VANDENBERG AFB OUTPATIENT FORMULARY … · 1 Alphabetical Listing by Name This document is current as of The availability of formulary items is subject to change. OUTPATIENT FORMULARY

1

Alphabetical Listing by Name

This document is current as of . The availability of formulary items is subject to change.

OUTPATIENT FORMULARY

AFBVANDENBERG

May 15, 2018

AcetaminophenOutpatient Dosage FormsSuppository, rectal:Generic: 120 mg (12s)

Suspension, oral:Generic: 160 mg/5 mL (120 mL)

Tablet, oral:Generic: 325 mg

Acetaminophen and CodeineOutpatient Dosage FormsSolution, 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]

Acyclovir (Systemic)Outpatient Dosage FormsCapsule, oral:Generic: 200 mg [BCF]

Suspension, oral:Generic: 200 mg/5 mL (473 mL) [BCF]

Tablet, oral:Generic: 400 mg [BCF], 800 mg [BCF]

Acyclovir (Topical)Outpatient Dosage FormsCream, External:Zovirax: 5% (5 g)

Ointment, External:Generic: 5% (5 g, 15 g, 30 g)

AdalimumabOutpatient Dosage FormsPen-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: 40 mg/0.8 mL (1 ea) [BCF] [contains polysorbate 80]

AdapaleneOutpatient Dosage FormsGel, topical:Generic: 0.3% (45 g)

AlbuterolOutpatient Dosage FormsAerosol, for oral inhalation:ProAir HFA: 90 mcg/inhalation (8.5 g) [chlorofluorocarbon free; 200 meteredactuations] [BCF]

Solution, for nebulization:Generic: 0.083% [2.5 mg/3 mL] (25s, 30s, 60s) [BCF]

Solution, for nebulization [preservative free]:Generic: 0.083% [2.5 mg/3 mL] (25s, 30s, 60s) [BCF]

AlendronateOutpatient Dosage FormsSolution, Oral:Generic: 70 mg/75 mL (75 mL) [BCF]

Tablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF], 35 mg [BCF], 70 mg

AlfuzosinOutpatient Dosage FormsTablet Extended Release 24 Hour, Oral, as hydrochloride:Generic: 10 mg [BCF]

AllopurinolOutpatient Dosage FormsTablet, Oral, as sodium:Generic: 100 mg [BCF], 300 mg [BCF]

ALPRAZolamOutpatient Dosage FormsTablet, Oral:Generic: 0.25 mg, 0.5 mg, 1 mg

Aluminum Chloride HexahydrateOutpatient Dosage FormsSolution, External:20% (35 mL, 37.5 mL, 60 mL)

Aluminum Hydroxide, Magnesium Hydroxide, and SimethiconeOutpatient Dosage FormsSuspension, oral:Generic: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, andsimethicone 20 mg per 5 mL (355 mL)

AmantadineOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 100 mg [BCF]

Syrup, Oral, as hydrochloride:Generic: 50 mg/5 mL (10 mL, 473 mL) [BCF]

AmiodaroneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 200 mg [BCF]

AmitriptylineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF]

AmLODIPineOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

Amlodipine and BenazeprilOutpatient Dosage FormsCapsule, Oral:Generic: 2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride10 mg [BCF]

Generic: 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF]Generic: 5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF]Generic: 5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF]Generic: 10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF]Generic: 10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF]

AmoxicillinOutpatient Dosage FormsCapsule, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

Suspension Reconstituted, Oral:250 mg/5 mL (80 mL, 100 mL, 150 mL) [BCF]; 400 mg/5 mL (50 mL, 75 mL,100 mL) [BCF]

Tablet, Oral:Generic: 875 mg

Amoxicillin and ClavulanateOutpatient Dosage FormsPowder for Suspension, Oral:200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (50 mL,75 mL, 100 mL) [BCF]

400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (50 mL,75 mL, 100 mL) [BCF]

600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (75 mL,125 mL, 200 mL) [BCF]

Amoclan:Tablet, oral: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]

ARIPiprazoleOutpatient Dosage FormsSolution, Oral:Generic: 1 mg/mL (150 mL)

Tablet, Oral:Generic: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg

Tablet Dispersible, Oral:Generic: 10 mg, 15 mg

Artificial TearsOutpatient Dosage FormsOintment, ophthalmic:Refresh Lacri-Lube

Solution, ophthalmic:Liquitears: (15 mL)Tears Naturale FreeGeneric: 15 mL and 30 mL dropper bottles

AspirinOutpatient Dosage FormsTablet, Enteric Coated, Oral:Generic: 81 mg, 325 mg

AtenololOutpatient Dosage FormsTablet, Oral:Generic: 25 mg [BCF], 50 mg [scored] [BCF], 100 mg [BCF]

AtoMOXetineOutpatient Dosage FormsCapsule, Oral:Strattera: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 100 mg

ACETAMINOPHEN

2

AtorvaSTATinOutpatient Dosage FormsTablet, Oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]

Atropine (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as sulfate:Generic: 1% (15 mL)

Azelastine (Nasal)Outpatient Dosage FormsSolution, Nasal, as hydrochloride:Generic: 0.1% (30 mL)

Azithromycin (Systemic)Outpatient Dosage FormsPacket, Oral:Generic: 1 g (3 ea, 10 ea) [BCF]

Suspension Reconstituted, Oral:Generic: 100 mg/5 mL (15 mL) [BCF]; 200 mg/5 mL (15 mL, 22.5 mL, 30 mL)

Tablet, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

Bacitracin (Topical)Outpatient Dosage FormsOintment, External, as zinc [strength expressed as base]:Generic: 500 units/g (15 g)

BaclofenOutpatient Dosage FormsTablet, Oral:Generic: 10 mg

BenazeprilOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg, 20 mg, 40 mg

BenzonatateOutpatient Dosage FormsCapsule, Oral:Generic: 100 mg

Benzoyl PeroxideOutpatient Dosage FormsGel, External:Generic: 2.5% (60 g); 5% (45 g); 10% (45 g)

BenztropineOutpatient Dosage FormsTablet, Oral, as mesylate:Generic: 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF]

Betamethasone and ClotrimazoleOutpatient Dosage FormsCream, External:Generic: Betamethasone dipropionate 0.05% (base) and clotrimazole1% (45 g)

Betamethasone (Topical)Outpatient Dosage FormsCream, External, as dipropionate augmented [strength expressed as base]:Generic: 0.05% (15 g, 50 g)

Cream, External, as valerate [strength expressed as base]:Generic: 0.1% (15 g, 45 g)

BicalutamideOutpatient Dosage FormsTablet, Oral:Generic: 50 mg [BCF]

BisacodylOutpatient Dosage FormsTablet, Enteric Coated, Oral:Generic: 5 mg

Bismuth SubsalicylateOutpatient Dosage FormsTablet Chewable, Oral, as subsalicylate:Generic: 262 mg

Brimonidine and TimololOutpatient Dosage FormsSolution, ophthalmic [drops]:Combigan: Brimonidine tartrate 0.2% and timolol 0.5% (5 mL) [containsbenzalkonium chloride]

Brimonidine (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as tartrate:Generic: 0.1% (15 mL); 0.15% (5 mL, 10 mL, 15 mL) [BCF]; 0.2% (5 mL, 10mL, 15 mL) [BCF]

BromfenacOutpatient Dosage FormsSolution, Ophthalmic:Generic: 0.09% (1.7 mL)

Budesonide (Oral Inhalation)Outpatient Dosage FormsSuspension, Inhalation:Generic: 0.25 mg/2 mL (2 mL); 0.5 mg/2 mL (2 mL)

BumetanideOutpatient Dosage FormsTablet, Oral:Generic: 1 mg

BuPROPionOutpatient Dosage FormsTablet, 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]


BusPIRoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF]

Butalbital, Acetaminophen, and CaffeineOutpatient Dosage FormsTablet, Oral:Generic: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg [BCF]

Butalbital, Aspirin, and CaffeineOutpatient Dosage FormsCapsule, Oral:Generic: Butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg

Calcitriol (Systemic)Outpatient Dosage FormsCapsule, softgel, oral:Generic: 0.25 mcg, 0.5 mcg

Calcium AcetateOutpatient Dosage FormsCapsule, Oral:Generic: 667 mg

CaptoprilOutpatient Dosage FormsTablet, Oral:Generic: 12.5 mg [BCF], 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

CarBAMazepineOutpatient Dosage FormsSuspension, Oral:Generic: 100 mg/5 mL (10 mL, 450 mL) [BCF]


Tablet, Chewable, Oral:Generic: 100 mg [BCF]

Tablet, Extended Release, Oral:Generic: 400 mg [BCF]

Carbamide PeroxideOutpatient Dosage FormsSolution, otic [drops]:Generic: 6.5% (15 mL)

Carbidopa and LevodopaOutpatient Dosage FormsTablet, oral: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]

CarboxymethylcelluloseOutpatient Dosage FormsSolution, Ophthalmic, as sodium [preservative free]:Refresh Celluvisc: 1% (30 ea)Refresh Plus: 0.5%

CARBOXYMETHYLCELLULOSE

3

CarisoprodolOutpatient Dosage FormsTablet, Oral:Generic: 350 mg

CarvedilolOutpatient Dosage FormsCapsule, Extended Release, Oral, as phosphate:Coreg CR: 10 mg, 20 mg, 40 mg, 80 mg

Tablet, Oral:Generic: 3.125 mg [BCF], 6.25 mg [BCF], 12.5 mg [BCF], 25 mg [BCF]

CefdinirOutpatient Dosage FormsSuspension Reconstituted, Oral:Generic: 125 mg/5 mL (60 mL); 250 mg/5 mL (60 mL)

CefiximeOutpatient Dosage FormsSuspension Reconstituted, Oral:Generic: 100 mg/5 mL (100 mL)

CefpodoximeOutpatient Dosage FormsTablet, Oral:Generic: 100 mg, 200 mg

CefuroximeOutpatient Dosage FormsTablet, Oral:Generic: 250 mg, 500 mg

CelecoxibOutpatient Dosage FormsCapsule, oral:Generic: 100 mg, 200 mg

CephalexinOutpatient Dosage FormsCapsule, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

Suspension Reconstituted, Oral:Generic: 250 mg/5 mL (100 mL, 200 mL) [BCF]

Cetirizine (Systemic)Outpatient Dosage FormsSyrup, Oral, as hydrochloride:Generic: 5 mg/5 mL (118 mL)

Tablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg

ChlordiazePOXIDEOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 5 mg, 10 mg

Chlorhexidine Gluconate (Oral)Outpatient Dosage FormsSolution, Mouth/Throat:Generic: 0.12% (473 mL) [BCF]

ChlorthalidoneOutpatient Dosage FormsTablet, Oral:Generic: 25 mg [BCF], 50 mg [BCF]

CholecalciferolOutpatient Dosage FormsCapsule, Oral:Generic: 50,000 units

Cholestyramine ResinOutpatient Dosage FormsPowder, Oral:Generic: 4 g/dose (210 g)

Ciprofloxacin (Systemic)Outpatient Dosage FormsSuspension Reconstituted, Oral:Generic: 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]

CitalopramOutpatient Dosage FormsSolution, Oral:Generic: 10 mg/5 mL (240 mL) [BCF]

Tablet, Oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]

ClarithromycinOutpatient Dosage FormsTablet, Oral:Generic: 250 mg, 500 mg

Clindamycin and Benzoyl PeroxideOutpatient Dosage FormsGel, External:Duac: Clindamycin phosphate 1.2% and benzoyl peroxide 5% (45 g)Clindamycin phosphate 1.2% and benzoyl peroxide 5% (45 g)

Clindamycin (Systemic)Outpatient Dosage FormsCapsule, Oral, as hydrochloride [strength expressed as base]:Generic: 150 mg [BCF]

Solution Reconstituted, Oral, as palmitate hydrochloride [strength expressed asbase]:Generic: 75 mg/5 mL (100 mL)

Clindamycin (Topical)Outpatient Dosage FormsCream,Vaginal, as phosphate [strength expressed as base]:Generic: 2% (40 g) [BCF]

Gel, External, as phosphate [strength expressed as base]:Generic: 1% (30 g, 60 g)

Lotion, External, as phosphate [strength expressed as base]:Generic: 1% (60 mL)

Solution, External, as phosphate [strength expressed as base]:Generic: 1% (30 mL, 60 mL) [BCF]

ClobetasolOutpatient Dosage FormsCream, External, as propionate:Generic: 0.05% (15 g)

Gel, External, as propionate:Generic: 0.05% (15 g, 30 g)

Ointment, External, as propionate:Generic: 0.05% (15 g)

Solution, External, as propionate [for scalp application]:Generic: 0.05% (25 mL)

ClomiPHENEOutpatient Dosage FormsTablet, Oral, as citrate:Generic: 50 mg

ClonazePAMOutpatient Dosage FormsTablet, Oral:Generic: 0.5 mg [BCF], 1 mg

CloNIDineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 0.1 mg [BCF], 0.2 mg [BCF], 0.3 mg [BCF]

ClopidogrelOutpatient Dosage FormsTablet, Oral:Generic: 75 mg [BCF], 300 mg [BCF]

Clotrimazole (Topical)Outpatient Dosage FormsCream, External:Generic: 1% (30 g)

Cream, Vaginal:Generic: 1% (45 g)

Solution, External:Generic: 1% (10 mL, 30 mL) [BCF]

ColchicineOutpatient Dosage FormsTablet, Oral:Generic: 0.6 mg

Copper IUDOutpatient Dosage FormsDevice, intrauterine:ParaGard: 1 ea

CyclobenzaprineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg [BCF]

CycloSPORINE (Ophthalmic)Outpatient Dosage FormsEmulsion, Ophthalmic [preservative free]:Restasis: 0.05% (1 ea) [contains polysorbate 80]

CARISOPRODOL

4

CyproheptadineOutpatient Dosage FormsSyrup, Oral, as hydrochloride:Generic: 2 mg/5 mL (473 mL) [BCF]

Tablet, Oral, as hydrochloride:Generic: 4 mg [BCF]

Dabigatran EtexilateOutpatient Dosage FormsCapsule, Oral:Pradaxa: 75 mg,150 mg

DesmopressinOutpatient Dosage FormsTablet, Oral, as acetate:Generic: 0.2 mg

DesonideOutpatient Dosage FormsCream, External:Generic: 0.05% (15 g, 60 g)

Ointment, ExternalGeneric: 0.05% (15 g, 60 g)

Dexamethasone (Systemic)Outpatient Dosage FormsTablet, oral:Generic: 0.5 mg, 4 mg, 6 mg

Dextroamphetamine and AmphetamineOutpatient Dosage FormsCapsule, Extended Release, Oral:5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sul-fate 1.25 mg (equivalent to amphetamine base 3.1 mg)] [BCF]

10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate2.5 mg (equivalent to amphetamine base 6.3 mg)] [BCF]

15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccharate3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine sul-fate 3.75 mg (equivalent to amphetamine base 9.4 mg)] [BCF]

20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate5 mg (equivalent to amphetamine base 12.5 mg)] [BCF]

25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine saccharate6.25 mg, amphetamine aspartate monohydrate 6.25 mg, amphetamine sul-fate 6.25 mg (equivalent to amphetamine base 15.6 mg)] [BCF]

30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sulfate7.5 mg (equivalent to amphetamine base 18.8 mg)] [BCF]

Tablet, Oral:Generic:5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetaminesulfate 1.25 mg (equivalent to amphetamine base 3.13 mg)]

10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sul-fate 2.5 mg (equivalent to amphetamine base 6.3 mg)]

Diabetic SuppliesOutpatient Dosage FormsGlucose meter:FreeStyle Freedom Lite Monitor [BCF]

Lancets:BD Ultrafine 30G Lancets

Syringe and needle:BD™ Syringe 0.3 mL (Ultra-Fine™) 31 gauge x 5/16" (100s)BD™ Syringe 0.5 mL (Ultra-Fine II) 31 gauge x 5/16" [BCF]BD™ Syringe 1 mL (Ultra-Fine II) 31 gauge x 5/16" [BCF]BD™ Ultra-Fine Mini Pen Needle 31 gauge x 5 mm

Test Strips/Kit:Freestyle Lite Test Strips (50s, 100s) [BCF]

DiazePAMOutpatient Dosage FormsTablet, oral:Generic: 2 mg, 5 mg [BCF]

Diclofenac (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as sodium:Generic: 0.1% (5 mL)

Diclofenac (Systemic)Outpatient Dosage FormsTablet Delayed Release, Oral, as sodium:Generic: 25 mg, 50 mg, 75 mg

Diclofenac (Topical)Outpatient Dosage FormsGel, Transdermal, as sodium:Generic: 1% (100 g)

DicloxacillinOutpatient Dosage FormsCapsule, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

DicyclomineOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 10 mg [BCF]

Solution, Oral, as hydrochloride:Generic: 10 mg/5 mL (473 mL) [BCF]


DifluprednateOutpatient Dosage FormsEmulsion, Ophthalmic:Durezol: 0.05% (5 mL) [contains edetate sodium (tetrasodium), polysor-bate 80]

DigoxinOutpatient Dosage FormsTablet, oral:Generic: 125 mcg [BCF], 250 mcg [BCF]

DilTIAZemOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as hydrochloride:Generic: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF], 300 mg [BCF],360 mg [BCF], 420 mg [BCF]

DiphenhydrAMINE (Systemic)Outpatient Dosage FormsCapsule, oral, as hydrochloride:Generic: 25 mg, 50 mg

Diphenoxylate and AtropineOutpatient Dosage FormsTablet, Oral:Generic: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate 0.025 mg

DipyridamoleOutpatient Dosage FormsTablet, Oral:Generic: 75 mg

DocusateOutpatient Dosage FormsCapsule, Oral, as sodium:Generic: 100 mg, 250 mg

DonepezilOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg

DorzolamideOutpatient Dosage FormsSolution, Ophthalmic:Generic: 2% (10 mL)

Dorzolamide and TimololOutpatient Dosage FormsSolution, Ophthalmic [drops]:Generic: Dorzolamide 2% [20 mg/mL] and timolol 0.5% [5 mg/mL] (10 mL)

DoxazosinOutpatient Dosage FormsTablet, Oral:Generic: 2 mg, 4 mg, 8 mg

Doxepin (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF]

Concentrate, Oral:Generic: 10 mg/mL (120 mL) [BCF]

DoxycyclineOutpatient Dosage FormsCapsule, Oral, as hyclate [strength expressed as base]:Generic: 50 mg, 100 mg [BCF]

Tablet, Oral, as hyclate [strength expressed as base]:Generic: 100 mg [BCF]

DOXYCYCLINE

5

DoxylamineOutpatient Dosage FormsTablet, Oral, as succinate:Nitetime Sleep-Aid: 25 mg [scored]Sleep Aid: 25 mg [scored]

DronedaroneOutpatient Dosage FormsTablet, Oral:Multaq: 400 mg

DulaglutideOutpatient Dosage FormsSolution Pen-injector, Subcutaneous [preservative free]:Trulicity: 0.75 mg/0.5 mL (0.5 mL); 1.5 mg/0.5 mL (0.5 mL) [contains poly-sorbate 80]

DULoxetineOutpatient Dosage FormsCapsule Delayed Release Particles, Oral:Generic: 20 mg, 30 mg, 60 mg

EmollientsOutpatient Dosage FormsCream, topical:EucerinMinerin

EmpagliflozinOutpatient Dosage FormsTablet, Oral:Jardiance: 10 mg, 25 mg

EnalaprilOutpatient Dosage FormsTablet, Oral, as maleate:Generic: 5 mg, 10 mg, 20 mg

EnoxaparinOutpatient Dosage FormsSolution, Injection, as sodium:Generic: 300 mg/3 mL (3 mL) [BCF]

Solution, Subcutaneous, as sodium:Generic: 100 mg/mL (1 mL) [BCF]; 120 mg/0.8 mL (0.8 mL) [BCF];150 mg/mL (1 mL) [BCF]

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] [prefilled syringe]

EPINEPHrine (Systemic)Outpatient Dosage FormsInjection, solution:0.15 mg/0.15 mL (1.1 mL) [1:1000 solution; delivers 0.15 mg per injection]0.3 mg/0.3 mL (1.1 mL) [1:1000 solution; delivers 0.3 mg per injection]

ErgocalciferolOutpatient Dosage FormsCapsule, Oral:Generic: 50,000 int. units

Erythromycin (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Generic: 5 mg/g (1 g, 3.5 g) [BCF]

Erythromycin (Systemic)Outpatient Dosage FormsSuspension Reconstituted, Oral, as ethylsuccinate:E.E.S. Granules: 200 mg/5 mL (100 mL, 200 mL) [cherry flavor] [BCF]EryPed: 200 mg/5 mL (100 mL) [fruit flavor] [BCF]

Tablet Delayed Release, Oral, as base:Ery-Tab: 250 mg [BCF]

Erythromycin (Topical)Outpatient Dosage FormsGel, External:Generic: 2% (30 g, 60 g) [BCF]

Solution, External:Generic: 2% (60 mL) [BCF]

EscitalopramOutpatient Dosage FormsTablet, Oral:Generic: 5 mg, 10 mg, 20 mg

Estradiol and LevonorgestrelOutpatient Dosage FormsPatch, transdermal: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]

Estradiol (Systemic)Outpatient Dosage FormsPatch, 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 hours (4s) [BCF]0.075 mg/24 hours (4s) [BCF]; 0.1 mg/24 hours (4s) [BCF]

Tablet, oral [micronized]:Generic: 0.5 mg, 1 mg, 2 mg

Estradiol (Topical)Outpatient Dosage FormsCream, Vaginal:Estrace: 0.1 mg/g (42.5 g) [contains alcohol, usp, edetate disodium, methyl-paraben, propylene glycol]

Estrogens (Conjugated/Equine) and MedroxyprogesteroneOutpatient Dosage FormsTablet, Oral:Prempro: 0.3/1.5: Conjugated estrogens 0.3 mg and medroxyprogesteroneacetate 1.5 mg [BCF]

Prempro: 0.45/1.5: Conjugated estrogens 0.45 mg and medroxyprogesteroneacetate 1.5 mg [BCF]

Prempro: 0.625/2.5: Conjugated estrogens 0.625 mg and medroxyprogester-one acetate 2.5 mg [BCF]

Prempro: 0.625/5: Conjugated estrogens 0.625 mg and medroxyprogesteroneacetate 5 mg [BCF]

Estrogens (Conjugated/Equine, Systemic)Outpatient Dosage FormsTablet, Oral:Premarin: 0.3 mg [BCF], 0.45 mg [BCF], 0.625 mg [BCF], 0.9 mg,1.25 mg [BCF]

Estrogens (Conjugated/Equine, Topical)Outpatient Dosage FormsCream, Vaginal:Premarin: 0.625 mg/g (30 g) [BCF]

EszopicloneOutpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2 mg, 3 mg

EthambutolOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 100 mg [BCF], 400 mg [BCF]

Ethinyl Estradiol and DesogestrelOutpatient Dosage FormsTablet, oral [monophasic formulation]:Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 tablets and 7 inactivetablets] (28s)

Ethinyl Estradiol and DrospirenoneOutpatient Dosage FormsTablet, Oral:Ethinyl estradiol 0.02 mg and drospirenone 3 mg [24 active tablets and 4inactive tablets] (28s) [BCF]

Ethinyl estradiol 0.03 mg and drospirenone 3 mg [21 active tablets and 7inactive tablets] (28s) [BCF]

Ethinyl Estradiol and Ethynodiol DiacetateOutpatient Dosage FormsTablet, oral:Zovia 1/35: Ethinyl estradiol 0.035 mg and ethynodiol diacetate 1 mg [21 lightpink tablets and 7 white inactive tablets]

Ethinyl Estradiol and EtonogestrelOutpatient Dosage FormsRing, vaginal:NuvaRing: Ethinyl estradiol 0.015 mg/day and etonogestrel 0.12 mg/day (3s)[3-week duration]

Ethinyl Estradiol and LevonorgestrelOutpatient Dosage FormsTablet, Oral [extended cycle regimen]:Jolessa: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (91s) [84 pinktablets and 7 white inactive tablets] [BCF]

Generic: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 tablets and7 inactive tablets] (91s) [BCF]

Tablet, Oral [low dose formulation]:Generic: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg [21 tablets and 7inactive tablets] (28s) [BCF]

Tablet, Oral [monophasic formulation]:Generic: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [21 tablets and7 inactive tablets] (28s) [BCF]

DOXYLAMINE

6

Tablet, oral [triphasic formulation]:Day 1-6: Ethinyl estradiol 0.03 mg and levonorgestrel 0.05 mg [6 tablets]Day 7-11: Ethinyl estradiol 0.04 mg and levonorgestrel 0.075 mg [5 tablets]Day 12-21: Ethinyl estradiol 0.03 mg and levonorgestrel 0.125 mg [10 tab-lets] (28s)

Day 22-28: 7 peach inactive tablets [7 peach tablets]

Ethinyl Estradiol and NorelgestrominOutpatient Dosage FormsPatch, transdermal:Xulane: Ethinyl estradiol 0.53 mg and norelgestromin 4.86 mg [releasesethinyl estradiol 35 mcg and norelgestromin 150 mcg per day] (3s)

Ethinyl Estradiol and NorethindroneOutpatient Dosage FormsTablet, oral [monophasic formulation]:Microgestin Fe 1/20: Ethinyl estradiol 0.02 mg and norethindrone acetate1 mg [21 white tablets] and ferrous fumarate 75 mg [7 brown tablets] (28s)

Microgestin Fe 1.5/30: Ethinyl estradiol 0.03 mg and norethindrone acetate1.5 mg [21 green tablets] and ferrous fumarate 75 mg [7 brown tablets] (28s)

Necon 1/35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 darkyellow tablets and 7 white inactive tablets] (28s) [BCF]

Noriny® 1+35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 yellowgreen tablets and 7 orange inactive tablets] (28s) [BCF]

Nortrel 1/35:Ethinyl estradiol 0.035 mg and norethindrone 1 mg [yellow tablets](21s) [BCF]

Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 yellow tablets and 7white inactive tablets] (28s) [BCF]

Ortho-Novum 1/35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21peach tablets and 7 green inactive tablets] (28s) [BCF]

Tablet, oral [triphasic formulation]:Estrostep Fe:Day 1-5: Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg [5 whitetriangular tablets]

Day 6-12: Ethinyl estradiol 0.03 mg and norethindrone acetate 1 mg [7 whitesquare tablets]

Day 13-21: Ethinyl estradiol 0.035 mg and norethindrone acetate 1 mg [9white round tablets] (28s)

Day 22-28: Ferrous fumarate 75 mg [7 brown tablets]Necon 7/7/7: Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [7white tablets]Day 8-14: Ethinyl estradiol 0.035 mg and norethindrone 0.75 mg [7 lightpeach tablets]

Day 15-21: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [7 peachtablets]

Day 22-28: 7 green inactive tablets (28s)Ortho-Novum 7/7/7:Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [7 whitetablets]

Day 8-14: Ethinyl estradiol 0.035 mg and norethindrone 0.75 mg [7 lightpeach tablets] (28s)

Day 15-21: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [7 peachtablets]

Day 22-28: 7 green inactive tablets

Ethinyl Estradiol and NorgestimateOutpatient Dosage FormsTablet, oral:Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 tablets and 7inactive tablets] [BCF]

Tablet, oral [monophasic formulation]:Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 tablets and 7inactive tablets] [BCF]

Tablet, oral [triphasic formulation]: [BCF]Day 1-7: Ethinyl estradiol 0.025 mg and norgestimate 0.18 mg [7 tablets]Day 8-14: Ethinyl estradiol 0.025 mg and norgestimate 0.215 mg [7 tablets]Day 15-21: Ethinyl estradiol 0.025 mg and norgestimate 0.25 mg [7 tablets]Day 22-28: 7 inactive tablets

Ethinyl Estradiol and NorgestrelOutpatient Dosage FormsTablet, oral [monophasic formulation]:Ogestrel: Ethinyl estradiol 0.05 mg and norgestrel 0.5 mg [21 white tabletsand 7 peach inactive tablets] (28s)

Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [21 tablets and 7 inactivetablets] (28s)

ExenatideOutpatient Dosage FormsAuto-injector, Subcutaneous:Bydureon BCise: 2 mg/0.85 mL (0.85 mL)

Pen-injector, Subcutaneous:Bydureon: 2 mg (1 ea)

EzetimibeOutpatient Dosage FormsTablet, Oral:Zetia: 10 mg

FelodipineOutpatient Dosage FormsTablet Extended Release 24 Hour, Oral:Generic: 5 mg, 10 mg

Fenofibrate and DerivativesOutpatient Dosage FormsTablet, Oral, as fenofibrate:Generic: 48 mg [BCF], 145 mg [BCF]

Ferrous SulfateOutpatient Dosage FormsLiquid, Oral:Generic: 75 mg/mL (50 mL) [elemental iron 15 mg/mL]

Tablet, Oral:Generic: 325 mg [elemental iron 65 mg]

FexofenadineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 60 mg, 180 mg

Fexofenadine and PseudoephedrineOutpatient Dosage FormsTablet, Extended Release:Fexofenadine hydrochloride 60 mg [immediate release] and pseudoephedrinehydrochloride 120 mg [extended release]

Fexofenadine hydrochloride 180 mg [immediate release] and pseudoephe-drine hydrochloride 240 mg [extended release]

FinasterideOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF]

FlecainideOutpatient Dosage FormsTablet, Oral, as acetate:Generic: 50 mg

FluconazoleOutpatient Dosage FormsTablet, Oral:Generic: 100 mg, 150 mg [BCF]

FludrocortisoneOutpatient Dosage FormsTablet, Oral, as acetate:Generic: 0.1 mg

Fluocinolone (Topical)Outpatient Dosage FormsCream, External, as acetonide:Generic: 0.01% (15 g)

Solution, External, as acetonide:Generic: 0.01% (60 mL)

FluocinonideOutpatient Dosage FormsCream, External:Generic: 0.05% (15 g, 30 g, 60 g, 120 g) [BCF]

Ointment, External:Generic: 0.05% (15 g, 60 g) [BCF]

Solution, External:Generic: 0.05% (20 mL, 60 mL)

FluorideOutpatient Dosage FormsCream, Oral, as sodium [toothpaste]:Generic: 1.1% (51 g) [equivalent to fluoride 2.5 mg/dose]

Solution, oral, as sodium [drops]:Generic: 1.1 mg/mL (50 mL) [equivalent to fluoride 0.5 mg/mL]

FluorometholoneOutpatient Dosage FormsSuspension, Ophthalmic, as base:Generic: 0.1% (15 mL)

Fluorouracil (Topical)Outpatient Dosage FormsCream, External:Generic: 5% (40 g)

FLUoxetineOutpatient Dosage FormsCapsule, Oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]

Solution, Oral:Generic: 20 mg/5 mL (5 mL, 120 mL) [BCF]

FLUOXETINE

7

Fluticasone and SalmeterolOutpatient Dosage FormsAerosol, for Oral Inhalation:Advair HFA: 45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg perinhalation (8 g) [chlorofluorocarbon free; 60 metered actuations] [BCF]

Advair HFA: 45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg perinhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]

Advair HFA: 115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcgper inhalation (8 g) [chlorofluorocarbon free; 60 metered actuations] [BCF]




Powder, for Oral Inhalation:Advair Diskus: 100/50: Fluticasone propionate 100 mcg and salmeterol 50mcg (14s, 60s) [contains lactose] [BCF]

Advair Diskus: 250/50: Fluticasone propionate 250 mcg and salmeterol 50mcg (14s, 60s) [contains lactose] [BCF]

Advair Diskus: 500/50: Fluticasone propionate 500 mcg and salmeterol 50mcg (14s, 60s) [contains lactose] [BCF]

Fluticasone (Nasal)Outpatient Dosage FormsSuspension, Nasal, as propionate:Generic: 50 mcg/inhalation (16 g) [BCF]

Fluticasone (Oral Inhalation)Outpatient Dosage FormsAerosol, Inhalation, as propionate:Flovent HFA: 44 mcg/inhalation (10.6 g) [chlorofluorocarbon free; 120 meteredactuations] [BCF]

Flovent HFA: 110 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 meteredactuations] [BCF]

Flovent HFA: 220 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 meteredactuations] [BCF]

Aerosol Powder Breath Activated, Inhalation, as furoate:Arnuity Ellipta: 100 mcg/actuation (30 ea); 200 mcg/actuation (30 ea) [containslactose monohydrate]

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]

FluvoxaMINEOutpatient Dosage FormsTablet, Oral, as maleate:Generic: 25 mg, 100 mg

Folic AcidOutpatient Dosage FormsTablet, Oral:Generic: 1 mg [BCF]

FosinoprilOutpatient Dosage FormsTablet, Oral, as sodium:Generic: 10 mg, 20 mg, 40 mg

FurosemideOutpatient Dosage FormsSolution, Oral:Generic: 10 mg/mL (60 mL, 120 mL) [BCF]

Tablet, Oral:Generic: 20 mg [BCF], 40 mg [BCF] , 80 mg

GabapentinOutpatient Dosage FormsCapsule, Oral:Generic: 100 mg [BCF], 300 mg [BCF], 400 mg [BCF]


Ganciclovir (Ophthalmic)Outpatient Dosage FormsGel, Ophthalmic:Zirgan: 0.15% (5 g) [contains benzalkonium chloride]

GemfibrozilOutpatient Dosage FormsTablet, Oral:Generic: 600 mg [BCF]

Gentamicin (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Generic: 0.3% (3.5 g) [BCF]

Solution, Ophthalmic [drops]:Generic: 0.3% (5 mL, 15 mL) [BCF]

GlimepirideOutpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2 mg, 4 mg

GlipiZIDEOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF]

Tablet Extended Release 24 Hour, Oral:Generic: 2.5 mg, 5 mg, 10 mg

GlucagonOutpatient Dosage FormsSolution Reconstituted, Injection:Generic: 1 mg (1 ea)

GlyBURIDEOutpatient Dosage FormsTablet, Oral:Generic: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF]

GlycerinOutpatient Dosage FormsSuppository, Rectal:Glycerin (Infants & Children): 1 g (12 ea)

Glycopyrrolate (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2 mg

GriseofulvinOutpatient Dosage FormsSuspension, Oral:Generic: 125 mg/5 mL (120 mL) [BCF]


GuaiFENesinOutpatient Dosage FormsSyrup, Oral:Generic: 100 mg/5 mL (118 m mL)

Tablet Extended Release 12 Hour, Oral:Generic: 600 mg

Guaifenesin and CodeineOutpatient Dosage FormsSolution, Oral:Generic: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL(118 mL)

Guaifenesin and DextromethorphanOutpatient Dosage FormsLiquid, Oral:Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL(118 mL)

GuanFACINEOutpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2 mg

Tablet Extended Release 24 Hour, Oral:Generic: 1 mg, 2 mg, 3 mg, 4 mg

HaloperidolOutpatient Dosage FormsTablet, Oral:Generic: 1 mg

HomatropineOutpatient Dosage FormsSolution, Ophthalmic, as hydrobromide:Generic: 5% (5 mL)

HydrALAZINEOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 100 mg

HydroCHLOROthiazideOutpatient Dosage FormsCapsule, oral:Generic: 12.5 mg [BCF]

Tablet, oral:Generic: 12.5 mg, 25 mg [BCF], 50 mg [BCF]

FLUTICASONE AND SALMETEROL

8

Hydrochlorothiazide and SpironolactoneOutpatient Dosage FormsTablet, Oral:Aldactazide: 50/50: Hydrochlorothiazide 50 mg and spironolactone 50 mgGeneric: 25/25: Hydrochlorothiazide 25 mg and spironolactone 25 mg

Hydrochlorothiazide and TriamtereneOutpatient Dosage FormsTablet, Oral:Generic: Hydrochlorothiazide 25 mg and triamterene 37.5 mg [BCF]Generic: Hydrochlorothiazide 50 mg and triamterene 75 mg [BCF]

Hydrocodone and AcetaminophenOutpatient Dosage FormsTablet, Oral:Hydrocodone bitartrate 5 mg and acetaminophen 325 mgHydrocodone bitartrate 7.5 mg and acetaminophen 325 mgHydrocodone bitartrate 10 mg and acetaminophen 325 mg

Hydrocortisone (Topical)Outpatient Dosage FormsCream, External, as base:Generic: 0.5% (30 g); 1% (30 g); 2.5% (28.35 g, 30 g) [BCF]

Cream, External, as valerate:Generic: 0.2% (15 g)

Lotion, External, as base:Generic: 1% (118 mL); 2.5% (59 mL, 118 mL)

Ointment, External, as base:Generic: 1% (28 g), 2.5% (30 g)

Ointment, External, as valerate:Generic: 0.2% (15 g)

Suppository, Rectal, as acetate:Generic: 25 mg (12s, 24s, 100s) [BCF]

HydroxychloroquineOutpatient Dosage FormsTablet, Oral, as sulfate:Generic: 200 mg

HydroxyureaOutpatient Dosage FormsCapsule, Oral:Generic: 500 mg

HydrOXYzineOutpatient Dosage FormsSolution, Oral, as hydrochloride:Generic: 10 mg/5 mL (473 mL) [BCF]

Syrup, Oral, as hydrochloride:Generic: 10 mg/5 mL (118 mL, 473 mL) [BCF]

Tablet, Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

HyoscyamineOutpatient Dosage FormsTablet Dispersible, Oral, as sulfate:Generic: 0.125 mg

IbandronateOutpatient Dosage FormsTablet, Oral:Generic: 150 mg

IbuprofenOutpatient Dosage FormsSuspension, Oral:Generic: 100 mg/5 mL (120 mL)

Tablet, Oral:Generic: 200 mg, 400 mg [BCF], 600 mg [BCF], 800 mg [BCF]

ImipramineOutpatient Dosage FormsCapsule, Oral, as pamoate:Generic: 75 mg [BCF]

Tablet, Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

ImiquimodOutpatient Dosage FormsCream, External:Generic: 5% (24 ea)

IndomethacinOutpatient Dosage FormsCapsule, Oral:Generic: 25 mg [BCF], 50 mg [BCF]

Inhalation DevicesOutpatient Dosage FormsInhalation Spacer: [BCF]

AeroChamber, AeroChamber with mask (small, medium, large)

Insulin AspartOutpatient Dosage FormsSolution, Subcutaneous:NovoLOG: 100 units/mL (10 mL) [contains metacresol, phenol] [BCF]

Solution Pen-injector, Subcutaneous:NovoLOG FlexPen: 100 units/mL (3 mL) [contains metacresol, phenol] [BCF]

Insulin Aspart Protamine and Insulin AspartOutpatient Dosage FormsSuspension, Subcutaneous:NovoLOG Mix 70/30 FlexPen: Insulin aspart protamine suspension 70%[intermediate acting] and insulin aspart solution 30% [rapid-acting]: 100units/mL (3 mL) [contains metacresol, phenol] [BCF]

Insulin GlargineOutpatient Dosage FormsSolution, Subcutaneous:Lantus: 100 units/mL (10 mL) [contains metacresol] [BCF]

Solution Pen-injector, Subcutaneous:Toujeo SoloStar: 300 units/mL (1.5 mL) [contains metacresol]

Insulin NPHOutpatient Dosage FormsSuspension, Subcutaneous:NovoLIN N: 100 units/mL (10 mL) [contains metacresol, phenol] [BCF]

Insulin NPH and Insulin RegularOutpatient Dosage FormsSuspension, Subcutaneous:NovoLIN 70/30: Insulin NPH suspension 70% [intermediate acting] and insulinregular solution 30% [short acting]: 100 units/mL (10 mL) [contains meta-cresol, phenol] [BCF]

Insulin RegularOutpatient Dosage FormsSolution, Injection:NovoLIN R: 100 units/mL (10 mL) [contains metacresol] [BCF]

Interferon Beta-1bOutpatient Dosage FormsKit, Subcutaneous:Betaseron: 0.3 mg [contains albumin human] [BCF]

Ipratropium and AlbuterolOutpatient Dosage FormsSolution, for oral inhalation [spray]:Combivent Respimat: Ipratropium bromide 20 mcg and albuterol (base) 100mcg per inhalation (4 g) [contains benzalkonium chloride]

Ipratropium (Nasal)Outpatient Dosage FormsSolution, Nasal, as bromide:Generic: 0.03% (30 mL); 0.06% (15 mL)

Ipratropium (Oral Inhalation)Outpatient Dosage FormsAerosol Solution, Inhalation, as bromide:Atrovent HFA: 17 mcg/actuation (12.9 g) [contains alcohol, usp] [BCF]

Solution, Inhalation, as bromide:Generic: 0.02% (2.5 mL)

Solution, Inhalation, as bromide [preservative free]:Generic: 0.02% (2.5 mL)

IsoniazidOutpatient Dosage FormsTablet, Oral:Generic: 100 mg [BCF], 300 mg [BCF]

Isosorbide DinitrateOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg [BCF]

Tablet Extended Release, Oral:Generic: 40 mg [BCF]

Isosorbide MononitrateOutpatient Dosage FormsTablet Extended Release 24 Hour, Oral:Generic: 30 mg [BCF], 60 mg [BCF], 120 mg [BCF]

ISOtretinoin (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 10 mg, 20 mg, 30 mg, 40 mg

Ketoconazole (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 200 mg

KETOCONAZOLE (SYSTEMIC)

9

Ketoconazole (Topical)Outpatient Dosage FormsCream, External:Generic: 2% (15 g, 30 g, 60 g)

Shampoo, External:Generic: 2% (120 mL)

Ketorolac (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as tromethamine:Generic: 0.5% (5 mL)

Ketorolac (Systemic)Outpatient Dosage FormsTablet, Oral, as tromethamine:Generic: 10 mg

Ketotifen (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic:Generic: 0.025% (5 mL)

LabetalolOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 100 mg, 200 mg

Lactic Acid and Ammonium HydroxideOutpatient Dosage FormsLotion, External:Lactic acid 12% with ammonium hydroxide (225 g)

LactuloseOutpatient Dosage FormsSolution, Oral:Generic: 10 g/15 mL (15 mL, 30 mL, 236 mL, 237 mL, 473 mL, 500 mL, 946mL, 1892 mL) [BCF]

LamoTRIgineOutpatient Dosage FormsTablet, Oral:Generic: 25 mg, 100 mg, 150 mg, 200 mg

LatanoprostOutpatient Dosage FormsSolution, Ophthalmic:Generic: 0.005% (2.5 mL) [BCF]

LetrozoleOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg

LevETIRAcetamOutpatient Dosage FormsTablet, Oral:Generic: 500 mg, 750 mg

Tablet Extended Release 24 Hour, Oral:Generic: 500 mg, 750 mg

LevoFLOXacin (Systemic)Outpatient Dosage FormsSolution, Oral:Generic: 25 mg/mL (480 mL) [BCF]


Levonorgestrel (IUD)Outpatient Dosage FormsIntrauterine Device:Mirena: 20 mcg/24 hrSkyla: 13.5 mg

Levonorgestrel (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 1.5 mg

LevothyroxineOutpatient Dosage FormsTablet, oral, as sodium:Synthroid: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg [BCF], 100mcg [BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150 mcg[BCF], 175 mcg [BCF], 200 mcg [BCF], 300 mcg [BCF]

Generic: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg [BCF], 100mcg [BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150 mcg[BCF], 175 mcg [BCF], 200 mcg [BCF], 300 mcg [BCF]

Lidocaine (Topical)Outpatient Dosage FormsGel, External, as hydrochloride:Generic: 2% (30 mL)

Patch, External:Generic: 5% (30 ea)

Ointment, External:Generic: 5%

Solution, Mouth/Throat, as hydrochloride:Generic: 2% (100 mL)

LifitegrastOutpatient Dosage FormsSolution, Ophthalmic:Xiidra: 5% (5 ea)

LinaclotideOutpatient Dosage FormsCapsule, Oral:Linzess: 145 mcg, 290 mcg

LinagliptinOutpatient Dosage FormsTablet, Oral:Tradjenta: 5 mg

LiothyronineOutpatient Dosage FormsTablet, Oral:Generic: 5 mcg, 25 mcg

LisinoprilOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg[BCF], 40 mg [BCF]

Lisinopril and HydrochlorothiazideOutpatient Dosage FormsTablet, Oral:Generic: 10/12.5: Lisinopril 10 mg and hydrochlorothiazide 12.5 mg [BCF]Generic: 20/12.5: Lisinopril 20 mg and hydrochlorothiazide 12.5 mg [BCF]Generic: 20/25: Lisinopril 20 mg and hydrochlorothiazide 25 mg [BCF]

LithiumOutpatient Dosage FormsCapsule, 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:Generic: 300 mg

LoperamideOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 2 mg [BCF]

LoratadineOutpatient Dosage FormsSyrup, Oral:5 mg/5 mL (120 mL)


LORazepamOutpatient Dosage FormsTablet, oral:Generic: 0.5 mg, 1 mg, 2 mg

LosartanOutpatient Dosage FormsTablet, Oral, as potassium:Cozaar: 25 mg [contains potassium 2.12 mg (0.054 mEq)]Cozaar: 50 mg [contains potassium 4.24 mg (0.108 mEq)]Cozaar: 100 mg [contains potassium 8.48 mg (0.216 mEq)]

Losartan and HydrochlorothiazideOutpatient Dosage FormsTablet, oral:50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg100/12.5: Losartan potassium 100 mg and hydrochlorothiazide 12.5 mg100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg

LoteprednolOutpatient Dosage FormsGel, Ophthalmic, as etabonate:Lotemax: 0.5% (5 g) [contains benzalkonium chloride, edetate disodiumdihydrate, propylene glycol]

KETOCONAZOLE (TOPICAL)

10

Suspension, ophthalmic, as etabonate [drops]:Alrex: 0.2% (5 mL, 10 mL)Lotemax: 0.5% (5 mL) [contains benzalkonium chloride]

LurasidoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Latuda: 20 mg, 40 mg, 60 mg, 80 mg

MeclizineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 25 mg

MedroxyPROGESTERoneOutpatient Dosage FormsSuspension, Intramuscular, as acetate:Generic: 150 mg/mL (1 mL)

Tablet, Oral, as acetate:Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

MegestrolOutpatient Dosage FormsSuspension, Oral, as acetate:Generic: 40 mg/mL (10 mL)

Tablet, Oral, as acetate:Generic: 20 mg

MelatoninOutpatient Dosage FormsTablet, Oral:Generic: 1 mg

MeloxicamOutpatient Dosage FormsTablet, Oral:Generic: 7.5 mg [BCF], 15 mg [BCF]

MemantineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg

MercaptopurineOutpatient Dosage FormsTablet, Oral:Generic: 50 mg

MesalamineOutpatient Dosage FormsCapsule Delayed Release, Oral:Delzicol: 400 mg

Tablet Delayed Release, Oral:Lialda: 1.2 g [BCF]

MetaxaloneOutpatient Dosage FormsTablet, Oral:Generic: 800 mg

MetFORMINOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 500 mg [BCF], 850 mg [BCF], 1000 mg [BCF]


MethenamineOutpatient Dosage FormsTablet, Oral, as hippurate:Generic: 1 g

MethIMAzoleOutpatient Dosage FormsTablet, Oral:Generic: 5 mg

MethocarbamolOutpatient Dosage FormsTablet, Oral:Generic: 500 mg [BCF], 750 mg

MethotrexateOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg [BCF]

MethyldopaOutpatient Dosage FormsTablet, Oral:Generic: 250 mg, 500 mg

MethylphenidateOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF]

Tablet Extended Release, Oral, as hydrochloride:Generic: 18 mg [BCF], 20 mg [BCF], 27 mg [BCF], 36 mg [BCF],54 mg [BCF]

MethylPREDNISoloneOutpatient Dosage FormsTablet Therapy Pack, Oral:Generic: 4 mg (21 ea)

MetoclopramideOutpatient Dosage FormsSolution, Oral:Generic: 5 mg/5 mL (10 mL, 473 mL) [BCF]

Tablet, Oral:Generic: 10 mg [BCF]

MetOLazoneOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg, 5 mg

MetoprololOutpatient Dosage FormsTablet, 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]

MetroNIDAZOLE (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

MetroNIDAZOLE (Topical)Outpatient Dosage FormsGel, External:Metrogel: 1% (55 g, 60 g) [contains methylparaben, propylparaben]Generic: 0.75% (45 g); 1% (60 g)

Gel, Vaginal:Generic: 0.75% (70 g)[BCF]

Miconazole (Topical)Outpatient Dosage FormsCream, External, as nitrate:Generic: 2% (30 g)

MinocyclineOutpatient Dosage FormsCapsule, Oral:Generic: 50 mg, 100 mgg

MirabegronOutpatient Dosage FormsTablet Extended Release 24 Hour, Oral:Myrbetriq: 25 mg, 50 mg

MirtazapineOutpatient Dosage FormsTablet, Oral:Generic: 15 mg, 30 mg, 45 mg

MiSOPROStolOutpatient Dosage FormsTablet, Oral:Generic: 200 mcg

MontelukastOutpatient Dosage FormsPacket, Oral:Generic: 4 mg/packet (30s) [BCF]

Tablet, Oral:Generic: 10 mg [BCF]

Tablet Chewable, Oral:Generic: 4 mg [BCF], 5 mg [BCF]

Morphine (Systemic)Outpatient Dosage FormsTablet, Oral, as sulfate:Generic: 15 mg

Tablet Extended Release, Oral, as sulfate:Generic: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF],200 mg [BCF]

MORPHINE (SYSTEMIC)

11

Moxifloxacin (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic:Vigamox: 0.5% (3 mL)

Moxifloxacin (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 400 mg

MupirocinOutpatient Dosage FormsOintment, External:Generic: 2% (22 g) [BCF]

MycophenolateOutpatient Dosage FormsCapsule, Oral, as mofetil:Generic: 250 mg

Tablet, Oral, as mofetil:Generic: 500 mg

NabumetoneOutpatient Dosage FormsTablet, Oral:Generic: 500 mg, 750 mg

NaproxenOutpatient Dosage FormsSuspension, oral:Generic: 125 mg/5 mL (500 mL) [BCF]

Tablet, oral:Generic: 250 mg [BCF], 375 mg, 500 mg [BCF]

Neomycin, Polymyxin B, and DexamethasoneOutpatient Dosage FormsOintment, Ophthalmic:Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame-thasone 0.1% per g (3.5 g)

Suspension, Ophthalmic [drops]:Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame-thasone 0.1% per 1 mL (5 mL)

Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic)Outpatient Dosage FormsSuspension, Ophthalmic [drops]:Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone10 mg per 1 mL (7.5 mL)

Neomycin, Polymyxin B, and Hydrocortisone (Otic)Outpatient Dosage FormsSolution, Otic:Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone10 mg per 1 mL (10 mL) [BCF]

NepafenacOutpatient Dosage FormsSuspension, Ophthalmic:Ilevro: 0.3% (1.7 mL, 3 mL) [contains benzalkonium chloride, edetate diso-dium, propylene glycol]

Nevanac: 0.1% (3 mL) [contains edentate disodium benzalkonium chloride]

NiacinOutpatient Dosage FormsTablet Extended Release, Oral:Generic: 500 mg [BCF], 750 mg [BCF], 1000 mg [BCF]

NicotineOutpatient Dosage FormsGum, chewing, oral, as polacrilex:Generic: 2 mg (50s) [BCF]; 4 mg (50s) [BCF]

Patch, transdermal:Generic: 7 mg/24 hours (7s, 14s) [BCF]; 14 mg/24 hours (7s, 14s) [BCF];21 mg/24 hours (7s, 14s) [BCF]

NIFEdipineOutpatient Dosage FormsCapsule, Oral:Generic: 10 mg

Tablet Extended Release 24 Hour, Oral:Generic: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF]

NitrofurantoinOutpatient Dosage FormsCapsule, oral [macrocrystal]:Generic: 50 mg [BCF], 100 mg

Capsule, oral [macrocrystal/monohydrate]:Generic: 100 mg [BCF]

NitroglycerinOutpatient Dosage FormsPatch 24 Hour, Transdermal: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, 12 g) [BCF]

Tablet, Sublingual:Nitrostat: 0.3 mg, 0.4 mg [BCF], 0.6 mg

NorethindroneOutpatient Dosage FormsTablet, Oral:Generic: 0.35 mg [BCF]

Tablet, Oral, as acetate:Generic: 5 mg

NortriptylineOutpatient Dosage FormsCapsule, Oral:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

Solution, Oral:Generic: 10 mg/5 mL (473 mL) [BCF]

Nystatin and TriamcinoloneOutpatient Dosage FormsCream, External:Generic: Nystatin 100,000 units and triamcinolone acetonide 0.1% (15 g)

Nystatin (Oral)Outpatient Dosage FormsSuspension, Mouth/Throat:Generic: 100,000 units/mL (5 mL, 60 mL, 473 mL) [BCF]

Nystatin (Topical)Outpatient Dosage FormsCream, External:Generic: 100,000 units/g (15 g, 30 g) [BCF]

Ointment, External:Generic: 100,000 units/g (15 g, 30 g) [BCF]

Powder, External:Generic: 100,000 units/g (15 g)

Ofloxacin (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic:Generic: 0.3% (10 mL)

OLANZapineOutpatient Dosage FormsTablet, Oral:Generic: 5 mg, 10 mg

Olopatadine (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic:Pazeo: 0.7% (2.5 mL) [contains benzalkonium chloride]Generic: 0.1% (5 mL) [BCF]

OmeprazoleOutpatient Dosage FormsCapsule Delayed Release, Oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg

OndansetronOutpatient Dosage FormsTablet, Oral:Generic: 4 mg, 8 mg

Tablet Dispersible, Oral [ODT]:Generic: 4 mg, 8 mg

OxybutyninOutpatient Dosage FormsTablet, Oral, as chloride:Generic: 5 mg

Tablet Extended Release 24 Hour, Oral, as chloride:Generic: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF]

Oxycodone and AcetaminophenOutpatient Dosage FormsTablet, Oral:5/325: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg [BCF]10/325: Oxycodone hydrochloride 10 mg and acetaminophen 325 mg

Oxymetazoline (Nasal)Outpatient Dosage FormsSolution, Nasal, as hydrochloride:Generic: 0.05% (30 mL)

MOXIFLOXACIN (OPHTHALMIC)

12

PancrelipaseOutpatient Dosage FormsCapsule, Delayed Release, Enteric Coated Microspheres, Oral [porcinederived]:Creon: Lipase 3000 USP units, protease 9500 USP units, and amylase 15,000USP units [BCF]

Creon: Lipase 6000 USP units, protease 19,000 USP units, and amylase30,000 USP units [BCF]

Creon: Lipase 12,000 USP units, protease 38,000 USP units, and amylase60,000 USP units [BCF]

Creon: Lipase 24,000 USP units, protease 76,000 USP units, and amylase120,000 USP units

Creon: Lipase 36,000 USP units, protease 114,000 USP units, and amylase180,000 USP units [BCF]

PantoprazoleOutpatient Dosage FormsTablet Delayed Release, Oral:Generic: 20 mg, 40 mg

PARoxetineOutpatient Dosage FormsTablet, oral, as hydrochloride [strength expressed as base]:Generic: 10 mg, 20 mg, 30 mg, 40 mg

Penicillin V PotassiumOutpatient Dosage FormsSolution Reconstituted, Oral:Generic: 125 mg/5 mL (100 mL, 200 mL) [BCF]; 250 mg/5 mL (100 mL, 200mL) [BCF]


PermethrinOutpatient Dosage FormsCream, External:Generic: 5% (60 g) [BCF]

PhenazopyridineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 100 mg [BCF], 200 mg [BCF]

PHENobarbitalOutpatient Dosage FormsElixir, Oral:Generic: 20 mg/5 mL (5 mL, 7.5 mL, 15 mL) [BCF]

Tablet, Oral:Generic: 15 mg [BCF], 16.2 mg, 30 mg [BCF], 60 mg [BCF], 100 mg [BCF]

PhenytoinOutpatient Dosage FormsCapsule, Oral, as sodium:Generic: 100 mg [BCF]

Suspension, Oral:Generic: 100 mg/4 mL (4 mL) [BCF]; 125 mg/5 mL (237 mL) [BCF]

Tablet Chewable, Oral:Generic: 50 mg [BCF]

Pilocarpine (Ophthalmic)Outpatient Dosage FormsGel, Ophthalmic, as hydrochloride:Pilopine HS: 4% (4 g) [contains benzalkonium chloride, edetate diso-dium] [BCF]

Solution, Ophthalmic, as hydrochloride:Generic: 1% (15 mL) [BCF]; 2% (15 mL) [BCF]; 4% (15 mL) [BCF]

PimecrolimusOutpatient Dosage FormsCream, External:Elidel: 1% (30 g, 60 g, 100 g) [contains benzyl alcohol, cetyl alcohol, propy-lene glycol] [BCF]

PioglitazoneOutpatient Dosage FormsTablet, Oral:Generic: 15 mg, 30 mg, 45 mg

Piroxicam (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 20 mg

PodofiloxOutpatient Dosage FormsGel, External:Generic: 0.5% (3.5 mL)

Polyethylene Glycol 3350Outpatient Dosage FormsPowder for Solution, Oral:Generic: 17 g/dose (119 g, 238 g, 255 g, 510 g, 527 g)

Polyethylene Glycol-Electrolyte SolutionOutpatient Dosage FormsPowder for Solution, Oral:PEG 3350 240 g, sodium sulfate 22.72 g, sodium bicarbonate 6.72 g, sodiumchloride 5.84 g, and potassium chloride 2.98 g (4000 mL)

PEG 3350 236 g, sodium sulfate 22.74 g, sodium bicarbonate 6.74 g, sodiumchloride 5.86 g, and potassium chloride 2.97 g (4000 mL)

PEG 3350 240 g, sodium bicarbonate 5.72 g, sodium chloride 11.2 g, andpotassium chloride 1.48 g (4000 mL)

PEG 3350 420 g, sodium bicarbonate 5.72 g, sodium chloride 11.2 g, andpotassium chloride 1.48 g (4000 mL)

Potassium ChlorideOutpatient Dosage FormsCapsule Extended Release, Oral:Generic: 10 mEq [BCF]

Packet, Oral:Generic: 20 mEq (30 ea, 100 ea) [BCF]

Solution, Oral:Generic: 20 mEq/15 mL (15 mL, 30 mL, 473 mL) [BCF]

Tablet Extended Release, Oral:Generic: 8 mEq, 10 mEq [BCF], 20 mEq [BCF]

Potassium CitrateOutpatient Dosage FormsTablet, Oral:Generic: 10 mEq (1080 mg), 15 mEq (1620 mg)

Pramoxine and HydrocortisoneOutpatient Dosage FormsAerosol, foam, rectal:ProctoFoam HC: Pramoxine hydrochloride 1% and hydrocortisone acetate1% (10 g)

PrasugrelOutpatient Dosage FormsTablet, Oral:Effient: 5 mg, 10 mg

PravastatinOutpatient Dosage FormsTablet, Oral, as sodium:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]

PrazosinOutpatient Dosage FormsCapsule, Oral:Generic: 1 mg, 2 mg, 5 mg

PrednisoLONE (Ophthalmic)Outpatient Dosage FormsSuspension, Ophthalmic, as acetate [drops]:Pred Mild: 0.12% (5 mL, 10 mL) [contains benzalkonium chloride, sodiumbisulfite] [BCF]

Generic: 1% (5 mL, 10 mL, 15 mL) [BCF]

PrednisoLONE (Systemic)Outpatient Dosage FormsSolution, Oral, as sodium phosphate [strength expressed as base]:Generic: 15 mg/5 mL (237 mL) [BCF]

PredniSONEOutpatient Dosage FormsTablet, Oral:Generic: 1 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 50 mg

PrimaquineOutpatient Dosage FormsTablet, Oral, as phosphate:Generic: 26.3 mg

PrimidoneOutpatient Dosage FormsTablet, Oral:Generic: 50 mg, 250 mg

ProbenecidOutpatient Dosage FormsTablet, Oral:Generic: 500 mg [BCF]

ProchlorperazineOutpatient Dosage FormsTablet, oral, as maleate [strength expressed as base]:Generic: 10 mg

PROCHLORPERAZINE

13

ProgesteroneOutpatient Dosage FormsCapsule, Oral:Generic: 100 mg, 200 mg

PromethazineOutpatient Dosage FormsSuppository, rectal, as hydrochloride:Generic: 12.5 mg (12s) [BCF]; 25 mg (12s) [BCF]

Syrup, oral, as hydrochloride:Generic: 6.25 mg/5 mL (118 mL, 473 mL) [BCF]

Tablet, oral, as hydrochloride:Generic: 25 mg [BCF]

Promethazine and CodeineOutpatient Dosage FormsSyrup, Oral:Generic: Promethazine hydrochloride 6.25 mg and codeine phosphate 10 mgper 5 mL (118 mL)

PropranololOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as hydrochloride:Generic: 60 mg, 80 mg, 120 mg

Tablet, Oral, as hydrochloride:Generic: 10 mg, 20 mg, 40 mg

PropylthiouracilOutpatient Dosage FormsTablet, Oral:Generic: 50 mg [BCF]

PseudoephedrineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 30 mg

Tablet Extended Release 12 Hour, Oral, as hydrochloride:Generic: 120 mg

PyrazinamideOutpatient Dosage FormsTablet, Oral:Generic: 500 mg [BCF]

PyridoxineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 50 mg, 100 mg

QUEtiapineOutpatient Dosage FormsTablet, Oral:Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF], 300 mg[BCF], 400 mg [BCF]

Tablet Extended Release 24 Hour, Oral:SEROquel XR: 50 mg [BCF], 150 mg [BCF], 200 mg [BCF], 300 mg [BCF],400 mg [BCF]

RABEprazoleOutpatient Dosage FormsTablet Delayed Release, Oral, as sodium:Generic: 20 mg

RaloxifeneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 60 mg [BCF]

RamiprilOutpatient Dosage FormsCapsule, Oral:Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

RaNITIdineOutpatient Dosage FormsSyrup, Oral:Generic: 15 mg/mL (10 mL, 473 mL, 474 mL, 480 mL) [BCF]

Tablet, Oral:Generic: 150 mg [BCF], 300 mg

RifapentineOutpatient Dosage FormsTablet, Oral:Priftin: 150 mg [contains disodium edta]

RisperiDONEOutpatient Dosage FormsSolution, Oral:Generic: 1 mg/mL (30 mL) [BCF]

Tablet, Oral:Generic: 0.25 mg [BCF], 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF], 3 mg[BCF], 4 mg [BCF]

RivaroxabanOutpatient Dosage FormsTablet, Oral:Xarelto: 10 mg, 15 mg, 20 mg

RivastigmineOutpatient Dosage FormsPatch 24 Hour, Transdermal:Generic: 4.6 mg/24 hr (30 ea); 9.5 mg/24 hr (30 ea); 13.3 mg/24 hr (30 ea)

RizatriptanOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF]

Tablet Dispersible, Oral:Generic: 5 mg [BCF], 10 mg [BCF]

ROPINIRoleOutpatient Dosage FormsTablet, Oral:Generic: 0.25 mg, 0.5 mg, 1 mg, 5 mg

RosuvastatinOutpatient Dosage FormsTablet, Oral:Generic: 5 mg, 10 mg, 20 mg, 40 mg

SalmeterolOutpatient Dosage FormsAerosol Powder Breath Activated, Inhalation:Serevent Diskus: 50 mcg (28s, 60s) [contains lactose] [BCF]

SalsalateOutpatient Dosage FormsTablet, Oral:Generic: 500 mg [BCF], 750 mg [BCF]

Scopolamine (Systemic)Outpatient Dosage FormsPatch, transdermal:Transderm Scōp®: 1.5 mg (24s) [contains metal; releases ~1 mg over 72hours]

Selenium SulfideOutpatient Dosage FormsLotion, External:Generic: 2.5% (120 mL) [BCF]

SertralineOutpatient Dosage FormsConcentrate, Oral:Generic: 20 mg/mL (60 mL) [BCF]


SevelamerOutpatient Dosage FormsTablet, Oral, as carbonate:Renvela: 800 mg

SildenafilOutpatient Dosage FormsTablet, Oral:Viagra: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Silver SulfadiazineOutpatient Dosage FormsCream, External:Generic: 1% (25 g) [BCF]

SimethiconeOutpatient Dosage FormsSuspension, Oral [drops]:Generic: 40 mg/0.6 mL (30 mL)

SimvastatinOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg

SITagliptinOutpatient Dosage FormsTablet, Oral:Januvia: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

PROGESTERONE

14

Sitagliptin and MetforminOutpatient Dosage FormsTablet, Oral:Janumet 50/500: Sitagliptin 50 mg and metformin hydrochloride500 mg [BCF]

Janumet 50/1000: Sitagliptin 50 mg and metformin hydrochloride1000 mg [BCF]

Tablet, Extended Release, Oral:Janumet XR: 50/1000: Sitagliptin 50 mg [immediate release] and metforminhydrochloride 1000 mg [extended release] [BCF]

Janumet XR: 100/1000: Sitagliptin 100 mg and metformin hydrochloride1000 mg [BCF]

Sodium ChlorideOutpatient Dosage FormsAerosol Solution, Inhalation:Generic: 0.9% (5 mL)

Ointment, Ophthalmic:Generic: 5% (3.5 g)

Solution, Nasal [mist]:Generic: 0.65% (45 mL)

Solution, Nasal [rinse]:Neilmed Sinus Rinse Kit

Solution, Ophthalmic [drops]:Generic: 5% (15 mL)

Sodium PhosphatesOutpatient Dosage FormsSolution, Rectal [enema]:Monobasic sodium phosphate 19 g and dibasic sodium phosphate 7 g per 118mL delivered dose (133 mL)

Sodium Sulfate, Potassium Sulfate, and Magnesium SulfateOutpatient Dosage FormsSolution, oral:Suprep Bowel Prep Kit: Sodium sulfate 17.5 g, potassium sulfate 3.13 g, andmagnesuim sulfate 1.6 g per 180 mL (180 mL) [contains sodium benzoate]

SolifenacinOutpatient Dosage FormsTablet, oral, as succinate:VESIcare: 5 mg, 10 mg

SpironolactoneOutpatient Dosage FormsTablet, Oral:Generic: 25 mg [BCF], 50 mg, 100 mg

SucralfateOutpatient Dosage FormsTablet, Oral:Generic: 1 g

Sulfacetamide (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as sodium:Generic: 10% (15 mL) [BCF]

Sulfamethoxazole and TrimethoprimOutpatient Dosage FormsSuspension, Oral:Generic: Sulfamethoxazole 200 mg and trimethoprim 40 mg per 5 mL (20 mL,473 mL) [BCF]

Tablet, Oral:Generic: Sulfamethoxazole 400 mg and trimethoprim 80 mg [BCF]Generic: Sulamethoxazole 800 mg and trimethoprim 160 mg [BCF]

SulfaSALAzineOutpatient Dosage FormsTablet, Oral:Generic: 500 mg [BCF]

Tablet Delayed Release, Oral:Generic: 500 mg [BCF]

SUMAtriptanOutpatient Dosage FormsSolution, Subcutaneous, as succinate [strength expressed as base]:Generic: 6 mg/0.5 mL (0.5 mL) [BCF]

Tablet, Oral, as succinate [strength expressed as base]:Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

TamoxifenOutpatient Dosage FormsTablet, Oral:Generic: 10 mg [BCF], 20 mg [BCF]

TamsulosinOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 0.4 mg [BCF]

TelmisartanOutpatient Dosage FormsTablet, Oral:Generic: 20 mg, 40 mg, 80 mg

Telmisartan and HydrochlorothiazideOutpatient Dosage FormsTablet, oral:Generic:40/12.5: Telmisartan 40 mg and hydrochlorothiazide 12.5 mg80/12.5: Telmisartan 80 mg and hydrochlorothiazide 12.5 mg80/25: Telmisartan 80 mg and hydrochlorothiazide 25 mg

TemazepamOutpatient Dosage FormsCapsule, Oral:Generic: 15 mg [BCF], 30 mg [BCF]

TerazosinOutpatient Dosage FormsCapsule, Oral:Generic: 1 mg [BCF], 2 mg [BCF], 5 mg [BCF], 10 mg [BCF]

Terbinafine (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 250 mg

TestosteroneOutpatient Dosage FormsGel, Transdermal:Testim: 50 mg/5 g (1%) (5 g) [contains alcohol, usp, propylene glycol, trometh-amine]

Generic: 10 mg/actuation (2%) (60 g) [BCF]Solution, Intramuscular, as cypionate:Generic: 200 mg/mL (1 mL)

Tetracycline (Systemic)Outpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 250 mg [BCF], 500 mg [BCF]

TheophyllineOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral:Theo-24: 300 mg [BCF], 400 mg [BCF]

Elixir, Oral:Elixophyllin: 80 mg/15 mL (473 mL) [mixed fruit flavor] [BCF]

Tablet Extended Release 12 Hour, Oral:Generic: 200 mg [BCF], 300 mg [BCF]

Tablet Extended Release 24 Hour, Oral:Generic: 400 mg [BCF]

Thyroid, DesiccatedOutpatient Dosage FormsTablet, Oral:Armour Thyroid: 15 mg, 30 mg, 60 mg, 90 mg, 120 mg

Timolol (Ophthalmic)Outpatient Dosage FormsGel Forming Solution, Ophthalmic, as maleate [strength expressed as base]:Generic: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF]

Solution, Ophthalmic, as maleate [strength expressed as base]:Generic: 0.25% (5 mL, 10 mL, 15 mL) [BCF]; 0.5% (5 mL, 10 mL, 15mL) [BCF]

TiotropiumOutpatient Dosage FormsAerosol Solution, Inhalation:Spiriva Respimat: 1.25 mcg/actuation (4 g); 2.5 mcg/actuation (4 g) [containsbenzalkonium chloride, disodium edta]

Capsule, Inhalation:Spiriva HandiHaler: 18 mcg [contains milk protein] [BCF]

TiZANidineOutpatient Dosage FormsTablet, Oral:Generic: 2 mg, 4 mg

Tobramycin and DexamethasoneOutpatient Dosage FormsOintment, ophthalmic:TobraDex: Tobramycin 0.3% and dexamethasone 0.1% (3.5 g) [containschlorobutanol]

Suspension, ophthalmic [drops]:Generic: Tobramycin 0.3% and dexamethasone 0.1% (2.5 mL)

TOBRAMYCIN AND DEXAMETHASONE

15

TolnaftateOutpatient Dosage FormsCream, External:Generic: 1% (30 g)

Powder, External:Generic: 1% (45 g)

TolterodineOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as tartrate:Generic: 2 mg [BCF], 4 mg [BCF]

TopiramateOutpatient Dosage FormsTablet, Oral:Generic: 25 mg, 50 mg, 100 mg

TraMADolOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 50 mg [BCF]

TraZODoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 50 mg [BCF], 100 mg [BCF], 150 mg [BCF], 300 mg [BCF]

Tretinoin (Topical)Outpatient Dosage FormsCream, External:Generic: 0.025% (20 g, 45 g) [BCF]; 0.05% (20 g, 45 g) [BCF]

Gel, External:Generic:: 0.01% (15 g); 0.025% (45 g)

Triamcinolone (Topical)Outpatient Dosage FormsCream, External, as acetonide:Generic: 0.1% (15 g, 80 g, 454 g) [BCF]; 0.5% (15 g)

Lotion, External, as acetonide:Generic: 0.1% (60 mL)

Ointment, External, as acetonide:Generic: 0.1% (15 g, 80 g, 454 g) [BCF]; 0.5% (15 g)

Paste, Oral, External,as acetonide:Generic: 0.1% (5 g)

TriazolamOutpatient Dosage FormsTablet, Oral:Generic: 0.25 mg

TrihexyphenidylOutpatient Dosage FormsElixir, Oral, as hydrochloride:Generic: 0.4 mg/mL (473 mL) [BCF]


Trimethoprim and Polymyxin BOutpatient Dosage FormsSolution, Ophthalmic:Generic: Trimethoprim 1 mg and polymyxin B sulfate 10,000 units per 1 mL(10 mL) [BCF]

TropicamideOutpatient Dosage FormsSolution, Ophthalmic [drops]:Generic: 1% (15 mL)

Umeclidinium and VilanterolOutpatient Dosage FormsAerosol Powder Breath Activated, Inhalation:Anoro Ellipta: Umeclidinium 62.5 mcg and vilanterol 25 mcg per inhalation (7dose, 30 dose) [contains milk protein]

UrsodiolOutpatient Dosage FormsCapsule, Oral:Generic: 300 mg


ValACYclovirOutpatient Dosage FormsTablet, Oral:Generic: 500 mg, 1 g

Valproic Acid and DerivativesOutpatient Dosage FormsCapsule Sprinkle, Oral, as divalproex sodium:Generic: 125 mg [BCF]

Tablet Delayed Release, Oral, as divalproex sodium:Generic: 125 mg [BCF], 250 mg [BCF], 500 mg [BCF]

Tablet Extended Release 24 Hour, Oral, as divalproex sodium:Generic: 250 mg [BCF], 500 mg [BCF]

ValsartanOutpatient Dosage FormsTablet, Oral:Generic: 40 mg [BCF], 80 mg [BCF], 160 mg [BCF], 320 mg [BCF]

Valsartan and HydrochlorothiazideOutpatient Dosage FormsTablet, Oral:Generic: 80 mg/12.5 mg: Valsartan 80 mg and hydrochlorothiazide12.5 mg [BCF]

Generic: 160 mg/12.5 mg: Valsartan 160 mg and hydrochlorothiazide12.5 mg [BCF]

Generic: 160 mg/25 mg: Valsartan 160 mg and hydrochlorothiazide25 mg [BCF]

Generic: 320 mg/12.5 mg: Valsartan 320 mg and hydrochlorothiazide12.5 mg [BCF]

Generic: 320 mg/25 mg: Valsartan 320 mg and hydrochlorothiazide25 mg [BCF]

VareniclineOutpatient Dosage FormsTablet, Oral:Chantix: 1 mgChantix Starting Month Pak: 0.5 mg x 11 & 1 mg x 42

VenlafaxineOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral:Generic: 37.5 mg [BCF], 75 mg [BCF], 150 mg [BCF]

Tablet, Oral:Generic: 25 mg [BCF], 37.5 mg [BCF], 50 mg [BCF], 75 mg [BCF],100 mg [BCF]

Tablet Extended Release 24 Hour, Oral:Generic: 225 mg [BCF]

VerapamilOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 80 mg, 120 mg

Tablet Extended Release, Oral, as hydrochloride:Generic: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF]

Vitamins (Multiple/Pediatric)Outpatient Dosage FormsContent varies depending on product used.Polyvitamin liquidPolyvitamin liquid with ironTrivitamin liquid

Vitamins (Multiple/Prenatal)Outpatient Dosage FormsContent varies depending on product used.Tablet, oral

WarfarinOutpatient Dosage FormsTablet, Oral, as sodium:Generic: 1 mg [BCF], 2 mg [BCF], 2.5 mg [BCF], 3 mg [BCF], 4 mg [BCF],5 mg [BCF], 6 mg [BCF], 7.5 mg [BCF], 10 mg [BCF]

Zinc OxideOutpatient Dosage FormsOintment, External:Generic: 20% (454 g)

ZOLMitriptanOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg, 5 mg

Tablet Dispersible, Oral:Generic: 2.5 mg, 5 mg

ZolpidemOutpatient Dosage FormsTablet, Oral, as tartrate:Generic: 5 mg [BCF], 10 mg [BCF]

Tablet Extended Release, Oral, as tartrate:Generic: 6.25 mg, 12.5 mg

TOLNAFTATE

16

Therapeutic Category Index

17

Acetylcholinesterase Inhibitor (Central)Donepezil ..................................................................................................5Rivastigmine ...........................................................................................14

Acne ProductsAdapalene ................................................................................................ 2Benzoyl Peroxide ..................................................................................... 3Clindamycin and Benzoyl Peroxide ......................................................... 4Erythromycin (Topical) ..............................................................................6ISOtretinoin (Systemic) ............................................................................ 9Tretinoin (Topical) ...................................................................................16

Adrenergic Agonist AgentOxymetazoline (Nasal) ...........................................................................12

Alkalinizing Agent, OralPotassium Citrate ...................................................................................13

Alpha1 BlockerAlfuzosin ...................................................................................................2Doxazosin .................................................................................................5Prazosin ..................................................................................................13Tamsulosin ............................................................................................. 15Terazosin ................................................................................................ 15

Alpha2-Adrenergic AgonistCloNIDine ................................................................................................. 4GuanFACINE ............................................................................................8Methyldopa ............................................................................................. 11TiZANidine ..............................................................................................15

Alpha2 Agonist, OphthalmicBrimonidine and Timolol ...........................................................................3Brimonidine (Ophthalmic) .........................................................................3

Alpha/Beta AgonistEPINEPHrine (Systemic) ..........................................................................6Fexofenadine and Pseudoephedrine ....................................................... 7Pseudoephedrine ................................................................................... 14

5 Alpha-Reductase InhibitorFinasteride ................................................................................................7

AmebicideMetroNIDAZOLE (Systemic) .................................................................. 11

Aminoquinoline (Antimalarial)Hydroxychloroquine ..................................................................................9Primaquine ............................................................................................. 13

5-Aminosalicylic Acid DerivativeMesalamine ............................................................................................ 11SulfaSALAzine ........................................................................................15

Ammonium DetoxicantLactulose ................................................................................................ 10

Analgesic Combination (Opioid)Acetaminophen and Codeine ...................................................................2Hydrocodone and Acetaminophen ...........................................................9Oxycodone and Acetaminophen ............................................................12

Analgesic, NonopioidAcetaminophen .........................................................................................2Aspirin .......................................................................................................2Celecoxib ..................................................................................................4Diclofenac (Systemic) ...............................................................................5Ibuprofen .................................................................................................. 9Indomethacin ............................................................................................9Ketorolac (Systemic) .............................................................................. 10Meloxicam ...............................................................................................11Nabumetone ...........................................................................................12Naproxen ................................................................................................12Piroxicam (Systemic) ..............................................................................13

Analgesic, OpioidAcetaminophen and Codeine ...................................................................2Hydrocodone and Acetaminophen ...........................................................9Morphine (Systemic) ...............................................................................11Oxycodone and Acetaminophen ............................................................12Promethazine and Codeine ................................................................... 14TraMADol ............................................................................................... 16

Analgesic, TopicalLidocaine (Topical) ................................................................................. 10

Analgesic, UrinaryPhenazopyridine .....................................................................................13

AndrogenTestosterone ...........................................................................................15

Anesthetic/CorticosteroidPramoxine and Hydrocortisone ..............................................................13

Angiotensin II Receptor BlockerLosartan ..................................................................................................10Losartan and Hydrochlorothiazide ......................................................... 10Telmisartan ............................................................................................. 15Telmisartan and Hydrochlorothiazide .....................................................15Valsartan .................................................................................................16Valsartan and Hydrochlorothiazide ........................................................ 16

Angiotensin-Converting Enzyme (ACE) InhibitorAmlodipine and Benazepril ...................................................................... 2Benazepril .................................................................................................3Captopril ................................................................................................... 3Enalapril ....................................................................................................6Fosinopril ..................................................................................................8Lisinopril ................................................................................................. 10Lisinopril and Hydrochlorothiazide ......................................................... 10Ramipril .................................................................................................. 14

AntacidAluminum Hydroxide, Magnesium Hydroxide, and Simethicone .............2

Antianginal AgentAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 2Atenolol .....................................................................................................2DilTIAZem .................................................................................................5Isosorbide Dinitrate .................................................................................. 9Isosorbide Mononitrate .............................................................................9Metoprolol ...............................................................................................11NIFEdipine ..............................................................................................12Nitroglycerin ............................................................................................12Propranolol ............................................................................................. 14Verapamil ............................................................................................... 16

Antianxiety Agent, MiscellaneousBusPIRone ............................................................................................... 3

Antiarrhythmic Agent, Class IcFlecainide ................................................................................................. 7

Antiarrhythmic Agent, Class IIPropranolol ............................................................................................. 14

Antiarrhythmic Agent, Class IIIAmiodarone .............................................................................................. 2Dronedarone .............................................................................................6

Antiarrhythmic Agent, Class IVDilTIAZem .................................................................................................5Verapamil ............................................................................................... 16

Antiarrhythmic Agent, MiscellaneousDigoxin ......................................................................................................5

Antibiotic, AminoglycosideGentamicin (Ophthalmic) ..........................................................................8

Antibiotic, Cephalosporin (First Generation)Cephalexin ................................................................................................4

Antibiotic, Cephalosporin (Second Generation)Cefuroxime ............................................................................................... 4

Antibiotic, Cephalosporin (Third Generation)Cefdinir ..................................................................................................... 4Cefixime ....................................................................................................4Cefpodoxime ............................................................................................ 4

Antibiotic/Corticosteroid, OphthalmicNeomycin, Polymyxin B, and Dexamethasone ......................................12Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ..................12Tobramycin and Dexamethasone .......................................................... 15

Antibiotic/Corticosteroid, OticNeomycin, Polymyxin B, and Hydrocortisone (Otic) ..............................12

Antibiotic, FluoroquinoloneCiprofloxacin (Systemic) ...........................................................................4LevoFLOXacin (Systemic) ......................................................................10Moxifloxacin (Ophthalmic) ......................................................................12Moxifloxacin (Systemic) ..........................................................................12Ofloxacin (Ophthalmic) ...........................................................................12

Antibiotic, LincosamideClindamycin (Systemic) ............................................................................4Clindamycin (Topical) ............................................................................... 4

Antibiotic, MacrolideAzithromycin (Systemic) ...........................................................................3Clarithromycin ...........................................................................................4

ACETYLCHOLINESTERASE INHIBITOR (CENTRAL)

18

Erythromycin (Ophthalmic) .......................................................................6Erythromycin (Systemic) .......................................................................... 6Erythromycin (Topical) ..............................................................................6

Antibiotic, MiscellaneousMethenamine ..........................................................................................11MetroNIDAZOLE (Systemic) .................................................................. 11Nitrofurantoin ..........................................................................................12Sulfamethoxazole and Trimethoprim ..................................................... 15

Antibiotic, OphthalmicErythromycin (Ophthalmic) .......................................................................6Gentamicin (Ophthalmic) ..........................................................................8Moxifloxacin (Ophthalmic) ......................................................................12Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ..................12Ofloxacin (Ophthalmic) ...........................................................................12Sulfacetamide (Ophthalmic) ...................................................................15Trimethoprim and Polymyxin B .............................................................. 16

Antibiotic, Oral RinseChlorhexidine Gluconate (Oral) ............................................................... 4

Antibiotic, OticNeomycin, Polymyxin B, and Hydrocortisone (Otic) ..............................12

Antibiotic, PenicillinAmoxicillin .................................................................................................2Amoxicillin and Clavulanate ..................................................................... 2Dicloxacillin ...............................................................................................5Penicillin V Potassium ............................................................................13

Antibiotic, Respiratory FluoroquinoloneLevoFLOXacin (Systemic) ......................................................................10Moxifloxacin (Systemic) ..........................................................................12

Antibiotic, Sulfonamide DerivativeSulfamethoxazole and Trimethoprim ..................................................... 15

Antibiotic, Tetracycline DerivativeDoxycycline .............................................................................................. 5Minocycline .............................................................................................11Tetracycline (Systemic) .......................................................................... 15

Antibiotic, TopicalBacitracin (Topical) ...................................................................................3Erythromycin (Topical) ..............................................................................6MetroNIDAZOLE (Topical) ......................................................................11Mupirocin ................................................................................................12Silver Sulfadiazine ..................................................................................14

Anticholinergic AgentBenztropine .............................................................................................. 3Dicyclomine .............................................................................................. 5Glycopyrrolate (Systemic) ........................................................................ 8Hyoscyamine ............................................................................................9Ipratropium and Albuterol .........................................................................9Ipratropium (Nasal) ...................................................................................9Ipratropium (Oral Inhalation) .................................................................... 9Scopolamine (Systemic) .........................................................................14Solifenacin ..............................................................................................15Tiotropium ...............................................................................................15Tolterodine ..............................................................................................16Trihexyphenidyl ...................................................................................... 16Umeclidinium and Vilanterol ...................................................................16

Anticholinergic Agent, Long-ActingTiotropium ...............................................................................................15Umeclidinium and Vilanterol ...................................................................16

Anticholinergic Agent, OphthalmicAtropine (Ophthalmic) .............................................................................. 3Homatropine .............................................................................................8

AnticoagulantDabigatran Etexilate .................................................................................5Enoxaparin ............................................................................................... 6Rivaroxaban ........................................................................................... 14Warfarin .................................................................................................. 16

Anticoagulant, Direct Thrombin InhibitorDabigatran Etexilate .................................................................................5

Anticoagulant, Factor Xa InhibitorRivaroxaban ........................................................................................... 14

Anticoagulant, Low Molecular Weight HeparinEnoxaparin ............................................................................................... 6

Anticoagulant, Vitamin K AntagonistWarfarin .................................................................................................. 16

Anticonvulsant, BarbituratePHENobarbital ........................................................................................13

Anticonvulsant, BenzodiazepineClonazePAM .............................................................................................4DiazePAM .................................................................................................5LORazepam ........................................................................................... 10

Anticonvulsant, HydantoinPhenytoin ................................................................................................13

Anticonvulsant, MiscellaneousCarBAMazepine ....................................................................................... 3Gabapentin ...............................................................................................8LamoTRIgine ..........................................................................................10LevETIRAcetam ..................................................................................... 10Primidone ............................................................................................... 13Topiramate ..............................................................................................16Valproic Acid and Derivatives ................................................................ 16

Antidepressant, Alpha-2 AntagonistMirtazapine ............................................................................................. 11

Antidepressant, Dopamine/Norepinephrine-Reuptake InhibitorBuPROPion .............................................................................................. 3

Antidepressant, Selective Serotonin Reuptake InhibitorCitalopram ................................................................................................ 4Escitalopram .............................................................................................6FLUoxetine ............................................................................................... 7FluvoxaMINE ............................................................................................8PARoxetine .............................................................................................13Sertraline ................................................................................................ 14

Antidepressant, Serotonin/Norepinephrine Reuptake InhibitorDULoxetine ...............................................................................................6Venlafaxine .............................................................................................16

Antidepressant, Serotonin Reuptake Inhibitor/AntagonistTraZODone .............................................................................................16

Antidepressant, Tricyclic (Secondary Amine)Nortriptyline ............................................................................................ 12

Antidepressant, Tricyclic (Tertiary Amine)Amitriptyline ..............................................................................................2Doxepin (Systemic) .................................................................................. 5Imipramine ................................................................................................9

Antidiabetic Agent, BiguanideMetFORMIN ............................................................................................11Sitagliptin and Metformin ....................................................................... 15

Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) InhibitorLinagliptin ............................................................................................... 10SITagliptin ...............................................................................................14Sitagliptin and Metformin ....................................................................... 15

Antidiabetic Agent, Glucagon-Like Peptide-1 (GLP-1) ReceptorAgonist

Dulaglutide ................................................................................................6Exenatide ..................................................................................................7

Antidiabetic Agent, Sodium-Glucose Cotransporter 2 (SGLT2)Inhibitor

Empagliflozin ............................................................................................ 6

Antidiabetic Agent, SulfonylureaGlimepiride ............................................................................................... 8GlipiZIDE .................................................................................................. 8GlyBURIDE ...............................................................................................8

Antidiabetic Agent, ThiazolidinedionePioglitazone ............................................................................................13

AntidiarrhealBismuth Subsalicylate .............................................................................. 3Diphenoxylate and Atropine .....................................................................5Loperamide .............................................................................................10

AntidoteCalcium Acetate ....................................................................................... 3Glucagon .................................................................................................. 8

Antidote, ExtravasationNitroglycerin ............................................................................................12

Antidote, HypoglycemiaGlucagon .................................................................................................. 8

AntiemeticDexamethasone (Systemic) ..................................................................... 5HydrOXYzine ............................................................................................9Meclizine .................................................................................................11Metoclopramide ...................................................................................... 11Ondansetron ...........................................................................................12

ANTIEMETIC

19

Prochlorperazine .................................................................................... 13Promethazine ......................................................................................... 14

AntiflatulentAluminum Hydroxide, Magnesium Hydroxide, and Simethicone .............2Simethicone ............................................................................................14

Antifungal Agent, Imidazole DerivativeClotrimazole (Topical) ...............................................................................4Ketoconazole (Systemic) ..........................................................................9Ketoconazole (Topical) ...........................................................................10Miconazole (Topical) ...............................................................................11

Antifungal Agent, OralFluconazole .............................................................................................. 7Griseofulvin ...............................................................................................8Ketoconazole (Systemic) ..........................................................................9Terbinafine (Systemic) ............................................................................15

Antifungal Agent, Oral Nonabsorbed/Partially AbsorbedClotrimazole (Topical) ...............................................................................4Miconazole (Topical) ...............................................................................11Nystatin (Oral) ........................................................................................ 12

Antifungal Agent, ParenteralFluconazole .............................................................................................. 7

Antifungal Agent, TopicalBetamethasone and Clotrimazole ............................................................3Clotrimazole (Topical) ...............................................................................4Ketoconazole (Topical) ...........................................................................10Miconazole (Topical) ...............................................................................11Nystatin and Triamcinolone ....................................................................12Nystatin (Topical) ....................................................................................12Tolnaftate ................................................................................................16

Antifungal Agent, VaginalClotrimazole (Topical) ...............................................................................4Miconazole (Topical) ...............................................................................11

Antigout AgentAllopurinol .................................................................................................2Colchicine .................................................................................................4

Antihemophilic AgentDesmopressin ...........................................................................................5

Antihemorrhoidal AgentHydrocortisone (Topical) .......................................................................... 9

AntihypertensiveAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 2Atenolol .....................................................................................................2Benazepril .................................................................................................3Bumetanide .............................................................................................. 3Captopril ................................................................................................... 3Carvedilol ..................................................................................................4Chlorthalidone .......................................................................................... 4CloNIDine ................................................................................................. 4DilTIAZem .................................................................................................5Doxazosin .................................................................................................5Enalapril ....................................................................................................6Felodipine .................................................................................................7Fosinopril ..................................................................................................8Furosemide ...............................................................................................8GuanFACINE ............................................................................................8HydrALAZINE ...........................................................................................8HydroCHLOROthiazide ............................................................................ 8Hydrochlorothiazide and Spironolactone ................................................. 9Hydrochlorothiazide and Triamterene ...................................................... 9Labetalol .................................................................................................10Lisinopril ................................................................................................. 10Lisinopril and Hydrochlorothiazide ......................................................... 10Losartan ..................................................................................................10Losartan and Hydrochlorothiazide ......................................................... 10Methyldopa ............................................................................................. 11Metoprolol ...............................................................................................11NIFEdipine ..............................................................................................12Prazosin ..................................................................................................13Propranolol ............................................................................................. 14Ramipril .................................................................................................. 14Spironolactone ....................................................................................... 15Telmisartan ............................................................................................. 15Telmisartan and Hydrochlorothiazide .....................................................15Terazosin ................................................................................................ 15Valsartan .................................................................................................16Valsartan and Hydrochlorothiazide ........................................................ 16Verapamil ............................................................................................... 16

Anti-inflammatory AgentDexamethasone (Systemic) ..................................................................... 5

Anti-inflammatory, Locally AppliedCarbamide Peroxide .................................................................................3

Antilipemic Agent, 2-AzetidinoneEzetimibe ..................................................................................................7

Antilipemic Agent, Bile Acid SequestrantCholestyramine Resin .............................................................................. 4

Antilipemic Agent, Fibric AcidFenofibrate and Derivatives ..................................................................... 7Gemfibrozil ............................................................................................... 8

Antilipemic Agent, HMG-CoA Reductase InhibitorAtorvaSTATin ............................................................................................3Pravastatin ..............................................................................................13Rosuvastatin ...........................................................................................14Simvastatin .............................................................................................14

Antilipemic Agent, MiscellaneousNiacin ......................................................................................................12

Antimalarial AgentHydroxychloroquine ..................................................................................9Primaquine ............................................................................................. 13

Antimanic AgentLithium ....................................................................................................10OLANZapine ...........................................................................................12RisperiDONE ..........................................................................................14Valproic Acid and Derivatives ................................................................ 16

Antimigraine AgentRizatriptan .............................................................................................. 14SUMAtriptan ........................................................................................... 15ZOLMitriptan ...........................................................................................16

Antineoplastic Agent, AntiandrogenBicalutamide .............................................................................................3

Antineoplastic Agent, AntimetaboliteFluorouracil (Topical) ................................................................................7Mercaptopurine .......................................................................................11

Antineoplastic Agent, Antimetabolite (Antifolate)Methotrexate ...........................................................................................11

Antineoplastic Agent, Antimetabolite (Purine Analog)Mercaptopurine .......................................................................................11

Antineoplastic Agent, Antimetabolite (Pyrimidine Analog)Fluorouracil (Topical) ................................................................................7

Antineoplastic Agent, Aromatase InhibitorLetrozole .................................................................................................10

Antineoplastic Agent, Estrogen Receptor AntagonistTamoxifen ............................................................................................... 15

Antineoplastic Agent, HormoneMegestrol ................................................................................................11

Antineoplastic Agent, MiscellaneousHydroxyurea ............................................................................................. 9

Antineoplastic Agent, Retinoic Acid DerivativeISOtretinoin (Systemic) ............................................................................ 9

Antiparasitic Agent, TopicalPermethrin ..............................................................................................13

Anti-Parkinson Agent, AnticholinergicBenztropine .............................................................................................. 3Trihexyphenidyl ...................................................................................... 16

Anti-Parkinson Agent, Decarboxylase InhibitorCarbidopa and Levodopa .........................................................................3

Anti-Parkinson Agent, Dopamine AgonistAmantadine .............................................................................................. 2ROPINIRole ............................................................................................14

Anti-Parkinson Agent, Dopamine PrecursorCarbidopa and Levodopa .........................................................................3

Antiplatelet AgentAspirin .......................................................................................................2Clopidogrel ............................................................................................... 4Dipyridamole .............................................................................................5Prasugrel ................................................................................................ 13

ANTIEMETIC

20

Antiplatelet Agent, ThienopyridineClopidogrel ............................................................................................... 4Prasugrel ................................................................................................ 13

Antiprotozoal, NitroimidazoleMetroNIDAZOLE (Systemic) .................................................................. 11

Antirheumatic, Disease ModifyingAdalimumab ..............................................................................................2Methotrexate ...........................................................................................11

Antiseborrheic Agent, TopicalSelenium Sulfide .................................................................................... 14

Antispasmodic Agent, UrinaryOxybutynin ..............................................................................................12

Antithyroid AgentMethIMAzole ...........................................................................................11Propylthiouracil .......................................................................................14

Antitubercular AgentEthambutol ............................................................................................... 6Isoniazid ................................................................................................... 9Pyrazinamide ..........................................................................................14Rifapentine ............................................................................................. 14

AntitussiveBenzonatate ............................................................................................. 3Guaifenesin and Codeine ........................................................................ 8Guaifenesin and Dextromethorphan ........................................................ 8Promethazine and Codeine ................................................................... 14

Antiviral AgentAcyclovir (Systemic) .................................................................................2Amantadine .............................................................................................. 2ValACYclovir ...........................................................................................16

Antiviral Agent, AdamantaneAmantadine .............................................................................................. 2

Antiviral Agent, OphthalmicGanciclovir (Ophthalmic) ..........................................................................8

Antiviral Agent, OralValACYclovir ...........................................................................................16

Antiviral Agent, TopicalAcyclovir (Topical) .................................................................................... 2

Appetite StimulantMegestrol ................................................................................................11

BarbiturateButalbital, Acetaminophen, and Caffeine .................................................3Butalbital, Aspirin, and Caffeine ...............................................................3PHENobarbital ........................................................................................13Primidone ............................................................................................... 13

BenzodiazepineALPRAZolam ............................................................................................2ChlordiazePOXIDE ...................................................................................4ClonazePAM .............................................................................................4DiazePAM .................................................................................................5LORazepam ........................................................................................... 10Temazepam ............................................................................................15Triazolam ................................................................................................16

Beta2-Adrenergic AgonistIpratropium and Albuterol .........................................................................9

Beta2-Adrenergic Agonist, Long-ActingFluticasone and Salmeterol ..................................................................... 8Salmeterol .............................................................................................. 14Umeclidinium and Vilanterol ...................................................................16

Beta2 AgonistAlbuterol ................................................................................................... 2Fluticasone and Salmeterol ..................................................................... 8Salmeterol .............................................................................................. 14Umeclidinium and Vilanterol ...................................................................16

Beta3 AgonistMirabegron ..............................................................................................11

Beta-Adrenergic Blocker, NonselectiveDorzolamide and Timolol ......................................................................... 5Propranolol ............................................................................................. 14

Beta-Blocker, Beta-1 SelectiveAtenolol .....................................................................................................2Metoprolol ...............................................................................................11

Beta-Blocker, NonselectiveBrimonidine and Timolol ...........................................................................3Timolol (Ophthalmic) .............................................................................. 15

Beta-Blocker With Alpha-Blocking ActivityCarvedilol ..................................................................................................4Labetalol .................................................................................................10

Bisphosphonate DerivativeAlendronate .............................................................................................. 2Ibandronate .............................................................................................. 9

Calcineurin InhibitorCycloSPORINE (Ophthalmic) ...................................................................4Pimecrolimus ..........................................................................................13

Calcium Channel BlockerAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 2DilTIAZem .................................................................................................5Felodipine .................................................................................................7NIFEdipine ..............................................................................................12Verapamil ............................................................................................... 16

Calcium Channel Blocker, DihydropyridineAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 2Felodipine .................................................................................................7NIFEdipine ..............................................................................................12

Calcium Channel Blocker, NondihydropyridineDilTIAZem .................................................................................................5Verapamil ............................................................................................... 16

Calcium SaltCalcium Acetate ....................................................................................... 3

Carbonic Anhydrase Inhibitor (Ophthalmic)Dorzolamide ............................................................................................. 5Dorzolamide and Timolol ......................................................................... 5

Cardiac GlycosideDigoxin ......................................................................................................5

CatharticSodium Phosphates ............................................................................... 15

Central Nervous System StimulantDextroamphetamine and Amphetamine .................................................. 5Methylphenidate ..................................................................................... 11

ContraceptiveCopper IUD .............................................................................................. 4Ethinyl Estradiol and Desogestrel ............................................................6Ethinyl Estradiol and Drospirenone ......................................................... 6Ethinyl Estradiol and Ethynodiol Diacetate ..............................................6Ethinyl Estradiol and Etonogestrel ...........................................................6Ethinyl Estradiol and Levonorgestrel ....................................................... 6Ethinyl Estradiol and Norelgestromin .......................................................7Ethinyl Estradiol and Norethindrone ........................................................ 7Ethinyl Estradiol and Norgestimate ..........................................................7Ethinyl Estradiol and Norgestrel .............................................................. 7Levonorgestrel (IUD) ..............................................................................10Levonorgestrel (Systemic) ......................................................................10MedroxyPROGESTERone ..................................................................... 11Norethindrone .........................................................................................12

Corticosteroid, Inhalant (Oral)Budesonide (Oral Inhalation) ................................................................... 3Fluticasone and Salmeterol ..................................................................... 8Fluticasone (Oral Inhalation) ....................................................................8

Corticosteroid, NasalFluticasone (Nasal) .................................................................................. 8

Corticosteroid, OphthalmicDifluprednate ............................................................................................ 5Fluorometholone .......................................................................................7Loteprednol ............................................................................................ 10Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ..................12PrednisoLONE (Ophthalmic) ..................................................................13

Corticosteroid, OticNeomycin, Polymyxin B, and Hydrocortisone (Otic) ..............................12

Corticosteroid, RectalHydrocortisone (Topical) .......................................................................... 9

Corticosteroid, SystemicDexamethasone (Systemic) ..................................................................... 5Fludrocortisone .........................................................................................7MethylPREDNISolone ............................................................................ 11

CORTICOSTEROID, SYSTEMIC

21

PrednisoLONE (Systemic) ..................................................................... 13PredniSONE ...........................................................................................13

Corticosteroid, TopicalBetamethasone and Clotrimazole ............................................................3Betamethasone (Topical) ......................................................................... 3Clobetasol .................................................................................................4Desonide .................................................................................................. 5Fluocinolone (Topical) .............................................................................. 7Fluocinonide ............................................................................................. 7Hydrocortisone (Topical) .......................................................................... 9Nystatin and Triamcinolone ....................................................................12Triamcinolone (Topical) .......................................................................... 16

DecongestantFexofenadine and Pseudoephedrine ....................................................... 7Oxymetazoline (Nasal) ...........................................................................12Pseudoephedrine ................................................................................... 14

Diagnostic AgentGlucagon .................................................................................................. 8

Direct Oral Anticoagulant (DOAC)Dabigatran Etexilate .................................................................................5Rivaroxaban ........................................................................................... 14

Diuretic, LoopBumetanide .............................................................................................. 3Furosemide ...............................................................................................8

Diuretic, Potassium-SparingHydrochlorothiazide and Triamterene ...................................................... 9Spironolactone ....................................................................................... 15

Diuretic, ThiazideHydroCHLOROthiazide ............................................................................ 8Hydrochlorothiazide and Spironolactone ................................................. 9Hydrochlorothiazide and Triamterene ...................................................... 9Lisinopril and Hydrochlorothiazide ......................................................... 10Losartan and Hydrochlorothiazide ......................................................... 10Telmisartan and Hydrochlorothiazide .....................................................15Valsartan and Hydrochlorothiazide ........................................................ 16

Diuretic, Thiazide-RelatedChlorthalidone .......................................................................................... 4MetOLazone ........................................................................................... 11

Electrolyte Supplement, OralPotassium Chloride ................................................................................ 13

Electrolyte Supplement, ParenteralPotassium Chloride ................................................................................ 13Sodium Chloride .....................................................................................15Sodium Phosphates ............................................................................... 15

EnzymePancrelipase ...........................................................................................13

Estrogen and Progestin CombinationEstradiol and Levonorgestrel ................................................................... 6Estrogens (Conjugated/Equine) and Medroxyprogesterone ....................6Ethinyl Estradiol and Desogestrel ............................................................6Ethinyl Estradiol and Drospirenone ......................................................... 6Ethinyl Estradiol and Ethynodiol Diacetate ..............................................6Ethinyl Estradiol and Etonogestrel ...........................................................6Ethinyl Estradiol and Levonorgestrel ....................................................... 6Ethinyl Estradiol and Norelgestromin .......................................................7Ethinyl Estradiol and Norethindrone ........................................................ 7Ethinyl Estradiol and Norgestimate ..........................................................7Ethinyl Estradiol and Norgestrel .............................................................. 7

Estrogen DerivativeEstradiol (Systemic) ................................................................................. 6Estradiol (Topical) .....................................................................................6Estrogens (Conjugated/Equine, Systemic) .............................................. 6Estrogens (Conjugated/Equine, Topical) ..................................................6

Ethanolamine DerivativeDiphenhydrAMINE (Systemic) ..................................................................5Doxylamine ...............................................................................................6

ExpectorantGuaiFENesin ............................................................................................ 8Guaifenesin and Codeine ........................................................................ 8Guaifenesin and Dextromethorphan ........................................................ 8

First Generation (Typical) AntipsychoticHaloperidol ............................................................................................... 8Prochlorperazine .................................................................................... 13

GABA AnalogGabapentin ...............................................................................................8

Gallstone Dissolution AgentUrsodiol .................................................................................................. 16

Gastrointestinal Agent, MiscellaneousAdalimumab ..............................................................................................2Linaclotide .............................................................................................. 10Sucralfate ............................................................................................... 15

Gastrointestinal Agent, ProkineticMetoclopramide ...................................................................................... 11

Genitourinary IrrigantSodium Chloride .....................................................................................15

Guanylate Cyclase-C (GC-C) AgonistLinaclotide .............................................................................................. 10

Hemostatic AgentAluminum Chloride Hexahydrate ............................................................. 2Desmopressin ...........................................................................................5

Histamine H1 AntagonistAzelastine (Nasal) .................................................................................... 3Cetirizine (Systemic) ................................................................................ 4Cyproheptadine ........................................................................................ 5DiphenhydrAMINE (Systemic) ..................................................................5Doxylamine ...............................................................................................6Fexofenadine ............................................................................................7Fexofenadine and Pseudoephedrine ....................................................... 7HydrOXYzine ............................................................................................9Ketotifen (Ophthalmic) ............................................................................10Loratadine ...............................................................................................10Meclizine .................................................................................................11Olopatadine (Ophthalmic) ...................................................................... 12Promethazine ......................................................................................... 14Promethazine and Codeine ................................................................... 14

Histamine H1 Antagonist, First GenerationCyproheptadine ........................................................................................ 5DiphenhydrAMINE (Systemic) ..................................................................5Doxylamine ...............................................................................................6HydrOXYzine ............................................................................................9Meclizine .................................................................................................11Promethazine ......................................................................................... 14Promethazine and Codeine ................................................................... 14

Histamine H1 Antagonist, Second GenerationAzelastine (Nasal) .................................................................................... 3Cetirizine (Systemic) ................................................................................ 4Fexofenadine ............................................................................................7Fexofenadine and Pseudoephedrine ....................................................... 7Ketotifen (Ophthalmic) ............................................................................10Loratadine ...............................................................................................10Olopatadine (Ophthalmic) ...................................................................... 12

Histamine H2 AntagonistRaNITIdine ............................................................................................. 14

Histone Deacetylase InhibitorValproic Acid and Derivatives ................................................................ 16

HormoneMelatonin ................................................................................................ 11

Hormone, Posterior PituitaryDesmopressin ...........................................................................................5

Hypnotic, MiscellaneousEszopiclone .............................................................................................. 6Melatonin ................................................................................................ 11Zolpidem .................................................................................................16

Imidazoline DerivativeOxymetazoline (Nasal) ...........................................................................12

Immunosuppressant AgentCycloSPORINE (Ophthalmic) ...................................................................4Mercaptopurine .......................................................................................11Methotrexate ...........................................................................................11Mycophenolate ....................................................................................... 12Pimecrolimus ..........................................................................................13

Inhalation, MiscellaneousInhalation Devices ....................................................................................9

Insulin, CombinationInsulin Aspart Protamine and Insulin Aspart ........................................... 9Insulin NPH and Insulin Regular ..............................................................9

Insulin, Intermediate-ActingInsulin NPH .............................................................................................. 9

CORTICOSTEROID, SYSTEMIC

22

Insulin, Long-ActingInsulin Glargine ........................................................................................ 9

Insulin, Rapid-ActingInsulin Aspart ............................................................................................9

Insulin, Short-ActingInsulin Regular ......................................................................................... 9

InterferonInterferon Beta-1b .................................................................................... 9

Iron SaltFerrous Sulfate .........................................................................................7

IrrigantSodium Chloride .....................................................................................15

Keratolytic AgentPodofilox .................................................................................................13

Laxative, Bowel EvacuantSodium Phosphates ............................................................................... 15

Laxative, OsmoticGlycerin .................................................................................................... 8Lactulose ................................................................................................ 10Polyethylene Glycol 3350 ...................................................................... 13Polyethylene Glycol-Electrolyte Solution ............................................... 13Sodium Sulfate, Potassium Sulfate, and Magnesium Sulfate ............... 15

Laxative, StimulantBisacodyl .................................................................................................. 3

Leukotriene-Receptor AntagonistMontelukast ............................................................................................ 11

Local AnestheticLidocaine (Topical) ................................................................................. 10

Lubricant, OcularSodium Chloride .....................................................................................15

Lymphocyte Function-Associated Antigen 1 (LFA-1) AntagonistLifitegrast ................................................................................................10

Mast Cell StabilizerKetotifen (Ophthalmic) ............................................................................10

Melatonin Receptor AgonistMelatonin ................................................................................................ 11

Mineralocorticoid (Aldosterone) Receptor AntagonistsHydrochlorothiazide and Spironolactone ................................................. 9Spironolactone ....................................................................................... 15

Miscellaneous ProductDiabetic Supplies ......................................................................................5

Monoclonal AntibodyAdalimumab ..............................................................................................2

N-Methyl-D-Aspartate Receptor AntagonistMemantine ..............................................................................................11

Nonsteroidal Anti-inflammatory Drug (NSAID)Diclofenac (Ophthalmic) ...........................................................................5Diclofenac (Systemic) ...............................................................................5Diclofenac (Topical) ..................................................................................5

Nonsteroidal Anti-inflammatory Drug (NSAID), COX-2 SelectiveCelecoxib ..................................................................................................4

Nonsteroidal Anti-inflammatory Drug (NSAID), OphthalmicBromfenac ................................................................................................ 3Diclofenac (Ophthalmic) ...........................................................................5Ketorolac (Ophthalmic) ...........................................................................10Nepafenac .............................................................................................. 12

Nonsteroidal Anti-inflammatory Drug (NSAID), OralAspirin .......................................................................................................2Diclofenac (Systemic) ...............................................................................5Ibuprofen .................................................................................................. 9Indomethacin ............................................................................................9Ketorolac (Systemic) .............................................................................. 10Meloxicam ...............................................................................................11Nabumetone ...........................................................................................12Naproxen ................................................................................................12Piroxicam (Systemic) ..............................................................................13

Nonsteroidal Anti-inflammatory Drug (NSAID), ParenteralIbuprofen .................................................................................................. 9Indomethacin ............................................................................................9Ketorolac (Systemic) .............................................................................. 10

Nonsteroidal Anti-inflammatory Drug (NSAID), TopicalDiclofenac (Topical) ..................................................................................5

Norepinephrine Reuptake Inhibitor, SelectiveAtoMOXetine ............................................................................................ 2

Nutritional SupplementFluoride .....................................................................................................7

Ophthalmic Agent, AntiglaucomaBrimonidine and Timolol ...........................................................................3Brimonidine (Ophthalmic) .........................................................................3Dorzolamide ............................................................................................. 5Dorzolamide and Timolol ......................................................................... 5Latanoprost .............................................................................................10Pilocarpine (Ophthalmic) ........................................................................13Timolol (Ophthalmic) .............................................................................. 15

Ophthalmic Agent, MioticPilocarpine (Ophthalmic) ........................................................................13

Ophthalmic Agent, MiscellaneousArtificial Tears ...........................................................................................2Carboxymethylcellulose ............................................................................3

Ophthalmic Agent, MydriaticAtropine (Ophthalmic) .............................................................................. 3Homatropine .............................................................................................8Tropicamide ............................................................................................16

Otic Agent, CerumenolyticCarbamide Peroxide .................................................................................3

Ovulation StimulatorClomiPHENE ............................................................................................4

Partial Nicotine AgonistVarenicline ..............................................................................................16

PediculocidePermethrin ..............................................................................................13

Phenothiazine DerivativeProchlorperazine .................................................................................... 13Promethazine ......................................................................................... 14Promethazine and Codeine ................................................................... 14

Phosphate BinderCalcium Acetate ....................................................................................... 3Sevelamer .............................................................................................. 14

Phosphodiesterase-5 Enzyme InhibitorSildenafil .................................................................................................14

Phosphodiesterase Enzyme Inhibitor, NonselectiveTheophylline ........................................................................................... 15

Piperazine DerivativeCetirizine (Systemic) ................................................................................ 4HydrOXYzine ............................................................................................9Meclizine .................................................................................................11

Piperidine DerivativeCyproheptadine ........................................................................................ 5Fexofenadine ............................................................................................7Fexofenadine and Pseudoephedrine ....................................................... 7Ketotifen (Ophthalmic) ............................................................................10Loratadine ...............................................................................................10Olopatadine (Ophthalmic) ...................................................................... 12

ProgestinLevonorgestrel (IUD) ..............................................................................10Levonorgestrel (Systemic) ......................................................................10MedroxyPROGESTERone ..................................................................... 11Megestrol ................................................................................................11Norethindrone .........................................................................................12Progesterone ..........................................................................................14

ProstaglandinMiSOPROStol .........................................................................................11

Prostaglandin, OphthalmicLatanoprost .............................................................................................10

Proton Pump InhibitorOmeprazole ............................................................................................12Pantoprazole .......................................................................................... 13RABEprazole ..........................................................................................14

Retinoic Acid DerivativeISOtretinoin (Systemic) ............................................................................ 9Tretinoin (Topical) ...................................................................................16

RETINOIC ACID DERIVATIVE

23

RifamycinRifapentine ............................................................................................. 14

SalicylateAspirin .......................................................................................................2Salsalate .................................................................................................14

Scabicidal AgentPermethrin ..............................................................................................13

Second Generation (Atypical) AntipsychoticARIPiprazole .............................................................................................2Lurasidone ..............................................................................................11OLANZapine ...........................................................................................12QUEtiapine ............................................................................................. 14RisperiDONE ..........................................................................................14

Selective 5-HT3 Receptor AntagonistOndansetron ...........................................................................................12

Selective Estrogen Receptor Modulator (SERM)ClomiPHENE ............................................................................................4Raloxifene ...............................................................................................14Tamoxifen ............................................................................................... 15

Serotonin 5-HT1B, 1D Receptor AgonistRizatriptan .............................................................................................. 14SUMAtriptan ........................................................................................... 15ZOLMitriptan ...........................................................................................16

Skeletal Muscle RelaxantBaclofen ....................................................................................................3Carisoprodol ............................................................................................. 4Cyclobenzaprine .......................................................................................4Metaxalone ............................................................................................. 11Methocarbamol .......................................................................................11

Skin and Mucous Membrane AgentImiquimod .................................................................................................9

Skin and Mucous Membrane Agent, MiscellaneousEmollients .................................................................................................6

Smoking Cessation AidBuPROPion .............................................................................................. 3Nicotine ...................................................................................................12Varenicline ..............................................................................................16

Sodium-Glucose Cotransporter 2 (SGLT2) InhibitorEmpagliflozin ............................................................................................ 6

Sodium SaltSodium Chloride .....................................................................................15

Stool SoftenerDocusate .................................................................................................. 5

Substituted BenzimidazoleOmeprazole ............................................................................................12Pantoprazole .......................................................................................... 13RABEprazole ..........................................................................................14

ThioamideMethIMAzole ...........................................................................................11Propylthiouracil .......................................................................................14

Thyroid ProductLevothyroxine ......................................................................................... 10Liothyronine ............................................................................................10Thyroid, Desiccated ................................................................................15

Topical Skin ProductAluminum Chloride Hexahydrate ............................................................. 2Benzoyl Peroxide ..................................................................................... 3Clindamycin and Benzoyl Peroxide ......................................................... 4Emollients .................................................................................................6Erythromycin (Topical) ..............................................................................6Fluorouracil (Topical) ................................................................................7Imiquimod .................................................................................................9Lactic Acid and Ammonium Hydroxide ..................................................10Pimecrolimus ..........................................................................................13Podofilox .................................................................................................13Selenium Sulfide .................................................................................... 14Zinc Oxide .............................................................................................. 16

Topical Skin Product, AcneAdapalene ................................................................................................ 2Benzoyl Peroxide ..................................................................................... 3Clindamycin and Benzoyl Peroxide ......................................................... 4Clindamycin (Topical) ............................................................................... 4Erythromycin (Topical) ..............................................................................6Tretinoin (Topical) ...................................................................................16

Tumor Necrosis Factor (TNF) Blocking Agent

Adalimumab ..............................................................................................2

Uricosuric Agent

Probenecid ............................................................................................. 13

Vasodilator

Dipyridamole .............................................................................................5

HydrALAZINE ...........................................................................................8

Isosorbide Dinitrate .................................................................................. 9

Isosorbide Mononitrate .............................................................................9

Nitroglycerin ............................................................................................12

Vasopressin Analog, Synthetic

Desmopressin ...........................................................................................5

Vitamin

Vitamins (Multiple/Pediatric) ...................................................................16

Vitamins (Multiple/Prenatal) ................................................................... 16

Vitamin D Analog

Calcitriol (Systemic) ..................................................................................3

Cholecalciferol ..........................................................................................4

Ergocalciferol ............................................................................................6

Vitamin, Water Soluble

Folic Acid ..................................................................................................8

Niacin ......................................................................................................12

Pyridoxine ...............................................................................................14

Xanthine Oxidase Inhibitor

Allopurinol .................................................................................................2

RIFAMYCIN

24

VANDENBERG AFB OUTPATIENT FORMULARY … · 1 Alphabetical Listing by Name This document is current as of The availability of formulary items is subject to change. OUTPATIENT FORMULARY

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