formulary
TRANSCRIPT
Lemuel Shattuck Hospital - Formulary
UPDATED - June 2007
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Table of Content
ANTIHISTAMINE......................................................................................................................................................................3
ANTI-INFECTIVE AGENTS....................................................................................................................................................3
ANTHELMINTIC...............................................................................................................................................3ANTIBIOTICS....................................................................................................................................................3
AMINOGLYCOSIDES..............................................................................................................3ANTIFUNGAL ANTIBIOTICS...................................................................................................3CEPHALOSPORINS................................................................................................................3MISC. BETA-LACTAM ANTIBIOTICS......................................................................................3MACROLIDES.......................................................................................................................... 3PENICILLINS........................................................................................................................... 3TETRACYCLINES....................................................................................................................3MISCELLANEOUS ANTIBACTERIALS...................................................................................3
ANTITUBERCULOSIS......................................................................................................................................3ANTI-VIRAL......................................................................................................................................................3
ANTIRETROVIRAL.................................................................................................................. 3QUINOLONES...................................................................................................................................................3SULFONAMIDES..............................................................................................................................................3ANTIPROZOALS...............................................................................................................................................3
ANTIMALARIALS.....................................................................................................................3URINARY ANTI-INFECTIVES........................................................................................................................3ANTI-INFECTIVES – MISCELLANEOUS......................................................................................................3
ANTINEOPLASTIC AGENTS.................................................................................................................................................3
AUTONOMIC DRUGS..............................................................................................................................................................3
PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS...........................................................................3ANTICHOLINERGIC AGENTS........................................................................................................................3
ANTIPARKINSONIAN AGENTS..............................................................................................3ANTIMUSCARINICS/ANTISPASMODICS...............................................................................3
SYMPATHOMIMETIC (ADRENERGIC) AGENTS.......................................................................................3SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS.......................................................................3SKELETON MUSCLE RELAXANTS..............................................................................................................3AUTONOMIC DRUGS – MISCELLANEOUS ................................................................................................3
BLOOD FORMATION AND COAGULATION.....................................................................................................................3
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ANTIANEMIA...................................................................................................................................................3IRON PREPARATIONS...........................................................................................................3
COAGULANTS AND ANTICOAGULANTS...................................................................................................3ANTICOAGULANTS................................................................................................................3ANTIHEPARIN AGENTS..........................................................................................................3HEMOSTATICS....................................................................................................................... 3
HEMATOPOIETIC AGENTS............................................................................................................................3HEMORRHEOLOGIC AGENTS.......................................................................................................................3THROMBOLYTIC AGENTS............................................................................................................................3
CARDIOVASCULAR DRUGS.................................................................................................................................................3
CARDIAC DRUGS............................................................................................................................................3ANTIARRYTHMIC AGENTS....................................................................................................3ANTILIPEMIC AGENTS...........................................................................................................3HYPOTENSIVE AGENTS........................................................................................................3VASODILATING AGENTS.......................................................................................................3SCLEROSING AGENT............................................................................................................3a-ADRENERGIC BLOCKING AGENTS...................................................................................3b-ADRENERGIC BLOCKING AGENTS...................................................................................3CALCIUM-CHANNEL BLOCKING AGENTS............................................................................3
DIHYDROPYRIDINES.............................................................................................................3MISCELLANEOUS...................................................................................................................3
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS...........................................3A.C.E. INHIBITORS.................................................................................................................3ANGIOTENSIN II RECEPTOR ANTAGONISTS.................................................................3
CENTRAL NERVOUS SYSTEM AGENTS............................................................................................................................3
ANALGESICS AND ANTIPYRETICS.............................................................................................................3ANTI-INFLAMMATORY AGENTS – NONSTEROIDAL............................................................3OPIATE AGONISTS.................................................................................................................3OPIATE PARTIAL AGONISTS.................................................................................................3ANALGESICS AND ANTIPYRETICS – MISCELLANEOUS.....................................................3
OPIATE ANTAGONISTS..................................................................................................................................3ANTICONVULSANTS......................................................................................................................................3
BARBITURATES...................................................................................................................... 3BENZODIAZEPINES................................................................................................................3HYDANTOINS.......................................................................................................................... 3SUCCINIMIDES....................................................................................................................... 3ANTICONVULSANTS – MISCELLANEOUS............................................................................3
PSYCHOTHERAPEUTIC AGENTS.................................................................................................................3ANTIDEPRESSANTS..............................................................................................................3ANTIPSYCHOTICS..................................................................................................................3
ANOREXIGENIC AGENTS AND RESPIRATORY AND CEREBRAL STIMULANTS..............................3ANXIOLYTICS, SEDATIVES, AND HYPNOTICS........................................................................................3
BARBITURATES...................................................................................................................... 3BENZODIAZEPINES................................................................................................................3MISCELLANEOUS ANXIOLYTICS, SEDATIVES AND HYPNOTICS......................................3
ANTIMANIC AGENTS.....................................................................................................................................3CENTRAL NERVOUS SYSTEM AGENTS – MISCELLANEOUS................................................................3
DIAGNOSTIC AGENTS............................................................................................................................................................3
GALLBLADDER FUNCTION..........................................................................................................................3TUBERCULOSIS...............................................................................................................................................3
ELECTROLYTIC, CALORIC, AND WATER BALANCE..................................................................................................3
ALKALINIZING AGENTS................................................................................................................................3
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AMMONIA DETOXICANTS............................................................................................................................3REPLACEMENT PREPARATIONS.................................................................................................................3ION – REMOVING AGENTS............................................................................................................................3
POTASSIUM-REMOVING RESINS.........................................................................................3CALORIC AGENTS...........................................................................................................................................3DIURETICS........................................................................................................................................................3
POTASSIUM-SPARING DIURETICS.......................................................................................3IRRIGATING SOLUTION.................................................................................................................................3URICOSURIC AGENT......................................................................................................................................3
ENZYMES...................................................................................................................................................................................3
ANTITUSSIVES, EXPECTORANTS, AND MYCOLYTIC AGENTS................................................................................3
ANTITUSSIVES.................................................................................................................................................3EXPECTORANTS..............................................................................................................................................3MUCOLYTIC AGENTS....................................................................................................................................3
EYE, EAR, NOSE, AND THROAT PREPARATIONS..........................................................................................................3
ANTIALLERGIC................................................................................................................................................3ANTI-INFECTIVES – OPHTHALMICS...........................................................................................................3
ANTIBIOTICS........................................................................................................................... 3ANTIVIRALS............................................................................................................................ 3SULFONAMIDES.....................................................................................................................3MISCELLANEOUS ANTIINFECTIVES.....................................................................................3
ANTI-INFLAMMATORY AGENTS.................................................................................................................3CARBONIC ANHYDRASE INHIBITOR.........................................................................................................3LOCAL ANESTHETIC......................................................................................................................................3MIOTICS.............................................................................................................................................................3MYDRIATIC......................................................................................................................................................3VASOCONSTRICTOR......................................................................................................................................3MISCELLANEOUS EENT DRUGS..................................................................................................................3
GASTROINTESTINAL DRUGS..............................................................................................................................................3
ANTACIDS AND ADSORBENTS....................................................................................................................3ANTIDIARRHEA AGENTS..............................................................................................................................3ANTIFLATULENTS..........................................................................................................................................3CATHARTICS AND LAXATIVES...................................................................................................................3DIGESTANT.......................................................................................................................................................3EMETICS............................................................................................................................................................3ANTIEMETICS..................................................................................................................................................3ANTI-INFLAMMATORY AGENTS.................................................................................................................3MISCELLANEOUS GASTROINTESTINAL DRUGS....................................................................................3
HEAVY METAL ANTAGONISTS...........................................................................................................................................3
HORMONES AND SYNTHETIC SUBSTITUTES.................................................................................................................3
ADRENALS........................................................................................................................................................3ANDROGENS....................................................................................................................................................3CONTRACEPTIVES..........................................................................................................................................3ESTROGENS & ANTI ESTROGENS...............................................................................................................3
ESTROGENS........................................................................................................................... 3ANTIDIABETIC AGENTS................................................................................................................................3
INSULIN................................................................................................................................... 3SULFONYLUREAS.................................................................................................................. 3ANTIDIABETIC AGENTS - MISCELLANEOUS.......................................................................3
PARATHYROID................................................................................................................................................3
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PITUITARY HORMONE...................................................................................................................................3PROGESTINS.....................................................................................................................................................3THYROID AND ANTITHYROID AGENTS....................................................................................................3
THYROID AGENTS.................................................................................................................3ANTITHYROID AGENTS.........................................................................................................3
LOCAL ANESTHETICS...........................................................................................................................................................3
OXYTOCICS...............................................................................................................................................................................3
SERUMS, TOXOIDS, AND VACCINES.................................................................................................................................3
SERUMS.............................................................................................................................................................3TOXOIDS...........................................................................................................................................................3VACCINES.........................................................................................................................................................3
SKIN AND MUCOUS MEMBRANE AGENTS......................................................................................................................3
ANTI-INFECTIVES – SKIN & MUCOUS MEMBRANE AGENTS...............................................................3ANTIBIOTICS (topical).............................................................................................................3ANTIVIRALS............................................................................................................................ 3ANTIFUNGALS........................................................................................................................ 3SCABICIDES AND PEDICULICIDES.......................................................................................3ANTI-INFECTIVES – LOCAL - MISCELLANEOUS..................................................................3
ANTI-INFLAMMATORY AGENTS.................................................................................................................3ANTIPURITICS AND LOCAL ANESTHETICS..............................................................................................3ASTRIGENTS.....................................................................................................................................................3CELL STIMULANTS, PROLIFERANTS.........................................................................................................3EMOLLIENT, DEMULCENT, PROTECTANTS.............................................................................................3KERATOLYTIC AGENTS................................................................................................................................3KERATOPLASTIC AGENTS............................................................................................................................3SKIN AND MUCOUS MEMBRANE AGENTS...............................................................................................3
SMOOTH MUSCLE RELAXANTS.........................................................................................................................................3
GENITOURINARY SMOOTH MUSCLE RELAXANTS................................................................................3RESPIRATORY SMOOTH MUSCLE RELAXANTS......................................................................................3
UNCLASSIFIED THERAPEUTIC AGENTS.........................................................................................................................3
VITAMINS..................................................................................................................................................................................3
VITAMIN B COMPLEX....................................................................................................................................3VITAMIN C........................................................................................................................................................3VITAMIN D........................................................................................................................................................3VITAMIN E........................................................................................................................................................3VITAMIN K ACTIVITY....................................................................................................................................3MULTIVITAMIN PREPARATIONS................................................................................................................3
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FORMULARY - LEMUEL SHATTUCK HOSPITAL
Approved September 2003 (Updated June 11, 2007)
ANTIHISTAMINE04:00
Chlorpheniramine Maleate Chlortrimeton cap 4 mg DOC FORMULARY ITEM
Cyproheptadine Periactintab 4mg
Diphenhydramine Benadrylcap 25mg, 50mg PYXIS DOC FORMULARY ITEMSliq 12.5mg/5ml DOC FORMULARY ITEMinj 50mg/ml PYXIS DOC FORMULARY ITEMcream 2%
Fexofenadine Allegracap 60mg
Loratadine Claritintab 10mg DOC FORMULARY ITEMliq 10mg/10ml
Promethazine Phenergantab 25mgliq 6.25mg/5mlinj 25mg/ml
ANTI-INFECTIVE AGENTS08:00
ANTHELMINTIC08:08
Mebendazole Vermoxtab 100mg
ANTIBIOTICS08:12
AMINOGLYCOSIDES08:12.02
Amikacin Sulfate Amikininj 250mg/ml 4ml vial PYXIS
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Gentamicin Garamycininj 40mg/ml 2ml PYXISinj 40mg/ml 20 ml vials
60mg, 80mg, 100mg premixed IV Bags PYXIS
Kanamycin Kantrexinj
1Gm/3ml
Neomycintab 500mg
Streptomycin Streptomycininj 1Gm/vial
Tobramycin Sulfate Nebcininj 40mg/ml 2ml vial PYXIS
ANTIFUNGAL ANTIBIOTICS08:12.04
Amphotericin B Fungizone (Refrigerate)inj 50mg
Amphotereicin B Lipid Complex Ablecet (Refrigerate)(ID Consult Needed)inj 100mg
Amphotericin B Liposome Ambisome (Refrigerate)(ID Consult Needed)inj 50mg
Caspofungin Cancidis (Refrigerate) (ID Consult Needed)inj 50mg, 70 mg(initial dose vial)
Fluconazole Diflucantab 50mg, 100mg, 200mg PYXIS DOC FORMULARY ITEMSliq 40mg/mlinj 2mg/ml (100ml & 200ml premixed bags) PYXIS DOC FORMULARY-2mg
Flucytosine Ancoboncap 250mg, 500mg
Itraconazole Sporanoxcap 100mg
Ketoconazole Nizoraltab 200mg
Nystatin Mycostatintab 500,000units DOC FORMULARY ITEMliq 100,000units/ml DOC FORMULARY ITEM
Voriconazole Vfendtab 200mginj 200mg PYXIS
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CEPHALOSPORINS08:12.06
Cefaclor Ceclorcap 250mgsusp 250mg/5ml
Cefepime Maxipimeinj 1Gm, 2Gm PYXIS
Cephalexin Keflexcap 250mg, 500mg PYXIS DOC FORMULARY ITEMSsusp 250mg/5ml 200ml DOC FORMULARY ITEM
Cefazolin Ancefinj 1gm premixed bags PYXIS DOC FORMULARY ITEM
Ceftazidime Fortazinj 1Gm and 2Gm (Add-Vantage vial) PYXISinj 1Gm and 2Gm vial PYXIS
Ceftriaxone Rocephininj 500mginj 1 Gm PYXIS DOC FORMULARY ITEMinj 1 Gm, 2Gm (Add-Vantage vial) PYXIS DOC FORMULARY ITEM
Cefuroxime Axetil Ceftintab 250mg DOC FORMULARY ITEMtab 500mg PYXIS
MISC. BETA-LACTAM ANTIBIOTICS08:12.07
Aztreonam Azactaminj 1Gm PYXISinj 2Gm
Ertapenem Invanzinj 1Gm PYXIS
Meropenem Merreminj 500mg, 1Gm PYXIS
MACROLIDES08:12.12
Azithromycin Zithromaxtab 250mg, 600mg PYXIS DOC FORMULARY ITEMSliq 200mg/5ml DOC FORMULARY ITEMinj 500mg PYXIS DOC FORMULARY ITEM
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Clarithromycin Biaxintab 250mg, 500mg PYXISliq 250mg/5ml
Erythromycin Base E-Mycintab 250mg enteric coated PYXIStab 500mg enteric coated DOC FORMULARY ITEM
PENICILLINS08:12.16
Amoxicillin Trimoxcap 250mg, 500mg PYXIS DOC FORMULARY ITEMSliq 250mg/5ml DOC FORMULARY ITEM
Amoxicillin/Clavulanate AugmentinTab 250mg, 500mg, 875mg PYXIS liq 250mg/5ml
Ampicillin Sodium Omnipen-Ninj 1Gm PYXIS
Ampicillin/Sulbactam Unasyninj 1.5Gm, 3Gm PYXIS DOC FORMULARY ITEMS
Dicloxacillin Dynapencap 250mg, 500mg PYXIS DOC FORMULARY ITEMS
Nafcillin Unipeninj 1Gm (Add-Vantage vial) PYXISinj 2Gm (Add-Vantage vial) PYXIS
Penicillin G Benzathine Bicillin-LAinj 1.2million units, 2.4 million units DOC FORMULARY-1.2MILLION UNITS
Penicillin G Potassiuminj. 5,000,000 unit vials PYXISinj 20,000,000 unit vials
Penicillin G Sodiuminj 5,000,000 unit vials PYXIS
Penicillin V Potassium V-Cillin-Ktab 250mg, 500mg PYXIS DOC FORMULARY ITEMSliq 250mg/5ml DOC FORMULARY ITEM
Pipercillin/Tazobactam Zosyninj 2.25Gm, 4.5Gminj 3.375Gm (Add-Vantage vial) PYXIS
TETRACYCLINES08:12.24
Demeclocycline Declomycin
- 8 -
tab 150mg (Non-Formulary Item) PYXIS
Doxycycline Vibramycincap 100mg PYXIS DOC FORMULARY ITEMinj 100mg
Minocycline Minocincap 50mg PYXIScap 100mg
Tetracycline Sumycincap 250mg, 500mg PYXIS DOC FORMULARY ITEMS
Tigecycline Tygacilinj 50mg PYXIS
MISCELLANEOUS ANTIBACTERIALS08:12.28
Clindamycin Cleocincap 150mg PYXIS DOC FORMULARY ITEMcap 300mg DOC FORMULARY ITEMinj 300mginj 600mg, 900mg premixed IV Bags PYXIS
Daptomycin Cubicin (Refrigerate)inj 500mg PYXIS
Linezolid Zyvox (ID Consult Needed)tab 600mg PYXISinj 600mg premixed Bags PYXIS
Neomycin/Polymyxin B Neosporin GU Irrigant (Refrigerate)sol for irrig
Vancomycin Vancocincap 125mg, 250mginj 500mg, 1Gm vials PYXIS DOC FORMULARY ITEMSinj 1Gm (Add-Vantage vials) PYXIS
ANTITUBERCULOSIS08:16
Aminosalicylate Sodium P.A.S.E.R. (Refrigerate)packets 4Gm/packet
Capreomycin Sulfate Capastatinj 1Gm/5ml
Cycloserine Seromycincap 250mg
Ethambutol Myambutoltab 100mg, 400mg PYXIS DOC FORMULARY ITEMS
- 9 -
Ethionamide Trecator SCtab 250mg
Isoniazid INHtab 100mg, 300mg DOC FORMULARY ITEMSliq 50mg/5ml
Pyrazinamide Pyrazinamidetab 500mg PYXIS DOC FORMULARY ITEM
Rifabutin Mycobutincap 150mg DOC FORMULARY ITEM
Rifampin Rifadincap 150mg, 300mg PYXIS DOC FORMULARY ITEMSinj. 600mg vials
Rifampin/Isoniazid Rifamatecap 300mg/150mg DOC FORMULARY ITEMS
Rifampin/Isoniazid/Pyrazinamide Rifatertab 120mg/50mg/300mg
ANTI-VIRAL08:18
Acyclovir Zoviraxcap 200mg, 400mg PYXIS DOC FORMULARY ITEMStab 800mg DOC FORMULARY ITEMinj 500mg PYXISliq 200mg/5ml
Amantadine Symmetrelcap 100mg PYXISliq 50mg/5ml
Foscarnet Foscavirinj 24mg/ml DOC FORMULARY ITEM
Ganciclovir Cytovenecap 250mg, 500mginj 500mg PYXIS DOC FORMULARY ITEM
Interferon Alfa-2b Recombinant Intron A (Refrigerate)inj 10 million international units per vial
Interferon Beta-1a Avonex inj 30mcg once per week dosing
Peginterferon Alfa-2b Peg-Introninj 120mcg/0.5ml DOC FORMULARY ITEM
150mcg/0.5ml DOC FORMULARY ITEMRimantadine Flumadine
tab 100mg
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Ribavirincap 200mg DOC FORMULARY ITEM
Valacyclovir Valtrexcap 500mg, 1Gm
Valgancyclovir Valcytetab 450mg DOC FORMULARY ITEM
ANTIRETROVIRAL08:18.08
Abacavir Ziagentab 300mg PYXIS DOC FORMULARY ITEM
Abacavir/Lamivudine Epizonetab 600mg/300mg PYXIS DOC FORMULARY ITEM
Abacavir/Lamivudine/Zidovudine Trizivirtab 300mg/150mg/300mg PYXIS DOC FORMULARY ITEM
Atazanavir Reyatazcap 150mg, 200mg PYXIS DOC FORMULARY ITEMS
Darunavir Prezistatab 300mg PYXIS DOC FORMULARY ITEM
Didanosine Videx, DDIcap 200mg, 250mg, 400mg extended release DOC FORMULARY ITEMpwd 2Gm/bottle
Emtricitabine/Tenofovir Truvadacap 200mg/300mg PYXIS DOC FORMULARY ITEM
Efavirenz Sustivacap 200mg, 600mg PYXIS DOC FORMULARY ITEM
Efavirenz/Emtricitabine/Tenofovir Atriplatab 600/200/300 mg PYXIS DOC FORMULARY ITEM
Fosamprenavir Lexivatab 700mg PYXIS DOC FORMULARY ITEM
Indinavir Crixivancap 200mg, 400mg PYXIS DOC FORMULARY ITEM
Lamivudine Epivirtab 150mg PYXIS DOC FORMULARY ITEMliq 10mg/ml
Lamivudine/Zidovudine Combivirtab 150mg/300mg PYXIS DOC FORMULARY ITEM
Lopinavir/Ritonavir Kaletra tab 200mg/50mg PYXIS DOC FORMULARY ITEM
(strength change dose= 2 tablets BID)
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liq 80mg/20mg per 1ml
Nelfinavir Viracepttab 625mg PYXIS DOC FORMULARY ITEMpdr oral
Nevirapine Viramunetab 200mg PYXIS DOC FORMULARY ITEMliq 50mg/5ml
Ritonavir Norvir (Refrigerate)cap 100mg soft gel DOC FORMULARY ITEM
(1 month exp. Date if not refrigerated)liq 80mg/ml DOC FORMULARY ITEM
Saquinavir Mesylate Invirasecap 200mg
Stavudine Zeritcap 20mg,30mg,40mg PYXIS DOC FORMULARY ITEMSliq 1mg/ml
Tenofovir Disoproxil Fumarate Vireadtab 300mg DOC FORMULARY ITEM
Tipranavir Aptivuscap 250mg
Zalcitabine Hividtab 0.375mg, 0.75mg DOC FORMULARY ITEMS
Zidovudine Retrovirtab 300mg DOC FORMULARY ITEMcap 100mg PYXIS DOC FORMULARY ITEMinj 10mg/mlsyr 50mg/5ml
QUINOLONES08:22
Ciprofloxacin Ciprotab 250mg, 500mg, 750mg PYXIS DOC FORMULARY ITEMSliq 500mg/5mlinj 200mginj 400 mg Premixed IV Bag PYXIS DOC FORMULARY ITEM
Levofloxacin Levaquintab 250mg, 500mg, 750mg PYXISinj 250mg, 500mg, 750mg Premixed IV Bags PYXIS
SULFONAMIDES08:24
Dapsonetab 25mg, 100mg PYXIS DOC FORMULARY ITEMS
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Sulfadiazine Sulfadiazinetab 500mg
Sulfasalazine Azulfidinetab 500mg PYXIS DOC FORMULARY ITEM
Sulfasoxazole Gantrisintab 500mg
Trimethoprim/Sulfamethoxazole Bactrimtab 80mg/400mg (single strength) PYXIS DOC FORMULARY ITEMtab 160mg/800mg (double strength) PYXIS DOC FORMULARY ITEMliq 40mg/200mg per 5mlinj 16mg/80mg per ml, 10ml vial PYXISinj 16mg/80mg per ml, 30ml vial
ANTIPROZOALS08:30
ANTIMALARIALS08:30.08
Hydroxychloroquinine Plaqueniltab 200mg DOC FORMULARY ITEM
Primaquine Phosphate Primaquinetab 15mg
Pyrimethamine Daraprimtab 25mg DOC FORMULARY ITEM
Quinine Sulfatetab 260mgcap 325mg
URINARY ANTI-INFECTIVES08:36
Methenamine Mandelate Mandelaminetab 500mg
Nitrofurantoin Macrodantincap 25mg, 100mg DOC FORMULARY ITEMScap 50 mg PYXIS DOC FORMULARY ITEM
Trimethoprim Trimpextab 100mg PYXIS
ANTI-INFECTIVES – MISCELLANEOUS08:40
Atovaquone Mepronliq 750mg/5ml DOC FORMULARY ITEM
Metronidazole Flagyl
- 13 -
tab 250mg, 500mg PYXIS DOC FORMULARY ITEMSinj 500mg Premixed IV Bag PYXIS
Pentamadine Nebupent, Pentaminj 300mg PYXISinh 300mg
ANTINEOPLASTIC AGENTS10:00
Asparaginase Elspar (Refrigerate) inj
10,000 Units
Bleomycin Blenoxane (Refrigerate)inj 15units
Carboplatin Paraplatininj 150mg, 450mg
Carmustine BiCNU (Refrigerate)inj 100mg
Chlorambucil Leukeran (Refrigerate)tab 2mg
Cisplatin Platinolinj 50mg, 100mg vials
Cyclophosphamide Cytoxantab 25mg, 50mginj 100mg, 500mginj 1Gm,
Cytarabine Cytosar-U inj 100mg, 500mg, 2Gm
Dacarbazine Dtic-Dome (Refrigerate)inj 10mg/ml
Daunorubicin Cerubidine (Refrigerate)inj 20mg
Docetaxel Taxotere (Refrigerate)inj 80mg
Doxorubicin Adriamycin (Refrigerate)inj 10mg, 50mg
Etoposide Vepesid (Refrigerate)cap 50mginj 20mg/ml
Fluorouracil 5-Fluorouracilinj 50mg/ml
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Fludarabine Fludara (Refrigerate)inj 50mg/vial
Flutamide Eulexincap 125mg
Gemcitabine Gemzarinj 200mg, 1Gm
Hydroxyurea Hydreacap 500mg DOC FORMULARY ITEM
Ifosfamide Ifexinj 1Gm
Ifosfamide/Mesna Ifex-Mesnexinj 3mg/1Gm
Interferon alpha-2a Roferon-A (Refrigerate)inj 3million units
Interferon alpha-2b Intron-A (Refrigerate)inj 10million units
Interferon beta-1a Avonex (Refrigerate)inj 30mcg
Interferon gamma-1b Actimmune (Refrigerate)inj 3million units
Irinotecan Camptosar inj 20mg
Leuprolide Acetate Luproninj3.75mg, 7.5mg depot
Lomustine CEENUcap 40mg
Megestrol Megacetab 20mg, 40mgliq 40mg/ml, 200mg/5ml
Mercaptopurine Purinetholtab 50mg DOC FORMULARY ITEM
Methotrexate Mexatetab 2.5mginj 50mg, 250mg
Mitomycin Mutamycininj 5mg, 20mg
Paclitaxel Taxolinj 30mg, 100mg, 300mg
- 15 -
Rituximab Rituxan (Refrigerate)inj 10mg/ml (100mg vial)
10mg/ml (500mg vial)
Tamoxifen Citrate Nolvadextab 10mg, 20mg DOC FORMULARY-10mg
Vinblastine Sulfate Velban (Refrigerate)inj 1mg/ml, 10mg
Vincristine Sulfate Oncovin (Refrigerate)inj 1mg/ml, 2mg/2ml
AUTONOMIC DRUGS12:00
PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS12:04
Bethanechol Urecholinetab 5mg, 50 mg DOC FORMULARY ITEMStab 10mg, 25mg PYXIS DOC FORMULARY ITEMSinj 5mg/ml
Neostigmine Methylsulfate Prostigmineinj 1mg/ml (1:1000)
Physostigmine Salicylate Antiliriuminj 1mg/ml
Pyridostigmine Bromide Regonol, Mestinoninj 5mg/ml
ANTICHOLINERGIC AGENTS12:08
ANTIPARKINSONIAN AGENTS12:08.04
Benztropine Mesylate Cogentintab 0.5mg, 1mg, 2mg PYXIS DOC FORMULARY ITEMSinj 1mg/ml PYXIS DOC FORMULARY ITEM
Trihexyphenidyl Artanetab 2mg, 5mgliq 2mg/5ml
ANTIMUSCARINICS/ANTISPASMODICS12:08.08
Atropine Sulfateinj 0.4mg/ml, 1mg/ml DOC FORMULARY ITEMS
- 16 -
Dicyclomine Bentylcap 10mg PYXIS DOC FORMULARY ITEMtab 20mg PYXIS DOC FORMULARY ITEM
Glycopyrrolate Robinultab 1mg DOC FORMULARY ITEMinj 0.2mg/ml
Hyoscyamine Sulfatetab 0.125mg DOC FORMULARY ITEMcap 0.375mg extended release Levsinexliq 0.125mg/ml DOC FORMULARY ITEM
Ipratropium Atroventinh 18mcg PYXIS DOC FORMULARY ITEMnasl 0.03% inhalant solution
Ipratropium/Albuterol Combiventinh 18mg/103mcg PYXIS DOC FORMULARY ITEM
Scopolamine Transderm-scoptop 1.5mg transdermal
SYMPATHOMIMETIC (ADRENERGIC) AGENTS12:12
Albuterol Sulfate Ventolin, Proventil HFAtab 4mg DOC FORMULARY ITEMinh 90mcg/spray HFA MDI PYXIS
DOC FORMULARY ITEM200 metered inhalations
sol 0.08%/3ml nebulizer inhalant solution PYXIS DOC FORMULARY ITEM
Dobutamine Dobutrexinj 250mg/20ml
Dopamine Hcl Intropininj 800mg/500ml D5W Premixed IV bag
Ephedrine Sulfate Ephedrinecap 25mginj 50mg/ml
Epinephrine Adrenalininj 1mg/ml (1:1000) 1 ml vial, 1:10,000 10 ml pre-filled syringe DOC
FORMULARY- 1mg/ml (1:1000) 1ml vial
Epinephrine/Chlorpheniramine Ana-kitinj/tab 1:1000/2mg
Epinephrine Racemic Vaponefrininh 2.25% solution
Fluticasone/Salmeterol Advair Diskusinh 100/50, 250/50, 500/50 60 puff inhaler PYXIS
- 17 -
Isoproterenol Isuprelinj 0.2mg/ml (1:5000)
Metaproterenol Alupentinh 5% metered dose inhaler PYXIS
Norepinephrine Bitartrate Levophedinj 4mg/4ml
Pseudoephedrine HCl Sudafedtab 30mg, 60mg PYXISliq 30mg/5ml
Salmeterol Sereventinh 50mcg Diskus PYXIS DOC FORMULARY ITEM
Terbutaline Sulfate Brethinetab 2.5mg, 5mg
SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS12:16
Phentolamine Mesylate Regitineinj 5mg/ml
SKELETON MUSCLE RELAXANTS12:20
Atracurium Besylate Tracrium (Refrigerate)inj 10mg/ml, 10ml vial
Baclofen Lioresaltab 10mg PYXIS DOC FORMULARY ITEMtab 20mg DOC FORMULARY ITEM
Cyclobenzaprine Flexeriltab 10mg PYXIS
Dantrolene Dantriumcap 25mginj 20mg vials
Methocarbamol Robaxintab 500mg, 750mg PYXIS DOC FORMULARY ITEMS
Pancuronium Bromide Pavulon (Refrigerate)inj 1mg/ml
Succinylcholine Chloride Anectine (Refrigerate)inj 20mg/ml
- 18 -
AUTONOMIC DRUGS – MISCELLANEOUS 12:92
Nicotine gum 2mg/piece Nicoretteinh 10mg/cartridge Nicotrolpatch 7mg, 14mg, 21mg Nicoderm
BLOOD FORMATION AND COAGULATION20:00
ANTIANEMIA20:04
IRON PREPARATIONS20:04.04
Ferrous Gluconatetab 324mg
Ferrous Sulfatetab 325mg DOC FORMULARY ITEMliq 220mg/5ml, 300mg/5ml
Iron Dextran Dexferruminj 50mg/ml
COAGULANTS AND ANTICOAGULANTS20:12
ANTICOAGULANTS20:12.04
Enoxaparin Lovenoxinj 30mg/0.3mlinj 40mg/0.4ml, 60mg/0.6ml, 80 mg/0.8ml, PYXIS
100mg/ml, 120mg/0.8 ml prefilled syringes PYXIS
Heparin Heparininj 100units/ml (flush) 1ml vial, 3ml & 5ml pre-filled syringeinj 1000units/ml, 20,000units/mlinj 25,000 units in 500ml D5W premixed bag PYXISinj 5000units/ml, 10,000units/ml PYXIS
Warfarin Sodium Coumadintab 1mg, 2mg, 2.5mg, 3mg,
4mg, 5mg, 7.5mg, 10mg PYXIS DOC FORMULARY ITEMStab 6mg DOC FORMULARY ITEM
- 19 -
ANTIHEPARIN AGENTS20:12.08
Protamine Sulfateinj 10mg/ml 25 ml vial PYXIS
HEMOSTATICS20:12.16
Aminocaproic Acid Amicartab 500mginj 250mg/ml
Gelatin, Absorbable Gelfoamtop 12cm x 7cm spongetop 12.5cm x 8 cm sponge
Thrombin, Bovine Thrombostattop 1000units, 5000units
HEMATOPOIETIC AGENTS20:16
Epoetin Alfa Epogen, Procrit (Refrigerate)inj 2,000 units, 3,000 units, 4,000units
10,000 units, 20,000 units, 40,000 units
Filgrastim (G-CSF) Neupogen (Refrigerate)inj 300mcg/ml 1 ml vial
HEMORRHEOLOGIC AGENTS20:24
Pentoxifylline Trentaltab 400mg
THROMBOLYTIC AGENTS20:40
Alteplase, recombinant (TPA)inj 100mg Activaseinj 2 mg Cathflo Activase DOC FORMULARY ITEM
(Refrigerate)
CARDIOVASCULAR DRUGS24:00
CARDIAC DRUGS24:04
ANTIARRYTHMIC AGENTS24:04.04
Amiodarone HCl Cordarone
- 20 -
tab 200mginj
Lidocaine Xylocaineinj 2% prefilled syringe 100mg/5mlinj 2Gm/500ml 5% Dextrose
Procainamide Pronestylcap 500mg DOC FORMULARY ITEMtab 500mg sustained releaseinj 100mg/ml, 10ml vial PYXIS
Quinidine Gluconate Quinaglutetab 324mg DOC FORMULARY ITEMinj 80mg/ml 10 ml vial
Quinidine Sulfate Quinoracap 300 mg PYXIS DOC FORMULARY ITEM
CARDIOTONIC AGENTS24:04.08
Digoxin Lanoxintab 0.125mg, 0.25mg PYXIS DOC FORMULARY ITEMSliq 0.05mg/mlinj 0.25mg/ml PYXIS DOC FORMULARY ITEM
ANTILIPEMIC AGENTS24:06
Lovastatin Mevacor DOC FORMULARY ITEM
tab 10mg, 20mg, 40mg PYXIS Cholestyramine resin Questran
pwd 4Gm/dose
Gemfibrozil Lopidtab 600mg PYXIS DOC FORMULARY ITEM
HYPOTENSIVE AGENTS24:08
Benazepril Lotensintab 5mg, 10mg, 20mg
Captopril Capotentab 12.5mg, 25mg, 50mg PYXIS DOC FORMULARY ITEMS
Clonidine HCl Cataprestab 0.1mg, 0.2mg PYXIS DOC FORMULARY ITEMStab 0.3mg DOC FORMULARY ITEMtop 100mcg, 200mcg, 300mcg patch DOC FORMULARY-100mcg, 200mcg
- 21 -
Diazoxide Hyperstatinj 300mg/20ml
Hydralazine Apresolinetab 10mg, 25mg PYXIStab 50mginj 20mg/ml
Labetalol Normodynetab 100mg PYXIStab 200mginj 5mg/ml
Methyldopa Aldomettab 250mg, 500mg
Nitroprusside Sodium Niprideinj 50mg/5ml
Pindolol Viskentab 5mg
Prazosin Minipresscap 1mg, 2mg PYXIS DOC FORMULARY ITEMScap 5mg DOC FORMULARY ITEM
Terazosin Hytrintab 1mg, 2mg, 5mg, 10mg PYXIS DOC FORMULARY ITEMS
VASODILATING AGENTS24:12
Amyl Nitriteinh
Dipyridamole Persantinetab 25mg, 50mginj 5mg/ml
Dipyridamole /Aspirin Aggrenoxcap 200mg extended release/20mg
Isosorbide Dinitrate Isordiltab 5mg, 30mg DOC FORMULARY ITEMStab 10mg, 20mg, 40mg PYXIS DOC FORMULARY ITEMStab 40mg sustained release DOC FORMULARY ITEM
Isosorbide Mononitrate Imdurtab 30mg, 60mg, 120mg extended release PYXIS DOC FORMULARY ITEMS
Nitroglycerin Nitrostattab 0.3mg, 0.6mg DOC FORMULARY ITEMtab 0.4mg PYXIS DOC FORMULARY ITEMinj 50mg/250ml D5W premixed bottle PYXIStop 2% ointment PYXIS DOC FORMULARY ITEMtop 0.1mg/hr, 0.2mg/hr patch PYXIS DOC FORMULARY ITEMS
- 22 -
top 0.4mg/hr, 0.8mg/hr patch
SCLEROSING AGENT24:16
Sodium Tetradecyl Sotradecolinj 1%
a-ADRENERGIC BLOCKING AGENTS24:20
Doxazosin Mesylate Carduratab 1mg, 2mg, 4mg PYXIS
b-ADRENERGIC BLOCKING AGENTS24:24
Atenolol Tenormintab 25mg, 50mg, 100mg PYXIS DOC FORMULARY ITEMS
Esmolol Breviblocinj 10mg/ml, 250mg/ml
Metoprolol Tartrate Lopressortab 25mg, 50mg, 100mg PYXIS DOC FORMULARY ITEMStab 25mg, 50mg, 100mg extended release Toprol XLinj 1mg/ml 5ml ampoule PYXIS
Nadolol Corgardtab 20mg, 40mg PYXIStab 80mg
Propranolol Inderal tab 10mg, 20mg, 40mg PYXIS DOC FORMULARY ITEMStab 60mg DOC FORMULARY ITEM
Inderal LAcap 60mg, 80mg, 120mg (long acting capsules) PYXIS DOC FORMULARY
ITEMScap 160mg (long acting capsules) DOC FORMULARY ITEM inj 1mg/ml 1 ml vial PYXIS
CALCIUM-CHANNEL BLOCKING AGENTS24:28
DIHYDROPYRIDINES
24:28.08Amlodipine Besylate Norvasc
tab 2.5mg, 5mg, 10mg PYXIS
Nifedipine Procardiacap 10mg, 20mg PYXIStab 30mg, 60mg, 90mg extended release PYXIS DOC FORMULARY ITEMS
- 23 -
MISCELLANEOUS
24:28.92Diltiazem Cardizem, Cardizem SR, Cardizem CD
tab 30mg, 60mg, 90mg PYXIS DOC FORMULARY ITEMStab 120mg DOC FORMULARY ITEMcap 60mg, 90mg, 120mg sustained release (twice a day dosing) PYXIS
DOC FORMULARY ITEMScap 180mg (once a day dosing) DOC FORMULARY ITEMcap 120mg, 240mg, 300mg extended release (once a day dosing) PYXIS DOC
FORMULARY ITEMSinj 5mg/ml 5ml, 10ml vials, and pre-filled syringes (for code cart)
Verapamil Isoptintab 40mg, 80mg PYXIS DOC FORMULARY ITEMStab 120mg DOC FORMULARY ITEMtab 120mg, 180mg, 240mg sustained release PYXIS DOC FORMULARY ITEMSinj 2.5mg/ml 2 ml amps PYXIS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS24:32
A.C.E. INHIBITORS
24:32.04Enalapril Vasotec (Preferred Product)
tab 2.5mg, 5mg, 10mg PYXIS DOC FORMULARY ITEMStab 20mg DOC FORMULARY ITEMinj 1.25mg/ml PYXIS
Lisinopril Prinivil, Zestril tab 5mg, 10mg, 20mg PYXIS DOC FORMULARY ITEMS
ANGIOTENSIN II RECEPTOR ANTAGONISTS
24:32.08Losartan potassium Cozaartablet 50 mg PYXIStablet 25 mg PYXIS
CENTRAL NERVOUS SYSTEM AGENTS28:00
ANALGESICS AND ANTIPYRETICS28:08
ANTI-INFLAMMATORY AGENTS – NONSTEROIDAL28:08.04
Aspirintab 81mg Chewable, 325mg Aspirin PYXIS DOC FORMULARY ITEMS
- 24 -
tab 81mg, 325mg Aspirin enteric coated PYXIS DOC FORMULARY-
325mgsupp 300mg, 600mg
Aspirin, Buffered Ascriptintab 325mg
Choline Magnesium Trisalicylate Trilisatetab 500mg, 750mg PYXISliq 500mg/5ml
Diclofenac Sodium Voltarentab 25mg, 50mg, 75mg, delayed release DOC FORMULARY ITEMStab 100mg extended release
Ibuprofen Motrintab 200mg, 400mg, 600mg, 800mg PYXIS DOC FORMULARY ITEMSliq 100mg/5ml DOC FORMULARY ITEM
Indomethacin Indocincap 25mg, 50mg DOC FORMULARY ITEMS
Ketorolac Tromethamine Toradoltab 10mg PYXISinj 15mg, 30mg PYXIS
Naproxen Naprosyntab 250mg, 375mg, 500mg PYXIS DOC FORMULARY ITEMSliq 125mg/5ml
Piroxicam Feldenecap 10mg, 20mg
Salsalate Disalcidtab 500mg, 750mg DOC FORMULARY ITEMS
Sulindac Clinoriltab 150mg, 200mg
OPIATE AGONISTS28:08.08
Acetaminophen/Codeine Tylenol w/ Codeine #3tab 325mg/32mg #3liq 120mg/12mg per 5ml DOC FORMULARY ITEM
Codeine Phos/Sulftab 30mginj 30mg
Fentanyl Citrate Sublimazeinj 50mcg/mltop 25mcg/hr, 50mcg/hr, 75mcg/hr, 100mcg/hr
- 25 -
Hydromorphone Hcl Dilaudidtab 1mg, 2mg, 4mginj 2mg/mlsupp 3mg (Refrigerate)
Meperidine Demeroltab 50mginj 50mg, 75mg, 100mg
Methadone Dolophinetab 5mg, 10mg, 40mginj 10mg/ml
Morphine Sulfatetab 15mg, 30mg immediate releasetab 15mg, 30mg, 60mg, 100 mg sustained release MS Contin liq 10mg/5ml Unit Dose, 20mg/1ml 30ml inj 4mg, 10mg, 15mg Tubex, 15mg/1ml & 25mg/1ml vials
1mg/1ml 100ml, 250ml, 500mg Premixed Bottle in D5W
Oxycodonetab 5mg, 15mg immediate release Percolone, Roxicodonetab 10mg, 20mg, 40mg sustained release OxyContin
Oxycodone/APAP Percocet, Roxicettab 5mg/325mg DOC FORMULARY ITEM
Propoxyphene Napsylate + Acetaminophen Darvocet-N 100tab 100mg/650mg
OPIATE PARTIAL AGONISTS28:08.12
Nalbuphine Nubaininj 10mg/ml DOC FORMULARY ITEM
ANALGESICS AND ANTIPYRETICS – MISCELLANEOUS28:08.92
Acetaminophen Tylenoltab 325mg PYXIS DOC FORMULARY ITEMliq 160mg/5ml PYXIS supp 650mg PYXIS
OPIATE ANTAGONISTS28:10
Naloxone Narcaninj 400mcg, 1mg/ml PYXIS DOC FORMULARY ITEM
Naltrexone Reviatab 50mg
ANTICONVULSANTS28 :12
- 26 -
BARBITURATES28 :12.04
Phenobarbitaltab 15mg, 30mg, 60mg DOC FORMULARY ITEMSliq 20mg/5ml, 30mg/7.5ml Unit Doseinj 30mg/ml, 130mg/ml
Primidone Mysolinetab 50mg, 250mg DOC FORMULARY ITEMS
BENZODIAZEPINES28:12.08
Clonazepam Klonopintab 0.5mg, 1mg, 2mg
HYDANTOINS28:12.12
Fosphenytoin Cerebyx (Refrigerate)inj 50mg PE/ml, 2ml
Phenytoin Dilantincap 100mg PYXIS DOC FORMULARY ITEMtab 50mg chewable PYXIS DOC FORMULARY ITEMliq 125mg/5ml DOC FORMULARY ITEMinj 100mg/2ml, 250mg/5ml PYXIS DOC FORMULARY ITEMS
SUCCINIMIDES28 :12.20
Ethosuximide Zarontincap 250 mgliq 250mg/5ml
ANTICONVULSANTS – MISCELLANEOUS28:12.92
Carbamazepine Tegretoltab 100mg chewable PYXIS DOC FORMULARY ITEMtab 200mg PYXIS DOC FORMULARY ITEMtab 200mg extended release Tegretol XRliq 100mg/5ml
Divalproex Sodium Depakotecap 125mg sprinkle PYXIStab 125mg, 250mg, 500mg PYXIS
Gabapentin Neurontincap 100mg, 300mg, 400mg, 600mg PYXIS
Lamotrigine Lamictaltab 25mg, 100mg, 150mg, 200mg PYXIS
Magnesium Sulfate
- 27 -
inj 4meq/ml, 50% 2ml vial PYXIS
Topiramate Topamaxtab 25mg, 100mg, 200mg
Valproic Acid Depakeneliq 50mg/ml PYXIS DOC FORMULARY ITEMcap 250 mg PYXIS DOC FORMULARY ITEM
inj 500mg/5ml Depacon
PSYCHOTHERAPEUTIC AGENTS28 :16.00
ANTIDEPRESSANTS28 :16.04
Amitriptyline Elaviltab 10mg, 25mg, 50mg PYXIS DOC FORMULARY ITEMStab 75mg, 100mg, 150mg DOC FORMULARY- 75mg, 100mg
Bupropiontab 75mg, 100mg PYXIS Wellbutrin DOC FORMULARY ITEMS
tab 100 mg, 150mg sustained release Wellbutrin SR DOC FORMULARY ITEMS
Citalopram Celexatab 10mg, 20mg, 40mg DOC FORMULARY- 10mg, 20mg
Clomipramine Anafranilcap 25mg, 50mg
Desipramine Norpramintab 10mg, 25mg, 50mg PYXIS DOC FORMULARY ITEMStab 75mg, 100mg DOC FORMULARY ITEMS
Doxepin Sinequancap 10mg, 25mg, 50mg PYXIS DOC FORMULARY ITEMScap 75mg, 100mg DOC FORMULARY ITEMS
Fluoxetine Prozaccap 10mg, 20mg PYXIS DOC FORMULARY ITEMSliq 20mg/5ml
Fluvoxamine Luvoxtab 25mgtab 50mg, 100mg PYXIS
Imipramine Tofraniltab 10mg DOC FORMULARY ITEMtab 25mg, 50mg PYXIS DOC FORMULARY ITEMS
Mirtazapine Remerontab 15mg, 30mg PYXIS DOC FORMULARY ITEMStab 45mg DOC FORMULARY ITEM
Nefazodone Serzone
- 28 -
tab 50mg, 200mg tab 100mg, 150mg PYXIS
Nortriptyline Pamelor, Aventylcap 10mg, 25mg, 50mg PYXIS DOC FORMULARY ITEMScap 75mg DOC FORMULARY ITEM
Paroxetine Paxiltab 10mg, 20mg, 30mg PYXIStab 40mgliq 10mg/5ml
Sertraline Zolofttab 25mgtab 50mg, 100mg PYXISliq 20mg/ml
Tranylcypromine Parnatetab 10mg
Trazodone Desyreltab 50mg, 100mg PYXIS DOC FORMULARY ITEMS
Venlafaxinetab 25mg, 37.5mg, 50mg, 75mg, 100mg Effexorcap 37.5mg, 75mg, 150mg extended release Effexor XR
ANTIPSYCHOTICS28:16.08 Aripiprazole Abilify
tab 10mg, 15mg(Doses Greater Than 15mg/day Require Non-Formulary Request)
Chlorpromazine Thorazinetab 10mg, 25mg, 50mg, 100mg PYXIS DOC FORMULARY ITEMStab 200mg DOC FORMULARY ITEMliq 10mg/5mlliq 100mg/ml concentrate DOC FORMULARY ITEMinj 25mg/ml (2 ml vial) PYXIS DOC FORMULARY ITEM
Clozapine Clozariltab 25mg, 100mg PYXIS DOC FORMULARY ITEMS
Droperidol InapsineInj 2.5mg/ml PYXIS
Fluphenazine Prolixintab 1mg, 2.5mg, 5mg, 10mg PYXIS DOC FORMULARY ITEMSliq 5mg/ml concentrate DOC FORMULARY ITEMinj 2.5mg/ml PYXIS DOC FORMULARY ITEMinj 25mg/ml decanoate DOC FORMULARY ITEM
- 29 -
Haloperidol Haldoltab 0.5mg, 1mg, 2mg, 5mg, 10mg PYXIS DOC FORMULARY ITEMStab 20mg DOC FORMULARY ITEMliq 2mg/ml DOC FORMULARY ITEMinj 5mg/ml lactate PYXIS DOC FORMULARY ITEMinj 50mg/ml, 100mg/ml decanoate DOC FORMULARY ITEMS
Loxapine Loxitanecap 5mg, 10mg, 25mg PYXIScap 50mg
Olanzapine Zyprexatab 2.5mg, 5 mg, 7.5 mg, 10 mg PYXIS DOC FORMULARY ITEMStab 15mginj 10 mg/vial PYXIS DOC FORMULARY ITEM
Perphenazine Trilafontab 2mg, 4mg, 8mg, 16mg PYXIS DOC FORMULARY ITEMS
Quetiapine Seroqueltab 25mg, 100mg, 200mg, 300mg PYXIS DOC FORMULARY ITEMS
Risperidone Risperdaltab 0.5mg, 1mg, 2mg, 3mg, 4mg PYXIS DOC FORMULARY- 1mg, 2mg, 3mg, 4mgtab 0.25mgliq 1mg/ml
Thioridazine Mellariltab 10mg, 25mg, 50mg PYXIStab 200mgliq 30mg/ml
Thiothixene Navanecap 1mg DOC FORMULARY ITEMcap 2mg, 5mg, 10mg PYXIS DOC FORMULARY ITEMS
Trifluoperazine Stelazinetab 1mg DOC FORMULARY ITEMtab 2mg, 5mg, 10mg PYXIS DOC FORMULARY ITEMSinj 2mg/ml
Ziprasidone Geodoncap 20mg, 40mg, 60mg, 80mg PYXIS DOC FORMULARY ITEMSinj 20mg/ml (Requires Non Form request)
ANOREXIGENIC AGENTS AND RESPIRATORY AND CEREBRAL STIMULANTS
28:20Alcohol/Ammonia Ammonia Inhalants
inh 35%/15%
Doxapram Dopraminj 20mg/ml
- 30 -
Methylphenidate Ritalintab 5mg, 10mg DOC FORMULARY ITEMS
ANXIOLYTICS, SEDATIVES, AND HYPNOTICS28 :24
BARBITURATES28 :24.04
Phenobarbitaltab 15mg, 30mg, 60mgliq 20mg/5ml, 30mg/7.5ml Unit Doseinj 30mg/ml, 130mg/ml
Thiopental Pentothalinj 500mg
BENZODIAZEPINES28:24.08
Alprazolam Xanaxtab 0.25mg, 0.5mg, 1mg
Chlordiazepoxide Libriumcap 5mg, 10mg, 25mg DOC FORMULARY ITEMSinj 100mg
Clonazepam Klonopintab 0.5mg, 1mg, 2mg DOC FORMULARY ITEMS
Diazepam Valiumtab 2mg, 5mg, 10mg DOC FORMULARY ITEMSinj 10mg/2ml DOC FORMULARY ITEM
Lorazepam Ativantab 0.5mg, 1mg, 2mg DOC FORMULARY ITEMSinj 2mg/ml, 4mg/ml (REFRIGERATE) DOC FORMULARY-2mg/ml
Midazolam Versedinj 5mg/ml
Oxazepam Seraxtab 10mg, 15mg
Temazepam Restorilcap 15mg, 30mg
Triazolam Halciontab 0.125mg, 0.25mg
MISCELLANEOUS ANXIOLYTICS, SEDATIVES AND HYPNOTICS28:24.92
Buspirone Buspartab 5mg, 10mg PYXIS DOC FORMULARY ITEMS
- 31 -
Chloral Hydrate Nocteccap 500mgliq 500mg/5ml
Hydroxyzine HCl Atarax, Vistariltab 10mg DOC FORMULARY ITEMinj 25mg/ml, 50mg/ml PYXIS
Hydroxyzine Pamoate Vistarilcap 25mg, 50mg PYXIS DOC FORMULARY ITEMS
Propofol Diprivaninj 10mg/ml 20ml vial
10mg/ml 50ml & 100ml IV vial
Zolpidem Ambientab 5mg, 10mg
ANTIMANIC AGENTS28:28
Lithium Carbonatecap 150mg, 300mg PYXIS DOC FORMULARY ITEMStab 300mgtab 300mg slow release Lithobid DOC FORMULARY ITEM tab 450mg extended release Eskalith DOC FORMULARY ITEM
Lithium Citrate Lithonateliq 300mg/5ml DOC FORMULARY ITEM
CENTRAL NERVOUS SYSTEM AGENTS – MISCELLANEOUS28:92 Flumazenil Romazicon
inj 0.5mg/5ml
DIAGNOSTIC AGENTS36:00
GALLBLADDER FUNCTION36:34
Sincilide Kinevacinj 50mcg/ml
INTESTINAL ABSORPTION36:38
Xylosepwdr
MYASTHENIA GRAVIS36:56
Edrophonium Tensilon, Enlon
- 32 -
inj 10mg/ml
TUBERCULOSIS36:84
Tuberculin Purified Protein Derivative Mantoux (Refrigerate)inj
ELECTROLYTIC, CALORIC, AND WATER BALANCE40:00
ALKALINIZING AGENTS40:08 Citric Acid/Sodium Citrate Bicitra
liq
Sodium Bicarbonatetab 325mg, 650mginj 0.5meq/mlinj 1meq/ml 50 ml vial PYXIS
AMMONIA DETOXICANTS40:10
Lactulose Enulosesol 10 Gm/15ml 30ml for oral or rectal use PYXIS DOC FORMULARY-
10Gm/15ml
REPLACEMENT PREPARATIONS40:12
Calcium Acetate Phoslotab 667mg DOC FORMULARY ITEM
Calcium Carbonateliq 1250mg/5ml
Calcium Carbonate Oyster Shelltab 500mg PYXIS DOC FORMULARY ITEM
Calcium Chlorideinj 1gm/10ml DOC FORMULARY ITEM
Calcium Gluconateinj 4.65 mEq/10ml calcium PYXIS
Magnesium Magonate Dietary Liquidliq 54mg/5ml
Potassium Acetateinj 40meq/20ml
Potassium Chloridetab 10meq, 20mEq PYXIS DOC FORMULARY-10meqliq 10% 20mEq/15ml PYXIS DOC FORMULARY ITEM
- 33 -
inj 10mEq in 50ml SWFI, 100ml SWFI, 1L D5/0.45% NS PYXISinj 20mEq in 100ml SWFI (FOR USE IN ICU ONLY!!) PYXISinj 20mEq in 1L NS, 1L D5/NS, 1L D5/0.45% NS PYXISinj 30mEq in 1L D5/0.45% NS PYXIS inj 40mEq in 1L D5W, 1L D5/0.45% NS PYXIS
Potassium Phosphateinj 45mM/15ml
Sodium Acetateinj 2meq/ml
Sodium Bicarbonateinj 50mEq/50mltab 650mg
Sodium Chloridetab 1gm PYXISinj 0.9% Preservative-Free 10ml, 20ml, 50mlinj 0.9% Bacteriostatic 30mlinj 3% Hypertonic Solution PYXIS
Sodium Phospateinj 3mM/ml
Sodium/Potassium Phosphate Mixture Phos-NaKpwdr packet Potassium 280mg PYXIS
Sodium 160mg PYXISPhosphorus 250mg PYXIS
Trace Metals M.T.E.-5 (For Use in TPN Admixtures)Inj zinc 1mg/ml
copper 0.4mg/mlmanganese 0.1mg/mlchromium 4mcg/mlselenium 20mcg/ml
ION – REMOVING AGENTS40:18
POTASSIUM-REMOVING RESINS40:18.18
Sodium Polystyrene Sulfonate Kayexylateliq 15 grams/60ml 60ml bottle PYXIS DOC FORMULARY ITEMliq 15 grams/60ml 500ml bottle
40:18.19Sevelemer Hydrochloride Renagel
tab 800mg PYXIS
CALORIC AGENTS40:20
AminoAcids Aminosyn
- 34 -
inj 15%
Dextroseinj 25%, 50% DOC FORMULARY-50%
Fat Emulsion Intralipidinj 10%, 20%
DIURETICS40:28
Bumetanide Bumexinj 0.25mg/ml 4 & 10 ml PYXIStab 0.5mg PYXIStab 1mg, 2mg
Chlorothiazide Diuriltab 250mginj 0.5gm
Furosemide Lasixtab 20mg, 40mg, 80mg PYXIS DOC FORMULARY- 20mg, 40mgliq 10mg/mlinj 10mg/ml 2ml, 4ml, 10ml vials PYXIS DOC FORMULARY-10mg/ml
Hydrochlorothiazide Hydrodiuril, MicrozideTab 25mg, 50mg PYXIS DOC FORMULARY ITEMScap 12.5mg
Mannitolinj 20%, 25%
Metolazone Zaroxolyntab 2.5mg, 5mg
POTASSIUM-SPARING DIURETICS40:28.10
Spironolactone Aldactonetab 25mg, 100mg PYXIS DOC FORMULARY ITEMStab 50mg
Triamterene/HCTZ Dyazidecap 37.5mg/25mg DOC FORMULARY ITEM
IRRIGATING SOLUTION40:36
Sterile Eye Irrigation Dacrioseopth solution
URICOSURIC AGENT40:40
Probenecid Benemidtab 500mg
- 35 -
ENZYMES44:00
Deoxyribonuclease Pulmozyme (Refrigerate)inj 1mg/ml
ANTITUSSIVES, EXPECTORANTS, AND MYCOLYTIC AGENTS48 :00
ANTITUSSIVES48 :08
Codeinetab 15mg, 30mg
EXPECTORANTS48:16
Guaifenesin Robitussinliq 100mg/5ml
Guafenesin Sustained Release Humibid LAtab 600mg
Guafenesin/Codeine Robitussin ACliq 100mg/10mg per 5 ml
Guafenesin/Dextromethorphan Robitussin DMliq 100mg/10mg per 5ml
Guafenesin/Dextro/Phenylephrine Tussexliq 100mg/10mg/5mg per 5ml
MUCOLYTIC AGENTS48:24
Acetylcysteine Mucomystinh 20% solution PYXIS
EYE, EAR, NOSE, AND THROAT PREPARATIONS52:00
ANTIALLERGIC52:02
Levocabastine Livostinopth 0.05% solution
Olopatadine Patanolophth 0.1% solution
Pemirolast Alamastophth 0.1% solution
- 36 -
ANTI-INFECTIVES – Ophthalmics52:04
ANTIBIOTICS52:04.04
Bacitracinopth 500U/gm ointment PYXIS
Bacitracin/Zinc/PolyBopth ointment
Colistin/Neo/Thozonium/Hydrocort Cortisporin TCotic suspension
Dexameth/Neom/Polymixin Maxitrolopth solution
Dexamethasone/Tobramycin Tobradexopth 0.1%/0.3% solution
Erythromycinopth 0.5% ointment PYXIS DOC FORMULARY ITEM
Gentamicinopth 0.3% ointment PYXIS DOC FORMULARY ITEMophth 0.3% solution DOC FORMULARY ITEM
Neomycin/Polymyxin/Gramicidinophth solution
Neomycin/Polymixin/HC Cortisporinophth ointmentophth suspensionotic solution PYXISotic suspension PYXIS
Polymyxin/Neom/Bacitracin Neosporinophth ointmentophth solution
Tobramycin Tobrexophth 0.3% ointmentophth 0.3% solution DOC FORMULARY ITEM
ANTIVIRALS52:04.06
Trifluridine Viropticophth 1% solution
SULFONAMIDES52:04.08
Acetic Acid/Hydrocort Vosol HCotic solution
- 37 -
Sulfacetamide Sodium Sulamydophth 10% solophth 10% ointment
MISCELLANEOUS ANTIINFECTIVES52:04.12
Boric Acid Collyriumophth wash
Carbamide Peroxide Debroxotic 6.5% PYXIS
Ciprofloxacin Ciloxanophth 0.3% solution
Ciprofloxacin/Hydrocort Cipro HCotic 0.2%/1% solution
Olfloxacin Ocufloxophth 0.3% solution
Silver Nitratetop applicators
Zinc Sulfate Zincatecap 220mginj 10mg/10ml
ANTI-INFLAMMATORY AGENTS52:08
Beclomethasone BeconaseAQnasl 0.042% aqueous spray PYXIS
Budesonide Rhinocort Aquanasl 32mcg aqueousinh 200mcg PYXIS Pulmicort Turbuhaler
Dexamethasone Decadronopth 0.1% solution DOC FORMULARY ITEM
Flunisolide Aerobid, Nasalidenasl 0.025% spray DOC FORMULARY ITEMinh 7gm PYXIS
Fluticasone Flonase, Floventinh 44mcg, 110mcg, 220mcg PYXIS DOC FORMULARY-44mcgnasl 50mcg
Fluoramethalone F.M.L., F.M.L-Forteopth 0.1%, 0.25% solution
- 38 -
Fluoramethalone/Sulfacetamide F.M.L-Sopth 0.1%/10% solution Acularopth 0.5% solution
Prednisolone Acetate Pred Foreopth 1% solution PYXIS DOC FORMULARY ITEM
Sulfacetamide/Prednisolone Vasocidinopth 10%/0.23% solutionopth 100mg/2.5mg solution
Triamcinolone Kenalog Orabasetop 0.1% dental paste
CARBONIC ANHYDRASE INHIBITOR52:10
Acetazolamide Diamoxtab 250mg PYXIS DOC FORMULARY ITEMcap 500mg sustained releaseinj 500mg
Dorzolamide Trusoptopth 22.3mg/ml solution PYXIS
LOCAL ANESTHETIC52 :16.00
Cocaine Hcltop 4%, 10% solution
Proparacaine Opthaineopth 0.5% solution DOC FORMULARY ITEM
Tetracaineopth 0.5% solution
MIOTICS52:20
Pilocarpine Isopto Carpineopth 0.5%, 1%, 2% solution DOC FORMULARY ITEMSopth 3%, 4%, 5%, 6% solution DOC FORMULARY ITEMSopth 4% gel DOC FORMULARY ITEM
MYDRIATIC52:24
Atropine Sulfate Isopto Atropineinj 0.1mg/mlophth 1% ointmentophth 1% solution
Cyclopentolate Cyclogylophth 0.5%, 1%, 2% solution
Dipivefrin Hcl Propine
- 39 -
ophth 0.1% solution
Homatropine Hydrobromide Isopto Homatropineophth 2%, 5% solution DOC FORMULARY ITEMS
Phenylephrine Hydrochloride Mydfrinophth 2.5% solution
Scopolamine Isopto Hyoscineophth 0.25% solution
Tropicamide Mydriacylophth 0.5%, 1% solution
VASOCONSTRICTOR52:32
Naphazoline Naphconopth 0.012% solution
Naphazoline/Pheniramine Naphcon-Aopth 0.025%/0.3% solution
Oxymetazoline Afrinnasl 0.05% solution
Phenylephrine Neo-synephrine, Mydfrininj 10mg/mlopth 0.12%, 2.5%, 10% solutionnasl 0.125%, 0.25%, 0.5%, 1% solutionnasl 0.5% nasal spray PYXIS
Tetrahydrozoline Visineopth 0.05% solution
MISCELLANEOUS EENT DRUGS52:36
Apraclonidine Iopidineopth 0.5%, 1% solution
Artificial Tears Duratearsopth solution PYXISopth ointment PYXIS
Betaxolol Betopticopth 0.25%, 5% solution DOC FORMULARY ITEMS
Bimatoprost Lumiganophth 0.03% solution
Brimonidine Alphaganophh 0.2% solution DOC FORMULARY ITEM
- 40 -
Dorzolamide/Timolol Cosoptophth 22.3mg/6.8mg/ml solution PYXIS
Fluorescein Fluor-1-Stripophth 9mg/strip
Latanoprost Xalatan (Refrigerate)ophth 0.005% solution DOC FORMULARY ITEM
Levobunolol Betaganophth 0.25% 0.5% solution
Petrolatum Duralubeophth ointment
Polyethylene Glycol/Polyvinyl Acetate Hypotears PFophth 1% solution
Sodium Chloride Ocean, Muro 128ophth 5% ointmentophth 2% solution nasl 0.65% solution
Timolol Maleate Timopticopth 0.25% solution DOC FORMULARY ITEMopht 0.5% solution PYXIS DOC FORMULARY ITEM
Triethanolamine Polypeptide Cerumenexotic 10% 6 ml solution PYXIS
GASTROINTESTINAL DRUGS56:00
ANTACIDS AND ADSORBENTS56:04
Alum-Hydrox Gel Amphogelliq
Alum-Mag Hydrox w/Simethicone Mylantaliq 200mg/200mg/20mg per 5 ml PYXIS
Aluminum-Magnesium Hydroxide Maaloxliq 225mg/200mg per 5ml
Calcium Carbonate Tumstab 500mg DOC FORMULARY ITEM
Charcoal, ActivatedLiq 25 gm/120 ml PYXIS Char-Flo
Magaldrate Riopanliq 540mg/5ml
- 41 -
Magnesium Hydroxide Milk of Magnesialiq 77.5mg/g
Magnesium Oxide Magoxtab 400mg PYXIS DOC FORMULARY ITEM
ANTIDIARRHEA AGENTS56:08
Attapulgitesusp 750mg/15ml
Bismuth Subsalicylate Pepto-Bismoltab 262mg DOC FORMULARY ITEMliq 252mg/15ml DOC FORMULARY ITEM
Diphenoxylate/Atropine Lomotiltab 2.5mg/0.025mg DOC FORMULARY ITEM
Lactobacillus Acidophilus Lactinex (Refrigerate)tab 1gm
Loperamide Imodiumcap 2mg PYXIS DOC FORMULARY ITEMliq 1mg/5ml
ANTIFLATULENTS56:10
Simethicone Gas-Xtab 80mg chewable PYXISliq 40mg/0.6ml drops
CATHARTICS AND LAXATIVES56:12
Bisacodyl Dulcolaxtab 5mg enteric coated PYXISsupp 10mg PYXIS
Cellulose UniFiberpwd 3Gm fiber /tablespoonful
Docusate Sodium Colacecap 100mg DOC FORMULARY ITEMliq 100mg/10ml
Glycerinsupp adult, pediatric
Lactulose Chronulacliq 10gm/15ml
Magnesium Citrate Citromaliq
Magnesium Sulfate Epsom Saltspdr
- 42 -
Milk of Magnesia MOMliq
Mineral OilLiq oralrect enema
PEG Lavage solution Golytelyliq
Psyllium Metamucilpdr 3.75gm
Saline Fleet Enemarect enema PYXIS
Senna Senokottab 187mgliq 325mg/ 5ml
Sodium Phosphate Fleet Phospho-sodaliq
Sorbitolliq 70% solution PYXIS
Unifiber Powdered CellulosePdr
DIGESTANT56:16
Pancrelipase Pancreasetab 8000mg DOC FORMULARY ITEMcap 4500mg enteric coated DOC FORMULARY ITEM
EMETICS56:20
Ipecacliq
ANTIEMETICS56:22
Granisetron Kytriltab 1mginj 1mg/ml PYXIS
Meclizine Antiverttab 12.5mgtab 25mg PYXIS DOC FORMULARY ITEM
Ondansetron Zofrantab 4mg PYXIStab 8mg
- 43 -
sol 4mg/5mlinj 2mg/ml, 4mg/5ml
Prochlorperazine Maleate Compazinetab 5mg, 10mg PYXIS DOC FORMULARY ITEMScap 10mg, 15mgliq 1mg/mlinj 10mg/2ml PYXIS DOC FORMULARY ITEMsupp 5mg DOC FORMULARY ITEMsupp 25mg PYXIS DOC FORMULARY ITEM
Trimethobenzamide Tigancap 300mg inj 200mg/2mlsupp 200mg
ANTI-INFLAMMATORY AGENTS56:36
Mesalamine Asacoltab 400 mg PYXIS DOC FORMULARY ITEMenema 4Gm per 60ml PYXIS
MISCELLANEOUS GASTROINTESTINAL DRUGS56:40
Famotidine Pepcid (Preferred Product)tab 20mg PYXIS DOC FORMULARY ITEMinj 20mg vialsinj 20mg/50ml Premixed Bag PYXIS
Lactase Enzyme Lactaidtab 3000 FCC Units DOC FORMULARY ITEM
Metoclopramide Reglantab 5mg, DOC FORMULARY ITEMtab 10mg PYXIS DOC FORMULARY ITEMliq 5mg/5ml DOC FORMULARY ITEMinj 5mg/ml 2 ml vial PYXIS DOC FORMULARY ITEM
Misoprostol Cytotectab 100mcg, 200mcg
Omeprazole* PrilosecCap 20mg makes suspension for G-tube / NG-tube PYXIS
Pantoprazole Protonixtab 40 mg PYXIS DOC FORMULARY ITEMinj 40 mg PYXIS
Sucralfate Carafatetab 1gm PYXIS DOC FORMULARY ITEMliq 1gm/10ml DOC FORMULARY ITEM
- 44 -
HEAVY METAL ANTAGONISTS64:00
Deferoxamine Desferalinj 500mg
Penicillamine Cupriminecap 250mg
HORMONES AND SYNTHETIC SUBSTITUTES68:00
ADRENALS68:04
Cortisone Acetate Cortonetab 5mg, 25mg
Dexamethasone Decadrontab 0.5mg, 0.75mg DOC FORMULARY ITEMtab 1mg, 2mg, 4mg PYXIS DOC FORMULARY-2mg, 4mgliq 0.5mg/5mlinj 4mg/ml 5 ml vial PYXIS DOC FORMULARY ITEM
Fludrocortisone Acetate Florineftab 0.1mg PYXIS
Hydrocortisonetab 10mg, 20mginj 100mg/2ml, 250mg/2ml, 1000mg/8ml PYXISinj 500mg/4ml
Hydrocortisone Acetateinj 25mg/ml, 50mg/ml
Methylprednisolone Medroltab 4mg
Methylprednisolone Sodium Succinate Solu-Medrolinj 40mg/ml, 125mg/2ml, 1000mg/8ml PYXIS inj 500mg/ml
Methylprednisolone Acetate Depo-Medrolinj 40mg/ml, 80mg/ml
Prednisone Deltasonetab 1mg, 5mg, 10mg, 20mg, 50mg PYXIS DOC FORMULARY ITEMStab 2.5mgliq 5mg/ml
Triamcinolone Acetonide Kenaloginj 10mg/ml, 40mg/mltop 0.025%, 0.5% creamtop 0.025% ointment
- 45 -
ANDROGENS68:08
Testosterone Cypionate Depo-testosteroneinj 50mg/ml, 100mg/ml, 200mg/ml
Testosterone Enanthate Delatestrylinj 200mg/ml
CONTRACEPTIVES68:12
Levonorgestrel Plan Btab 0.75 mg PYXIS
Levonorgestrel/Ethinyl Estradiol Triphasil 28tab 0.050mg/0.030mg 6 tabs
0.075mg/0.040mg 5 tabs0.125mg/0.030mg 10 tabs7 inert tabs
ESTROGENS & ANTI ESTROGENS68:16
ESTROGENS68 :16.04
Estrogen, congugated Premarintab 0.3mg, 0.625mg, 1.25mg, DOC FORMULARY ITEMSinj 25mg/5ml (Refrigerate)vag 0.625mg/applicator cream
ANTIDIABETIC AGENTS68:20
INSULIN68:20.08
Insulin, Human NPH Novolin-N (Refrigerate)inj 100units/ml PYXIS REFRIGERATOR DOC FORMULARY ITEM
Insulin, Human Regular Novolin-R (Refrigerate)inj 100units/ml PYXIS REFRIGERATOR DOC FORMULARY ITEM
Insulin, Human, 70/30 Novolin-70/30 (Refrigerate)inj 70units NPH + 30units REGULAR/ml DOC FORMULARY ITEM
- 46 -
PYXIS REFRIGERATOR
Insulin, Aspart NovoLog (Refrigerate) inj 100units/ml PYXIS REFRIGERATOR(Therapeutically equivalent to Humalog, Insulin Lispro)
Insulin, Aspart Protamine 70%/ Insulin Aspart 30% NovoLog Mix 70/30 (Refrigerate)Inj 70units aspart protamine susp./ml
30units aspart/ml PYXIS REFRIGERATOR(Therapeutically equivalent to Humalog Mix 75/25 Lispro Protamine, Lispro)
Insulin, Glargine Lantus (Refrigerate)Inj 100units/ml PYXIS REFRIGERATOR
SULFONYLUREAS68:20.20
Acetohexamide Dymelortab 250mg, 500mg
Chlorpropamide Diabinesetab 250 mg
Glipizide Glucotroltab 5mg, 10mg PYXIS DOC FORMULARY ITEMStab 5mg, 10mg extended release DOC FORMULARY ITEMS
Glyburide Diabeta, Glynasetab 1.25mg DOC FORMULARY ITEMtab 2.5mg, 5mg PYXIS DOC FORMULARY ITEMS
Metformin Glucophagetab 500mg, 850mg, 1000mg PYXIS DOC FORMULARY-500mg, 800mg
ANTIDIABETIC AGENTS - MISCELLANEOUS68:20.92
Glucagoninj 1mg/ml
Pioglitazoone Actostab 15mg, 30mg
Rosiglitazone Avandiatab 2mg, 4mg DOC FORMULARY ITEMS
PARATHYROID68:24
Calcitonin Miacalcin (Refrigerate)nasl spray
PITUITARY HORMONE68:28
Corticotropin ACTH, Acthar
- 47 -
inj 40units
Cosyntropin Cortrosyninj 250mcg/ml
Desmopressin Acetate DDAVPinj 4mcg/ml (Refrigerate)inh 0.1mg/ml nasal
Vasopressin Pitressininj 20units/ml
PROGESTINS68:32 Medroxyprogesterone Acetate Provera, Depo-Provera
tab 2.5mg, 5mg, 10mg DOC FORMULARY ITEMSinj 150mg/ml
THYROID AND ANTITHYROID AGENTS68:36
THYROID AGENTS68:36.04
Levothyroxine Synthroidtab 25mcg, 50mcg, 75mcg, 88mcg, 100mcg DOC FORMULARY ITEMStab 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg DOC FORMULARY
ITEMSinj 200mcg, 500mcg
Liothyronine Cytomeltab 25mcg
Thyroidtab 15mg, 30mg, 60mg, 120mg
ANTITHYROID AGENTS68:36.08
Methimazole Tapazoletab 10mg
Propylthiouracil PTUtab 50mg DOC FORMULARY ITEM
LOCAL ANESTHETICS72:00
Benzocaine Orabase B, Oragelliq 10%, 20%
Bupivicaine/Epinephrine Marcaine/Epiinj 0.25%/1:200000, 0.5%/1:200000
Ethyl Chloridetop spray
- 48 -
Lidocaine Xylocaineliq 2% viscous oral solution Xylocaine Viscousinj 0.5%, 1.5%, 2% DOC FORMULARY- 2%inj 1% 2ml, 20ml, 30ml PYXIS DOC FORMULARY ITEMSinj 1% preservative-freetop 2% jellytop 4% topical solutiontop 5% ointmenttop 5% transdermal patch
Lidocaine/Epinephrine Xylocaine/Epiinj 0.5%/1:100000, 1%/1:100000, 2%/1:200000 DOC FORMULARY-1%/1:100000
Lidocaine/Glucose Xylocaine Spinalinj 1.5%/7.5%, 5%/7.5%
Lidocaine/Prilocaine Emlatop 2.5%/2.5% cream
Tetracaine Pontocainetop 2% solution
OXYTOCICS76:00 Methylergonovine Maleate Methergine
tab 0.2mginj 0.2mg
Bacteriostatic Sodium Chlorideinj 0.9%
SERUMS, TOXOIDS, AND VACCINES80:00
SERUMS80:04
Digoxin Immune Fab Digibind (Refrigerate)inj 38mg vial neutralizes 500mcg of digoxin
Hepatitis B Immune Globulin H-BIG (Refrigerate)inj 5ml DOC FORMULARY ITEM
Varicella Zoster Immune Globulin Varicella Zoster (Refrigerate)inj 125units/2ml
TOXOIDS80:08
Tetanus/Diptheria Adult TET-DIP (Refrigerate)inj DOC FORMULARY ITEM
VACCINES80:12
Hepatitis A Virus Vaccine Havrix (Refrigerate)
- 49 -
inj DOC FORMULARY ITEM
Hepatitis B Virus Vaccineinj 20mcg/ml Engerix-B (Refrigerate) DOC FORMULARY ITEM
40mcg/ml Dialysis Formulation
Measles/Mumps/Rubella M-M-R-II (Refrigerate)inj DOC FORMULARY ITEM
Pneumococcal Vaccine Pnu-Immune-23 (Refrigerate)inj 0.5ml DOC FORMULARY ITEM
Rabies Vaccine RabAvert (Refrigerate)inj
SKIN AND MUCOUS MEMBRANE AGENTS84:00
ANTI-INFECTIVES – Skin & Mucous Membrane agents84:04
ANTIBIOTICS (topical)84:04.04
Bacitracin/Zinctop ointment
Clindamycin Cleocin, Cleocin Ttop 1% solutionvag 2% cream
Erythromycintop 2% geltop 2% oint
Gentamicin Garamycintop 1% ointment, cream DOC FORMULARY ITEMS
Mupirocin Bactrobantop 2% ointment
Polym/Bac/Neo Neosprorintop ointment DOC FORMULARY ITEM
Polym/Bac/Neo/Hydrocort Cortisporintop ointment, cream
Polymixin B/Bacitracin Polysporintop ointment
ANTIVIRALS84:04.06
Acyclovir Zovirax
- 50 -
top ointment
ANTIFUNGALS84:04.08
Clotrimazole Mycelexoral 10mg troche PYXIStop 1% cream, lotion, solution DOC FORMULARY-1% cream
vag 100mg, 500mg tabletvag 1% cream
Clotrimazole/Betameth Lotrisonetop 1%/0.05% cream
Gentian Violettop 1% solution
Ketoconazole Nizoraltop 2% creamtop 2% shampoo
Miconazole Monistatpdr 2%top 2% creamvag 100mg, 200mg suppository DOC FORMULARY ITEMS
vag 2% cream DOC FORMULARY ITEM
Nystatin Nystoptop 100,000 creamtop 100,000 ointmentpdrvag tablet
Nystatin/Triamcinolone Mycolog IItop 1%/100000 cream DOC FORMULARY ITEM
Terbinafine Lamisiltop 1% creamtop 1% solution
Terconazole Terazolvag 0.4%, 0.8% creamvag 80mg suppository
Tolnaftate Tinactintop 1% cream, powder, spray
SCABICIDES AND PEDICULICIDES84:04.12
Permethrin Acticin, Nixtop 1% rinsetop 50mg cream
- 51 -
ANTI-INFECTIVES – LOCAL - MISCELLANEOUS84.04.16
Aluminum Acetate Domeborotop solution
Chlorhexidine Hibiclenstop 4% solution
Hexachlorophene Phisohextop 3% cleanser solution
Hydrogen Peroxidetop 3% solution
Iodine Strong Iodinetop 7% solution
Povidone -Iodine Betadinetop 10% ointmenttop 10% solution, 7.5% surgical scrug
Selenium Selsuninj 400mcg/mltop 1%, 2.5% shampoo
Silver Sulfadiazine Silvadenetop 1% cream
ANTI-INFLAMMATORY AGENTS84:06
Betamethasone Dipropionate Diprosonetop 0.05% cream (High/Medium Potency) DOC FORMULARY ITEM
0.05% ointment (High Potency) DOC FORMULARY ITEM0.05% lotion (Medium Potency) DOC FORMULARY ITEM
Betamethasone Diproprionate Augmentedtop 0.05% cream (High Potency) Diprolene AF DOC FORMULARY ITEM
0.05% ointment (Very High Potency) Diprolene DOC FORMULARY ITEM
Betamethasone Valeratetop 0.1% ointment (High/Medium Potency)
Bismusthsubgal./Hydrocort Anusol-HCrect 2.5% HC cream DOC FORMULARY ITEMrect 1% HC ointment
Clobetasol Proprionatetop 0.05% cream, ointment (Very High Potency) DOC FORMULARY ITEMS
Fluocinonide Acetonide Lidextop 0.05%, cream, ointment, solution (High Potency) DOC FORMULARY-
CREAM, OINTMENT
- 52 -
Fluocinolone Acetonide Synalartop 0.01% cream, solution (Low Potency) DOC FORMULARY ITEMtop 0.025% cream (Medium/Low Potency) DOC FORMULARY ITEM
0.025% ointment (Medium Potency) DOC FORMULARY ITEM
Hydrocortisone Cortaidtop 0.5%, 1%, 2.5% cream (Lowest Potency) DOC FORMULARY-2.5%top 0.5%, 1%, 2.5% ointment (Lowest Potency)enema 100mg/60ml PYXIS Cortenema
Hydrocort/Phenylephrine Preparation Htop 0.25% ointmentrect 0.25% suppositories
Triamcinolone Acetonideinh 200mcg PYXIS Azmacortnasl 55mcg Nasacorttop 0.025% ointment (Medium Potency) Aristocort
DOC FORMULARY ITEM0.025% cream (Low Potency) Aristocort0.1% cream (Medium Potency) Aristocort0.1% ointment (High/Medium Potency) Aristocort
DOC FORMULARY ITEM
ANTIPURITICS AND LOCAL ANESTHETICS84:08
Benzocaine Combinations Cetacainetop spray
Hydrocortisone Anusol HCrect 25 mg suppository
Phenazopyridine Pyridiumtab 100mg, 200mg PYXIS DOC FORMULARY ITEMS
Pramoxine, Mineral Oil, Zinc Oxide Anusolrect ointment
Starch Anusolrect 51% suppository
ASTRIGENTS84:12
Bismuth Subgallate/Hydrocortisone Annusol HCrect Suppository, ointment
Witch Hazel Tuckstop 50% saturated pads
CELL STIMULANTS, PROLIFERANTS84:16
Tretinoin Retin-A
- 53 -
top 0.025%, 0.1% creamtop 0.01%, 0.025% gel
Urea Carmoltop 10% lotion
EMOLLIENT, DEMULCENT, PROTECTANTS84:24
Analgesic Balm Ben Gaytop ointment
Balsam Per/Castor Oil/Trypsin Granulextop spray
Benzoin Cpd. Tincture Aerozointop liquid spray
Calaminetop lotion
Camphor/Menthol Sarnatop 0.5%/0.5% lotion
Collodion Flexible Collodiontop liquid
Hydrophilic Ointment Aquaphortop ointment
Lanolin Hydroustop ointment
Mineral Oil Muri-Lubetop solution
Oatmeal, Collodial Aveenotop oilated flakes
Papain/Urea Accuzyme, Ethezyme top ointment
Papain/Urea/Chlorophyllin/Copper Panafil, Zioxtop ointment
Petrolatum/Mineral Oil Eucerintop cream
Petrolatum, White Vaselinetop ointment
Talcum Powder Talctop powder
Vitamin A+D A+D Ointmenttop ointment
- 54 -
Zinc Oxidetop 20% ointment, 40% ointment (Equivalent to Desitin)
KERATOLYTIC AGENTS84:28 Lactic Acid Lac-Hydrin
top 12% lotion
Podophyllum Resin Podofintop 25% solution DOC FORMULARY ITEM
Salicylic Acid SalActop 2% solution
Salicylic Acid/Sulfur Sebulextop shampoo
KERATOPLASTIC AGENTS84:32 Coal Tar Sebutone
top 0.5% shampoo
SKIN AND MUCOUS MEMBRANE AGENTS84:36 Calcipotriene Dovonex
top 0.005% ointment
Fluorouraciltop 5% cream
SMOOTH MUSCLE RELAXANTS86:00
GENITOURINARY SMOOTH MUSCLE RELAXANTS86:12
Flavoxate Urispastab 100mg
Oxybutynin Ditropantab 5mg PYXIS DOC FORMULARY ITEMliquid 5mg/5mltab 5mg, 10mg extended release
RESPIRATORY SMOOTH MUSCLE RELAXANTS86:16
Aminophyllineinj 25mg/ml 20ml PYXIS
Theophylline TheoDurtab extended release 100mg, 200mg, 300mg PYXIS DOC FORMULARY ITEMSliq 80mg/15ml solution DOC FORMULARY ITEM
- 55 -
UNCLASSIFIED THERAPEUTIC AGENTS92:00
Adenosine Adenocardinj 6mg/2ml, 9mg
Alendronate Fosamaxtab 10mg, 70mg
Allopurinol Zyloprimtab 100mg DOC FORMULARY ITEMtab 300mg PYXIS DOC FORMULARY ITEM
Azathioprine Imurantab 50mg
Bromocriptine Parlodeltab 2.5mg
Carbidopa/Levodopa Sinemettab 10mg/100mg, 25mg/100mg, 25/250mgtab sustained release 25mg/100mg, 50mg/200mg
Clopidogrel Plavixtab 75mg
Colchicinetab 600mcg PYXISinj 0.5mg/ml
Cherry Syrupliq
Chlorahexidine Gluconate Peridexliq oral rinseinj 500mcg/ml, 1mg/ml
Cromolyn Sodium Intalcap 20mginh 20mg solution for inhalationnasl 4% sprayopth 4% solution
Cyclosporine Sandimmunecap 25mg, 100mggel caps 25mg, 100mg (not bioequivalent with Sandimmune)liq 100mg/ml
Disulfiram Antabusetab 250mg
Finasteride Proscartab 5mg
Glutaminepdr
- 56 -
Leucovorin Calcium Leucovorintab 5mg PYXISinj 100mg
Methylene Blueinj 1%
Octreotide Acetate Sandostatin (Refrigerate)inj 50mcg/ml, 100mcg/ml, 500mcg/ml
Oprelverin Neumegainj 5mg
Pamidronate Avediainj 90mg/vial
Peppermint Spiritsliq
Phenol Chlorasepticliq 1.4% spray
Saliva Substituteliq
Selegiline Eldepryltab 5mg
Sumatriptan Imitrexinj 6mg/0.5mltab 25mg, 50mg PYXIS
VITAMINS
88:00
VITAMIN B COMPLEX88:08
Cyancobalamine Vitamin B12inj 100mcg, 1000mcg DOC FORMULARY-1000mcg
Folic Acid Folvitetab 1mg DOC FORMULARY ITEMinj 5mg/ml
Niacin/Niacinamide Nicotinic Acid
- 57 -
tab 50mg, 100mg, 250mg, 500mgcap 250mg, 500mg extended release DOC FORMULARY-250mg
Pyridoxine Vitamin B-6tab 25mg, 50mg PYXIS DOC FORMULARY ITEMStab 100mg DOC FORMULARY ITEMinj 100mg/ml
Thiamine Vitamin B-1tab 50mg, 100mg DOC FORMULARY ITEMSinj 100mg/ml
Vitamin B Complextab
Vitamin B with C Nephrocapcap
Vitamin B Complex with C Stress Capcap
VITAMIN C88:12
Ascorbic Acidtab 250mg DOC FORMULARY ITEMtab 500mg PYXIS DOC FORMULARY ITEMliq 100mg/mlinj 500mg/ml
VITAMIN D88:16
Calcitriol Rocaltrolcap 0.25mcg PYXIScap 0.5mcg
Paricalcitol ZemplarInj 5mcg/ml
VITAMIN E88:20
Vitamin E Eprolincap 200units, 400units DOC FORMULARY-400units
top cream
VITAMIN K ACTIVITY88:24
Phytonadione Mephyton, Aqua-mephytontab 5mg PYXISinj 1mg/0.5mlinj 10mg/ml PYXIS
MULTIVITAMIN PREPARATIONS88:28
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Multivitamintabliqinj MVI-12 (Refrigerate)
Multivitamin /Iron Theragran Hematinictab
Multivitamins Theragrantabliq
Multivitamins /Minerals Theragran Mtab DOC FORMULARY ITEM
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