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Alphabetical Listing by Name Dod UNIFORM OUTPATIENT DoD UNIFORM OUTPATIENTFORMULARY Alphabetical Listing by Name This document is current as of July 14, 2021 The availability of formulary items is subject to change. Basic Core Formulary: MTF must have on formulary Uniform Formulary: MTF may have on formulary Nonformulary: MTF must not have on formulary Extended Core Formulary: MTF must be on formulary if includes any drugs from that drug class 1 ABACAVIR Abacavir Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Mapap Extra Strength: 500 mg UNIFORM FORMULARY Elixir, Oral: Solution, Oral: Mapap Children's: 160 mg/5 mL (118 mL, 480 mL) [ethanol free; contains Ziagen: 20 mg/mL (240 mL) [contains methylparaben, propylene glycol, benzoic acid, propylene glycol, sodium benzoate; cherry flavor] propylparaben, saccharin sodium; strawberry-banana flavor] Injection, Solution [preservative free]: Tablet, Oral: Ofirmev: 10 mg/mL (100 mL) Generic: 300 mg Liquid, Oral: Generic: 160 mg/5 mL (120 mL, 473 mL); 500 mg/5 mL (240 mL) Abacavir and Lamivudine Solution, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 160 mg/5 mL (5 mL, 10 mL, 20 mL) UNIFORM FORMULARY Suppository, Rectal: Tablet, Oral: Generic: 120 mg (12s); 325 mg (12s) Generic: Abacavir 600 mg and lamivudine 300 mg Suspension, Oral: Generic: 160 mg/5 mL (5 mL, 10.15 mL, 20.3 mL) Abacavir, Dolutegravir, and Lamivudine Syrup, Oral: DoD Uniform Formulary Outpatient Dosage Forms Triaminic Children's Fever Reducer Pain Reliever: 160 mg/5 mL (118 mL) UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Generic: 325 mg, 500 mg Triumeq: Abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg Tablet, Chewable, Oral: Generic: 80 mg Abacavir, Lamivudine, and Zidovudine NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Caplet, Extended Release, Oral: UNIFORM FORMULARY Mapap Arthritis Pain: 650 mg Tablet, Oral: Tylenol 8 HR Arthritis Pain: 650 mg Generic: Abacavir sulfate 300 mg, lamivudine 150 mg, and zidovudine Suppository, Rectal: 300 mg Generic: 650 mg (12s) Abciximab Acetaminophen and Caffeine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous: Tablet, Oral: ReoPro: 2 mg/mL (5 mL) [contains polysorbate 80] Excedrin Tension Headache: Acetaminophen 500 mg and caffeine 65 mg [contains benzoic acid] Abemaciclib Excedrin Tension Headache: Acetaminophen 500 mg and caffeine 65 mg DoD Uniform Formulary Outpatient Dosage Forms [aspirin free; contains benzoic acid] UNIFORM FORMULARY Tablet, Oral: Acetaminophen and Codeine Verzenio: 50 mg, 100 mg, 150 mg, 200 mg DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Abiraterone Acetate Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Acetaminophen 300 mg and codeine phosphate 30 mg UNIFORM FORMULARY Tablet, Oral: UNIFORM FORMULARY Yonsa: 125 mg Solution, Oral: Zytiga: 250 mg, 500 mg Generic: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 mL (5 Generic: 250 mg mL, 12.5 mL, 118 mL, 473 mL) Tablet, Oral: AbobotulinumtoxinA Acetaminophen 300 mg and codeine phosphate 15 mg DoD Uniform Formulary Outpatient Dosage Forms Acetaminophen 300 mg and codeine phosphate 60 mg UNIFORM FORMULARY Acetaminophen and Diphenhydramine Solution Reconstituted, Intramuscular: Dysport: 300 units (1 ea); 500 units (1 ea) [contains milk protein] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Absorption Base Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Aceta-Gesic: Acetaminophen 325 mg and diphenhydramine hydrochloride UNIFORM FORMULARY 12.5 mg Cream: 480 g Excedrin PM: Acetaminophen 500 mg and diphenhydramine citrate 38 mg Ointment, topical: 480 g Legatrin PM: Acetaminophen 500 mg and diphenhydramine hydrochlor- ide 50 mg Acalabrutinib Percogesic Extra Strength: Acetaminophen 500 mg and diphenhydramine DoD Uniform Formulary Outpatient Dosage Forms hydrochloride 12.5 mg UNIFORM FORMULARY Generic: Acetaminophen 500 mg and diphenhydramine hydrochloride 25 mg Capsule, Oral: Calquence: 100 mg Acetaminophen and Pamabrom DoD Uniform Formulary Outpatient Dosage Forms Acamprosate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Caplet, Oral: UNIFORM FORMULARY Midol Teen Formula: Acetaminophen 500 mg and pamabrom 25 mg Tablet Delayed Release, Oral, as calcium: Tylenol Women’s Menstrual Relief: Acetaminophen 500 mg and pamab- Generic: 333 mg rom 25 mg Tablet, Oral: Acarbose Cramp Tabs: Acetaminophen 325 mg and pamabrom 25 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Acetaminophen and Phenylephrine Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 25 mg, 50 mg, 100 mg UNIFORM FORMULARY Caplet, Oral: Acebutolol Contac Cold + Flu Maximum Strength Non Drowsy: Acetaminophen 500 mg DoD Uniform Formulary Outpatient Dosage Forms and phenylephrine hydrochloride 5 mg UNIFORM FORMULARY Mapap Sinus PE, Sudafed PE Pressure + Pain: Acetaminophen 325 mg and Capsule, Oral, as hydrochloride: phenylephrine hydrochloride 5 mg Generic: 200 mg, 400 mg Tylenol Sinus Congestion & Pain Daytime: Acetaminophen 325 mg and phenylephrine hydrochloride 5 mg [Cool Burst flavor] Acetaminophen Capsule, Liquid Filled, Oral: DoD Uniform Formulary Outpatient Dosage Forms Vicks DayQuil Sinex Daytime Sinus: Acetaminophen 325 mg and phenyl- UNIFORM FORMULARY ephrine hydrochloride 5 mg Caplet, Oral: Tablet, Oral: Generic: 500 mg Cetafen Cold: Acetaminophen 500 mg and phenylephrine hydrochloride 5 mg 2 ACETAMINOPHEN, DIPHENHYDRAMINE, AND PHENYLEPHRINE Robitussin Peak Cold Nasal Relief: Acetaminophen 325 mg and phenyl- Tylenol Cold Max: Acetaminophen 325 mg, dextromethorphan hydrobromide ephrine hydrochloride 5 mg 10 mg, and phenylephrine hydrochloride 5 mg Sinus Pain & Pressure: Acetaminophen 500 mg and phenylephrine hydro- Capsule, Liquid filled, Oral: chloride 5 mg Alka-Seltzer Plus Day Cold: Acetaminophen 325 mg, dextromethorphan hydrobromide 10 mg, and phenylephrine hydrochloride 5 mg Acetaminophen and Phenyltoloxamine Mucinex Fast-Max Severe Cold & Sinus: Acetaminophen 325 mg, dextro- DoD Uniform Formulary Outpatient Dosage Forms methorphan hydrobromide 10 mg, and phenylephrine hydrochloride 5 mg UNIFORM FORMULARY [contains soybean lecithin] Tablet, Oral: Vicks DayQuil Cold & Flu Multi-Symptom: Acetaminophen 325 mg, dextro- Dolorex: Acetaminophen 325 mg and phenyltoloxamine citrate 25 mg methorphan hydrobromide 10 mg, and phenylephrine hydrochloride 5 mg Acetaminophen and Pseudoephedrine Liquid, Oral: Tylenol Cold Max: Acetaminophen 325 mg, dextromethorphan hydrobromide DoD Uniform Formulary Outpatient Dosage Forms 10 mg, and phenylephrine hydrochloride 5 mg per 15 mL (240 mL) [contains UNIFORM FORMULARY propylene glycol, sodium 5 mg/15 mL, sodium benzoate; citrus burst flavor] Caplet, Oral: Vicks DayQuil Cold & Flu Multi-Symptom: Acetaminophen 325 mg, dextro- Ornex Maximum Strength: Acetaminophen 500 mg and pseudoephedrine methorphan hydrobromide 10 mg, and phenylephrine hydrochloride 5 mg hydrochloride 30 mg per 15 mL (180 mL, 300 mL) [ethanol free, sugar free; contains propylene Acetaminophen and Tramadol glycol, sodium 50 mg/15 mL, sodium benzoate] DoD Uniform Formulary Outpatient Dosage Forms Powder for Solution, Oral: UNIFORM FORMULARY Theraflu Daytime Severe Cold & Cough: Acetaminophen 650 mg, dextro- Tablet, Oral: methorphan hydrobromide 20 mg, and phenylephrine hydrochloride 10 mg Generic: Acetaminophen 325 mg and tramadol hydrochloride 37.5 mg per packet (6s) [contains phenylalanine 14 mg/packet, potassium 10 mg/ packet, and sodium 20 mg/packet; berry-green tea-menthol flavor] Acetaminophen, Aspirin, and Caffeine Theraflu Multi-Symptom Severe Cold: Acetaminophen 500 mg, dextromethor- DoD Uniform Formulary Outpatient Dosage Forms phan hydrobromide 20 mg, and phenylephrine hydrochloride 10 mg per UNIFORM FORMULARY packet (6s) [contains phenylalanine 20 mg/packet, potassium 10 mg/packet, Caplet, Oral: and sodium 19 mg/packet; Lipton green tea and honey lemon flavors] Excedrin Extra Strength, Excedrin Migraine: Acetaminophen 250 mg, aspirin Syrup, Oral: 250 mg, and caffeine 65 mg Theraflu ExpressMax Daytime Severe Cold & Cough: Acetaminophen Vanquish Extra Strength Pain Reliever: Acetaminophen 194 mg, aspirin 325 mg, dextromethorphan hydrobromide 10 mg, and phenylephrine hydro- 227 mg, and caffeine 33 mg chloride 5 mg per 15 mL (245.5 mL) [contains ethanol, potassium 12 mg/15 Powder, Oral: mL, propylene glycol, sodium 8 mg/15 mL, sodium benzoate; berry flavor] Goody's Extra Strength Headache Powder: Acetaminophen 260 mg, aspirin 520 mg, and caffeine 32.5 mg [contains lactose] Acetaminophen, Diphenhydramine, and Phenylephrine Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Anacin Advanced Headache Formula: Acetaminophen 250 mg, aspirin UNIFORM FORMULARY 250 mg, and caffeine 65 mg Caplet, Oral: Excedrin Extra Strength, Excedrin Migraine, Pain-Off: Acetaminophen One Tab Allergy & Sinus: Acetaminophen 650 mg, diphenhydramine hydro- 250 mg, aspirin 250 mg, and caffeine 65 mg chloride 25 mg, and phenylephrine hydrochloride 10 mg [dye free] Fem-Prin: Acetaminophen 194.4 mg, aspirin 226.8 mg, and caffeine 32.4 mg One Tab Cold and Flu: Acetaminophen 650 mg, diphenhydramine hydro- chloride 25 mg, and phenylephrine hydrochloride 10 mg [dye free] Acetaminophen, Caffeine, and Dihydrocodeine Cold Control PE: Acetaminophen 650 mg, diphenhydramine hydrochloride DoD Uniform Formulary Outpatient Dosage Forms 25 mg, and phenylephrine hydrochloride 10 mg UNIFORM FORMULARY Theraflu ExpressMax Nighttime Severe Cold & Cough: Acetaminophen
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