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DWIGHT D EISENHOWER ARMY MEDICAL CENTER OUTPATIENT FORMULARY Alphabetical Listing by Name

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DWIGHT D EISENHOWER ARMY MEDICAL CENTER OUTPATIENT FORMULARY Alphabetical Listing by Name DWIGHT D EISENHOWER ARMY MEDICAL CENTER OUTPATIENT FORMULARY Alphabetical Listing by Name This document is current as of May 5, 2021. The availability of formulary items is subject to change. ABACAVIR Abacavir Adalimumab Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Pen-injector Kit, Subcutaneous [preservative free]: Generic: 300 mg Humira Pen: 40 mg/0.8 mL (1 ea) [BCF]; 40 mg/0.4 mL (1 ea) [BCF] [contains polysorbate 80] Abacavir and Lamivudine Prefilled Syringe Kit, Subcutaneous [preservative free]: Outpatient Dosage Forms Humira: 40 mg/0.8 mL (1 ea) [contains polysorbate 80] [BCF] Tablet, Oral: Epzicom®: Abacavir 600 mg and lamivudine 300 mg Adapalene Outpatient Dosage Forms Abacavir, Dolutegravir, and Lamivudine Cream, External: Outpatient Dosage Forms Differin: 0.1% (45 g) Tablet, Oral: Generic: 0.1% (45 g) Triumeq: Abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg Gel, External: Acamprosate Differin: 0.1% (45 g) Outpatient Dosage Forms Albuterol Tablet Delayed Release, Oral, as calcium: Outpatient Dosage Forms Campral: 333 mg Aerosol Solution, Inhalation: Acebutolol ProAir HFA: 108 (90 Base) mcg/actuation (8.5 g) [BCF] Outpatient Dosage Forms Nebulization Solution, Inhalation: Capsule, Oral, as hydrochloride: Generic: 0.083% [2.5 mg/3 mL] (25s, 30s, 60s) [BCF] Generic: 200 mg, 400 mg Syrup, Oral: Generic: 2 mg/5 mL (473 mL) Acetaminophen Outpatient Dosage Forms Alclometasone Suspension, Oral: Outpatient Dosage Forms Q-PAP Childrens: 160 mg/5 mL (118 mL) [alcohol free, aspirin free, ibuprofen Ointment, External, as dipropionate: free; contains butylparaben, fd&c red #40, sodium benzoate; bubble-gum Generic: 0.05% (15 g, 45 g) flavor] Alendronate Tylenol Childrens: 160 mg/5 mL (120 mL) [alcohol free; contains butylparaben, Outpatient Dosage Forms fd&c red #40, propylene glycol, sodium benzoate; cherry flavor] Generic: 160 mg/5 mL (5 mL) Tablet, Oral: Suppository, Rectal: Generic: 10 mg [BCF], 35 mg [BCF], 70 mg [BCF] Generic: 120 mg (12s); 650 mg (12s) Alendronate and Cholecalciferol Suspension, oral [drops]: Outpatient Dosage Forms Generic: 80 mg/0.8 mL (15 mL) Tablet, Oral: Tablet, Oral: Fosamax Plus D: Alendronate 70 mg and cholecalciferol 5600 int. units Mapap: 325 mg Generic: 325 mg, 500 mg Alfuzosin Acetaminophen and Codeine Outpatient Dosage Forms Outpatient Dosage Forms Tablet, extended release, oral, as hydrochloride: Solution, Oral [C-V]: Uroxatral®: 10 mg [BCF] Generic: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 mL (5 Allopurinol mL, 10 mL, 118 mL) [BCF] Outpatient Dosage Forms Tablet, Oral [C-III]: Tablet, oral: Generic: Acetaminophen 300 mg and codeine phosphate 30 mg [BCF] Generic: 100 mg [BCF], 300 mg [BCF] AcetaZOLAMIDE ALPRAZolam Outpatient Dosage Forms Outpatient Dosage Forms Capsule Extended Release 12 Hour, Oral: Tablet, Oral: Diamox Sequels: 500 mg Tablet, Oral: Generic: 0.5 mg Generic: 250 mg Alprostadil Acetic Acid (Otic) Outpatient Dosage Forms Outpatient Dosage Forms Kit, Intracavernosal: Solution, Otic: Edex: 10 mcg, 20 mcg, 40 mcg Generic: 2% (60 mL) Pellet, Urethral: Muse: 250 mcg (6 ea); 500 mcg (6 ea); 1000 mcg (6 ea) Acetic Acid (Topical) Outpatient Dosage Forms Aluminum Chloride Hexahydrate Solution, Irrigation: Outpatient Dosage Forms Generic: 0.25% (1000 mL) Solution, External: Drysol: 20% (37.5 mL) Acetylcholine Outpatient Dosage Forms Aluminum Hydroxide, Magnesium Hydroxide, and Simethicone Solution Reconstituted, Intraocular, as chloride: Outpatient Dosage Forms Miochol-E: 20 mg (1 ea) [contains mannitol] Liquid, oral: Aldroxicon II: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, Acetylcysteine and simethicone 40 mg per 5 mL (30 mL) Outpatient Dosage Forms Mi-Acid Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydrox- Solution, Inhalation: ide 400 mg, and simethicone 40 mg per 5 mL (360 mL) Generic: 20% (10 mL, 30 mL) Amantadine Acitretin Outpatient Dosage Forms Outpatient Dosage Forms Capsule, oral, as hydrochloride: Capsule, Oral: Generic: 100 mg [BCF] Soriatane: 10 mg, 25 mg [contains edetate calcium disodium] AMILoride Acyclovir (Systemic) Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Capsule, oral: Generic: 5 mg Generic: 200 mg [BCF] Suspension, oral: Aminocaproic Acid Zovirax®: 200 mg/5 mL (473 mL) [BCF] Outpatient Dosage Forms Tablet, oral: Syrup, Oral: Generic: 400 mg [BCF] Generic: 25% (473 mL) 2 AZITHROMYCIN (SYSTEMIC) Tablet, Oral: Solution, Ophthalmic [preservative free]: Amicar: 500 mg [scored] Systane Preservative Free: Polyethylene glycol 400 0.4% and propylene glycol 0.3% (28 ea) [contains boric acid, calcium chloride anhydrous, Aminolevulinic Acid (Topical) hydroxylpropyl guar, magnesium chloride, potassium chloride, sodium chlor- Outpatient Dosage Forms ide, zinc chloride] Solution Reconstituted, External, as hydrochloride: Levulan Kerastick: 20% (1 ea) [contains alcohol, usp, isopropyl alcohol, Aspirin laureth, polyethylene glycol] Outpatient Dosage Forms Suppository, Rectal: Amiodarone Generic: 300 mg (12 ea) Outpatient Dosage Forms Tablet, Oral: Tablet, oral, as hydrochloride: Generic: 325 mg Generic: 200 mg [BCF] Tablet Chewable, Oral: Generic: 81 mg Amitriptyline Tablet Delayed Release, Oral: Outpatient Dosage Forms Generic: 325 mg Tablet, Oral, as hydrochloride: Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF] Aspirin and Dipyridamole Outpatient Dosage Forms AmLODIPine Capsule, variable release: Outpatient Dosage Forms Aggrenox®: Aspirin 25 mg [immediate release] and dipyridamole 200 mg Tablet, oral: [extended release] [contains lactose, sucrose] Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF] Atazanavir Amlodipine and Benazepril Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral, as sulfate: Capsule, oral: Reyataz: 150 mg, 200 mg Lotrel®: 2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF] Lotrel®: 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF] Atenolol Lotrel®: 5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF] Outpatient Dosage Forms Lotrel®: 5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF] Tablet, oral: Lotrel®: 10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF] Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Lotrel®: 10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF] AtoMOXetine Ammonia Spirit (Aromatic) Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Inhaler, Inhalation: Strattera: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg Generic: (10 ea) AtorvaSTATin Amoxicillin Outpatient Dosage Forms Outpatient Dosage Forms Tablet, oral: Capsule, oral: Lipitor®: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Generic: 250 mg [BCF], 500 mg [BCF] Powder for suspension, oral: Atovaquone and Proguanil Generic: 250 mg/5 mL (150 mL) [BCF]; 400 mg/5 mL (100 mL) [BCF] Outpatient Dosage Forms Tablet, oral: Amoxicillin and Clavulanate Generic: Atovaquone 250 mg and proguanil hydrochloride 100 mg Outpatient Dosage Forms Suspension Reconstituted, Oral: Atropine (Ophthalmic) Generic: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (75 Outpatient Dosage Forms mL, 100 mL) [BCF] Solution, Ophthalmic, as sulfate: Generic: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (100 Generic: 1% (5 mL) mL) [BCF] Generic: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL AzaTHIOprine (125 mL) [BCF] Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: Amoxicillin 250 mg and clavulanate potassium 125 mg [BCF] Generic: 50 mg Generic: Amoxicillin 500 mg and clavulanate potassium 125 mg [BCF] Generic: Amoxicillin 875 mg and clavulanate potassium 125 mg [BCF] Azelaic Acid Outpatient Dosage Forms Amyl Nitrite Gel, External: Outpatient Dosage Forms Finacea: 15% (50 g) [contains benzoic acid, disodium edta, polysorbate 80, Liquid, for inhalation: USP: 85% to 103% (0.3 mL) propylene glycol] Anagrelide Azelastine (Nasal) Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Solution, Nasal, as hydrochloride: Generic: 0.5 mg, 1 mg Astelin: 137 mcg/spray (30 mL) [contains benzalkonium chloride, edetate disodium] Anastrozole Outpatient Dosage Forms Azilsartan Tablet, Oral: Outpatient Dosage Forms Generic: 1 mg Tablet, Oral, as medoxomil: Edarbi: 40 mg, 80 mg Aprepitant Outpatient Dosage Forms Azilsartan and Chlorthalidone Capsule, Oral: Outpatient Dosage Forms Emend: 80 mg, 125 mg Tablet, Oral: Edarbyclor: 40/25: Azilsartan medoxomil 40 mg and chlorthalidone 25 mg ARIPiprazole Edarbyclor: 40/12.5: Azilsartan medoxomil 40 mg and chlorthalidone 12.5 mg Outpatient Dosage Forms Tablet, Oral: Azithromycin (Ophthalmic) Abilify: 2 mg, 5 mg, 15 mg, 20 mg, 30 mg Outpatient Dosage Forms Solution, Ophthalmic: Artificial Tears AzaSite: 1% (2.5 mL) [contains benzalkonium chloride, disodium edta] Outpatient Dosage Forms Solution, Ophthalmic: Azithromycin (Systemic) Akwa Tears: 1.4% (15 mL) [contains benzalkonium chloride, disodium edta] Outpatient Dosage Forms LiquiTears: 1.4% (15 mL) [contains chlorobutanol (chlorobutol), sodium Packet, Oral, as dihydrate [strength expressed as base]: chloride] Zithromax: 1 g (10 ea) [cherry-banana flavor] [BCF] 3 AZITHROMYCIN (SYSTEMIC) Suspension Reconstituted, Oral, as dihydrate [strength expressed as base]: Ointment, External, as dipropionate [strength expressed as base]: Zithromax: 100 mg/5 mL (15 mL) [cherry-vanilla-banana flavor] Generic: 0.05% (15 g) Zithromax: 200 mg/5 mL (15 mL, 22.5 mL, 30 mL) [cherry flavor] Tablet, oral, as dihydrate [strength expressed as base]: Bethanechol Zithromax: 600 mg Outpatient Dosage Forms
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