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2020-2021 Crisis Medicaion List

Health Choice AZ Crisis List effective: 07/01/2021 Name Requirements/Limits ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS hcl cap 10 mg (base equiv) (generic QL (Max 7 days) of STRATTERA) atomoxetine hcl cap 18 mg (base equiv) (generic QL (Max 7 days) of STRATTERA) atomoxetine hcl cap 25 mg (base equiv) (generic QL (Max 7 days) of STRATTERA) atomoxetine hcl cap 40 mg (base equiv) (generic QL (Max 7 days) of STRATTERA) atomoxetine hcl cap 60 mg (base equiv) (generic QL (Max 7 days) of STRATTERA) atomoxetine hcl cap 80 mg (base equiv) (generic QL (Max 7 days) of STRATTERA) atomoxetine hcl cap 100 mg (base equiv) (generic QL (Max 7 days) of STRATTERA) - OPIOID PARTIAL buprenorphine hcl- hcl sl film 2-0.5 mg QL (Max 7 days) (base equiv) (generic of SUBOXONE) buprenorphine hcl-naloxone hcl sl film 4-1 mg QL (Max 7 days) (base equiv) (generic of SUBOXONE) buprenorphine hcl-naloxone hcl sl film 8-2 mg QL (Max 7 days) (base equiv) (generic of SUBOXONE) buprenorphine hcl-naloxone hcl sl film 12-3 mg QL (Max 7 days) (base equiv) (generic of SUBOXONE) buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg QL (Max 7 days) (base equiv) buprenorphine hcl-naloxone hcl sl tab 8-2 mg QL (Max 7 days) (base equiv) ANTIANXIETY AGENTS ANTIANXIETY AGENTS - MISC. hydroxyzine hcl syrup 10 mg/5ml QL (Max 7 days) hydroxyzine hcl tab 10 mg QL (Max 7 days) hydroxyzine hcl tab 25 mg QL (Max 7 days) hydroxyzine hcl tab 50 mg QL (Max 7 days) hydroxyzine pamoate cap 25 mg (generic of QL (Max 7 days) VISTARIL) hydroxyzine pamoate cap 50 mg (generic of QL (Max 7 days) VISTARIL) hydroxyzine pamoate cap 100 mg QL (Max 7 days) tab 0.5 mg (generic of XANAX) QL (Max 7 days) alprazolam tab 0.25 mg (generic of XANAX) QL (Max 7 days) alprazolam tab 1 mg (generic of XANAX) QL (Max 7 days)

OTC - Over the counter QL - Quantity Limits 1

Drug Name Requirements/Limits alprazolam tab 2 mg (generic of XANAX) QL (Max 7 days) hcl cap 5 mg QL (Max 7 days) chlordiazepoxide hcl cap 10 mg QL (Max 7 days) chlordiazepoxide hcl cap 25 mg QL (Max 7 days) dipotassium tab 3.75 mg QL (Max 7 days) clorazepate dipotassium tab 7.5 mg QL (Max 7 days) clorazepate dipotassium tab 15 mg QL (Max 7 days) tab 2 mg (generic of VALIUM) QL (Max 7 days) diazepam tab 5 mg (generic of VALIUM) QL (Max 7 days) diazepam tab 10 mg (generic of VALIUM) QL (Max 7 days) tab 0.5 mg (generic of ATIVAN) QL (Max 7 days) lorazepam tab 1 mg (generic of ATIVAN) QL (Max 7 days) lorazepam tab 2 mg (generic of ATIVAN) QL (Max 7 days) cap 10 mg QL (Max 7 days) oxazepam cap 15 mg QL (Max 7 days) oxazepam cap 30 mg QL (Max 7 days) ANTICONVULSANTS ANTICONVULSANTS - BENZODIAZEPINES tab 0.5 mg (generic of KLONOPIN) QL (Max 7 days) clonazepam tab 1 mg (generic of KLONOPIN) QL (Max 7 days) clonazepam tab 2 mg (generic of KLONOPIN) QL (Max 7 days) ANTICONVULSANTS - MISC. chew tab 100 mg QL (Max 7 days) carbamazepine susp 100 mg/5ml (generic of QL (Max 7 days) TEGRETOL) carbamazepine tab 200 mg (generic of TEGRETOL) QL (Max 7 days) carbamazepine tab er 12hr 100 mg (generic of QL (Max 7 days) TEGRETOL-XR) carbamazepine tab er 12hr 200 mg (generic of QL (Max 7 days) TEGRETOL-XR) carbamazepine tab er 12hr 400 mg (generic of QL (Max 7 days) TEGRETOL-XR) susp 300 mg/5ml (60 mg/ml) QL (Max 7 days) (generic of TRILEPTAL) oxcarbazepine tab 150 mg (generic of TRILEPTAL) QL (Max 7 days) oxcarbazepine tab 300 mg (generic of TRILEPTAL) QL (Max 7 days) oxcarbazepine tab 600 mg (generic of TRILEPTAL) QL (Max 7 days) VALPROIC ACID divalproex sodium tab delayed release 125 mg QL (Max 7 days) (generic of DEPAKOTE) divalproex sodium tab delayed release 250 mg QL (Max 7 days) (generic of DEPAKOTE) divalproex sodium tab delayed release 500 mg QL (Max 7 days) (generic of DEPAKOTE) divalproex sodium tab er 24 hr 250 mg (generic of QL (Max 7 days) DEPAKOTE ER)

OTC - Over the counter QL - Quantity Limits 2

Drug Name Requirements/Limits divalproex sodium tab er 24 hr 500 mg (generic of QL (Max 7 days) DEPAKOTE ER) sodium oral soln 250 mg/5ml (base QL (Max 7 days) equiv) valproic acid cap 250 mg QL (Max 7 days) ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS) tab 15 mg (generic of REMERON) QL (Max 7 days) mirtazapine tab 30 mg (generic of REMERON) QL (Max 7 days) mirtazapine tab 45 mg QL (Max 7 days) ANTIDEPRESSANTS - MISC. hcl tab 75 mg QL (Max 7 days) bupropion hcl tab 100 mg QL (Max 7 days) bupropion hcl tab er 12hr 100 mg (generic of QL (Max 7 days) WELLBUTRIN SR) bupropion hcl tab er 12hr 150 mg (generic of QL (Max 7 days) WELLBUTRIN SR) bupropion hcl tab er 12hr 200 mg (generic of QL (Max 7 days) WELLBUTRIN SR) SELECTIVE REUPTAKE INHIBITORS (SSRIS) hydrobromide oral soln 10 mg/5ml QL (Max 7 days) citalopram hydrobromide tab 10 mg (base equiv) QL (Max 7 days) (generic of CELEXA) citalopram hydrobromide tab 20 mg (base equiv) QL (Max 7 days) (generic of CELEXA) citalopram hydrobromide tab 40 mg (base equiv) QL (Max 7 days) (generic of CELEXA) hcl cap 10 mg (generic of PROZAC) QL (Max 7 days) fluoxetine hcl cap 20 mg (generic of PROZAC) QL (Max 7 days) fluoxetine hcl cap 40 mg (generic of PROZAC) QL (Max 7 days) fluoxetine hcl solution 20 mg/5ml QL (Max 7 days) fluoxetine hcl tab 60 mg (generic of FLUOXETINE QL (Max 7 days) HYDROCHLORIDE) FLUOXETINE TAB 60MG QL (Max 7 days) maleate tab 25 mg QL (Max 7 days) fluvoxamine maleate tab 50 mg QL (Max 7 days) fluvoxamine maleate tab 100 mg QL (Max 7 days) hcl tab 10 mg (generic of PAXIL) QL (Max 7 days) paroxetine hcl tab 20 mg (generic of PAXIL) QL (Max 7 days) paroxetine hcl tab 30 mg (generic of PAXIL) QL (Max 7 days) paroxetine hcl tab 40 mg (generic of PAXIL) QL (Max 7 days) hcl oral concentrate for solution 20 QL (Max 7 days) mg/ml (generic of ZOLOFT) sertraline hcl tab 25 mg (generic of ZOLOFT) QL (Max 7 days) sertraline hcl tab 50 mg (generic of ZOLOFT) QL (Max 7 days) sertraline hcl tab 100 mg (generic of ZOLOFT) QL (Max 7 days)

OTC - Over the counter QL - Quantity Limits 3

Drug Name Requirements/Limits SEROTONIN MODULATORS hcl tab 50 mg QL (Max 7 days) trazodone hcl tab 100 mg QL (Max 7 days) trazodone hcl tab 150 mg QL (Max 7 days) trazodone hcl tab 300 mg QL (Max 7 days) SEROTONIN- REUPTAKE INHIBITORS (SNRIS) hcl cap er 24hr 37.5 mg (base QL (Max 7 days) equivalent) (generic of EFFEXOR XR) venlafaxine hcl cap er 24hr 75 mg (base QL (Max 7 days) equivalent) (generic of EFFEXOR XR) venlafaxine hcl cap er 24hr 150 mg (base QL (Max 7 days) equivalent) (generic of EFFEXOR XR) venlafaxine hcl tab 25 mg (base equivalent) QL (Max 7 days) venlafaxine hcl tab 50 mg (base equivalent) QL (Max 7 days) venlafaxine hcl tab 75 mg (base equivalent) QL (Max 7 days) venlafaxine hcl tab 100 mg (base equivalent) QL (Max 7 days) ANTIDOTES AND SPECIFIC ANTAGONISTS OPIOID ANTAGONISTS hcl tab 50 mg QL (Max 7 days) ANTIHISTAMINES - ETHANOLAMINES hcl cap 25 mg QL (Max 7 days), OTC diphenhydramine hcl cap 50 mg QL (Max 7 days), OTC diphenhydramine hcl tab 25 mg QL (Max 7 days), OTC ANTIHISTAMINES - PIPERIDINES hcl tab 4 mg QL (Max 7 days) ANTIHYPERTENSIVES ANTIADRENERGIC ANTIHYPERTENSIVES hcl tab 0.1 mg QL (Max 7 days) clonidine hcl tab 0.2 mg QL (Max 7 days) clonidine hcl tab 0.3 mg QL (Max 7 days) hcl tab 1 mg QL (Max 7 days) guanfacine hcl tab 2 mg QL (Max 7 days) ANTIPARKINSON AND RELATED THERAPY AGENTS ANTIPARKINSON benztropine mesylate tab 0.5 mg QL (Max 7 days) benztropine mesylate tab 1 mg QL (Max 7 days) benztropine mesylate tab 2 mg QL (Max 7 days) trihexyphenidyl hcl tab 2 mg QL (Max 7 days) trihexyphenidyl hcl tab 5 mg QL (Max 7 days) /ANTIMANIC AGENTS ANTIMANIC AGENTS carbonate cap 150 mg QL (Max 7 days) cap 300 mg QL (Max 7 days)

OTC - Over the counter QL - Quantity Limits 4

Drug Name Requirements/Limits lithium carbonate cap 600 mg QL (Max 7 days) lithium carbonate tab er 300 mg (generic of QL (Max 7 days) LITHOBID) lithium carbonate tab er 450 mg QL (Max 7 days) LITHIUM SOL 8MEQ/5ML QL (Max 7 days) BENZISOXAZOLES orally disintegrating tab 0.5 mg QL (Max 7 days) risperidone orally disintegrating tab 0.25 mg QL (Max 7 days) risperidone orally disintegrating tab 1 mg QL (Max 7 days) risperidone orally disintegrating tab 2 mg QL (Max 7 days) risperidone orally disintegrating tab 3 mg QL (Max 7 days) risperidone orally disintegrating tab 4 mg QL (Max 7 days) risperidone soln 1 mg/ml (generic of RISPERDAL) QL (Max 7 days) risperidone tab 0.5 mg (generic of RISPERDAL) QL (Max 7 days) risperidone tab 0.25 mg QL (Max 7 days) risperidone tab 1 mg (generic of RISPERDAL) QL (Max 7 days) risperidone tab 2 mg (generic of RISPERDAL) QL (Max 7 days) risperidone tab 3 mg (generic of RISPERDAL) QL (Max 7 days) risperidone tab 4 mg (generic of RISPERDAL) QL (Max 7 days) BUTYROPHENONES decanoate im soln 50 mg/ml (generic QL (Max 7 days) of HALDOL DECANOATE 50) im soln 100 mg/ml (generic QL (Max 7 days) of HALDOL DECANOATE 100) haloperidol tab 0.5 mg QL (Max 7 days) haloperidol tab 1 mg QL (Max 7 days) haloperidol tab 2 mg QL (Max 7 days) haloperidol tab 5 mg QL (Max 7 days) haloperidol tab 10 mg QL (Max 7 days) haloperidol tab 20 mg QL (Max 7 days) DIBENZAPINES succinate cap 5 mg QL (Max 7 days) loxapine succinate cap 10 mg QL (Max 7 days) loxapine succinate cap 25 mg QL (Max 7 days) loxapine succinate cap 50 mg QL (Max 7 days) tab 2.5 mg (generic of ZYPREXA) QL (Max 7 days) olanzapine tab 5 mg (generic of ZYPREXA) QL (Max 7 days) olanzapine tab 7.5 mg (generic of ZYPREXA) QL (Max 7 days) olanzapine tab 10 mg (generic of ZYPREXA) QL (Max 7 days) olanzapine tab 15 mg (generic of ZYPREXA) QL (Max 7 days) olanzapine tab 20 mg (generic of ZYPREXA) QL (Max 7 days) fumarate tab 25 mg (generic of QL (Max 7 days) SEROQUEL) quetiapine fumarate tab 50 mg (generic of QL (Max 7 days) SEROQUEL)

OTC - Over the counter QL - Quantity Limits 5

Drug Name Requirements/Limits quetiapine fumarate tab 100 mg (generic of QL (Max 7 days) SEROQUEL) quetiapine fumarate tab 200 mg (generic of QL (Max 7 days) SEROQUEL) quetiapine fumarate tab 300 mg (generic of QL (Max 7 days) SEROQUEL) quetiapine fumarate tab 400 mg (generic of QL (Max 7 days) SEROQUEL) hcl tab 10 mg QL (Max 7 days) chlorpromazine hcl tab 25 mg QL (Max 7 days) chlorpromazine hcl tab 50 mg QL (Max 7 days) chlorpromazine hcl tab 100 mg QL (Max 7 days) chlorpromazine hcl tab 200 mg QL (Max 7 days) decanoate inj 25 mg/ml QL (Max 7 days) fluphenazine hcl tab 1 mg QL (Max 7 days) fluphenazine hcl tab 2.5 mg QL (Max 7 days) fluphenazine hcl tab 5 mg QL (Max 7 days) fluphenazine hcl tab 10 mg QL (Max 7 days) tab 2 mg QL (Max 7 days) perphenazine tab 4 mg QL (Max 7 days) perphenazine tab 8 mg QL (Max 7 days) perphenazine tab 16 mg QL (Max 7 days) hcl tab 1 mg (base equivalent) QL (Max 7 days) trifluoperazine hcl tab 2 mg (base equivalent) QL (Max 7 days) trifluoperazine hcl tab 5 mg (base equivalent) QL (Max 7 days) trifluoperazine hcl tab 10 mg (base equivalent) QL (Max 7 days) thiothixene cap 1 mg QL (Max 7 days) thiothixene cap 2 mg QL (Max 7 days) thiothixene cap 5 mg QL (Max 7 days) thiothixene cap 10 mg QL (Max 7 days) //SLEEP DISORDER AGENTS HYPNOTICS diphenhydramine hcl (sleep) cap 25 mg QL (Max 7 days), OTC diphenhydramine hcl (sleep) cap 50 mg QL (Max 7 days), OTC diphenhydramine hcl (sleep) tab 25 mg QL (Max 7 days), OTC diphenhydramine hcl (sleep) tab 50 mg QL (Max 7 days), OTC NON- HYPNOTICS cap 15 mg (generic of RESTORIL) QL (Max 7 days) temazepam cap 30 mg (generic of RESTORIL) QL (Max 7 days) PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. AGENTS FOR CHEMICAL DEPENDENCY calcium tab delayed release 333 mg QL (Max 7 days) tab 250 mg QL (Max 7 days)

OTC - Over the counter QL - Quantity Limits 6

Drug Name Requirements/Limits disulfiram tab 500 mg QL (Max 7 days)

OTC - Over the counter QL - Quantity Limits 7

Index A C acamprosate calcium tab delayed carbamazepine chew tab 100 mg ...... 2 release 333 mg ...... 6 carbamazepine susp 100 mg/5ml ...... 2 alprazolam tab 0.25 mg ...... 1 carbamazepine tab 200 mg ...... 2 alprazolam tab 0.5 mg ...... 1 carbamazepine tab er 12hr 100 mg ... 2 alprazolam tab 1 mg ...... 1 carbamazepine tab er 12hr 200 mg ... 2 alprazolam tab 2 mg ...... 2 carbamazepine tab er 12hr 400 mg ... 2 ATIVAN CELEXA see lorazepam tab 0.5 mg ...... 2 see citalopram hydrobromide tab 10 see lorazepam tab 1 mg ...... 2 mg (base equiv) ...... 3 see lorazepam tab 2 mg ...... 2 see citalopram hydrobromide tab 20 atomoxetine hcl cap 10 mg (base mg (base equiv) ...... 3 equiv) ...... 1 see citalopram hydrobromide tab 40 atomoxetine hcl cap 100 mg (base mg (base equiv) ...... 3 equiv) ...... 1 chlordiazepoxide hcl cap 10 mg ...... 2 atomoxetine hcl cap 18 mg (base chlordiazepoxide hcl cap 25 mg ...... 2 equiv) ...... 1 chlordiazepoxide hcl cap 5 mg ...... 2 atomoxetine hcl cap 25 mg (base chlorpromazine hcl tab 10 mg ...... 6 equiv) ...... 1 chlorpromazine hcl tab 100 mg ...... 6 atomoxetine hcl cap 40 mg (base chlorpromazine hcl tab 200 mg ...... 6 equiv) ...... 1 chlorpromazine hcl tab 25 mg ...... 6 atomoxetine hcl cap 60 mg (base chlorpromazine hcl tab 50 mg ...... 6 equiv) ...... 1 citalopram hydrobromide oral soln 10 atomoxetine hcl cap 80 mg (base mg/5ml ...... 3 equiv) ...... 1 citalopram hydrobromide tab 10 mg B (base equiv) ...... 3 benztropine mesylate tab 0.5 mg ...... 4 citalopram hydrobromide tab 20 mg benztropine mesylate tab 1 mg ...... 4 (base equiv) ...... 3 benztropine mesylate tab 2 mg ...... 4 citalopram hydrobromide tab 40 mg buprenorphine hcl-naloxone hcl sl film (base equiv) ...... 3 12-3 mg (base equiv) ...... 1 clonazepam tab 0.5 mg ...... 2 buprenorphine hcl-naloxone hcl sl film clonazepam tab 1 mg ...... 2 2-0.5 mg (base equiv) ...... 1 clonazepam tab 2 mg ...... 2 buprenorphine hcl-naloxone hcl sl film clonidine hcl tab 0.1 mg ...... 4 4-1 mg (base equiv) ...... 1 clonidine hcl tab 0.2 mg ...... 4 buprenorphine hcl-naloxone hcl sl film clonidine hcl tab 0.3 mg ...... 4 8-2 mg (base equiv) ...... 1 clorazepate dipotassium tab 15 mg ... 2 buprenorphine hcl-naloxone hcl sl tab clorazepate dipotassium tab 3.75 mg . 2 2-0.5 mg (base equiv) ...... 1 clorazepate dipotassium tab 7.5 mg .. 2 buprenorphine hcl-naloxone hcl sl tab cyproheptadine hcl tab 4 mg ...... 4 8-2 mg (base equiv) ...... 1 D bupropion hcl tab 100 mg ...... 3 DEPAKOTE bupropion hcl tab 75 mg ...... 3 see divalproex sodium tab delayed bupropion hcl tab er 12hr 100 mg ..... 3 release 125 mg ...... 2 bupropion hcl tab er 12hr 150 mg ..... 3 see divalproex sodium tab delayed bupropion hcl tab er 12hr 200 mg ..... 3 release 250 mg ...... 2 8

see divalproex sodium tab delayed FLUOXETINE HYDROCHLORIDE release 500 mg ...... 2 see fluoxetine hcl tab 60 mg ...... 3 DEPAKOTE ER FLUOXETINE TAB 60MG ...... 3 see divalproex sodium tab er 24 hr fluphenazine decanoate inj 25 mg/ml 6 250 mg ...... 2 fluphenazine hcl tab 1 mg ...... 6 see divalproex sodium tab er 24 hr fluphenazine hcl tab 10 mg ...... 6 500 mg ...... 3 fluphenazine hcl tab 2.5 mg ...... 6 diazepam tab 10 mg ...... 2 fluphenazine hcl tab 5 mg ...... 6 diazepam tab 2 mg ...... 2 fluvoxamine maleate tab 100 mg ...... 3 diazepam tab 5 mg ...... 2 fluvoxamine maleate tab 25 mg ...... 3 diphenhydramine hcl (sleep) cap 25 mg fluvoxamine maleate tab 50 mg ...... 3 ...... 6 G diphenhydramine hcl (sleep) cap 50 mg guanfacine hcl tab 1 mg ...... 4 ...... 6 guanfacine hcl tab 2 mg ...... 4 diphenhydramine hcl (sleep) tab 25 mg H ...... 6 HALDOL DECANOATE 100 diphenhydramine hcl (sleep) tab 50 mg see haloperidol decanoate im soln ...... 6 100 mg/ml...... 5 diphenhydramine hcl cap 25 mg ...... 4 HALDOL DECANOATE 50 diphenhydramine hcl cap 50 mg ...... 4 see haloperidol decanoate im soln 50 diphenhydramine hcl tab 25 mg ...... 4 mg/ml ...... 5 disulfiram tab 250 mg ...... 6 haloperidol decanoate im soln 100 disulfiram tab 500 mg ...... 7 mg/ml ...... 5 divalproex sodium tab delayed release haloperidol decanoate im soln 50 125 mg ...... 2 mg/ml ...... 5 divalproex sodium tab delayed release haloperidol tab 0.5 mg ...... 5 250 mg ...... 2 haloperidol tab 1 mg...... 5 divalproex sodium tab delayed release haloperidol tab 10 mg ...... 5 500 mg ...... 2 haloperidol tab 2 mg...... 5 divalproex sodium tab er 24 hr 250 mg haloperidol tab 20 mg ...... 5 ...... 2 haloperidol tab 5 mg...... 5 divalproex sodium tab er 24 hr 500 mg hydroxyzine hcl syrup 10 mg/5ml...... 1 ...... 3 hydroxyzine hcl tab 10 mg ...... 1 E hydroxyzine hcl tab 25 mg ...... 1 EFFEXOR XR hydroxyzine hcl tab 50 mg ...... 1 see venlafaxine hcl cap er 24hr 150 hydroxyzine pamoate cap 100 mg ..... 1 mg (base equivalent) ...... 4 hydroxyzine pamoate cap 25 mg ...... 1 see venlafaxine hcl cap er 24hr 37.5 hydroxyzine pamoate cap 50 mg ...... 1 mg (base equivalent) ...... 4 K see venlafaxine hcl cap er 24hr 75 KLONOPIN mg (base equivalent) ...... 4 see clonazepam tab 0.5 mg ...... 2 F see clonazepam tab 1 mg ...... 2 fluoxetine hcl cap 10 mg ...... 3 see clonazepam tab 2 mg ...... 2 fluoxetine hcl cap 20 mg ...... 3 L fluoxetine hcl cap 40 mg ...... 3 lithium carbonate cap 150 mg ...... 4 fluoxetine hcl solution 20 mg/5ml ...... 3 lithium carbonate cap 300 mg ...... 4 fluoxetine hcl tab 60 mg ...... 3 lithium carbonate cap 600 mg ...... 5 9 lithium carbonate tab er 300 mg ...... 5 PROZAC lithium carbonate tab er 450 mg ...... 5 see fluoxetine hcl cap 10 mg ...... 3 LITHIUM SOL 8MEQ/5ML ...... 5 see fluoxetine hcl cap 20 mg ...... 3 LITHOBID see fluoxetine hcl cap 40 mg ...... 3 see lithium carbonate tab er 300 mg5 Q lorazepam tab 0.5 mg ...... 2 quetiapine fumarate tab 100 mg ...... 6 lorazepam tab 1 mg ...... 2 quetiapine fumarate tab 200 mg ...... 6 lorazepam tab 2 mg ...... 2 quetiapine fumarate tab 25 mg ...... 5 loxapine succinate cap 10 mg ...... 5 quetiapine fumarate tab 300 mg ...... 6 loxapine succinate cap 25 mg ...... 5 quetiapine fumarate tab 400 mg ...... 6 loxapine succinate cap 5 mg ...... 5 quetiapine fumarate tab 50 mg ...... 5 loxapine succinate cap 50 mg ...... 5 R M REMERON mirtazapine tab 15 mg ...... 3 see mirtazapine tab 15 mg ...... 3 mirtazapine tab 30 mg ...... 3 see mirtazapine tab 30 mg ...... 3 mirtazapine tab 45 mg ...... 3 RESTORIL N see temazepam cap 15 mg ...... 6 naltrexone hcl tab 50 mg ...... 4 see temazepam cap 30 mg ...... 6 O RISPERDAL olanzapine tab 10 mg ...... 5 see risperidone soln 1 mg/ml ...... 5 olanzapine tab 15 mg ...... 5 see risperidone tab 0.5 mg ...... 5 olanzapine tab 2.5 mg ...... 5 see risperidone tab 1 mg ...... 5 olanzapine tab 20 mg ...... 5 see risperidone tab 2 mg ...... 5 olanzapine tab 5 mg ...... 5 see risperidone tab 3 mg ...... 5 olanzapine tab 7.5 mg ...... 5 see risperidone tab 4 mg ...... 5 oxazepam cap 10 mg ...... 2 risperidone orally disintegrating tab oxazepam cap 15 mg ...... 2 0.25 mg ...... 5 oxazepam cap 30 mg ...... 2 risperidone orally disintegrating tab 0.5 oxcarbazepine susp 300 mg/5ml (60 mg ...... 5 mg/ml) ...... 2 risperidone orally disintegrating tab 1 oxcarbazepine tab 150 mg ...... 2 mg ...... 5 oxcarbazepine tab 300 mg ...... 2 risperidone orally disintegrating tab 2 oxcarbazepine tab 600 mg ...... 2 mg ...... 5 P risperidone orally disintegrating tab 3 paroxetine hcl tab 10 mg ...... 3 mg ...... 5 paroxetine hcl tab 20 mg ...... 3 risperidone orally disintegrating tab 4 paroxetine hcl tab 30 mg ...... 3 mg ...... 5 paroxetine hcl tab 40 mg ...... 3 risperidone soln 1 mg/ml ...... 5 PAXIL risperidone tab 0.25 mg ...... 5 see paroxetine hcl tab 10 mg ...... 3 risperidone tab 0.5 mg ...... 5 see paroxetine hcl tab 20 mg ...... 3 risperidone tab 1 mg ...... 5 see paroxetine hcl tab 30 mg ...... 3 risperidone tab 2 mg ...... 5 see paroxetine hcl tab 40 mg ...... 3 risperidone tab 3 mg ...... 5 perphenazine tab 16 mg ...... 6 risperidone tab 4 mg ...... 5 perphenazine tab 2 mg ...... 6 S perphenazine tab 4 mg ...... 6 SEROQUEL perphenazine tab 8 mg ...... 6 see quetiapine fumarate tab 100 mg6 10

see quetiapine fumarate tab 200 mg6 temazepam cap 30 mg ...... 6 see quetiapine fumarate tab 25 mg 5 thiothixene cap 1 mg ...... 6 see quetiapine fumarate tab 300 mg6 thiothixene cap 10 mg ...... 6 see quetiapine fumarate tab 400 mg6 thiothixene cap 2 mg ...... 6 see quetiapine fumarate tab 50 mg 5 thiothixene cap 5 mg ...... 6 sertraline hcl oral concentrate for trazodone hcl tab 100 mg ...... 4 solution 20 mg/ml ...... 3 trazodone hcl tab 150 mg ...... 4 sertraline hcl tab 100 mg ...... 3 trazodone hcl tab 300 mg ...... 4 sertraline hcl tab 25 mg ...... 3 trazodone hcl tab 50 mg ...... 4 sertraline hcl tab 50 mg ...... 3 trifluoperazine hcl tab 1 mg (base STRATTERA equivalent) ...... 6 see atomoxetine hcl cap 10 mg (base trifluoperazine hcl tab 10 mg (base equiv) ...... 1 equivalent) ...... 6 see atomoxetine hcl cap 100 mg trifluoperazine hcl tab 2 mg (base (base equiv)...... 1 equivalent) ...... 6 see atomoxetine hcl cap 18 mg (base trifluoperazine hcl tab 5 mg (base equiv) ...... 1 equivalent) ...... 6 see atomoxetine hcl cap 25 mg (base trihexyphenidyl hcl tab 2 mg ...... 4 equiv) ...... 1 trihexyphenidyl hcl tab 5 mg ...... 4 see atomoxetine hcl cap 40 mg (base TRILEPTAL equiv) ...... 1 see oxcarbazepine susp 300 mg/5ml see atomoxetine hcl cap 60 mg (base (60 mg/ml) ...... 2 equiv) ...... 1 see oxcarbazepine tab 150 mg ...... 2 see atomoxetine hcl cap 80 mg (base see oxcarbazepine tab 300 mg ...... 2 equiv) ...... 1 see oxcarbazepine tab 600 mg ...... 2 SUBOXONE V see buprenorphine hcl-naloxone hcl VALIUM sl film 12-3 mg (base equiv) ...... 1 see diazepam tab 10 mg ...... 2 see buprenorphine hcl-naloxone hcl see diazepam tab 2 mg ...... 2 sl film 2-0.5 mg (base equiv) ...... 1 see diazepam tab 5 mg ...... 2 see buprenorphine hcl-naloxone hcl valproate sodium oral soln 250 mg/5ml sl film 4-1 mg (base equiv) ...... 1 (base equiv) ...... 3 see buprenorphine hcl-naloxone hcl valproic acid cap 250 mg ...... 3 sl film 8-2 mg (base equiv) ...... 1 venlafaxine hcl cap er 24hr 150 mg T (base equivalent) ...... 4 TEGRETOL venlafaxine hcl cap er 24hr 37.5 mg see carbamazepine susp 100 mg/5ml (base equivalent) ...... 4 ...... 2 venlafaxine hcl cap er 24hr 75 mg see carbamazepine tab 200 mg ...... 2 (base equivalent) ...... 4 TEGRETOL-XR venlafaxine hcl tab 100 mg (base see carbamazepine tab er 12hr 100 equivalent) ...... 4 mg ...... 2 venlafaxine hcl tab 25 mg (base see carbamazepine tab er 12hr 200 equivalent) ...... 4 mg ...... 2 venlafaxine hcl tab 50 mg (base see carbamazepine tab er 12hr 400 equivalent) ...... 4 mg ...... 2 venlafaxine hcl tab 75 mg (base temazepam cap 15 mg ...... 6 equivalent) ...... 4 11

VISTARIL see alprazolam tab 1 mg ...... 1 see hydroxyzine pamoate cap 25 mg see alprazolam tab 2 mg ...... 2 ...... 1 Z see hydroxyzine pamoate cap 50 mg ZOLOFT ...... 1 see sertraline hcl oral concentrate for W solution 20 mg/ml ...... 3 WELLBUTRIN SR see sertraline hcl tab 100 mg ...... 3 see bupropion hcl tab er 12hr 100 see sertraline hcl tab 25 mg...... 3 mg ...... 3 see sertraline hcl tab 50 mg...... 3 see bupropion hcl tab er 12hr 150 ZYPREXA mg ...... 3 see olanzapine tab 10 mg ...... 5 see bupropion hcl tab er 12hr 200 see olanzapine tab 15 mg ...... 5 mg ...... 3 see olanzapine tab 2.5 mg ...... 5 X see olanzapine tab 20 mg ...... 5 XANAX see olanzapine tab 5 mg ...... 5 see alprazolam tab 0.25 mg ...... 1 see olanzapine tab 7.5 mg ...... 5 see alprazolam tab 0.5 mg ...... 1

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