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Wake Brook Formulary ­ Category Wake Brook Formulary ­ Category Dosage Category Therapeutic Classification Brand Name Generic Name Strength Form Anti‐Diabetic Sulfonylurea Glucotrol XL glipizide extended release 5 mg tablet Anti‐Diabetic Glucose elevating agent Glucagon Injection glucagon emergency kit 1 mg injection Anti‐Diabetic Glucose elevating agent Glutose glucose, instant 15 gm oral gel Anti‐Diabetic Insulin Lantus insulin glargine, long acting 100 units/ml injection Anti‐Diabetic Insulin Humalog insulin lispro, rapid onset 100 units/ml injection insulin‐70% isophane insulin, intermediate acting & 30% regular Anti‐Diabetic Insulin Humulin 70/30 insulin, rapid acting 100 units/ml injection Anti‐Diabetic biguanide Glucophage metformin 500 mg tablet Antidotes Narcotic antagonist Narcan naloxone 0.4 mg/ml injection Antidotes Narcotic antagonist ReVia naltrexone 50 mg tablet Anti‐Infective Antiviral Zovirax acyclovir 400 mg tablet Anti‐Infective Penicillin Amoxicillin amoxicillin 500 mg capsule Anti‐Infective Penicillin Augmentin amoxicillin/clavulanate potassium 875 mg/125 mg tablet Anti‐Infective Macrolide Zithromax azithromycin 250 mg tablet STD State Free (for treatment of STD Anti‐Infective only) Zithromax azithromycin 500 mg tablet STD State Free (for treatment of STD Anti‐Infective only) Rocephin ceftriaxone 250 mg injection Anti‐Infective Cephalosporin, second generation Ceftin cefuroxime 500 mg tablet Anti‐Infective Cephalosporin, first generation Keflex cephalexin 500 mg capsule Anti‐Infective Fluroquinolones Cipro ciprofloxacin 500 mg tablet Anti‐Infective Lincosamide Cleocin clindamycin 150 mg capsule STD State Free (for treatment of STD Anti‐Infective only) Vibramycin doxycycline 100 mg tablet Anti‐Infective Tetracycline Vibramycin doxycycline 100 mg tablet Anti‐Infective Antifungal diflucan fluconazole 100 mg tablet Anti‐Infective Fluroquinolones Levaquin levofloxacin 500 mg tablet Anti‐Infective Amebicide Flagyl metronidazole 500 mg tablet STD State Free (for treatment of STD Anti‐Infective only) Flagyl metronidazole 500 mg tablet Macrobid‐ 3/12‐price incr, Anti‐Infective Nitrofurans ‐ 3/12‐ Not available N/A nitrofurantoin 3/12‐price incr, N/A 100 mg (BID dosing) capsule Anti‐Infective Penicillin Pen VK penicillin VK 500 mg tablet Anti‐Infective Sulfa combination Bactrim DS sulfamethoxazole/trimethoprim 800 mg/160 mg tablet Bold = Sample (may not be available) 1 5/7/2013 Wake Brook Formulary ­ Category Dosage Category Therapeutic Classification Brand Name Generic Name Strength Form Cardiac agent Calcium channel blocker Norvasc amlodipine 5mg, 10 mg tablet Cardiac agent Beta blocker Tenormin atenolol 50 mg tablet Cardiac agent Central alpha‐agonist Catapress clonidine 0.1 mg tablet Cardiac agent inotropic agent Lanoxin digoxin 0.125 mg tablet Cardiac agent ACE inhibitor Vasotec enalapril 5 mg tablet Cardiac agent Nitrate‐vasodilator Imdur isosorbide monohydrate ER 30 mg tablet Cardiac agent Beta blocker Trandate labetalol 100 mg tablet Cardiac agent ACE inhibitor Zestril/Prinivil lisinopril 5 mg, 10 mg tablet Cardiac agent Beta blocker Lopressor metoprolol 25 mg , 50 mg tablet Cardiac agent Nitrate‐vasodilator Nitroglycerin SL nitroglycerin 0.4 mg tablet Cardiac agent Beta blocker Inderal propranolol 20 mg tablet Cardiac agent Potassium removing resin Kayexalate sodium polystrene sulfonate 15 gm/60 ml suspension Cardiac agent Angiotensin II receptor blocker (ARB) Diovan valsartan 40 mg tablet Cardiac agent Calcium channel blocker Calan SR verapamil ER 240 mg tablet CNS Antialcoholic agent Campral acamprosate 333 mg tablet CNS Analgesics Tylenol acetaminophen 500 mg/5 ml liquid CNS Analgesics Tylenol acetaminophen 325 mg, 500 mg tablet CNS Antianxiety Xanax alprazolam 0.5 mg. 1 mg tablet CNS Antidepressant‐tricyclic Elavil amitriptyline 25 mg tablet CNS Antipsychotic Abilify aripiprazole 2mg, 5 mg, 10 mg, 15 mg tablet Excedrin CNS Migraine Agent Migraine/Geneced ASA/APAP/Caffene 250 mg/ 250 mg/65 mg tablet CNS Antipsychotic Saphris asenapine 5mg, 10 mg SL tablet CNS Analgesics Ecotrin aspirin, enteric coated 81 mg, 325 mg tablet CNS Misc. psychotherapeutic, ADHD Strattera atomoxetine 10 mg, 18 mg, 25mg, 40 mg tablet CNS Antiparkinson agent/anticholinergic Cogentin benztropine mesylate 1 mg/1 ml injection CNS Antiparkinson agent/anticholinergic Cogentin benztropine mesylate 1 mg tablet CNS Narcotic agonist Subutex buprenorphine 2 mg tablet CNS Antidepressant‐miscellaneous Wellbutrin bupropion immediate release 75 mg, 100 mg tablet CNS Antidepressant‐miscellaneous Wellbutrin SR bupropion sustained release 100 mg, 150 mg tablet CNS Antianxiety Buspar buspirone 5 mg, 10 mg tablet CNS Anticonvulsant Tegretol carbamazepine 200 mg tablet Bold = Sample (may not be available) 2 5/7/2013 Wake Brook Formulary ­ Category Dosage Category Therapeutic Classification Brand Name Generic Name Strength Form CNS Antianxiety Librium chlordiazepoxide 25 mg capsule CNS Antiemetic Thorazine chlorpromazine 25 mg/1 ml injection CNS Antiemetic Thorazine chlorpromazine 25 mg tablet CNS Antipsychotic Thorazine chlorpromazine 25mg/1 ml injection CNS Antipsychotic Thorazine chlorpromazine 25 mg tablet CNS Antidepressant‐SSRI Celexa citalopram 10 mg, 20 mg tablet CNS Antianxiety Klonopin clonazepam 0.5 mg, 1 mg tablet CNS Anticonvulsant Klonopin clonazepam 0.5 mg, 1 mg tablet CNS Muscle relaxant Flexeril cyclobenzaprine 10 mg tablet CNS Antidepressant­SNRI Pristiq desvenlafaxine 50 mg tablet CNS Antianxiety Valium diazepam 5 mg/1 ml injection CNS Antianxiety Valium diazepam 5 mg tablet CNS Anticonvulsant Valium diazepam 5 mg/1 ml injection CNS Anticonvulsant Valium diazepam 5 mg tablet CNS Antivertigo Dramamine dimenhydrinate 50 mg tablet capsule/tabl CNS Antiparkinson agent/anticholinergic Benadryl diphenhydramine 25 mg et CNS Antiparkinson agent/anticholinergic Benadryl diphenhydramine 50 mg/1 ml injection capsule/tabl CNS Antivertigo Benadryl diphenhydramine 25 mg et CNS Antialcoholic agent Antabuse disulfiram 250mg or 500 mg tablet CNS Anticonvulsant Depakote divalproic acid DR (delayed release) 250 mg, 500 mg tablet CNS Anticonvulsant Depakote ER divalproic acid ER (extended release) 250 mg, 500 mg tablet CNS Antianxiety Sinequan doxepin 25 mg, 50 mg capsule CNS Antidepressant‐tricyclic Sinequan doxepin 25 mg, 50 mg capsule CNS Antidepressant­SNRI Cymbalta duloxetine HCL 30mg, 60 mg capsule CNS Antidepressant‐SSRI Prozac fluoxetine 10 mg, 20 mg capsule CNS Antipsychotic Prolixin fluphenazine 1 mg, 5 mg tablet CNS Antipsychotic Prolixin decanoate fluphenazine decanoate 25mg/1 ml injection capsule/tabl CNS Anticonvulsant Neurontin gabapentin 100 mg, 300 mg, 400 mg et CNS Antipsychotic Haldol haloperidol 1 mg, 2 mg, 5 mg tablet CNS Antipsychotic Haldol decanoate haloperidol decanoate 100 mg/1 ml injection CNS Antipsychotic Haldol haloperidol immediate release 5 mg/1 ml injection Bold = Sample (may not be available) 3 5/7/2013 Wake Brook Formulary ­ Category Dosage Category Therapeutic Classification Brand Name Generic Name Strength Form CNS Analgesics Vicodin hydrocodone/APAP 5 mg/500 mg tablet CNS Antianxiety Vistaril hydroxyzine pamoate 25 mg, 50 mg capsule CNS Nonsteroidal Anti‐inflamatory drug Motrin ibuprofen 400mg, 600mg, 800mg tablet CNS Antidepressant‐tricyclic Tofranil imipramine 25 mg, 50 mg tablet CNS Nonsteroidal Anti‐inflamatory drug Indocin indomethacin 25 mg capsule CNS Anticonvulsant Lamictal lamotrigine 25 mg,100 mg tablet CNS Antipsychotic Eskalith lithium carbonate 300 mg capsule CNS Antipsychotic Eskalith CR lithium carbonate ER 450 mg tablet CNS Antipsychotic Lithobid lithium carbonate ER 300 mg tablet CNS Antianxiety Ativan lorazepam 0.5 mg, 1 mg, 2 mg tablet CNS Anticonvulsant Ativan lorazepam 0.5 mg, 1 mg, 2 mg tablet CNS Antipsychotic Latuda lurasidone 40mg, 80 mg tablet CNS Antidepressant‐tetracyclic Remeron mirtazapine 15 mg, 30 mg tablet CNS Nonsteroidal Anti‐inflamatory drug Naprosyn naproxen 500 mg tablet CNS Smoking Deterrents Nicorette nicotine gum 2 mg lozenge CNS Smoking Deterrents Nicotine Transdermal nicotine transdermal 14 mg, 21 mg patch CNS Antipsychotic Zyprexa Zydis olanzapine, orally disintegrating 5 mg, 10mg, 15mg, 20mg tablet CNS Antipsychotic Zyprexa olanzapine 5 mg tablet CNS Antipsychotic Invega paliperidone 3 mg tablet CNS Antidepressant‐SSRI Paxil paroxetine HCL 20 mg tablet CNS Anticonvulsant Phenobarbital phenobarbital 30 mg tablet CNS Sedative, barbiturate Phenobarbital phenobarbital 30 mg tablet CNS Anticonvulsant Dilantin phenytoin 100 mg capsule CNS Antiemetic Phenergan promethazine 25 mg/1 ml injection CNS Antiemetic Phenergan promethazine 25 mg suppository CNS Antiemetic Phenergan promethazine 25 mg tablet 50 mg, 150 mg, 200 mg, 300 CNS Antipsychotic Seroquel XR quetiapine ER mg, 400 mg tablet CNS Antipsychotic Risperdal risperidone 0.25 mg, 0.5 mg, 1 mg, 2 mg tablet CNS Antidepressant Zoloft sertraline 50 mg, 100 mg tablet CNS Antipsychotic Navane thiothixene 2 mg, 5 mg tablet CNS Antidepressant‐miscellaneous Desyrel trazodone 50 mg, 100 mg tablet CNS Antiparkinson agent/anticholinergic Artane trihexylphenidyl 5 mg tablet Bold = Sample (may not be available) 4 5/7/2013 Wake Brook Formulary ­ Category Dosage Category Therapeutic Classification Brand Name Generic Name Strength Form CNS Antidepressant‐SNRI Effexor XR venlafaxine 37.5 mg, 75 mg capsule CNS Antipsychotic Geodon ziprasidone 20 mg, 40 mg, 60 mg, 80 mg capsule CNS Hypnotic Ambien zolpidem 5 mg tablet Cough/Cold agent Antihistamine Chlor‐Trimeton chlorpheniramine 4 mg tablet Cough/Cold agent Mast cell stabilizer NasalCrom cromolyn sodium 5.2 mg/spray
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