Arkansas Hospice Preferred Drug List

GENERIC NAME BRAND NAME COST GENERIC NAME BRAND NAME COST ANTICHOLENERGIC / ANTISECRETORY AUTONOMIC & CENTRAL NERVOUS SYSTEM Atropine Drops Atropine $$ Alzheimer’s Agents - Clinical Consult Required Glycopyrrolate Robinul $$$ Analgesics, Narcotic Hyoscyamine Levsin $$ APAP/Codeine Tylenol #3 $$ APAP/Hydrocodone Norco $$ ANTIHISTAMINE / DECONGESTANTS Fentanyl Transdermal Duragesic $$$$ Diphenhydramine Benadryl $ Hydromorphone Dilaudid $$ Hydroxyzine HCl Atarax $ Methadone Dolophine $ Loratadine Claritin $ Morphine Sulfate IR/Conc Roxanol $$ Promethazine Phenergan $ Morphine Sulfate LA MS Contin $$$ Expectorant and Cough Products Oxycodone IR** Oxycodone IR (tablets only) $ Benzonatate Tessalon Perles $$ Tramadol 50mg Tablet Ultram 50mg Tablet $ Guaifenesin Robitussin/Mucinex $ Analgesics, Non Narcotic Guaifenesin/Codeine Robitussin AC $ Acetaminophen Tylenol $ Guaifenesin/ Pseudoephedrin Deconsal/DuratussGP $$ Analgesics, Salicylates Promethazine/Codeine or DM Phenergan/Codeine or DM $ Aspirin Bayer Aspirin $ Promethazine/Phenylephrine/CD Phenergan VS w Codeine $$ Anticonvulsants Carbamazepine Tegretol $$ ANTI-INFECTIVE AGENTS (ORAL) Clonazepam Klonopin $ Diazepam Suppositories Valium $ Antibiotics Divalproex Sodium DR Tablets Depakote DR Tablets $$ Cephalosporins Divalproex Sodium Syrup Depakene Syrup $$ Cefadroxil Duricef $$ Gabapentin Neurontin $$ Cefuroxime Ceftin $ Levetiracetam Keppra $$ Cephalexin Keflex $ Phenobarbital Phenobarbital $ Fluoroquinolones Phenytoin Dilantin $ Ciprofloxacin Cipro $ Misc. Anticonvulsants Levofloxacin Levoquin $$ Pregabalin Capsules Lyrica Capsules $$ Macrolides Anxiolitics, Sedatives, and Hypnotics Azithromycin Zithromax $ Alprazolam Xanax $ Clarithromycin Biaxin $$ Buspirone Buspar $ Erythromycin Emycin/Ery-tab $ Diazepam Valium $ Penicillins Lorazepam Ativan $ Amoxicillin Amoxil/Trimox $ Melatonin Melatonin $ Amoxicillin/Clavulanate Augmentin $ Temazepam Restoril $ Penicillin Pen VK $ Zolpidem** Ambien 5 & 10mg $ Sulfonamides Nonsteroidal Anti-Inflammatory TMP-SMX/DS Bactrim/Septra/DS $ Diclofenac Gel 1% Voltaren Gel 1% $$ Other Anti-Infectives Etodolac Lodine $$ Clindamycin Cleocin $ Ibuprofen Motrin $ Doxycycline Vibramycin $ Indomethacin/SR Indocin $ Metronidazole** Flagyl (tablets only) $ Melxicam Mobic $ Nitrofurantoin Macrodantin $ Nabumetone Relafen $$ Antifungal Agents Naproxen/EC Naprosyn $ Fluconazole Diflucan $$ Celecoxib Celebrex $$$ Ketoconazole Oral Nizoral $$ Stimulants Nystatin Oral Mycostatin $$ Methylphenidate Ritalin $ GENERIC NAME BRAND NAME COST GENERIC NAME BRAND NAME COST CARDIOVASCULAR AGENTS CORTICOSTEROIDS Aldosterone Antagonists Dexamethasone Decadron $ Spironolactone Aldactone $ Methylprednisolone Medrol $$ Angiotensin Converting Enzyme Inhibitors Prednisolone Tablets/Liquid Orapred $$$$ Benzapril Lotensin $ Prednisone Tablets/Liquid Prednisone $ Enalapril Vasotec $ Lisinopril Zestril $ DERMATOLOGICALS Angiotensin II Antagonists Antibiotics Losartan Cozaar $$ Metronidazole MetroGel $$ Anti-Adrenergic Agents – Beta Blockers Polymoxin B Neomycin/HC Cortisporin $ Atenolol Tenormin $ Silver Sulfadiazine Silvadene $ Carvedilol Coreg $$ Corticosteroids-Topical Metoprolol/XL Toprol $ Triamcinolone Cream Aristocort $$ Propranolol Inderal $ Fungicides Anti-Adrenergic Blockers – Centrally Acting Ketoconazole Nizoral $$$$ Clonidine** Catapress (tablets only) $ Nystatin Mycostatin $$ Anti-Adrenergic Blockers – Peripherally Acting Nystatin/Triamcinolone Mycolog $$ Doxazosin Cardura $$ Terazosin Hytrin $ DIURETICS Antianginal Agents Bumetanide Bumex $ Nitroglycerin Patch Minitran/Nitro-Dur $$ Furosemide (covered all diagnoses) Lasix $ Nitroglycerin SR Nitro-Bid $ Hydrochlorothiazide HydroDIURIL/Esidrex $ Nitroglycerin Sublingual Nitrostat $ HCTZ/Triamterene Maxzide $$ Antiarrhythmics Methazolamide Metolazone $ Amiodarone Cordarone $$ Spironolactone/HCTZ Aldactone $$ Digoxin Lanoxin $ Disopyramide/CR Norpace $$ Flecainide Tambocor $ GASTROINTESTINAL AGENTS Esomeprazole 20,40 DR Caps Nexium 20, 40mg DR Caps $$ Mexiletine Mexitil $$ Famotidine** Famotidine (tablets only) $ Propafenone Rhythmol $$ Lansoprazole 15 & 30mg Caps Prevacid 15 & 30mg Caps $$ Quinidine Gluconate SR Quinaglute $$ Omeprazole Prilosec $ Quinidine Sulfate/SR Quinora/Quinidex Extentabs $$ Pantoprazole Protonix $ Sotalol Betapace AF $ Ranitidine Zantac $ Anticoagulants/Antithrombotics Sucralfate** Carafate (tablets only) $ Clopidogrel Bisulfate Plavix $ Antiemetics/Antivertigo Warfarin Coumadin $ Meclizine Antivert $ Calcium Channel Blockers Metoclopramide Reglan $ Amlodipine Norvasc $ Ondansetron Oral Zofran $$ Diltiazem/SR/XR Cardizem $ Prochlorperazine** Compazine (tablets only) $ Felodipine Plendil $$$ Promethazine Phenergan $ Nifedipine XL/ SR Procardia $$$ Antispasmodic/GI Motility Verapamil/SR Verelan/Calan $ Diphenoxylate/Atropine Lomotil $$ Potassium Chloride Loperamide Imodium AD $$ ONLY WITH DIURETIC K-Dur/Klor-Con $$ Metoclopramide Reglan $ Vasodilators Hydralazine Apresoline $ Isosorbide Dinitrate/SR Isordil/Dilatrate-SR $$ Isosorbide Mononitrate Isosorbide Mononitrate $$ GENERIC NAME BRAND NAME COST GENERIC NAME BRAND NAME COST GASTROINTESTINAL AGENTS (cont’d) PSYCHOTHERAPEUTIC AGENTS (con’t) Laxatives Antipsychotic Agents Bisacodyl Dulcolax $ Chlorpromazine Thorazine $$$ Docusate Calcium Surfak $ Haloperidol Haldol $ Docusate Sodium Colace $ Olanzapine 5mg Tablets Zyprexa 5mg Tablets $$ Lactulose Cephulac/Chronulac $ Risperidone Risperdal $$ Milk of Magnesia MOM $ Quetiapine Seroquel $$ Polyethylene Glycol Miralax $$ Senna Tabs Senokot $ RESPIRATORY AGENTS Senna S Tabs Senokot S $ Albuterol (covered all Diagnoses) Proventil/Ventolin $$ Sodium Phosphate Enema Fleet Enema $ Albuterol SR Tablets Proventil Repitabs $$ Other GI Products Beclomethasone Qvar $$$ Calcium Carbonate Tums $ Ipratropium/Albuterol Inhaled DuoNeb (covered all diagnoses) $$ Milk of Magnesia MOM $ Ipratropium Bromide Atrovent $$$ Mineral Oil Mineral Oil $ Theophylline IR/SR Uniphyl/Theo-24 $$ Simethicone Maalox/Mylanta $ Sorbitol Sorbitol $ SKELETAL MUSCLE RELAXANTS Ursodiol Urso $$ Baclofen Lioresal $ Cyclobenzaprine Flexeril $ MISCELLANEOUS Diazepam Valium $ Artificial Saliva Artificial Saliva $$ Tizanidine Zanaflex $$ Artificial Tears Artificial Tears $ Dakins Solution Dakins Solution $$ URINARY AGENTS Lidocaine** Lidocaine (no patches) $ Oxybutynin Ditropan $$ Magic Mouthwash Magic Mouthwash $$ Phenazopyridine Pyridium $$

PARKINSON’S DISEASE AGENTS Parkinson’s Disease Primary Diagnosis Only Carbidopa/Levodopa Sinemet $ Entacapone Comtan $$ Selegiline Eldepryl $

PSYCHOTHERAPEUTIC AGENTS Antidepressants Amitriptyline Elavil $ Buproprion/SR Wellbutrin $$ Citalopram Celexa $ Desipramine Norpramin $ Doxepin Sinequan $ Duloxetine Cymbalta $$ Escitalopram Lexapro $$ Fluoxetine Prozac $$ Mirtazapine Remeron $$ Nortripyline Pamelor $ Paroxetine Paxil $$ Sertraline Zoloft $$ Trazodone Deseryl $ Venlafaxine Effexor $$