luke air force base outpatient formulary alphabetical...

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Alphabetical Listing by Name

This do cument is cu rrent as of The availability of formulary items is subject to change.

Luke Air Force Base Outpatient Formulary

May 15, 2018.

AcetaminophenOutpatient Dosage FormsSolution, Oral:Generic: 160 mg/5 mL (5 mL, 10 mL, 20 mL)

Suppository, Rectal:Generic: 120 mg (12 ea)

Tablet, Oral:Generic: 325 mg

Acetaminophen and CodeineOutpatient Dosage FormsSolution, oral [C-V]: Acetaminophen 120 mg and codeine phosphate 12 mg per5 mL (5 mL, 10 mL, 12.5 mL, 15 mL, 118 mL, 473 mL) [BCF]

Tablet, oral [C-III]: Acetaminophen 300 mg and codeine phosphate30 mg [BCF]

AcetaZOLAMIDEOutpatient Dosage FormsCapsule Extended Release 12 Hour, Oral:Generic: 500 mg

Acetic Acid, Propylene Glycol Diacetate, and HydrocortisoneOutpatient Dosage FormsSolution, Otic [drops]:Acetasol HC: Acetic acid 2%, propylene glycol diacetate 3%, and hydro-cortisone 1% (10 mL) [contains benzethonium chloride]

AcitretinOutpatient Dosage FormsCapsule, Oral:Soriatane: 10 mg, 25 mg [contains edetate calcium disodium]

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

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

Tablet, Oral:Generic: 800 mg [BCF]

Acyclovir (Topical)Outpatient Dosage FormsOintment, external: 5% (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]Humira Pen-Crohns Starter: 40 mg/0.8 mL (1 ea) [contains polysorbate80] [BCF]

Prefilled Syringe Kit, Subcutaneous [preservative free]:Humira: 20 mg/0.4 mL (1 ea) [BCF] [contains polysorbate 80]

AdapaleneOutpatient Dosage FormsGel, External:Generic: 0.1% (45 g)

AlbiglutideOutpatient Dosage FormsPen-injector, Subcutaneous [preservative free]:Tanzeum: 30 mg (1 ea); 50 mg (1 ea) [contains polysorbate 80]

AlbuterolOutpatient Dosage FormsSolution, for nebulization: 0.083% [2.5 mg/3 mL] (25s, 30s, 60s) [BCF], 0.5%(20 mL)

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

Syrup, oral: 2 mg/5 mL (473 mL)

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

Tablet, oral: 5 mg [BCF], 10 mg [BCF], 35 mg [BCF], 70 mg [BCF]

Alendronate and CholecalciferolOutpatient Dosage FormsTablet, oral:Fosamax Plus D 70/2800: Alendronate 70 mg and cholecalciferol 2800 unitsFosamax Plus D: 70/5600: Alendronate 70 mg and cholecalciferol 5600 int.units

AlfuzosinOutpatient Dosage FormsTablet, extended release, oral, as hydrochloride: 10 mg [BCF]

AliskirenOutpatient Dosage FormsTablet, Oral:Tekturna: 150 mg, 300 mg

AllopurinolOutpatient Dosage FormsTablet, oral: 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:Drysol: 20% (35 mL, 37.5 mL, 60 mL)

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

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

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

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

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

Amlodipine and BenazeprilOutpatient Dosage FormsCapsule, oral:2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF]5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF]5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF]5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF]10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF]10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF]

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

Powder for suspension, oral:Generic: 125 mg/5 mL (80 mL, 100 mL, 150 mL); 250 mg/5 mL (80 mL, 100mL, 150 mL) [BCF]


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]

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]

AnastrozoleOutpatient Dosage FormsTablet, Oral:Generic: 1 mg

ApixabanOutpatient Dosage FormsTablet, Oral:Eliquis: 2.5 mg, 5 mg

ARIPiprazoleOutpatient Dosage FormsTablet, Oral:Abilify: 2 mg, 5 mg, 10 mg, 20 mg, 30 mg

ACETAMINOPHEN

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Artificial TearsOutpatient Dosage FormsSolution, ophthalmic:Tears Again®: Polyvinyl alcohol 1.4% (30 mL) [contains benzalkoniumchloride]

AspirinOutpatient Dosage FormsTablet, enteric coated, oral: 81 mg, 325 mg

Aspirin and DipyridamoleOutpatient Dosage FormsCapsule, variable release, oral:Aggrenox®: Aspirin 25 mg [immediate release] and dipyridamole 200 mg[extended release] [contains lactose, sucrose]

AtenololOutpatient Dosage FormsTablet, oral: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

AtoMOXetineOutpatient Dosage FormsCapsule, Oral:Strattera: 10 mg, 18 mg, 25 mg, 40 mg, 60 mgStrattera: 80 mg, 100 mg [contains fd&c blue #2 (indigotine)]

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

Atropine (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as sulfate:Generic: 1% (5 mL, 15 mL)

Azelaic AcidOutpatient Dosage FormsCream, External:Azelex: 20% (30 g, 50 g)

Azelastine (Nasal)Outpatient Dosage FormsSolution, Nasal, as hydrochloride:Generic: 137 mcg/spray (30 mL)

Azithromycin (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic:AzaSite: 1% (2.5 mL) [contains benzalkonium chloride, disodium edta]

Azithromycin (Systemic)Outpatient Dosage FormsPowder for suspension, oral, as dihydrate [strength expressed as base]:100 mg/5 mL (15 mL) [BCF]; 200 mg/5 mL (15 mL, 22.5 mL, 30 mL); 1 g/packet (3s) [BCF]

Powder for suspension, oral, as monohydrate [strength expressed as base]:100 mg/5 mL (15 mL) [BCF]

Tablet, oral, as anhydrous: 250 mg [BCF], 500 mg [BCF]Tablet, oral, as dihydrate [strength expressed as base]: 250 mg [BCF],500 mg [BCF]

Tablet, oral, as monohydrate [strength expressed as base]: 250 mg [BCF],500 mg [BCF]

Tablet, oral [tri-pak]: 500 mg

Bacitracin and Polymyxin B (Ophthalmic)Outpatient Dosage FormsOintment, ophthalmic: Bacitracin 500 units and polymyxin B 10,000 units per g(3.5 g)

Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone(Ophthalmic)Outpatient Dosage FormsOintment, ophthalmic: Bacitracin 400 units, neomycin 3.5 mg, polymyxin B10,000 units, and hydrocortisone 10 mg per g (3.5 g)

Bacitracin (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Generic: 500 units/g (3.5 g)

Bacitracin (Topical)Outpatient Dosage FormsOintment, External, as zinc [strength expressed as base]:Generic: 500 units/g (1 ea, 1 g, 14.2 g, 15 g, 28 g, 28.35 g, 28.4 g, 30 g,120 g, 453.9 g, 454 g

BaclofenOutpatient Dosage FormsTablet, Oral:Generic: 10 mg

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

Benazepril and HydrochlorothiazideOutpatient Dosage FormsTablet, oral:Generic: 5/6.25: Benazepril hydrochloride 5 mg and hydrochlorothiazide6.25 mg

Generic: 10/12.5: Benazepril hydrochloride 10 mg and hydrochlorothiazide12.5 mg

Generic: 20/12.5: Benazepril hydrochloride 20 mg and hydrochlorothiazide12.5 mg

Generic: 20/25: Benazepril hydrochloride 20 mg and hydrochlorothia-zide 25 mg

BenzonatateOutpatient Dosage FormsCapsule, Oral:Generic: 100 mg

Benzoyl PeroxideOutpatient Dosage FormsGel, External:Generic: 5% (42.5 g, 60 g, 90 g)

Liquid, External:Benzoyl Peroxide Wash: 10% (142 g) [contains edetate disodium]

BenztropineOutpatient Dosage FormsTablet, oral, as mesylate: 0.5 mg [BCF], 2 mg [BCF]

Betamethasone and ClotrimazoleOutpatient Dosage FormsCream, External:Generic: Betamethasone dipropionate 0.05% (base) and clotrimazole1% (15 g)

Betamethasone (Topical)Outpatient Dosage FormsCream, External, as dipropionate [strength expressed as base]:Generic: 0.05% (15 g, 45 g, 50 g)

Ointment, External, as dipropionate [strength expressed as base]:Generic: 0.05% (15 g, 45 g, 50 g)

Betaxolol (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic: 0.5% (5 mL, 10 mL, 15 mL)

BimatoprostOutpatient Dosage FormsSolution, Ophthalmic:Lumigan: 0.01% (7.5 mL) [contains benzalkonium chloride]

BisacodylOutpatient Dosage FormsSuppository, Rectal:Dulcolax: 10 mg (4 ea, 8 ea, 16 ea, 28 ea, 50 ea)

Tablet Delayed Release, Oral:Dulcolax: 5 mg [contains fd&c yellow #10 (quinoline yellow), methylparaben,propylparaben, sodium benzoate]

Bismuth SubsalicylateOutpatient Dosage FormsSuspension, Oral, as subsalicylate:Pepto-Bismol: 262 mg/15 mL (473 mL) [contains benzoic acid, d&c red #22(eosine), saccharin sodium]

Tablet 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 [drops]:Alphagan P: 0.1% (5 mL, 10 mL, 15 mL); 0.15% (5 mL, 10 mL, 15 mL) [BCF][contains carboxymethylcellulose sodium]

Generic: 0.15% (5 mL, 10 mL, 15 mL) [BCF]; 0.2% (5 mL, 10 mL, 15mL) [BCF]

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

BUDESONIDE (ORAL INHALATION)

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BuPROPionOutpatient Dosage FormsTablet, oral, as hydrochloride: 75 mg [generic for Wellbutrin®] [BCF], 100 mg[generic for Wellbutrin®] [BCF]

Tablet, extended release, oral, as hydrochloride: 100 mg [generic for WellbutrinSR®] [BCF], 150 mg [generic for Wellbutrin XL®] [BCF], 150 mg [generic forZyban®] [BCF], 300 mg [generic for Wellbutrin XL®] [BCF]

Tablet, sustained release, oral, as hydrochloride:Wellbutrin SR®: 100 mg [BCF], 150 mg [BCF]

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

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

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

CalcipotrieneOutpatient Dosage FormsCream, External:Generic: 0.005% (60 g, 120 g)

Ointment, External:Generic: 0.005% (60 g, 120 g)

Solution, External:Generic: 0.005% (60 mL)

Calcitriol (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 0.25 mcg

CandesartanOutpatient Dosage FormsTablet, Oral, as cilexetil:Generic: 4 mg, 8 mg, 16 mg, 32 mg

Candesartan and HydrochlorothiazideOutpatient Dosage FormsTablet, oral: 16/12.5: Candesartan cilexetil 16 mg and hydrochlorothiazide12.5 mg; 32/12.5: Candesartan cilexetil 32 mg and hydrochlorothiazide12.5 mg

CapsaicinOutpatient Dosage FormsCream, External:Trixaicin: 0.025% (60 g) [contains benzyl alcohol]

CaptoprilOutpatient Dosage FormsTablet, oral: 12.5 mg [BCF], 25 mg [BCF], 50 mg [BCF]

CarBAMazepineOutpatient Dosage FormsSuspension, oral: 100 mg/5 mL (10 mL, 450 mL) [BCF]Tablet, oral: 200 mg [BCF]Tablet, chewable, oral: 100 mg [BCF]Tablet, extended release, oral: 200 mg, 400 mg [BCF]

Carbamide PeroxideOutpatient Dosage FormsSolution, Otic:Auraphene-B: 6.5% (15 mL)Debrox: 6.5% (15 mL) [contains propylene glycol]E-R-O Ear Drops: 6.5% (15 mL) [contains glycerin]E-R-O Ear Wax Removal System: 6.5% (15 mL)Ear Drops Earwax Aid: 6.5% (15 mL)Ear Wax Remover: 6.5% (15 mL) [contains propylene glycol]Earwax Treatment Drops: 6.5% (15 mL)Thera-Ear: 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:Refresh Optive Advanced: 0.5% (10 mL)Refresh Plus: 0.5% (30 ea, 50 ea, 70 ea)

Solution, Ophthalmic, as sodium [preservative free]:Refresh Celluvisc: 1% (30 ea)

Refresh Plus: 0.5% (30 ea, 50 ea)

CarvedilolOutpatient Dosage FormsTablet, oral: 3.125 mg [BCF], 6.25 mg [BCF], 12.5 mg [BCF], 25 mg [BCF]

CefdinirOutpatient Dosage FormsCapsule, Oral:Generic: 300 mg

Suspension Reconstituted, Oral:Generic: 125 mg/5 mL (60 mL, 100 mL); 250 mg/5 mL (60 mL, 100 mL)

CefprozilOutpatient Dosage FormsSuspension Reconstituted, Oral:Generic: 125 mg/5 mL (50 mL, 75 mL, 100 mL); 250 mg/5 mL (50 mL, 75 mL,100 mL)

Tablet, Oral:Generic: 250 mg, 500 mg

CelecoxibOutpatient Dosage FormsCapsule, Oral:CeleBREX: 100 mg, 200 mg, 400 mg

CephalexinOutpatient Dosage FormsCapsule, oral: 250 mg [BCF], 500 mg [BCF]Powder for suspension, oral: 125 mg/5 mL (100 mL, 200 mL); 250 mg/5 mL(100 mL, 200 mL) [BCF]

Cetirizine (Systemic)Outpatient Dosage FormsSyrup, Oral, as hydrochloride:Generic: 1 mg/mL (120 mL, 480 mL); 5 mg/5 mL (5 mL, 120 mL, 473 mL)

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

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

ChloroquineOutpatient Dosage FormsTablet, Oral, as phosphate:Generic: 500 mg [equivalent to chloroquine base 300 mg]

ChlorpheniramineOutpatient Dosage FormsTablet, Oral, as maleate:Generic: 4 mg

ChlorthalidoneOutpatient Dosage FormsTablet, oral: 25 mg [BCF], 50 mg [BCF]

Cholestyramine ResinOutpatient Dosage FormsPacket, oral:Questran Light: 4 g (1 ea, 60 ea) [sugar free; contains aspartame; orangeflavor]

Powder, oral:Questran Light: 4 g/dose (210 g) [sugar free; contains aspartame]

CiclopiroxOutpatient Dosage FormsSolution, External:Generic: 8% (6.6 mL)

CilostazolOutpatient Dosage FormsTablet, Oral:Generic: 50 mg, 100 mg

Ciprofloxacin and DexamethasoneOutpatient Dosage FormsSuspension, Otic:Ciprodex: Ciprofloxacin 0.3% and dexamethasone 0.1% (7.5 mL) [containsbenzalkonium chloride]

Ciprofloxacin and HydrocortisoneOutpatient Dosage FormsSuspension, otic:Cipro HC: Ciprofloxacin hydrochloride 0.2% and hydrocortisone 1% (10 mL)[contains benzyl alcohol]

BUPROPION

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Ciprofloxacin (Systemic)Outpatient Dosage FormsTablet, Oral, as hydrochloride [strength expressed as base]:Generic: 250 mg [BCF], 500 mg [BCF], 750 mg [BCF]

CitalopramOutpatient Dosage FormsSolution, oral: 10 mg/5 mL (240 mL) [BCF]Tablet, oral: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]

ClarithromycinOutpatient Dosage FormsSuspension Reconstituted, Oral:Generic: 125 mg/5 mL (50 mL, 100 mL); 250 mg/5 mL (50 mL, 100 mL)


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

Clindamycin and Benzoyl PeroxideOutpatient Dosage FormsGel, topical: Clindamycin phosphate 1% and benzoyl peroxide 5% (50 g);Clindamycin phosphate 1.2% and benzoyl peroxide 5% (45 g)

Clindamycin (Systemic)Outpatient Dosage FormsCapsule, oral, as hydrochloride [strength expressed as base]: 150 mg [BCF],300 mg

Solution reconstituted, oral, as palmitate hydrochloride [strength expressed asbase]: 75 mg/5 mL (100 mL)

Clindamycin (Topical)Outpatient Dosage FormsCream, vaginal, as phosphate [strength expressed as base]: 2% (40 g) [BCF]Solution, topical, as phosphate [strength expressed as base]: 1% (30 mL, 60mL) [BCF]

ClobetasolOutpatient Dosage FormsGel, External, as propionate:Generic: 0.05% (15 g, 30 g, 60 g)

Ointment, External, as propionate:Generic: 0.05% (15 g, 30 g, 45 g, 60 g)

Solution, External, as propionate:Generic: 0.05% (25 mL, 50 mL)

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

ClonazePAMOutpatient Dosage FormsTablet, oral: 0.5 mg [BCF], 1 mg

CloNIDineOutpatient Dosage FormsPatch Weekly, Transdermal: 0.1 mg/24 hr (4 ea); 0.2 mg/24 hr (4 ea); 0.3 mg/24 hr (4 ea)

Tablet, oral, as hydrochloride: 0.1 mg [BCF], 0.2 mg [BCF], 0.3 mg [BCF]

ClopidogrelOutpatient Dosage FormsTablet, oral: 75 mg [BCF]

Clotrimazole (Oral)Outpatient Dosage FormsTroche, Mouth/Throat:Generic: 10 mg

Clotrimazole (Topical)Outpatient Dosage FormsCream, External:Generic: 1% (15 g, 30 g, 45 g)

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

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

CodeineOutpatient Dosage FormsTablet, Oral, as sulfate:Generic: 30 mg

ColestipolOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 1 g

Compounded Topical ProductsOutpatient Dosage FormsGel, Topical [scar gel]:Generic: extemporaneously prepared

Ointment, Topical [Magic Bottom]:Generic: extemporaneously prepared

Solution, Topical [Pain compound]:Generic: extemporaneously prepared

Cromolyn (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as sodium:Generic: 4% (10 mL)

CyanocobalaminOutpatient Dosage FormsSolution, Injection:Generic: 1000 mcg/mL (1 mL, 10 mL, 30 mL)

Tablet, Oral:Generic: 1000 mcg

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

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

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 [contains fd&c yellow #6 (sunset yellow)]Pradaxa: 150 mg [contains fd&c blue #2 (indigotine), fd&c yellow #6 (sunsetyellow)]

DesmopressinOutpatient Dosage FormsSolution, Nasal, as acetate:Generic: 0.01% (2.5 mL, 5 mL)

Dexamethasone (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 0.5 mg, 0.75 mg, 4 mg

Dextroamphetamine and AmphetamineOutpatient Dosage FormsCapsule, extended release, oral: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]

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: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 3.13 mg)]

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)]

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)]

20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate5 mg (equivalent to amphetamine base 12.6 mg)]

Diabetic SuppliesOutpatient Dosage FormsGlucose meter:Precision Xtra Blood Glucose Monitoring System

Lancet:FreeStyle Lancets (100s)

DIABETIC SUPPLIES

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Syringe and needle:BD Syringe 0.3 mL [31 gauge] (100s)BD Syringe 1 mL [29 gauge x 1/2"] (100s)BD Syringe 0.5 mL [29 gauge x 1/2"] (100s)BD Syringe and Luer-Lok™ tip: 3 mL [23 gauge]BD Short Pen Needles (Ultra-Fine™ III) [31 gauge] (100s)BD Syringe 0.3 mL (Ultra-Fine™) [30 gauge] (100s)BD Ultra-Fine Pen Needles Nano [32 gauge x 4 mm) (100s)

Test Strips/Kit:Keto-Diastix Reagent Strips [50/box]Precision Xtra Blood Glucose Test Strips (100s) [BCF]

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

Diclofenac (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as sodium:Generic: 0.1% (2.5 mL, 5 mL)

Diclofenac (Systemic)Outpatient Dosage FormsTablet, Oral, as potassium:Generic: 50 mg

Tablet Delayed Release, Oral, as sodium:Generic: 25 mg, 50 mg, 75 mg

Diclofenac (Topical)Outpatient Dosage FormsGel, Transdermal, as sodium:Voltaren: 1% (100 g) [contains isopropyl alcohol, propylene glycol]

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

DicyclomineOutpatient Dosage FormsCapsule, oral, as hydrochloride: 10 mg [BCF]Syrup, oral, as hydrochloride: 10 mg/5 mL (473 mL) [BCF]Tablet, oral, as hydrochloride: 20 mg [BCF]

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

DigoxinOutpatient Dosage FormsSolution,oral: 0.05 mg/mL (60 mL)Tablet, oral: 125 mcg [BCF], 250 mcg [BCF]

DilTIAZemOutpatient Dosage FormsCapsule, extended release, oral, as hydrochloride [once-daily dosing]: 120 mg[BCF], 180 mg [BCF], 240 mg [BCF], 300 mg [BCF], 360 mg [BCF], 420 mg[BCF]

Tablet, oral, as hydrochloride: 60 mg

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

Elixir, Oral, as hydrochloride:Generic: 12.5 mg/5 mL (5 mL, 10 mL)

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

DipyridamoleOutpatient Dosage FormsTablet, Oral:Generic: 25 mg, 75 mg

DisulfiramOutpatient Dosage FormsTablet, Oral:Generic: 250 mg

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

Docusate and SennaOutpatient Dosage FormsTablet, Oral:Generic: Docusate sodium 50 mg and sennosides 8.6 mg

DonepezilOutpatient Dosage FormsTablet, oral, as hydrochloride: 5 mg, 10 mg

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

Dorzolamide and TimololOutpatient Dosage FormsSolution, ophthalmic [drops, preservative free]:Cosopt® PF: Dorzolamide 2% and timolol 0.5% (0.2 mL)

DoxazosinOutpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2 mg, 4 mg, 8 mg

Doxepin (Systemic)Outpatient Dosage FormsCapsule, oral: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF], 100 mgSolution, oral [concentrate]: 10 mg/mL (118 mL, 120 mL) [BCF]

DoxycyclineOutpatient Dosage FormsCapsule, oral, as hyclate [strength expressed as base]: 100 mg [BCF]Tablet, oral, as hyclate [strength expressed as base]: 100 mg [BCF]

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

EmollientsOutpatient Dosage FormsCream, topical:Vanicream: (453 g) [dye free, fragrance free]

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

EnalaprilOutpatient Dosage FormsTablet, Oral, as maleate:Generic: 2.5 mg, 5 mg, 10 mg, 20 mg

EnoxaparinOutpatient Dosage FormsInjection, solution, as sodium: 100 mg/mL (3 mL) [BCF]Injection, solution, as sodium [preservative free]: 30 mg/0.3 mL (0.3 mL) [BCF];40 mg/0.4 mL (0.4 mL) [BCF]; 60 mg/0.6 mL (0.6 mL) [BCF]; 80 mg/0.8 mL(0.8 mL) [BCF]; 100 mg/mL (1 mL) [BCF]; 120 mg/0.8 mL (0.8 mL) [BCF]

EPINEPHrine (Systemic)Outpatient Dosage FormsDevice, Injection:EpiPen 2-Pak: 0.3 mg/0.3 mL (2 ea) [latex free; contains sodium metabisulfite]EpiPen Jr 2-Pak: 0.15 mg/0.3 mL (2 ea) [contains sodium metabisulfite]Generic: 0.15 mg/0.15 mL (2 ea); 0.3 mg/0.3 mL (2 ea)

ErgocalciferolOutpatient Dosage FormsCapsule, Oral:Generic: 50,000 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]

Tablet, Oral, as stearate:Erythrocin Stearate: 250 mg [BCF]

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

DIABETIC SUPPLIES

6

Erythromycin (Topical)Outpatient Dosage FormsGel, topical: 2% (30 g, 60 g) [BCF]Solution, topical: 2% (60 mL) [BCF]

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

Estradiol (Systemic)Outpatient Dosage FormsPatch, transdermal [once-weekly patch]:Climara: 0.0375 mg/24 hours (4s) [9.375 cm2, total estradiol 2.85 mg] [BCF]Vivelle-Dot: 0.0375 mg/24 hr (8 ea); 0.1 mg/24 hr (8 ea)Generic: 0.025 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/24hours (4s) [BCF]

Tablet, Oral:Generic: 0.5 mg, 1 mg, 2 mg

Estradiol (Topical)Outpatient Dosage FormsCream, Vaginal:Estrace: 0.1 mg/g (42.5 g)

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 medroxyprogester-one acetate 1.5 mg [BCF]

Prempro®: 0.625/2.5: Conjugated estrogens 0.625 mg and medroxyproges-terone acetate 2.5 mg [BCF]

Prempro®: 0.625/5: Conjugated estrogens 0.625 mg and medroxyprogester-one acetate 5 mg [BCF]

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

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

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

Ethinyl Estradiol and DesogestrelOutpatient Dosage FormsTablet, oral [low dose formulation]:Azurette:Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 whitetablets]

Day 22-23: 2 inactive green tabletsDay 24-28: Ethinyl estradiol 0.01 mg [5 blue tablets] (28s)

Tablet, oral [monophasic formulation]:Desogen, Reclipsen: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21white tablets and 7 green inactive tablets] (28s)

Ortho-Cept 28: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 lightorange tablets and 7 green inactive tablets] (28s)

Ethinyl Estradiol and DrospirenoneOutpatient Dosage FormsTablet, oral:Yasmin®: Ethinyl estradiol 0.03 mg and drospirenone 3 mg [21 yellow activetablets and 7 white inactive tablets] (28s) [BCF]

Yaz®: Ethinyl estradiol 0.02 mg and drospirenone 3 mg [24 light pink activetablets and 4 white inactive tablets] (28s) [BCF]

Ethinyl Estradiol and Ethynodiol DiacetateOutpatient Dosage FormsTablet, oral [monophasic formulation]:Kelnor™ 1/35: Ethinyl estradiol 0.035 mg and ethynodiol diacetate 1 mg [21light yellow tablets and 7 white inactive tablets] (28s)

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]: Ethinyl estradiol 0.03 mg and levonor-gestrel 0.15 mg [84 tablets and 7 inactive tablets] (91s)

Tablet, oral [low dose formulation]: Ethinyl estradiol 0.02 mg and levonorgestrel0.1 mg [21 tablets and 7 inactive tablets] (28s)

Tablet, oral [monophasic formulation]: Ethinyl estradiol 0.03 mg and levonor-gestrel 0.15 mg [21 tablets and 7 inactive tablets] (28s)

Tablet, oral [triphasic formulation]:Trivora®:Day 1-6: Ethinyl estradiol 0.03 mg and levonorgestrel 0.05 mg [6 bluetablets]

Day 7-11: Ethinyl estradiol 0.04 mg and levonorgestrel 0.075 mg [5 whitetablets]

Day 12-21: Ethinyl estradiol 0.03 mg and levonorgestrel 0.125 mg [10 pinktablets]

Day 22-28: 7 peach inactive tablets (28s)

Ethinyl Estradiol and NorelgestrominOutpatient Dosage FormsPatch, transdermal:Ortho Evra®: Ethinyl estradiol 0.75 mg and norelgestromin 6 mg [releasesethinyl estradiol 20 mcg and norelgestromin 150 mcg per day] (1s, 3s)

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

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

Ethinyl Estradiol and NorgestimateOutpatient Dosage FormsTablet, oral [monophasic formulation]:Ortho-Cyclen®: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 bluetablets and 7 dark green inactive tablets] (28s) [BCF]

Tablet, oral [triphasic formulation]:Ortho Tri-Cyclen® [BCF]:Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 whitetablets]

Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light bluetablets]

Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 bluetablets]

Day 22-28: 7 dark green inactive tablets (28s)Ortho Tri-Cyclen® Lo [BCF]:Day 1-7: Ethinyl estradiol 0.025 mg and norgestimate 0.18 mg [7 whitetablets]


Day 15-21: Ethinyl estradiol 0.025 mg and norgestimate 0.25 mg [7 darkblue tablets]

Day 22-28: 7 dark green inactive tabletsTriNessa® [BCF]:Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 whitetablets]


Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 bluetablets]

Day 22-28: 7 green inactive tablets

ExenatideOutpatient Dosage FormsSuspension Reconstituted, Subcutaneous:Bydureon: 2 mg (1 ea)

EzetimibeOutpatient Dosage FormsTablet, Oral:Zetia: 10 mg

FelodipineOutpatient Dosage FormsTablet Extended Release 24 Hour, Oral:Generic: 2.5 mg, 5 mg, 10 mg

Fenofibrate and DerivativesOutpatient Dosage FormsCapsule, oral: 67 mg, 134 mgTablet, oral:TriCor®: 48 mg [BCF], 145 mg [BCF] [contains soybean lecithin], 160 mg

FentaNYLOutpatient Dosage FormsPatch, Transdermal, as base:Generic: 12 [delivers 12.5 mcg/hr] (5s); 25 [delivers 25 mcg/hr] (5s); 50[delivers 50 mcg/hr] (5s); 75 [delivers 75 mcg/hr] (5s)

FENTANYL

7

Ferrous SulfateOutpatient Dosage FormsElixir, Oral:Generic: 220 (44 Fe) mg/5 mL (5 mL, 473 mL)

Solution, Oral:Generic: 15 mg/mL (5 mL)

Tablet, Oral:Generic: 325 mg (65 Fe)

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

FinasterideOutpatient Dosage FormsTablet, oral: 5 mg [BCF]

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

FluconazoleOutpatient Dosage FormsTablet, oral: 100 mg, 150 mg [BCF], 200 mg

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

Fluocinolone (Topical)Outpatient Dosage FormsCream, External, as acetonide:Generic: 0.025% (15 g, 60 g)

Oil, External, as acetonide:Derma-Smoothe/FS Body: 0.01% (118.28 mL) [contains isopropyl alcohol,peanut oil]

Derma-Smoothe/FS Scalp: 0.01% (118.28 mL) [contains isopropyl alcohol,peanut oil]

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

FluocinonideOutpatient Dosage FormsCream, anhydrous, emollient, topical: 0.05% (15 g, 30 g, 60 g, 120 g) [BCF]Gel, external: 0.05% (15 g, 30 g, 60 g)Ointment, external: 0.05% (15 g, 30 g, 60 g)

FluorideOutpatient Dosage FormsGel, Oral, as sodium [toothpaste]:PreviDent 5000 Booster Plus: 1.1% (100 mL)

FluorometholoneOutpatient Dosage FormsSuspension, Ophthalmic, as base:Generic: 0.1% (5 mL, 10 mL, 15 mL)

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

FLUoxetineOutpatient Dosage FormsCapsule, oral: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]Solution, oral: 20 mg/5 mL (5 mL, 120 mL) [BCF]Tablet, oral: 10 mg [BCF]

Fluticasone and SalmeterolOutpatient Dosage FormsAerosol, for oral inhalation:Advair HFA:45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg per inhalation(8 g, 12 g) [chlorofluorocarbon free] [BCF]

115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcg per inhala-tion (8 g, 12 g) [chlorofluorocarbon free] [BCF]

230/21: Fluticasone propionate 230 mcg and salmeterol 21 mcg per inhala-tion (8 g, 12 g) [chlorofluorocarbon free] [BCF]

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

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

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

Fluticasone (Nasal)Outpatient Dosage FormsSuspension, intranasal, as propionate [spray]: 50 mcg/inhalation (16 g) [BCF]Flonase®: 50 mcg/inhalation (16 g) [contains benzalkonium chloride; 120metered actuations] [BCF]

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

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

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

Powder, for oral inhalation, as propionate:Flovent® Diskus®: 50 mcg (60s) [contains lactose] [BCF]Flovent® Diskus®: 100 mcg (60s) [contains lactose] [BCF]Flovent® Diskus®: 250 mcg (60s) [contains lactose] [BCF]

Folic AcidOutpatient Dosage FormsTablet, oral: 1 mg [BCF]

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

FurosemideOutpatient Dosage FormsSolution, oral: 10 mg/mL (60 mL, 120 mL) [BCF]Tablet, oral: 20 mg [BCF], 40 mg [BCF]

GabapentinOutpatient Dosage FormsCapsule, oral: 100 mg [BCF], 300 mg [BCF], 400 mg [BCF]Tablet, oral: 600 mg [BCF], 800 mg [BCF]

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

GatifloxacinOutpatient Dosage FormsSolution, Ophthalmic:Zymaxid: 0.5% (2.5 mL) [contains benzalkonium chloride, edetate disodium]

GemfibrozilOutpatient Dosage FormsTablet, oral: 600 mg [BCF]

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

Ointment, ophthalmic [preservative free]:Garamycin™: 0.3% (3.5 g) [BCF]

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

GlimepirideOutpatient Dosage FormsTablet, oral: 1 mg, 2 mg, 4 mg

GlipiZIDEOutpatient Dosage FormsTablet, oral: 5 mg [BCF], 10 mg [BCF]Tablet extended release 24 hour, oral: 5 mg, 10 mg

GlucagonOutpatient Dosage FormsKit, Injection:Glucagon Emergency: 1 mg

GlyBURIDEOutpatient Dosage FormsTablet, oral: 1.25 mg [BCF], 1.5 mg, 2.5 mg [BCF], 5 mg [BCF]Tablet, oral [micronized]: 3 mg [BCF], 6 mg [BCF]

Glyburide and MetforminOutpatient Dosage FormsTablet, oral:Generic: 1.25 mg/250 mg: Glyburide 1.25 mg and metformin hydrochloride250 mg

Generic: 2.5 mg/500 mg: Glyburide 2.5 mg and metformin hydrochloride500 mg

Generic: 5 mg/500 mg: Glyburide 5 mg and metformin hydrochloride 500 mg

FERROUS SULFATE

8

GriseofulvinOutpatient Dosage FormsSuspension, oral [microsize]: 125 mg/5 mL (120 mL) [BCF]Tablet, oral [ultramicrosize]: 125 mg [BCF], 250 mg [BCF]

GuaiFENesinOutpatient Dosage FormsTablet extended release 12 hour, oral: 600 mg

Guaifenesin and CodeineOutpatient Dosage FormsSyrup, oral: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (473mL)

Guaifenesin and DextromethorphanOutpatient Dosage FormsSyrup, oral: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mgper 5 mL (5 mL, 10 mL, 120 mL, 480 mL)

Guaifenesin and PseudoephedrineOutpatient Dosage FormsTablet, extended release, oral:Mucinex® D: Guaifenesin 600 mg and pseudoephedrine hydrochloride 60 mg

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

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

HydroCHLOROthiazideOutpatient Dosage FormsCapsule, oral: 12.5 mg [BCF]Tablet, oral: 25 mg [BCF], 50 mg [BCF]

Hydrochlorothiazide and TriamtereneOutpatient Dosage FormsTablet, oral: Hydrochlorothiazide 25 mg and triamterene 37.5 mg [BCF]; hydro-chlorothiazide 50 mg and triamterene 75 mg [BCF]

Hydrocodone and AcetaminophenOutpatient Dosage FormsSolution, oral: Hydrocodone bitartrate 7.5 mg and acetaminophen 325 mg per15 mL

Tablet, 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 valerate:Generic: 0.2% (15 g, 45 g, 60 g)

Cream, External, as base:Anusol-HC: 2.5% (30 g) [contains benzyl alcohol] [BCF]ProctoCream-HC: 2.5% (30 g) [contains benzyl alcohol] [BCF]Proctosol-HC: 2.5% (28.35 g) [BCF]Generic: 1% (1 g, 1.5 g, 15 g, 20 g, 28 g, 28.35 g, 28.4 g, 30 g, 120 g,453.6 g, 454 g); 2.5% (20 g, 28 g, 28.35 g, 30 g, 453.6 g)

Ointment, External, as base:Generic: 2.5% (20 g)

Ointment, External, as valerate:Generic: 0.2% (15 g, 45 g, 60 g)

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

HYDROmorphoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 2 mg, 4 mg

HydroquinoneOutpatient Dosage FormsCream, External:Generic: 4% (28.35 g)

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

HydrOXYzineOutpatient Dosage FormsSyrup, oral, as hydrochloride: 10 mg/5 mL (118 mL, 473 mL) [BCF]Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

HyoscyamineOutpatient Dosage FormsTablet, Sublingual, as sulfate:Generic: 0.125 mg

Hyoscyamine, Atropine, Scopolamine, and PhenobarbitalOutpatient Dosage FormsElixir: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, scopol-amine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg per 5 mL (473mL)

Tablet: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, scopol-amine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg

IbandronateOutpatient Dosage FormsTablet, oral: 150 mg

IbuprofenOutpatient Dosage FormsSuspension, oral: 100 mg/5 mL (5 mL, 118 mL, 120 mL, 473 mL)Tablet, oral: 400 mg [BCF], 600 mg [BCF], 800 mg [BCF]

ImipramineOutpatient Dosage FormsCapsule, Oral, as pamoate:Generic: 75 mg

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

ImiquimodOutpatient Dosage FormsCream, External:Generic: 5% (1 ea, 12 ea, 24 ea)

IndomethacinOutpatient Dosage FormsCapsule, oral: 25 mg [BCF], 50 mg [BCF]

Inhalation DevicesOutpatient Dosage FormsSpacer for use with oral inhalers

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 DetemirOutpatient Dosage FormsSolution, Subcutaneous:Levemir: 100 units/mL (10 mL) [contains metacresol, phenol]

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

Solution Pen-injector, Subcutaneous:Lantus Solostar: 100 units/mL (3 mL) [BCF]

Insulin LisproOutpatient Dosage FormsSolution, Subcutaneous:HumaLOG: 100 units/mL (3 mL, 10 mL) [contains metacresol, phenol]

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]

INSULIN REGULAR

9

Ipratropium and AlbuterolOutpatient Dosage FormsAerosol, for oral inhalation:Combivent®: Ipratropium bromide 18 mcg and albuterol (base) 90 mcg perinhalation (14.7 g) [contains chlorofluorocarbon, soya lecithin; 200 meteredactuations] [BCF]

Solution, for nebulization: Ipratropium bromide 0.5 mg and albuterol (base)2.5 mg per 3 mL (30s, 60s)

Ipratropium (Nasal)Outpatient Dosage FormsSolution, nasal, as bromide: 0.03% (30 mL)

Ipratropium (Oral Inhalation)Outpatient Dosage FormsAerosol, for oral inhalation, as bromide:Atrovent® HFA: 17 mcg/actuation (12.9 g) [chlorofluorocarbon free; 200metered actuations] [BCF]

Solution, for nebulization, as bromide: 0.02% [500 mcg/2.5 mL] (25s, 30s, 60s)Solution, for nebulization, as bromide [preservative free]: 0.02% [500 mcg/2.5mL] (25s, 30s, 60s)

IsoniazidOutpatient Dosage FormsSyrup, oral: 50 mg/5 mL (473 mL)Tablet, oral: 100 mg [BCF], 300 mg [BCF]

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

Isosorbide MononitrateOutpatient Dosage FormsTablet, extended release, oral: 30 mg [BCF], 60 mg [BCF], 120 mg [BCF]

ISOtretinoin (Systemic)Outpatient Dosage FormsCapsule, Oral:Amnesteem: 10 mg, 20 mg, 40 mg [contains soybean oil]

Ketoconazole (Systemic)Outpatient Dosage FormsTablet, oral: 200 mg

Ketoconazole (Topical)Outpatient Dosage FormsCream, external: 2% (15 g, 30 g, 60 g)Shampoo, external: 2% (120 mL)

Ketorolac (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic, as tromethamine: 0.4% (5 mL); 0.5% (3 mL, 5 mL, 10 mL)

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

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

Lactic Acid and Ammonium HydroxideOutpatient Dosage FormsCream, topical: Lactic acid 12% with ammonium hydroxide (140 g, 280 g,385 g)Lac-Hydrin®: Lactic acid 12% with ammonium hydroxide (280 g, 385 g)

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

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

LatanoprostOutpatient Dosage FormsSolution, ophthalmic [drops]: 0.005% (2.5 mL) [BCF]

LevalbuterolOutpatient Dosage FormsNebulization Solution, Inhalation, as hydrochloride [strength expressed as base,preservative free]:Generic: 0.31 mg/3 mL (3 mL); 0.63 mg/3 mL (3 mL); 1.25 mg/3 mL (3 mL);1.25 mg/0.5 mL (1 ea, 30 ea)

LevETIRAcetamOutpatient Dosage FormsSolution, Oral:Generic: 100 mg/mL (5 mL, 473 mL, 500 mL)

Tablet, Oral:Generic: 250 mg, 500 mg, 750 mg, 1000 mg

LevoFLOXacin (Systemic)Outpatient Dosage FormsSolution, oral: 25 mg/mL (100 mL, 200 mL, 480 mL) [BCF]Tablet, oral: 250 mg [BCF], 500 mg [BCF], 750 mg [BCF]

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

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]

Lidocaine (Topical)Outpatient Dosage FormsJelly, External, as hydrochloride:Generic: 2% (5 mL, 20 mL, 30 mL)

Jelly, External, as hydrochloride [preservative free]:Generic: 2% (5 mL, 10 mL)

Patch, External:Lidoderm: 5% (30 ea) [contains disodium edta, methylparaben, propyleneglycol, propylparaben]

Solution, Mouth/Throat, as hydrochloride:Generic: 2% (15 mL, 100 mL)

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

LisinoprilOutpatient Dosage FormsTablet, oral: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]

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

LithiumOutpatient Dosage FormsCapsule, oral, as carbonate: 150 mg [BCF], 300 mg [BCF]Solution, oral, as citrate: 300 mg/5 mL (5 mL, 500 mL) [equivalent to amount oflithium in lithium carbonate] [BCF]

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

LoratadineOutpatient Dosage FormsSyrup, Oral:Claritin: 5 mg/5 mL (60 mL, 120 mL) [alcohol free, color free, dye free, sugarfree; contains edetate disodium, propylene glycol, sodium benzoate; grapeflavor]


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

LosartanOutpatient Dosage FormsTablet, oral, as potassium: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

INSULIN REGULAR

10

Losartan and HydrochlorothiazideOutpatient Dosage FormsTablet, oral:50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg [BCF]100/12.5: Losartan potassium 100 mg and hydrochlorothiazide12.5 mg [BCF]

100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg [BCF]

LoteprednolOutpatient Dosage FormsSuspension, Ophthalmic, as etabonate:Lotemax: 0.5%

LovastatinOutpatient Dosage FormsTablet, Oral:Generic: 10 mg, 20 mg, 40 mg

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

Magnesium OxideOutpatient Dosage FormsTablet, Oral:Generic: 400 mg

MeclizineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 12.5 mg, 25 mg

MedroxyPROGESTERoneOutpatient Dosage FormsTablet, oral, as acetate: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

MefloquineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 250 mg

MegestrolOutpatient Dosage FormsSuspension, Oral, as acetate:Generic: 400 mg/10 mL (10 mL)

Tablet, Oral, as acetate:Generic: 20 mg

MelatoninOutpatient Dosage FormsTablet, oral:Generic: 3 mg

Tablet, controlled release, oral:Generic: 3 mg

MeloxicamOutpatient Dosage FormsTablet, oral: 7.5 mg [BCF], 15 mg [BCF]

MemantineOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as hydrochloride:Namenda XR: 7 mg, 14 mg, 28 mg

Tablet, Oral, as hydrochloride:Namenda: 5 mg [contains fd&c blue #2 (indigotine), fd&c yellow #6 (sunsetyellow)]

Namenda: 10 mg

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

Tablet Delayed Release, Oral:Lialda: 1.2 g

MetaxaloneOutpatient Dosage FormsTablet, Oral:Generic: 800 mg

MetFORMINOutpatient Dosage FormsTablet, oral, as hydrochloride: 500 mg [BCF], 850 mg [BCF], 1000 mg [BCF]Tablet, extended release, oral, as hydrochloride: 500 mg [BCF], 750 mg [BCF]

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

MethazolAMIDEOutpatient Dosage FormsTablet, Oral:Generic: 50 mg

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

MethocarbamolOutpatient Dosage FormsTablet, oral: 500 mg [BCF], 750 mg

MethotrexateOutpatient Dosage FormsTablet, oral: 2.5 mg [BCF]

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

MethylphenidateOutpatient Dosage FormsCapsule, extended release, oral, as hydrochloride [bi-modal release]: 20 mg[generic for Ritalin LA®] [BCF], 30 mg [generic for Ritalin LA®] [BCF], 40 mg[generic for Ritalin LA®] [BCF]

Tablet, oral, as hydrochloride: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF]Tablet, extended release, oral, as hydrochloride [bi-modal release]: 18 mg[BCF], 20 mg, 36 mg [BCF], 54 mg [BCF]

MethylPREDNISoloneOutpatient Dosage FormsTablet, Oral:Medrol (Pak): 4 mg [scored]Generic: 4 mg

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

MetOLazoneOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg, 5 mg, 10 mg

MetoprololOutpatient Dosage FormsTablet, oral, as tartrate: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]Tablet, extended release, oral, as succinate [expressed as mg equivalent totartrate]: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF]

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

MetroNIDAZOLE (Topical)Outpatient Dosage FormsCream, external: 0.75% (45 g)Gel, vaginal: 0.75% (70 g) [BCF]

MidodrineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg

MinocyclineOutpatient Dosage FormsTablet, Oral:Generic: 50 mg, 100 mg

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

Tablet Dispersible, Oral:Generic: 15 mg, 30 mg

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

MontelukastOutpatient Dosage FormsPacket, Oral:Generic: 4 mg (1 ea, 30 ea) [BCF]

MONTELUKAST

11

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, 30 mg

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

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

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

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

MycophenolateOutpatient Dosage FormsCapsule, Oral:Generic: 250 mg


NaftifineOutpatient Dosage FormsCream, External, as hydrochloride:Naftin: 1% (60 g, 90 g) [contains benzyl alcohol, cetyl alcohol]

Naphazoline and PheniramineOutpatient Dosage FormsSolution, ophthalmic:Opcon-A®: Naphazoline hydrochloride 0.027% and pheniramine maleate0.3% (15 mL) [contains benzalkonium chloride]

NaproxenOutpatient Dosage FormsSuspension, oral: 125 mg/5 mL (500 mL) [BCF]Tablet, oral: 375 mg , 500 mg [BCF]

NateglinideOutpatient Dosage FormsTablet, oral: 60 mg, 120 mg

NeomycinOutpatient Dosage FormsTablet, Oral, as sulfate:Generic: 500 mg

Neomycin and Polymyxin BOutpatient Dosage FormsSolution, Ophthalmic:Generic: Neomycin 40 mg and polymyxin B sulfate 200,000 units per 1 mL (1mL, 20 mL)

Neomycin, Polymyxin B, and DexamethasoneOutpatient Dosage FormsOintment, ophthalmic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, anddexamethasone 0.1% per g (3.5 g)

Neomycin, Polymyxin B, and Hydrocortisone (Otic)Outpatient Dosage FormsSuspension, otic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydro-cortisone 10 mg per 1 mL (10 mL) [BCF]

NepafenacOutpatient Dosage FormsSuspension, Ophthalmic:Nevanac: 0.1% (3 mL) [contains edentate disodium benzalkonium chloride]

NiacinOutpatient Dosage FormsTablet, Oral:Generic: 50 mg, 500 mg

Tablet, extended release, oral:Niaspan®: 1000 mg [BCF]Generic: 500 mg, 750 mg

NicotineOutpatient Dosage FormsPatch 24 Hour, Transdermal:Generic: 7 mg/24 hr (7 ea, 14 ea) [BCF]; 14 mg/24 hr (7 ea, 14 ea) [BCF];21 mg/24 hr (7 ea, 14 ea, 28 ea) [BCF]

NIFEdipineOutpatient Dosage FormsTablet, extended release, oral: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF]

NisoldipineOutpatient Dosage FormsTablet Extended Release 24 Hour, Oral:Generic: 20 mg, 30 mg, 40 mg

NitrofurantoinOutpatient Dosage FormsCapsule, oral [macrocrystal]: 50 mg [BCF]Capsule, oral [macrocrystal/monohydrate]: 100 mg [BCF]

NitroglycerinOutpatient Dosage FormsCapsule extended release, oral: 2.5 mg, 6.5 mgPatch, transdermal: 0.1 mg/hour (30s) [BCF]; 0.2 mg/hour (30s) [BCF];0.4 mg/hour (30s) [BCF]; 0.6 mg/hour (30s) [BCF]Nitro-Dur: 0.3 mg/hour (30s) [BCF]; 0.8 mg/hour (30s) [BCF]

Solution, translingual [spray]: 0.4 mg/spray (4.9 g, 12 g) [BCF]Tablet, sublingual:Nitrostat: 0.4 mg [BCF]

NorethindroneOutpatient Dosage FormsTablet, oral: 0.35 mg [BCF]

NortriptylineOutpatient Dosage FormsCapsule, oral: 10 mg [BCF], 25 mg [BCF]Solution, Oral:Generic: 10 mg/5 mL (473 mL) [BCF]

Nystatin and TriamcinoloneOutpatient Dosage FormsCream: Nystatin 100,000 units and triamcinolone acetonide 0.1% (15 g, 30 g,60 g)

Nystatin (Oral)Outpatient Dosage FormsSuspension, oral: 100,000 units/mL (5 mL, 60 mL, 473 mL) [BCF]Tablet, oral: 500,000 units

Nystatin (Topical)Outpatient Dosage FormsCream, topical: 100,000 units/g (15 g, 30 g) [BCF]Ointment, topical: 100,000 units/g (15 g, 30 g) [BCF]Powder, external: 100,000 units/g (15 g, 30 g, 60 g)

Ocular LubricantOutpatient Dosage FormsOintment, Ophthalmic:Refresh Lacri-Lube: (3.5 g)

Ofloxacin (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic: 0.3% (5 mL, 10 mL)

Ofloxacin (Otic)Outpatient Dosage FormsSolution, otic: 0.3% (5 mL, 10 mL)

OLANZapineOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg, 5 mg, 7.5 mg, 10 mg

OlmesartanOutpatient Dosage FormsTablet, Oral, as medoxomil:Benicar: 5 mg, 20 mg, 40 mg

Olmesartan and HydrochlorothiazideOutpatient Dosage FormsTablet, Oral:Benicar HCT: Olmesartan medoxomil 20 mg and hydrochlorothiazide 12.5 mgBenicar HCT: Olmesartan medoxomil 40 mg and hydrochlorothiazide 12.5 mg

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

MONTELUKAST

12

OmeprazoleOutpatient Dosage FormsCapsule, delayed release, oral: 10 mg [BCF], 20 mg [BCF]

OndansetronOutpatient Dosage FormsSolution, Oral:Generic: 4 mg/5 mL (50 mL)


Tablet Dispersible, Oral:Generic: 4 mg, 8 mg

OseltamivirOutpatient Dosage FormsCapsule, Oral, as phosphate:Tamiflu: 75 mg

OxybutyninOutpatient Dosage FormsTablet, Oral, as chloride: 5 mgTablet, extended release, oral, as chloride: 5 mg [BCF], 10 mg [BCF],15 mg [BCF]

OxyCODONEOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 30 mg

Tablet Extended Release 12 Hour, Oral, as hydrochloride:OxyCONTIN: 10 mg, 20 mg, 40 mg, 60 mgGeneric: 10 mg, 20 mg, 40 mg

Oxycodone and AcetaminophenOutpatient Dosage FormsTablet, oral:5/325: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg [BCF]7.5/325: Oxycodone hydrochloride 7.5 mg and acetaminophen 325 mg10/325: Oxycodone hydrochloride 10 mg and acetaminophen 325 mg

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

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]



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

Penicillin V PotassiumOutpatient Dosage FormsPowder for solution, oral: 250 mg/5 mL (100 mL, 200 mL) [BCF]Tablet, oral: 250 mg [BCF], 500 mg [BCF]

PentoxifyllineOutpatient Dosage FormsTablet Extended Release, Oral:Generic: 400 mg

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

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

PHENobarbitalOutpatient Dosage FormsElixir, oral: 20 mg/5 mL (5 mL, 7.5 mL, 15 mL, 473 mL) [BCF]Tablet, oral: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF]

Phenylephrine (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic, as hydrochloride: 2.5% (2 mL, 3 mL, 5 mL, 15 mL)Solution, ophthalmic, as hydrochloride [preservative free]: 2.5% (1 ea)

PhenytoinOutpatient Dosage FormsCapsule, Oral, as sodium:Dilantin: 30 mg [contains fd&c yellow #10 (quinoline yellow)]

Capsule, extended release, oral, as sodium: 100 mg [BCF]Suspension, oral: 125 mg/5 mL (237 mL, 240 mL) [BCF]Tablet, chewable, oral: 50 mg [BCF]

PhytonadioneOutpatient Dosage FormsTablet, oral:Mephyton®: 5 mg [scored]

Pilocarpine (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as hydrochloride [drops]:Generic: 1% (15 mL) [BCF]

Pilocarpine (Systemic)Outpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 7.5 mg

PimecrolimusOutpatient Dosage FormsCream, topical:Elidel®: 1% (30 g, 60 g, 100 g) [BCF] [contains benzyl alcohol]

PioglitazoneOutpatient Dosage FormsTablet, oral: 15 mg, 30 mg, 45 mg

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

PodofiloxOutpatient Dosage FormsGel, External:Condylox: 0.5% (3.5 g)

Polyethylene Glycol-Electrolyte SolutionOutpatient Dosage FormsPowder, for Solution, Oral:GoLYTELY: PEG 3350 236 g, sodium sulfate 22.74 g, sodium bicarbonate6.74 g, sodium chloride 5.86 g, and potassium chloride 2.97 g (4000 mL)[regular and pineapple flavor]

MoviPrep: Pouch A: PEG 3350 100 g, sodium sulfate 7.5 g, sodium chloride2.69 g, potassium chloride 1.02 g; Pouch B: Ascorbic acid 4.7 g, sodiumascorbate 5.9 g (1000 mL) [contains phenylalanine 131 mg/treatment; lemonflavor; packaged with 2 of Pouch A and 2 of Pouch B in carton and adisposable reconstitution container]

NuLYTELY: PEG 3350 420 g, sodium bicarbonate 5.72 g, sodium chloride11.2 g, and potassium chloride 1.48 g (4000 mL) [supplied with cherry,lemon-lime, orange, and pineapple flavor packs]

Generic: PEG 3350 236 g, sodium sulfate 22.74 g, sodium bicarbonate6.74 g, sodium chloride 5.86 g, and potassium chloride 2.97 g (4000 mL)

Potassium ChlorideOutpatient Dosage FormsCapsule, extended release, microencapsulated, oral: 10 mEq [BCF]Powder for solution, oral:Klor-Con: 20 mEq/packet (30s, 100s) [sugar free; fruit flavor] [BCF]

Solution, oral: 20 mEq/15 mL (15 mL, 30 mL, 473 mL) [BCF]Tablet, extended release, oral: 10 mEq [BCF]Tablet, extended release, microencapsulated, oral: 20 mEq [BCF]Tablet, extended release, wax matrix, oral: 10 mEq [BCF]

PramipexoleOutpatient Dosage FormsTablet, Oral, as dihydrochloride monohydrate:Generic: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 1.5 mg

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

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

PRAVASTATIN

13

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

PrednisoLONE (Ophthalmic)Outpatient Dosage FormsSuspension, Ophthalmic, as acetate: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 base:Generic: 15 mg/5 mL (240 mL, 480 mL)

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

PregabalinOutpatient Dosage FormsCapsule, Oral:Lyrica: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 300 mg

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

PrimidoneOutpatient Dosage FormsTablet, Oral:Generic: 50 mg

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

ProchlorperazineOutpatient Dosage FormsSuppository, Rectal:Generic: 25 mg (12 ea, 1000 ea)

Tablet, Oral, as maleate [strength expressed as base]:Generic: 5 mg, 10 mg

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

PromethazineOutpatient Dosage FormsSuppository, rectal, as hydrochloride: 12.5 mg (12s) [BCF]; 25 mg (12s) [BCF]Syrup, oral, as hydrochloride: 6.25 mg/5 mL (118 mL, 473 mL) [BCF]Tablet, oral, as hydrochloride: 25 mg [BCF]

Promethazine and CodeineOutpatient Dosage FormsSyrup: Promethazine hydrochloride 6.25 mg and codeine phosphate 10 mg per5 mL (5 mL, 118 mL, 473 mL)

Promethazine and DextromethorphanOutpatient Dosage FormsSyrup: Promethazine hydrochloride 6.25 mg and dextromethorphan hydrobro-mide 15 mg per 5 mL (120 mL, 240 mL, 480 mL)

PropafenoneOutpatient Dosage FormsCapsule Extended Release 12 Hour, Oral, as hydrochloride:Generic: 225 mg, 325 mg, 425 mg

Tablet, Oral, as hydrochloride:Generic: 150 mg, 225 mg, 300 mg

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: 50 mg [BCF]

PseudoephedrineOutpatient Dosage FormsSyrup, Oral, as hydrochloride:Nasal Decongestant: 30 mg/5 mL (473 mL) [contains fd&c red #40, methyl-paraben, saccharin sodium, sodium benzoate; raspberry flavor]

Tablet, Oral, as hydrochloride: 30 mg

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

PyridoxineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 25 mg, 50 mg

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

Tablet, extended release, oral:SEROquel XR®: 50 mg [BCF], 150 mg [BCF], 200 mg [BCF], 300 mg [BCF],400 mg [BCF]

RaloxifeneOutpatient Dosage FormsTablet, oral, as hydrochloride:Evista®: 60 mg [BCF]

RamiprilOutpatient Dosage FormsCapsule, oral: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

RaNITIdineOutpatient Dosage FormsSyrup, Oral:Generic: 15 mg/mL (5 mL, 10 mL, 473 mL, 474 mL, 480 mL) [BCF]

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

RanolazineOutpatient Dosage FormsTablet Extended Release 12 Hour, Oral:Ranexa: 500 mg, 1000 mg

RifAMPinOutpatient Dosage FormsCapsule, oral:Generic: 300 mg [BCF]

RisperiDONEOutpatient Dosage FormsSolution, oral: 1 mg/mL (30 mL) [BCF]Tablet, oral: 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

RizatriptanOutpatient Dosage FormsTablet, oral: 5 mg [BCF], 10 mg [BCF]Tablet, orally disintegrating: 5 mg [BCF], 10 mg [BCF]

ROPINIRoleOutpatient Dosage FormsTablet, Oral:Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg

RosuvastatinOutpatient Dosage FormsTablet, oral:Crestor: 5 mg, 10 mg, 20 mg, 40 mg

SalmeterolOutpatient Dosage FormsPowder, for oral inhalation:Serevent® Diskus®: 50 mcg (28s, 60s) [contains lactose] [BCF]

SalsalateOutpatient Dosage FormsTablet, oral: 500 mg [BCF], 750 mg [BCF]

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

PRAZOSIN

14

SertralineOutpatient Dosage FormsSolution, oral [concentrate]: 20 mg/mL (60 mL) [BCF]Tablet, oral: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

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

Silver SulfadiazineOutpatient Dosage FormsCream, topical: 1% (20 g, 25 g, 50 g, 85 g, 400 g) [BCF]

SimvastatinOutpatient Dosage FormsTablet, oral: 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]

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: 50/500: Sitagliptin 50 mg and metformin hydrochloride500 mg [BCF]

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

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

Sodium ChlorideOutpatient Dosage FormsSolution, Nasal:Generic: 0.65% (44 mL, 45 mL)

Solution, Ophthalmic:Muro 128: 2% (15 mL)Generic: 5% (15 mL)

Sodium PhosphatesOutpatient Dosage FormsSolution, Rectal [enema]:Fleet Pedia-Lax Enema: Monobasic sodium phosphate monohydrate 9.5 gand dibasic sodium phosphate heptahydrate 3.5 g per 59 mL delivered dose(66 mL) [contains sodium 2.2 g/59 mL]

Generic: Monobasic sodium phosphate monohydrate 19 g and dibasic sodiumphosphate heptahydrate 7 g per 118 mL delivered dose (133 mL)

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

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

SpironolactoneOutpatient Dosage FormsTablet, oral: 25 mg [BCF]

SucralfateOutpatient Dosage FormsTablet, Oral:Generic: 1 g

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

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

Tablet, oral: Sulfamethoxazole 400 mg and trimethoprim 80 mg [BCF]Tablet, double strength, oral: Sulamethoxazole 800 mg and trimethoprim160 mg [BCF]

SulfaSALAzineOutpatient Dosage FormsTablet, oral: 500 mg [BCF]Tablet, delayed release, enteric coated, oral: 500 mg [BCF]

SulindacOutpatient Dosage FormsTablet, Oral:Generic: 150 mg, 200 mg

SUMAtriptanOutpatient Dosage FormsSolution, Nasal:Generic: 20 mg/actuation (1 ea)

Solution, 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]

Tacrolimus (Topical)Outpatient Dosage FormsOintment, External:Protopic: 0.03% (30 g, 60 g, 100 g); 0.1% (30 g, 60 g, 100 g)

TamoxifenOutpatient Dosage FormsTablet, oral: 10 mg [BCF], 20 mg [BCF]

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

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

Telmisartan and HydrochlorothiazideOutpatient Dosage FormsTablet, oral:Micardis HCT: 40/12.5: Telmisartan 40 mg and hydrochlorothiazide 12.5 mgMicardis HCT: 80/12.5: Telmisartan 80 mg and hydrochlorothiazide 12.5 mgMicardis HCT: 80/25: Telmisartan 80 mg and hydrochlorothiazide 25 mg

TemazepamOutpatient Dosage FormsCapsule, oral: 15 mg [BCF], 30 mg [BCF]

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

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

TerbutalineOutpatient Dosage FormsTablet, Oral, as sulfate:Generic: 5 mg

TerconazoleOutpatient Dosage FormsCream, Vaginal:Generic: 0.4% (45 g)

Suppository, Vaginal:Generic: 80 mg (3 ea)

TestosteroneOutpatient Dosage FormsGel, Transdermal:Fortesta: 10 mg/actuation (60 g) [contains ethanol; 0.5 g gel/actuation; 120metered actuations] [BCF]

Oil, Intramuscular, as cypionate:Generic: 200 mg/mL (1 mL, 10 mL)

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

TheophyllineOutpatient Dosage FormsTablet Extended Release 12 Hour, Oral:Generic: 200 mg [BCF], 300 mg [BCF]

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

Timolol (Ophthalmic)Outpatient Dosage FormsGel forming solution, ophthalmic, as maleate [strength expressed as base,drops]: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF]

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

TIMOLOL (OPHTHALMIC)

15

TiotropiumOutpatient Dosage FormsAerosol Solution, Inhalation:Spiriva Respimat: 2.5 mcg/actuation (4 g) [contains benzalkonium 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: Tobramycin 0.3% and dexamethasone 0.1% (2.5 mL,5 mL, 10 mL)

Tobramycin (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic:Generic: 0.3% (5 mL)

TolterodineOutpatient Dosage FormsCapsule, extended release, oral, as tartrate:Detrol® LA: 2 mg [BCF], 4 mg [BCF]

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

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

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

TraZODoneOutpatient Dosage FormsTablet, oral, as hydrochloride: 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: 0.1% (20 g)

Triamcinolone (Topical)Outpatient Dosage FormsAerosol solution, external, as acetonide:Kenalog: (63 g)

Cream, topical, as acetonide: 0.1% (15 g, 30 g, 80 g, 454 g) [BCF]Ointment, external, as acetonide: 0.1% (15 g, 80 g, 453.6 g, 454 g)Paste, Mouth/Throat, as acetonide: 0.1% (5 g)

TriazolamOutpatient Dosage FormsTablet, Oral:Generic: 0.125 mg, 0.25 mg

Trimethoprim and Polymyxin BOutpatient Dosage FormsSolution, ophthalmic [drops]: Trimethoprim 1 mg and polymyxin B sulfate10,000 units per 1 mL (10 mL) [BCF]

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

Valproic Acid and DerivativesOutpatient Dosage FormsCapsule, sprinkle, oral [strength expressed as valproic acid]: 125 mg [BCF]

Solution, oral, as valproate sodium: 250 mg/5 mL (5 mL) [strength expressed asvalproic acid]

Tablet, delayed release, oral [strength expressed as valproic acid]: 250 mg[BCF], 500 mg [BCF]

Tablet, extended release, oral [strength expressed as valproic acid]: 250 mg[BCF], 500 mg [BCF]

ValsartanOutpatient Dosage FormsTablet, oral:Diovan®: 40 mg [scored] [BCF], 80 mg [BCF], 160 mg [BCF], 320 mg [BCF]

Valsartan and HydrochlorothiazideOutpatient Dosage FormsTablet, oral: 160 mg/12.5 mg: Valsartan 160 mg and hydrochlorothiazide12.5 mg [BCF]; 160 mg/25 mg: Valsartan 160 mg and hydrochlorothiazide25 mg [BCF]; 320 mg/12.5 mg: Valsartan 320 mg and hydrochlorothiazide12.5 mg [BCF]; 320 mg/25 mg: Valsartan 320 mg and hydrochlorothiazide25 mg [BCF]

VareniclineOutpatient Dosage FormsTablet, Oral:Chantix Continuing Month Pak: 1 mgChantix Starting Month Pak: 0.5 MG X 11 & 1 MG X 42

VenlafaxineOutpatient Dosage FormsCapsule, extended release, oral: 37.5 mg [BCF], 75 mg [BCF], 150 mg [BCF]

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

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

Vitamins (Multiple/Pediatric)Outpatient Dosage FormsSolution, Oral [drops]:Poly-Vi-Sol: 50 mL

Solution, Oral [drops, with iron]:Generic: 50 mL

Suspension, Oral:Poly-Vi-Flor: 0.25 mg/mL (50 mL)

Vitamins (Prenatal)Outpatient Dosage FormsTablet, Oral

WarfarinOutpatient Dosage FormsTablet, oral, as sodium: 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]

ZaleplonOutpatient Dosage FormsCapsule, Oral:Generic: 5 mg, 10 mg

ZidovudineOutpatient Dosage FormsCapsule, Oral:Generic: 100 mg

ZOLMitriptanOutpatient Dosage FormsSolution, nasal:Zomig: 2.5 mg (6 ea); 5 mg (6 ea)

Tablet, oral: 2.5 mg, 5 mgTablet dispersible, oral: 2.5 mg, 5 mg

ZolpidemOutpatient Dosage FormsTablet, oral, as tartrate: 5 mg [BCF], 10 mg [BCF]Tablet Extended Release, Oral, as tartrate:Ambien CR: 6.25 mgAmbien CR: 12.5 mg [contains fd&c blue #2 (indigotine)]

ZonisamideOutpatient Dosage FormsCapsule, Oral:Generic: 100 mg

TIOTROPIUM

16

Therapeutic Category Index

17

Acetylcholinesterase Inhibitor (Central)Donepezil ..................................................................................................6

Acne ProductsAdapalene ................................................................................................ 2Benzoyl Peroxide ..................................................................................... 3Clindamycin and Benzoyl Peroxide ......................................................... 5Erythromycin (Topical) ..............................................................................7ISOtretinoin (Systemic) .......................................................................... 10Tretinoin (Topical) ...................................................................................16

Adrenergic Agonist AgentOxymetazoline (Nasal) ...........................................................................13

Aldehyde Dehydrogenase InhibitorDisulfiram ..................................................................................................6

Alkylamine DerivativeChlorpheniramine ..................................................................................... 4Naphazoline and Pheniramine ...............................................................12

Alpha1 AgonistMidodrine ................................................................................................11Naphazoline and Pheniramine ...............................................................12

Alpha1 BlockerAlfuzosin ...................................................................................................2Doxazosin .................................................................................................6Prazosin ..................................................................................................14Tamsulosin ............................................................................................. 15Terazosin ................................................................................................ 15

Alpha2-Adrenergic AgonistCloNIDine ................................................................................................. 5Methyldopa ............................................................................................. 11TiZANidine ..............................................................................................16

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

Alpha-Adrenergic AgonistPhenylephrine (Ophthalmic) ...................................................................13

Alpha/Beta AgonistEPINEPHrine (Systemic) ..........................................................................6Guaifenesin and Pseudoephedrine ..........................................................9Pseudoephedrine ................................................................................... 14

5 Alpha-Reductase InhibitorFinasteride ................................................................................................8

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

Aminoquinoline (Antimalarial)Chloroquine .............................................................................................. 4Hydroxychloroquine ..................................................................................9Primaquine ............................................................................................. 14

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

Ammonium DetoxicantLactulose ................................................................................................ 10Neomycin ................................................................................................12

Analgesic Combination (Opioid)Acetaminophen and Codeine ...................................................................2Hydrocodone and Acetaminophen ...........................................................9Oxycodone and Acetaminophen ............................................................13

Analgesic, NonopioidAcetaminophen .........................................................................................2Aspirin .......................................................................................................3Celecoxib ..................................................................................................4Diclofenac (Systemic) ...............................................................................6Ibuprofen .................................................................................................. 9Indomethacin ............................................................................................9Ketorolac (Systemic) .............................................................................. 10Meloxicam ...............................................................................................11Naproxen ................................................................................................12Piroxicam (Systemic) ..............................................................................13Sulindac ..................................................................................................15

Analgesic, OpioidAcetaminophen and Codeine ...................................................................2Codeine .................................................................................................... 5FentaNYL ................................................................................................. 7Hydrocodone and Acetaminophen ...........................................................9HYDROmorphone .................................................................................... 9Methadone ..............................................................................................11

Morphine (Systemic) .............................................................................. 12OxyCODONE ......................................................................................... 13Oxycodone and Acetaminophen ............................................................13Promethazine and Codeine ................................................................... 14TraMADol ............................................................................................... 16

Analgesic, TopicalCapsaicin ..................................................................................................4Lidocaine (Topical) ................................................................................. 10

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

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

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

Angiotensin II Receptor BlockerCandesartan .............................................................................................4Candesartan and Hydrochlorothiazide .....................................................4Losartan ..................................................................................................10Losartan and Hydrochlorothiazide ..........................................................11Olmesartan .............................................................................................12Olmesartan and Hydrochlorothiazide .....................................................12Telmisartan ............................................................................................. 15Telmisartan and Hydrochlorothiazide .....................................................15Valsartan .................................................................................................16Valsartan and Hydrochlorothiazide ........................................................ 16

Angiotensin-Converting Enzyme (ACE) InhibitorAmlodipine and Benazepril ...................................................................... 2Benazepril .................................................................................................3Benazepril and Hydrochlorothiazide ........................................................ 3Captopril ................................................................................................... 4Enalapril ....................................................................................................6Fosinopril ..................................................................................................8Lisinopril ................................................................................................. 10Lisinopril and Hydrochlorothiazide ......................................................... 10Ramipril .................................................................................................. 14Trandolapril .............................................................................................16

Anilidopiperidine OpioidFentaNYL ................................................................................................. 7

Antianginal AgentAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 2Atenolol .....................................................................................................3DilTIAZem .................................................................................................6Isosorbide Dinitrate ................................................................................ 10Isosorbide Mononitrate ...........................................................................10Metoprolol ...............................................................................................11NIFEdipine ..............................................................................................12Nitroglycerin ............................................................................................12Propranolol ............................................................................................. 14Ranolazine ..............................................................................................14Verapamil ............................................................................................... 16

Antianxiety Agent, MiscellaneousBusPIRone ............................................................................................... 4

Antiarrhythmic Agent, Class IcFlecainide ................................................................................................. 8Propafenone ...........................................................................................14

Antiarrhythmic Agent, Class IIPropranolol ............................................................................................. 14Sotalol .....................................................................................................15

Antiarrhythmic Agent, Class IIIAmiodarone .............................................................................................. 2Sotalol .....................................................................................................15

Antiarrhythmic Agent, Class IVDilTIAZem .................................................................................................6Verapamil ............................................................................................... 16

Antiarrhythmic Agent, MiscellaneousDigoxin ......................................................................................................6

Antibiotic, AminoglycosideGentamicin (Ophthalmic) ..........................................................................8Neomycin ................................................................................................12Tobramycin (Ophthalmic) ....................................................................... 16

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

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

ACETYLCHOLINESTERASE INHIBITOR (CENTRAL)

18

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

Antibiotic/Corticosteroid, OphthalmicNeomycin, Polymyxin B, and Dexamethasone ......................................12Tobramycin and Dexamethasone .......................................................... 16

Antibiotic/Corticosteroid, OticCiprofloxacin and Dexamethasone .......................................................... 4Ciprofloxacin and Hydrocortisone ............................................................ 4Neomycin, Polymyxin B, and Hydrocortisone (Otic) ..............................12

Antibiotic, FluoroquinoloneCiprofloxacin (Systemic) ...........................................................................5Gatifloxacin ...............................................................................................8LevoFLOXacin (Systemic) ......................................................................10Moxifloxacin (Ophthalmic) ......................................................................12Moxifloxacin (Systemic) ..........................................................................12Ofloxacin (Ophthalmic) ...........................................................................12Ofloxacin (Otic) .......................................................................................12

Antibiotic, LincosamideClindamycin (Systemic) ............................................................................5Clindamycin (Topical) ............................................................................... 5

Antibiotic, MacrolideAzithromycin (Ophthalmic) ....................................................................... 3Azithromycin (Systemic) ...........................................................................3Clarithromycin ...........................................................................................5Erythromycin (Ophthalmic) .......................................................................6Erythromycin (Systemic) .......................................................................... 6Erythromycin (Topical) ..............................................................................7

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

Antibiotic, OphthalmicAzithromycin (Ophthalmic) ....................................................................... 3Bacitracin and Polymyxin B (Ophthalmic) ................................................3Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone(Ophthalmic) .......................................................................................... 3

Bacitracin (Ophthalmic) ............................................................................3Erythromycin (Ophthalmic) .......................................................................6Gatifloxacin ...............................................................................................8Gentamicin (Ophthalmic) ..........................................................................8Moxifloxacin (Ophthalmic) ......................................................................12Ofloxacin (Ophthalmic) ...........................................................................12Sulfacetamide (Ophthalmic) ...................................................................15Tobramycin (Ophthalmic) ....................................................................... 16Trimethoprim and Polymyxin B .............................................................. 16

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

Antibiotic, OticCiprofloxacin and Dexamethasone .......................................................... 4Ciprofloxacin and Hydrocortisone ............................................................ 4Neomycin, Polymyxin B, and Hydrocortisone (Otic) ..............................12Ofloxacin (Otic) .......................................................................................12

Antibiotic, PenicillinAmoxicillin .................................................................................................2Amoxicillin and Clavulanate ..................................................................... 2Dicloxacillin ...............................................................................................6Penicillin V Potassium ............................................................................13

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

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

Antibiotic, Tetracycline DerivativeDoxycycline .............................................................................................. 6Minocycline .............................................................................................11Tetracycline (Systemic) .......................................................................... 15

Antibiotic, TopicalBacitracin (Topical) ...................................................................................3Erythromycin (Topical) ..............................................................................7MetroNIDAZOLE (Topical) ......................................................................11Mupirocin ................................................................................................12Neomycin and Polymyxin B ................................................................... 12Silver Sulfadiazine ..................................................................................15

Anticholinergic AgentBenztropine .............................................................................................. 3Dicyclomine .............................................................................................. 6Hyoscyamine ............................................................................................9

Hyoscyamine, Atropine, Scopolamine, and Phenobarbital ......................9Ipratropium and Albuterol .......................................................................10Ipratropium (Nasal) .................................................................................10Ipratropium (Oral Inhalation) .................................................................. 10Solifenacin ..............................................................................................15Tiotropium ...............................................................................................16Tolterodine ..............................................................................................16

Anticholinergic Agent, Long-ActingTiotropium ...............................................................................................16

Anticholinergic Agent, OphthalmicAtropine (Ophthalmic) .............................................................................. 3Homatropine .............................................................................................9

AnticoagulantApixaban ...................................................................................................2Dabigatran Etexilate .................................................................................5Enoxaparin ............................................................................................... 6Rivaroxaban ........................................................................................... 14Warfarin .................................................................................................. 16

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

Anticoagulant, Factor Xa InhibitorApixaban ...................................................................................................2Rivaroxaban ........................................................................................... 14

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

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

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

Anticonvulsant, BenzodiazepineClonazePAM .............................................................................................5DiazePAM .................................................................................................6LORazepam ........................................................................................... 10

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

Anticonvulsant, MiscellaneousAcetaZOLAMIDE ......................................................................................2CarBAMazepine ....................................................................................... 4Gabapentin ...............................................................................................8LamoTRIgine ..........................................................................................10LevETIRAcetam ..................................................................................... 10Pregabalin .............................................................................................. 14Primidone ............................................................................................... 14Topiramate ..............................................................................................16Valproic Acid and Derivatives ................................................................ 16Zonisamide .............................................................................................16

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

Antidepressant, Dopamine/Norepinephrine-Reuptake InhibitorBuPROPion .............................................................................................. 4

Antidepressant, Selective Serotonin Reuptake InhibitorCitalopram ................................................................................................ 5Escitalopram .............................................................................................7FLUoxetine ............................................................................................... 8PARoxetine .............................................................................................13Sertraline ................................................................................................ 15

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) .................................................................................. 6Imipramine ................................................................................................9

Antidiabetic Agent, BiguanideGlyburide and Metformin ..........................................................................8MetFORMIN ............................................................................................11Sitagliptin and Metformin ....................................................................... 15

Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) InhibitorSITagliptin ...............................................................................................15Sitagliptin and Metformin ....................................................................... 15

ANTIDIABETIC AGENT, DIPEPTIDYL PEPTIDASE 4 (DPP-4) INHIBITOR

19

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

Albiglutide .................................................................................................2Exenatide ..................................................................................................7

Antidiabetic Agent, Meglitinide AnalogNateglinide ..............................................................................................12

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

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

Antidiabetic Agent, SulfonylureaGlimepiride ............................................................................................... 8GlipiZIDE .................................................................................................. 8GlyBURIDE ...............................................................................................8Glyburide and Metformin ..........................................................................8

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

AntidiarrhealBismuth Subsalicylate .............................................................................. 3Diphenoxylate and Atropine .....................................................................6Loperamide .............................................................................................10

AntidoteGlucagon .................................................................................................. 8

Antidote, ExtravasationNitroglycerin ............................................................................................12Terbutaline ..............................................................................................15

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

AntiemeticDexamethasone (Systemic) ..................................................................... 5HydrOXYzine ............................................................................................9Meclizine .................................................................................................11Metoclopramide ...................................................................................... 11Ondansetron ...........................................................................................13Prochlorperazine .................................................................................... 14Promethazine ......................................................................................... 14

Antifungal Agent, Azole DerivativeTerconazole ............................................................................................ 15

Antifungal Agent, Imidazole DerivativeClotrimazole (Oral) ................................................................................... 5Clotrimazole (Topical) ...............................................................................5Ketoconazole (Systemic) ........................................................................10Ketoconazole (Topical) ...........................................................................10

Antifungal Agent, OralFluconazole .............................................................................................. 8Griseofulvin ...............................................................................................9Ketoconazole (Systemic) ........................................................................10Terbinafine (Systemic) ............................................................................15

Antifungal Agent, Oral NonabsorbedClotrimazole (Oral) ................................................................................... 5

Antifungal Agent, Oral Nonabsorbed/Partially AbsorbedClotrimazole (Topical) ...............................................................................5Nystatin (Oral) ........................................................................................ 12

Antifungal Agent, ParenteralFluconazole .............................................................................................. 8

Antifungal Agent, TopicalBetamethasone and Clotrimazole ............................................................3Ciclopirox ..................................................................................................4Clotrimazole (Topical) ...............................................................................5Ketoconazole (Topical) ...........................................................................10Naftifine .................................................................................................. 12Nystatin and Triamcinolone ....................................................................12Nystatin (Topical) ....................................................................................12

Antifungal Agent, VaginalClotrimazole (Topical) ...............................................................................5Terconazole ............................................................................................ 15

Antigout AgentAllopurinol .................................................................................................2

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

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

AntihypertensiveAmLODIPine .............................................................................................2

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

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

Anti-inflammatory, Locally AppliedCarbamide Peroxide .................................................................................4

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

Antilipemic Agent, Bile Acid SequestrantCholestyramine Resin .............................................................................. 4Colestipol ..................................................................................................5

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

Antilipemic Agent, HMG-CoA Reductase InhibitorAtorvaSTATin ............................................................................................3Lovastatin ............................................................................................... 11Pravastatin ..............................................................................................13Rosuvastatin ...........................................................................................14Simvastatin .............................................................................................15

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

Antimalarial AgentChloroquine .............................................................................................. 4Hydroxychloroquine ..................................................................................9Mefloquine .............................................................................................. 11Primaquine ............................................................................................. 14

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

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

Antineoplastic Agent, AntimetaboliteFluorouracil (Topical) ................................................................................8

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

ANTIDIABETIC AGENT, GLUCAGON-LIKE PEPTIDE-1 (GLP-1) RECEPTOR AGONIST

20

Antineoplastic Agent, Antimetabolite (Pyrimidine Analog)Fluorouracil (Topical) ................................................................................8

Antineoplastic Agent, Aromatase InhibitorAnastrozole ...............................................................................................2

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

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

Antineoplastic Agent, Retinoic Acid DerivativeISOtretinoin (Systemic) .......................................................................... 10

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

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

Anti-Parkinson Agent, Decarboxylase InhibitorCarbidopa and Levodopa .........................................................................4

Anti-Parkinson Agent, Dopamine AgonistAmantadine .............................................................................................. 2Pramipexole ............................................................................................13ROPINIRole ............................................................................................14

Anti-Parkinson Agent, Dopamine PrecursorCarbidopa and Levodopa .........................................................................4

Antiplatelet AgentAspirin .......................................................................................................3Aspirin and Dipyridamole ......................................................................... 3Cilostazol ..................................................................................................4Clopidogrel ............................................................................................... 5Dipyridamole .............................................................................................6

Antiplatelet Agent, ThienopyridineClopidogrel ............................................................................................... 5

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

Antiretroviral, Reverse Transcriptase Inhibitor, Nucleoside (Anti-HIV)

Zidovudine ..............................................................................................16

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

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

Antispasmodic Agent, GastrointestinalHyoscyamine, Atropine, Scopolamine, and Phenobarbital ......................9

Antispasmodic Agent, UrinaryOxybutynin ..............................................................................................13

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

Antitubercular AgentEthambutol ............................................................................................... 7Isoniazid ................................................................................................. 10Pyrazinamide ..........................................................................................14RifAMPin .................................................................................................14

AntitussiveBenzonatate ............................................................................................. 3Codeine .................................................................................................... 5Guaifenesin and Codeine ........................................................................ 9Guaifenesin and Dextromethorphan ........................................................ 9Promethazine and Codeine ................................................................... 14Promethazine and Dextromethorphan ................................................... 14

Antiviral AgentAcyclovir (Systemic) .................................................................................2Amantadine .............................................................................................. 2Oseltamivir ..............................................................................................13ValACYclovir ...........................................................................................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 .................................................4Butalbital, Aspirin, and Caffeine ...............................................................4PHENobarbital ........................................................................................13Primidone ............................................................................................... 14

BenzodiazepineALPRAZolam ............................................................................................2ClonazePAM .............................................................................................5DiazePAM .................................................................................................6LORazepam ........................................................................................... 10Temazepam ............................................................................................15Triazolam ................................................................................................16

Beta2-Adrenergic AgonistIpratropium and Albuterol .......................................................................10

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

Beta2 AgonistAlbuterol ................................................................................................... 2Fluticasone and Salmeterol ..................................................................... 8Levalbuterol ............................................................................................10Salmeterol .............................................................................................. 14Terbutaline ..............................................................................................15

Beta-Adrenergic Blocker, NonselectiveDorzolamide and Timolol ......................................................................... 6Propranolol ............................................................................................. 14Sotalol .....................................................................................................15

Beta-Blocker, Beta-1 SelectiveAtenolol .....................................................................................................3Metoprolol ...............................................................................................11

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

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

Bisphosphonate DerivativeAlendronate .............................................................................................. 2Alendronate and Cholecalciferol .............................................................. 2Ibandronate .............................................................................................. 9

Blood Viscosity Reducer AgentPentoxifylline .......................................................................................... 13

Calcineurin InhibitorCycloSPORINE (Ophthalmic) ...................................................................5Pimecrolimus ..........................................................................................13Tacrolimus (Topical) ............................................................................... 15

Calcium Channel BlockerAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 2DilTIAZem .................................................................................................6Felodipine .................................................................................................7NIFEdipine ..............................................................................................12Nisoldipine ..............................................................................................12Verapamil ............................................................................................... 16

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

Calcium Channel Blocker, NondihydropyridineDilTIAZem .................................................................................................6Verapamil ............................................................................................... 16

Carbonic Anhydrase InhibitorAcetaZOLAMIDE ......................................................................................2MethazolAMIDE ......................................................................................11

Carbonic Anhydrase Inhibitor (Ophthalmic)Dorzolamide ............................................................................................. 6Dorzolamide and Timolol ......................................................................... 6

CARBONIC ANHYDRASE INHIBITOR (OPHTHALMIC)

21

Cardiac GlycosideDigoxin ......................................................................................................6

Cardiovascular Agent, MiscellaneousRanolazine ..............................................................................................14

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

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

Cholinergic AgonistPilocarpine (Systemic) ............................................................................13

ContraceptiveEthinyl Estradiol and Desogestrel ............................................................7Ethinyl Estradiol and Drospirenone ......................................................... 7Ethinyl Estradiol and Ethynodiol Diacetate ..............................................7Ethinyl Estradiol and Etonogestrel ...........................................................7Ethinyl Estradiol and Levonorgestrel ....................................................... 7Ethinyl Estradiol and Norelgestromin .......................................................7Ethinyl Estradiol and Norethindrone ........................................................ 7Ethinyl Estradiol and Norgestimate ..........................................................7MedroxyPROGESTERone ..................................................................... 11Norethindrone .........................................................................................12

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

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

Corticosteroid, OphthalmicBacitracin, Neomycin, Polymyxin B, and Hydrocortisone(Ophthalmic) .......................................................................................... 3

Difluprednate ............................................................................................ 6Fluorometholone .......................................................................................8Loteprednol .............................................................................................11PrednisoLONE (Ophthalmic) ..................................................................14

Corticosteroid, OticCiprofloxacin and Dexamethasone .......................................................... 4Ciprofloxacin and Hydrocortisone ............................................................ 4Neomycin, Polymyxin B, and Hydrocortisone (Otic) ..............................12

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

Corticosteroid, SystemicDexamethasone (Systemic) ..................................................................... 5Fludrocortisone .........................................................................................8MethylPREDNISolone ............................................................................ 11PrednisoLONE (Systemic) ..................................................................... 14PredniSONE ...........................................................................................14

Corticosteroid, TopicalBetamethasone and Clotrimazole ............................................................3Betamethasone (Topical) ......................................................................... 3Clobetasol .................................................................................................5Fluocinolone (Topical) .............................................................................. 8Fluocinonide ............................................................................................. 8Hydrocortisone (Topical) .......................................................................... 9Nystatin and Triamcinolone ....................................................................12Triamcinolone (Topical) .......................................................................... 16

DecongestantOxymetazoline (Nasal) ...........................................................................13Pseudoephedrine ................................................................................... 14

Depigmenting AgentHydroquinone ........................................................................................... 9

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

Direct Oral Anticoagulant (DOAC)Apixaban ...................................................................................................2Dabigatran Etexilate .................................................................................5Rivaroxaban ........................................................................................... 14

Diuretic, Carbonic Anhydrase InhibitorAcetaZOLAMIDE ......................................................................................2MethazolAMIDE ......................................................................................11

Diuretic, LoopFurosemide ...............................................................................................8

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

Diuretic, ThiazideBenazepril and Hydrochlorothiazide ........................................................ 3Candesartan and Hydrochlorothiazide .....................................................4HydroCHLOROthiazide ............................................................................ 9Hydrochlorothiazide and Triamterene ...................................................... 9Lisinopril and Hydrochlorothiazide ......................................................... 10Losartan and Hydrochlorothiazide ..........................................................11Olmesartan and Hydrochlorothiazide .....................................................12Telmisartan and Hydrochlorothiazide .....................................................15Valsartan and Hydrochlorothiazide ........................................................ 16

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

Electrolyte Supplement, OralMagnesium Oxide ...................................................................................11Potassium Chloride ................................................................................ 13

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

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

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

Estrogen DerivativeEstradiol (Systemic) ................................................................................. 7Estradiol (Topical) .....................................................................................7Estrogens (Conjugated/Equine, Systemic) .............................................. 7Estrogens (Conjugated/Equine, Topical) ..................................................7

Ethanolamine DerivativeDiphenhydrAMINE (Systemic) ..................................................................6

ExpectorantGuaiFENesin ............................................................................................ 9Guaifenesin and Codeine ........................................................................ 9Guaifenesin and Dextromethorphan ........................................................ 9Guaifenesin and Pseudoephedrine ..........................................................9

First Generation (Typical) AntipsychoticProchlorperazine .................................................................................... 14

GABA AnalogGabapentin ...............................................................................................8Pregabalin .............................................................................................. 14

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

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

General AnestheticFentaNYL ................................................................................................. 7

Genitourinary IrrigantNeomycin and Polymyxin B ................................................................... 12Sodium Chloride .....................................................................................15

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

Histamine H1 AntagonistAzelastine (Nasal) .................................................................................... 3Cetirizine (Systemic) ................................................................................ 4Chlorpheniramine ..................................................................................... 4Cyproheptadine ........................................................................................ 5DiphenhydrAMINE (Systemic) ..................................................................6Fexofenadine ............................................................................................8HydrOXYzine ............................................................................................9Loratadine ...............................................................................................10Meclizine .................................................................................................11Naphazoline and Pheniramine ...............................................................12

CARDIAC GLYCOSIDE

22

Olopatadine (Ophthalmic) ...................................................................... 12Promethazine ......................................................................................... 14Promethazine and Codeine ................................................................... 14Promethazine and Dextromethorphan ................................................... 14

Histamine H1 Antagonist, First GenerationChlorpheniramine ..................................................................................... 4Cyproheptadine ........................................................................................ 5DiphenhydrAMINE (Systemic) ..................................................................6HydrOXYzine ............................................................................................9Meclizine .................................................................................................11Naphazoline and Pheniramine ...............................................................12Promethazine ......................................................................................... 14Promethazine and Codeine ................................................................... 14Promethazine and Dextromethorphan ................................................... 14

Histamine H1 Antagonist, Second GenerationAzelastine (Nasal) .................................................................................... 3Cetirizine (Systemic) ................................................................................ 4Fexofenadine ............................................................................................8Loratadine ...............................................................................................10Olopatadine (Ophthalmic) ...................................................................... 12

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

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

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

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

Hypnotic, MiscellaneousMelatonin ................................................................................................ 11Zaleplon ..................................................................................................16Zolpidem .................................................................................................16

Imidazoline DerivativeNaphazoline and Pheniramine ...............................................................12Oxymetazoline (Nasal) ...........................................................................13

Immunosuppressant AgentCycloSPORINE (Ophthalmic) ...................................................................5Methotrexate ...........................................................................................11Mycophenolate ....................................................................................... 12Pimecrolimus ..........................................................................................13Tacrolimus (Topical) ............................................................................... 15

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

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

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

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

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

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

Iron SaltFerrous Sulfate .........................................................................................8

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

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

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

Laxative, OsmoticLactulose ................................................................................................ 10Polyethylene Glycol-Electrolyte Solution ............................................... 13

Laxative, StimulantBisacodyl .................................................................................................. 3Docusate and Senna ............................................................................... 6

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

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

Lubricant, OcularOcular Lubricant .....................................................................................12Sodium Chloride .....................................................................................15

Magnesium SaltMagnesium Oxide ...................................................................................11

Mast Cell StabilizerCromolyn (Ophthalmic) ............................................................................ 5

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

Mineralocorticoid (Aldosterone) Receptor AntagonistsSpironolactone ....................................................................................... 15

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

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

Neuraminidase InhibitorOseltamivir ..............................................................................................13

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

Nonsteroidal Anti-inflammatory Drug (NSAID)Diclofenac (Ophthalmic) ...........................................................................6Diclofenac (Systemic) ...............................................................................6Diclofenac (Topical) ..................................................................................6

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

Nonsteroidal Anti-inflammatory Drug (NSAID), OphthalmicDiclofenac (Ophthalmic) ...........................................................................6Ketorolac (Ophthalmic) ...........................................................................10Nepafenac .............................................................................................. 12

Nonsteroidal Anti-inflammatory Drug (NSAID), OralAspirin .......................................................................................................3Diclofenac (Systemic) ...............................................................................6Ibuprofen .................................................................................................. 9Indomethacin ............................................................................................9Ketorolac (Systemic) .............................................................................. 10Meloxicam ...............................................................................................11Naproxen ................................................................................................12Piroxicam (Systemic) ..............................................................................13Sulindac ..................................................................................................15

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

Nonsteroidal Anti-inflammatory Drug (NSAID), TopicalDiclofenac (Topical) ..................................................................................6

Norepinephrine Reuptake Inhibitor, SelectiveAtoMOXetine ............................................................................................ 3

Nutritional SupplementFluoride .....................................................................................................8

Ophthalmic Agent, AntiglaucomaAcetaZOLAMIDE ......................................................................................2Betaxolol (Ophthalmic) .............................................................................3Bimatoprost .............................................................................................. 3Brimonidine and Timolol ...........................................................................3Brimonidine (Ophthalmic) .........................................................................3Dorzolamide ............................................................................................. 6Dorzolamide and Timolol ......................................................................... 6Latanoprost .............................................................................................10MethazolAMIDE ......................................................................................11Phenylephrine (Ophthalmic) ...................................................................13Pilocarpine (Ophthalmic) ........................................................................13Timolol (Ophthalmic) .............................................................................. 15

Ophthalmic Agent, MioticPilocarpine (Ophthalmic) ........................................................................13

Ophthalmic Agent, MiscellaneousArtificial Tears ...........................................................................................3Carboxymethylcellulose ............................................................................4Ocular Lubricant .....................................................................................12

Ophthalmic Agent, MydriaticAtropine (Ophthalmic) .............................................................................. 3

OPHTHALMIC AGENT, MYDRIATIC

23

Homatropine .............................................................................................9Phenylephrine (Ophthalmic) ...................................................................13

Ophthalmic Agent, VasoconstrictorNaphazoline and Pheniramine ...............................................................12

Otic Agent, Anti-infectiveAcetic Acid, Propylene Glycol Diacetate, and Hydrocortisone ................2

Otic Agent, CerumenolyticCarbamide Peroxide .................................................................................4

Ovulation StimulatorClomiPHENE ............................................................................................5

Partial Nicotine AgonistVarenicline ..............................................................................................16

PediculocidePermethrin ..............................................................................................13

Phenothiazine DerivativeProchlorperazine .................................................................................... 14Promethazine ......................................................................................... 14Promethazine and Codeine ................................................................... 14Promethazine and Dextromethorphan ................................................... 14

Phosphodiesterase-3 Enzyme InhibitorCilostazol ..................................................................................................4

Phosphodiesterase-5 Enzyme InhibitorSildenafil .................................................................................................15

Phosphodiesterase Enzyme Inhibitor, NonselectiveTheophylline ........................................................................................... 15

Piperazine DerivativeCetirizine (Systemic) ................................................................................ 4HydrOXYzine ............................................................................................9Meclizine .................................................................................................11

Piperidine DerivativeCyproheptadine ........................................................................................ 5Fexofenadine ............................................................................................8Loratadine ...............................................................................................10Olopatadine (Ophthalmic) ...................................................................... 12

ProgestinMedroxyPROGESTERone ..................................................................... 11Megestrol ................................................................................................11Norethindrone .........................................................................................12Progesterone ..........................................................................................14

Prostaglandin, OphthalmicBimatoprost .............................................................................................. 3Latanoprost .............................................................................................10

Proton Pump InhibitorOmeprazole ............................................................................................13Pantoprazole .......................................................................................... 13

Renin InhibitorAliskiren ....................................................................................................2

Retinoic Acid DerivativeISOtretinoin (Systemic) .......................................................................... 10Tretinoin (Topical) ...................................................................................16

Retinoid-Like CompoundAcitretin .....................................................................................................2

RifamycinRifAMPin .................................................................................................14

SalicylateAspirin .......................................................................................................3Salsalate .................................................................................................14

Scabicidal AgentPermethrin ..............................................................................................13

Second Generation (Atypical) AntipsychoticARIPiprazole .............................................................................................2Lurasidone ..............................................................................................11OLANZapine ...........................................................................................12QUEtiapine ............................................................................................. 14RisperiDONE ..........................................................................................14

Selective 5-HT3 Receptor AntagonistOndansetron ...........................................................................................13

Selective Estrogen Receptor Modulator (SERM)ClomiPHENE ............................................................................................5Raloxifene ...............................................................................................14Tamoxifen ............................................................................................... 15

Serotonin 5-HT1B, 1D Receptor AgonistRizatriptan .............................................................................................. 14SUMAtriptan ........................................................................................... 15ZOLMitriptan ...........................................................................................16

Skeletal Muscle RelaxantBaclofen ....................................................................................................3Cyclobenzaprine .......................................................................................5Metaxalone ............................................................................................. 11Methocarbamol .......................................................................................11

Skin and Mucous Membrane AgentImiquimod .................................................................................................9

Skin and Mucous Membrane Agent, MiscellaneousEmollients .................................................................................................6

Smoking Cessation AidBuPROPion .............................................................................................. 4Nicotine ...................................................................................................12Varenicline ..............................................................................................16

Sodium-Glucose Cotransporter 2 (SGLT2) InhibitorEmpagliflozin ............................................................................................ 6

Sodium SaltSodium Chloride .....................................................................................15

Stool SoftenerDocusate .................................................................................................. 6Docusate and Senna ............................................................................... 6

Substituted BenzimidazoleOmeprazole ............................................................................................13Pantoprazole .......................................................................................... 13

ThioamideMethIMAzole ...........................................................................................11Propylthiouracil .......................................................................................14

Thyroid ProductLevothyroxine ......................................................................................... 10Liothyronine ............................................................................................10

Topical Skin ProductAluminum Chloride Hexahydrate ............................................................. 2Benzoyl Peroxide ..................................................................................... 3Calcipotriene .............................................................................................4Capsaicin ..................................................................................................4Clindamycin and Benzoyl Peroxide ......................................................... 5Emollients .................................................................................................6Erythromycin (Topical) ..............................................................................7Fluorouracil (Topical) ................................................................................8Imiquimod .................................................................................................9Lactic Acid and Ammonium Hydroxide ..................................................10Pimecrolimus ..........................................................................................13Podofilox .................................................................................................13Selenium Sulfide .................................................................................... 14Tacrolimus (Topical) ............................................................................... 15

Topical Skin Product, AcneAdapalene ................................................................................................ 2Azelaic Acid ..............................................................................................3Benzoyl Peroxide ..................................................................................... 3Clindamycin and Benzoyl Peroxide ......................................................... 5Clindamycin (Topical) ............................................................................... 5Erythromycin (Topical) ..............................................................................7Tretinoin (Topical) ...................................................................................16

Transient Receptor Potential Vanilloid 1 (TRPV1) AgonistCapsaicin ..................................................................................................4

Tumor Necrosis Factor (TNF) Blocking AgentAdalimumab ..............................................................................................2

Uricosuric AgentProbenecid ............................................................................................. 14

VasodilatorCilostazol ..................................................................................................4Dipyridamole .............................................................................................6HydrALAZINE ...........................................................................................9Isosorbide Dinitrate ................................................................................ 10Isosorbide Mononitrate ...........................................................................10Nitroglycerin ............................................................................................12

Vasopressin Analog, SyntheticDesmopressin ...........................................................................................5

VitaminVitamins (Multiple/Pediatric) ...................................................................16Vitamins (Prenatal) .................................................................................16

OPHTHALMIC AGENT, MYDRIATIC

24

Vitamin D Analog

Alendronate and Cholecalciferol .............................................................. 2

Calcipotriene .............................................................................................4

Calcitriol (Systemic) ..................................................................................4

Ergocalciferol ............................................................................................6

Vitamin, Fat Soluble

Phytonadione ......................................................................................... 13

Vitamin, Water Soluble

Cyanocobalamin .......................................................................................5

Folic Acid ..................................................................................................8

Niacin ......................................................................................................12

Pyridoxine ...............................................................................................14

Xanthine Oxidase Inhibitor

Allopurinol .................................................................................................2

XANTHINE OXIDASE INHIBITOR

25

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