BLANCHFIELD ARMY COMMUNITY HOSPITAL OUTPATIENT FORMULARY Alphabetical Listing by Name

This document is current as of February 24, 2021. The availability of formulary items is subject to change.

1 ABACAVIR, DOLUTEGRAVIR, AND LAMIVUDINE Abacavir, Dolutegravir, and Lamivudine Acyclovir (Systemic) Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Capsule, Oral: Triumeq: Abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg Generic: 200 mg [BCF] Suspension, Oral: Abemaciclib Generic: 200 mg/5 mL [BCF] Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 400 mg [BCF], 800 mg [BCF] Verzenio: 150 mg Acyclovir (Topical) Abiraterone Acetate Outpatient Dosage Forms Outpatient Dosage Forms Cream, External: Tablet, Oral: Generic: 5% (5 g) Generic: 500 mg Ointment, External: Generic: 5% (15 g) Acamprosate Outpatient Dosage Forms Adalimumab Tablet Delayed Release, Oral, as calcium: Outpatient Formulary Brands Available Humira Generic: 333 mg Outpatient Dosage Forms Kit, Subcutaneous [preservative free]: Acarbose Humira: 40 mg/0.8 mL [contains polysorbate 80] [BCF] Outpatient Dosage Forms Pen-injector Kit, Subcutaneous [preservative free]: Tablet, Oral: Humira Pen: 40 mg/0.4 mL (1 ea)[contains polysorbate 80] [BCF] Generic: 25 mg, 50 mg Humira Pen-CD/UC/HS Starter: 80 mg/0.8 mL (1 ea) [contains polysorbate 80] [BCF] Acetaminophen Humira Pen-Psor/Uveit Starter: 80 MG/0.8ML & 40MG/0.4ML (1 ea) [contains Outpatient Dosage Forms polysorbate 80] [BCF] Caplet, Oral: Prefilled Syringe Kit, Subcutaneous [preservative free]: Generic: 500 mg Humira: 20 mg/0.4 mL (1 ea) [BCF]; 20 mg/0.2 mL (1 ea) [BCF]; 40 mg/0.4 Suppository, Rectal: mL (1 ea) [BCF] [contains polysorbate 80] Generic: 120 mg (12s) Humira Pediatric Crohns Start: 80 mg/0.8 mL (1 ea) [BCF] [contains poly- Suspension, Oral: sorbate 80] Generic: 160 mg/5 mL (120 mL) Tablet, Oral: Adapalene Generic: 325 mg (bottle of 100 tablets) Outpatient Dosage Forms Cream, External: Acetaminophen and Codeine Generic: 0.1% (45 g) Outpatient Dosage Forms Gel, External: Solution, Oral [C-V]: Generic: 0.1% (45 g); 0.3% (45 g) Generic: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 mL Lotion, External: (120 mL, 473 mL) [contains alcohol 7%] Generic: 0.1% (59 mL [DSC]) Tablet, Oral [C-III] : Adefovir Generic: Acetaminophen 300 mg and codeine phosphate 30 mg [BCF] Outpatient Dosage Forms AcetaZOLAMIDE Tablet, Oral, as dipivoxil: Outpatient Dosage Forms Generic: 10 mg Capsule Extended Release 12 Hour, Oral: Albendazole Generic: 500 mg Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 250 mg Generic: 200 mg Acetic Acid (Otic) Albuterol Outpatient Dosage Forms Outpatient Dosage Forms Solution, Otic: Aerosol Powder Breath Activated, Inhalation: Generic: 2% (15 mL) ProAir RespiClick: 90 mcg/actuation (1 ea) [contains milk protein] Acetic Acid, Propylene Glycol Diacetate, and Hydrocortisone Aerosol Solution, Inhalation: Outpatient Dosage Forms ProAir HFA: 108 (90 Base) mcg/actuation (8.5 g) [BCF] Syrup, Oral: Solution, Otic: Generic: 2 mg/5 mL (120 mL) Generic: Acetic acid 2%, propylene glycol diacetate 3%, and hydrocortisone 1% (10 mL) Alclometasone Acetohydroxamic Acid Outpatient Dosage Forms Cream, External, as dipropionate: Outpatient Dosage Forms Generic: 0.05% (45 g) Tablet, Oral: Ointment, External, as dipropionate: Lithostat: 250 mg Generic: 0.05% (15 g, 60 g) Acetylcysteine Alcohol (Ethyl) Outpatient Dosage Forms Outpatient Dosage Forms Solution, Inhalation [preservative free]: Pad, External: Generic: 20% [200 mg/mL] (4 mL, 10 mL, 30 mL) Generic: 70% (100s) Acitretin Alendronate Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Solution, Oral: Generic: 10 mg, 25 mg Generic: 70 mg/75 mL (75 mL) [BCF] Aclidinium Tablet, Oral: Generic: 5 mg [BCF], 10 mg [BCF], 35 mg [BCF], 70 mg [BCF] Outpatient Dosage Forms Aerosol Powder Breath Activated, Inhalation, as bromide: Alendronate and Cholecalciferol Tudorza Pressair: 400 mcg/actuation (1 ea) [contains lactose monohydrate] Outpatient Dosage Forms Tablet, Oral: Acyclovir and Hydrocortisone Fosamax Plus D: 70/5600: Alendronate 70 mg and cholecalciferol 5600 int. Outpatient Dosage Forms units Cream, External: Xerese: Acyclovir 5% and hydrocortisone 1% (5 g) [contains cetostearyl Alfuzosin alcohol, propylene glycol] Outpatient Formulary Brands Available Uroxatral 2 AMOXICILLIN AND CLAVULANATE Outpatient Dosage Forms Aminocaproic Acid Tablet Extended Release 24 Hour, Oral, as hydrochloride: Outpatient Dosage Forms Uroxatral: 10 mg [BCF] Solution, Oral: Generic: 10 mg [BCF] Generic: 25% (236.5 mL) Tablet, Oral: Alirocumab Generic: 500 mg Outpatient Formulary Brands Available Praluent Outpatient Dosage Forms Amiodarone Solution Auto-injector, Subcutaneous [preservative free]: Outpatient Formulary Brands Available Pacerone Praluent: 75 mg/mL (1 mL); 150 mg/mL (1 mL) [contains mouse (murine) and/ Outpatient Dosage Forms or hamster protein] Tablet, Oral, as hydrochloride: Pacerone: 200 mg [scored] [BCF] Aliskiren Generic: 200 mg [BCF] Outpatient Dosage Forms Tablet, Oral: Amitriptyline Generic: 150 mg, 300 mg Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Allopurinol Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF], Outpatient Dosage Forms 100 mg [BCF] Tablet, Oral: Generic: 100 mg [BCF], 300 mg [BCF] AmLODIPine Outpatient Dosage Forms Alosetron Tablet, Oral: Outpatient Dosage Forms Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF] Tablet, Oral: Generic: 0.5 mg, 1 mg Amlodipine and Atorvastatin Outpatient Dosage Forms Alpelisib Tablet, Oral: Outpatient Dosage Forms Generic: Amlodipine 5 mg and atorvastatin 20 mg, Amlodipine 5 mg and Tablet Therapy Pack, Oral: atorvastatin 40 mg Piqray (300 MG Daily Dose): 2 x 150 MG (28 ea) Amlodipine and Benazepril ALPRAZolam Outpatient Formulary Brands Available Lotrel Outpatient Dosage Forms Outpatient Dosage Forms Concentrate, Oral: Capsule, Oral: ALPRAZolam Intensol: 1 mg/mL (30 mL) [unflavored flavor] Lotrel: Tablet, Oral: 2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF] Generic: 0.5 mg, 1 mg 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF] Tablet Disintegrating, Oral: 5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF] Generic: 1 mg 5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF] Tablet Extended Release 24 Hour, Oral: 10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF] Generic: 0.5 mg, 1 mg 10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF] Generic: Alprostadil 2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF] Outpatient Dosage Forms 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF] Kit, Intracavernosal: 5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF] Caverject Impulse: 10 mcg (2/box) [contains benzyl alcohol, lactose] 5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF] Edex: 10 mcg (1 ea), 20 mcg (1 ea), 40 mcg (1 ea) [pyrogen free; contains 10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF] lactose] 10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF] Pellet, Urethral: Amlodipine and Olmesartan Muse: 500 mcg (6 ea); 1000 mcg (6 ea) Outpatient Dosage Forms Solution, Injection: Tablet, Oral: Generic: 500 mcg/mL (1 mL) Generic: Amlodipine 10 mg and olmesartan medoxomil 20 mg, Amlodipine Solution Reconstituted, Intracavernosal: 10 mg and olmesartan medoxomil 40 mg, Amlodipine 5 mg and olmesartan Caverject: 40 mcg (1 ea) [contains benzyl alcohol, lactose] medoxomil 40 mg Aluminum Chloride Hexahydrate Amlodipine and Valsartan Outpatient Formulary Brands Available Drysol Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Solution, External: Generic: Amlodipine 10 mg and valsartan 320 mg, Amlodipine 5 mg and Drysol: 20% (37.5 mL, 60 mL) valsartan 160 mg, Amlodipine 5 mg and valsartan 320 mg Amoxicillin Amantadine Outpatient Dosage Forms Capsule, Oral: Outpatient Dosage Forms Generic: 250 mg [BCF], 500 mg [BCF] Suspension Reconstituted, Oral: Capsule, Oral, as hydrochloride: Generic: 125 mg/5 mL; 250 mg/5 mL [BCF]; 400 mg/5 mL [BCF] Generic: 100 mg [BCF] Syrup, Tablet, Chewable, Oral: Oral, as hydrochloride: Generic: 250 mg Tablet, Oral: Generic: 50 mg/5 mL [BCF] Generic: 875 mg AMILoride Amoxicillin and Clavulanate Outpatient Formulary Brands Available Augmentin; Augmentin ES-600 Outpatient Dosage Forms Outpatient Dosage Forms Suspension Reconstituted, Oral: Tablet, Oral, as hydrochloride: Augmentin: Generic: 5 mg 125: Amoxicillin 125 mg and clavulanate potassium 31.25 mg per 5 mL (75 mL, 100 mL, 150 mL) [contains potassium 0.16 mEq/5 mL; banana Amiloride and Hydrochlorothiazide flavor] [BCF] Augmentin ES-600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg Outpatient Dosage Forms per 5 mL (125 mL, 200 mL) [contains phenylalanine 7 mg/5 mL and potassium 0.23 mEq/5 mL; strawberry cream flavor] Tablet: 5/50: Amiloride hydrochloride 5 mg and hydrochlorothiazide 50 mg Generic: 200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (50 mL, 75 mL, 100 mL) [BCF] 3 AMOXICILLIN AND CLAVULANATE

400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (50 mL, Outpatient Dosage Forms 75 mL, 100 mL) [BCF] Tablet, Oral: 600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (75 Evotaz: Atazanavir 300 mg and cobicistat 150 mg mL, 125 mL, 200 mL) [BCF] Tablet, Oral: Atenolol Generic: Outpatient Dosage Forms Amoxicillin 250 mg and clavulanate potassium 125 mg [BCF] Tablet, Oral: Amoxicillin 500 mg and clavulanate potassium 125 mg [BCF] Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Amoxicillin 875 mg and clavulanate potassium 125 mg [BCF] Tablet, Chewable, Oral: AtoMOXetine Generic: Outpatient Dosage Forms 200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg Capsule, Oral: 400: Amoxicillin 400 mg and clavulanate potassium 57 mg Generic: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg Anagrelide AtorvaSTATin Outpatient Dosage Forms Outpatient Formulary Brands Available Lipitor Capsule, Oral: Outpatient Dosage Forms Generic: 0.5 mg, 1 mg Tablet, Oral: Lipitor: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Anastrozole Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Outpatient Dosage Forms Tablet, Oral: Atovaquone and Proguanil Generic: 1 mg Outpatient Dosage Forms Tablet, Oral: Apixaban Generic: Atovaquone 250 mg and proguanil hydrochloride 100 mg Outpatient Dosage Forms Tablet, Oral [pediatric]: Tablet, Oral: Generic: Atovaquone 62.5 mg and proguanil hydrochloride 25 mg Eliquis: 2.5 mg, 5 mg Atropine (Ophthalmic) Apraclonidine Outpatient Dosage Forms Outpatient Dosage Forms Solution, Ophthalmic, as sulfate: Solution, Ophthalmic: Generic: 1% (5 mL, 15 mL) Iopidine: 1% (24 ea) [contains benzalkonium chloride] Generic: 0.5% (10 mL) AzaTHIOprine Outpatient Dosage Forms Apremilast Tablet, Oral: Outpatient Dosage Forms Generic: 50 mg Tablet, Oral: Otezla: 30 mg Azelaic Acid Tablet Therapy Pack, Oral: Outpatient Formulary Brands Available Azelex Otezla: 10 & 20 & 30 mg (55 ea) Outpatient Dosage Forms Cream, External: Aprepitant Azelex: 20% (30 g, 50 g) [contains benzoic acid] Outpatient Dosage Forms Gel, External: Capsule, Oral: Generic: 15% (50 g) Generic: 40 mg, 80 mg & 125 mg Azelastine (Nasal) Arformoterol Outpatient Dosage Forms Outpatient Dosage Forms Solution, Nasal, as hydrochloride: Nebulization Solution, Inhalation: Generic: 0.1% [137 mcg/spray] (30 mL) Brovana: 15 mcg/2 mL (2 mL) Azelastine (Ophthalmic) ARIPiprazole Outpatient Dosage Forms Outpatient Dosage Forms Solution, Ophthalmic, as hydrochloride: Solution, Oral: Generic: 0.05% (6 mL) Generic: 1 mg/mL Tablet, Oral: Azithromycin (Systemic) Generic: 2 mg [BCF], 5 mg [BCF], 10 mg [BCF], 15 mg [BCF], 20 mg [BCF], Outpatient Formulary Brands Available Zithromax 30 mg [BCF] Outpatient Dosage Forms Packet, Oral: Armodafinil Generic: 1 g (3 ea) [BCF] Outpatient Dosage Forms Suspension Reconstituted, Oral: Tablet, Oral: Zithromax: 100 mg/5 mL (15 mL) [cherry-vanilla-banana flavor] [BCF] Generic: 50 mg, 150 mg, 200 mg, 250 mg Generic: 100 mg/5 mL (15 mL) [BCF]; 200 mg/5 mL (15 mL, 30 mL) Tablet, Oral: Artemether and Lumefantrine Zithromax: 250 mg [BCF] Outpatient Dosage Forms Generic: 250 mg [BCF], 500 mg [BCF] Tablet, Oral: Coartem: Artemether 20 mg and lumefantrine 120 mg Bacitracin and Polymyxin B (Ophthalmic) Outpatient Dosage Forms Aspirin Ointment, Ophthalmic: Outpatient Dosage Forms Generic: Bacitracin 500 units and polymyxin B 10,000 units per g (3.5 g) Tablet, Chewable, Oral: Generic: 81 mg Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) Tablet, Enteric Coated, Oral: Outpatient Dosage Forms Generic: 81 mg, 325 mg Ointment, Ophthalmic: Generic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units Aspirin and Dipyridamole per g (3.5 g) [BCF] Outpatient Dosage Forms Capsule Extended Release 12 Hour, Oral: Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone Generic: Aspirin 25 mg [immediate release] and dipyridamole 200 mg (Ophthalmic) [extended release] Outpatient Dosage Forms Ointment, Ophthalmic: Atazanavir Generic: Bacitracin 400 units, neomycin 3.5 mg, polymyxin B 10,000 units, Outpatient Dosage Forms and hydrocortisone 10 mg per g (3.5 g) Capsule, Oral, as sulfate: Generic: 300 mg Bacitracin (Topical) Outpatient Dosage Forms Atazanavir and Cobicistat Ointment, External, as zinc [strength expressed as base]: Outpatient Formulary Brands Available Evotaz Generic: 500 units/g (28.35 g) 4 BUDESONIDE (TOPICAL) Baclofen Bicalutamide Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 10 mg Generic: 50 mg [BCF] Balsalazide Bictegravir, Emtricitabine, and Tenofovir Alafenamide Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral, as disodium: Tablet, Oral: Generic: 750 mg Biktarvy: Bictegravir 50 mg, emtricitabine 200 mg, and tenofovir alafena- Baricitinib mide 25 mg Outpatient Dosage Forms Bimatoprost Tablet, Oral: Outpatient Dosage Forms Olumiant: 2 mg [contains soybean lecithin] Solution, Ophthalmic: Belimumab Lumigan: 0.01% (2.5 mL) [contains benzalkonium chloride] Outpatient Dosage Forms Bisacodyl Solution Auto-injector, Subcutaneous [preservative free]: Outpatient Dosage Forms Benlysta: 200 mg/mL (1 mL) [contains polysorbate 80] Tablet, Enteric Coated, Oral: Belladonna and Opium Generic: 5 mg Outpatient Dosage Forms Bisoprolol Suppository, Rectal: Outpatient Dosage Forms Generic: Belladonna extract 16.2 mg and opium 60 mg Tablet, Oral, as fumarate: Benazepril Generic: 5 mg, 10 mg Outpatient Dosage Forms Bisoprolol and Hydrochlorothiazide Tablet, Oral, as hydrochloride: Outpatient Dosage Forms Generic: 5 mg, 10 mg, 20 mg, 40 mg Tablet, Oral: Benzonatate Generic: 10/6.25: Bisoprolol fumarate 10 mg and hydrochlorothiazide Outpatient Dosage Forms 6.25 mg, 2.5/6.25: Bisoprolol fumarate 2.5 mg and hydrochlorothiazide Capsule, Oral: 6.25 mg, 5/6.25: Bisoprolol fumarate 5 mg and hydrochlorothiazide 6.25 mg Generic: 100 mg Bremelanotide Benztropine Outpatient Dosage Forms Outpatient Dosage Forms Solution Auto-injector, Subcutaneous, as acetate [preservative free]: Tablet, Oral, as mesylate: Vyleesi: 1.75 mg/0.3 mL (0.3 mL) Generic: 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF] Brimonidine and Timolol Benzyl Alcohol Outpatient Dosage Forms Outpatient Dosage Forms Solution, Ophthalmic: Lotion, External: Combigan: Brimonidine tartrate 0.2% and timolol 0.5% (10 mL) [contains Ulesfia: 5% (227 g [DSC]) [contains polysorbate 80, trolamine (triethanol- benzalkonium chloride] amine)] Brimonidine (Ophthalmic) Besifloxacin Outpatient Formulary Brands Available Alphagan P Outpatient Dosage Forms Outpatient Dosage Forms Suspension, Ophthalmic: Solution, Ophthalmic, as tartrate [drops]: Besivance: 0.6% (5 mL) [contains benzalkonium chloride, edetate (edta) Alphagan P: 0.1% (10 mL); 0.15% (5 mL) [contains Purite] [BCF] disodium dihydrate] Generic: 0.15% (5 mL) [BCF]; 0.2% (5 mL, 15 mL) [BCF] Betamethasone and Clotrimazole Brinzolamide and Brimonidine Outpatient Dosage Forms Outpatient Dosage Forms Cream, External: Suspension, Ophthalmic: Generic: Betamethasone dipropionate 0.05% (base) and clotrimazole Simbrinza: Brinzolamide 1% and brimonidine tartrate 0.2% (8 mL) [contains 1% (45 g) benzalkonium chloride, propylene glycol] Betamethasone (Topical) Bromfenac Outpatient Formulary Brands Available Beta-Val [DSC] Outpatient Dosage Forms Outpatient Dosage Forms Solution, Ophthalmic: Cream, External, as dipropionate [strength expressed as base]: Generic: 0.09% (1.7 mL) Generic: 0.05% (15 g, 45 g) Cream, External, as valerate [strength expressed as base]: Bromocriptine Beta-Val: 0.1% (15 g) [DSC] Outpatient Dosage Forms Generic: 0.1% (45 g) Capsule, Oral: Ointment, External, as dipropionate [strength expressed as base]: Generic: 5 mg Generic: 0.05% (45 g) Tablet, Oral: Ointment, External, as dipropionate augmented [strength expressed as base]: Generic: 2.5 mg Generic: 0.05% (15 g) Budesonide (Oral Inhalation) Betaxolol (Ophthalmic) Outpatient Dosage Forms Outpatient Formulary Brands Available Betoptic S Suspension, Inhalation: Outpatient Dosage Forms Generic: 0.25 mg/2 mL (2 mL); 0.5 mg/2 mL (2 mL); 1 mg/2 mL (2 mL) Suspension, Ophthalmic: Budesonide (Systemic) Betoptic S: 0.25% (10 mL) [contains benzalkonium chloride] Outpatient Dosage Forms Bethanechol Capsule Delayed Release Particles, Oral: Outpatient Dosage Forms Generic: 3 mg Tablet, Oral, as chloride: Budesonide (Topical) Generic: 10 mg, 25 mg Outpatient Formulary Brands Available Uceris Bexarotene (Topical) Outpatient Dosage Forms Outpatient Dosage Forms Foam, Rectal: Gel, External: Uceris: 2 mg/actuation (33.4 g) [contains cetyl alcohol, edetate disodium, Targretin: 1% (60 g) [contains alcohol, usp] propylene glycol] 5 BUPRENORPHINE Buprenorphine Calcium Acetate Outpatient Dosage Forms Outpatient Dosage Forms Patch Weekly, Transdermal: Capsule, Oral: Generic: 5 mcg/hr (4 ea); 7.5 mcg/hr (4 ea); 10 mcg/hr (4 ea); 15 mcg/hr (4 Generic: 667 mg ea); 20 mcg/hr (4 ea) Candesartan Buprenorphine and Naloxone Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as cilexetil: Film, Sublingual: Generic: 4 mg, 8 mg, 16 mg, 32 mg Generic: Buprenorphine 12 mg and naloxone 3 mg (1 ea, 30 ea); Buprenor- Candesartan and Hydrochlorothiazide phine 2 mg and naloxone 0.5 mg (1 ea, 30 ea); Buprenorphine 4 mg and Outpatient Dosage Forms naloxone 1 mg (1 ea, 30 ea); Buprenorphine 8 mg and naloxone 2 mg (1 ea, Tablet, Oral: 30 ea) Generic: 16/12.5: Candesartan cilexetil 16 mg and hydrochlorothiazide Tablet Sublingual, Sublingual: 12.5 mg, 32/12.5: Candesartan cilexetil 32 mg and hydrochlorothiazide Generic: Buprenorphine 2 mg and naloxone 0.5 mg, Buprenorphine 8 mg and 12.5 mg, 32/25: Candesartan cilexetil 32 mg and hydrochlorothiazide 25 mg naloxone 2 mg Captopril BuPROPion Outpatient Dosage Forms Outpatient Formulary Brands Available Wellbutrin SR; Wellbutrin XL Tablet, Oral: Outpatient Dosage Forms Generic: 12.5 mg [BCF], 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Tablet, Oral, as hydrochloride: Generic: 75 mg [BCF], 100 mg [BCF] CarBAMazepine Tablet Extended Release 12 Hour, Oral, as hydrochloride: Outpatient Formulary Brands Available TEGretol; TEGretol-XR Wellbutrin SR: 100 mg [BCF] Outpatient Dosage Forms Generic: 100 mg [BCF], 150 mg [BCF] Capsule Extended Release 12 Hour, Oral: Tablet Extended Release 24 Hour, Oral, as hydrochloride: Generic: 100 mg, 200 mg, 300 mg Wellbutrin XL: 150 mg [BCF], 300 mg [BCF] Suspension, Oral: Generic: 150 mg [BCF], 300 mg [BCF] TEGretol: 100 mg/5 mL (450 mL) [contains propylene glycol; citrus-vanilla flavor] [BCF] BusPIRone Generic: 100 mg/5 mL (450 mL) [BCF] Outpatient Dosage Forms Tablet, Oral: Tablet, Oral, as hydrochloride: Generic: 200 mg [BCF], 400 mg [BCF] Generic: 5 mg [BCF], 7.5 mg [BCF], 10 mg [BCF], 15 mg [BCF] Tablet, Chewable, Oral: Generic: 100 mg [BCF] Butalbital, Acetaminophen, and Caffeine Tablet Extended Release 12 Hour, Oral: Outpatient Dosage Forms TEGretol-XR: 100 mg, 200 mg, 400 mg [BCF] Tablet, Oral: Generic: 100 mg, 200 mg, 400 mg [BCF] Generic: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg [BCF] Carbidopa and Levodopa Butorphanol Outpatient Formulary Brands Available Sinemet Outpatient Dosage Forms Outpatient Dosage Forms Solution, Nasal, as tartrate: Tablet, Oral: Generic: 10 mg/mL (2.5 mL) Sinemet: 10/100: Carbidopa 10 mg and levodopa 100 mg [BCF] Cabergoline 25/100: Carbidopa 25 mg and levodopa 100 mg [BCF] Outpatient Dosage Forms 25/250: Carbidopa 25 mg and levodopa 250 mg [BCF] Tablet, Oral: Generic: Generic: 0.5 mg 10/100: Carbidopa 10 mg and levodopa 100 mg [scored] [BCF] 25/100: Carbidopa 25 mg and levodopa 100 mg [scored] [BCF] Calcipotriene 25/250: Carbidopa 25 mg and levodopa 250 mg [scored] [BCF] Outpatient Dosage Forms Tablet Extended Release, Oral: Cream, External: Generic: Carbidopa 25 mg and levodopa 100 mg, Carbidopa 50 mg and Generic: 0.005% (60 g) levodopa 200 mg Foam, External: Generic: 0.005% (60 g) Carisoprodol Solution, External: Outpatient Dosage Forms Generic: 0.005% (60 mL) Tablet, Oral: Generic: 350 mg Calcipotriene and Betamethasone Outpatient Dosage Forms Carisoprodol and Aspirin Foam, External: Outpatient Dosage Forms Enstilar: Calcipotriene 0.005% and betamethasone dipropionate Tablet, Oral: 0.064% (60 g) Generic: Carisoprodol 200 mg and aspirin 325 mg [DSC] Ointment, External: Carvedilol Generic: Calcipotriene 0.005% and betamethasone dipropionate Outpatient Dosage Forms 0.064% (60 g) Capsule Extended Release 24 Hour, Oral, as phosphate: Suspension, External: Generic: 10 mg, 20 mg, 40 mg, 80 mg Generic: Calcipotriene 0.005% and betamethasone dipropionate Tablet, Oral: 0.064% (60 g) Generic: 3.125 mg [BCF], 6.25 mg [BCF], 12.5 mg [BCF], 25 mg [BCF] Calcitonin Cefaclor Outpatient Dosage Forms Outpatient Dosage Forms Solution, Nasal: Capsule, Oral: Generic: 200 units/actuation (3.7 mL) Generic: 250 mg Calcitriol (Systemic) Cefadroxil Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Capsule, Oral: Generic: 0.25 mcg, 0.5 mcg Generic: 500 mg Solution, Oral: Generic: 1 mcg/mL (15 mL) Cefdinir Outpatient Dosage Forms Calcitriol (Topical) Capsule, Oral: Outpatient Dosage Forms Generic: 300 mg Ointment, External: Suspension Reconstituted, Oral: Generic: 3 mcg/g (100 g) Generic: 125 mg/5 mL; 250 mg/5 mL (100 mL) 6 CLOBAZAM Cefpodoxime Cinacalcet Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 200 mg Generic: 30 mg, 90 mg Cefuroxime Ciprofloxacin and Dexamethasone Outpatient Dosage Forms Outpatient Formulary Brands Available Ciprodex Tablet, Oral, as axetil [strength expressed as base]: Outpatient Dosage Forms Generic: 250 mg, 500 mg Suspension, Otic: Ciprodex: Ciprofloxacin 0.3% and dexamethasone 0.1% (7.5 mL) [contains Celecoxib benzalkonium chloride] Outpatient Dosage Forms Capsule, Oral: Ciprofloxacin and Fluocinolone Generic:100 mg, 200 mg Outpatient Dosage Forms Solution, Otic [preservative free]: Cephalexin Generic: Ciprofloxacin 0.3 % and fluocinolone acetonide 0.025 % (14 ea) Outpatient Formulary Brands Available Keflex Outpatient Dosage Forms Ciprofloxacin and Hydrocortisone Capsule, Oral: Outpatient Dosage Forms Keflex: 250 mg [BCF], 500 mg [BCF] Suspension, Otic: Generic: 250 mg [BCF], 500 mg [BCF] Cipro HC: Ciprofloxacin hydrochloride 0.2% and hydrocortisone 1% (10 mL) Suspension Reconstituted, Oral: [contains benzyl alcohol] Generic: 125 mg/5 mL; 250 mg/5 mL [BCF] Ciprofloxacin (Ophthalmic) Cetirizine (Systemic) Outpatient Dosage Forms Outpatient Dosage Forms Solution, Ophthalmic, as hydrochloride: Generic: 0.3% (5 mL) Syrup, Oral, as hydrochloride: Generic: 5 mg/5 mL Ciprofloxacin (Systemic) Tablet, Oral, as hydrochloride: Outpatient Formulary Brands Available Cipro Generic: 10 mg Outpatient Dosage Forms Cetrorelix Suspension Reconstituted, Oral: Cipro: 250 mg/5 mL [strawberry flavor] [BCF]; 500 mg/5 mL [strawberry flavor] Outpatient Dosage Forms Generic: 250 mg/5 mL [BCF]; 500 mg/5 mL Kit, Subcutaneous: Tablet, Oral, as hydrochloride [strength expressed as base]: Cetrotide: 0.25 mg [contains mannitol] Generic: 100 mg, 250 mg [BCF], 500 mg [BCF], 750 mg ChlordiazePOXIDE Citalopram Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral, as hydrochloride: Solution, Oral: Generic: 25 mg Generic: 10 mg/5 mL (240 mL) [BCF] Chlorhexidine Gluconate (Oral) Tablet, Oral: Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF] Outpatient Formulary Brands Available Periogard Outpatient Dosage Forms Clarithromycin Solution, Mouth/Throat: Outpatient Dosage Forms Generic: 0.12% (473 mL) [BCF] Suspension Reconstituted, Oral: Generic: 125 mg/5 mL; 250 mg/5 mL Chloroquine Tablet, Oral: Outpatient Dosage Forms Generic: 250 mg, 500 mg Tablet, Oral, as phosphate: Tablet Extended Release 24 Hour, Oral: Generic: 500 mg [equivalent to chloroquine base 300 mg] Generic: 500 mg ChlorproMAZINE Clindamycin and Benzoyl Peroxide Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Gel, External: Generic: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg Duac: Clindamycin phosphate 1.2% and benzoyl peroxide 5% (45 g) Generic: Clindamycin 1% and benzoyl peroxide 5% (25 g, 50 g [BCF]); Chlorthalidone Clindamycin phosphate 1.2% and benzoyl peroxide 5% (45 g) [BCF]; Outpatient Dosage Forms Clindamycin phosphate 1.2% and benzoyl peroxide 2.5% (50 g) Tablet, Oral: Generic: 25 mg [BCF], 50 mg [BCF] Clindamycin (Systemic) Outpatient Dosage Forms Chlorzoxazone Capsule, Oral, as hydrochloride [strength expressed as base]: Outpatient Dosage Forms Generic: 75 mg, 150 mg [BCF], 300 mg Tablet, Oral: Solution Reconstituted, Oral, as palmitate hydrochloride [strength expressed as Generic: 500 mg base]: Generic: 75 mg/5 mL (100 mL) Cholestyramine Resin Outpatient Dosage Forms Clindamycin (Topical) Packet, Oral: Outpatient Dosage Forms Generic: 4 g (60 ea) Cream, Vaginal, as phosphate [strength expressed as base]: Cleocin: 2% (40 g) [contains benzyl alcohol, mineral oil] [BCF] Ciclopirox Generic: 2% (40 g) Outpatient Dosage Forms Gel, External, as phosphate [strength expressed as base]: Solution, External: Generic: 1% (30 g) [BCF] Generic: 8% (6.6 mL) Lotion, External, as phosphate [strength expressed as base]: Generic: 1% (60 mL) Cilostazol Solution, External, as phosphate [strength expressed as base]: Outpatient Dosage Forms Generic: 1% (30 mL, 60 mL) [BCF] Tablet, Oral: Swab, External, as phosphate [strength expressed as base]: Generic: 50 mg, 100 mg Generic: 1% (1 ea) Cimetidine CloBAZam Outpatient Dosage Forms Outpatient Dosage Forms Solution, Oral, as hydrochloride [strength expressed as base]: Suspension, Oral: Generic: 300 mg/5 mL (237 mL) Generic: 2.5 mg/mL (120 mL) Tablet, Oral: Tablet, Oral: Generic: 300 mg, 400 mg Generic: 10 mg 7 CLOBETASOL Clobetasol Condom Outpatient Dosage Forms Outpatient Dosage Forms Cream, External, as propionate: Condom: 3s Generic: 0.05% (30 g, 45 g, 60 g) [BCF] Foam, External, as propionate: Cromolyn (Ophthalmic) Generic: 0.05% (50 g) Outpatient Dosage Forms Gel, External, as propionate: Solution, Ophthalmic, as sodium: Generic: 0.05% (30 g) [BCF] Generic: 4% (10 mL) Liquid, External, as propionate [spray]: Generic: 0.05% (125 mL) Crotamiton Lotion, External, as propionate: Outpatient Dosage Forms Generic: 0.05% (118 mL) [BCF] Cream, External: Ointment, External, as propionate: Eurax: 10% (60 g [DSC]) Generic: 0.05% (15 g, 30 g, 45 g, 60 g) [BCF] Shampoo, External, as propionate: Cyanocobalamin Generic: 0.05% (118 mL) Outpatient Dosage Forms Solution, External, as propionate: Solution, Injection: Generic: 0.05% (25 mL, 50 mL) Generic: 1000 mcg/mL (1 mL, 10 mL) Tablet, Oral: ClomiPHENE Generic: 1000 mcg Outpatient Dosage Forms Tablet, Oral, as citrate: Cyclobenzaprine Generic: 50 mg Outpatient Dosage Forms Capsule Extended Release 24 Hour, Oral, as hydrochloride: ClomiPRAMINE Generic: 15 mg, 30 mg Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Capsule, Oral, as hydrochloride: Generic: 5 mg, 10 mg [BCF] Generic: 25 mg, 50 mg, 75 mg Cyclopentolate ClonazePAM Outpatient Dosage Forms Outpatient Dosage Forms Solution, Ophthalmic, as hydrochloride: Tablet, Oral: Generic: 0.5% (15 mL); 1% (15 mL); 2% (5 mL) Generic: 0.5 mg [BCF], 1 mg, 2 mg Tablet Disintegrating, Oral: Cyclopentolate and Phenylephrine Generic: 0.125 mg, 0.5 mg, 1 mg [BCF] Outpatient Formulary Brands Available Cyclomydril Outpatient Dosage Forms CloNIDine Solution, Ophthalmic: Outpatient Dosage Forms Cyclomydril: Cyclopentolate hydrochloride 0.2% and phenylephrine hydro- Patch Weekly, Transdermal: chloride 1% (5 mL) [contains benzalkonium chloride] Generic: 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: CycloSERINE Generic: 0.1 mg [BCF], 0.2 mg [BCF], 0.3 mg [BCF] Outpatient Dosage Forms Tablet Extended Release 12 Hour, Oral, as hydrochloride: Capsule, Oral: Generic: 0.1 mg Generic: 250 mg Clopidogrel CycloSPORINE (Ophthalmic) Outpatient Formulary Brands Available Plavix Outpatient Formulary Brands Available Restasis; Restasis MultiDose Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Emulsion, Ophthalmic [preservative free]: Plavix: 75 mg [BCF] Restasis: 0.05% (30 ea, 60 ea) [contains polysorbate 80] Generic: 75 mg [BCF] Restasis: 0.05% (0.4 mL) [contains castor oil] Clorazepate Restasis MultiDose: 0.05% (5.5 mL) [contains polysorbate 80] Outpatient Dosage Forms CycloSPORINE (Systemic) Tablet, Oral, as dipotassium: Outpatient Dosage Forms Generic: 7.5 mg Capsule, Oral: Clotrimazole (Oral) Generic: 25 mg, 50 mg, 100 mg Outpatient Dosage Forms Solution, Oral: Troche, Mouth/Throat: Generic: 100 mg/mL (50 mL) Generic: 10 mg Cyproheptadine Clotrimazole (Topical) Outpatient Dosage Forms Outpatient Dosage Forms Syrup, Oral, as hydrochloride: Cream, External: Generic: 2 mg/5 mL [BCF] Generic: 1% (30 g) Tablet, Oral, as hydrochloride: Cream, Vaginal: Generic: 4 mg [BCF] Generic: 1% (45 g) Dabigatran Etexilate Solution, External: Generic: 1% (10 mL) [BCF] Outpatient Formulary Brands Available Pradaxa Outpatient Dosage Forms Codeine Capsule, Oral: Outpatient Dosage Forms Pradaxa: 75 mg, 150 mg Tablet, Oral, as sulfate: Generic: 30 mg Dapsone (Systemic) Outpatient Dosage Forms Colchicine Tablet, Oral: Outpatient Dosage Forms Generic: 25 mg Tablet, Oral: Generic: 0.6 mg Darolutamide Outpatient Formulary Brands Available Nubeqa Colestipol Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Granules, Oral, as hydrochloride: Nubeqa: 300 mg Colestid Flavored: 5 g/7.5 g scoop (450 g) [contains aspartame; orange flavor] Desipramine Generic: 5 g/5 g scoop (500 g) Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Tablet, Oral, as hydrochloride: Generic: 1 g Generic: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg 8 DIGOXIN Desmopressin Diabetic Supplies Outpatient Dosage Forms Outpatient Dosage Forms Solution, Nasal, as acetate: Lancet: (200s) Generic: 0.01% (5 mL) Meter: Tablet, Oral, as acetate: Precision Xtra [limit of one machine per patient] Generic: 0.2 mg Pen needle: BD Ultra-Fine Original Pen Needle (100s) Desonide BD Ultra-Fine Short Pen Needle (100s) Outpatient Dosage Forms BD Ultra-Fine Mini Pen Needle (100s) Cream, External: Syringe and needle: Generic: 0.05% (60 g) BD Insulin Syringe 1 mL (Ultra-Fine) [BCF] Ointment, External: BD Lo-Dose Insulin Syringe 0.5 mL (Ultra-Fine)[BCF] Generic: 0.05% (15 g, 60 g) BD Lo-Dose Insulin Syringe 0.3 mL (Ultra-Fine) Test Strips: Desvenlafaxine Precision Xtra Blood Glucose Test Strips (100s) Outpatient Dosage Forms Precision Xtra Ketone Test Strips (10s) Tablet Extended Release 24 Hour, Oral, as succinate [strength expressed as base]: DiazePAM Generic: 25 mg, 50 mg, 100 mg Outpatient Dosage Forms Solution, Oral: DexAMETHasone (Systemic) Generic: 5 mg/5 mL (5 mL) Outpatient Dosage Forms Tablet, Oral: Elixir, Oral: Generic: 5 mg [BCF] Generic: 0.5 mg/5 mL (237 mL) Diazoxide Tablet, Oral: Generic: 0.5 mg, 4 mg Outpatient Dosage Forms Suspension, Oral: Dextroamphetamine Generic: 50 mg/mL (30 mL) Outpatient Dosage Forms Dibucaine Capsule Extended Release 24 Hour, Oral, as sulfate: Outpatient Dosage Forms Generic: 10 mg, 15 mg Ointment, External: Tablet, Oral, as sulfate: Generic: 1% [10 mg/g] (30 g) Generic: 5 mg Diclofenac and Misoprostol Dextroamphetamine and Amphetamine Outpatient Dosage Forms Outpatient Dosage Forms Tablet Delayed Release, Oral: Capsule, Extended release, Oral: Generic: Diclofenac sodium 50 mg and misoprostol 200 mcg, Diclofenac Adderall XR: sodium 75 mg and misoprostol 200 mcg 5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate 1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine Diclofenac (Ophthalmic) sulfate 1.25 mg (equivalent to amphetamine base 3.1 mg)] [BCF] Outpatient Dosage Forms 10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate Solution, Ophthalmic, as sodium: 2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sul- Generic: 0.1% (5 mL) fate 2.5 mg (equivalent to amphetamine base 6.3 mg)] [BCF] 15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccha- Diclofenac (Systemic) rate 3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphet- Outpatient Dosage Forms amine sulfate 3.75 mg (equivalent to amphetamine base 9.4 mg)] [BCF] Tablet Delayed Release, Oral, as sodium: 20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate Generic: 50 mg, 75 mg 5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate Diclofenac (Topical) 5 mg (equivalent to amphetamine base 12.5 mg)] [BCF] Outpatient Formulary Brands Available Voltaren 25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine saccha- rate 6.25 mg, amphetamine aspartate 6.25 mg, amphetamine sulfate Outpatient Dosage Forms Gel, Transdermal, as sodium: 6.25 mg (equivalent to amphetamine base 15.6 mg)] [BCF] Voltaren: 1% (100 g) [contains isopropyl alcohol, propylene glycol] 30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate Solution, Transdermal, as sodium: 7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sul- Generic: 1.5% (150 mL) fate 7.5 mg (equivalent to amphetamine base 18.8 mg)] [BCF] Generic: Dicloxacillin 5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate Outpatient Dosage Forms 1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine Capsule, Oral: sulfate 1.25 mg (equivalent to amphetamine base 3.1 mg)] [BCF] Generic: 250 mg [BCF], 500 mg [BCF] 10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate 2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sul- Dicyclomine fate 2.5 mg (equivalent to amphetamine base 6.3 mg)] [BCF] Outpatient Dosage Forms 15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccha- Capsule, Oral, as hydrochloride: rate 3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphet- Generic: 10 mg [BCF] amine sulfate 3.75 mg (equivalent to amphetamine base 9.4 mg)] [BCF] Solution, Oral, as hydrochloride: 20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate Generic: 10 mg/5 mL (473 mL) 5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate Tablet, Oral, as hydrochloride: 5 mg (equivalent to amphetamine base 12.5 mg)] [BCF] Generic: 20 mg [BCF] 25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine saccha- Diflunisal rate 6.25 mg, amphetamine aspartate monohydrate 6.25 mg, amphet- amine sulfate 6.25 mg (equivalent to amphetamine base 15.6 mg)] [BCF] Outpatient Dosage Forms Tablet, Oral: 30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate Generic: 500 mg 7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sul- fate 7.5 mg (equivalent to amphetamine base 18.8 mg)] [BCF] Difluprednate Tablet, Oral: Outpatient Formulary Brands Available Durezol Generic: Outpatient Dosage Forms 5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate Emulsion, Ophthalmic: 1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine Durezol: 0.05% (5 mL) [contains edetate sodium (tetrasodium), polysor- sulfate 1.25 mg (equivalent to amphetamine base 3.13 mg)] bate 80] 10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate 2.5 mg, amphetamine aspartate 2.5 mg, amphetamine sulfate 2.5 mg Digoxin (equivalent to amphetamine base 6.3 mg)] Outpatient Formulary Brands Available Lanoxin 20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate Outpatient Dosage Forms 5 mg, amphetamine aspartate 5 mg, amphetamine sulfate 5 mg (equiva- Solution, Oral: lent to amphetamine base 12.6 mg)] Generic: 0.05 mg/mL (60 mL) 9 DIGOXIN Tablet, Oral: Doxycycline Lanoxin: 125 mcg [BCF], 250 mcg [BCF] [scored] Outpatient Dosage Forms Generic: 125 mcg [BCF], 250 mcg [BCF] Capsule, Oral, as hyclate: DilTIAZem Generic: 100 mg [strength expressed as base] [BCF] Tablet, Oral, as hyclate: Outpatient Formulary Brands Available Tiazac Generic: 100 mg [strength expressed as base] [BCF] Outpatient Dosage Forms Capsule Extended Release 24 Hour, Oral, as hydrochloride: DULoxetine Tiazac: 180 mg [BCF], 240 mg [BCF] Outpatient Dosage Forms Generic: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF], 300 mg [BCF], Capsule Delayed Release Particles, Oral: 360 mg [BCF], 420 mg [BCF] Generic: 20 mg, 30 mg, 60 mg Tablet, Oral, as hydrochloride: Generic: 60 mg Efavirenz, Emtricitabine, and Tenofovir Disoproxil Fumarate Outpatient Dosage Forms Dimethyl Sulfoxide Tablet, Oral: Outpatient Formulary Brands Available Rimso-50 Atripla: Efavirenz 600 mg, emtricitabine 200 mg, and tenofovir disoproxil Outpatient Dosage Forms fumarate 300 mg Solution, Intravesical: Rimso-50: 50% (50 mL) Empagliflozin Outpatient Dosage Forms Dinoprostone Tablet, Oral: Outpatient Dosage Forms Jardiance: 10 mg, 25 mg Insert, Vaginal: Cervidil: 10 mg (1 ea) Emtricitabine and Tenofovir Disoproxil Fumarate Outpatient Dosage Forms DiphenhydrAMINE (Systemic) Tablet, Oral: Outpatient Dosage Forms Truvada: Emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg Capsule, Oral, as hydrochloride: Generic: 25 mg, 50 mg Emtricitabine, Rilpivirine, and Tenofovir Disoproxil Fumarate Solution, Oral, as hydrochloride: Outpatient Dosage Forms Generic: 12.5 mg/5 mL (5 mL) Tablet, Oral: Complera: emtricitabine 200 mg, rilpivirine 25 mg, and tenofovir disoproxil Diphenoxylate and Atropine fumarate 300 mg [contains fd&c blue #2 aluminum lake, fd&c yellow #6 Outpatient Dosage Forms aluminum lake] Tablet, Oral: Generic: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate 0.025 mg Enalapril Outpatient Dosage Forms Dipyridamole Tablet, Oral, as maleate: Outpatient Dosage Forms Generic: 2.5 mg, 5 mg, 10 mg, 20 mg Tablet, Oral: Generic: 25 mg Enoxaparin Outpatient Formulary Brands Available Lovenox Disulfiram Outpatient Dosage Forms Outpatient Dosage Forms Solution, Subcutaneous, as sodium [preservative free]: Tablet, Oral: Lovenox: 30 mg/0.3 mL (0.3 mL) [BCF]; 40 mg/0.4 mL (0.4 mL) [BCF]; Generic: 250 mg 60 mg/0.6 mL (0.6 mL) [BCF]; 80 mg/0.8 mL (0.8 mL) [BCF]; 100 mg/mL Dofetilide (1 mL) [BCF]; 120 mg/0.8 mL (0.8 mL) [BCF]; 150 mg/mL (1 mL) [BCF] Outpatient Dosage Forms Generic: 30 mg/0.3 mL (0.3 mL) [BCF]; 40 mg/0.4 mL (0.4 mL) [BCF]; 60 mg/ Capsule, Oral: 0.6 mL (0.6 mL) [BCF]; 80 mg/0.8 mL (0.8 mL) [BCF]; 100 mg/mL (1 mL) Generic: 125 mcg, 250 mcg, 500 mcg [BCF]; 120 mg/0.8 mL (0.8 mL) [BCF]; 150 mg/mL (1 mL) [BCF] Donepezil Entrectinib Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Capsule, Oral: Generic: 5 mg, 10 mg Rozlytrek: 100 mg, 200 mg Dornase Alfa EPINEPHrine (Systemic) Outpatient Dosage Forms Outpatient Formulary Brands Available EpiPen; EpiPen Jr. Solution, Inhalation: Outpatient Dosage Forms Pulmozyme: 1 mg/mL (2.5 mL) Solution, Injection: Generic: 0.1 mg/mL (10 mL); 1 mg/mL (1 mL) Dorzolamide Solution Auto-injector, Injection: Outpatient Dosage Forms EpiPen 2-Pak: 0.3 mg/0.3 mL (2 mL) [contains sodium metabisulfite; 1:1000 Solution, Ophthalmic: solution; delivers 0.3 mg per injection] Generic: 2% (10 mL) EpiPen Jr 2-Pak: 0.15 mg/0.3 mL (2 mL) [contains sodium metabisulfite; 1:2000 solution; delivers 0.15 mg per injection] Dorzolamide and Timolol Generic: 0.15 mg/0.15 mL (1 ea [DSC], 2 ea); 0.3 mg/0.3 mL (1 ea, 2 ea) Outpatient Dosage Forms Solution, Ophthalmic: Eplerenone Generic: Dorzolamide 2% [20 mg/mL] and timolol 0.5% [5 mg/mL] (10 mL) Outpatient Dosage Forms Tablet, Oral: Doxazosin Generic: 25 mg, 50 mg Outpatient Dosage Forms Tablet, Oral: Ergocalciferol Generic: 2 mg, 8 mg Outpatient Dosage Forms Capsule, Oral: Doxepin (Systemic) Generic: 50,000 units Outpatient Dosage Forms Capsule, Oral, as hydrochloride: Ergotamine and Caffeine Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF] Outpatient Dosage Forms Concentrate, Oral: Tablet, Oral: Generic: 10 mg/mL (120 mL) [BCF] Generic: Ergotamine tartrate 1 mg and caffeine 100 mg Doxepin (Topical) Erythromycin (Ophthalmic) Outpatient Dosage Forms Outpatient Dosage Forms Cream, External, as hydrochloride: Ointment, Ophthalmic: Generic: 5% (45 g) Generic: 5 mg/g (3.5 g) [BCF] 10 ETHINYL ESTRADIOL AND NORETHINDRONE Erythromycin (Systemic) Eszopiclone Outpatient Formulary Brands Available E.E.S. Granules; Ery-Tab; EryPed Outpatient Dosage Forms 200; Erythrocin Stearate Tablet, Oral: Outpatient Dosage Forms Generic: 1 mg, 2 mg, 3 mg Suspension Reconstituted, Oral, as ethylsuccinate: E.E.S. Granules: 200 mg/5 mL (100 mL, 200 mL) [cherry flavor] [BCF] Ethambutol EryPed: 200 mg/5 mL (100 mL) [fruit flavor] [BCF] Outpatient Dosage Forms Generic: 200 mg/5 mL (100 mL, 200 mL) Tablet, Oral, as hydrochloride: Tablet, Oral, as stearate: Generic: 100 mg [BCF], 400 mg [BCF] Erythrocin Stearate: 250 mg [BCF] Ethinyl Estradiol and Desogestrel Tablet Delayed Release, Oral, as base: Ery-Tab: 250 mg [BCF] Outpatient Dosage Forms Tablet, Oral: Erythromycin (Topical) Generic: Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 Outpatient Dosage Forms tablets]; Day 22-23: 2 inactive tablets; Day 24-28: Ethinyl estradiol 0.01 mg Gel, External: [5 tablets], Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg Generic: 2% (30 g, 60 g) [BCF] Ethinyl Estradiol and Drospirenone Solution, External: Generic: 2% (60 mL) [BCF] Outpatient Formulary Brands Available Yasmin; Yaz Outpatient Dosage Forms Escitalopram Tablet, Oral: Outpatient Dosage Forms Yasmin: Ethinyl estradiol 0.03 mg and drospirenone 3 mg (28s) [21 yellow Solution, Oral: active tablets and 7 white inactive tablets] [BCF] Generic: 5 mg/5 mL (240 mL) Yaz: Ethinyl estradiol 0.02 mg and drospirenone 3 mg (28s) [24 light pink Tablet, Oral: tablets and 4 white inactive tablets] [BCF] Generic: 5 mg, 10 mg, 20 mg Generic: Ethinyl estradiol 0.02 mg and drospirenone 3 mg [21 active tablets and 7 inactive tablets] (28s) [BCF] Esketamine Generic: Ethinyl estradiol 0.03 mg and drospirenone 3 mg [21 active tablets Outpatient Dosage Forms and 7 inactive tablets] (28s) [BCF] Solution Therapy Pack, Nasal, as hydrochloride: Spravato (56 MG Dose): 28 mg/device (dose pack of 2) (1 ea) [contains Ethinyl Estradiol and Ethynodiol Diacetate edetate disodium] Outpatient Dosage Forms Spravato (84 MG Dose): 28 mg/device (dose pack of 3) (1 ea) [contains Tablet, Oral: edetate disodium] Generic: Ethinyl estradiol 0.035 mg and ethynodiol diacetate 1 mg [21 tablets and 7 inactive tablets], Ethinyl estradiol 0.05 mg and ethynodiol diacetate Esomeprazole 1 mg [21 tablets and 7 inactive tablets] Outpatient Dosage Forms Capsule Delayed Release, Oral, as magnesium [strength expressed as base]: Ethinyl Estradiol and Etonogestrel Generic: 20 mg, 40 mg Outpatient Formulary Brands Available NuvaRing Outpatient Dosage Forms Estradiol (Systemic) Ring, Vaginal: Outpatient Formulary Brands Available Climara NuvaRing: Ethinyl estradiol 0.015 mg/day and etonogestrel 0.12 mg/day (1s) Outpatient Dosage Forms [3-week duration] Patch Weekly, Transdermal: Climara: Ethinyl Estradiol and Levonorgestrel 0.025 mg/24 hours (4s) [6.5 cm2, total estradiol 2.04 mg] [BCF] Outpatient Formulary Brands Available Aviane; Lessina; Levora; Sronyx 0.0375 mg/24 hours (4s) [9.375 cm2, total estradiol 2.85 mg] [BCF] Outpatient Dosage Forms 0.05 mg/24 hours (4s) [12.5 cm2, total estradiol 3.8 mg] [BCF] Tablet, Oral [low dose formulation]: 0.06 mg/24 hours (4s) [15 cm2, total estradiol 4.55 mg] [BCF] Aviane 28: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 0.075 mg/24 hours (4s) [18.75 cm2, total estradiol 5.7 mg] [BCF] orange tablets and 7 light green inactive tablets] [BCF] 0.1 mg/24 hours (4s) [25 cm2, total estradiol 7.6 mg] [BCF] Lessina 28: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 pink Generic: 0.025 mg/24 hours (4 ea) [BCF]; 0.0375 mg/24 hours (4 ea) [BCF]; tablets and 7 white inactive tablets] [BCF] 0.05 mg/24 hours (4 ea) [BCF]; 0.06 mg/24 hours (4 ea) [BCF]; 0.075 mg/24 Sronyx: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 white hours (4 ea) [BCF]; 0.1 mg/24 hours (4 ea) [BCF] tablets and 7 peach inactive tablets] [BCF] Tablet, Oral: Generic: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg [21 tablets and 7 Generic: 1 mg, 2 mg inactive tablets] (28s) [BCF] Tablet, Oral [monophasic formulation]: Estrogens (Conjugated/Equine) and Medroxyprogesterone Levora 28: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (28s) [21 Outpatient Formulary Brands Available Prempro white tablets and 7 peach inactive tablets] [BCF] Outpatient Dosage Forms Generic: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [21 tablets and Tablet, Oral: 7 inactive tablets] (28s) [BCF] Prempro: Tablet, Oral [triphasic formulation]: 0.3/1.5: Conjugated estrogens 0.3 mg and medroxyprogesterone acetate Generic: 1.5 mg (28s) [BCF] Day 1-6: Ethinyl estradiol 0.03 mg and levonorgestrel 0.05 mg [6 tablets] 0.45/1.5: Conjugated estrogens 0.45 mg and medroxyprogesterone acetate Day 7-11: Ethinyl estradiol 0.04 mg and levonorgestrel 0.075 mg [5 tablets] 1.5 mg (28s) [BCF] Day 12-21: Ethinyl estradiol 0.03 mg and levonorgestrel 0.125 mg [10 0.625/2.5: Conjugated estrogens 0.625 mg and medroxyprogesterone ace- tablets] tate 2.5 mg (28s) [BCF] Day 22-28: 7 inactive tablets 0.625/5: Conjugated estrogens 0.625 mg and medroxyprogesterone acetate 5 mg (28s) [BCF] Ethinyl Estradiol and Norelgestromin Outpatient Formulary Brands Available Ortho Evra [DSC] Estrogens (Conjugated/Equine, Systemic) Outpatient Dosage Forms Outpatient Formulary Brands Available Premarin Patch Weekly, Transdermal: Outpatient Dosage Forms Ortho Evra: Ethinyl estradiol 35 mcg and norelgestromin 150 mcg per day (1 Tablet, Oral: ea [DSC], 3 ea [DSC]) Premarin: 0.3 mg [BCF], 0.45 mg [BCF], 0.625 mg [BCF], 1.25 mg [BCF] Ethinyl Estradiol and Norethindrone Estrogens (Conjugated/Equine, Topical) Outpatient Formulary Brands Available Cyclafem 1/35; Cyclafem 7/7/7; Outpatient Formulary Brands Available Premarin Loestrin Fe 1.5/30; Necon 7/7/7; Norinyl 1+35 Outpatient Dosage Forms Outpatient Dosage Forms Cream, Vaginal: Tablet, Oral: Premarin: 0.625 mg/g (30 g) [BCF] Cyclafem 1/35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 pink tablets and 7 light green inactive tablets] (28s) [BCF] Estrogens (Esterified) and Methyltestosterone Cyclafem 7/7/7: Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg Outpatient Dosage Forms [7 tablets]; Day 8-14: Ethinyl estradiol 0.035 mg and norethindrone 0.75 mg Tablet, Oral: [7 tablets]; Day 15-21: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [7 Generic: Esterified estrogen 0.625 mg and methyltestosterone 1.25 mg; tablets]; Day 22-28: 7 inactive tablets [contains fd&c blue #2 (indigotine), esterified estrogens 1.25 mg and methyltestosterone 2.5 mg fd&c red #40 aluminum lake] 11 ETHINYL ESTRADIOL AND NORETHINDRONE Loestrin Fe 1.5/30: Ethinyl estradiol 0.03 mg and norethindrone acetate FentaNYL 1.5 mg [21 pink tablets] and ferrous fumarate 75 mg [7 brown tablets] (28s) Outpatient Dosage Forms Norinyl 1+35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 yellow Patch, Transdermal, as base: green tablets and 7 orange inactive tablets] (28s) [BCF] Generic: 25 mcg/hr (5s); 50 mcg/hr (5s); 75 mcg/hr (5s); 100 mcg/hr (5s) Generic: Ethinyl estradiol 0.005 mg and norethindrone acetate 1 mg, Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg [21 tablets] and ferrous Ferrous Sulfate fumarate 75 mg [7 tablets]; Ethinyl estradiol 0.03 mg and norethindrone Outpatient Formulary Brands Available Fer-In-Sol [OTC]; Fer-iron [OTC] acetate 1.5 mg [21 tablets] and ferrous fumarate 75 mg [7 tablets] Outpatient Dosage Forms Tablet, Oral [triphasic formulation]: Elixir, Oral: Necon 7/7/7: Generic: 220 mg/5 mL (473 mL) [elemental iron 44 mg/5 mL] Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [7 white Liquid, Oral: tablets] Fer-In-Sol: 75 mg/mL (50 mL) [gluten free; contains ethanol 0.2%, sodium Day 8-14: Ethinyl estradiol 0.035 mg and norethindrone 0.75 mg [7 light bisulfite; elemental iron 15 mg/mL] peach tablets] Fer-iron: 75 mg/mL (50 mL) [contains ethanol 0.2%, sodium bisulfite; lemon Day 15-21: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [7 peach tablets] flavor; elemental iron 15 mg/mL] Day 22-28: 7 green inactive tablets Tablet, Oral: Generic: 325 mg [elemental iron 65 mg] Ethinyl Estradiol and Norgestimate Outpatient Formulary Brands Available MonoNessa; Ortho Tri-Cyclen Lo; Fexofenadine TriNessa Outpatient Formulary Brands Available Allegra Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral [monophasic formulation]: Suspension, Oral, as hydrochloride: MonoNessa: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg (28s) [21 Allegra Allergy Childrens: 30 mg/5 mL (120 mL) [alcohol free, dye free; blue tablets and 7 green inactive tablets] [BCF] contains butylparaben, edetate disodium, propylene glycol, propylparaben; Tablet, Oral [triphasic formulation]: raspberry creme flavor] Ortho Tri-Cyclen Lo [BCF]: Tablet, Oral, as hydrochloride: Day 1-7: Ethinyl estradiol 0.025 mg and norgestimate 0.18 mg [7 white Generic: 60 mg, 180 mg tablets] Day 8-14: Ethinyl estradiol 0.025 mg and norgestimate 0.215 mg [7 light blue Finasteride tablets] Outpatient Dosage Forms Day 15-21: Ethinyl estradiol 0.025 mg and norgestimate 0.25 mg [7 dark Tablet, Oral: blue tablets] Generic: 5 mg [BCF] Day 22-28: 7 dark green inactive tablets TriNessa [BCF]: Flecainide Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 white Outpatient Dosage Forms tablets] Tablet, Oral, as acetate: Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light blue Generic: 50 mg, 100 mg, 150 mg tablets] Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 blue Fluconazole tablets] Outpatient Formulary Brands Available Diflucan Day 22-28: 7 green inactive tablets Outpatient Dosage Forms Suspension Reconstituted, Oral: Ethinyl Estradiol, Drospirenone, and Levomefolate Generic: 10 mg/mL (35 mL); 40 mg/mL (35 mL) Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 100 mg, 150 mg [BCF], 200 mg Generic: Ethinyl estradiol 0.02 mg, drospirenone 3 mg, and levomefolate calcium 0.451 mg [24 tablets] and levomefolate calcium 0.451 mg [4 tablets], Fludrocortisone Outpatient Dosage Forms Ethosuximide Tablet, Oral, as acetate: Outpatient Dosage Forms Generic: 0.1 mg Capsule, Oral: Generic: 250 mg Flunisolide (Nasal) Solution, Oral: Outpatient Dosage Forms Generic: 250 mg/5 mL (473 mL,474 mL) Solution, Nasal: Generic: 25 mcg/actuation (0.025%) (25 mL) Etodolac Outpatient Dosage Forms Fluocinolone (Topical) Tablet, Oral: Outpatient Dosage Forms Generic: 400 mg Oil, External, as acetonide: Generic: 0.01% (118.28 mL) Exenatide Solution, External, as acetonide: Outpatient Formulary Brands Available Bydureon Generic: 0.01% (60 mL) Outpatient Dosage Forms Pen-injector, Subcutaneous: Fluocinonide Bydureon: 2 mg (1 ea) Outpatient Dosage Forms Suspension Reconstituted, Subcutaneous: Cream, External: Bydureon: 2 mg (1 ea) Generic: 05% (30 g, 60 g) [BCF] Ezetimibe Gel, External: Generic: 0.05% (45 g) Outpatient Dosage Forms Ointment, External: Tablet, Oral: Generic: 0.05% (30 g, 60 g) [BCF] Generic: 10 mg Famotidine Fluoride Outpatient Dosage Forms Outpatient Formulary Brands Available Gel-Kam [OTC]; PreviDent 5000 Tablet, Oral: Plus Generic: 10 mg, 20 mg, 40 mg Outpatient Dosage Forms Cream, Oral, as sodium [toothpaste]: Fedratinib PreviDent 5000 Plus: 1.1% (51 g) [contains sodium benzoate; spearmint Outpatient Dosage Forms flavor; equivalent to fluoride 2.5 mg/dose] Capsule, Oral, as hydrochloride: Gel, Topical, as stannous flouride: Inrebic: 100 mg Gel-Kam: 0.4% (129 g) [fruit & berry flavor] Tablet, Chewable, Oral, as sodium: Fenofibrate and Derivatives Generic: 2.2 mg [equivalent to fluoride 1 mg] Outpatient Formulary Brands Available TriCor Outpatient Dosage Forms Fluorometholone Tablet, Oral: Outpatient Dosage Forms TriCor: 48 mg [BCF], 145 mg [BCF] [contains soybean lecithin] Suspension, Ophthalmic, as base [drops]: Generic: 48 mg [BCF], 145 mg [BCF] Generic: 0.1% (10 mL) 12 GLYCOPYRROLATE (SYSTEMIC) Fluorouracil (Topical) Fosfomycin Outpatient Dosage Forms Outpatient Dosage Forms Cream, External: Packet, Oral: Generic: 0.5% (30 g); 5% (40 g) Monurol: 3 g (1 ea) [orange flavor] FLUoxetine Fosinopril Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Tablet, Oral, as sodium: Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF] Generic: 10 mg, 20 mg, 40 mg Solution, Oral: Furosemide Generic: 20 mg/5 mL (5 mL, 120 mL) [BCF] Outpatient Formulary Brands Available Lasix Tablet, Oral: Outpatient Dosage Forms Generic: 10 mg [scored] [BCF] Solution, Oral: Flurandrenolide Generic: 20 mg [BCF], 40 mg [BCF] 10 mg/mL (120 mL) [BCF] Outpatient Formulary Brands Available Cordran Tablet, Oral: Outpatient Dosage Forms Lasix: 20 mg [scored] [BCF], 40 mg [scored] [BCF] Generic: 20 mg [BCF], 40 mg [BCF] Tape, External: Cordran: 4 mcg/cm2 (1 ea) Gabapentin Flurbiprofen (Systemic) Outpatient Dosage Forms Capsule, Oral: Outpatient Dosage Forms Generic: 100 mg [BCF], 300 mg [BCF], 400 mg [BCF] Tablet, Oral: Solution, Oral: Generic: 50 mg, 100 mg Generic: 250 mg/5 mL (470 mL) Flutamide Tablet, Oral: Generic: 600 mg [BCF], 800 mg [BCF] Outpatient Dosage Forms Capsule, Oral: Ganciclovir (Ophthalmic) Generic: 125 mg Outpatient Formulary Brands Available Zirgan Fluticasone and Salmeterol Outpatient Dosage Forms Gel, Ophthalmic: Outpatient Formulary Brands Available Advair Diskus; Advair HFA Zirgan: 0.15% (5 g) [contains benzalkonium chloride] Outpatient Dosage Forms Aerosol, for Oral Inhalation: Gemfibrozil Advair HFA: Outpatient Dosage Forms 45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg per inhalation Tablet, Oral: (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF] Generic: 600 mg [BCF] 115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcg per inhala- tion (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF] Gentamicin (Ophthalmic) 230/21: Fluticasone propionate 230 mcg and salmeterol 21 mcg per inhala- Outpatient Dosage Forms tion (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF] Ointment, Ophthalmic: Powder, for Oral Inhalation: Gentak: 0.3% (3.5 g) [BCF] Advair Diskus: Generic: 0.3% (3.5 g) [BCF] 100/50: Fluticasone propionate 100 mcg and salmeterol 50 mcg (60s) Solution, Ophthalmic: Generic: 0.3% (5 mL, 15 mL) [BCF] [contains lactose] [BCF] 250/50: Fluticasone propionate 250 mcg and salmeterol 50 mcg (60s) Glimepiride [contains lactose] [BCF] Outpatient Dosage Forms 500/50: Fluticasone propionate 500 mcg and salmeterol 50 mcg (60s) Tablet, Oral: [contains lactose] [BCF] Generic: 1 mg, 2 mg, 4 mg Fluticasone (Nasal) GlipiZIDE Outpatient Formulary Brands Available Flonase Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Suspension, Nasal, as propionate: Generic: 5 mg [BCF], 10 mg [BCF] Flonase: 50 mcg/inhalation (16 g) [contains benzalkonium chloride; 120 Tablet Extended Release 24 Hour, Oral: metered actuations] [BCF] Generic: 2.5 mg, 5 mg, 10 mg Generic: 50 mcg/inhalation (16 g) [BCF] Glucagon Fluticasone (Oral Inhalation) Outpatient Formulary Brands Available Glucagon Emergency Outpatient Formulary Brands Available Flovent Diskus; Flovent HFA Outpatient Dosage Forms Outpatient Dosage Forms Kit, Injection: Aerosol, Inhalation, as propionate: Glucagon Emergency: 1 mg [contains lactose] Flovent HFA: Powder, Nasal [preservative free]: 44 mcg/inhalation (10.6 g) [chlorofluorocarbon free; 120 metered actua- Baqsimi One Pack: 3 mg/dose (1 ea) tions] [BCF] Baqsimi Two Pack: 3 mg/dose (1 ea) 110 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actua- Solution Reconstituted, Injection: tions] [BCF] Generic: 1 mg (1 ea) 220 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actua- GlyBURIDE tions] [BCF] Outpatient Dosage Forms Aerosol Powder Breath Activated, Inhalation, as propionate: Tablet, Oral: Flovent Diskus: Generic: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF] 50 mcg (60s) [contains lactose] [BCF] Tablet, Micronized, Oral: 100 mcg (60s) [contains lactose] [BCF] Glynase: 1.5 mg [BCF], 3 mg [BCF], 6 mg [BCF] [scored] 250 mcg (60s) [contains lactose] [BCF] Glyburide and Metformin FluvoxaMINE Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Capsule Extended Release 24 Hour, Oral, as maleate: Generic: 1.25 mg/250 mg: Glyburide 1.25 mg and metformin hydrochloride Generic: 100 mg, 150 mg 250 mg; 2.5 mg/500 mg: Glyburide 2.5 mg and metformin hydrochloride Tablet, Oral, as maleate: 500 mg; 5 mg/500 mg: Glyburide 5 mg and metformin hydrochloride 500 mg Generic: 25 mg, 50 mg, 100 mg Glycopyrrolate (Systemic) Folic Acid Outpatient Formulary Brands Available Robinul Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 1 mg [BCF] Generic: 1 mg 13 GOSERELIN Goserelin Generic: 1% (30 g) [available through Self Care program] Outpatient Formulary Brands Available Zoladex Lotion, External, as base: Outpatient Dosage Forms Generic: 2.5% (59 mL, 118 mL) Implant, Subcutaneous: Suspension, Rectal, as base: Zoladex: Generic: 100 mg/60 mL (60 mL) 3.6 mg (1s) [1 month implant] [BCF] 10.8 mg (1s) [3 month implant] [BCF] HYDROmorphone Outpatient Dosage Forms Griseofulvin Tablet, Oral, as hydrochloride: Outpatient Formulary Brands Available Gris-PEG Generic: 2 mg Outpatient Dosage Forms Suspension, Oral: Hydroquinone Generic: 125 mg/5 mL (120 mL) [BCF] Outpatient Formulary Brands Available Melanex Tablet, Oral: Outpatient Dosage Forms Gris-PEG: 125 mg [BCF], 250 mg [BCF] [scored] Cream, External: Generic: 125 mg [BCF], 250 mg [BCF] Generic: 4% (28.35 g) Solution, External: Guaifenesin and Codeine Melanex: 3% (30 mL) [contains ethanol, sodium metabisulfite] Outpatient Dosage Forms Solution, Oral: Hydroxychloroquine Generic: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL Outpatient Dosage Forms (118 mL) Tablet, Oral, as sulfate: Guaifenesin and Dextromethorphan Generic: 200 mg Outpatient Dosage Forms HYDROXYprogesterone Caproate Liquid, Oral: Outpatient Dosage Forms Generic: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per Oil, Intramuscular: 5 mL (480 mL) Generic: 250 mg/mL (5 mL) GuanFACINE Hydroxyurea Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Capsule, Oral: Generic: 1 mg Tablet Extended Release 24 Hour, Oral: Generic: 500 mg Generic: 1 mg, 2 mg, 3 mg, 4 mg HydrOXYzine Haloperidol Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral, as pamoate: Tablet, Oral: Generic: 50 mg Generic: 0.5 mg, 2 mg Solution, Oral, as hydrochloride: Generic: 10 mg/5 mL (473 mL) [BCF] Homatropine Syrup, Oral, as hydrochloride: Outpatient Dosage Forms Generic: 10 mg/5 mL (473 mL) [BCF] Solution, Ophthalmic, as hydrobromide: Tablet, Oral, as hydrochloride: Generic: 5% (5 mL) Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] HydrALAZINE Hyoscyamine Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Tablet, Oral, as sulfate: Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] Generic: 0.125 mg HydroCHLOROthiazide Tablet Disintegrating, Oral, as sulfate: Outpatient Dosage Forms Generic: 0.125 mg Tablet Sublingual, Sublingual, as sulfate: Capsule, Oral: Generic: 12.5 mg [BCF] Generic: 0.125 mg Tablet, Oral: Tablet Extended Release 12 Hour, Oral, as sulfate: Generic: 25 mg [BCF], 50 mg [BCF] Generic: 0.375 mg Hydrochlorothiazide and Spironolactone Hyoscyamine, Atropine, Scopolamine, and Phenobarbital Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Elixir, Oral: Generic: Hydrochlorothiazide 25 mg and spironolactone 25 mg Generic: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, scopol- amine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg per 5 mL Hydrochlorothiazide and Triamterene (473 mL) Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, scopol- Generic: amine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg Hydrochlorothiazide 25 mg and triamterene 37.5 mg [BCF] Hydrochlorothiazide 50 mg and triamterene 75 mg [BCF] Ibandronate Outpatient Dosage Forms Hydrocodone and Acetaminophen Tablet, Oral: Outpatient Dosage Forms Generic: 150 mg Solution, Oral: Generic: Hydrocodone bitartrate 7.5 mg and acetaminophen 500 mg per 15 Ibuprofen mL (118 mL, 473 mL) Outpatient Formulary Brands Available Ibu-200 [OTC] Tablet, Oral: Outpatient Dosage Forms Generic: Suspension, Oral: Hydrocodone bitartrate 5 mg and acetaminophen 325 mg Generic: 100 mg/5 mL (120 mL) [available through Self Care program] Hydrocodone bitartrate 7.5 mg and acetaminophen 325 mg Tablet, Oral: Hydrocortisone (Systemic) Ibu-200: 200 mg [available through Self Care program] Outpatient Dosage Forms Generic: 200 mg [available through Self Care program], 400 mg [BCF], Tablet, Oral, as base: 600 mg [BCF], 800 mg [BCF] Generic: 5 mg, 20 mg Imipramine Hydrocortisone (Topical) Outpatient Dosage Forms Outpatient Formulary Brands Available Anucort-HC; Proctozone-HC 2.5% Capsule, Oral, as pamoate: Outpatient Dosage Forms Generic: 75 mg [BCF] Cream, External, as base: Tablet, Oral, as hydrochloride: Proctozone-HC 2.5%: 2.5% (30 g) [BCF] Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] 14 KETOCONAZOLE (TOPICAL) Imiquimod Outpatient Dosage Forms Outpatient Dosage Forms Solution, Injection: Cream, External: NovoLIN R: 100 units/mL (10 mL) [BCF] Generic: 5% (24 ea) Iodine Indapamide Outpatient Dosage Forms Outpatient Dosage Forms Gel, External: Tablet, Oral: Iodosorb: 0.9% (40 g) Generic: 1.25 mg, 2.5 mg Ipratropium and Albuterol Indomethacin Outpatient Formulary Brands Available Combivent Respimat Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Solution, for Nebulization: Generic: 25 mg [BCF], 50 mg [BCF] Generic: Ipratropium bromide 0.5 mg and albuterol (base) 2.5 mg per 3 mL (30s) Inhalation Devices Solution, for Oral Inhalation [spray]: Outpatient Formulary Brands Available AeroChamber; OptiChamber Combivent Respimat: Ipratropium bromide 20 mcg and albuterol (base) 100 Outpatient Dosage Forms mcg per inhalation (4 g) [contains benzalkonium chloride; 120 metered Holding Chamber: actuations] OptiChamber Ipratropium (Nasal) Mask: Outpatient Dosage Forms AeroChamber with mask (small, medium) Solution, Nasal, as bromide: Insulin Aspart Generic: 0.03% (30 mL); 0.06% (15 mL) Outpatient Formulary Brands Available NovoLOG; NovoLOG FlexPen Ipratropium (Oral Inhalation) Outpatient Dosage Forms Outpatient Formulary Brands Available Atrovent HFA Solution, Subcutaneous: Outpatient Dosage Forms NovoLOG: 100 units/mL (10 mL) [contains metacresol, phenol] [BCF] Aerosol Solution, Inhalation, as bromide: Solution Pen-injector, Subcutaneous: Atrovent HFA: 17 mcg/actuation (12.9 g) [chlorofluorocarbon free; 200 NovoLOG FlexPen: 100 units/mL (3 mL) [contains metacresol, phenol] [BCF] metered actuations] [BCF] Insulin Aspart Protamine and Insulin Aspart Solution, Inhalation, as bromide [preservative free]: Generic: 0.02% (2.5 mL) Outpatient Formulary Brands Available NovoLOG Mix 70/30; NovoLOG Mix 70/30 FlexPen Irbesartan Outpatient Dosage Forms Outpatient Dosage Forms Suspension, Subcutaneous: Tablet, Oral: NovoLOG Mix 70/30: Insulin aspart protamine suspension 70% [intermediate Generic: 75 mg, 150 mg, 300 mg acting] and insulin aspart solution 30% [rapid-acting] (10 mL) [BCF] NovoLOG Mix 70/30 FlexPen: 100 units/mL: Insulin aspart protamine suspen- Isoniazid sion 70% [intermediate acting] and insulin aspart solution 30% [rapid-acting] Outpatient Dosage Forms (3 mL) [BCF] Solution, Oral: Generic: 50 mg/5 mL (473 mL) Insulin Detemir Tablet, Oral: Outpatient Formulary Brands Available Levemir Generic: 100 mg [BCF], 300 mg [BCF] Outpatient Dosage Forms Solution, Subcutaneous: Isosorbide Dinitrate Levemir: 100 units/mL (10 mL) Outpatient Formulary Brands Available Dilatrate-SR Outpatient Dosage Forms Insulin Glargine Capsule Extended Release, Oral: Outpatient Formulary Brands Available Lantus; Lantus Solostar Dilatrate-SR: 40 mg Outpatient Dosage Forms Tablet, Oral: Solution, Subcutaneous: Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg [BCF] Lantus: 100 units/mL (10 mL) [contains metacresol] [BCF] Tablet Extended Release, Oral: Solution Pen-injector, Subcutaneous: Generic: 40 mg [BCF] Lantus Solostar: 100 units/mL (3 mL) [BCF] Tablet, Sublingual: Generic: 5 mg Insulin Glulisine Outpatient Dosage Forms Isosorbide Mononitrate Solution, Injection: Outpatient Dosage Forms Apidra: 100 units/mL (10 mL) [contains metacresol] Tablet Extended Release 24 Hour, Oral: Solution Pen-injector, Subcutaneous: Generic: 30 mg [BCF], 60 mg [BCF], 120 mg [BCF] Apidra SoloStar: 100 units/mL (3 mL) [contains metacresol] ISOtretinoin (Systemic) Insulin Lispro Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Solution, Injection: Generic: 10 mg Lyumjev: Insulin lispro-aabc 100 unit/mL (10 mL) [contains metacresol] Itraconazole Solution, Subcutaneous: Outpatient Dosage Forms Generic: 100 units/mL (10 mL) Capsule, Oral: Solution Pen-injector, Subcutaneous: Generic: 100 mg Generic: 100 units/mL (3 mL) Ivermectin (Systemic) Insulin NPH Outpatient Dosage Forms Outpatient Formulary Brands Available NovoLIN N Tablet, Oral: Outpatient Dosage Forms Generic: 3 mg Suspension, Subcutaneous: NovoLIN N: 100 units/mL (10 mL) [BCF] Ketoconazole (Systemic) Outpatient Dosage Forms Insulin NPH and Insulin Regular Tablet, Oral: Outpatient Formulary Brands Available NovoLIN 70/30 Generic: 200 mg Outpatient Dosage Forms Suspension, Subcutaneous: Ketoconazole (Topical) NovoLIN 70/30: Insulin NPH suspension 70% [intermediate acting] and insulin Outpatient Dosage Forms regular solution 30% [short acting]: 100 units/mL (10 mL) [BCF] Cream, External: Generic: 2% (30 g) Insulin Regular Shampoo, External: Outpatient Formulary Brands Available NovoLIN R Generic: 2% (120 mL) 15 KETOROLAC (OPHTHALMIC) Ketorolac (Ophthalmic) LevETIRAcetam Outpatient Dosage Forms Outpatient Dosage Forms Solution, Ophthalmic, as tromethamine: Solution, Oral: Generic: 0.4% (5 mL) Generic: 100 mg/mL (473 mL) Tablet, Oral: Ketorolac (Systemic) Generic: 250 mg, 500 mg, 750 mg, 1000 mg Outpatient Dosage Forms Kit, Injection, as tromethamine: LevoFLOXacin (Systemic) ReadySharp Ketorolac: 15 mg/mL [contains alcohol, usp] Outpatient Formulary Brands Available Levaquin Solution, Injection, as tromethamine: Outpatient Dosage Forms Generic: 15 mg/mL (1 mL); 30 mg/mL (1 mL) Solution, Oral: Solution, Injection, as tromethamine [preservative free]: Levaquin: 25 mg/mL (480 mL) [contains benzyl alcohol, propylene gly- Generic: 15 mg/mL (1 mL); 30 mg/mL (1 mL) col] [BCF] Solution, Intramuscular, as tromethamine: Generic: 25 mg/mL (480 mL) [BCF] Generic: 60 mg/2 mL (2 mL) Tablet, Oral: Solution, Intramuscular, as tromethamine [preservative free]: Levaquin: 250 mg [BCF], 500 mg [BCF], 750 mg [BCF] Generic: 60 mg/2 mL (2 mL) Generic: 250 mg [BCF], 500 mg [BCF], 750 mg [BCF] Tablet, Oral, as tromethamine: Generic: 10 mg Levonorgestrel (Systemic) Outpatient Dosage Forms Ketotifen (Ophthalmic) Tablet, Oral: Outpatient Dosage Forms Generic: 0.75 mg [BCF] Solution, Ophthalmic: Generic: 0.025% (5 mL) Levothyroxine Outpatient Formulary Brands Available Synthroid Labetalol Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as sodium: Tablet, Oral, as hydrochloride: Synthroid: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg [BCF], 100 Generic: 100 mg, 200 mg mcg [BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150 mcg Lactulose [BCF], 175 mcg [BCF], 200 mcg [BCF], 300 mcg [BCF] Generic: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg [BCF], 100 Outpatient Dosage Forms mcg [BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150 mcg Solution, Oral: [BCF], 175 mcg [BCF], 200 mcg [BCF], 300 mcg [BCF] Generic: 10 g/15 mL (473 mL) [BCF] Solution, Oral/Rectal: Lidocaine (Topical) Generic: 10 g/15 mL (473 mL) [BCF] Outpatient Formulary Brands Available Xylocaine Lamivudine and Tenofovir Disoproxil Fumarate Outpatient Dosage Forms Outpatient Dosage Forms Cream, External: Generic: 4% (5 g, 30 g) Tablet, Oral: Jelly, Topical, as hydrochloride: Cimduo: Lamivudine 300 mg and tenofovir disoproxil fumarate 300 mg Xylocaine: 2% (30 mL) Temixys: Lamivudine 300 mg and tenofovir disoproxil fumarate 300 mg Jelly, Topical, as hydrochloride [preservative free]: LamoTRIgine Generic: 2% (10 mL) Outpatient Dosage Forms Patch, External: Tablet, Oral: Generic: 5% (30 ea) Generic: 25 mg, 100 mg, 150 mg, 200 mg Solution, External, as hydrochloride: Tablet Chewable, Oral: Generic: 4% [40 mg/mL] (50 mL) Generic: 25 mg Solution, Mouth/Throat, as hydrochloride: Generic: 2% (15 mL, 100 mL) Lanthanum Outpatient Dosage Forms Lifitegrast Packet, Oral: Outpatient Dosage Forms Fosrenol: 750 mg (10 ea, 90 ea); 1000 mg (10 ea, 90 ea) Solution, Ophthalmic: Tablet Chewable, Oral: Xiidra: 5% (5 ea) Generic: 500 mg, 750 mg, 1000 mg LinaCLOtide Latanoprost Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Solution, Ophthalmic: Linzess: 72 mcg, 145 mcg, 290 mcg Generic: 0.005% (2.5 mL) [BCF] Liothyronine Leflunomide Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 5 mcg, 25 mcg, 50 mcg Generic: 10 mg, 20 mg Lisinopril Letrozole Outpatient Formulary Brands Available Zestril Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 10 mg, 20 mg Zestril: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 40 mg [BCF] Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg Leuprolide [BCF], 40 mg [BCF] Outpatient Formulary Brands Available Lupron Depot; Lupron Depot-3 Month; Lupron Depot-4 Month Lisinopril and Hydrochlorothiazide Outpatient Dosage Forms Outpatient Dosage Forms Kit, Intramuscular, as acetate [preservative free]: Tablet, Oral: Lupron Depot: 3.75 mg, 7.5 mg [contains polylactide-co-glycolide, polysorbate Generic: 80; released over 1 month] 10/12.5: Lisinopril 10 mg and hydrochlorothiazide 12.5 mg [BCF] Lupron Depot-3 Month: 11.25 mg, 22.5 mg [contains polylactide-co-glycolide, 20/12.5: Lisinopril 20 mg and hydrochlorothiazide 12.5 mg [BCF] polysorbate 80; released over 3 months] 20/25: Lisinopril 20 mg and hydrochlorothiazide 25 mg [BCF] Lupron Depot-4 Month: 30 mg [contains polylactide-co-glycolide, polysorbate 80; released over 4 months] Lithium Outpatient Dosage Forms Levalbuterol Capsule, Oral, as carbonate: Outpatient Dosage Forms Generic: 150 mg [BCF], 300 mg [BCF] Nebulization Solution, Inhalation, as hydrochloride [strength expressed as base, Solution, Oral, as citrate: preservative free]: Generic: 300 mg/5 mL (5 mL, 500 mL) [equivalent to amount of lithium in Generic: 0.31 mg/3 mL (3 mL); 0.63 mg/3 mL (3 mL); 1.25 mg/3 mL (3 mL) lithium carbonate] [BCF] 16 METHOCARBAMOL Tablet Extended Release, Oral, as carbonate: Mefenamic Acid Generic: 450 mg Outpatient Dosage Forms Loperamide Capsule, Oral: Outpatient Dosage Forms Generic: 250 mg Capsule, Oral, as hydrochloride: Mefloquine Generic: 2 mg (pack of 12 capsules) [BCF] [available through Self Care Outpatient Dosage Forms program] Tablet, Oral, as hydrochloride: Loratadine Generic: 250 mg Outpatient Dosage Forms Megestrol Syrup, Oral: Outpatient Dosage Forms Generic: 5 mg/5 mL (120 mL) Suspension, Oral, as acetate: Tablet, Oral: Generic: 10 mg Generic: 40 mg/mL (240 mL) Tablet, Oral, as acetate: LORazepam Generic: 40 mg Outpatient Dosage Forms Tablet, Oral: Meloxicam Generic: 0.5 mg, 1 mg, 2 mg Outpatient Dosage Forms Tablet, Oral: Losartan Generic: 7.5 mg [BCF], 15 mg [BCF] Outpatient Formulary Brands Available Cozaar Outpatient Dosage Forms Memantine Tablet, Oral, as potassium: Outpatient Dosage Forms Cozaar: 25 mg [contains potassium 2.12 mg (0.054 mEq)] [BCF] Tablet, Oral, as hydrochloride: Cozaar: 50 mg [contains potassium 4.24 mg (0.108 mEq)] [BCF] Generic: 5 mg, 10 mg Cozaar: 100 mg [contains potassium 8.48 mg (0.216 mEq)] [BCF] Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Meperidine Outpatient Dosage Forms Losartan and Hydrochlorothiazide Solution, Oral, as hydrochloride: Outpatient Formulary Brands Available Hyzaar Generic: 50 mg/5 mL (500 mL) Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Tablet, Oral: Generic: 50 mg Hyzaar 50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg [contains potassium 4.24 mg (0.108 mEq)] [BCF] Mercaptopurine Hyzaar 100/12.5: Losartan potassium 100 mg and hydrochlorothiazide Outpatient Dosage Forms 12.5 mg [contains potassium 8.48 mg (0.216 mEq)] [BCF] Tablet, Oral: Hyzaar 100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg Generic: 50 mg [contains potassium 8.48 mg (0.216 mEq)] [BCF] Generic: Mesalamine 50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg [BCF] Outpatient Formulary Brands Available Apriso; Delzicol; Lialda 100/12.5: Losartan potassium 100 mg and hydrochlorothiazide Outpatient Dosage Forms 12.5 mg [BCF] Capsule Delayed Release, Oral: 100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg [BCF] Delzicol: 400 mg Capsule Extended Release 24 Hour, Oral: Loteprednol Apriso: 0.375 g [contains aspartame] Outpatient Formulary Brands Available Lotemax Suppository, Rectal: Outpatient Dosage Forms Generic: 1000 mg (30 ea) Gel, Ophthalmic, as etabonate: Kit, Rectal: Lotemax: 0.5% (5 g) [contains benzalkonium chloride, edetate disodium Generic: 4 g dihydrate, propylene glycol] Tablet Delayed Release, Oral: Ointment, Ophthalmic, as etabonate: Lialda: 1.2 g [BCF] Lotemax: 0.5% (3.5 g) Generic: 1.2 g [BCF] Suspension, Ophthalmic, as etabonate: Lotemax: 0.5% (5 mL, 10 mL, 15 mL) Metaxalone Outpatient Dosage Forms Lovastatin Tablet, Oral: Outpatient Dosage Forms Generic: 400 mg, 800 mg Tablet, Oral: Generic: 10 mg, 20 mg, 40 mg MetFORMIN Lubiprostone Outpatient Formulary Brands Available Glucophage XR Outpatient Dosage Forms Outpatient Formulary Brands Available Amitiza Tablet, Oral, as hydrochloride: Outpatient Dosage Forms Generic: 500 mg [BCF], 850 mg [BCF], 1000 mg [BCF] Capsule, Oral: Tablet Extended Release 24 Hour, Oral, as hydrochloride: Amitiza: 8 mcg, 24 mcg Glucophage® XR: 500 mg [BCF], 750 mg [BCF] Lurasidone Generic: 500 mg [BCF], 750 mg [BCF] Outpatient Dosage Forms Methadone Tablet, Oral, as hydrochloride: Latuda: 20 mg, 40 mg, 60 mg Outpatient Dosage Forms Latuda: 80 mg [contains fd&c blue #2 aluminum lake] Tablet, Oral, as hydrochloride: Latuda: 120 mg Generic: 5 mg, 10 mg Magnesium Citrate MethazolAMIDE Outpatient Dosage Forms Outpatient Dosage Forms Solution, Oral: Tablet, Oral: Generic: 1.745 g/30 mL (296 mL) Generic: 50 mg Meclizine MethIMAzole Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Tablet, Oral: Generic: 25 mg Generic: 5 mg, 10 mg MedroxyPROGESTERone Methocarbamol Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as acetate: Tablet, Oral: Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF] Generic: 500 mg [BCF] 17 METHOTREXATE Methotrexate Minocycline (Systemic) Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Capsule, Oral: Generic: 2.5 mg [BCF] Generic: 50 mg, 100 mg Methylergonovine Minoxidil (Systemic) Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as maleate: Tablet, Oral: Generic: 0.2 mg Generic: 2.5 mg Methylphenidate Mirabegron Outpatient Formulary Brands Available Concerta; Ritalin LA Outpatient Formulary Brands Available Myrbetriq Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Extended Release, Oral, as hydrochloride [bi-modal release]: Tablet Extended Release 24 Hour, Oral: Ritalin LA: 10 mg [5 mg immediate release, 5 mg extended release] [BCF] Myrbetriq: 25 mg, 50 mg Generic: 20 mg [generic for Ritalin LA] [BCF], 30 mg [generic for Ritalin LA] Mirtazapine [BCF], 40 mg [generic for Ritalin LA] [BCF] Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Tablet, Oral: Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF] Generic: 15 mg, 30 mg Tablet Extended Release, Oral, as hydrochloride: Generic: 20 mg MiSOPROStol Tablet Extended Release 24 Hour, Oral, as hydrochloride: Outpatient Dosage Forms Concerta: 18 mg [BCF], 27 mg [BCF], 36 mg [BCF], 54 mg [BCF] Tablet, Oral: Generic: 18 mg [BCF], 27 mg [BCF], 36 mg [BCF], 54 mg [BCF] Generic: 100 mcg, 200 mcg MethylPREDNISolone Modafinil Outpatient Dosage Forms Outpatient Dosage Forms Solution Reconstituted, Injection, as sodium succinate [strength expressed as Tablet, Oral: base]: Generic: 100 mg, 200 mg Generic: 40 mg (1 ea); 125 mg (1 ea); 1000 mg (1 ea) Solution Reconstituted, Injection, as sodium succinate [strength expressed as Mometasone (Nasal) base, preservative free]: Outpatient Dosage Forms SOLU-Medrol: 40 mg (1 ea) [contains lactose] Suspension, Nasal, as furoate: SOLU-Medrol: 125 mg (1 ea); 1000 mg (1 ea) Generic: 50 mcg/actuation (17 g) Suspension, Injection, as acetate: Mometasone (Oral Inhalation) Generic: 40 mg/mL (5 mL) Suspension, Injection, as acetate [preservative free]: Outpatient Formulary Brands Available Asmanex Twisthaler DEPO-Medrol: 40 mg/mL (1 mL) Outpatient Dosage Forms Tablet, Oral: Powder, for oral inhalation, as furoate: Generic: 4 mg Asmanex Twisthaler: 110 mcg (30 units) [contains lactose; delivers 100 mcg/ actuation] Metipranolol Asmanex Twisthaler: 1220 mcg (120 units) [contains lactose; delivers 200 Outpatient Formulary Brands Available OptiPranolol mcg/actuation] Outpatient Dosage Forms Montelukast Solution, Ophthalmic: Outpatient Formulary Brands Available Singulair OptiPranolol: 0.3% (5 mL) [contains benzalkonium chloride] Outpatient Dosage Forms Metoclopramide Packet, Oral: Outpatient Dosage Forms Singulair: 4 mg/packet (30s) [BCF] Generic: 4 mg/packet (30s) [BCF] Solution, Oral: Tablet, Oral: Generic: 5 mg/5 mL (473 mL) [BCF] Singulair: 10 mg [BCF] Tablet, Oral: Generic: 10 mg [BCF] Generic: 10 mg [BCF] Tablet, Chewable, Oral: MetOLazone Singulair: Outpatient Dosage Forms 4 mg [contains phenylalanine 0.674 mg/tablet; cherry flavor] [BCF] 5 mg [contains phenylalanine 0.842 mg/tablet; cherry flavor] [BCF] Tablet, Oral: Generic: 4 mg [BCF], 5 mg [BCF] Generic: 2.5 mg Metoprolol Morphine (Systemic) Outpatient Formulary Brands Available MS Contin Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as tartrate: Solution, Oral, as sulfate: Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Generic: 10 mg/5 mL (500 mL) Tablet Extended Release 24 Hour, Oral, as succinate: Tablet, Oral, as sulfate: Generic: 25 mg [expressed as mg equivalent to tartrate] [BCF], 50 mg Generic: 15 mg [expressed as mg equivalent to tartrate] [BCF], 100 mg [expressed as mg Tablet Extended Release, Oral, as sulfate: equivalent to tartrate] [BCF], 200 mg [expressed as mg equivalent to MS Contin: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF], tartrate] [BCF] 200 mg [BCF] MetroNIDAZOLE (Systemic) Generic: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF], 200 mg [BCF] Outpatient Dosage Forms Tablet, Oral: Moxifloxacin (Ophthalmic) Generic: 250 mg [BCF], 500 mg [BCF] Outpatient Dosage Forms MetroNIDAZOLE (Topical) Solution, Ophthalmic: Generic: 0.5% (3 mL) Outpatient Formulary Brands Available MetroGel-Vaginal Outpatient Dosage Forms Moxifloxacin (Systemic) Cream, External: Outpatient Formulary Brands Available Avelox ABC Pack [DSC] Generic: 0.75% (45 g) Outpatient Dosage Forms Gel, Vaginal: Tablet, Oral: MetroGel-Vaginal: 0.75% (70 g) [BCF] Avelox ABC Pack: 400 mg [DSC] Generic: 0.75% (70 g) [BCF] Generic: 400 mg Midazolam Mupirocin Outpatient Dosage Forms Outpatient Dosage Forms Solution, Nasal: Ointment, External: Nayzilam: 5 mg/0.1 mL (1 ea, 2 ea) [contains propylene glycol] Generic: 2% (22 g) [BCF] 18 NYSTATIN (ORAL) Mycophenolate Niacin Outpatient Dosage Forms Outpatient Formulary Brands Available Niaspan Capsule, Oral, as mofetil: Outpatient Dosage Forms Generic: 250 mg Tablet, Extended Release, Oral: Suspension Reconstituted, Oral, as mofetil: Niaspan: 500 mg [BCF], 750 mg [BCF], 1000 mg [BCF] Generic: 200 mg/mL (160 mL) Tablet, Oral, as mofetil: Nicotine Generic: 500 mg Outpatient Dosage Forms Nadolol Gum, Mouth/Throat, as polacrilex: Generic: 2 mg (50 ea) [BCF]; 4 mg (50 ea, 110 ea) [BCF] Outpatient Dosage Forms Patch 24 Hour, Transdermal: Tablet, Oral: Generic: 7 mg/24 hours (7 ea) [BCF]; 14 mg/24 hours (14 ea) [BCF]; 21 mg/ Generic: 20 mg, 40 mg, 80 mg 24 hours (7 ea) [BCF] Naftifine NIFEdipine Outpatient Formulary Brands Available Naftin Outpatient Dosage Forms Outpatient Formulary Brands Available Adalat CC; Procardia Cream, External, as hydrochloride: Outpatient Dosage Forms Naftin: 1% (30 g) [contains benzyl alcohol] Capsule, Oral: Procardia: 10 mg Naldemedine Generic: 10 mg Outpatient Dosage Forms Tablet Extended Release 24 Hour, Oral: Tablet, Oral: Adalat CC: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF] Symproic: 0.2 mg Generic: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF] Naloxone Nitrofurantoin Outpatient Dosage Forms Outpatient Formulary Brands Available Furadantin Liquid, Nasal: Outpatient Dosage Forms Narcan: 4 mg/0.1 mL (1 ea) [contains benzalkonium chloride, edetate Capsule, Oral [macrocrystal/monohydrate]: disodium] Generic: 100 mg [BCF] Naltrexone Suspension, Oral: Outpatient Dosage Forms Furadantin: 25 mg/5 mL (230 mL) Tablet, Oral, as hydrochloride: Nitroglycerin Generic: 50 mg Outpatient Formulary Brands Available Nitro-Bid; Nitro-Dur; Nitrolingual; Naproxen Nitrostat Outpatient Dosage Forms Outpatient Dosage Forms Suspension, Oral: Ointment, Transdermal: Generic: 125 mg/5 mL (500 mL) [BCF] Nitro-Bid: 2% (1 g) [20 mg/g] Tablet, Oral: Patch 24 Hour, Transdermal: Generic: 250 mg [BCF], 375 mg, 500 mg [BCF] Nitro-Dur: 0.1 mg/hr (30s) [BCF]; 0.2 mg/hr (30s) [BCF]; 0.3 mg/hr (30s) Tablet, Oral, as sodium: [BCF]; 0.4 mg/hr (30s) [BCF]; 0.6 mg/hr (30s) [BCF]; 0.8 mg/hr (30s) [BCF] Generic: 275 mg [equivalent to naproxen base 250 mg] [BCF], 550 mg Generic: 0.1 mg/hour (30s) [BCF]; 0.2 mg/hour (30s) [BCF]; 0.4 mg/hour [equivalent to naproxen base 500 mg] [BCF] (30s) [BCF]; 0.6 mg/hour (30s) [BCF] Neomycin Solution, Translingual: Nitrolingual: 0.4 mg/spray (12 g) [contains ethanol 20%; 200 metered Outpatient Dosage Forms sprays] [BCF] Tablet, Oral, as sulfate: Generic: 0.4 mg/spray (12 g) [BCF] Generic: 500 mg Tablet, Sublingual: Neomycin, Polymyxin B, and Dexamethasone Nitrostat: 0.4 mg [BCF] Outpatient Dosage Forms Norethindrone Ointment, Ophthalmic: Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame- Outpatient Formulary Brands Available Nor-QD thasone 0.1% per g (3.5 g) Outpatient Dosage Forms Suspension, Ophthalmic: Tablet, Oral: Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame- Nor-QD: 0.35 mg [BCF] thasone 0.1% per 1 mL (5 mL) Generic: 0.35 mg [BCF] Tablet, Oral, as acetate: Neomycin, Polymyxin B, and Gramicidin Generic: 5 mg Outpatient Formulary Brands Available Neosporin Outpatient Dosage Forms Norethindrone and Mestranol Solution, Ophthalmic: Outpatient Formulary Brands Available Norinyl 1+50 Neosporin: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin Outpatient Dosage Forms 0.025 mg per 1 mL (10 mL) [BCF] Tablet, Oral: Generic: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin Norinyl 1+50: Norethindrone 1 mg and mestranol 0.05 mg [21 white tablets 0.025 mg per 1 mL (10 mL) [BCF] and 7 orange inactive tablets] (28s) Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) Nortriptyline Outpatient Dosage Forms Outpatient Formulary Brands Available Pamelor Suspension, Ophthalmic: Outpatient Dosage Forms Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone Capsule, Oral: 10 mg per 1 mL (7.5 mL) [BCF] Pamelor: 10 mg [BCF], 25 mg [BCF] Neomycin, Polymyxin B, and Hydrocortisone (Otic) Pamelor: 50 mg [contains sodium bisulfite (may have trace amounts)] [BCF] Outpatient Dosage Forms Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] Solution, Otic: Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone Nystatin and Triamcinolone 10 mg per 1 mL (10 mL) [BCF] Outpatient Dosage Forms Suspension, Otic: Cream, External: Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone Generic: Nystatin 100,000 units and triamcinolone acetonide 0.1% (30 g) 10 mg per 1 mL (10 mL) [BCF] Nystatin (Oral) Nepafenac Outpatient Dosage Forms Outpatient Formulary Brands Available Nevanac Suspension, Mouth/Throat: Outpatient Dosage Forms Generic: 100,000 units/mL (60 mL, 480 mL) [BCF] Suspension, Ophthalmic: Tablet, Oral: Nevanac: 0.1% (3 mL) [contains benzalkonium chloride] Generic: 500,000 units 19 NYSTATIN (TOPICAL) Nystatin (Topical) Tablet, Oral, as hydrochloride: Outpatient Dosage Forms Generic: 5 mg, 10 mg Cream, External: Tablet, Controlled Release, Oral, as hydrochloride: Generic: 100,000 units/g (15 g) [BCF] OxyCONTIN: 10 mg, 20 mg, 40 mg, 80 mg Ointment, External: Generic: 100,000 units/g (30 g) [BCF] Oxycodone and Acetaminophen Powder, External: Outpatient Dosage Forms Generic: 100,000 units/g (15 g) Tablet, Oral: Generic: Ofloxacin (Ophthalmic) 5/325: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg [BCF] Outpatient Dosage Forms 7.5/325: Oxycodone hydrochloride 7.5 mg and acetaminophen 325 mg Solution, Ophthalmic: 10/325: Oxycodone hydrochloride 10 mg and acetaminophen 325 mg Generic: 0.3% (5 mL) Oxymetazoline (Nasal) Ofloxacin (Otic) Outpatient Dosage Forms Outpatient Dosage Forms Solution, Nasal, as hydrochloride: Solution, Otic: Generic: 0.05% (15 mL) [available through Self Care program] Generic: 0.3% (5 mL) Olopatadine (Nasal) Palivizumab Outpatient Formulary Brands Available Patanase Outpatient Dosage Forms Outpatient Dosage Forms Solution, Intramuscular [preservative free]: Solution, Nasal: Synagis: 50 mg/0.5 mL (0.5 mL); 100 mg/mL (1 mL) [contains glycine, Patanase: 0.6% (30.5 g) [contains benzalkonium chloride, edetate disodium] histidine] Olopatadine (Ophthalmic) Pancrelipase Outpatient Formulary Brands Available Patanol; Pazeo Outpatient Formulary Brands Available Creon; Pancreaze Outpatient Dosage Forms Outpatient Dosage Forms Solution, Ophthalmic [drops]: Capsule, Delayed Release, Enteric Coated Microspheres, Oral [porcine Patanol: 0.1% (5 mL) [contains benzalkonium chloride] [BCF] derived]: Pazeo: 0.7% (2.5 mL) [contains benzalkonium chloride] Creon: Lipase 3000 USP units, protease 9500 USP units, and amylase 15,000 USP Omalizumab units [BCF] Outpatient Dosage Forms Lipase 6000 USP units, protease 19,000 USP units, and amylase 30,000 Solution Reconstituted, Subcutaneous [preservative free]: USP units [BCF] Xolair: 150 mg (1 ea) Lipase 12,000 USP units, protease 38,000 USP units, and amylase 60,000 Omega-3 Fatty Acids USP units [BCF] Outpatient Dosage Forms Lipase 24,000 USP units, protease 76,000 USP units, and amylase 120,000 Capsule, Oral: USP units [BCF] Lovaza: 1 g [contains soybean oil, tocopherol, dl-alpha] Lipase 36,000 USP units, protease 114,000 USP units, and amylase 180,000 USP units [BCF] Omeprazole Capsule, Delayed Release, Enteric Coated Microtablets, Oral [porcine derived]: Outpatient Dosage Forms Pancreaze: Capsule Delayed Release, Oral: Lipase 4200 units, protease 10,000 units, and amylase 17,500 units Generic: 10 mg [BCF], 20 mg [BCF], 40 mg Lipase 10,500 units, protease 25,000 units, and amylase 43,750 units Ondansetron Lipase 16,800 units, protease 40,000 units, and amylase 70,000 units Outpatient Dosage Forms Lipase 21,000 units, protease 37,000 units, and amylase 61,000 units Tablet, Oral: Pantoprazole Generic: 4 mg, 8 mg Tablet Disintegrating, Oral: Outpatient Dosage Forms Generic: 4 mg, 8 mg Tablet Delayed Release, Oral: Generic: 20 mg, 40 mg Oseltamivir Outpatient Formulary Brands Available Tamiflu Papillomavirus (9-Valent) Vaccine (Human, Recombinant) Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral, as phosphate: Suspension, Intramuscular [preservative free]: Tamiflu: 75 mg Gardasil 9: (0.5 mL) [contains polysorbate 80, yeast extract] Suspension Reconstituted, Oral, as base: Tamiflu: 12 mg/mL (25 mL) [contains sodium benzoate; tutti frutti flavor] PARoxetine Outpatient Dosage Forms Oxaprozin Tablet, Oral, as hydrochloride [strength expressed as base]: Outpatient Dosage Forms Generic: 20 mg, 30 mg, 40 mg Tablet, Oral: Generic: 600 mg Penicillin V Potassium Outpatient Dosage Forms OXcarbazepine Solution Reconstituted, Oral: Outpatient Formulary Brands Available Trileptal Generic: 125 mg/5 mL (100 mL, 200 mL) [BCF]; 250 mg/5 mL (100 mL, 200 Outpatient Dosage Forms mL) [BCF] Suspension, Oral: Tablet, Oral: Trileptal: 300 mg/5 mL (250 mL) [contains ethanol, propylene glycol] Generic: 250 mg [BCF], 500 mg [BCF] Tablet, Oral: Trileptal: 150 mg, 300 mg, 600 mg [scored] Penicillin G (Parenteral/Aqueous) Oxybutynin Outpatient Formulary Brands Available Pfizerpen Outpatient Dosage Forms Outpatient Dosage Forms Syrup, Oral, as chloride: Solution Reconstituted, Injection, as potassium [preservative free]: Generic: 5 mg/5 mL (473 mL) Pfizerpen: 20,000,000 units (1 ea) Tablet, Oral, as chloride: Generic: 5 mg Penicillin G Procaine Tablet Extended Release 24 Hour, Oral, as chloride: Outpatient Dosage Forms Generic: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF] Suspension, Intramuscular: Generic: 600,000 units/mL (1 mL, 2 mL) OxyCODONE Outpatient Formulary Brands Available OxyCONTIN Pentoxifylline Outpatient Dosage Forms Outpatient Dosage Forms Solution, Oral, as hydrochloride: Tablet Extended Release, Oral: Generic: 5 mg/5 mL (500 mL) Generic: 400 mg 20 PRAVASTATIN Perindopril and Amlodipine Outpatient Dosage Forms Outpatient Dosage Forms Powder for Solution, Oral: Tablet, Oral: GlycoLax: PEG 3350 527 g (24 oz) [DSC] Prestalia: Perindopril arginine 3.5 mg and amlodipine 2.5 mg, Perindopril Polyethylene Glycol-Electrolyte Solution arginine 7 mg and amlodipine 5 mg, Perindopril arginine 14 mg and amlo- Outpatient Formulary Brands Available GoLYTELY; MoviPrep; NuLYTELY dipine 10 mg Outpatient Dosage Forms Permethrin Powder for Solution, Oral: Outpatient Dosage Forms GoLYTELY: PEG 3350 236 g, sodium sulfate 22.74 g, sodium bicarbonate Cream, External: 6.74 g, sodium chloride 5.86 g, and potassium chloride 2.97 g (4000 mL) Generic: 5% (60 g) [BCF] [original flavor] Lotion, External: MoviPrep: Pouch A: PEG 3350 100 g, sodium sulfate 7.5 g, sodium chloride Generic: 1% (59 mL) [available through Self Care program] 2.69 g, potassium chloride 1.015 g; Pouch B: Ascorbic acid 4.7 g, sodium ascorbate 5.9 g (1000 mL) [contains phenylalanine 2.33 mg/treatment; Pexidartinib lemon flavor] Outpatient Dosage Forms NuLYTELY: PEG 3350 420 g, sodium bicarbonate 5.72 g, sodium chloride Capsule, Oral, as hydrochloride: 11.2 g, and potassium chloride 1.48 g (4000 mL) [available with cherry, Turalio: 200 mg lemon-lime, orange and pineapple flavor packs] Phenazopyridine Potassium Chloride Outpatient Dosage Forms Outpatient Formulary Brands Available Epiklor; Klor-Con; Klor-Con 10; Tablet, Oral, as hydrochloride: Klor-Con M20 Generic: 100 mg [BCF], 200 mg [BCF] Outpatient Dosage Forms Capsule Extended Release, Oral: PHENobarbital Generic: 10 mEq [BCF] Outpatient Dosage Forms Packet, Oral: Elixir, Oral: Epiklor: 20 mEq/packet (30s, 100s) [sugar free; orange flavor] [BCF] Generic: 20 mg/5 mL (5 mL) [BCF] Klor-Con: 20 mEq/packet (30s, 100s) [sugar free; fruit flavor] [BCF] Tablet, Oral: Generic: 20 mEq (30 ea, 100 ea) [BCF] Generic: 16.2 mg, 32.4 mg, 64.8 mg, 97.2 mg Solution, Oral: Generic: 20 mEq/15 mL (473 mL) [BCF] Phenylephrine (Ophthalmic) Tablet Extended Release, Oral: Outpatient Formulary Brands Available AK-Dilate Klor-Con 10: 10 mEq [750 mg] [BCF] Outpatient Dosage Forms Klor-Con M20: 20 mEq [scored; 1500 mg] [BCF] Solution, Ophthalmic, as hydrochloride [drops]: Generic: 10 mEq [BCF], 20 mEq [BCF] AK-Dilate: 10% (5 mL) [contains benzalkonium chloride] Potassium Citrate Generic: 2.5% (15 mL) Outpatient Formulary Brands Available Urocit-K Phenytoin Outpatient Dosage Forms Outpatient Formulary Brands Available Dilantin; Dilantin-125 Tablet, Oral: Outpatient Dosage Forms Urocit-K: 1080 mg [10 mEq] Capsule, Oral, as sodium: Potassium Iodide Dilantin: 30 mg Outpatient Formulary Brands Available SSKI Generic: 100 mg [BCF] Outpatient Dosage Forms Suspension, Oral: Solution, Oral: Dilantin-125: 125 mg/5 mL (240 mL) [contains ethanol ≤0.6%, sodium ben- SSKI: 1 g/mL (237 mL) zoate; orange-vanilla flavor] [BCF] Tablet, Chewable, Oral: Potassium Phosphate Dilantin: 50 mg [scored] [BCF] Outpatient Formulary Brands Available K-Phos Outpatient Dosage Forms Phytonadione Tablet, Oral: Outpatient Formulary Brands Available Mephyton K-Phos Original: 500 mg [scored; phosphorus 114 mg and potassium 144 mg Outpatient Dosage Forms (3.7 mEq) per tablet] Tablet, Oral: Mephyton: 5 mg [scored] Potassium Phosphate and Sodium Phosphate Outpatient Formulary Brands Available K-Phos Neutral; Neutra-Phos Pilocarpine (Ophthalmic) [OTC] [DSC] Outpatient Dosage Forms Outpatient Dosage Forms Solution, Ophthalmic, as hydrochloride [drops]: Powder for Solution, Oral: Generic: 0.5% (15 mL [DSC]); 1% (15 mL) [BCF]; 2% (15 mL) [BCF] Neutra-Phos: Dibasic potassium phosphate, monobasic potassium phos- phate, dibasic sodium phosphate, and monobasic sodium phosphate per Pilocarpine (Systemic) packet (100s) [equivalent to elemental phosphorus 250 mg (14.25 mEq), Outpatient Dosage Forms sodium 164 mg (7.1 mEq), and potassium 278 mg (7.1 mEq) per Tablet, Oral, as hydrochloride: packet] [DSC] Generic: 5 mg, 7.5 mg Tablet, Oral: K-Phos Neutral: Monobasic potassium phosphate 155 mg, dibasic sodium Pimecrolimus phosphate 852 mg, and monobasic sodium phosphate 130 mg [scored; Outpatient Formulary Brands Available Elidel equivalent to elemental phosphorus 250 mg, sodium 298 mg (13 mEq), Outpatient Dosage Forms and potassium 45 mg (1.1 mEq)] Cream, External: Elidel: 1% (30 g) [BCF] Pramipexole Outpatient Dosage Forms Pindolol Tablet, Oral, as dihydrochloride monohydrate: Outpatient Dosage Forms Generic: 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg Tablet, Oral: Generic: 5 mg, 10 mg Pramoxine and Hydrocortisone Outpatient Formulary Brands Available ProctoFoam HC Piroxicam (Systemic) Outpatient Dosage Forms Outpatient Dosage Forms Aerosol, foam, rectal: Capsule, Oral: ProctoFoam HC: Pramoxine hydrochloride 1% and hydrocortisone acetate Generic: 10 mg, 20 mg 1% (10 g) Podofilox Prasugrel Outpatient Dosage Forms Outpatient Dosage Forms Solution, External: Tablet, Oral: Generic: 0.5% (3.5 mL) Effient: 10 mg Polyethylene Glycol 3350 Pravastatin Outpatient Formulary Brands Available GlycoLax [DSC] Outpatient Formulary Brands Available Pravachol 21 PRAVASTATIN

Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as sodium: Capsule Extended Release 24 Hour, Oral, as hydrochloride: Pravachol: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Inderal LA: 80 mg, 120 mg, 160 mg Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Tablet, Oral, as hydrochloride: Generic: 10 mg, 40 mg Prazosin Outpatient Formulary Brands Available Minipress Propylthiouracil Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral, as hydrochloride: Tablet, Oral: Minipress: 1 mg, 2 mg, 5 mg Generic: 50 mg [BCF] PrednisoLONE (Ophthalmic) Prothrombin Complex Concentrate (Human) [(Factors II, VII, IX, Outpatient Formulary Brands Available Pred Mild X), Protein C, and Protein S] Outpatient Dosage Forms Outpatient Dosage Forms Suspension, Ophthalmic, as acetate: Kit, Intravenous [preservative free]: Pred Mild: 0.12% (5 mL) [contains benzalkonium chloride, sodium bisul- Kcentra: ~500 units, ~1000 units [pyrogen free; contains albumin human, fite] [BCF] heparin] Generic: 1% (10 mL) [BCF] Pseudoephedrine PrednisoLONE (Systemic) Outpatient Formulary Brands Available Sudafed 12 Hour [OTC]; SudoGest Outpatient Dosage Forms [OTC] Outpatient Dosage Forms Solution, Oral, as sodium phosphate [strength expressed as base]: Syrup, Oral, as hydrochloride: Generic: 15 mg/5 mL (237 mL) [BCF] Generic: 30 mg/5 mL (118 mL) PredniSONE Tablet, Oral, as hydrochloride: Outpatient Dosage Forms SudoGest: 30 mg Tablet Extended Release 12 Hour, Oral, as hydrochloride: Tablet, Oral: Sudafed 12 Hour: 120 mg Generic: 1 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF] Tablet Therapy Pack, Oral: Pyrazinamide Generic: 5 mg (21 ea) Outpatient Dosage Forms Pregabalin Tablet, Oral: Generic: 500 mg [BCF] Outpatient Dosage Forms Capsule, Oral: Pyridostigmine Generic: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg Outpatient Formulary Brands Available Mestinon Outpatient Dosage Forms Primaquine Tablet, Oral, as bromide: Outpatient Dosage Forms Generic: 60 mg Tablet, Oral, as phosphate: Tablet Extended Release, Oral, as bromide: Generic: 26.3 mg Mestinon: 180 mg [scored] Primidone Pyridoxine Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral, as hydrochloride: Generic: 50 mg, 250 mg Generic: 50 mg Probenecid QUEtiapine Outpatient Dosage Forms Outpatient Formulary Brands Available SEROquel; SEROquel XR Tablet, Oral: Outpatient Dosage Forms Generic: 500 mg [BCF] Tablet, Oral: SEROquel: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF], Prochlorperazine 300 mg [BCF], 400 mg [BCF] Outpatient Formulary Brands Available Compro Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF], 300 mg Outpatient Dosage Forms [BCF], 400 mg [BCF] Suppository, Rectal: Tablet Extended Release 24 Hour, Oral: Compro: 25 mg (12 ea) [contains coconut oil, palm oil] SEROquel XR: 50 mg [BCF], 150 mg [BCF], 200 mg [BCF], 300 mg [BCF], Tablet, Oral, as maleate [strength expressed as base]: 400 mg [BCF] Generic: 5 mg Generic: 50 mg [BCF], 150 mg [BCF], 200 mg [BCF], 300 mg [BCF], 400 mg [BCF] Progesterone Outpatient Formulary Brands Available First-Progesterone VGS 100; First- QuiNIDine Progesterone VGS 200; Prometrium Outpatient Dosage Forms Outpatient Dosage Forms Tablet Extended Release, Oral, as gluconate: Capsule, Oral: Generic: 324 mg Prometrium: 100 mg, 200 mg [contains peanut oil] Raloxifene Suppository, Vaginal [compounding kit]: Outpatient Formulary Brands Available Evista First-Progesterone VGS 100: 100 mg (30s) Outpatient Dosage Forms First-Progesterone VGS 200: 200 mg (30s) Tablet, Oral, as hydrochloride: Promethazine Evista: 60 mg [BCF] Generic: 60 mg [BCF] Outpatient Formulary Brands Available Promethegan Outpatient Dosage Forms Raltegravir Suppository, Rectal, as hydrochloride: Outpatient Dosage Forms Promethegan: 12.5 mg (12s) [BCF]; 25 mg (12s) [BCF] Tablet, Oral: Syrup, Oral, as hydrochloride: Isentress: 400 mg Generic: 6.25 mg/5 mL (473 mL) [BCF] Tablet, Oral, as hydrochloride: Ramipril Generic: 25 mg [BCF] Outpatient Formulary Brands Available Altace Outpatient Dosage Forms Propafenone Capsule, Oral: Outpatient Dosage Forms Altace: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF] Capsule Extended Release 12 Hour, Oral, as hydrochloride: Generic: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF] Generic: 225 mg, 325 mg, 425 mg Tablet, Oral, as hydrochloride: RaNITIdine (Withdrawn From US Market) Generic: 150 mg, 225 mg, 300 mg Outpatient Formulary Brands Available Zantac Outpatient Dosage Forms Propranolol Syrup, Oral: Outpatient Formulary Brands Available Inderal LA Zantac: 15 mg/mL (480 mL) [contains ethanol 7.5%; peppermint flavor] [BCF] 22 SODIUM CHLORIDE

Tablet, Oral: Xpovio (60 MG Twice Weekly): 20 mg (6 ea, 24 ea) Generic: 150 mg [BCF] Xpovio (80 MG Once Weekly): 20 mg (4 ea, 16 ea) Xpovio (80 MG Twice Weekly): 20 mg (8 ea, 32 ea) RifAMPin Outpatient Dosage Forms Semaglutide Capsule, Oral: Outpatient Dosage Forms Generic: 300 mg [BCF] Solution Pen-injector, Subcutaneous: Ozempic (0.25 or 0.5 MG/DOSE): 0.25 mg or 0.5 mg per dose [2 mg/1.5 mL] Risedronate (1.5 mL) [contains phenol, propylene glycol] Outpatient Formulary Brands Available Actonel Ozempic (1 MG/DOSE): 1 mg per dose [2 mg/1.5 mL] (1.5 mL) [contains Outpatient Dosage Forms phenol, propylene glycol] Tablet, Oral, as sodium: Tablet, Oral: Actonel: 35 mg, 150 mg Rybelsus: 3 mg, 7 mg, 14 mg RisperiDONE Sertraline Outpatient Formulary Brands Available RisperDAL Outpatient Dosage Forms Outpatient Dosage Forms Concentrate, Oral: Solution, Oral: Generic: 20 mg/mL (60 mL) [BCF] RisperDAL: 1 mg/mL (30 mL) [contains benzoic acid] [BCF] Tablet, Oral: Generic: 1 mg/mL (30 mL) [BCF] Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Tablet, Oral: RisperDAL: 0.25 mg [BCF], 0.5 mg [BCF], 1 mg [scored] [BCF], 2 mg [BCF], Sevelamer 3 mg [BCF], 4 mg [BCF] Outpatient Dosage Forms Generic: 0.25 mg [BCF], 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF], 3 mg Packet, Oral, as carbonate: [BCF], 4 mg [BCF] Generic: 0.8 g (1 ea, 90 ea); 2.4 g (1 ea, 90 ea) Tablet, Oral, as carbonate: Rivaroxaban Generic: 800 mg Outpatient Formulary Brands Available Xarelto Tablet, Oral, as hydrochloride: Outpatient Dosage Forms Generic: 400 mg, 800 mg Tablet, Oral: Xarelto: 10 mg, 15 mg, 20 mg Sildenafil Outpatient Formulary Brands Available Viagra Rivastigmine Outpatient Dosage Forms Outpatient Formulary Brands Available Exelon Tablet, Oral: Outpatient Dosage Forms Generic: 20 mg [ECF] , 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Patch 24 Hour, Transdermal: Exelon: 4.6 mg/24 hr (1 ea, 30 ea); 9.5 mg/24 hr (1 ea, 30 ea); 13.3 mg/24 hr Silver Nitrate (1 ea, 30 ea) Outpatient Dosage Forms Applicator Sticks, External: Rizatriptan Generic: Silver nitrate 75% and potassium nitrate 25% (100s) [6"] Outpatient Formulary Brands Available Maxalt; Maxalt-MLT Outpatient Dosage Forms Silver Sulfadiazine Tablet, Oral: Outpatient Dosage Forms Maxalt: 5 mg [BCF], 10 mg [BCF] Cream, External: Generic: 5 mg [BCF], 10 mg [BCF] Generic: 1% (85 g) [BCF] Tablet Dispersible, Oral: Maxalt-MLT: Simethicone 5 mg [contains phenylalanine 1.05 mg/tablet; peppermint flavor] [BCF] Outpatient Formulary Brands Available Infants Gas Relief Drops [OTC] 10 mg [contains phenylalanine 2.1 mg/tablet; peppermint flavor] [BCF] Outpatient Dosage Forms Generic: 5 mg [BCF], 10 mg [BCF] Suspension, Oral: Infants Gas Relief Drops: 40 mg/0.6 mL (30 mL) [vanilla flavor] ROPINIRole Tablet, Chewable, Oral: Outpatient Dosage Forms Generic: 80 mg Tablet, Oral: Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg Simvastatin Outpatient Dosage Forms Rosuvastatin Tablet, Oral: Outpatient Dosage Forms Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], Tablet, Oral: 80 mg [BCF] Crestor: 5 mg, 10 mg, 20 mg, 40 mg SITagliptin Salmeterol Outpatient Formulary Brands Available Januvia Outpatient Formulary Brands Available Serevent Diskus Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Aerosol Powder Breath Activated, Inhalation: Januvia: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Serevent Diskus: 50 mcg (60s) [contains lactose] [BCF] Sitagliptin and Metformin Salsalate Outpatient Formulary Brands Available Janumet; Janumet XR Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 500 mg [BCF], 750 mg [BCF] Janumet 50/500: Sitagliptin 50 mg and metformin hydrochloride Segesterone Acetate and Ethinyl Estradiol 500 mg [BCF] Outpatient Dosage Forms Janumet 50/1000: Sitagliptin 50 mg and metformin hydrochloride Ring, Vaginal: 1000 mg [BCF] Annovera: Ethinyl estradiol 0.013 mg/day and segesterone acetate Tablet, Extended Release, Oral: 0.15 mg/day [3-week duration] (1 ea) Janumet XR: 50/500: Sitagliptin 50 mg and metformin hydrochloride 500 mg [BCF] Selenium Sulfide Janumet XR: 50/1000: Sitagliptin 50 mg and metformin hydrochloride Outpatient Dosage Forms 1000 mg [BCF] Lotion, External: Janumet XR: 100/1000: Sitagliptin 100 mg and metformin hydrochloride Generic: 2.5% (120 mL) [BCF] 1000 mg [BCF] Selinexor Sodium Chloride Outpatient Dosage Forms Outpatient Formulary Brands Available Muro 128 [OTC] Tablet Therapy Pack, Oral: Outpatient Dosage Forms Xpovio (100 MG Once Weekly): 20 mg (5 ea, 20 ea) Solution, Nasal: Xpovio (40 MG Once Weekly): 20 mg (2 ea, 8 ea) Generic: 0.65% (45 mL) [available through Self Care program] Xpovio (40 MG Twice Weekly): 20 mg (4 ea, 16 ea) Solution, Ophthalmic: Xpovio (60 MG Once Weekly): 20 mg (3 ea, 12 ea) Muro 128: 5% (15 mL) 23 SODIUM CITRATE AND CITRIC ACID Sodium Citrate and Citric Acid Outpatient Dosage Forms Outpatient Dosage Forms Shampoo, External: Solution, Oral: Sebex: Micropulverized sulfur 2% and salicylic acid 2% (120 mL) Generic: Sodium citrate 500 mg and citric acid 334 mg per 5 mL (473 mL) [equivalent to bicarbonate 1 mEq/mL] Sulfur and Sulfacetamide Outpatient Formulary Brands Available Clenia Sodium Phosphates Outpatient Dosage Forms Outpatient Formulary Brands Available Fleet Enema [OTC]; OsmoPrep Cream, Topical: Outpatient Dosage Forms Clenia: Sulfur 5% and sulfacetamide sodium 10% (28 g) Solution, Rectal [enema]: Wash, Topical: Fleet Enema: Monobasic sodium phosphate monohydrate 19 g and dibasic Clenia: Sulfur 5% and sulfacetamide sodium 10% (340 g) sodium phosphate heptahydrate 7 g per 118 mL delivered dose (133 mL) [contains sodium 4.4 g/118 mL] SUMAtriptan Tablet, Oral: Outpatient Formulary Brands Available Imitrex OsmoPrep: Sodium phosphate monobasic monohydrate 1.102 g and sodium Outpatient Dosage Forms phosphate dibasic anhydrous 0.398 g [scored; gluten free; sodium phos- Injection, solution, as succinate [strength expressed as base]: phate 1.5 g per tablet] Imitrex: 6 mg/0.5 mL (0.5 mL) [BCF] Tablet, Oral, as succinate [strength expressed as base]: Sodium Polystyrene Sulfonate Imitrex: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Outpatient Formulary Brands Available Kayexalate; Kionex; SPS Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Outpatient Dosage Forms Powder, Oral: Tacrolimus (Topical) Kayexalate: 454 g [contains sodium 100 mg (4.1 mEq)/g] Outpatient Formulary Brands Available Protopic Suspension, Oral: Outpatient Dosage Forms Kionex: 15 g/60 mL (480 mL) [contains ethanol 0.2%, propylene glycol, Ointment, External: sodium 1500 mg (65 mEq)/60 mL, sorbitol; raspberry flavor] Protopic: 0.03% (60 g); 0.1% (60 g) SPS: 15 g/60 mL (473 mL) [contains ethanol 0.3%, propylene glycol, sodium 1500 mg (65 mEq)/60 mL, sorbitol; cherry flavor] Tadalafil Outpatient Dosage Forms Solifenacin Tablet, Oral: Outpatient Formulary Brands Available VESIcare Generic: 2.5 mg, 5 mg, 10 mg, 20 mg Outpatient Dosage Forms Tablet, Oral, as succinate: Tamoxifen VESIcare: 5 mg, 10 mg Outpatient Dosage Forms Tablet, Oral: Sotalol Generic: 10 mg [BCF], 20 mg [BCF] Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Tamsulosin Generic: 80 mg, 120 mg Outpatient Formulary Brands Available Flomax Outpatient Dosage Forms Spironolactone Capsule, Oral, as hydrochloride: Outpatient Formulary Brands Available Aldactone Flomax: 0.4 mg [BCF] Outpatient Dosage Forms Generic: 0.4 mg [BCF] Tablet, Oral: Tablet, Oral, as hydrochloride: Aldactone: 100 mg [scored] Generic: 0.4 mg Generic: 25 mg [BCF] Telmisartan Sucralfate Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Suspension, Oral: Generic: 20 mg, 40 mg, 80 mg Carafate: 1 g/10 mL (420 mL) [contains fd&c red #40, methylparaben; cherry flavor] Telmisartan and Hydrochlorothiazide Tablet, Oral: Outpatient Formulary Brands Available Micardis HCT Generic: 1 g Outpatient Dosage Forms Tablet, Oral: Sugammadex Micardis HCT: 40/12.5: Telmisartan 40 mg and hydrochlorothiazide 12.5 mg Outpatient Formulary Brands Available Bridion Micardis HCT: 80/12.5: Telmisartan 80 mg and hydrochlorothiazide 12.5 mg Outpatient Dosage Forms Micardis HCT: 80/25: Telmisartan 80 mg and hydrochlorothiazide 25 mg Solution, Intravenous: Bridion: 200 mg/2 mL (2 mL); 500 mg/5 mL (5 mL) Temazepam Outpatient Dosage Forms Sulfacetamide (Ophthalmic) Capsule, Oral: Outpatient Dosage Forms Generic: 15 mg [BCF], 30 mg [BCF] Solution, ophthalmic, as sodium [drops]: 10% (15 mL) [BCF] Terazosin Sulfamethoxazole and Trimethoprim Outpatient Dosage Forms Outpatient Formulary Brands Available Sulfatrim Capsule, Oral: Outpatient Dosage Forms Generic: 1 mg [BCF], 2 mg [BCF], 5 mg [BCF], 10 mg [BCF] Suspension, Oral: Sulfatrim: Sulfamethoxazole 200 mg and trimethoprim 40 mg per 5 mL (480 Terbinafine (Systemic) mL) [contains ethanol ≤0.5%, propylene glycol; cherry flavor] [BCF] Outpatient Dosage Forms Generic: Sulfamethoxazole 200 mg and trimethoprim 40 mg per 5 mL (480 Tablet, Oral: mL) [BCF] Generic: 250 mg Tablet, Oral: Generic: Sulfamethoxazole 400 mg and trimethoprim 80 mg [BCF]; Sulfame- Terbinafine (Topical) thoxazole 800 mg and trimethoprim 160 mg [BCF] Outpatient Dosage Forms Cream, External, as hydrochloride: SulfaSALAzine Generic: 1% (15 g, 30 g) Outpatient Formulary Brands Available Azulfidine EN-tabs Outpatient Dosage Forms Terbutaline Tablet, Oral: Outpatient Dosage Forms Generic: 500 mg [BCF] Tablet, Oral, as sulfate: Tablet Delayed Release, Oral: Generic: 2.5 mg, 5 mg Azulfidine EN-tabs: 500 mg [BCF] Generic: 500 mg [BCF] Terconazole Outpatient Dosage Forms Sulfur and Salicylic Acid Cream, Vaginal: Outpatient Formulary Brands Available Sebex [OTC] Generic: 0.4% (45 g) 24 TROPICAMIDE Testosterone Outpatient Dosage Forms Outpatient Formulary Brands Available Androderm; Depo-Testosterone; Solution, Ophthalmic: Fortesta; Xyosted Tobrex: 0.3% (5 mL) Outpatient Dosage Forms Generic: 0.3% (5 mL) Gel, Transdermal: Tolnaftate Fortesta: 10 mg/actuation (2%) (60 g) [odorless; contains propylene glycol, Outpatient Dosage Forms trolamine (triethanolamine)] [BCF] Powder, External: Generic: 10 mg/actuation (2%) (60 g) [BCF] Generic: 1% (45 g) Solution, Intramuscular, as cypionate: Depo-Testosterone: 100 mg/mL (10 mL); 200 mg/mL (1 mL) [contains benzyl Tolterodine alcohol, benzyl benzoate] Outpatient Formulary Brands Available Detrol LA Patch 24 Hour, Transdermal: Outpatient Dosage Forms Androderm: 2 mg/24 hr (60 ea); 4 mg/24 hr (30 ea) Capsule Extended Release 24 Hour, Oral, as tartrate: Solution Auto-injector, Subcutaneous [preservative free]: Detrol LA: 2 mg [BCF], 4 mg [BCF] Xyosted: 50 mg/0.5 mL (0.5 mL); 75 mg/0.5 mL (0.5 mL); 100 mg/0.5 mL (0.5 Generic: 2 mg [BCF], 4 mg [BCF] mL) [contains sesame oil] Topiramate Tetracycline (Systemic) Outpatient Formulary Brands Available Topamax Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral, as hydrochloride: Tablet, Oral: Generic: 250 mg [BCF], 500 mg [BCF] Generic: 25 mg, 50 mg, 100 mg, 200 mg Theophylline Torsemide Outpatient Formulary Brands Available Elixophyllin; Theo-24 Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Capsule Extended Release 24 Hour, Oral: Generic: 5 mg, 10 mg, 20 mg, 100 mg Theo-24: 300 mg [24 hours] [BCF], 400 mg [24 hours] [BCF] Elixir, Oral: TraMADol Elixophyllin: 80 mg/15 mL (473 mL) [mixed fruit flavor] [BCF] Outpatient Dosage Forms Tablet Extended Release 12 Hour, Oral: Tablet, Oral, as hydrochloride: Generic: 200 mg [BCF], 300 mg [BCF] Generic: 50 mg [BCF] Tablet Extended Release 24 Hour, Oral: Generic: 400 mg [BCF] Tranexamic Acid Outpatient Dosage Forms Thyroid, Desiccated Tablet, Oral: Outpatient Dosage Forms Generic: 650 mg Tablet, Oral: Armour Thyroid: 15 mg, 30 mg, 60 mg, 90 mg, 120 mg TraZODone Armour Thyroid: 180 mg [scored] Outpatient Dosage Forms Armour Thyroid: 240 mg Tablet, Oral, as hydrochloride: Armour Thyroid: 300 mg [scored] Generic: 50 mg [BCF], 100 mg [BCF], 150 mg [BCF], 300 mg [BCF] Ticagrelor Tretinoin (Systemic) Outpatient Formulary Brands Available Brilinta Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Tablet, Oral: Generic: 10 mg Brilinta: 60 mg, 90 mg Tretinoin (Topical) Timolol (Ophthalmic) Outpatient Formulary Brands Available Avita Outpatient Formulary Brands Available Timolol GFS Outpatient Dosage Forms Outpatient Dosage Forms Cream, External: Avita: 0.025% (45 g) [BCF] Gel Forming Solution, Ophthalmic, as maleate [strength expressed as base]: Generic: 0.025% (20 g, 45 g) [BCF]; 0.05% (45 g) [BCF]; 0.1% (45 g) Timolol GFS: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF] Gel, External: Solution, Ophthalmic, as maleate [strength expressed as base]: Generic: 0.025% (45 g) Generic: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF] Triamcinolone (Topical) Tiopronin Outpatient Dosage Forms Outpatient Dosage Forms Cream, External, as acetonide: Tablet Delayed Release, Oral: Generic:0.1% (15 g, 80 g, 454 g) [BCF]; 0.5% (15 g) Thiola EC: 100 mg, 300 mg Ointment, External, as acetonide: Tiotropium Generic: 0.1% (15 g, 80 g, 454 g) [BCF] Paste, Mouth/Throat, as acetonide: Outpatient Formulary Brands Available Spiriva® HandiHaler® Generic: 0.1% (5 g) Outpatient Dosage Forms Aerosol Solution, Inhalation: Trihexyphenidyl Spiriva Respimat: 2.5 mcg/actuation (4 g) [contains benzalkonium chloride, Outpatient Dosage Forms disodium edta] Elixir, Oral, as hydrochloride: Capsule, Inhalation: Generic: 2 mg/5 mL (473 mL) [BCF] Spiriva HandiHaler: 18 mcg [contains milk protein] [BCF] Tablet, Oral, as hydrochloride: TiZANidine Generic: 2 mg [BCF] Outpatient Dosage Forms Trimethoprim Tablet, Oral: Outpatient Dosage Forms Generic: 4 mg Tablet, Oral: Generic: 100 mg Tobramycin and Dexamethasone Outpatient Formulary Brands Available TobraDex Trimethoprim and Polymyxin B Outpatient Dosage Forms Outpatient Dosage Forms Ointment, Ophthalmic: Solution, Ophthalmic: TobraDex: Tobramycin 0.3% and dexamethasone 0.1% (3.5 g) [contains Generic: Trimethoprim 1 mg and polymyxin B sulfate 10,000 units per 1 mL chlorobutanol] (10 mL) [BCF] Suspension, Ophthalmic: TobraDex: Tobramycin 0.3% and dexamethasone 0.1% (5 mL) [contains Tropicamide benzalkonium chloride] Outpatient Formulary Brands Available Mydriacyl Generic: Tobramycin 0.3% and dexamethasone 0.1% (5 mL) Outpatient Dosage Forms Solution, Ophthalmic: Tobramycin (Ophthalmic) Mydriacyl: 1% (15 mL) [contains benzalkonium chloride] Outpatient Formulary Brands Available Tobrex Generic: 1% (15 mL) 25 TYPHOID VACCINE Typhoid Vaccine Outpatient Dosage Forms Outpatient Formulary Brands Available Vivotif Capsule Extended Release 24 Hour, Oral: Outpatient Dosage Forms Effexor XR: 37.5 mg [BCF], 75 mg [BCF], 150 mg [BCF] Capsule, enteric coated [live]: Generic: 37.5 mg [BCF], 75 mg [BCF], 150 mg [BCF] Vivotif: Viable S. typhi Ty21a 2-6.8 x 109 colony-forming units and nonviable S. Tablet, Oral: typhi Ty21a 5-50 x 109 bacterial cells [contains lactose 100-180 mg/capsule Generic: 25 mg [BCF], 37.5 mg [BCF], 50 mg [BCF], 75 mg [BCF], and sucrose 26-130 mg/capsule] 100 mg [BCF] Tablet Extended Release 24 Hour, Oral: Urea (Topical) Generic: 225 mg [BCF] Outpatient Formulary Brands Available Carmol 20; Vanamide Outpatient Dosage Forms Verapamil Cream, External: Outpatient Formulary Brands Available Calan; Calan SR Carmol 20: 20% (90 g) Outpatient Dosage Forms Vanamide: 40% (85 g) [DSC] Tablet, Oral, as hydrochloride: Calan: 80 mg [scored] Ursodiol Tablet Extended Release, Oral, as hydrochloride: Outpatient Dosage Forms Calan SR: 120 mg [BCF], 180 mg [scored] [BCF], 240 mg [scored] [BCF] Capsule, Oral: Generic: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF] Generic: 300 mg Vitamins (Multiple/Oral) ValACYclovir Outpatient Formulary Brands Available Certavite Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 1 g Certavite Valproic Acid and Derivatives Vitamins (Multiple/Pediatric) Outpatient Formulary Brands Available Depakene; Depakote; Depakote Outpatient Formulary Brands Available Cerovite Junior ER; Depakote Sprinkle Outpatient Dosage Forms Outpatient Dosage Forms Liquid, Oral [drops]: Capsule Sprinkle, Oral, as divalproex sodium: Generic: (50 mL) Depakote Sprinkle: 125 mg [BCF] Tablet, Oral: Generic: 125 mg [BCF] Cerovite Junior: 60s Syrup, Oral, as valproate sodium: Depakene: 250 mg/5 mL (473 mL) [strength expressed as valproic acid] Vitamins (Multiple/Prenatal) Tablet Delayed Release, Oral, as divalproex sodium: Outpatient Formulary Brands Available Prenatal Plus Depakote: 125 mg [BCF], 250 mg [BCF], 500 mg [BCF] Outpatient Dosage Forms Generic: 125 mg [BCF], 250 mg [BCF], 500 mg [BCF] Content varies depending on product used. Tablet Extended Release 24 Hour, Oral, as divalproex sodium: Tablet, Oral [only available to females under 46 years of age]: Depakote ER: 250 mg [BCF], 500 mg [BCF] Prenatal Plus: 100s [BCF] Generic: 250 mg [BCF], 500 mg [BCF] Warfarin Valsartan Outpatient Dosage Forms Outpatient Formulary Brands Available Diovan Tablet, Oral, as sodium: Outpatient Dosage Forms Generic: 1 mg [BCF], 2 mg [BCF], 2.5 mg [BCF], 3 mg [BCF], 4 mg [BCF], Tablet, Oral: 5 mg [BCF], 6 mg [BCF], 7.5 mg [BCF], 10 mg [BCF] Diovan: 40 mg [scored] [BCF], 80 mg [BCF], 160 mg [BCF], 320 mg [BCF] Generic: 40 mg [BCF], 80 mg [BCF], 160 mg [BCF], 320 mg [BCF] Zaleplon Outpatient Dosage Forms Valsartan and Hydrochlorothiazide Capsule, Oral: Outpatient Formulary Brands Available Diovan HCT Generic: 5 mg, 10 mg Outpatient Dosage Forms Ziprasidone Tablet, Oral: Diovan HCT Outpatient Dosage Forms 80 mg/12.5 mg: Valsartan 80 mg and hydrochlorothiazide 12.5 mg [BCF] Capsule, Oral, as hydrochloride: 160 mg/12.5 mg: Valsartan 160 mg and hydrochlorothiazide 12.5 mg [BCF] Generic: 20 mg, 40 mg, 60 mg, 80 mg 320 mg/12.5 mg: Valsartan 320 mg and hydrochlorothiazide 12.5 mg [BCF] Zolpidem 160 mg/25 mg: Valsartan 160 mg and hydrochlorothiazide 25 mg [BCF] Outpatient Dosage Forms 320 mg/25 mg: Valsartan 320 mg and hydrochlorothiazide 25 mg [BCF] Tablet, Oral, as tartrate: Generic: Generic: 5 mg [BCF], 10 mg [BCF] 80 mg/12.5 mg: Valsartan 80 mg and hydrochlorothiazide 12.5 mg [BCF] Tablet Extended Release, Oral, as tartrate: 160 mg/12.5 mg: Valsartan 160 mg and hydrochlorothiazide 12.5 mg [BCF] Generic: 6.25 mg, 12.5 mg 160 mg/25 mg: Valsartan 160 mg and hydrochlorothiazide 25 mg [BCF] 320 mg/12.5 mg: Valsartan 320 mg and hydrochlorothiazide 12.5 mg [BCF] Zonisamide 320 mg/25 mg: Valsartan 320 mg and hydrochlorothiazide 25 mg [BCF] Outpatient Dosage Forms Venlafaxine Capsule, Oral: Generic:25 mg, 50 mg, 100 mg Outpatient Formulary Brands Available Effexor XR

26 Therapeutic Category Index

27 ABORTIFACIENT

Abortifacient Meloxicam ...... 17 Dinoprostone ...... 10 Naproxen ...... 19 Oxaprozin ...... 20 Acetylcholinesterase Inhibitor Piroxicam (Systemic) ...... 21 Pyridostigmine ...... 22 Analgesic, Opioid Acetylcholinesterase Inhibitor (Central) Acetaminophen and Codeine ...... 2 Donepezil ...... 10 Belladonna and Opium ...... 5 Rivastigmine ...... 23 Buprenorphine ...... 6 Acne Products Buprenorphine and Naloxone ...... 6 Adapalene ...... 2 Butorphanol ...... 6 Clindamycin and Benzoyl Peroxide ...... 7 Codeine ...... 8 Erythromycin (Topical) ...... 11 FentaNYL ...... 12 ISOtretinoin (Systemic) ...... 15 Hydrocodone and Acetaminophen ...... 14 Sulfur and Sulfacetamide ...... 24 HYDROmorphone ...... 14 Tretinoin (Topical) ...... 25 Meperidine ...... 17 Methadone ...... 17 Adrenergic Agonist Agent Morphine (Systemic) ...... 18 Oxymetazoline (Nasal) ...... 20 OxyCODONE ...... 20 Oxycodone and Acetaminophen ...... 20 Aldehyde Dehydrogenase Inhibitor TraMADol ...... 25 Disulfiram ...... 10 Analgesic, Opioid Partial Agonist Alkalinizing Agent, Oral Buprenorphine ...... 6 Potassium Citrate ...... 21 Buprenorphine and Naloxone ...... 6 Sodium Citrate and Citric Acid ...... 24 Butorphanol ...... 6 Alpha1 Blocker Analgesic, Topical Alfuzosin ...... 2 Benzyl Alcohol ...... 5 Doxazosin ...... 10 Lidocaine (Topical) ...... 16 Prazosin ...... 22 Tamsulosin ...... 24 Analgesic, Urinary Terazosin ...... 24 Phenazopyridine ...... 21

Alpha2-Adrenergic Agonist Androgen CloNIDine ...... 8 Testosterone ...... 25 GuanFACINE ...... 14 TiZANidine ...... 25 Anesthetic/Corticosteroid Pramoxine and Hydrocortisone ...... 21 Alpha2 Agonist, Ophthalmic Apraclonidine ...... 4 Angiotensin II Receptor Blocker Brimonidine and Timolol ...... 5 Amlodipine and Olmesartan ...... 3 Brimonidine (Ophthalmic) ...... 5 Amlodipine and Valsartan ...... 3 Brinzolamide and Brimonidine ...... 5 Candesartan ...... 6 Candesartan and Hydrochlorothiazide ...... 6 Alpha-Adrenergic Agonist Irbesartan ...... 15 Phenylephrine (Ophthalmic) ...... 21 Losartan ...... 17 Alpha/Beta Agonist Losartan and Hydrochlorothiazide ...... 17 Telmisartan ...... 24 EPINEPHrine (Systemic) ...... 10 Telmisartan and Hydrochlorothiazide ...... 24 Pseudoephedrine ...... 22 Valsartan ...... 26 5 Alpha-Reductase Inhibitor Valsartan and Hydrochlorothiazide ...... 26 Finasteride ...... 12 Angiotensin-Converting Enzyme (ACE) Inhibitor Amebicide Amlodipine and Benazepril ...... 3 MetroNIDAZOLE (Systemic) ...... 18 Benazepril ...... 5 Captopril ...... 6 Aminoquinoline (Antimalarial) Enalapril ...... 10 Chloroquine ...... 7 Fosinopril ...... 13 Hydroxychloroquine ...... 14 Lisinopril ...... 16 Primaquine ...... 22 Lisinopril and Hydrochlorothiazide ...... 16 5-Aminosalicylic Acid Derivative Perindopril and Amlodipine ...... 21 Balsalazide ...... 5 Ramipril ...... 22 Mesalamine ...... 17 Anilidopiperidine Opioid SulfaSALAzine ...... 24 FentaNYL ...... 12 Ammonium Detoxicant Lactulose ...... 16 Anthelmintic Neomycin ...... 19 Albendazole ...... 2 Analgesic Combination (Opioid) Acetaminophen and Codeine ...... 2 Ivermectin (Systemic) ...... 15 Belladonna and Opium ...... 5 Hydrocodone and Acetaminophen ...... 14 Antiandrogen Oxycodone and Acetaminophen ...... 20 Abiraterone Acetate ...... 2 Analgesic, Nonopioid Antianginal Agent Acetaminophen ...... 2 AmLODIPine ...... 3 Aspirin ...... 4 Amlodipine and Atorvastatin ...... 3 Butalbital, Acetaminophen, and Caffeine ...... 6 Amlodipine and Benazepril ...... 3 Celecoxib ...... 7 Amlodipine and Olmesartan ...... 3 Diclofenac and Misoprostol ...... 9 Amlodipine and Valsartan ...... 3 Diclofenac (Systemic) ...... 9 Atenolol ...... 4 Diflunisal ...... 9 DilTIAZem ...... 10 Etodolac ...... 12 Isosorbide Dinitrate ...... 15 Flurbiprofen (Systemic) ...... 13 Isosorbide Mononitrate ...... 15 Ibuprofen ...... 14 Metoprolol ...... 18 Indomethacin ...... 15 Nadolol ...... 19 Ketorolac (Systemic) ...... 16 NIFEdipine ...... 19 Mefenamic Acid ...... 17 Nitroglycerin ...... 19 28 ANTICOAGULANT, FACTOR XA INHIBITOR

Perindopril and Amlodipine ...... 21 Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone Propranolol ...... 22 (Ophthalmic) ...... 4 Verapamil ...... 26 Besifloxacin ...... 5 Ciprofloxacin (Ophthalmic) ...... 7 Antianxiety Agent, Miscellaneous Erythromycin (Ophthalmic) ...... 10 BusPIRone ...... 6 Gentamicin (Ophthalmic) ...... 13 Antiarrhythmic Agent, Class Ia Moxifloxacin (Ophthalmic) ...... 18 QuiNIDine ...... 22 Neomycin, Polymyxin B, and Gramicidin ...... 19 Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ...... 19 Antiarrhythmic Agent, Class Ic Ofloxacin (Ophthalmic) ...... 20 Flecainide ...... 12 Sulfacetamide (Ophthalmic) ...... 24 Propafenone ...... 22 Tobramycin (Ophthalmic) ...... 25 Antiarrhythmic Agent, Class II Trimethoprim and Polymyxin B ...... 25 Propranolol ...... 22 Antibiotic, Oral Rinse Sotalol ...... 24 Chlorhexidine Gluconate (Oral) ...... 7 Antiarrhythmic Agent, Class III Antibiotic, Otic Amiodarone ...... 3 Ciprofloxacin and Dexamethasone ...... 7 Dofetilide ...... 10 Ciprofloxacin and Fluocinolone ...... 7 Sotalol ...... 24 Ciprofloxacin and Hydrocortisone ...... 7 Antiarrhythmic Agent, Class IV Neomycin, Polymyxin B, and Hydrocortisone (Otic) ...... 19 DilTIAZem ...... 10 Ofloxacin (Otic) ...... 20 Verapamil ...... 26 Antibiotic, Penicillin Antiarrhythmic Agent, Miscellaneous Amoxicillin ...... 3 Digoxin ...... 9 Amoxicillin and Clavulanate ...... 3 Dicloxacillin ...... 9 Antibiotic, Aminoglycoside Penicillin V Potassium ...... 20 Gentamicin (Ophthalmic) ...... 13 Penicillin G (Parenteral/Aqueous) ...... 20 Neomycin ...... 19 Penicillin G Procaine ...... 20 Tobramycin (Ophthalmic) ...... 25 Antibiotic, Respiratory Fluoroquinolone Antibiotic, Cephalosporin (First Generation) LevoFLOXacin (Systemic) ...... 16 Cefadroxil ...... 6 Moxifloxacin (Systemic) ...... 18 Cephalexin ...... 7 Antibiotic, Sulfonamide Derivative Antibiotic, Cephalosporin (Second Generation) Sulfamethoxazole and Trimethoprim ...... 24 Cefaclor ...... 6 Sulfur and Sulfacetamide ...... 24 Cefuroxime ...... 7 Antibiotic, Tetracycline Derivative Antibiotic, Cephalosporin (Third Generation) Doxycycline ...... 10 Cefdinir ...... 6 Minocycline (Systemic) ...... 18 Cefpodoxime ...... 7 Tetracycline (Systemic) ...... 25 Antibiotic/Corticosteroid, Ophthalmic Antibiotic, Topical Neomycin, Polymyxin B, and Dexamethasone ...... 19 Bacitracin (Topical) ...... 4 Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ...... 19 Erythromycin (Topical) ...... 11 Tobramycin and Dexamethasone ...... 25 MetroNIDAZOLE (Topical) ...... 18 Mupirocin ...... 18 Antibiotic/Corticosteroid, Otic Silver Nitrate ...... 23 Ciprofloxacin and Dexamethasone ...... 7 Silver Sulfadiazine ...... 23 Ciprofloxacin and Fluocinolone ...... 7 Ciprofloxacin and Hydrocortisone ...... 7 Anticholinergic Agent Neomycin, Polymyxin B, and Hydrocortisone (Otic) ...... 19 Aclidinium ...... 2 Benztropine ...... 5 Antibiotic, Fluoroquinolone Dicyclomine ...... 9 Besifloxacin ...... 5 Glycopyrrolate (Systemic) ...... 13 Ciprofloxacin and Fluocinolone ...... 7 Hyoscyamine ...... 14 Ciprofloxacin (Ophthalmic) ...... 7 Hyoscyamine, Atropine, Scopolamine, and Phenobarbital ...... 14 Ciprofloxacin (Systemic) ...... 7 Ipratropium and Albuterol ...... 15 LevoFLOXacin (Systemic) ...... 16 Ipratropium (Nasal) ...... 15 Moxifloxacin (Ophthalmic) ...... 18 Ipratropium (Oral Inhalation) ...... 15 Moxifloxacin (Systemic) ...... 18 Solifenacin ...... 24 Ofloxacin (Ophthalmic) ...... 20 Tiotropium ...... 25 Ofloxacin (Otic) ...... 20 Tolterodine ...... 25 Antibiotic, Lincosamide Trihexyphenidyl ...... 25 Clindamycin (Systemic) ...... 7 Anticholinergic Agent, Long-Acting Clindamycin (Topical) ...... 7 Aclidinium ...... 2 Antibiotic, Macrolide Tiotropium ...... 25 Azithromycin (Systemic) ...... 4 Anticholinergic Agent, Ophthalmic Clarithromycin ...... 7 Atropine (Ophthalmic) ...... 4 Erythromycin (Ophthalmic) ...... 10 Cyclopentolate ...... 8 Erythromycin (Systemic) ...... 11 Homatropine ...... 14 Erythromycin (Topical) ...... 11 Anticoagulant Antibiotic, Miscellaneous Apixaban ...... 4 CycloSERINE ...... 8 Dabigatran Etexilate ...... 8 Dapsone (Systemic) ...... 8 Enoxaparin ...... 10 Fosfomycin ...... 13 Rivaroxaban ...... 23 MetroNIDAZOLE (Systemic) ...... 18 Warfarin ...... 26 Nitrofurantoin ...... 19 Sulfamethoxazole and Trimethoprim ...... 24 Anticoagulant, Direct Thrombin Inhibitor Trimethoprim ...... 25 Dabigatran Etexilate ...... 8 Antibiotic, Ophthalmic Anticoagulant, Factor Xa Inhibitor Bacitracin and Polymyxin B (Ophthalmic) ...... 4 Apixaban ...... 4 Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) ...... 4 Rivaroxaban ...... 23 29 ANTICOAGULANT, LOW MOLECULAR WEIGHT HEPARIN

Anticoagulant, Low Molecular Weight Heparin Antidiabetic Agent, Sulfonylurea Enoxaparin ...... 10 Glimepiride ...... 13 GlipiZIDE ...... 13 Anticoagulant, Vitamin K Antagonist GlyBURIDE ...... 13 Warfarin ...... 26 Glyburide and Metformin ...... 13 Anticonvulsant, Barbiturate Antidiarrheal PHENobarbital ...... 21 Diphenoxylate and Atropine ...... 10 Anticonvulsant, Benzodiazepine Loperamide ...... 17 CloBAZam ...... 7 Antidote ClonazePAM ...... 8 Acetylcysteine ...... 2 Clorazepate ...... 8 Alcohol (Ethyl) ...... 2 DiazePAM ...... 9 Calcitonin ...... 6 LORazepam ...... 17 Calcium Acetate ...... 6 Midazolam ...... 18 Glucagon ...... 13 Anticonvulsant, Hydantoin Naloxone ...... 19 Phenytoin ...... 21 Naltrexone ...... 19 Potassium Iodide ...... 21 Anticonvulsant, Miscellaneous Sodium Polystyrene Sulfonate ...... 24 AcetaZOLAMIDE ...... 2 Sugammadex ...... 24 CarBAMazepine ...... 6 Gabapentin ...... 13 Antidote, Extravasation LamoTRIgine ...... 16 Dimethyl Sulfoxide ...... 10 LevETIRAcetam ...... 16 Nitroglycerin ...... 19 OXcarbazepine ...... 20 Terbutaline ...... 24 Pregabalin ...... 22 Antidote, Hypoglycemia Primidone ...... 22 Diazoxide ...... 9 Topiramate ...... 25 Glucagon ...... 13 Valproic Acid and Derivatives ...... 26 Zonisamide ...... 26 Antiemetic Aprepitant ...... 4 Anticonvulsant, Succinimide DexAMETHasone (Systemic) ...... 9 Ethosuximide ...... 12 HydrOXYzine ...... 14 Antidepressant, Alpha-2 Antagonist Meclizine ...... 17 Mirtazapine ...... 18 Metoclopramide ...... 18 Ondansetron ...... 20 Antidepressant, Dopamine/Norepinephrine-Reuptake Inhibitor Prochlorperazine ...... 22 BuPROPion ...... 6 Promethazine ...... 22 Antidepressant, Selective Serotonin Reuptake Inhibitor Antifibrinolytic Agent Citalopram ...... 7 Aminocaproic Acid ...... 3 Escitalopram ...... 11 Tranexamic Acid ...... 25 FLUoxetine ...... 13 Antiflatulent FluvoxaMINE ...... 13 PARoxetine ...... 20 Simethicone ...... 23 Sertraline ...... 23 Antifungal Agent, Azole Derivative Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor Itraconazole ...... 15 Desvenlafaxine ...... 9 Terconazole ...... 24 DULoxetine ...... 10 Venlafaxine ...... 26 Antifungal Agent, Imidazole Derivative Antidepressant, Serotonin Reuptake Inhibitor/Antagonist Clotrimazole (Oral) ...... 8 Clotrimazole (Topical) ...... 8 TraZODone ...... 25 Ketoconazole (Systemic) ...... 15 Antidepressant, Tricyclic (Secondary Amine) Ketoconazole (Topical) ...... 15 Desipramine ...... 8 Antifungal Agent, Oral Nortriptyline ...... 19 Fluconazole ...... 12 Antidepressant, Tricyclic (Tertiary Amine) Griseofulvin ...... 14 Amitriptyline ...... 3 Itraconazole ...... 15 ClomiPRAMINE ...... 8 Ketoconazole (Systemic) ...... 15 Doxepin (Systemic) ...... 10 Terbinafine (Systemic) ...... 24 Imipramine ...... 14 Antifungal Agent, Oral Nonabsorbed Antidiabetic Agent, Alpha-Glucosidase Inhibitor Clotrimazole (Oral) ...... 8 Acarbose ...... 2 Antifungal Agent, Oral Nonabsorbed/Partially Absorbed Antidiabetic Agent, Biguanide Clotrimazole (Topical) ...... 8 Glyburide and Metformin ...... 13 Nystatin (Oral) ...... 19 MetFORMIN ...... 17 Antifungal Agent, Parenteral Sitagliptin and Metformin ...... 23 Fluconazole ...... 12 Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) Inhibitor Antifungal Agent, Topical SITagliptin ...... 23 Betamethasone and Clotrimazole ...... 5 Sitagliptin and Metformin ...... 23 Ciclopirox ...... 7 Antidiabetic Agent, Dopamine Agonist Clotrimazole (Topical) ...... 8 Bromocriptine ...... 5 Ketoconazole (Topical) ...... 15 Naftifine ...... 19 Antidiabetic Agent, Glucagon-Like Peptide-1 (GLP-1) Receptor Nystatin and Triamcinolone ...... 19 Agonist Nystatin (Topical) ...... 20 Exenatide ...... 12 Terbinafine (Topical) ...... 24 Semaglutide ...... 23 Tolnaftate ...... 25 Antidiabetic Agent, Sodium-Glucose Cotransporter 2 (SGLT2) Antifungal Agent, Vaginal Inhibitor Clotrimazole (Topical) ...... 8 Empagliflozin ...... 10 Terconazole ...... 24 30 ANTINEOPLASTIC AGENT, TYROSINE KINASE INHIBITOR

Antigout Agent Pravastatin ...... 21 Allopurinol ...... 3 Rosuvastatin ...... 23 Colchicine ...... 8 Simvastatin ...... 23 Antihemophilic Agent Antilipemic Agent, Miscellaneous Aminocaproic Acid ...... 3 Niacin ...... 19 Desmopressin ...... 9 Antilipemic Agent, Omega-3 Fatty Acids Tranexamic Acid ...... 25 Omega-3 Fatty Acids ...... 20 Antihemorrhoidal Agent Antilipemic Agent, PCSK9 Inhibitor Dibucaine ...... 9 Hydrocortisone (Topical) ...... 14 Alirocumab ...... 3 Antihepadnaviral, Reverse Transcriptase Inhibitor, Nucleotide Antimalarial Agent Artemether and Lumefantrine ...... 4 (Anti-HBV) Atovaquone and Proguanil ...... 4 Adefovir ...... 2 Chloroquine ...... 7 Antihypertensive Hydroxychloroquine ...... 14 AMILoride ...... 3 Mefloquine ...... 17 Amiloride and Hydrochlorothiazide ...... 3 Primaquine ...... 22 AmLODIPine ...... 3 QuiNIDine ...... 22 Amlodipine and Atorvastatin ...... 3 Antimanic Agent Amlodipine and Benazepril ...... 3 ChlorproMAZINE ...... 7 Amlodipine and Olmesartan ...... 3 Amlodipine and Valsartan ...... 3 Lithium ...... 16 Atenolol ...... 4 RisperiDONE ...... 23 Benazepril ...... 5 Valproic Acid and Derivatives ...... 26 Bisoprolol ...... 5 Antimigraine Agent Bisoprolol and Hydrochlorothiazide ...... 5 Ergotamine and Caffeine ...... 10 Candesartan ...... 6 Rizatriptan ...... 23 Candesartan and Hydrochlorothiazide ...... 6 SUMAtriptan ...... 24 Captopril ...... 6 Carvedilol ...... 6 Antineoplastic Agent, Antiandrogen Chlorthalidone ...... 7 Abiraterone Acetate ...... 2 CloNIDine ...... 8 Bicalutamide ...... 5 DilTIAZem ...... 10 Darolutamide ...... 8 Doxazosin ...... 10 Flutamide ...... 13 Enalapril ...... 10 Eplerenone ...... 10 Antineoplastic Agent, Antimetabolite Fosinopril ...... 13 Fluorouracil (Topical) ...... 13 Furosemide ...... 13 Mercaptopurine ...... 17 GuanFACINE ...... 14 Antineoplastic Agent, Antimetabolite (Antifolate) HydrALAZINE ...... 14 Methotrexate ...... 18 HydroCHLOROthiazide ...... 14 Hydrochlorothiazide and Spironolactone ...... 14 Antineoplastic Agent, Antimetabolite (Purine Analog) Hydrochlorothiazide and Triamterene ...... 14 Mercaptopurine ...... 17 Indapamide ...... 15 Antineoplastic Agent, Antimetabolite (Pyrimidine Analog) Irbesartan ...... 15 Labetalol ...... 16 Fluorouracil (Topical) ...... 13 Lisinopril ...... 16 Antineoplastic Agent, Aromatase Inhibitor Lisinopril and Hydrochlorothiazide ...... 16 Anastrozole ...... 4 Losartan ...... 17 Letrozole ...... 16 Losartan and Hydrochlorothiazide ...... 17 Metoprolol ...... 18 Antineoplastic Agent, Cyclin-Dependent Kinase Inhibitor Minoxidil (Systemic) ...... 18 Abemaciclib ...... 2 Nadolol ...... 19 Antineoplastic Agent, Estrogen Receptor Antagonist NIFEdipine ...... 19 Tamoxifen ...... 24 Perindopril and Amlodipine ...... 21 Pindolol ...... 21 Antineoplastic Agent, FLT3 Inhibitor Prazosin ...... 22 Fedratinib ...... 12 Propranolol ...... 22 Ramipril ...... 22 Antineoplastic Agent, Gonadotropin-Releasing Hormone Agonist Spironolactone ...... 24 Goserelin ...... 14 Telmisartan ...... 24 Leuprolide ...... 16 Telmisartan and Hydrochlorothiazide ...... 24 Antineoplastic Agent, Hormone Terazosin ...... 24 Megestrol ...... 17 Torsemide ...... 25 Valsartan ...... 26 Antineoplastic Agent, Janus Associated Kinase Inhibitor Valsartan and Hydrochlorothiazide ...... 26 Fedratinib ...... 12 Verapamil ...... 26 Antineoplastic Agent, Miscellaneous Anti-inflammatory Agent Hydroxyurea ...... 14 Balsalazide ...... 5 DexAMETHasone (Systemic) ...... 9 Antineoplastic Agent, Nuclear Export Inhibitor Selinexor ...... 23 Antilipemic Agent, 2-Azetidinone Ezetimibe ...... 12 Antineoplastic Agent, Phosphatidylinositol 3-Kinase Inhibitor Alpelisib ...... 3 Antilipemic Agent, Bile Acid Sequestrant Cholestyramine Resin ...... 7 Antineoplastic Agent, Retinoic Acid Derivative Colestipol ...... 8 Bexarotene (Topical) ...... 5 ISOtretinoin (Systemic) ...... 15 Antilipemic Agent, Fibric Acid Tretinoin (Systemic) ...... 25 Fenofibrate and Derivatives ...... 12 Gemfibrozil ...... 13 Antineoplastic Agent, Tropomyosin Receptor Kinase (TRK) Inhibitor Antilipemic Agent, HMG-CoA Reductase Inhibitor Entrectinib ...... 10 Amlodipine and Atorvastatin ...... 3 AtorvaSTATin ...... 4 Antineoplastic Agent, Tyrosine Kinase Inhibitor Lovastatin ...... 17 Entrectinib ...... 10 31 ANTINEOPLASTIC AGENT, TYROSINE KINASE INHIBITOR

Fedratinib ...... 12 Antispasmodic Agent, Urinary Pexidartinib ...... 21 Belladonna and Opium ...... 5 Antiparasitic Agent, Topical Oxybutynin ...... 20 Benzyl Alcohol ...... 5 Antithyroid Agent Permethrin ...... 21 MethIMAzole ...... 17 Anti-Parkinson Agent, Anticholinergic Potassium Iodide ...... 21 Propylthiouracil ...... 22 Benztropine ...... 5 Trihexyphenidyl ...... 25 Antitubercular Agent Anti-Parkinson Agent, Decarboxylase Inhibitor CycloSERINE ...... 8 Ethambutol ...... 11 Carbidopa and Levodopa ...... 6 Isoniazid ...... 15 Anti-Parkinson Agent, Dopamine Agonist Pyrazinamide ...... 22 Amantadine ...... 3 RifAMPin ...... 23 Bromocriptine ...... 5 Antitussive Pramipexole ...... 21 Benzonatate ...... 5 ROPINIRole ...... 23 Codeine ...... 8 Anti-Parkinson Agent, Dopamine Precursor Guaifenesin and Codeine ...... 14 Carbidopa and Levodopa ...... 6 Guaifenesin and Dextromethorphan ...... 14 Antiplatelet Agent Antiviral Agent Anagrelide ...... 4 Acyclovir (Systemic) ...... 2 Aspirin ...... 4 Amantadine ...... 3 Aspirin and Dipyridamole ...... 4 Oseltamivir ...... 20 Cilostazol ...... 7 ValACYclovir ...... 26 Clopidogrel ...... 8 Antiviral Agent, Adamantane Dipyridamole ...... 10 Amantadine ...... 3 Prasugrel ...... 21 Ticagrelor ...... 25 Antiviral Agent, Ophthalmic Ganciclovir (Ophthalmic) ...... 13 Antiplatelet Agent, Non-thienopyridine Ticagrelor ...... 25 Antiviral Agent, Oral ValACYclovir ...... 26 Antiplatelet Agent, Thienopyridine Clopidogrel ...... 8 Antiviral Agent, Topical Prasugrel ...... 21 Acyclovir and Hydrocortisone ...... 2 Acyclovir (Topical) ...... 2 Antiprotozoal, Nitroimidazole MetroNIDAZOLE (Systemic) ...... 18 Appetite Stimulant Megestrol ...... 17 Antiretroviral, Integrase Inhibitor (Anti-HIV) Abacavir, Dolutegravir, and Lamivudine ...... 2 Barbiturate Bictegravir, Emtricitabine, and Tenofovir Alafenamide ...... 5 Butalbital, Acetaminophen, and Caffeine ...... 6 Raltegravir ...... 22 PHENobarbital ...... 21 Primidone ...... 22 Antiretroviral, Protease Inhibitor (Anti-HIV) Atazanavir ...... 4 Benzodiazepine Atazanavir and Cobicistat ...... 4 ALPRAZolam ...... 3 ChlordiazePOXIDE ...... 7 Antiretroviral, Reverse Transcriptase Inhibitor, Non-nucleoside CloBAZam ...... 7 (Anti-HIV) ClonazePAM ...... 8 Efavirenz, Emtricitabine, and Tenofovir Disoproxil Fumarate ...... 10 Clorazepate ...... 8 Emtricitabine, Rilpivirine, and Tenofovir Disoproxil Fumarate ...... 10 DiazePAM ...... 9 Antiretroviral, Reverse Transcriptase Inhibitor, Nucleoside (Anti- LORazepam ...... 17 HIV) Midazolam ...... 18 Abacavir, Dolutegravir, and Lamivudine ...... 2 Temazepam ...... 24 Bictegravir, Emtricitabine, and Tenofovir Alafenamide ...... 5 Beta2-Adrenergic Agonist Efavirenz, Emtricitabine, and Tenofovir Disoproxil Fumarate ...... 10 Arformoterol ...... 4 Emtricitabine and Tenofovir Disoproxil Fumarate ...... 10 Ipratropium and Albuterol ...... 15 Emtricitabine, Rilpivirine, and Tenofovir Disoproxil Fumarate ...... 10 Lamivudine and Tenofovir Disoproxil Fumarate ...... 16 Beta2-Adrenergic Agonist, Long-Acting Arformoterol ...... 4 Antiretroviral, Reverse Transcriptase Inhibitor, Nucleotide (Anti- Fluticasone and Salmeterol ...... 13 HIV) Salmeterol ...... 23 Bictegravir, Emtricitabine, and Tenofovir Alafenamide ...... 5 Efavirenz, Emtricitabine, and Tenofovir Disoproxil Fumarate ...... 10 Beta2 Agonist Emtricitabine and Tenofovir Disoproxil Fumarate ...... 10 Albuterol ...... 2 Emtricitabine, Rilpivirine, and Tenofovir Disoproxil Fumarate ...... 10 Fluticasone and Salmeterol ...... 13 Lamivudine and Tenofovir Disoproxil Fumarate ...... 16 Levalbuterol ...... 16 Salmeterol ...... 23 Antirheumatic, Disease Modifying Terbutaline ...... 24 Adalimumab ...... 2 Baricitinib ...... 5 Beta3 Agonist Leflunomide ...... 16 Mirabegron ...... 18 Methotrexate ...... 18 Beta-Adrenergic Blocker, Nonselective Antirheumatic Miscellaneous Dorzolamide and Timolol ...... 10 Baricitinib ...... 5 Propranolol ...... 22 Sotalol ...... 24 Antiseborrheic Agent, Topical Selenium Sulfide ...... 23 Beta-Blocker, Beta-1 Selective Sulfur and Salicylic Acid ...... 24 Atenolol ...... 4 Sulfur and Sulfacetamide ...... 24 Bisoprolol ...... 5 Bisoprolol and Hydrochlorothiazide ...... 5 Antiseptic, Topical Metoprolol ...... 18 Iodine ...... 15 Beta-Blocker, Nonselective Antispasmodic Agent, Gastrointestinal Brimonidine and Timolol ...... 5 Hyoscyamine, Atropine, Scopolamine, and Phenobarbital ...... 14 Metipranolol ...... 18 32 DIURETIC, COMBINATION

Nadolol ...... 19 Ethinyl Estradiol and Drospirenone ...... 11 Timolol (Ophthalmic) ...... 25 Ethinyl Estradiol and Ethynodiol Diacetate ...... 11 Ethinyl Estradiol and Etonogestrel ...... 11 Beta-Blocker With Alpha-Blocking Activity Ethinyl Estradiol and Levonorgestrel ...... 11 Carvedilol ...... 6 Ethinyl Estradiol and Norelgestromin ...... 11 Labetalol ...... 16 Ethinyl Estradiol and Norethindrone ...... 11 Beta-Blocker With Intrinsic Sympathomimetic Activity Ethinyl Estradiol and Norgestimate ...... 12 Pindolol ...... 21 Ethinyl Estradiol, Drospirenone, and Levomefolate ...... 12 Levonorgestrel (Systemic) ...... 16 Bisphosphonate Derivative MedroxyPROGESTERone ...... 17 Alendronate ...... 2 Norethindrone ...... 19 Alendronate and Cholecalciferol ...... 2 Norethindrone and Mestranol ...... 19 Ibandronate ...... 14 Segesterone Acetate and Ethinyl Estradiol ...... 23 Risedronate ...... 23 Corticosteroid, Inhalant (Oral) Blood Product Derivative Budesonide (Oral Inhalation) ...... 5 Prothrombin Complex Concentrate (Human) [(Factors II, VII, IX, X), Fluticasone and Salmeterol ...... 13 Protein C, and Protein S] ...... 22 Fluticasone (Oral Inhalation) ...... 13 Mometasone (Oral Inhalation) ...... 18 Blood Viscosity Reducer Agent Pentoxifylline ...... 20 Corticosteroid, Nasal Flunisolide (Nasal) ...... 12 Calcimimetic Fluticasone (Nasal) ...... 13 Cinacalcet ...... 7 Mometasone (Nasal) ...... 18 Calcineurin Inhibitor Corticosteroid, Ophthalmic CycloSPORINE (Ophthalmic) ...... 8 Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone CycloSPORINE (Systemic) ...... 8 (Ophthalmic) ...... 4 Pimecrolimus ...... 21 Difluprednate ...... 9 Tacrolimus (Topical) ...... 24 Fluorometholone ...... 12 Calcium Channel Blocker Loteprednol ...... 17 AmLODIPine ...... 3 Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ...... 19 Amlodipine and Atorvastatin ...... 3 PrednisoLONE (Ophthalmic) ...... 22 Amlodipine and Benazepril ...... 3 Corticosteroid, Otic Amlodipine and Olmesartan ...... 3 Ciprofloxacin and Dexamethasone ...... 7 Amlodipine and Valsartan ...... 3 Ciprofloxacin and Fluocinolone ...... 7 DilTIAZem ...... 10 Ciprofloxacin and Hydrocortisone ...... 7 NIFEdipine ...... 19 Neomycin, Polymyxin B, and Hydrocortisone (Otic) ...... 19 Perindopril and Amlodipine ...... 21 Verapamil ...... 26 Corticosteroid, Rectal Budesonide (Topical) ...... 5 Calcium Channel Blocker, Dihydropyridine Hydrocortisone (Topical) ...... 14 AmLODIPine ...... 3 Amlodipine and Atorvastatin ...... 3 Corticosteroid, Systemic Amlodipine and Benazepril ...... 3 Budesonide (Systemic) ...... 5 Amlodipine and Olmesartan ...... 3 DexAMETHasone (Systemic) ...... 9 Amlodipine and Valsartan ...... 3 Fludrocortisone ...... 12 NIFEdipine ...... 19 Hydrocortisone (Systemic) ...... 14 Perindopril and Amlodipine ...... 21 MethylPREDNISolone ...... 18 PrednisoLONE (Systemic) ...... 22 Calcium Channel Blocker, Nondihydropyridine PredniSONE ...... 22 DilTIAZem ...... 10 Verapamil ...... 26 Corticosteroid, Topical Acyclovir and Hydrocortisone ...... 2 Calcium Salt Alclometasone ...... 2 Calcium Acetate ...... 6 Betamethasone and Clotrimazole ...... 5 Carbonic Anhydrase Inhibitor Betamethasone (Topical) ...... 5 AcetaZOLAMIDE ...... 2 Calcipotriene and Betamethasone ...... 6 MethazolAMIDE ...... 17 Clobetasol ...... 8 Desonide ...... 9 Carbonic Anhydrase Inhibitor (Ophthalmic) Fluocinolone (Topical) ...... 12 Brinzolamide and Brimonidine ...... 5 Fluocinonide ...... 12 Dorzolamide ...... 10 Flurandrenolide ...... 13 Dorzolamide and Timolol ...... 10 Hydrocortisone (Topical) ...... 14 Nystatin and Triamcinolone ...... 19 Cardiac Glycoside Triamcinolone (Topical) ...... 25 Digoxin ...... 9 Cytochrome P-450 Inhibitor Cathartic Atazanavir and Cobicistat ...... 4 Sodium Phosphates ...... 24 Decongestant Cauterizing Agent, Topical Oxymetazoline (Nasal) ...... 20 Silver Nitrate ...... 23 Pseudoephedrine ...... 22 Central Nervous System Stimulant Depigmenting Agent Armodafinil ...... 4 Hydroquinone ...... 14 Dextroamphetamine ...... 9 Dextroamphetamine and Amphetamine ...... 9 Diagnostic Agent Ergotamine and Caffeine ...... 10 Glucagon ...... 13 Methylphenidate ...... 18 Modafinil ...... 18 Direct Oral Anticoagulant (DOAC) Apixaban ...... 4 Chloride Channel Activator Dabigatran Etexilate ...... 8 Lubiprostone ...... 17 Rivaroxaban ...... 23 Cholinergic Agonist Diuretic, Carbonic Anhydrase Inhibitor Bethanechol ...... 5 AcetaZOLAMIDE ...... 2 Pilocarpine (Systemic) ...... 21 MethazolAMIDE ...... 17 Contraceptive Diuretic, Combination Ethinyl Estradiol and Desogestrel ...... 11 Amiloride and Hydrochlorothiazide ...... 3 33 DIURETIC, LOOP

Diuretic, Loop Gastrointestinal Agent, Miscellaneous Furosemide ...... 13 Adalimumab ...... 2 Torsemide ...... 25 LinaCLOtide ...... 16 Lubiprostone ...... 17 Diuretic, Potassium-Sparing Naldemedine ...... 19 AMILoride ...... 3 Sucralfate ...... 24 Eplerenone ...... 10 Hydrochlorothiazide and Triamterene ...... 14 Gastrointestinal Agent, Prokinetic Spironolactone ...... 24 Metoclopramide ...... 18 Diuretic, Thiazide General Anesthetic Bisoprolol and Hydrochlorothiazide ...... 5 FentaNYL ...... 12 Candesartan and Hydrochlorothiazide ...... 6 HydroCHLOROthiazide ...... 14 Genitourinary Irrigant Hydrochlorothiazide and Spironolactone ...... 14 Sodium Chloride ...... 23 Hydrochlorothiazide and Triamterene ...... 14 Gonadotropin Releasing Hormone Agonist Lisinopril and Hydrochlorothiazide ...... 16 Goserelin ...... 14 Losartan and Hydrochlorothiazide ...... 17 Leuprolide ...... 16 Telmisartan and Hydrochlorothiazide ...... 24 Valsartan and Hydrochlorothiazide ...... 26 Gonadotropin Releasing Hormone Antagonist Cetrorelix ...... 7 Diuretic, Thiazide-Related Chlorthalidone ...... 7 Guanylate Cyclase-C (GC-C) Agonist Indapamide ...... 15 LinaCLOtide ...... 16 MetOLazone ...... 18 Hemostatic Agent Dopamine Antagonist Aluminum Chloride Hexahydrate ...... 3 Metoclopramide ...... 18 Aminocaproic Acid ...... 3 Desmopressin ...... 9 Electrolyte Supplement, Oral Prothrombin Complex Concentrate (Human) [(Factors II, VII, IX, X), Potassium Chloride ...... 21 Protein C, and Protein S] ...... 22 Potassium Phosphate and Sodium Phosphate ...... 21 Tranexamic Acid ...... 25 Electrolyte Supplement, Parenteral Histamine H1 Antagonist Potassium Chloride ...... 21 Azelastine (Nasal) ...... 4 Potassium Phosphate ...... 21 Azelastine (Ophthalmic) ...... 4 Sodium Chloride ...... 23 Cetirizine (Systemic) ...... 7 Sodium Phosphates ...... 24 Cyproheptadine ...... 8 Enzyme DiphenhydrAMINE (Systemic) ...... 10 Dornase Alfa ...... 10 Fexofenadine ...... 12 Pancrelipase ...... 20 HydrOXYzine ...... 14 Ketotifen (Ophthalmic) ...... 16 Ergot Derivative Loratadine ...... 17 Bromocriptine ...... 5 Meclizine ...... 17 Cabergoline ...... 6 Olopatadine (Nasal) ...... 20 Ergotamine and Caffeine ...... 10 Olopatadine (Ophthalmic) ...... 20 Methylergonovine ...... 18 Promethazine ...... 22

Estrogen and Androgen Combination Histamine H1 Antagonist, First Generation Estrogens (Esterified) and Methyltestosterone ...... 11 Cyproheptadine ...... 8 DiphenhydrAMINE (Systemic) ...... 10 Estrogen and Progestin Combination HydrOXYzine ...... 14 Estrogens (Conjugated/Equine) and Medroxyprogesterone ...... 11 Meclizine ...... 17 Ethinyl Estradiol and Desogestrel ...... 11 Promethazine ...... 22 Ethinyl Estradiol and Drospirenone ...... 11 Ethinyl Estradiol and Ethynodiol Diacetate ...... 11 Histamine H1 Antagonist, Second Generation Ethinyl Estradiol and Etonogestrel ...... 11 Azelastine (Nasal) ...... 4 Ethinyl Estradiol and Levonorgestrel ...... 11 Azelastine (Ophthalmic) ...... 4 Ethinyl Estradiol and Norelgestromin ...... 11 Cetirizine (Systemic) ...... 7 Ethinyl Estradiol and Norethindrone ...... 11 Fexofenadine ...... 12 Ethinyl Estradiol and Norgestimate ...... 12 Ketotifen (Ophthalmic) ...... 16 Ethinyl Estradiol, Drospirenone, and Levomefolate ...... 12 Loratadine ...... 17 Norethindrone and Mestranol ...... 19 Olopatadine (Nasal) ...... 20 Segesterone Acetate and Ethinyl Estradiol ...... 23 Olopatadine (Ophthalmic) ...... 20

Estrogen Derivative Histamine H2 Antagonist Estradiol (Systemic) ...... 11 Cimetidine ...... 7 Estrogens (Conjugated/Equine, Systemic) ...... 11 Famotidine ...... 12 Estrogens (Conjugated/Equine, Topical) ...... 11 RaNITIdine (Withdrawn From US Market) ...... 22 Ethanolamine Derivative Histone Deacetylase Inhibitor DiphenhydrAMINE (Systemic) ...... 10 Valproic Acid and Derivatives ...... 26 Expectorant Hormone Guaifenesin and Codeine ...... 14 Calcitonin ...... 6 Guaifenesin and Dextromethorphan ...... 14 Potassium Iodide ...... 21 Hormone, Posterior Pituitary Desmopressin ...... 9 First Generation (Typical) Antipsychotic ChlorproMAZINE ...... 7 Hypnotic, Miscellaneous Haloperidol ...... 14 Eszopiclone ...... 11 Prochlorperazine ...... 22 Zaleplon ...... 26 Zolpidem ...... 26 GABA Agonist/Glutamate Antagonist Acamprosate ...... 2 Imidazoline Derivative Oxymetazoline (Nasal) ...... 20 GABA Analog Gabapentin ...... 13 Immunosuppressant Agent Pregabalin ...... 22 AzaTHIOprine ...... 4 CycloSPORINE (Ophthalmic) ...... 8 Gallstone Dissolution Agent CycloSPORINE (Systemic) ...... 8 Ursodiol ...... 26 Mercaptopurine ...... 17 34 OPIOID ANTAGONIST, PERIPHERALLY-ACTING

Methotrexate ...... 18 Belimumab ...... 5 Mycophenolate ...... 19 Palivizumab ...... 20 Pimecrolimus ...... 21 Tacrolimus (Topical) ...... 24 Monoclonal Antibody, Anti-Asthmatic Omalizumab ...... 20 Inhalation, Miscellaneous Inhalation Devices ...... 15 Mucolytic Agent Acetylcysteine ...... 2 Insulin, Combination Dornase Alfa ...... 10 Insulin Aspart Protamine and Insulin Aspart ...... 15 Insulin NPH and Insulin Regular ...... 15 Neuraminidase Inhibitor Oseltamivir ...... 20 Insulin, Intermediate-Acting Insulin NPH ...... 15 N-Methyl-D-Aspartate (NMDA) Receptor Antagonist Esketamine ...... 11 Insulin, Long-Acting Memantine ...... 17 Insulin Detemir ...... 15 Insulin Glargine ...... 15 Nonsteroidal Anti-inflammatory Drug (NSAID) Diclofenac (Ophthalmic) ...... 9 Insulin, Rapid-Acting Diclofenac (Systemic) ...... 9 Insulin Aspart ...... 15 Diclofenac (Topical) ...... 9 Insulin Glulisine ...... 15 Nonsteroidal Anti-inflammatory Drug (NSAID), COX-2 Selective Insulin Lispro ...... 15 Celecoxib ...... 7 Insulin, Short-Acting Nonsteroidal Anti-inflammatory Drug (NSAID), Ophthalmic Insulin Regular ...... 15 Bromfenac ...... 5 Iron Preparations Diclofenac (Ophthalmic) ...... 9 Ferrous Sulfate ...... 12 Ketorolac (Ophthalmic) ...... 16 Nepafenac ...... 19 Irrigant Sodium Chloride ...... 23 Nonsteroidal Anti-inflammatory Drug (NSAID), Oral Aspirin ...... 4 Janus Associated Kinase Inhibitor Diclofenac and Misoprostol ...... 9 Fedratinib ...... 12 Diclofenac (Systemic) ...... 9 Janus Kinase Inhibitor Diflunisal ...... 9 Baricitinib ...... 5 Etodolac ...... 12 Flurbiprofen (Systemic) ...... 13 Keratolytic Agent Ibuprofen ...... 14 Podofilox ...... 21 Indomethacin ...... 15 Urea (Topical) ...... 26 Ketorolac (Systemic) ...... 16 Mefenamic Acid ...... 17 Laxative, Bowel Evacuant Meloxicam ...... 17 Sodium Phosphates ...... 24 Naproxen ...... 19 Laxative, Osmotic Oxaprozin ...... 20 Lactulose ...... 16 Piroxicam (Systemic) ...... 21 Polyethylene Glycol 3350 ...... 21 Nonsteroidal Anti-inflammatory Drug (NSAID), Parenteral Polyethylene Glycol-Electrolyte Solution ...... 21 Ibuprofen ...... 14 Laxative, Saline Indomethacin ...... 15 Magnesium Citrate ...... 17 Ketorolac (Systemic) ...... 16 Meloxicam ...... 17 Laxative, Stimulant Bisacodyl ...... 5 Nonsteroidal Anti-inflammatory Drug (NSAID), Topical Diclofenac (Topical) ...... 9 Leukotriene-Receptor Antagonist Montelukast ...... 18 Norepinephrine Reuptake Inhibitor, Selective AtoMOXetine ...... 4 Local Anesthetic Dibucaine ...... 9 Nutritional Supplement Lidocaine (Topical) ...... 16 Fluoride ...... 12 Lubricant, Ocular Ophthalmic Agent, Antiglaucoma Sodium Chloride ...... 23 AcetaZOLAMIDE ...... 2 Betaxolol (Ophthalmic) ...... 5 Lymphocyte Function-Associated Antigen 1 (LFA-1) Antagonist Bimatoprost ...... 5 Lifitegrast ...... 16 Brimonidine and Timolol ...... 5 Brimonidine (Ophthalmic) ...... 5 Lysine Analog Brinzolamide and Brimonidine ...... 5 Aminocaproic Acid ...... 3 Dorzolamide ...... 10 Tranexamic Acid ...... 25 Dorzolamide and Timolol ...... 10 Magnesium Salt Latanoprost ...... 16 Magnesium Citrate ...... 17 MethazolAMIDE ...... 17 Metipranolol ...... 18 Mast Cell Stabilizer Pilocarpine (Ophthalmic) ...... 21 Cromolyn (Ophthalmic) ...... 8 Timolol (Ophthalmic) ...... 25 Ketotifen (Ophthalmic) ...... 16 Ophthalmic Agent, Miotic Melanocortin Receptor Agonist Pilocarpine (Ophthalmic) ...... 21 Bremelanotide ...... 5 Ophthalmic Agent, Mydriatic Mineralocorticoid (Aldosterone) Receptor Antagonists Atropine (Ophthalmic) ...... 4 Eplerenone ...... 10 Cyclopentolate and Phenylephrine ...... 8 Hydrochlorothiazide and Spironolactone ...... 14 Homatropine ...... 14 Spironolactone ...... 24 Phenylephrine (Ophthalmic) ...... 21 Tropicamide ...... 25 Miscellaneous Product Condom ...... 8 Opioid Antagonist Diabetic Supplies ...... 9 Naloxone ...... 19 Naltrexone ...... 19 Monoclonal Antibody Adalimumab ...... 2 Opioid Antagonist, Peripherally-Acting Alirocumab ...... 3 Naldemedine ...... 19 35 OTIC AGENT, ANTI-INFECTIVE

Otic Agent, Anti-infective Retinoid-Like Compound Acetic Acid (Otic) ...... 2 Acitretin ...... 2 Acetic Acid, Propylene Glycol Diacetate, and Hydrocortisone ...... 2 Rifamycin Ovulation Stimulator RifAMPin ...... 23 ClomiPHENE ...... 8 Salicylate P2Y12 Antagonist Aspirin ...... 4 Clopidogrel ...... 8 Salsalate ...... 23 Prasugrel ...... 21 Ticagrelor ...... 25 Scabicidal Agent Crotamiton ...... 8 Pediculocide Permethrin ...... 21 Benzyl Alcohol ...... 5 Permethrin ...... 21 Second Generation (Atypical) Antipsychotic ARIPiprazole ...... 4 Pharmaceutical Aid Lurasidone ...... 17 Alcohol (Ethyl) ...... 2 QUEtiapine ...... 22 Phenothiazine Derivative RisperiDONE ...... 23 Ziprasidone ...... 26 ChlorproMAZINE ...... 7 Prochlorperazine ...... 22 Selective 5-HT3 Receptor Antagonist Promethazine ...... 22 Alosetron ...... 3 Phosphate Binder Ondansetron ...... 20 Calcium Acetate ...... 6 Selective Estrogen Receptor Modulator (SERM) Lanthanum ...... 16 ClomiPHENE ...... 8 Sevelamer ...... 23 Raloxifene ...... 22 Phosphodiesterase-3 Enzyme Inhibitor Tamoxifen ...... 24 Anagrelide ...... 4 Selective Relaxant Binding Agent Cilostazol ...... 7 Sugammadex ...... 24

Phosphodiesterase-4 Enzyme Inhibitor Serotonin 5-HT1B, 1D Receptor Agonist Apremilast ...... 4 Rizatriptan ...... 23 Phosphodiesterase-5 Enzyme Inhibitor SUMAtriptan ...... 24

Sildenafil ...... 23 Serotonin 5-HT4 Receptor Agonist Tadalafil ...... 24 Metoclopramide ...... 18 Phosphodiesterase Enzyme Inhibitor, Nonselective Skeletal Muscle Relaxant Theophylline ...... 25 Baclofen ...... 5 Piperazine Derivative Carisoprodol ...... 6 Cetirizine (Systemic) ...... 7 Carisoprodol and Aspirin ...... 6 HydrOXYzine ...... 14 Chlorzoxazone ...... 7 Meclizine ...... 17 Cyclobenzaprine ...... 8 Metaxalone ...... 17 Piperidine Derivative Methocarbamol ...... 17 Cyproheptadine ...... 8 Fexofenadine ...... 12 Skin and Mucous Membrane Agent Ketotifen (Ophthalmic) ...... 16 Imiquimod ...... 15 Loratadine ...... 17 Smoking Cessation Aid Olopatadine (Nasal) ...... 20 BuPROPion ...... 6 Olopatadine (Ophthalmic) ...... 20 Nicotine ...... 19 Potassium Binder Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor Sodium Polystyrene Sulfonate ...... 24 Empagliflozin ...... 10 Progestin Sodium Salt HYDROXYprogesterone Caproate ...... 14 Sodium Chloride ...... 23 Levonorgestrel (Systemic) ...... 16 MedroxyPROGESTERone ...... 17 Substance P/Neurokinin 1 Receptor Antagonist Megestrol ...... 17 Aprepitant ...... 4 Norethindrone ...... 19 Progesterone ...... 22 Substituted Benzimidazole Esomeprazole ...... 11 Prostaglandin Omeprazole ...... 20 Alprostadil ...... 3 Pantoprazole ...... 20 Diclofenac and Misoprostol ...... 9 Dinoprostone ...... 10 Thioamide MiSOPROStol ...... 18 MethIMAzole ...... 17 Propylthiouracil ...... 22 Prostaglandin, Ophthalmic Bimatoprost ...... 5 Thyroid Product Latanoprost ...... 16 Levothyroxine ...... 16 Liothyronine ...... 16 Prothrombin Complex Concentrate (PCC) Thyroid, Desiccated ...... 25 Prothrombin Complex Concentrate (Human) [(Factors II, VII, IX, X), Protein C, and Protein S] ...... 22 Topical Skin Product Aluminum Chloride Hexahydrate ...... 3 Proton Pump Inhibitor Benzyl Alcohol ...... 5 Esomeprazole ...... 11 Calcipotriene ...... 6 Omeprazole ...... 20 Clindamycin and Benzoyl Peroxide ...... 7 Pantoprazole ...... 20 Doxepin (Topical) ...... 10 Renin Inhibitor Erythromycin (Topical) ...... 11 Aliskiren ...... 3 Fluorouracil (Topical) ...... 13 Imiquimod ...... 15 Retinoic Acid Derivative Pimecrolimus ...... 21 Adapalene ...... 2 Podofilox ...... 21 ISOtretinoin (Systemic) ...... 15 Selenium Sulfide ...... 23 Tretinoin (Systemic) ...... 25 Tacrolimus (Topical) ...... 24 Tretinoin (Topical) ...... 25 Urea (Topical) ...... 26 36 XANTHINE OXIDASE INHIBITOR

Topical Skin Product, Acne Adapalene ...... 2 Azelaic Acid ...... 4 Clindamycin and Benzoyl Peroxide ...... 7 Clindamycin (Topical) ...... 7 Erythromycin (Topical) ...... 11 Sulfur and Sulfacetamide ...... 24 Tretinoin (Topical) ...... 25 Topical Skin Product, Antibacterial Silver Nitrate ...... 23 Tumor Necrosis Factor (TNF) Blocking Agent Adalimumab ...... 2 Uricosuric Agent Probenecid ...... 22 Urinary Acidifying Agent Potassium Phosphate ...... 21 Urinary Tract Product Acetohydroxamic Acid ...... 2 Dimethyl Sulfoxide ...... 10 Tiopronin ...... 25 Vaccine Papillomavirus (9-Valent) Vaccine (Human, Recombinant) ...... 20 Typhoid Vaccine ...... 26 Vaccine, Inactivated (Bacterial) Typhoid Vaccine ...... 26 Vaccine, Inactivated (Viral) Papillomavirus (9-Valent) Vaccine (Human, Recombinant) ...... 20 Vaccine, Live (Bacterial) Typhoid Vaccine ...... 26 Vasodilator Alprostadil ...... 3 Cilostazol ...... 7 Dipyridamole ...... 10 HydrALAZINE ...... 14 Isosorbide Dinitrate ...... 15 Isosorbide Mononitrate ...... 15 Nitroglycerin ...... 19 Vasodilator, Direct-Acting Diazoxide ...... 9 Minoxidil (Systemic) ...... 18 Vasopressin Analog, Synthetic Desmopressin ...... 9 Vitamin Vitamins (Multiple/Oral) ...... 26 Vitamins (Multiple/Pediatric) ...... 26 Vitamins (Multiple/Prenatal) ...... 26 Vitamin D Analog Alendronate and Cholecalciferol ...... 2 Calcipotriene ...... 6 Calcipotriene and Betamethasone ...... 6 Calcitriol (Systemic) ...... 6 Calcitriol (Topical) ...... 6 Ergocalciferol ...... 10 Vitamin, Fat Soluble Phytonadione ...... 21 Vitamin, Water Soluble Cyanocobalamin ...... 8 Folic Acid ...... 13 Niacin ...... 19 Pyridoxine ...... 22 Xanthine Oxidase Inhibitor Allopurinol ...... 3 37