Formulary Brands Available Procrit® Outpatient Dosage Forms Doxazosin Outpatient Formulary Brands Available Cardura®
Procrit®: 20,000 units/mL (1 mL [DSC]) [contains albumin (human), benzyl
Outpatient Dosage Forms
Cardura®: 1 mg, 2 mg, 4 mg, 8 mg [scored]
Procrit®: 40,000 units/mL (1 mL) [contains albumin (human)]
Doxepin (Systemic) Ergocalciferol Outpatient Dosage Forms Outpatient Formulary Brands Available Drisdol®
Capsule, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], Outpatient Dosage Forms
75 mg [BCF]
Solution, oral, as hydrochloride [concentrate]: 10 mg/mL (120 mL) [BCF]
Drisdol®: 50,000 int. units [contains soybean oil, tartrazine; 1.25 mg]
Doxycycline Erythromycin (Ophthalmic) Outpatient Formulary Brands Available Vibramycin® Outpatient Dosage Forms Outpatient Dosage Forms
Ointment, ophthalmic [preservative free]: 0.5% [5 mg/g] (3.5 g) [BCF]
Capsule, oral, as hyclate: 50 mg, 100 mg [strength expressed as base] [BCF] Tablet, oral, as hyclate: 100 mg [strength expressed as base] [BCF] Erythromycin (Systemic) Outpatient Formulary Brands Available Ery-Tab®; EryPed® Doxylamine Outpatient Dosage Forms Outpatient Formulary Brands Available Aldex® AN
Granules for suspension, oral, as ethylsuccinate [strength expressed as base]:
Outpatient Dosage Forms
E.E.S.®: 200 mg/5 mL (100 mL, 200 mL) [contains sodium 25.9 mg (1.1 mEq)/
5 mL; cherry flavor] [BCF]
Tablet, oral, as stearate [strength expressed as base]:
Erythrocin®: 250 mg [contains potassium 5 mg (0.1 mEq)/tablet, sodium
Dronedarone
56.7 mg (2.5 mEq)/tablet] [BCF] Outpatient Formulary Brands Available Multaq®
Tablet, delayed release, enteric coated, oral, as base:
Outpatient Dosage Forms
Ery-Tab®: 250 mg [contains sodium 8.3 mg (0.4 mEq)/tablet] [BCF] Erythromycin (Topical) Outpatient Dosage Forms Efavirenz
Gel, topical: 2% (30 g, 60 g) [BCF] Outpatient Formulary Brands Available Sustiva®
Solution, topical: 2% (60 mL) [BCF] Outpatient Dosage Forms Escitalopram Outpatient Dosage Forms Efavirenz, Emtricitabine, and Tenofovir Outpatient Formulary Brands Available Atripla® Outpatient Dosage Forms Esomeprazole Outpatient Formulary Brands Available NexIUM®
Atripla®: Efavirenz 600 mg, emtricitabine 200 mg, and tenofovir disoproxil
Outpatient Dosage Forms
Capsule, delayed release, oral, as magnesium [strength expressed as base]:
NexIUM®: 20 mg [BCF], 40 mg [BCF] Emollients Outpatient Formulary Brands Available Biafine®; Vanicream® Estradiol and Levonorgestrel Outpatient Dosage Forms Outpatient Formulary Brands Available ClimaraPro® Outpatient Dosage Forms
ClimaraPro®: Estradiol 0.045 mg and levonorgestrel 0.015 mg per 24 hours
(4s) [22 cm2; contains estradiol 4.4 mg and levonorgestrel 1.39 mg]
Emtricitabine and Tenofovir Estradiol (Systemic) Outpatient Formulary Brands Available Truvada® Outpatient Formulary Brands Available Climara®; Femring® ETHINYL ESTRADIOL AND NORGESTIMATE Outpatient Dosage Forms Outpatient Dosage Forms
Patch, transdermal [once-weekly patch]: 0.025 mg/24 hours (4s) [BCF];
0.0375 mg/24 hours (4s) [BCF]; 0.05 mg/24 hours (4s) [BCF]; 0.06 mg/24
Demulen® 1/35-28: Ethinyl estradiol 0.035 mg and ethynodiol diacetate 1 mg
hours (4s) [BCF]; 0.075 mg/24 hours (4s) [BCF]; 0.1 mg/24 hours (4s) [BCF]
[21 white tablets and 7 blue inactive tablets] [DSC]
Climara®: 0.025 mg/24 hours (4s) [6.5 cm2, total estradiol 2.04 mg]Climara®: 0.05 mg/24 hours (4s) [12.5 cm2, total estradiol 3.8 mg]
Ethinyl Estradiol and Etonogestrel
Climara®: 0.075 mg/24 hours (4s) [18.75 cm2, total estradiol 5.7 mg]
Outpatient Formulary Brands Available NuvaRing®
Climara®: 0.1 mg/24 hours (4s) [25 cm2, total estradiol 7.6 mg]
Outpatient Dosage Forms
Femring®: 0.05 mg/24 hours (1s) [total estradiol 12.4 mg; releases 0.05 mg/24
NuvaRing®: Ethinyl estradiol 0.015 mg/day and etonogestrel 0.12 mg/day (1s)
Femring®: 0.1 mg/24 hours (1s) [total estradiol 24.8 mg; releases 0.1 mg/24
Ethinyl Estradiol and Levonorgestrel Outpatient Formulary Brands Available Aviane™; Jolessa™; Lessina®; Estradiol (Topical) Outpatient Dosage Forms Outpatient Formulary Brands Available Estrace®; Estring®; Vagifem® Outpatient Dosage Forms
Aviane™ 28: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21
orange tablets and 7 light green inactive tablets] [BCF]
Lessina® 28: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21
pink tablets and 7 white inactive tablets] [BCF]
Estring®: 2 mg (1s) [total estradiol 2 mg; releases 7.5 mcg/day over 90 days]
Levlite™ 28: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 pink
tablets and 7 white inactive tablets] [BCF]
Levora® 28: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (28s) [21
Estramustine
white tablets and 7 peach inactive tablets] [BCF] Outpatient Formulary Brands Available Emcyt®
Nordette® 28: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (28s) [21
Outpatient Dosage Forms
light orange tablets and 7 pink inactive tablets] [BCF]
Jolessa™: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (91s) [84 pink
tablets and 7 white inactive tablets] [BCF] Estrogens (Conjugated/Equine) and Medroxyprogesterone Ethinyl Estradiol and Norelgestromin Outpatient Formulary Brands Available Premphase®; Prempro® Outpatient Formulary Brands Available Ortho Evra® Outpatient Dosage Forms Outpatient Dosage Forms
Ortho Evra®: Ethinyl estradiol 0.75 mg and norelgestromin 6 mg (1s) [releases
0.3/1.5: Conjugated estrogens 0.3 mg and medroxyprogesterone acetate
ethinyl estradiol 20 mcg and norelgestromin 150 mcg per day]
1.5 mg (28s) [BCF]
0.45/1.5: Conjugated estrogens 0.45 mg and medroxyprogesterone acetate
Ethinyl Estradiol and Norethindrone
1.5 mg (28s) [BCF] Outpatient Formulary Brands Available femhrt®; Loestrin® Fe 1.5/30;
0.625/2.5: Conjugated estrogens 0.625 mg and medroxyprogesterone ace-
Loestrin® Fe 1/20; Necon® 1/35; Ortho-Novum® 7/7/7
tate 2.5 mg (28s) [BCF] Outpatient Dosage Forms
0.625/5: Conjugated estrogens 0.625 mg and medroxyprogesterone acetate
5 mg (28s) [BCF]
Norinyl® 1+35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg (28s) [21
Tablet, oral [therapy pack contains two separate tablet formulations]:
yellow green tablets and 7 orange inactive tablets] [BCF]
Premphase® [therapy pack contains 2 separate tablet formulations]: Conju-
Ortho-Novum® 1/35-28: Ethinyl estradiol 0.035 mg and norethindrone 1 mg
gated estrogens 0.625 mg [14 maroon tablets] and conjugated estrogen
(28s) [21 peach tablets and 7 green inactive tablets] [BCF]
0.625 mg/medroxyprogesterone acetate 5 mg [14 light blue tablets] (28s)
Loestrin® Fe 1.5/30: Ethinyl estradiol 0.03 mg and norethindrone acetate
Estrogens (Conjugated/Equine, Systemic)
Ferrous fumarate 75 mg [7 brown tablets] [DSC]
Outpatient Formulary Brands Available Premarin®
Loestrin® Fe 1/20: Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg
Outpatient Dosage Forms
[21 light yellow tablets] and ferrous fumarate 75 mg [7 brown tablets]
Necon® 1/35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 dark
Premarin®: 0.3 mg [BCF], 0.45 mg [BCF], 0.625 mg [BCF], 0.9 mg,
yellow tablets and 7 white inactive tablets]
1.25 mg [BCF]
femhrt®: 1/5: Ethinyl estradiol 0.005 mg and norethindrone acetate 1 mg [white
Estrogens (Conjugated/Equine, Topical) Outpatient Formulary Brands Available Premarin® Outpatient Dosage Forms
Ortho-Novum® 7/7/7: Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone
Premarin®: 0.625 mg/g (42.5 g) [BCF]
Day 8-14: Ethinyl estradiol 0.035 mg and norethindrone 0.75 mg [7 light
Ethambutol
Day 15-21: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [7 peach
Outpatient Formulary Brands Available Myambutol® Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 100 mg [BCF], 400 mg [BCF] Ethinyl Estradiol and Norgestimate Outpatient Formulary Brands Available Ortho Tri-Cyclen®; Ortho Tri- Ethinyl Estradiol and Desogestrel Outpatient Formulary Brands Available Mircette® Outpatient Dosage Forms Outpatient Dosage Forms
Ortho-Cyclen®: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg (28s) [21
blue tablets and 7 green inactive tablets] [BCF]
Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 white tablets]
Ortho Tri-Cyclen®: Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate
Day 24-28: Ethinyl estradiol 0.01 mg [5 yellow tablets] (28s)
0.18 mg [7 white tablets]Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light blue
Ethinyl Estradiol and Drospirenone Outpatient Formulary Brands Available Yasmin®; Yaz®
Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 blue
Outpatient Dosage Forms
Day 22-28: 7 green inactive tablets [DSC]
Yasmin®: Ethinyl estradiol 0.03 mg and drospirenone 3 mg (28s) [21 yellow
Ortho Tri-Cyclen® Lo: Day 1-7: Ethinyl estradiol 0.025 mg and norgestimate
active tablets and 7 white inactive tablets] [BCF]
Yaz®: Ethinyl estradiol 0.02 mg and drospirenone 3 mg (28s) [24 light pink
Day 8-14: Ethinyl estradiol 0.025 mg and norgestimate 0.215 mg [7 light blue
tablets and 4 white inactive tablets] [BCF]
Day 15-21: Ethinyl estradiol 0.025 mg and norgestimate 0.25 mg [7 dark blue
Ethinyl Estradiol and Ethynodiol Diacetate Outpatient Formulary Brands Available Demulen® 1/35-28 ETHINYL ESTRADIOL AND NORGESTREL Ethinyl Estradiol and Norgestrel Outpatient Dosage Forms Outpatient Formulary Brands Available Lo/Ovral®-28; Ogestrel® Outpatient Dosage Forms Fluconazole
Ogestrel®: Ethinyl estradiol 0.05 mg and norgestrel 0.5 mg
Outpatient Formulary Brands Available Diflucan®
Lo/Ovral®-28: Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [DSC]
Outpatient Dosage Forms
Tablet, oral: 150 mg [BCF] Etidronate Outpatient Dosage Forms Fludrocortisone Outpatient Formulary Brands Available Florinef® [DSC] Outpatient Dosage Forms Exenatide Outpatient Formulary Brands Available Bydureon™; Byetta® Outpatient Dosage Forms
Injection, microspheres for suspension, extended release:
Flunisolide (Nasal)
Bydureon™: 2 mg [contains polylactide-co-glycolide, sucrose 0.8 mg/vial;
Outpatient Dosage Forms
Solution, intranasal [spray]: 25 mcg/actuation (25 mL)
Byetta®: 250 mcg/mL (2.4 mL) [10 mcg/0.04 mL; 60 doses]
Fluocinolone (Topical)
Byetta®: 250 mcg/mL (1.2 mL) [5 mcg/0.02 mL; 60 doses]
Outpatient Formulary Brands Available Capex®; Derma-Smoothe/FS® Outpatient Dosage Forms Ezetimibe Outpatient Formulary Brands Available Zetia®
Derma-Smoothe/FS®: 0.01% (120 mL) [contains peanut oil]
Outpatient Dosage Forms Fluocinonide Ezetimibe and Simvastatin Outpatient Dosage Forms Outpatient Formulary Brands Available Vytorin®
Cream, anhydrous, emollient, topical: 0.05% (15 g, 30 g, 60 g, 120 g) [BCF] Outpatient Dosage Forms
10/10: Ezetimibe 10 mg and simvastatin 10 mg10/20: Ezetimibe 10 mg and simvastatin 20 mg
Fluoride
10/40: Ezetimibe 10 mg and simvastatin 40 mg
Outpatient Formulary Brands Available Fluorabon™ [DSC]; Gel-Kam®;
10/80: Ezetimibe 10 mg and simvastatin 80 mg
PreviDent® 5000 Dry Mouth; PreviDent® 5000 Plus®
Outpatient Dosage Forms Famciclovir Outpatient Formulary Brands Available Famvir®
PreviDent® 5000 Plus®: 1.1% (51 g) [contains sodium benzoate; spearmint
Outpatient Dosage Forms
flavor; equivalent to fluoride 2.5 mg/dose]
PreviDent® 5000 Dry Mouth: 1.1% (100 mL) [mint flavor; equivalent to fluoride
Fenofibrate and Derivatives Outpatient Formulary Brands Available
Gel-Kam®: 0.4% (129 mL) [fruit & berry flavor]
Outpatient Dosage Forms
Fluorabon™: 2.21 mg [DSC] [scored; sugar free; raspberry flavor; equivalent to
TriCor®: 48 mg [BCF], 145 mg [BCF] [contains soybean lecithin]
Triglide®: 50 mg, 160 mg [contains egg lecithin]
FentaNYL Fluorometholone Outpatient Formulary Brands Available Outpatient Formulary Brands Available Outpatient Dosage Forms Outpatient Dosage Forms
Patch, transdermal, as base: 12.5 mcg/hour (5s)
Suspension, ophthalmic, as base [drops]: 0.1% (5 mL, 10 mL, 15 mL)
Duragesic®: 25 mcg/hour (5s) [contains ethanol 0.1 mL/10 cm2; 10 cm2]
FML®: 0.1% (5 mL, 10 mL, 15 mL) [contains benzalkonium chloride]
Duragesic®: 50 mcg/hour (5s) [contains ethanol 0.1 mL/10 cm2; 20 cm2]
Fluorouracil (Topical)
Duragesic®: 75 mcg/hour (5s) [contains ethanol 0.1 mL/10 cm2; 30 cm2]
Outpatient Formulary Brands Available Efudex®
Duragesic®: 100 mcg/hour (5s) [contains ethanol 0.1 mL/10 cm2; 40 cm2]
Outpatient Dosage Forms Ferrous Sulfate Outpatient Formulary Brands Available Fer-iron [OTC] Outpatient Dosage Forms FLUoxetine
Fer-iron: 75 mg/mL (50 mL) [contains ethanol 0.2%, sodium bisulfite; lemon
Outpatient Dosage Forms
Capsule, oral: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]
Tablet, oral: 325 mg [elemental iron 65 mg]
Solution, oral: 20 mg/5 mL (120 mL) [BCF] Fexofenadine Flurandrenolide Outpatient Formulary Brands Available Allegra® Outpatient Formulary Brands Available Cordran® Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 60 mg, 180 mg
Fexofenadine and Pseudoephedrine Flurbiprofen (Ophthalmic) Outpatient Formulary Brands Available Allegra-D® 24-Hour Outpatient Formulary Brands Available Ocufen® Outpatient Dosage Forms Outpatient Dosage Forms
Allegra-D® 24-Hour: 180/240: Fexofenadine hydrochloride 180 mg and pseu-
Flutamide Finasteride Outpatient Formulary Brands Available Eulexin® [DSC] Outpatient Formulary Brands Available Proscar® Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral: 5 mg [BCF]
Eulexin®: 125 mg [DSC] [contains benzyl alcohol]
Flecainide Fluticasone and Salmeterol Outpatient Formulary Brands Available Tambocor™ Outpatient Formulary Brands Available Advair Diskus®; Advair® HFA GUAIFENESIN AND PSEUDOEPHEDRINE Outpatient Dosage Forms Gentamicin (Ophthalmic) Outpatient Formulary Brands Available Gentak® Outpatient Dosage Forms
45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg per inhalation
(12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]
115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcg per inhalation
Gentak®: 0.3% [3 mg/g] (3.5 g) [BCF]
(12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]
Solution, ophthalmic [drops]: 0.3% (5 mL) [BCF]
230/21: Fluticasone propionate 230 mcg and salmeterol 21 mcg per inhala-
Glimepiride
tion (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF] Outpatient Formulary Brands Available Amaryl® Outpatient Dosage Forms
100/50: Fluticasone propionate 100 mcg and salmeterol 50 mcg ((14s, 60s)
[contains lactose] [BCF]
250/50: Fluticasone propionate 250 mcg and salmeterol 50 mcg (60s)
[contains lactose] [BCF] GlipiZIDE
500/50: Fluticasone propionate 500 mcg and salmeterol 50 mcg (60s)
Outpatient Formulary Brands Available Glucotrol XL®
[contains lactose] [BCF] Outpatient Dosage Forms Fluticasone (Nasal)
Tablet, oral: 5 mg [BCF], 10 mg [BCF] Tablet, extended release, oral: 2.5 mg [DSC] Outpatient Formulary Brands Available Flonase® Outpatient Dosage Forms
Suspension, intranasal, as propionate [spray]:
Glucagon
Flonase®: 50 mcg/inhalation (16 g) [contains benzalkonium chloride; 120
Outpatient Formulary Brands Available Glucagon Emergency Kit
metered actuations] [BCF] Outpatient Dosage Forms Fluticasone (Oral Inhalation) Outpatient Formulary Brands Available Flovent® HFA
Glucagon Emergency Kit: 1 mg [contains glycerin (in diluent), lactose 49 mg;
Outpatient Dosage Forms
Aerosol, for oral inhalation, as propionate:
GlyBURIDE
44 mcg/inhalation (10.6 g) [chlorofluorocarbon free; 120 metered actua-
Outpatient Dosage Forms
tions] [BCF]
Tablet, oral: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF]
110 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actua-
Tablet, oral [micronized]: 1.5 mg [BCF], 3 mg [BCF], 6 mg [BCF]
tions] [BCF]
220 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actua-
Glyburide and Metformin
tions] [BCF] Outpatient Formulary Brands Available Glucovance®
Powder, for oral inhalation, as propionate:
Outpatient Dosage Forms
Flovent® Diskus®: 50 mcg (60s) [contains lactose] [BCF]; 100 mcg (60s)
[contains lactose] [BCF]; 250 mcg (60s) [contains lactose] [BCF]
1.25/250: Glyburide 1.25 mg and metformin hydrochloride 250 mg
Folic Acid
5/500: Glyburide 5 mg and metformin hydrochloride 500 mg
Outpatient Dosage Forms
Glucovance®: 2.5/500: Glyburide 2.5 mg and metformin hydrochloride 500 mg
Tablet, oral: 1 mg [BCF] Goserelin Fosamprenavir Outpatient Formulary Brands Available Zoladex® Outpatient Formulary Brands Available Lexiva® Outpatient Dosage Forms Outpatient Dosage Forms
Lexiva®: 700 mg [equivalent to amprenavir ~600 mg]
3.6 mg (1s) [1 month implant] [BCF] Fosinopril
10.8 mg (1s) [3 month implant] [BCF] Outpatient Dosage Forms Griseofulvin Outpatient Formulary Brands Available Grifulvin V®; Gris-PEG® Fructose, Dextrose, and Phosphoric Acid Outpatient Dosage Forms Outpatient Formulary Brands Available Emetrol® [OTC]
Suspension, oral [microsize]: 125 mg/5 mL (120 mL) [BCF] Outpatient Dosage Forms
Gris-PEG®: 125 mg [BCF], 250 mg [BCF] [scored]
Emetrol®: Fructose 1.87 g, dextrose 1.87 g, and phosphoric acid 21.5 mg per
GuaiFENesin Outpatient Formulary Brands Available Mucinex® [OTC] Furosemide Outpatient Dosage Forms Outpatient Dosage Forms
Solution, oral: 10 mg/mL (4 mL, 60 mL, 120 mL) [BCF]
Tablet, oral: 20 mg [BCF], 40 mg [BCF], 80 mg Guaifenesin and Codeine Gabapentin Outpatient Dosage Forms Outpatient Formulary Brands Available Neurontin® Outpatient Dosage Forms
Solution, oral: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (5
Capsule, oral: 100 mg [BCF], 300 mg [BCF], 400 mg [BCF]
Tablet, oral: 600 mg [BCF], 800 mg [BCF] Guaifenesin and Dextromethorphan Outpatient Formulary Brands Available Robitussin® Cough & Chest Con- Ganciclovir (Ophthalmic) Outpatient Formulary Brands Available Zirgan® Outpatient Dosage Forms Outpatient Dosage Forms
Syrup, oral: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg
Zirgan®: 0.15% (5 g) [contains benzalkonium chloride]
Robitussin® Cough & Chest Congestion DM: Guaifenesin 100 mg and dextro-
Gatifloxacin
methorphan hydrobromide 10 mg per 5 mL (120 mL, 240 mL, 360 mL)
Outpatient Formulary Brands Available
[ethanol free; contains propylene glycol, sodium 7 mg/5 mL, sodium ben-
Outpatient Dosage Forms Guaifenesin and Pseudoephedrine
Zymaxid™: 0.5% (2.5 mL) [contains benzalkonium chloride]
Outpatient Formulary Brands Available Mucinex® D [OTC] Gemfibrozil Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral: 600 mg [BCF]
Mucinex® D: Guaifenesin 600 mg and pseudoephedrine hydrochloride 60 mg
GUAIFENESIN AND PSEUDOEPHEDRINE Outpatient Dosage Forms GuanFACINE Outpatient Formulary Brands Available Intuniv™; Tenex® HydrOXYzine Outpatient Dosage Forms Outpatient Dosage Forms
Syrup, oral, as hydrochloride: 10 mg/5 mL (118 mL, 473 mL) [BCF]
Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] Hyoscyamine Homatropine Outpatient Formulary Brands Available Levsin® Outpatient Dosage Forms Outpatient Formulary Brands Available Isopto® Homatropine
Solution, oral, as sulfate [drops]: 0.125 mg/mL (15 mL)
Outpatient Dosage Forms
Levsin®: 0.125 mg/mL (15 mL [DSC]) [contains ethanol 5%; orange flavor]
Solution, ophthalmic, as hydrobromide [drops]:
Isopto® Homatropine: 5% (5 mL) [contains benzalkonium chloride]
Hyoscyamine, Atropine, Scopolamine, and Phenobarbital Outpatient Dosage Forms HydrALAZINE
Elixir, oral: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, scopol-
Outpatient Dosage Forms
amine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg per 5 mL (473
Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] Hydrochlorothiazide
Tablet, oral: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg,
scopolamine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg
Outpatient Dosage Forms
Capsule, oral: 12.5 mg [BCF] Ibandronate
Tablet, oral: 25 mg [BCF], 50 mg [BCF] Outpatient Formulary Brands Available Boniva® Hydrochlorothiazide and Triamterene Outpatient Dosage Forms Outpatient Dosage Forms
Boniva®: 150 mg [once-monthly formulation] [BCF]
Hydrochlorothiazide 25 mg and triamterene 37.5 mg [BCF] Ibuprofen
Hydrochlorothiazide 50 mg and triamterene 75 mg [BCF] Outpatient Formulary Brands Available Motrin® Children's Outpatient Dosage Forms Hydrocodone and Acetaminophen
Suspension, oral: 100 mg/5 mL (5 mL, 10 mL, 120 mL, 480 mL)
Outpatient Dosage Forms
Solution, oral: Hydrocodone bitartrate 7.5 mg and acetaminophen 500 mg per
Tablet, oral: 400 mg [BCF], 600 mg [BCF], 800 mg [BCF]
Tablet, oral: Hydrocodone bitartrate 5 mg and acetaminophen 500 mg; hydro-
Imipramine
codone bitartrate 7.5 mg and acetaminophen 500 mg
Outpatient Dosage Forms
Capsule, oral, as pamoate: 75 mg [BCF] Hydrocodone and Chlorpheniramine
Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] Outpatient Formulary Brands Available Tussionex® Pennkinetic® Outpatient Dosage Forms Imiquimod Outpatient Formulary Brands Available Aldara®
Tussionex® Pennkinetic®: Hydrocodone polistirex [equivalent to hydrocodone
Outpatient Dosage Forms
bitartrate 10 mg] and chlorpheniramine polistirex [equivalent to chlorphenir-
amine maleate 8 mg] per 5 mL (473 mL) [contains propylene glycol]
Aldara®: 5% (12s [DSC], 24s) [contains benzyl alcohol]
Hydrocodone and Ibuprofen Indomethacin Outpatient Formulary Brands Available Vicoprofen® Outpatient Dosage Forms Outpatient Dosage Forms
Capsule, oral: 25 mg [BCF], 50 mg [BCF] Ingenol Mebutate
Vicoprofen®: 7.5/200: Hydrocodone bitartrate 7.5 mg and ibuprofen 200 mg
Outpatient Formulary Brands Available Picato® Hydrocortisone (Systemic) Outpatient Dosage Forms Outpatient Formulary Brands Available Cortef® Outpatient Dosage Forms
Picato®: 0.015% (3s); 0.05% (2s) [contains benzyl alcohol, isopropyl alcohol]
Inhalation Devices Outpatient Dosage Forms Hydrocortisone (Topical)
AeroChamber™, AeroChamber™ with mask (small, medium)
Outpatient Formulary Brands Available Proctozone-HC 2.5%™ Insulin Aspart Outpatient Dosage Forms Outpatient Formulary Brands Available NovoLOG®; NovoLOG® FlexPen®
Cream, topical, as base: 1% (15 g); 2.5% (20 g, 28 g, 28.35 g, 30 g, 454 g)
Outpatient Dosage Forms
NovoLOG®: 100 units/mL (3 mL) [FlexPen® prefilled syringe or PenFill®
prefilled cartridge] [BCF]; (10 mL) [vial] [BCF]
Ointment, topical, as base: 1% (30 g)Ointment, topical, as valerate: 0.2% (15 g)
Insulin Aspart Protamine and Insulin Aspart
Suppository, rectal, as acetate: 25 mg (12s, 24s) [BCF] Outpatient Formulary Brands Available NovoLOG® Mix 70/30 FlexPen® Outpatient Dosage Forms HYDROmorphone Outpatient Formulary Brands Available Dilaudid®
NovoLOG® Mix 70/30: Insulin aspart protamine suspension 70% [intermediate
Outpatient Dosage Forms
acting] and insulin aspart solution 30% [rapid acting]: 100 units/mL (3 mL)
[FlexPen® prefilled syringe] [BCF]; (10 mL) [vial] [BCF]
Dilaudid®: 4 mg [contains sodium metabisulfite (may have trace amounts)]
Insulin Glargine Hydroquinone Outpatient Formulary Brands Available Lantus®; Lantus® Solostar® Outpatient Formulary Brands Available Solaquin Forte® [DSC] Outpatient Dosage Forms Outpatient Dosage Forms
Lantus®: 100 units/mL (3 mL, 10 mL) [BCF]
Solaquin Forte®: 4% (28.4 g [DSC]) [contains sunscreen]
Lantus® Solostar®: 100 units/mL (3 mL) [prefilled pen]
Hydroxychloroquine Insulin NPH Outpatient Dosage Forms Outpatient Formulary Brands Available HumuLIN® N; NovoLIN® N
Tablet, oral, as sulfate: 200 mg [equivalent to 155 mg base]
Outpatient Dosage Forms Hydroxyurea
HumuLIN® N: 100 units/mL (3 mL, 10 mL) [BCF] Outpatient Formulary Brands Available Hydrea®
NovoLIN® N: 100 units/mL (10 mL) [BCF] LEVETIRACETAM Insulin NPH and Insulin Regular Ketoconazole (Topical) Outpatient Formulary Brands Available HumuLIN® 70/30; NovoLIN® 70/30 Outpatient Dosage Forms Outpatient Dosage Forms
HumuLIN® 70/30: Insulin NPH suspension 70% [intermediate acting] and
Ketorolac (Ophthalmic)
insulin regular solution 30% [short acting]: 100 units/mL (3 mL) [disposable pen] [BCF]; (10 mL) [vial] [BCF] Outpatient Formulary Brands Available Acuvail®
NovoLIN® 70/30: Insulin NPH suspension 70% [intermediate acting] and
Outpatient Dosage Forms
insulin regular solution 30% [short acting]: 100 units/mL (10 mL) [BCF]
Solution, ophthalmic, as tromethamine [drops, preservative free]:
Insulin Regular Outpatient Formulary Brands Available HumuLIN® R; NovoLIN® R Labetalol Outpatient Dosage Forms Outpatient Dosage Forms
HumuLIN® R: 100 units/mL (3 mL, 10 mL) [BCF] Lactic Acid and Ammonium Hydroxide
NovoLIN® R: 100 units/mL (10 mL) [BCF] Outpatient Formulary Brands Available AmLactin® [OTC] Interferon Beta-1a Outpatient Dosage Forms Outpatient Formulary Brands Available Avonex® Outpatient Dosage Forms
AmLactin®: Lactic acid 12% with ammonium hydroxide (225 g)
Lactobacillus
Avonex®): 30 mcg/0.5 mL (0.5 mL) [albumin free; prefilled syringe; syringe cap
Outpatient Formulary Brands Available Culturelle® Digestive Health; Cul-
contains latex; packaged with alcohol wipes, gauze pad, and adhesive
bandages] [ECF] Outpatient Dosage Forms Interferon Beta-1b Outpatient Formulary Brands Available Betaseron®
Culturelle® Digestive Health: Lactobacillus GG 10 billion cells per capsule
Outpatient Dosage Forms
Culturelle® for Kids: Lactobacillus GG 1 billion cells per packet
Betaseron®: 0.3 mg [~9.6 million int. units] [contains albumin (human)]
Lactulose Ipecac Syrup Outpatient Dosage Forms Outpatient Dosage Forms
Solution, oral: 10 g/15 mL (15 mL, 30 mL, 237 mL, 240 mL, 473 mL, 480 mL, 500
mL, 946 mL, 960 mL) [BCF] Ipratropium and Albuterol LamiVUDine Outpatient Formulary Brands Available Outpatient Formulary Brands Available Outpatient Dosage Forms Outpatient Dosage Forms
Solution for nebulization: Ipratropium bromide 0.5 mg and albuterol (base)
DuoNeb®: Ipratropium bromide 0.5 mg and albuterol (base) 2.5 mg per 3 mL
Lamivudine and Zidovudine Outpatient Formulary Brands Available Combivir®
Combivent® Respimat®: Ipratropium bromide 20 mcg and albuterol (base) 100
Outpatient Dosage Forms
mcg per inhalation (4 g) [contains benzalkonium chloride; 120 metered
actuations] [BCF]
Combivir®: 300/150: Zidovudine 300 mg and lamivudine 150 mg
Ipratropium (Nasal) LamoTRIgine Outpatient Formulary Brands Available Atrovent® Outpatient Formulary Brands Available LaMICtal® Outpatient Dosage Forms Outpatient Dosage Forms
Solution, intranasal, as bromide [spray]:
Atrovent®: 0.03% (30 mL) [contains benzalkonium chloride; delivers 21 mcg/
LaMICtal®: 25 mg, 100 mg, 150 mg, 200 mg [scored]
Latanoprost Ipratropium (Oral Inhalation) Outpatient Formulary Brands Available Xalatan® Outpatient Formulary Brands Available Atrovent® HFA Outpatient Dosage Forms Outpatient Dosage Forms
Aerosol, for oral inhalation, as bromide:
Xalatan®: 0.005% (2.5 mL) [contains benzalkonium chloride] [BCF]
Atrovent® HFA: 17 mcg/actuation (12.9 g) [chlorofluorocarbon free] [BCF]
Solution, for nebulization, as bromide: 0.02% [500 mcg/2.5 mL] (25s, 30s, 60s)
Letrozole Outpatient Formulary Brands Available Femara® Isoniazid Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral: 100 mg [BCF], 300 mg [BCF] Isosorbide Dinitrate Leucovorin Calcium Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg [BCF]
Tablet, oral [strength expressed as base]: 5 mg
Tablet, extended release, oral: 40 mg [BCF] Leuprolide Isosorbide Mononitrate Outpatient Formulary Brands Available Lupron Depot® Outpatient Formulary Brands Available Imdur® Outpatient Dosage Forms Outpatient Dosage Forms
Injection, powder for reconstitution, as acetate [depot formulation]:
Lupron Depot®: 3.75 mg, 7.5 mg [contains polylactide-co-glycolide, polysor-
Tablet, extended release, oral: 30 mg [BCF], 60 mg [BCF], 120 mg [BCF] Levalbuterol ISOtretinoin Outpatient Formulary Brands Available Xopenex HFA™ Outpatient Formulary Brands Available Amnesteem®; Claravis™; Sotret® Outpatient Dosage Forms Outpatient Dosage Forms
Aerosol, for oral inhalation, as tartrate [strength expressed as base]:
Xopenex HFA™: 45 mcg/actuation (15 g) [chlorofluorocarbon free; 200 actua-
Claravis™: 40 mg [contains soybean oil]
Amnesteem®: 40 mg [contains soybean oil]
LevETIRAcetam
Sotret®: 40 mg [contains parabens, soybean oil]
Outpatient Formulary Brands Available Keppra XR™; Keppra® LEVETIRACETAM Outpatient Dosage Forms Outpatient Dosage Forms
Keppra®: 100 mg/mL (480 mL) [dye free; grape flavor]
Kaletra®: Lopinavir 200 mg and ritonavir 50 mg
Keppra®: 500 mg, 750 mg [scored; gluten free]
Loratadine Outpatient Formulary Brands Available Claritin® Outpatient Dosage Forms Levofloxacin (Systemic)
Claritin®: 1 mg/mL (473 mL [DSC]) [contains sodium benzoate; fruit flavor]
Outpatient Formulary Brands Available Levaquin® Outpatient Dosage Forms LORazepam
Levaquin®: 25 mg/mL (480 mL) [contains benzyl alcohol, propylene gly-
Outpatient Dosage Forms
col] [BCF]
Levaquin®: 250 mg [BCF], 500 mg [BCF], 750 mg [BCF] Losartan Outpatient Formulary Brands Available Cozaar® Levonorgestrel Outpatient Dosage Forms Outpatient Formulary Brands Available Next Choice™ Outpatient Dosage Forms
Cozaar®: 25 mg [contains potassium 2.12 mg (0.054 mEq)] [BCF]
Cozaar®: 50 mg [contains potassium 4.24 mg (0.108 mEq)] [BCF]
Cozaar®: 100 mg [contains potassium 8.48 mg (0.216 mEq)] [BCF]
Plan B One-Step: 1.5 mg [BCF] Losartan and Hydrochlorothiazide Levothyroxine Outpatient Formulary Brands Available Hyzaar® Outpatient Formulary Brands Available Synthroid® Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral, as sodium: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg
Hyzaar® 50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg
[BCF], 100 mcg [BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150
[contains potassium 4.24 mg (0.108 mEq)] [BCF]
mcg [BCF], 175 mcg [BCF], 200 mcg [BCF], 300 mcg [BCF]
Hyzaar® 100/12.5: Losartan potassium 100 mg and hydrochlorothiazide
Synthroid®: 25 mcg, 75 mcg, 88 mcg, 100 mcg, 125 mcg, 137 mcg, 150 mcg,
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] Lidocaine, Maalox®, Diphenhydramine Magnesium Citrate Outpatient Dosage Forms Outpatient Dosage Forms
Suspension, oral [mouthwash 1:1:1]: 1 part Lidocaine viscous 2%, 1 part
Maalox®, and 1 part diphenhydramine elixir 12.5 mg/5 mL per 120 mL
Magnesium Gluconate Lidocaine (Topical) Outpatient Dosage Forms Outpatient Formulary Brands Available L-M-X® 4; Lidoderm®
Tablet, oral: 500 mg [equivalent to elemental magnesium 27 mg (2.4 mEq)]
Outpatient Dosage Forms Magnesium Hydroxide
L-M-X® 4: 4% (5 g, 15 g, 30 g) [contains benzyl alcohol]
Outpatient Formulary Brands Available Milk of Magnesia [OTC]
Jelly, topical, as hydrochloride [preservative free]: 2% (10 mL)
Outpatient Dosage Forms Linezolid Outpatient Formulary Brands Available Zyvox® Magnesium Oxide Outpatient Dosage Forms Outpatient Formulary Brands Available Mag-Ox® 400 [OTC] Outpatient Dosage Forms
Zyvox®: 100 mg/5 mL (150 mL) [contains phenylalanine 20 mg/5 mL, sodium
8.52 mg (0.4 mEq)/5 mL, sodium benzoate; orange flavor]
Mag-Ox® 400: 400 mg [scored; equivalent to elemental magnesium 240 mg
Zyvox®: 600 mg [contains sodium 2.92 mg (0.1 mEq)/tablet]
Meclizine Liothyronine Outpatient Dosage Forms Outpatient Formulary Brands Available Cytomel® Outpatient Dosage Forms MedroxyPROGESTERone Outpatient Dosage Forms
Depo-Provera® Contraceptive: 150 mg/mL (1 mL)
Lisinopril
Tablet, oral, as acetate: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF] Outpatient Formulary Brands Available Zestril® Outpatient Dosage Forms Mefloquine
Tablet, oral: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg Outpatient Dosage Forms [BCF], 40 mg [BCF]
Tablet, oral, as hydrochloride: 250 mg [scored; equivalent to mefloquine base
Lisinopril and Hydrochlorothiazide Megestrol Outpatient Dosage Forms Outpatient Formulary Brands Available Megace® Outpatient Dosage Forms
10/12.5: Lisinopril 10 mg and hydrochlorothiazide 12.5 mg [BCF]
20/12.5: Lisinopril 20 mg and hydrochlorothiazide 12.5 mg [BCF]
Megace®: 40 mg/mL (240 mL) [contains ethanol 0.06%, sodium benzoate;
20/25: Lisinopril 20 mg and hydrochlorothiazide 25 mg [BCF] Outpatient Dosage Forms Melatonin
Capsule, oral, as carbonate: 150 mg [BCF], 300 mg [BCF] Outpatient Dosage Forms
Solution, oral, as citrate: 300 mg/5 mL (5 mL, 473 mL, 500 mL) [equivalent to
amount of lithium in lithium carbonate] [BCF]
Syrup, oral, as citrate: 300 mg/5 mL [BCF] Meloxicam Outpatient Dosage Forms Loperamide Outpatient Dosage Forms
Mobic®: 7.5 mg [BCF], 15 mg [BCF]
Capsule, oral, as hydrochloride: 2 mg [BCF]
Generic: 7.5 mg [BCF], 15 mg [BCF] Lopinavir and Ritonavir Melphalan Outpatient Formulary Brands Available Kaletra® Outpatient Formulary Brands Available Alkeran® MISOPROSTOL Outpatient Dosage Forms
Tablet, extended release, oral, as hydrochloride [bi-modal release]:
18 mg [4 mg immediate release, 14 mg extended release] [BCF] 27 mg [6 mg immediate release, 21 mg extended release] [BCF] Memantine
36 mg [8 mg immediate release, 28 mg extended release] [BCF] Outpatient Formulary Brands Available Namenda®
54 mg [12 mg immediate release, 42 mg extended release] [BCF] Outpatient Dosage Forms
Tablet, sustained release, oral, as hydrochloride: 20 mg
MethylPREDNISolone Meperidine Outpatient Dosage Forms Outpatient Formulary Brands Available Demerol® Outpatient Dosage Forms Metoclopramide Outpatient Dosage Forms
Solution, oral: 5 mg/5 mL (10 mL, 473 mL) [BCF] Mercaptopurine
Tablet, oral: 10 mg [BCF] Outpatient Formulary Brands Available Purinethol® Outpatient Dosage Forms Metolazone Outpatient Formulary Brands Available Zaroxolyn® Outpatient Dosage Forms Mesalamine Outpatient Formulary Brands Available Canasa®; Lialda®; Pentasa®; Metoprolol Outpatient Dosage Forms Outpatient Formulary Brands Available Toprol-XL® Outpatient Dosage Forms
Tablet, oral, as tartrate: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]
Tablet, extended release, oral, as succinate: 25 mg [BCF], 50 mg [BCF],
Canasa®: 1000 mg (30s) [contains saturated vegetable fatty esters]
100 mg [BCF], 200 mg [BCF] [expressed as mg equivalent to tartrate]
Toprol-XL®: 25 mg, 50 mg, 100 mg, 200 mg [scored; expressed as mg equiv-
Rowasa®: 4 g/60 mL (7s, 28s) [contains potassium metabisulfite, sodium
Tablet, delayed release, enteric coated, oral:
MetroNIDAZOLE (Systemic) Outpatient Dosage Forms Metaxalone
Tablet, oral: 250 mg [BCF], 500 mg [BCF] Outpatient Formulary Brands Available Skelaxin® MetroNIDAZOLE (Topical) Outpatient Dosage Forms Outpatient Formulary Brands Available MetroCream®; MetroGel-Vaginal®; Outpatient Dosage Forms MetFORMIN
MetroCream®: 0.75% (45 g) [contains benzyl alcohol]
Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 500 mg [BCF], 850 mg [BCF], 1000 mg [BCF]
Tablet, extended release, oral, as hydrochloride: 500 mg [BCF], 750 mg [BCF]
Gel, vaginal: 0.75% (70 g) [BCF] Methadone Outpatient Formulary Brands Available Dolophine® Miconazole (Topical) Outpatient Dosage Forms Outpatient Dosage Forms Methimazole Midodrine Outpatient Formulary Brands Available Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 5 mg, 10 mg
Mifepristone Outpatient Formulary Brands Available Mifeprex® Methocarbamol Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral: 500 mg [BCF] Methotrexate Mineral Oil Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral: 2.5 mg [BCF] Methyldopa Minocycline Outpatient Dosage Forms Outpatient Formulary Brands Available Minocin® Outpatient Dosage Forms Methylergonovine Outpatient Formulary Brands Available Methergine® Outpatient Dosage Forms Minoxidil (Systemic) Outpatient Dosage Forms Methylphenidate Mirtazapine Outpatient Formulary Brands Available Concerta®; Metadate® ER; Ritalin Outpatient Formulary Brands Available Remeron® Outpatient Dosage Forms Outpatient Dosage Forms
Capsule, extended release, oral, as hydrochloride [bi-modal release]:
Ritalin LA®: 10 mg [5 mg immediate release, 5 mg extended release] [BCF] Ritalin LA®: 20 mg [10 mg immediate release, 10 mg extended release] [BCF] Misoprostol
Ritalin LA®: 30 mg [15 mg immediate release, 15 mg extended release] [BCF] Outpatient Formulary Brands Available Cytotec®
Ritalin LA®: 40 mg [20 mg immediate release, 20 mg extended release] [BCF] Outpatient Dosage Forms
Methylin®: 5 mg [BCF], 10 mg [BCF]
Ritalin®: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF] MODAFINIL Modafinil Nabumetone Outpatient Formulary Brands Available Provigil® Outpatient Dosage Forms Outpatient Dosage Forms Naftifine Outpatient Formulary Brands Available Naftin® Outpatient Dosage Forms Mometasone and Formoterol Outpatient Formulary Brands Available Dulera®
Naftin®: 1% (15 g [DSC], 30 g) [contains benzyl alcohol]
Outpatient Dosage Forms Naphazoline and Pheniramine
Dulera®: Mometasone furoate 100 mcg and formoterol fumarate dihydrate 5
Outpatient Formulary Brands Available Naphcon® A [OTC]
mcg per inhalation (13 g) [120 metered actuations]
Outpatient Dosage Forms
Dulera®: Mometasone furoate 200 mcg and formoterol fumarate dihydrate 5
mcg per inhalation (13 g) [120 metered actuations]
Naphcon® A: Naphazoline hydrochloride 0.025% and pheniramine maleate
0.3% (15 mL) [contains benzalkonium chloride]
Mometasone (Nasal) Outpatient Formulary Brands Available Nasonex® Naproxen Outpatient Dosage Forms Outpatient Dosage Forms
Suspension, intranasal, as furoate [spray]:
Suspension, oral: 125 mg/5 mL (500 mL) [BCF]
Nasonex®: 50 mcg/spray (17 g) [contains benzalkonium chloride; delivers 120
Tablet, oral: 250 mg [BCF], 500 mg [BCF]
Tablet, oral, as sodium: 275 mg [equivalent to naproxen base 250 mg] [BCF], 550 mg [equivalent to naproxen base 500 mg] [BCF] Mometasone (Oral Inhalation) Outpatient Formulary Brands Available Neomycin Outpatient Dosage Forms Outpatient Dosage Forms Neomycin and Polymyxin B
110 mcg (30 units) [contains lactose; delivers 100 mcg/actuation] [BCF] Outpatient Formulary Brands Available Neosporin® G.U.
220 mcg (14 units, 30 units, 60 units, 120 units) [contains lactose; delivers
Outpatient Dosage Forms
200 mcg/actuation] [BCF] Mometasone (Topical)
Neosporin® G.U.: Neomycin 40 mg and polymyxin B sulfate 200,000 units per
Outpatient Formulary Brands Available Elocon® Outpatient Dosage Forms Neomycin, Polymyxin B, and Dexamethasone Outpatient Formulary Brands Available Maxitrol® Outpatient Dosage Forms Montelukast Outpatient Formulary Brands Available Singulair®
Maxitrol®: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame-
Outpatient Dosage Forms
Maxitrol®: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame-
Singulair®: 4 mg/packet (30s) [BCF]
thasone 0.1% per 1 mL (5 mL) [contains benzalkonium chloride]
Singulair®: 10 mg [BCF] Neomycin, Polymyxin B, and Gramicidin Outpatient Formulary Brands Available Neosporin® Ophthalmic Solution Outpatient Dosage Forms
4 mg [contains phenylalanine 0.674 mg/tablet; cherry flavor] [BCF]
Solution, ophthalmic [drops]: Neomycin 1.75 mg, polymyxin B 10,000 units, and
5 mg [contains phenylalanine 0.842 mg/tablet; cherry flavor] [BCF]
gramicidin 0.025 mg per 1 mL (10 mL) [BCF] Morphine (Systemic)
Neosporin® Ophthalmic Solution: Neomycin 1.75 mg, polymyxin B 10,000
Outpatient Formulary Brands Available
units, and gramicidin 0.025 mg per 1 mL (10 mL)
Outpatient Dosage Forms Neomycin, Polymyxin B, and Hydrocortisone
Solution, oral, as sulfate: 10 mg/5 mL (100 mL)
Outpatient Dosage Forms
Suspension, otic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydro-
Tablet, controlled release, oral, as sulfate:
cortisone 10 mg per mL (10 mL) [BCF]
MS Contin®: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF],
200 mg [BCF]
Tablet, extended release, oral, as sulfate: 15 mg [BCF], 30 mg [BCF], 60 mg Outpatient Formulary Brands Available Niaspan® [BCF], 100 mg [BCF], 200 mg [BCF] Outpatient Dosage Forms
Tablet, sustained release, oral, as sulfate:
Oramorph® SR: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF]
Niaspan®: 500 mg [BCF], 750 mg [BCF], 1000 mg [BCF] Moxifloxacin (Ophthalmic) Nicotine Outpatient Formulary Brands Available Vigamox® Outpatient Dosage Forms Outpatient Dosage Forms
Patch, transdermal: 14 mg/24 hours (7s) [BCF]; 21 mg/24 hours (7s) [BCF] NIFEdipine Outpatient Formulary Brands Available Adalat® CC; Procardia® Moxifloxacin (Systemic) Outpatient Dosage Forms Outpatient Formulary Brands Available Avelox®; Avelox® ABC Pack Outpatient Dosage Forms
Tablet, extended release, oral: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF] Nitrofurantoin Mupirocin Outpatient Formulary Brands Available Furadantin®; Macrodantin® Outpatient Dosage Forms Outpatient Dosage Forms
Ointment, topical: 2% (22 g) [BCF]
Capsule, oral [macrocrystal]: 50 mg [BCF] Mycophenolate
Capsule, oral [macrocrystal/monohydrate]: 100 mg [BCF] Outpatient Formulary Brands Available CellCept® Outpatient Dosage Forms Nitroglycerin Outpatient Formulary Brands Available Nitro-Dur®; Nitrolingual®; Nitro-
CellCept®: 500 mg [contains ethanol (may have trace amounts)]
PERMETHRIN Outpatient Dosage Forms Outpatient Dosage Forms
0.1 mg/hour (30s) [BCF]
0.2 mg/hour (30s) [BCF]
0.4 mg/hour (30s) [BCF]
Tablet, orally disintegrating, oral: 4 mg, 8 mg
0.6 mg/hour (30s) [BCF]
Zofran® ODT: 4 mg, 8 mg [contains phenylalanine <0.03 mg/tablet; strawberry
0.3 mg/hour (30s) [BCF] 0.8 mg/hour (30s) [BCF] Oxazepam Outpatient Dosage Forms
0.4 mg/spray (12 g) [contains ethanol 20%; 200 metered sprays] [BCF] OXcarbazepine
0.4 mg/spray (4.9 g) [contains ethanol 20%; 60 metered sprays] [BCF] Outpatient Formulary Brands Available Trileptal®
Nitrostat®: 0.4 mg [BCF] Outpatient Dosage Forms Norethindrone
Trileptal®: 300 mg/5 mL (250 mL) [contains ethanol, propylene glycol]
Outpatient Formulary Brands Available Aygestin®; Camila®; Errin®; Joliv-
ette®; Nor-QD®; Nora-BE®; Ortho Micronor®
Trileptal®: 150 mg, 300 mg, 600 mg [scored]
Outpatient Dosage Forms Oxybutynin Outpatient Formulary Brands Available Ditropan XL®
Camila®: 0.35 mg [BCF] Errin®: 0.35 mg [BCF] Outpatient Dosage Forms
Jolivette®: 0.35 mg [BCF]
Nor-QD®: 0.35 mg [BCF]
Tablet, extended release, oral, as chloride: 5 mg [BCF], 10 mg [BCF],
15 mg [BCF]
Nora-BE®: 0.35 mg [BCF]
Ortho Micronor®: 0.35 mg [BCF] OxyCODONE Outpatient Formulary Brands Available OxyCONTIN® Nortriptyline Outpatient Dosage Forms Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 5 mgTablet, controlled release, oral, as hydrochloride:
Capsule, oral: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]
OxyCONTIN®: 10 mg, 20 mg, 30 mg, 40 mg, 80 mg
Solution, oral: 10 mg/5 mL (473 mL, 480 mL)
Nystatin (Oral) Oxycodone and Acetaminophen Outpatient Dosage Forms Outpatient Formulary Brands Available Roxicet™; Tylox® Outpatient Dosage Forms
Suspension, oral: 100,000 units/mL (5 mL, 60 mL, 473 mL, 480 mL) [BCF] Tablet, oral: 500,000 units
Tylox®: 5/500: Oxycodone hydrochloride 5 mg and acetaminophen 500 mg
Nystatin (Topical)
[contains sodium benzoate, sodium metabisulfite]
Outpatient Formulary Brands Available Nystop® Outpatient Dosage Forms
Roxicet™: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg per 5
Cream, topical: 100,000 units/g (15 g, 30 g) [BCF]
mL (500 mL) [contains ethanol <0.5%; mint flavor]
Ointment, topical: 100,000 units/g (15 g, 30 g) [BCF]
Tablet, oral: 5/325: Oxycodone hydrochloride 5 mg and acetaminophen
325 mg [BCF]
Nystop®: 100,000 units/g (15 g) [contains talc]
Oxymetazoline (Nasal) Octreotide Outpatient Dosage Forms Outpatient Formulary Brands Available SandoSTATIN LAR®; SandoSTA-
Solution, intranasal, as hydrochloride [spray]: 0.05% (15 mL)
Pancrelipase Outpatient Dosage Forms Outpatient Formulary Brands Available Creon®; Pancreaze™
Injection, microspheres for suspension, as acetate [depot formulation]:
Outpatient Dosage Forms
SandoSTATIN LAR®: 10 mg, 20 mg, 30 mg [contains polylactide-co-glycolide]
Capsule, delayed release, enteric coated microspheres [new formulation; por-
Injection, solution, as acetate [preservative free]:
Creon®: Lipase 12000 units, protease 38,000 units, and amylase 60,000 units
Ofloxacin (Ophthalmic)
Capsule, delayed release, enteric coated microtablets [porcine derived]:
Pancreaze™: Lipase 16,800 units, protease 40,000 units, and amylase 70,000
Outpatient Formulary Brands Available Ocuflox® Outpatient Dosage Forms Pantoprazole
Ocuflox®: 0.3% (5 mL) [contains benzalkonium chloride]
Outpatient Dosage Forms Ofloxacin (Otic) Outpatient Formulary Brands Available Floxin® [DSC] Paricalcitol Outpatient Dosage Forms Outpatient Formulary Brands Available Zemplar® Outpatient Dosage Forms
Floxin®: 0.3% (5 mL [DSC]) [contains benzalkonium chloride]
Olopatadine (Ophthalmic)
Zemplar®: 1 mcg [contains coconut oil (may have trace amounts), ethanol,
palm kernel oil (may have trace amounts)]
Outpatient Formulary Brands Available Pataday™; Patanol® Outpatient Dosage Forms PARoxetine Outpatient Formulary Brands Available Paxil®
Pataday™: 0.2% (2.5 mL) [contains benzalkonium chloride, edetate disodium]
Outpatient Dosage Forms
Patanol®: 0.1% (5 mL) [contains benzalkonium chloride] [BCF]
Tablet, oral, as hydrochloride [strength expressed as base]: 20 mg, 30 mg
Omega-3-Acid Ethyl Esters Outpatient Formulary Brands Available Lovaza® Penicillin V Potassium Outpatient Dosage Forms Outpatient Dosage Forms
Powder for solution, oral: 125 mg/5 mL (100 mL, 200 mL) [BCF]; 250 mg/5 mL
Lovaza®: 1 g [contains DHA ~375 mg/capsule, EPA ~465 mg/capsule, soy-
(100 mL, 200 mL) [BCF]
Tablet, oral: 250 mg [BCF], 500 mg [BCF] Omeprazole Pentoxifylline Outpatient Dosage Forms Outpatient Dosage Forms
Capsule, delayed release, oral: 10 mg [BCF], 20 mg [BCF] Ondansetron Permethrin Outpatient Formulary Brands Available Zofran®; Zofran® ODT Outpatient Formulary Brands Available Elimite®; Nix® Creme Rinse [OTC] PERMETHRIN Outpatient Dosage Forms Outpatient Dosage Forms
Cream, topical: 5% (60 g) [BCF]
Elimite®: 5% (60 g) [contains coconut oil]
MiraLAX®: PEG 3350 255 g (14 oz [DSC]); PEG 3350 17 g/packet
Liquid, topical [creme rinse formulation]:
Nix® Creme Rinse: 1% (60 mL) [contains isopropyl alcohol 20%]
Potassium Chloride Phenazopyridine Outpatient Formulary Brands Available Klor-Con® 8 Outpatient Formulary Brands Available Pyridium® Outpatient Dosage Forms Outpatient Dosage Forms
Capsule, extended release, microencapsulated, oral: 10 mEq [BCF]
Tablet, oral, as hydrochloride: 100 mg [BCF], 200 mg [BCF]
Powder for solution, oral: 20 mEq/packet [BCF] Solution, oral: 20 mEq/15 mL (15 mL, 30 mL, 480 mL) [BCF] PHENobarbital
Tablet, extended release, microencapsulated, oral: 10 mEq [BCF], 20 Outpatient Dosage Forms
mEq [BCF]
Elixir, oral: 20 mg/5 mL (5 mL, 7.5 mL, 15 mL) [BCF]
Tablet, extended release, wax matrix, oral:
Tablet, oral: 60 mg [BCF], 100 mg [BCF]
Tablet, oral [new reformulated strengths]: 16.2 mg, 32.4 mg
Potassium Citrate Phenylephrine (Nasal) Outpatient Formulary Brands Available Urocit®-K Outpatient Formulary Brands Available Neo-Synephrine® Mild Formula Outpatient Dosage Forms Outpatient Dosage Forms
Solution, intranasal, as hydrochloride [spray]:
Neo-Synephrine® Mild Formula: 0.25% (15 mL) [contains benzalkonium
Pramipexole Phenylephrine (Ophthalmic) Outpatient Formulary Brands Available Mirapex® Outpatient Formulary Brands Available AK-Dilate™; Neo-Synephrine® Outpatient Dosage Forms
Tablet, oral, as dihydrochloride monohydrate: 0.25 mg, 0.5 mg, 1.5 mg
Outpatient Dosage Forms
Mirapex®: 0.25 mg, 0.5 mg, 1.5 mg [scored]
Solution, ophthalmic, as hydrochloride [drops]:
Prasugrel
AK-Dilate™: 10% (5 mL) [contains benzalkonium chloride]
Outpatient Formulary Brands Available Effient®
Neo-Synephrine®: 2.5% (15 mL [DSC]) [contains benzalkonium chloride]
Outpatient Dosage Forms Phenytoin Outpatient Formulary Brands Available Dilantin-125®; Dilantin® Outpatient Dosage Forms Pravastatin
Capsule, extended release, oral, as sodium: 100 mg [BCF] Outpatient Formulary Brands Available Pravachol®
Suspension, oral: 125 mg/5 mL (4 mL, 120 mL, 237 mL, 240 mL) [BCF] Outpatient Dosage Forms
Dilantin-125®: 125 mg/5 mL (240 mL) [contains ethanol ≤0.6%, sodium
Tablet, oral, as sodium: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Prazosin
Dilantin®: 50 mg [scored] [BCF] Outpatient Formulary Brands Available Minipress® Phytonadione Outpatient Dosage Forms Outpatient Formulary Brands Available Mephyton®
Capsule, oral, as hydrochloride: 1 mg, 2 mg, 5 mg
Outpatient Dosage Forms PrednisoLONE (Ophthalmic) Outpatient Formulary Brands Available Pred Forte®; Pred Mild® Pilocarpine (Ophthalmic) Outpatient Dosage Forms Outpatient Formulary Brands Available Pilopine HS®
Suspension, ophthalmic, as acetate [drops]: 1% (5 mL, 10 mL, 15 mL) [BCF] Outpatient Dosage Forms
Pred Mild®: 0.12% (5 mL, 10 mL) [contains benzalkonium chloride, sodium
Pilopine HS®: 4% (4 g) [contains benzalkonium chloride] [BCF]
bisulfite] [BCF]
Solution, ophthalmic, as hydrochloride [drops]: 1% (2 mL, 15 mL) [BCF]; 2% (2 PrednisoLONE (Systemic)
mL, 15 mL) [BCF]; 4% (2 mL, 15 mL) [BCF] [may contain benzalkonium chloride] Outpatient Formulary Brands Available Orapred® Outpatient Dosage Forms Pilocarpine (Systemic)
Solution, oral, as sodium phosphate [strength expressed as base]: 15 mg/5 mL
Outpatient Formulary Brands Available Salagen®
(237 mL, 473 mL) [BCF] Outpatient Dosage Forms
Orapred®: 15 mg/5 mL (237 mL) [dye free; contains ethanol 2%, sodium
PredniSONE Pimecrolimus Outpatient Dosage Forms Outpatient Formulary Brands Available Elidel®
Tablet, oral: 1 mg [BCF], 2.5 mg, 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], Outpatient Dosage Forms
Elidel®: 1% (30 g, 60 g, 100 g) [BCF] Primaquine Outpatient Dosage Forms Pioglitazone
Tablet, oral, as phosphate: 26.3 mg [15 mg base]
Outpatient Formulary Brands Available Actos® Outpatient Dosage Forms Primidone Outpatient Formulary Brands Available Mysoline® Outpatient Dosage Forms Piroxicam Outpatient Dosage Forms Probenecid Outpatient Dosage Forms Podofilox Outpatient Formulary Brands Available Condylox® Outpatient Dosage Forms Prochlorperazine Outpatient Dosage Forms
Condylox®: 0.5% (3.5 mL) [contains ethanol 95%]
Tablet, oral, as maleate [strength expressed as base]: 5 mg, 10 mg
Polyethylene Glycol 3350 Progesterone Outpatient Formulary Brands Available MiraLAX® [OTC] Outpatient Formulary Brands Available Prometrium® SEVELAMER Outpatient Dosage Forms Outpatient Dosage Forms
Capsule, oral: 300 mg [BCF]
Prometrium®: 100 mg [contains peanut oil]
Promethazine Rifapentine Outpatient Dosage Forms Outpatient Dosage Forms
Suppository, rectal, as hydrochloride: 12.5 mg (12s) [BCF]; 25 mg (12s) [BCF]
Syrup, oral, as hydrochloride: 6.25 mg/5 mL (118 mL, 473 mL) [BCF]
Tablet, oral, as hydrochloride: 25 mg [BCF] RisperiDONE Propranolol Outpatient Formulary Brands Available RisperDAL® Outpatient Formulary Brands Available Inderal® LA Outpatient Dosage Forms Outpatient Dosage Forms
Solution, oral: 1 mg/mL (30 mL) [BCF]
Capsule, sustained release, oral, as hydrochloride:
RisperDAL®: 1 mg/mL (30 mL) [contains benzoic acid]
Tablet, oral: 0.25 mg [BCF], 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF], 3 mg
Tablet, oral, as hydrochloride: 10 mg, 40 mg, 80 mg
[BCF], 4 mg [BCF] RisperDAL®: 0.25 mg, 0.5 mg Propylthiouracil Outpatient Dosage Forms
Tablet, oral: 50 mg [BCF] Ritonavir Pseudoephedrine Outpatient Formulary Brands Available Norvir® Outpatient Dosage Forms Outpatient Dosage Forms
Liquid, oral, as hydrochloride: 15 mg/5 mL (118 mL)
DECLENCHEMENT ARTIFICIEL DU TRAVAIL A PARTIR DE 37 SEMAINES D’AMENORRHEE (SA) Recommandations professionnelles Avril 2008 DECLENCHEMENT ARTIFICIEL DU TRAVAIL A PARTIR DE 37 SA Ces recommandations professionnelles sur le thème du « déclenchement artificiel du travail àpartir de 37 semaines d’aménorrhée » ont été élaborées par la Haute Autorité de Santé à la