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Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Abacavir Ziagen oral tab 300 mg BBW Abatacept Orencia IV soln 250 mg in NS 500mL Children's Tylenol oral liq 80 mg/0.8 mL Infants Tylenol Concentrated Drops oral liq 80 mg/0.8 mL oral liq 80 mg/0.8 mL, 160 mg/5 mL, 650 Acetaminophen mg/25 mL Tylenol rectal supp 120 mg, 325 mg, 650 mg oral tab 325 mg oral tab 325 mg-10 mg, 325 mg-5 mg, 300 mg- 7/1/2013 Vicodin 5 mg Acetaminophen-HYDROcodone oral tab 325 mg-10 mg, 325 mg-5 mg, 300 mg- Norco 10 mg Acetaminophen-oxyCODONE Percocet 5/325 oral tab 325 mg-5 mg inj powder 500 mg Diamox acetaZOLAMIDE oral tab 250 mg Diamox Sequels oral cap-XR 500 mg Acetic acid topical acetic acid irrigation irrigation soln 0.25% Acetylchloine opth Miochol intraocular powder 1% Acetadote IV soln 20% Mucomyst-10 inhalation soln 10% Mucomyst-20 inhalation soln 20% IV powder 500 mg Acyclovir Zovirax oral susp 200 mg/5 mL Adenosine Adenocard, Adenoscan IV soln 3 mg/mL Ado-trastuzumab emtansine Kadcyla® IV soln 100 mg, 160 mg 8/29/2013 Aerochamber N/A inhalation device n/a Aerochamber w/mask Large N/A inhalation device n/a Aerochamber w/mask small N/A inhalation device n/a Aluminum hydroxide/Magnesium oral susp 200 mg-200 mg-20 mg/5 mL Maalox Antacid Antigas Regular Strength hydroxide/simethicone Albendazole Albenza oral tab 200 mg Albumin human Albumar-5 IV soln 5%, 25% Albuterol Proventil oral syrup 2 mg/5 mL inhalation aerosol with adapter CFC free 90 mcg/inh Proventil HFA Albuterol inhalation soln 0.5%, 1.25mg/3 mL (0.042%), 2.5 N/A mg/3 mL (0.083%) Aldesleukin Proleukin IV powder 22000000 intl units BBW Alemtuxumab Campath 5/24/2012 IV powder 500 mg Allopurinol Zyloprim oral tab 100 mg, 300 mg ALPRAZolam Xanax oral tab 0.25 mg, 0.5 mg BBW Alprostadil Prostin VR inj soln 0.5 mg/mL Aluminum chloride hexahydrate topical Drysol top soln 20% Aluminum hydroxide Alternagel oral susp 320 mg/5 mL Aluminum sulfate-calcium acetate topical Domeboro top powder - Symmetrel oral cap 100 mg aMILoride Midamor oral tab 5 mg BBW Aminocaproic acid Amicar IV soln 250 mg/mL Aminophylline Phyllocontin IV soln 25 mg/mL Cordarone oral tab 200 mg BBW Amiodarone Cordarone IV IV soln 50 mg/mL Elavil oral tab 10 mg, 25 mg, 50 mg, 75 mg BBW AmLODIPine Norvasc oral tab 5 mg, 10 mg Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Ammonia inhalant N/A inhalation amp - oral cap 250 mg, 500 mg Amoxicillin Amoxil oral powder 125 mg/5 mL, 250 mg/5 mL oral powder 200 mg-28.5 mg/5 mL, 400 mg-57 mg/5 mL Amoxicillin-clavulanate Augmentin oral tab 250 mg-125 mg, 875 mg-125 mg, 10/4/2017 1000 mg-62.5 mg Amphetamine-dextroamphetamine Adderall oral tab 5 mg Ampicillin inj powder 1 g, 2 g, 125 mg, 250 mg, 500 mg Ampicillin Principen oral cap 1 g, 2 g, 125 mg, 250 mg, 500 mg Ampicillin-sulbactam Unasyn inj powder 1 g-0.5 g, 2 g-1 g Amyl /Na nitrite/Na Cyanide Kit inj kit 0.3 mL-30 mg-25 mg Anagrelide Agrylin oral cap 0.5 mg Anastrazole Arimidex oral tab 1 mg Antazoline-naphazoline ophth Naphcon-A opthalmic soln 0.5%-0.05% IV powder recombinant albumin-free Antihemophilic factor Advate rAHF-PFM IV powder recombinant Antihemophilic factor-von Willebrand Factor Humate-P, Wilate IV powder 1 IU - 1 IU Antipyrine-benzocaine otic Aurodex otic soln 54 mg-14 mg/mL Antivenin (crotalidae) polyvalent Crotalidae inj soln APAP/dichloralphenazone/isometheptene Midrin oral cap 325 mg-100 mg-65 mg Apixaban Eliquis oral tab 2.5 mg, 5 mg BBW Argatroban argatroban IV soln 100 mg/mL ARIPiprazole Abilify oral tab 5 mg, 10 mg, 15 mg, 30 mg BBW ARIPiprazole for extended release inj Abilify Maintena IM susp 300 mg, 400 mg BBW Arsenic trioxide Trisenox IV soln 1 mg/mL inj soln 500 mg/mL Ascorbic acid Vitamin C oral tab 500 mg rectal supp 300 mg Aspirin oral tab-chew 81 mg, 325 mg oral tab-EC 81 mg, 325 mg Aspirin-dipyridamole Aggrenox oral cap-XR 25 mg-200 mg Atazanavir Reyataz oral cap 200 mg, 300 mg Atenolol Tenormin oral tab 25 mg, 50 mg, 100 mg BBW Atomoxetine Strattera oral tab 10 mg, 25 mg, 40 mg BBW 6/23/2015 Atorvastatin Lipitor oral tab 10 mg, 20 mg, 40 mg, 80 mg Atovaquone Mepron oral susp 750 mg/5 mL Atropine inj soln 0.1 mg/mL, 0.4 mg/mL, 1 mg/mL Atropine opth Atropine opthalmic oint 1% oral liq 0.025 mg-2.5 mg/5 mL Atropine-diphenoxylate Lomotil oral tab 0.025 mg-2.5 mg Azacitidine Vidaza subQ Azathioprine Imuran oral tab 50 mg BBW IV powder 500 mg Azithromycin Zithromax oral powder 200 mg/5 mL oral tab 250 mg Bacitracin BacIM IM powder 50000 units BBW Bacitracin opthalmic Ak-Tracin opthalmic oint 500 units/g Bacitracin topical Baciguent top oint 500 units/g Bacitracin/HC/neomycin/polymyxin B opth Cortisporin Opthalmic opthalmic oint 400 units-10 mg-3.5 mg-10000 units/g Bacitracin/neomycin/polymyxin B opth Cortisporin Opthalmic Suspension opthalmic oint 400 units-3.5 mg-10000 units/g Bacitracin-polymyxin B opth Polysporin Ophthalmic opthalmic oint 500 units-10000 units/g Bacitracin-polymyxin B topical Polysporin top oint 500 units-10000 units/g Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Baclofen Lioresal oral tab 10 mg BBW Belimumab Benlysta Rx: Add TB Screen to Order - Belladonna-opium Belladonna-opium rectal supp 16.2 mg-60 mg Benazepril Lotensin oral tab 5 mg, 10 mg, 20 mg BBW Benzocaine topical Dermoplast top spray - mucous aerosol 14%-2%-2% Benzocaine/butamben/tetracaine topical Cetacain membrane Benzoin topical Tincture of benzoin top tincture - Benzonatate Tessalon Perles oral capsules 100 mg 6/1/2016 Benzoyl peroxide topical various top gel 5% inj soln 1 mg/mL Benztropine Cogentin oral tab 0.5 mg, 1 mg, 2 mg Beractant Survanta Intrathecal intrathecal susp 25 mg/mL Betamethasone Celestone Soluspan inj susp 6 mg/mL top oint, cream dipropionate 0.05%, dipropionate, Betamethasone topical Diprolene augmented 0.05% Betaxolol Betoptic S opthalmic susp 0.25% subQ soln 5 mg/mL Urecholine oral tab 25 mg Avastin IV soln 25 mg/mL Bicalutamide Casodex oral tab 50 mg rectal supp 10 mg Bisacodyl Dulcolax oral tab-EC 5 mg oral susp 262 mg/5 mL Bismuth subsalicylate Pepto Bismol oral tab-chew 262 mg Black widow spider Antivenin inj powder 6000 units Bleomycin Blenoxane inj powder 15 units BBW Botulinum toxin type A Botox inj powder 100 units Brentuximab vedotin Adcetris Rx: Add TB Screen to Order 9/22/2011 Brimonidine opth Alphagan P opthalmic soln 0.15% Bromocriptine Parlodel oral tab 2.5 mg Entocort EC oral cap-XR 3 mg Budesonide Pulmicort inhalation susp 0.5 mg/2 mL Pulmicort Respules inhalation susp 0.5 mg/2 mL 160 mcg-4.5 mcg/actuation, 80 mcg- 2/26/2009 Budesonide/Formoterol Symbicort inhalation liq 4.5 mcg/actuation inj soln 0.25 mg/mL BBW Bumetanide Bumex oral tab 1 mg BBW Bupivacaine Sensorcaine inj soln 0.25%, 0.5% 0.25%-1:200,000, 0.5%-1:200,000, Bupivacaine-EPINEPHrine Sensorcaine with Epinephrine inj soln 0.75%-1:200,000 Bupivacaine-fentaNYL N/A inj soln 0.1%-2mcg/mL Buprenorphine Subutex oral film 2 mg BBW 10/4/2017 Buprenorphine- Suboxone oral tab 2 mg-0.5 mg 1/9/2019 Wellbutrin oral tab 75 mg, 100 mg BBW oral tab-XR 100 mg/12 hours, 150 mg/12 hours BBW Wellbutrin XL BusPIRone BuSpar oral tab 5 mg Busulfan Myleran oral tab 2 mg Butorphanol Stadol inj soln 1 mg/mL, 2 mg/mL BBW oral liq citrate 20 mg/mL Caffeine Cafcit IV soln citrate 20 mg/mL Calamine topical Calamine top lotion - oral cap 0.25 mcg Calcitriol Rocaltrol Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Calcitriol Rocaltrol oral liq 1 mcg/mL Calcium acetate PhosLo oral tab 667 mg Tums oral tab-chew 500 mg Calcium carbonate oral susp 1250 mg/5 mL 9/12/2018 Calcium chloride various inj soln 100 mg/mL Calcium glubionate Calcium glubionate oral syrup 1.8 g/5 mL Calcium gluconate inj soln 100 mg/mL Calcium-vitamin D Oscal-D oral tab 500 mg-200 intl units Candida albicans extract Candida Skin Test intradermal soln Capecitabine Xeloda oral tab 500 mg BBW Capreomycin Capastate Sulfate IM powder 1 g Capsaicin topical Capzasin top cream 0.025%, 0.75% Captopril Capoten oral tab 12.5 mg, 25 mg BBW opth Isopto Carbachol opthalmic soln 3.00% oral susp 100 mg/5 mL BBW CarBAMazepine Tegretol oral tab 200 mg BBW oral tab-chew 100 mg BBW Carbamide peroxide otic Carbamoxide otic soln 6.50% oral tab 10 mg-100 mg, 25 mg-100 mg, 25 mg- Carbidopa-levodopa Sinemet 250 mg CARBOplatin Paraplatin IV powder 50 mg BBW Carboprost Hemabate inj soln 250 mcg/mL BBW Carfilzomib Kyprolis inj powder 30 mg, 60 mg Carmustine BiCNU IV powder 100 mg Carvedilol Coreg oral tab 3.125 mg, 6.25 mg, 12.5 mg, 25 mg Carvedilol Phosphate Coreg CR oral 7/26/2007 inj powder 1 g, 500 mg CeFAZolin Ancef IV soln 1 g/50 mL Cefepime Maxipime inj powder 1 g, 2 g inj powder 1 g, 2 g CefOXitin Mefoxin IV soln 1 g/50 mL, 2 g/50 mL Cefpodoxime proxetil Vantin oral tab 200 mg 1/9/2019 CefTAZidime Fortaz, Tazicef inj powder 1 g, 2 g CefTRIAXone Rocephin inj powder 1 g, 2 g, 250 mg, 500 mg Ceftin inj powder 1.5 g, 750 mg Ceftin oral powder 250 mg/5 mL Cefuroxime Ceftin, Zinacef oral tab 250 mg Kefurox inj powder 1.5 g Celecoxib CeleBREX oral cap 100 mg BBW oral cap 250 mg, 500 mg Cephalexin Keflex oral powder 125 mg/5 mL, 250 mg/5 mL Aquachloral Supprettes rectal supp 325 mg Chloral hydrate Somnote oral syrup 500 mg/5 mL Chlorambucil Leukeran oral tab 2 mg ChlordiazePOXIDE Librium oral cap 10 mg, 25 mg Chlorhexidine topical Peridex top oral liq 0.12% Chloramabucil Leukeran oral tab 2 mg BBW Chloroprocaine Nesacaine inj soln 3.00% Chloroquine Arelan oral tab 500 mg oral susp 250 mg/5 mL Chlorothiazide Diuril oral tab 500 mg IV powder 0.5 g Chlorpheniramine Chlor Phen oral tab 4 mg Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary oral concentrate 30 mg/mL Thorazine inj soln 25 mg/mL BBW oral tab 25 mg, 100 mg, 200 mg BBW Chlorthalidone Thalitone oral tab 50 mg Chlorzoxazone Lorzone oral tab 500 mg Cholestyramine Questran oral powder 4 g/5 g Chorionic gonadotropin (HCG) Pregnyl IM powder 10,000 units Chromic chloride hexahydrate chromium III chloride inj soln 4 mcg/mL Cidofovir Vistide IV soln 75 mg/mL BBW Cipro oral tab 250 mg, 500 mg, 750 mg BBW 10/5/16 restriction removed Ciprofloxacin Cipro IV IV soln 200 mg/100 mL, 400 mg/200mL BBW Ciprofloxacin opth Ciloxan opthalmic soln 0.30% Cisatracurium Nimbex IV soln 2 mg/mL CISplatin Platinol-AQ IV soln 1 mg/mL BBW Citalopram CeleXA oral tab 20 mg BBW Citric acid/K citrate/Na citrate Polycitra oral liq 334 mg-550 mg-500 mg/5 mL Citric acid-sodium citrate Bicitra oral soln 334 mg-500 mg/5 mL Cladribine Cladribine Novaplus IV soln 1 mg/mL oral powder 125 mg/5 mL Clarithromycin Biaxin oral tab 500 mg Clindamycin hydrochloride Cleocin HCl oral cap 150 mg BBW Clindamycin phosphate Cleocin Phosphate IV inj soln 150 mg/mL BBW Anafranil oral cap 25 mg ClonazePAM Klonopin oral tab 0.5 mg, 1 mg, 2 mg BBW Catapres, Kapvay oral tab 0.1 mg, 0.2 mg CloNIDine transdermal film 0.1 mg/24 hr, 0.2 mg/24 hr, 0.3 Catapres-TTS-1, -2, -3 mg/24 hr Clopidogrel Plavix oral tab 75 mg BBW Clotrimazole Mycelex Troche oral lozenge 10 mg Clotrimazole topical Gyne-Lotrimin vaginal cream w applicator 1% Clotrimazole topical Lotrimin top cream 1% Clove oil Clove oil oral oil - Coagulation factor IX BeneFIX IV powder - 9/23/2010 IV powder 1000 mcg (1 mg), 2000 mcg (2 mg), BBW Coagulation factor VIIa NovoSeven RT 5000 mcg (5 mg) tab 400 units, 1000 units Cholecalciferol Vitamin D3 oral cap 50,000 units 1/9/2019 soln 400 units/mL Colchicine Colcrys oral tab 0.6 mg 12/9/2010 Premarin oral tab 0.3 mg, 0.625 mg, 1.25 mg BBW Conjugated estrogens Premarin IV inj powder 25 mg BBW Conjugated estrogens topical Premarin Vaginal vaginal cream w applicator 0.625 mg/g BBW Copper chloride Cupric chloride inj soln 1 mg/mL Cortisone Cortone oral tab 25 mg Cosyntropin Cortrosyn inj powder 0.25 mg Gastrocrom oral soln 20 mg/mL Cromolyn Intal inhalation soln 10 mg/mL Intal inhaler inhalation aerosol with adapter 0.8 mg/inh Flexiril oral tab 5 mg, 10 mg otphalmic Cyclogyl opthalmic soln 1% lyophilized 1g, lyophilized 100 mg, IV powder Cyclophosphamide Cytoxan lyophilized 500 mg oral tab 25 mg, 50 mg oral cap modified 25 mg, 100 mg BBW cycloSPORINE Neoral Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary cycloSPORINE Neoral inj soln 50 mg/mL BBW Cyproheptadine oral tab 4 mg cysteine inj soln 50 mg/mL Cytarabine Cytorsar inj soln 100 mg/mL BBW Pradaxa oral cap 75 mg, 150 mg BBW Dacarbazine DTIC IV powder 200 mg BBW Dacriose Dacriose opthalmic soln - DACTINomycin Cosmegen IV powder 0.5 mg Danazol Danocrine oral cap 200 mg BBW Dantrium oral cap 25 mg BBW Dantrolene Dantrium IV IV powder 20 mg BBW Dapsone Dapsone oral tab 100 mg Darunavir Prezista oral tab 600mg, 800mg DAUNOrubicin Cerubidine IV powder 20 mg BBW DAUNOrubicin liposomal Daunoxome IV dispersion 2 mg/mL Decitabine Dacogen inj powder 50 mg Deferoxamine Desferal inj powder 500 mg Demeclocycline Declomycin oral tab 150 mg Norpramin oral tab 25 mg BBW Desmopressin DDAVP inj soln 4 mcg/mL BBW Desogestrel-ethinyl estradiol Ortho-Cept oral tab 0.15 mg-0.03 mg oral elixir 0.5 mg/5 mL Dexamethasone Decadron inj soln 4 mg/mL, 10 mg/mL oral tab 0.5 mg, 0.75 mg, 4 mg opthalmic oint, susp 1 mg-3.5 mg-10000 units Dexamethasone/neomycin/polymyxin B opth Maxitrol Dexamethasone-tobramycin opth Tobradex opthalmic oint, susp 0.1%-0.3% Dexmedetomidine Precedex IV soln 100 mcg/mL Dexrazoxane Zinecard IV powder 250 mg 11/29/2007 Dextran, high molecular weight Hyskon intrauteral soln 32%-10% Dextran, low molecular weight dextran, low molecular weight IV soln 10%-0.9% Dextroamphetamine Dexedrine oral tab 5 mg -guaiFENesin guaiFENesin-dextromethorphan oral liq 10 mg-100 mg/5 mL Dextrose 40% gel Glutose 15 oral gel 40% 1/9/2019 inj soln 5 mg/mL Valium oral soln 5 mg/5 mL oral tab 2 mg, 5 mg BBW Dibucaine topical Dibucaine top oint 1% Dicloxacillin Dycil oral cap 250 mg Dicyclomine Bentyl oral cap 10 mg oral elixir 50 mcg/mL Digoxin Lanoxin, Digitek inj soln 100 mcg/mL, 250 mcg/mL oral tab 125 mcg, 250 mcg Digibind inj powder 38 mg Dihydrotachysterol DHT oral tab 0.125 mg tab, cap extended 120 mg/24 houts, 180 mg/24 hours, Tiazac, Cardizem, Diltiazem oral release 240 mg/24 hours Diltiazem Diltiazem IR oral tab 30 mg, 60 mg IV powder 100 mg dilTIAZem IV soln 5 mg/mL Dramamine oral tab 50 mg Dimethyl sulfoxide Rimso-50 irrigation soln 50% Dinoprostone topical Cervidil vaginal insert 10 mg BBW Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Benadryl inj soln 50 mg/mL Benadryl Child Dye Free oral liq 12.5 mg/5 mL Bendaryl DF oral cap 25 mg, 50 mg Genahist oral liq 12.5 mg/5 mL oral susp Diphenhydramine 12.5mg/5mL (30mL), 5/24/2012 Diphenhydramine/lidocaine/maalox Magic Mouth Wash Lidocaine viscous 2% (30mL), Maalox (30mL)

Dipivefrin opth Propine opthalmic soln 0.10% Dipyridamole Persantine oral tab 50 mg Disopyramide Norpace CR oral cap-XR 100 mg BBW Disulfiram Antabuse oral tab 250 mg BBW Depakote oral tab-EC 250 mg, 500 mg BBW Divalproex sodium Depakote ER oral tab-XR 250 mg, 500 mg BBW Depakote Sprinkles oral cap-DR 125 mg BBW DOBUTamine Dobutrex IV soln 12.5 mg/mL DOCEtaxel Taxotere IV soln 40 mg/mL oral cap 100 mg, 200 mg Docusate Dulcolax oral syrup 100 mg/30 mL Dolutegravir Tivicay oral tab 10 mg, 25 mg, 50 mg 7/29/2014 Donepezil Aricept oral tab 5 mg DOPamine Intropin IV soln 1.6 mg/mL premix, 40 mg/mL vial BBW Dornase alfa Pulmozyme inhalation soln 2.5 mg/2.5 mL Dorzolamide-timolol opth Cosopt opthalmic soln 2%-0.5% 4/22/2010 oral cap 25 mg BBW SINEquan oral concentrate 10 mg/mL BBW DOXOrubicin Adriamycin IV soln 2 mg/mL BBW DOXOrubicin liposomal Doxil IV dispersion 2 mg/mL BBW oral cap 100 mg Doxycycline Vibramycin inj powder 100 mg Dronabinol Marinol oral cap 2.5 mg, 5 mg Edetate calcium disodium Calcium EDTA inj soln 200 mg/mL BBW Efavirenz Sustiva oral cap 50 mg Elvitegravir/cobicistat/emtricitabine/ tenofovir oral tab 150 mg/150 mg/200 mg/10 mg BBW 9/6/2017 Genvoya alafenamide Aquaphor top oint - Emollients, topical Eucerin top cream - various top lotion - Emtricitabine Emtriva oral cap 200 mg BBW 10/5/2016-restriction removed Enalaprilat Vasotec IV soln 1.25 mg/mL BBW Epaned oral powder 1 mg/mL BBW Enalapril Vasotec oral tab 5 mg, 10 mg BBW 30 mg/0.3 mL, 40 mg/0.4 mL, 60 BBW mg/0.6 mL, 80 mg/0.8 mL, 10 mg/mL, Enoxaparin Lovenox subQ soln 120 mg/0.8 mL, 150 mg/mL ePHEDrine ePHEDrine inj soln 50 mg/mL inhalation soln 2.25% inj soln 0.1 mg/mL, 1 mg/mL EPINEPHrine Adrenalin inj soln 10 mcg/mL prefilled syringe - 10 mL 12/7/2016

1:100000-1%, 1:100000-2%, 1:200000- EPINEPHrine-lidocaine Xylocaine with EPINEPHrine inj soln 0.5%, 1:200000-1% Epirubicin Ellence IV soln 2 mg/mL Eplerenone Inspra oral tab 25 mg Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary 2000 units/mL, 3000 units/mL, 4000 Epoetin alfa Procrit inj soln units/mL, 10000 units/mL, 20000 units/mL, 40000 units/mL Eptifibatide Integrelin IV soln 0.75 mg/mL Ery-Tab oral tab-EC 250 mg, 500 mg oral susp estolate 125 mg/5 mL, ethylsuccinate BBW Erythrocin, EES, various Erythromycin 400 mg/5 mL inj powder lactobionate 1g, lactobionate 500 mg Erythrocin, various Erythromycin opth E-mycin, various opthalmic oint 0.5% oral granule for 200 mg-600 mg/5 mL Erythromycin-sulfiSOXAZOLE Pediazole reconstitution oral tab 10 mg, 20 mg BBW Escitalopram Lexapro oral soln 1 mg/mL BBW 9/6/2017 Esmolol Brevibloc IV soln 10 mg/mL NexIUM IV IV powder 40 mg Esomeprazole NexIUM oral cap-DR 20 mg, 40 mg Delestrogen IM soln valerate 40 mg/mL Estradiol Estrace oral tab 1 mg BBW Edecrin oral tab 25 mg Ethacrynic acid Edecrine Sodium IV powder 50 mg Ethambutol Myambutol oral tab 100 mg, 400 mg Ethanol Ethyl inj soln 98.00% Ethanol topical Denatured Alcohol top liq 70.00% Ethanolamine oleate Ethamolin inj soln 50 mg/mL Ethinyl estradiol-norethindrone Nortrel 1/35 oral tab 35 mcg-1 mg Etidronate Didronel oral tab 200 mg Etomidate Amidate IV soln 2 mg/mL IV powder 100 mg Etoposide Vepesid IV soln 20 mg/mL IV soln 10 mg/mL Famotidine Pepcid oral tab 20 mg Fat emulsion, intravenous Intralipid IV emulsion 20% BBW; Administer with 1.2 micron filter Fat supplement, oral Fat supplement, oil oral oil - transdermal film 25 mcg/hr, 50 mcg/hr, 75 mcg/hr, 100 BBW Duragesic fentaNYL mcg/hr Sublimaze inj soln 50 mcg/mL top soln - Ferric subsulfate ferric subsulfate top stick - oral liq 75 mg/0.6 mL, 300 mg/5 mL BBW Ferrous sulfate various oral tab 325 mg BBW Filgrastim-sndz Zarxio inj soln 300 mcg/0.5 mL, 480 mcg/0.8 mL 6/27/2018 Finasteride Proscar oral tab 5 mg Floxuridine FUDR inj powder 0.5 g BBW IV soln 400 mg/200 mL, 200 mg/100 mL Fluconazole Diflucan oral tab 100 mg, 200 mg Flucytosine Ancobon oral cap 250 mg, 500 mg BBW Fludarabine Fludara IV powder 50 mg BBW Fludrocortisone Florinef Acetate oral tab 0.1 mg Romazicon IV soln 0.1 mg/mL BBW Fluocinonide topical Lidex top cream, oint 0.05% soln 2% Fluorescein opthalmic Ful-Glo opthalmic test 0.6 mg Fluoromethane topical Fluori-Methane top spray 15%-85% Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Fluorouracil 5-FU, Adrucil IV soln 50 mg/mL BBW oral cap 10 mg, 20 mg BBW FLUoxetine PROzac oral soln 20 mg/5 mL BBW fluPHENAZine Prolixin oral concentrate 5 mg/mL BBW fluPHENAZine Prolixin oral tab 1 mg, 2.5 mg, 5 mg BBW fluPHENAZine Prolixin, Prolixin Decanoate inj soln 2.5 mg/mL, decanoate 25 mg/mL BBW Flutamide Eulexin oral cap 125 mg BBW Fluticasone-salmeterol Advair Diskus inhalation powder 500 mcg-50 mcg/puff 4/8/2015 FluvoxaMINE Luvox oral tab 25 mg, 100 mg BBW inj soln 5 mg/mL Folic acid Folic acid oral tab 1 mg Folic acid/vit b1/vit b6/MVI folic acid/vit b1/vit b6/mvi IV inj 1 mg/100 mg/100 mg/10 mL Antizol IV soln 1 g/mL Foscarnet Foscavir IV soln 24 mg/mL BBW Fosphenytoin Cerebyx inj soln 50 mg/mL BBW Fulvestrant Faslodex IM soln 50 mg/mL inj soln 10 mg/mL Furosemide Lasix oral soln 40 mg/5 mL oral tab 20 mg, 40 mg, 80 mg BBW oral cap, soln 100 mg, 300 mg, 400 mg, 200 mg/5 Gabapentin Neurontin mL Gadobutrol Gadavist inj soln - BBW 9/2/2015 oral cap 250 mg BBW Ganciclovir Cytovene IV powder 500 mg BBW Gemcitabine Gemzar IV powder 200 mg Gemfibrozil Lopid oral tab 600 mg Gentamicin Garamycin inj soln 10 mg/mL, 40 mg/mL BBW Gentamicin opth Gentak opthalmic oint 0.3% Gentamicin opth Gentak opthalmic soln 0.3% Gentamicin topical Gentak top cream 0.1% Gentian violet topical Gentian violet topical top soln 2% Glucagon inj powder recombinant 1 mg compounding soln 5% 250 mL Glucose Dextrose IV soln 5% IV soln 10%, 50% compounding liq - Glycerin glycerin, various oral soln 50% rectal supp adult, pediatric Glycopyrrolate Robinul inj soln 0.2 mg/mL Gonadorelin Factrel IV powder 0.1 mg guaiFENesin Mucinex oral liq 100 mg/5 mL IM soln 25 mcg-10 mcg/0.5 mL Haemophilus b conjugate (HbOC) vaccine haemophilus b conjugate (HbOC) vaccine Haemophilus b-hepatitis B vaccine Comvax IM susp - oral concentrate 2 mg/mL Haloperidol Haldol inj soln 5 mg/mL BBW oral tab 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg BBW Haloperidol decanoate Haldol Decanoate IM soln 50 mg/mL, 100 mg/mL BBW Fluothane inhalation liq 100.00% inj soln 10 units/mL, 100 units/mL, 1000 Heparin units/mL, 5000 units/mL IV soln 50 units/mL premix Heparin flush Heparin Lock Flush IV soln 10 units/mL, 100 units/mL Hepatitis A adult vaccine Havrix IM susp 1440 units/mL Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Hepatitis A pediatric vaccine Havrix Pediatric IM susp 720 units/0.5 mL Hepatitis B immune globulin H-BIG IM soln - Heptatitis B immune globulin Bayhep B IM soln - Hetastarch Hextend IV soln 60 mg/mL-LR BBW opth Isopto Homatropine opthalmic soln 5% Horse antithymocyte globulin Atgam Human papillomavirus vaccine 9-valent Gardasil 9 IM susp 10/5/2016 hydrALAzine Apresoline inj soln 20 mg/mL hydrALAzine Apresoline oral tab 10 mg, 25 mg, 50 mg Hydrochlorothiazide HCTZ oral tab 25 tab Hydrochlorothiazide-triamterene Dyazide oral cap 25 mg-37.5 mg Hydrocortisone rectal susp 100 mg/60 mL Hydrocortisone Hydrocortone oral tab 10 mg, 20 mg Solu-CORTEF inj powder 100 mg, 250 mg, 500 mg Hydrocortisone topical Westcort top oint 0.5%, 1% hydrocortisone/neomycin/polymyxin B opthalmic susp 1%-0.35%-10000 units/mL Hydrocortisone/neomycin/polymyxin B opth opth otic soln 1%-0.35%-10000 units/mL Hydrocortisone/neomycin/polymyxin B otic Cortisporin Otic IV inj 10 mg/50 mL PCA HYDROmorphone Dilaudid inj soln 1 mg/mL, 2 mg/mL, 10 mg/mL BBW oral tab 2 mg, 4 mg BBW Hydroxychloroquine Plaquenil Sulfate oral tab 200 mg Hydroxycobalamin Hydroxycobalamin inj soln 1000 mcg/mL Hydroxyprogesterone Makena IM soln 250 mg/mL Use as Multi-Dose vial Hydroxypropyl methylcellulose GenTeal Gel opthalmic gel 0.3% 6/23/2015 Hydroxyurea Hydrea oral cap 500 mg BBW oral cap 25 mg, 50 mg 12/00/2016 hydrOXYzine HCl Atarax oral syrup 10 mg/5 mL hydrOXYzine HCl Vistaril IM IM soln 10 mg/5 mL 12/00/2016 Hylan G-F 20 Synvisc intraarticular soln 8 mg/mL Levsin SL sublingual SL tab 0.125 mg BBW; Clinics may only get 200 mg strength Motrin oral tab 200 mg, 400 mg, 600 mg, 800 mg Ibuprofen (6/27/18) Motrin Children's oral susp 100 mg/5 mL BBW Ibuprofen Lysine NeoProfen IV soln 10 mg/mL 2/28/2008 PraxBind IV soln 50 mg/mL 11/4/2015 Ifosfamide Ifex IV powder 1 g BBW Tofranil oral tab 10 mg, 25 mg BBW immune globluin (IVIG) Gammagard-SD immune globulin (IVIG) Carimune immune globulin (IVIG) Privigen BBW; See PH. 113 for dosing guide immune globulin intramuscular (IVIG) Baygam IM soln - immune globulin intravenous (IVIG) Polygam S/D IV powder 5 g immune globulin intravenous (IVIG) Venoglobulin-S 10% IV soln 10.00% Indigo carmine indigo carmine inj soln 8 mg/mL Indinavir Crixivan oral cap 400 mg Indocyanine green IC-Green inj powder 25 mg oral cap 25 mg BBW Indomethacin Indocin IV powder 1 mg BBW Influenza virus vaccine, inactivate Fluarix IM susp 0.5 mL Influenza virus vaccine, inactivated Fluzone SV IM susp 0.5 mL Influenza virus vaccine, quadrivalent FluLaval IM susp 0.5 mL 1/25/2017 Influenza virus vaccine, live, trivalent FluMist nasal spray 0.5 mL Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Insulin glargine Lantus subQ soln 100 units/mL subQ susp human recombinant 100 units/mL Insulin isophane NovoLIN N Insulin lispro HumaLOG subQ soln 100 units/mL inj soln 3,000,000 units/0.5 mL, 9,000,000 BBW Interferon alfa-2a Roferon-A units/0.9 mL Interferon alfa-2b Intron A inj powder 50,000,000 units BBW Interferon alfacon-1 Infergen inj soln 15 mcg/0.5 mL Interferon gamma-1b Actimmune subQ soln 2,000,000 units/0.5 mL IV soln LypholyteII/Nutrilyte Intravenous electrolyte solution LypholyteII/Nutrilyte II/TPN/Electrolytes II/TPN/Electrolytes Iodine topical top soln 5%-10% Iodoquinol Yodoxin oral tab 210 mg Ipecac Ipecac oral syrup 7% Ipilimumab Yervoy IV soln 5 mg/mL inhalation aerosol 18 mcg/inh Ipratropium Atrovent inhalation soln 0.02% and albuterol Combivent® Respimat® inhalation spray 20 mcg/100 mcg 8/29/2013 Irinotecan Camptosar IV soln 20 mg/mL BBW Iron sucrose Venofer IV soln 20 mg/mL Forane inhalation liq 100% oral syrup 50 mg/5 mL Isoniazid Nydrazid oral tab 100 mg, 300 mg IM soln 100 mg/mL Isosorbide dinitrate Isordil oral tab 10 mg Isosorbide mononitrate Imdur oral tab-XR 30 mg, 60 mg Isosulfan blue Lymphazurin inj soln 10 mg/mL oral cap 100 mg Itraconazole Sporanox IV kit 250 mg Stromectol oral tab 3 mg Kaolin-pectin Kaolin-pectin oral susp 5.8 g-130 mg/30 mL Ketalar inj soln 50 mg/mL, 100 mg/mL 11/7/2017 Ketoconazole Nizoral oral tab 200 mg BBW Ketorolac Toradol inj soln 15 mg/mL, 30 mg/mL BBW Ketorolac opth Acular opthalmic soln 0.5% IV soln 5 mg/mL Labetalol Trandate oral tab 100 mg, 200 mg Lactated ringer's Lactated ringer's IV soln lactated ringers Lactulose Cephulac oral syrup 10 g/15 mL oral tab 150 mg BBW LamiVUDine Epivir oral soln 10 mg/mL BBW 10/5/2016 LamiVUDine-zidovudine Combivir oral tab 150 mg-300 mg BBW oral tab 25 mg, 100 mg BBW LamoTRIgine LaMICtal oral tab-disperse 5 mg BBW Lansoprazole Prevacid SoluTab oral tab-ODT 30 mg L-E-T Injection L-E-T Injection vaginal soln 0.8%-1:2000-0.5% IV powder 50 mg Leucovorin Folinic Acid oral tab 5 mg, 10 mg IM powder-XR 3.75 mg/month, 7 mg/month, 11.25 Leuprolide Lupron Depot mg/month, 22.5 mg/3 months

Leuprolide Lupron Depot-Ped IM powder-XR 11.25 mg/month IV soln 100 mg/mL LevETIRAcetam Keppra oral soln 100 mg/mL Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary oral tab 250 mg, 500 mg, 750 mg oral soln 100 mg/mL levOCARNitine Carnitor inj soln 200 mg/mL IV soln 250 mg/50 mL, 500 mg/100 mL BBW Levofloxacin Levaquin oral tab 250 mg, 500 mg BBW Levonorgestrel Mirena intrauteral device 52 mg Levonorgestrel Kyleena intrauteral device 19.5 mg Levonorgestrel Liletta intrauteral device 52 mg Levonorgestrel Plan B oral tab 0.75 mg oral tab 100 mcg, 125 mcg, 150 mcg, 200 mcg, Levothyroxine Synthroid, Levothroid 25 mcg, 300 mcg, 50 mcg, 75 mcg

inj soln 0.5%, 1%, 1.5%, 2%, 5%-0.4%, 7.5%- Lidocaine Xylocaine HCl, Xylocaine HCl for Spinal 5% Lidocaine ophthalmic gel Akten ophthalmic gel 3.5% 10/24/2013 Ela-Max top cream 4% Ela-Max 5 top cream 5% mucous 2%, 4% BBW for 2% Lidocaine topical lidocaine topical soln membrane lidocaine topical top soln 4% LMX 4, LMX Plus top cream 4% lidocaine topical JELLY Uro-Jet top jelly 2% 10/5/2016 Liothyronine Cytomel oral tab 25 mcg BBW Lisinopril Prinivil, Zestril oral tab 5 mg, 10 mg, 20 mg BBW oral cap 300 mg, 600 mg Lithium Lithium oral syrup 300 mg/5 mL Lithobid oral tab-XR 300 mg oral cap 2 mg Loperamide Imodium oral liq 1 mg/5 mL oral liq 400 mg-100 mg/5 mL Lopinavir-ritonavir Kaletra oral tab 200 mg-50 mg oral syrup 5 mg/5 mL Loratadine Claritin oral tab 10 mg inj soln 2 mg/mL, 4 mg/mL BBW LORazepam Ativan oral tab 0.5 mg, 1 mg, 2 mg BBW oral soln 2 mg/mL 10/4/2017 Losartan Cozaar oral tab 25 mg, 50 mg BBW Loxitane oral cap 5 mg, 10 mg, 25 mg BBW IV soln Sodium Chloride 0.45%, Sodium LVP soln sodium chloride IV Chloride 0.9% IV soln sodium chloride 3% LVP soln w hypertonic saline sodium chloride with hypertonic saline IV soln Sodium Chloride 0.45%, Sodium Chloride 0.9%, Dextrose 5% in Water, Dextrose 5% LVP solution LVP solution with 0.2% NaCl, Dextrose 5% with 0.45% NaCl, Dextrose 5% with 0.9% NaCl, Dextrose 5% in Lactated Ringers Injection, Lactated Ringers Injection

IV soln Dextrose 5% in Water with KCl 20 mEq/L, Dextrose 5% with 0.2% NaCl and KCl 10 mEq/L, Dextrose 5% with 0.2% NaCl and KCl 20 mEq/L, Dextrose 5% with 0.45% NaCl and KCl 10 mEq/L, Dextrose 5% with 0.45% NaCl and KCl 20 mEq/L, Dextrose LVP solution with potassium LVP solution with potassium 5% with 0.45% NaCl and KCl 40 mEq/L, Dextrose 5% with 0.9% NaCl and KCl 20 mEq/L, Sodium Chloride 0.45% with KCl 20 mEq/L, Sodium Chloride 0.9% with KCl 20 mEq/L Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary LVP with hypertonic saline LVP with hypertonic saline IV soln Sodium Chloride 3% LVP-dextrose Dextrose in water IV soln dextrose 5% in water IV soln Dextrose 5% with 0.2% NaCl, LVP-dextrose with NaCl Dextrose and NaCl Dextrose 55 with 0.45% NaCl, Dextrose 5% with 0.9% NaCl IV soln equine 50 mg/mL Lymphocyte immune globulin, anti-thy (obs) Magnesium chloride Mag-Delay oral tab-XR 64 mg Magnesium gluconate Magonate oral liq 1000 mg/5 mL Magnesium hydroxide Milk of Magnesia oral susp 8.00% Magnesium oxide Mag-Ox 400 oral tab 400 mg 4/24/2008 intravesical inj 2 mg/250 mL normal saline Magnesium sulfate Magnesium sulfate inj soln 50%-40 mg/mL IV soln 40 mg/mL-D5% Malathion topical Ovide top lotion 0.5% Mannitol Mannitol IV soln 20%, 25% Measles virus vaccine Attenuvax subQ powder - Measles/mumps/rubella virus vaccine MMR subQ powder - Mebendazole Vermox oral tab-chew 100 mg Mechlorethamine Mustargen inj powder 10 mg Antivert, Bonine oral tab 12.5 mg medroxyPROGESTERone Depo-Provera Contraceptive IM susp 150 mg/mL BBW medroxyPROGESTERone Provera oral tab 5 mg BBW Megestrol megace oral susp 40 mg/mL Melatonin Melatonin oral tab 3 mg Melphalan Alkeran oral tab 2 mg Namenda oral tab 10 mg Meningococcal conjugate vaccine Menveo IM soln - 7/29/2010 Meningococcal polysaccharide vaccine Menomune ACYW-135 subQ powder single dose meningococcal B Vaccine Bexsero 3/2/2016 Cepacol Sore Throat from Post Nasal mucous lozenge - Menthol topical Drip Menthol membrane Menthol topical menthol topical top gel 2% Mepivacaine Carbocaine HCl inj soln 1.50% Mercaptopurine Purinethol oral tab 50 mg Asacol oral tab-EC 400 mg Mesalamine Pentasa oral cap-XR 250 mg Rowasa rectal enema 4 g/60 mL Mesna Mesnex inj soln 100 mg/mL Serentil inj soln 25 mg/mL BBW provocholine neb powder 100 mg Pending Respiratory protocol 5/8/2019 oral concentrate 1 mg/mL 11/4/2015 Dolophine oral concentrate 10 mg/mL 10/4/2017 oral tab 5 mg, 10 mg Methimazole Tapazole oral tab 5 mg, 10 mg Methocarbamol Robaxin oral tab 750 mg inj soln 25 mg/mL BBW Methotrexate Trexall, Rheumatrex oral tab 2.5 mg BBW Methylcellulose methylcellulose oral powder 2 g/19 g IV soln 50 mg/mL Methyldopa Aldomet oral tab 250 mg, 500 mg methylene blue inj soln 10 mg/mL BBW Methylergonovine Methergine inj soln 0.2 mg/mL Methylphenidate Ritalin oral tab 5 mg, 10 mg BBW Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Depo-Medrol inj susp 40 mg/mL methylPREDNISolone Solu-MEDROL inj powder 1 g, 2 g, 40 mg, 125 mg, 500 mg inj soln 5 mg/mL BBW Metoclopramide Reglan oral syrup 5 mg/5 mL BBW oral tab 10 mg BBW Metolazone Zaroxlyn oral tab 5 mg inj soln 1 mg/mL BBW Lopressor Metoprolol oral tab 12.5 mg, 25 mg, 50 mg, 100 mg BBW Toprol-XL oral tab-XR 25 mg, 50 mg BBW IV soln 500 mg/100 mL BBW metroNIDAZOLE Flagyl oral tab 250 mg, 500 mg BBW Metyrapone Metopirone oral cap 250 mg Miconazole topical Monistat 3 vaginal supp 200 mg inj soln 1 mg/mL PF, 5 mg/mL BBW Midazolam Versed oral syrup 2 mg/mL BBW Midodrine ProAmatine oral tab 2.5 mg BBW Mifepristone Mifeprex, Korlym oral tab 200 mg Pending Powerplan by OB dept 5/8/2019 Mineral oil mineral oil oral liq 100.00% Minoxidil minoxidil oral tab 10 mg BBW Remeron oral tab 15 mg, 30 mg BBW Remeron SolTab oral tab-ODT 30 mg BBW Misoprostol Cytotec oral tab 100 mcg, 200 mcg BBW MitoMYcin Mutamycin IV powder 5 mg, 20 mg mitoXANTRONE Novantrone IV soln 2 mg/mL Modafinil Provigil oral tab 100 mg Montelukast Singulair oral tab 10 mg Duramorph PF inj soln 0.5 mg/mL preservative-free Morphine IV inj 50 mg/50 mL inj soln 0.5 mg/mL PF, 2 mg/mL, 4 mg/mL, 10 BBW Morphine mg/mL, 25 mg/mL, 25 mg/mL PF, 50 mg/mL Morphine Morphine oral soln 10 mg/5 mL BBW Morphine oral tab 10 mg, 30 mg BBW MSIR oral cap 15 mg BBW oral tab-XR 15 mg/12 hr, 30 mg/12 hr, 100 mg/12 BBW Oramorph SR hr MVI Pediatric IV powder Pediatric Multiple Vitamins MVI-12 IV soln multivitamins oral cap Vitamin B complex with C and folic Nephrocaps acid oral cap Vitamin B complex with C and folic various acid Multivitamin oral liq multiple vitamins, pediatric multiple various vitamins IV soln multiple vitamins, pediatric multiple various vitamins various oral tab multiple vitamins Vi-Daylin oral liq multiple vitamins oral liq multiple vitamins with zinc oral tab therapeutic multiple vitamins with Multivitamin with minerals Various, ADEK minerals oral tab-chew multiple vitamins with zinc Multivitamin, prenatal Prenatal vitamins oral tab prenatal vitamins Mumps skin test antigen MSTA Mumps Skin Test Antigen intradermal soln - Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Mumps virus vaccine Mumps virus vaccine subQ powder - Mupirocin topical Bactroban top oint 2.00% Mycophenolate mofetil CellCept oral tab 500 mg BBW Nafcillin Nafcil inj powder 1 g, 2 g Naloxone Narcan inj soln 0.4 mg/mL, 1 mg/mL ReVia oral tab 50 mg Nandrolone Deca-Durabolin IM soln decanoate 200 mg/mL BBW Naproxen Naprosyn oral tab 250 mg BBW Neomycin neomycin oral tab 500 mg BBW Neomycin-polymyxin B sulfate opthalmic Neosporin opthalmic ointment opthalmic oint 400 units-3.5 mg-10000 units/g irrigation soln 40 mg-200000 units/mL Neomycin-polymyxin B sulfate topical neomycin-polymyxin B sulfate topical Prostigmin, Vagostigmin inj 1 mg/mL oral susp 50 mg/mL BBW Nevirapine Viramune oral tab 200 mg BBW niCARdipine Cardene IV inj soln 2.5 mg/mL, decanoate 25 mg/mL oral lozenge 6/29/2014 Various transdermal film 7 mg/24 hr, 14 mg/24 hr, 21 mg/24 hr

NIFEdipine Adalat oral tab-XR 30 mg Furadantin oral susp 25 mg/5 mL Nitrofurantoin oral cap macrocrystals-monohydrate 100 mg Macrobid Nitro-Bid transdermal oint 2% transdermal film 0.1 mg/hr, 0.2 mg/hr, 0.3 mg/hr, 0.4 Nitro-Dur mg/hr Nitroglycerin Nitroquick (0.3 mg), Nitrostat (0.3 mg, sublingual tab 0.3 mg, 0.4 mg 0.4 mg) NTG IV soln 200 mcg/mL-premix, 5 mg/mL Nitroprusside Nitropress IV powder 50 mg BBW Norepinephrine Levophed Bitartrate IV soln 1 mg/mL BBW Pamelor oral cap 10 mg, 25 mg BBW Nystatin Mycostatin oral susp 100000 units/mL nystatin topical top cream 100000 units/g Nystatin topical nystatin topical top oint 100000 units/g Nystop top powder 100000 units/g Octreotide SandoSTATIN inj soln 100 mcg/mL, 200 mcg/mL Artificial Tears opthalmic soln preserved Ocular lubricant Lacri-Lube SOP opthalmic oint - Zyprexa IM powder 10 mg BBW oral tab 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, BBW oLANZapine Zyprexa 20 mg oLANZapine Zyprexa Zydis oral tab-ODT 5 mg, 10 mg BBW Omalizumab Xolair BBW inj soln 2 mg/mL Ondansetron Zofran oral tab 4 mg oral tab-ODT 4 mg 12/19/2013 oO Opium oral tincture 10.00% Oprelvekin Neumega subQ powder 5 mg Opthalmic irrigation, intraocular BSS opthalmic soln Balanced Salt Soln Opthalmic irrigation, intraocular BSS Plus opthalmic soln Balanced Salt Soln Plus Oseltamivir Tamiflu oral cap 75 mg Oxaliplatin Eloxatin IV powder 50 mg, 100 mg BBW Oxandrolone Oxandrin oral tab 2.5 mg BBW Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Oxcarbazepine Trileptal oral tab 150 mg, 300 mg oral syrup 5 mg/5 mL Ditropan oral tab 5 mg oxyCODONE OxyCONTIN oral tab-XR 10 mg, 20 mg, 40 mg, 80 mg BBW oxyCODONE OxyCONTIN oral tab 5 mg BBW 1/6/2016 Oxymetazoline nasal Afrin nasal spray 0.05% Oxytocin Pitocin inj soln 10 units/mL BBW PACLitaxel Taxol IV soln 6 mg/mL BBW Palivizumab Synagis IM soln 50 mg Palonosetron Aloxi IV soln 0.25 mg/5 mL 1/7/2015 Pamidronate Aredia IV powder 90 mg oral cap-XR 33200 units-10000 units-3750 units Pancrelipase Creon 10 oral cap-XR 66400 units-20000 units-75000 units Creon 20 oral cap-DR 20000 units-4500 units-25000 units Pancrease oral cap-DR 30000 units-10000 units-30000 units Pancrease MT 10 oral cap-DR 56000 units-20000 units-44000 units Pancrease MT 20 oral cap-DR 12000 units-4000 units-12000 units Pancrease MT 4 Pancuronium Pavulon IV soln 1 mg/mL, 2 mg/mL BBW Panitumumab Vectibix BBW Papain-urea topical Accuzyme top oint 830,000 units/g-10% Papaverine papaverine inj soln 30 mg/mL Parenteral nutrition soln Amino Acids IV soln 6% (Trophamine) Parenteral nutrition soln Aminosyn II IV soln 10% (Aminosyn II) IV soln Dextrose 70% in water, amino acids Parenteral nutrition soln parenteral nutrition soln 6% (Trophamine), Amino Acids 10% (Aminosyn II) Paricalcitol Zemplar IV soln 5 mcg/mL Paromomycin Humatin oral cap 250 mg Paxil oral tab 10 mg, 20 mg, 30 mg BBW For pancreatic resection. To prevent leakage Pasireotide Diaspartate Signifor subq soln 0.9 mg/mL 6/12/2019 induced mortality. PEGaspargase Oncaspar Peginterferon alfa-2b Pegasys subQ powder 160 mcg/mL BBW pegLOTicase Krystexxa PEMEtrexed Alimta IV powder 500 mg IM susp G benzathine 600000 units/mL, G benzathine 1,200,000 units/2 mL, G Bicillin L-A (obsolete) benzathine 2,400,000 units/4 mL

inj powder G potassium 5000000 units, G sodium penicillin 5000000 units, G potassium 20000000 untis oral powder V potassium 125 mg/5 mL, V penicillin potassium 250 mg/5 mL Penicillin Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Penicillin IM susp G benzathine-procaine 300000 units- BBW 300000 units/mL, G benzathine 600000 units/mL, G benzathine- procaine 900000 units-300000 units/2 penicillin mL, Gbenzathine 1,200,000 units/2 mL, G benzathine 2,400,000 units/4 mL

penicillin oral tab V potassium 250 mg Pentamidine Nebupent inj powder 300 mg Pentoxifylline Trental oral tab-XR 400 mg Perflutren lipid microsphere Definity inj susp 1/25/2017 Elimite top cream 5% Permethrin topical Nix Cream Rinse top soln 1% Perphenazine Trilafon oral tab 4 mg BBW Pertuzumab Perjeta 6/28/2012 Petrolatum topical Vaseline top oint 100% Phenazopyridine Pyridium oral tab 95 mg PHENobarbital Luminal oral elixir 20 mg/5 mL PHENobarbital Luminal inj soln 60 mg/mL, 130 mg/mL PHENobarbital Luminal oral tab 15 mg, 30 mg, 64.8 mg, 97.2 mg phenol topical compounding liq 99% Phenol topical Phenasep Cherry top spray 1.4% Phentolamine OraVerse inj soln all strengths 11/4/2015 inj soln 10 mg/mL Phenylephrine Neo-Synephrine inj soln 100 mcg/mL PREFILLED syringe - 10 12/7/2016 mL Phenylephrine nasal Neo-Synephrine Nasal nasal spray 0.25% Phenylephrine opthalmic Neo-Synephrine Opthalmic opthalmic soln 2.5% Phenylephrine topical Hemorrhoidal Ointment rectal oint 0.25%-3% Dilantin inj soln 50 mg/mL BBW Dilantin Infatabs oral tab-chew 50 mg Phenytoin Dilantin Kapseals oral cap-XR 100 mg Dilantin-125 oral susp 25 mg/mL Antilirium inj soln 1 mg/mL Physostigmine opthalmic physostigmine opthalmic opthalmic oint 0.25% Phytonadione Vitamin K1, Mephyton inj soln 1 mg/0.5 mL, 10 mg/mL BBW opthalmic Salagen opthalmic soln 0.5%, 1%, 2%, 4% Pioglitazone Actos oral tab 15 mg, 30 mg, 45 mg BBW 9/27/2007 Piperacillin-tazobactam Zosyn IV powder 2 g-0.25 g, 3 g-0.375 g, 4 g-0.5 g Pneumococcal 13-valent conjugate vaccine Prevnar-13 IM susp - 4/22/2010 Pneumococcal 23-polyvalent vaccine Pneumovax 23 inj soln - Podophyllum resin topical Podocon-25 top soln 25% Poliovirus vaccine, inactivated poliovirus vaccine, inactivated inj susp - Polyethylene glycol 3350 MiraLax oral powder - Polyethylene glycol 3350 with electrolytes GoLYTELY oral powder - Poractant alfa Curosurf intratracheal susp 80 mg/mL Potassium acetate potassium acetate IV soln 2 mEq/mL oral effervescent tab 20 mEq Each 20 mEq potassium bicarbonate effervescent 6/27/2018 Potassium bicarbonate/citric acid Effer-K tablet contains 20 mEq of bicarb

K-Dur 20 oral tab-XR 20 mEq Klor-Con 10 oral tab-XR 10 mEq Klor-Con M10 oral tab-XR 10 mEq Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Potassium chloride Klor-Con M20 oral tab-XR 20 mEq potassium chloride IV inj 40 mEq/500 mL NS IV soln 20 mEq/100 mL, 2 mEq/mL, 40 potassium chloride mEq/100 mL IV soln KCl 20 mEq/L Potassium chloride in dextrose DEXTROSE 5% IN WATER w KCL 20 mEq/L DEXTROSE 5% WITH 0.45% NS w KCL 30 IV soln KCl 30 mEq/L Potassium chloride in dextrose and half NS mEq/L PREMIXED Potassium citrate Urocit-K oral tab-XR 10 mEq Potassium citrate-citric acid Cytra-K oral soln 334 mg/1100 mg/5 mL 3/4/2015 Potassium iodide oral soln 1 g/mL Potassium phosphate Neutra-Phos-K oral powder 250 mg-555 mg Potassium phosphate Potassium phosphate IV soln 3 mmol/mL Potassium phosphate-sodium phosphate K-Phos Neutral oral tab 250 mg-45 mg-298 mg Pramipexole Mirapex oral tab 0.125 mg, 1 mg Pravastatin Pravachol oral tab 10 mg, 20 mg, 40 mg Praziquantel Biltricide oral tab 600 mg Prazosin Minipress oral cap 1 mg prednisoLONE prednisoLONE oral syrup 15 mg/5 mL prednisoLONE opthalmic Pred Forte opthalmic soln sodium phosphate 1% predniSONE predniSONE oral tab 1 mg, 5 mg, 10 mg, 20 mg oral susp 250 mg/5 mL Primidone Mysoline oral tab 50 mg, 250 mg Probenecid Benemid oral tab 500 mg oral cap 250 mg BBW Procainamide Pronestyl inj soln 500 mg/mL BBW inj soln 5 mg/mL BBW Prochlorperazine Compazine rectal supp 25 mg BBW oral tab 5 mg, 10 mg BBW inj soln 25 mg/mL BBW Phenergan rectal supp 12.5 mg, 25 mg, 50 mg BBW oral tab 12.5 mg, 25 mg BBW Propafenone Rhytmol oral tab 150 mg, 300 mg BBW Proparacaine ophthalmic Alcaine opthalmic soln 0.50% Propofol Diprivan IV emulsion 10 mg/mL IV soln 1 mg/mL Propranolol Inderal oral soln 20 mg/5 mL oral tab 10 mg, 20 mg, 40 mg Propylthiouracil PTU oral tab 50 mg protamine inj soln 10 mg/mL BBW Protirelin Thyrel Trh IV soln 500 mcg/mL Pryridostigmine Mestinon oral tab 60 mg Pseudoephedrine Sudafed oral tab 60 mg oral wafers 6/29/2014 Psyllium Metamucil oral powder 3.4 g/3.7 g Pyrazinamide pyrazinamide oral tab 500 mg Pyridostigmine Mestinon oral tab 60 mg BBW inj soln 100 mg/mL Pyridoxine Vitamin B6 oral tab 100 mg Pyrimethamine Daraprim oral tab 25 mg oral tab 25 mg, 50 mg, 100 mg, 200 mg, 300 BBW Seroquel mg, 400 mg quiNIDine oral tab 200 mg BBW quiNIDine quiNIDine oral tab-XR 324 mg BBW Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary quiNINE quiNINE oral cap 200 mg BBW Rabies immune globulin, human Bayrab IM soln 150 units/mL Raltegravir Isentress oral tab 400 mg oral syrup 15 mg/mL Ranitidine Zantac oral tab 150 mg Regradenoson Lexiscan 6/28/2012 Remifentanil Ultiva IV powder 1 mg, 2 mg BBW Rho (D) immune globulin WinRho SDF inj powder 300 mcg, 1000 mcg Rifabutin Mycobutin oral cap 150 mg Rifadin oral cap 150 mg, 300 mg Rifampin Rifadin IV IV powder 600 mg Rifaximin Xifaxin oral tab 550 mg 1/8/2018 risperiDONE RisperDAL oral soln 1 mg/mL BBW risperiDONE RisperDAL Consta IM powder 25 mg/2 weeks BBW oral cap 100 mg BBW Norvir oral soln 80 mg/mL BBW Ritonavir oral cap 100 mg BBW Retrovir oral soln 80 mg/mL BBW oral liq 400 mg-100 mg/5 mL Ritonavir-lopinavir Kaletra oral tab 200 mg-50 mg riTUXimab Rituxan IV soln 10 mg/mL 12/11/2008 Rivaroxaban Xarelto oral tab 10 mg BBW 10/5/2016-restriction removed Rocuronium Zemuron IV soln 10 mg/mL Roflumilast Daliresp PO tab 500 mcg Ropivacaine Naropin inj soln 0.5% 11/29/2007 Rotavirus Vaccine RotaTeq oral susp 2 mL 1/25/2001 Rubella virus vaccine Meruvax II subQ powder - Salicylic acid topical Mediplast top pad 40% scopalamine inj soln 0.4 mg/mL Scopalamine Transderm-Scop transdermal film 1.5 mg IV soln 40 mcg/mL Selenium Selenium oral tab 50 mcg Selenium sulfide topical Selenium sulfide topical top lotion 2.5% Senna Senokot oral tab 8.6 mg Sertraline Zoloft oral tab 50 mg, 100 mg BBW Sevelamer Renagel, Renvela oral tab 400 mg, carbonate 800 mg Ultane inhalation liq - Sildanfil Revatio, Viagra oral tab 20 mg, 25 mg, 50 mg Silver nitrate topical silver nitrate topical top stick - Silver sulfADIAZINE topical Silvadene top cream 1% Genasyme oral liq 40 mg/0.6 mL Simethicone Mylicon oral tab-chew 80 mg Simple syrup simple syrup oral syrup - Sincalide Kinevac IV powder 5 mcg Sodium acetate sodium acetate IV soln 2 mEq/mL Neut IV soln 4% Sodium bicarbonate Sodium bicarbonate IV soln 4%, 4.2%, 8.4% Sodium bisphophate-sodium phosphate Fleet Phospho Soda oral soln 18%-48% SALINE FLUSH inj soln 0.9% NS 2.5 mL Sodium chloride inj soln 0.9% NS 2.5 mL, 0.45%, 0.9% Sodium chloride irrigation soln 0.9% Sodium chloride IV soln 14.6% Sodium chloride Sodium chloride injection inj soln 0.45%, 0.9% Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Sodium chloride injection IV soln 14.6% Sodium chloride inhalation inhalation soln 0.9%, 3%, 7% Sodium chloride inhalation inhalation soln 0.9%, 3% Sodium chloride 0.9% KCL 20 mEq/L 1000 mL Sodium chloride 0.9% KCL 20 mEq/L IV soln KCl 20 mEq/L premix IV 1000 mL premix IV Sodium chloride nasal sodium chloride nasal nasal soln 0.65% Sodium chondroitin-hyaluronate opthalmic Viscoat intraocular soln 40 mg-30 mg/mL Sodium hyaluronate opthalmic Amvisc Plus intraocular liq 1.6% 4/8/2015 Sodium hyaluronate opthalmic Healon intraocular liq 10 mg/mL Sodium hypochlorite topical Dakins Full Strength top soln 0.50% Sodium hypochlorite topical Dakins Half Strenth top soln 0.25% Sodium hypochlorite topical Dakin's Solution top soln 0.25% Sodium phosphate sodium phosphate inj soln 3 mmol/mL Sodium polystyrene sulfonate Kayexylate oral susp 15 g/60 mL sodium thiosulfate IV soln 10%, 25% sorbitol oral liq 70% Sorbitol Betapace oral tab 80 mg Spironolactone Aldactone oral tab 25 mg, 50 mg, 100 mg Starch topical Anusol suppositories rectal supp 51% Sterile talc sterile talc intrapleural aerosol - Flolan Sterile Diluent IV soln diluent Sterile water sterile water inj soln - sterile water irrigation soln - Stomahesive powder stomahesive powder top powder n/a Streptozocin Zanosar IV powder 1 g Succinylcholine Quelicin Chloride inj soln 20 mg/mL BBW Sucralfate Carafate oral tab 1 g SUFentanil Sufenta IV soln 50 mcg/mL BBW Sulf-10 opthalmic soln 10% Sulfacetamide sodium opthalmic sulfacetamide sodium opthalmic opthalmic oint 10% sulfaDIAZENE sulfaDIAZENE oral tab 500 mg Bactrim oral susp 200-40 mg/5 mL Bactrim DS oral tab 800 mg-160 mg Bactrim IV IV soln 80 mg-15 mg/mL Sulfamethoxazole-trimethoprim Cotrim DS oral tab 800 mg-160 mg Septra DS oral tab 800-160 mg Septra IV IV soln 80 mg-16 mg/mL Sulfanilamide topical AVC vaginal cream 15% Sulfasalazine Azulfidine oral tab 500 mg sulfiSOXAZOLE Gantrisin oral tab 500 mg Bridion IV soln 200 mg/2 mL 4/21/2016 SUMAtriptan Imitrex subQ soln 6 mg/0.5 mL Tacrolimus Prograf oral cap 1 mg BBW Tamoxifen Arimidex oral tab 10 mg BBW Tamsulosin Novaldex oral cap 0.4 mg Tdap Adacel IM susp 5 units-2 units-15.5 mcg/0.5 mL tdap Boostrix IM susp 5 units-2.5 units-18.5 mcg/0.5 mL Temazepam Restoril oral cap 7.5 mg, 15 mg, 30 mg Temsirolimus Torisel IV soln 25 mg/mL Tenofovir Viread oral tab 300 mg Terazosin Hytrin oral cap 5 mg Terbinafine LamISIL oral tab 250 mg inj soln 1 mg/mL BBW Terbutaline Brethine Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Terbutaline Brethine oral tab 2.5 mg, 5 mg BBW Testosterone Depo-Testosterone IM soln cypionate 200 mg/mL Tetanus immune globulin BayTet IM soln 250 units Tetanus toxoid Tetanus Toxoid IM soln 5 units/0.5 mL Tetanus toxoid Tetanus Toxoid Adsorbed IM susp 5 units/0.5 mL Tetanus/dipth/pertuss Tdap adult/adol IM susp 2.5 units-18.5 mcg-5 units/0.5 mL Tetanus-dipth toxoids Td adult/adol IM susp 6 units-2 units/0.5 mL Tetracaine Pontocaine HCl inj soln 1% Tetracaine opthalmic Tetracaine opthalmic opthalmic soln 0.5% Tetracaine topical Pontocaine top soln 2% Tetracycline Tetracycline oral cap 250 mg Slo-Phyllin 80 oral syrup 80 mg/15 mL Theophylline Theo-Dur oral tab-XR 100 mg, 200 mg Theophylline oral cap-XR 125 mg, 200 mg inj soln 100 mg/mL Vitamin B1 oral tab 100 mg Thioguanine Thioguanine oral tab 40 mg Thiopental Pentothal IV powder 5 g, 250 mg Mellaril oral tab 10 mg, 25 mg, 50 mg, 100 mg Thrombin topical Thrombin topical top powder 5000 units Thyrotropin alpha Thyrotropin alpha IM powder 1.1 mg Timolol opthalmic Timoptic opthalmic soln 0.5% Timolol-dorzolamide opthalmic Cosopt opthalmic soln 2%-0.5% Nebcin inj soln 40 mg/mL BBW Nebcin Pediatric inj soln 10 mg/mL BBW Tobramycin tobramycin inj powder 1.2 g BBW Tobi inhalation soln 60 mg/mL Lamisil top soln 1% Tolnaftate Tinactin top cream 1% Topiramate Topamax oral tab 25 mg, 50 mg, 100 mg, 200 mg Topotecan Hycamtin IV powder 4 mg BBW Torsemide Demadex oral IV form not approved 1/25/2007 TPN-dextrose Dextrose in water IV soln dextrose 70% in water IV soln 0.85 mcg-0.1 mg-0.025 mg-1.5 mg/mL Trace elements Neotrace-4 IV soln 4 mcg-0.4 mg-0.1 mg-20 mcg-1 Trace elements with selenium Multritrace-5 mg/mL Tranexamic acid Cyklokapron inj soln 1000 mg 6/28/2012 Trastuzumab Herceptin inj powder 150 mg, 400 mg BBW 9/23/2010 traZODone Desyrel oral tab 50 mg, 100 mg BBW Kenalog-10 inj susp 10 mg/mL Triamcinolone Kenalog-40 inj susp acetonide 40 mg/mL inhalation aerosol with adapter 100 mcg/inh Triamcinolone Azmacort top cream 0.1% top lotion 0.1% Triamcinolone topical Kenalog mucous paste 0.1% membrane Trichloroacetic acid topical Tri-Chlor top liq 80% Trifluridine opthalmic Viroptic opthalmic soln 1% Artane oral tab 2 mg, 5 mg oral cap 250 mg Trimethobenzamide Tigan IM soln 100 mg/mL Trimethoprim Proloprim oral tab 100 mg Ventura County Medical Center-Santa Paula Hospital Drug Formulary

Generic Brand Route Form Dose Special Notes Added to Formulary Triple dye topical Triple Dye top soln 2.29 mg-2.29 mg-1.14 mg/mL Tromethamine Tham IV soln 3.6 g/100 mL opth Mydriacyl opthalmic soln 1.00% Tuberculin PPD Aplisol intradermal soln 5 tuberculin units/0.1 mL Typhoid vaccine, inactivated Typhoid vaccine, inactivated IM soln - Urokinase Abbokinase Open Cath IV powder 5000 intl units Ursodiol Actigall oral cap 300 mg Valacyclovir Valtrex oral tab 1000 mg 5/9/2018 valGANciclovir Valcyte oral tab 450 mg BBW Depacon inj soln 100 mg/mL Valproic acid Depakene oral syrup 250 mg/5 mL Valproic acid oral cap-DR 250 mg, 500 mg BBW oral soln 5 gm/200 mL Vancomycin Vancocin IV powder 1 g, 500 mg Varicella virus vaccine Varivax subQ powder - Varicella zoster immune globulin varicella zoster immune globulin IM soln 125 unit, 625 units Vasopressin Pitressin inj soln 20 units/mL Vecuronium Norcuron IV powder 10 mg BBW Effexor oral tab 25 mg, 100 mg BBW Venlafaxine Effexor XR oral cap-XR 37.5 mg, 75 mg, 150 mg BBW Calan oral tab 80 mg, 120 mg Calan SR oral tab-XR 120 mg/12 hours Verapamil Verapamil oral cap-XR 180 mg/24 hrs, 240 mg/24 hrs Verapamil IV soln 2.5 mg/mL vinBLAStine Velban IV powder 10 mg BBW vinCRIStine Oncovin IV soln 1 mg/mL BBW Vinorelbine Navelbine IV soln 10 mg/mL Aquasol IM soln 50000 units/mL Vitamin A Vitamin A oral cap 10000 units Vitamin A and D Vitamin A and D top oint - Vitamin A and D w Zn Oxide Vitamin A and D w Zn Oxide top oint - Vitamin E Vitamin E oral cap 400 units Coumadin oral tab 1 mg, 2 mg, 2.5 mg, 5 mg, 7.5 mg BBW oral cap 100 mg BBW IV soln 10 mg/mL BBW Zidovudine Retrovir oral syrup 50 mg/5 mL BBW oral tab 300 mg BBW Zinc oxide Desitin top cream 6/27/2018 zinc sulfate IV soln 1 mg/mL Zinc sulfate Zinc-220 oral cap 220 mg oral cap 20 mg, 40 mg, 80 mg BBW 11/30/2006 Ziprasidone Geodon IM powder 20 mg BBW Reclast IV soln 5 mg/100 mL Zoledronic acid Zometa IV soln 4 mg/5 mL Zolpidem Ambien oral tab 5 mg Zoster vaccine recombinant, adjuvanted Shingrix inj soln 0.5 mL -