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],