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MSM Cross Reference Antihistamine Decongestant 20100701 Final Posted

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MSM Cross Reference Antihistamine Decongestant 20100701 Final Posted MISSISSIPPI DIVISION OF MEDICAID Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List The agents listed below are the antihistamine/decongestant drug products listed in the Mississippi Medicaid Preferred Drug List (PDL). This is a cross-reference between the drug product name and its active ingredients to reference the antihistamine/decongestant portion of the PDL. For more information concerning the PDL, including non- preferred agents, the OTC formulary, and other specifics, please visit our website at www.medicaid.ms.gov. List Effective 07/16/10 Therapeutic Class Active Ingredients Preferred Non-Preferred ANTIHISTAMINES - 1ST GENERATION BROMPHENIRAMINE MALEATE BPM BROMAX BROMPHENIRAMINE MALEATE J-TAN PD BROMSPIRO LODRANE 24 LOHIST 12HR VAZOL BROMPHENIRAMINE TANNATE BROMPHENIRAMINE TANNATE J-TAN P-TEX BROMPHENIRAMINE/DIPHENHYDRAM ALA-HIST CARBINOXAMINE MALEATE CARBINOXAMINE MALEATE PALGIC CHLORPHENIRAMINE MALEATE CHLORPHENIRAMINE MALEATE CPM 12 CHLORPHENIRAMINE TANNATE ED CHLORPED ED-CHLOR-TAN MYCI CHLOR-TAN MYCI CHLORPED PEDIAPHYL TANAHIST-PD CLEMASTINE FUMARATE CLEMASTINE FUMARATE CYPROHEPTADINE HCL CYPROHEPTADINE HCL DEXCHLORPHENIRAMINE MALEATE DEXCHLORPHENIRAMINE MALEATE DIPHENHYDRAMINE HCL ALLERGY MEDICINE ALLERGY RELIEF BANOPHEN BENADRYL BENADRYL ALLERGY CHILDREN'S ALLERGY CHILDREN'S COLD & ALLERGY COMPLETE ALLERGY DIPHEDRYL DIPHENDRYL DIPHENHIST DIPHENHYDRAMINE HCL DYTUSS GENAHIST HYDRAMINE MEDI-PHEDRYL PHARBEDRYL Q-DRYL QUENALIN SILADRYL SILPHEN DIPHENHYDRAMINE TANNATE DIPHENMAX DOXYLAMINE SUCCINATE DOXYTEX ALDEX AN PYRILAMINE MAL/DEXBROMPHEN TAN POLY TAN TRIPROLIDINE HCL TRIPOHIST TRIPROLIDINE HCL 1ST GEN ANTIHISTAMINE & BROMPHENIR/DIPHENHYD/PHENYLEPH ALA-HIST D DECONGESTANT COMBINATIONS PE TAN/PYRIL MAL/DEXBROMPH TAN POLY TAN D PE/PE & PYRILAMINE TANNATE/CPM PHENA-S 12 P-EPD TAN/BROMPHENIRAMIN B-VEX PD BROVEX PD LODRANE D P-EPD TAN/CHLOR-TAN DICEL SUDAL 12 P-EPHED HCL/BROMPHENIRAMIN BPM PSEUDO BROMFENEX BROMHIST BROMFENEX-PD BROMHIST-NR HISTEX SR BROMPHENIRAMINE-PSEUDOEPHEDRI J-TAN D PD BROVEX PSB BROVEX PSE LODRANE LODRANE 24D LOHIST 12D LOHIST-PD PSE BPM RESPAHIST SILDEC Brand names are designated in bold in the drug product name column; all other agents are considered generic products. MISSISSIPPI DIVISION OF MEDICAID Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List P-EPHED HCL/D-BROMP MAL CONEX DISOPHROL Active Ingredient Abbreviation Key BROMPH=brompheniramine DEXBROMPH=dexbrompheniramine MAL=maleate P-EPD=pseudoephedrine CPM=chlorpheniramine maleate DEXCHLOR=dexchlorpheniramine METHSCOP=methscopolamine PYR=pyrilamine CPT=chlorpheniramine tannate DIPH=diphenhydramine PE=phenylephrine TAN=tannate Brand names are designated in bold in the drug product name column; all other agents are considered generic products. MISSISSIPPI DIVISION OF MEDICAID Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List Therapeutic Class Active Ingredients Preferred Non-Preferred 1ST GEN ANTIHISTAMINE & P-EPHED HCL/TRIPROLIDINE HCL PEDIATEX TD HIST-PSE DECONGESTANT COMBINATIONS TRIPOHIST D TRIP-PSE (Continued) P-EPHED SUL/D-BROMP MAL DISOPHROL DRIXORAL PHENYLEPHRINE HCL/CHLOR-MAL C-PHEN DROPS 10PEH-4CPM C-PHEN SYRUP ALERSULE DALLERGY-JR CENTERGY RESCON-JR CERON TUSSANIL CP DEC DALLERGY ED A-HIST MAXICHLOR PEH NASOHIST NOHIST PD-HIST D PHENYLEPH-CHLORPHEN RONDEC SILDEC-PE SONAHIST PHENYLEPHRINE HCL/PROMETH HCL PROMETHAZINE VC PHENYLEPHRINE/BROMPHENIRAMINE BROM TANN-PE TANN BROMFED BROMPHENIRAMINE-PHENYLEPHRINE BROMFED-PD BROVEX ADT ENTRE-B BROVEX PEB J-TAN D C-TAN D SERADEX-LA C-TAN D PLUS VAZOBID PHENYLEPHRINE-BROMPHENIRAMIN VAZOTAB RESPAHIST-II ZOTEX-PE PHENYLEPHRINE/CHLOR-TAN ALLANTAN ALLERX ED CHLORPED D DALLERGY-JR PE TANN-CP TANN MYCI CHLORPED D PEDIAPHYL D NY-TANNIC R-TANNA PHENYLEPH-CHLORPHEN PEDIATRIC R-TANNA PEDIATRIC TANAHIST D RYNATAN TANNATE RYNATAN PEDIATRIC PE/DIPH ALAHIST LQ PHENYLEPHRINE/DP-HYDRAM TAN D-TANN DIPHENMAX D PHENYLEPHRINE/P-TLOX CI/CP PHENYLTOLOXAMINE PE CPM RHINACON A PHENYLEPHRINE/PYRIL MAL/CP MYHIST-PD PHENA-PLUS RU-HIST FORTE PHENA-S TRIPLEX AD POLY HIST FORTE POLY HIST PD PYRICHLOR PE PHENYLEPHRINE/PYRILAMINE TAN ALLANVAN-S CHLOR-TAN A 12 R-TANNAMINE DECONSAL CT RYNESA 12S RYNA-12 RY-T-12 RYNA-12 S TRI-HIST PSEUDOEPHED TAN/DEXCHLOR TAN ALLERDUR PSEUDOEPHED TAN/PYRILAMINE TAN VIRAVAN-P PSEUDOEPHEDRINE HCL/CHLOR-MAL COLFED-A 60PSE-4CPM CPM PSE ACCUHIST DECONAMINE CPM-PSE DECONAMINE SR DURATUSS DA LOHIST-D GENAPHED PLUS NEUTRAHIST HISTEX PSE-CPM MAXICHLOR PSE PSEUDOEPHEDRINE-CHLORPHENIRAM SUDOGEST COLD & ALLERGY SUDAHIST TIBAMINE LA Active Ingredient Abbreviation Key BROMPH=brompheniramine DEXBROMPH=dexbrompheniramine MAL=maleate P-EPD=pseudoephedrine CPM=chlorpheniramine maleate DEXCHLOR=dexchlorpheniramine METHSCOP=methscopolamine PYR=pyrilamine CPT=chlorpheniramine tannate DIPH=diphenhydramine PE=phenylephrine TAN=tannate Brand names are designated in bold in the drug product name column; all other agents are considered generic products. MISSISSIPPI DIVISION OF MEDICAID Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List Therapeutic Class Active Ingredients Preferred Non-Preferred ANTIHISTAMINES- FIRST CHLOR-MAL/PHENYLEPH/METHSCOP ALLERGY DN PE ALLERX PE GENERATION/DECONGESTANT/ CHLOR-MES DALLERGY PE ANTICHOLINERGIC COMBINATIONS CHLOR-MES D HISTA-VENT DA DALLERGY RESCON DEHISTINE DURADRYL DURADRYL SR HISTATAB PH NOHIST-PE NOHIST-PLUS NOHIST-PLUS JR PCM PHENYLEPHRINE CM PREHIST D RESCON-MX SCOPOHIST SCOPOHIST-PE TRIALL CPM & PE TANNATES/METHSCOP NIT DURATAN PE P-EPHED HCL/CHLOR-MAL/BELL ALK RU-TUSS RESPA A.R. DEXCHLORPH/P-EPHED HC/METHSCOP CORYZA-D D-HIST D HISTATAB D PHENYLEPH/DEXCHLOR/METHSCOPOL DEXPHEN M RE-DRYLEX PSEUDOEPH/METHSCOP/CPM/PE ALLERX 10 ALLERX 30 PSEUDOEPHEDRINE/CPM/METHSCOPOL COLDAMINE DALLERGY PSE HISTATAB HISTA-VENT PSE SCOPOHIST TIME-HIST QD VISRX DECONGESTANT-ANTICHOLINERGIC P-EPHED HCL/METHSCOPOLAMN AMDRY-D ALLERX-D COMBINATIONS RESPIVENT-D SUDATRATE 1ST GEN ANTIHISTAMINE- DECONGESTANT-ANALGESIC COMB PHENYLEPH/ACETAMINOP/P-TLOX/CP TRITAL SR NOREL SR Active Ingredient Abbreviation Key BROMPH=brompheniramine DEXBROMPH=dexbrompheniramine MAL=maleate P-EPD=pseudoephedrine CPM=chlorpheniramine maleate DEXCHLOR=dexchlorpheniramine METHSCOP=methscopolamine PYR=pyrilamine CPT=chlorpheniramine tannate DIPH=diphenhydramine PE=phenylephrine TAN=tannate Brand names are designated in bold in the drug product name column; all other agents are considered generic products..
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