outpatient formulary keesler afb

32 Pages·2016·0.17 MB·English

KEESLER AFB
OUTPATIENT FORMULARY
Alphabetical Listing by Name
This document is current as of February 27, 2018.
The availability of formulary items is subject to change.
1
ABACAVIR
Abacavir OutpatientDosageForms
OutpatientFormularyBrandsAvailableZiagen Solution,Intraocular[preservativefree]:
OutpatientDosageForms Eylea:2mg/0.05mL(0.05mL)[containsmouseprotein(murine)(hamster)]
Tablet,Oral: Albendazole
Ziagen:300mg[scored]
OutpatientFormularyBrandsAvailableAlbenza®
AbacavirandLamivudine OutpatientDosageForms
OutpatientFormularyBrandsAvailableEpzicom® Tablet,oral:
OutpatientDosageForms Albenza®:200mg
Tablet,oral: Albuterol
Epzicom®:600/300:Abacavir600mgandlamivudine300mg
OutpatientFormularyBrandsAvailableProAirHFA
Abacavir,Dolutegravir,andLamivudine OutpatientDosageForms
OutpatientFormularyBrandsAvailableTriumeq AerosolSolution,Inhalation:
OutpatientDosageForms ProAirHFA:108(90Base)mcg/actuation(8.5g)[BCF]
Tablet,oral: NebulizationSolution,Inhalation:0.083%[2.5mg/3mL](25ea,30ea,60ea)
[BCF];0.5%[100mg/20mL](1ea)
Triumeq:Abacavir600mg,dolutegravir50mg,andlamivudine300mg
Alclometasone
Acebutolol
OutpatientDosageForms
OutpatientDosageForms
Ointment,External,asdipropionate:
Capsule,Oral,ashydrochloride:
Generic:0.05%(15g)
Generic:200mg,400mg
Alendronate
Acetaminophen
OutpatientDosageForms OutpatientFormularyBrandsAvailableFosamax®
OutpatientDosageForms
Solution,oral:160mg/5mL(118mL)
Solution,oral[drops]:80mg/0.8mL(15mL) Solution,oral:
Fosamax®:70mg/75mL(75mL)[raspberryflavor][BCF]
Suppository,rectal:120mg(12s);650mg(12s)
Tablet,oral:5mg[BCF],10mg[BCF],35mg[BCF],70mg[BCF]
Tablet,oral:500mg
Tablet,chewable,oral:80mg Alfuzosin
AcetaminophenandCodeine OutpatientFormularyBrandsAvailableUroxatral®
OutpatientFormularyBrandsAvailableTylenol®withCodeineNo.3 OutpatientDosageForms
OutpatientDosageForms Tablet,extendedrelease,oral,ashydrochloride:
Uroxatral®:10mg[BCF]
Solution,oral[C-V]:Acetaminophen120mgandcodeinephosphate12mgper
5mL(5mL,10mL,12.5mL,15mL,120mL,480mL)[containsalcohol7%] Aliskiren
[BCF] OutpatientFormularyBrandsAvailableTekturna®
Tablet, oral [C-III]: Acetaminophen 300mg and codeine phosphate
OutpatientDosageForms
30mg[BCF]
Tablet,oral:
AcetaminophenandTramadol Tekturna®:150mg,300mg
OutpatientFormularyBrandsAvailableUltracet® Allopurinol
OutpatientDosageForms
OutpatientDosageForms
Tablet,oral:Acetaminophen325mgandtramadolhydrochloride37.5mg
Tablet,oral:100mg[BCF],300mg[BCF]
Ultracet®:Acetaminophen325mgandtramadolhydrochloride37.5mg
ALPRAZolam
Acetaminophen,Caffeine,andIsomethepteneMucate
OutpatientFormularyBrandsAvailableXanax®
OutpatientDosageForms
OutpatientDosageForms
Capsule,oral:Acetaminophen500mg,caffeine20mg,isometheptenemucate
Tablet,oral:0.25mg,0.5mg,1mg
130mg
Xanax®:0.25mg,0.5mg,1mg
AcetaZOLAMIDE
Alprostadil
OutpatientFormularyBrandsAvailableDiamox®Sequels® OutpatientFormularyBrandsAvailableEdex®;Muse®
OutpatientDosageForms
OutpatientDosageForms
Capsule,sustainedrelease,oral:
Injection,powderforreconstitution:
Diamox®Sequels®:500mg
Edex®:20mcg
Tablet,oral:250mg
Pellet,urethral:
AceticAcid(Otic) Muse®:500mcg(6s);1000mcg(6s)
OutpatientDosageForms AluminumChlorideHexahydrate
Solution,otic[drops]:2%(15mL) OutpatientFormularyBrandsAvailableDrysol™
Acyclovir(Systemic) OutpatientDosageForms
Solution,topical:
OutpatientFormularyBrandsAvailableZovirax®
Drysol™:20%(37.5mL)[containsethanol93%]
OutpatientDosageForms
Capsule,oral:200mg[BCF] Amantadine
Zovirax®:200mg OutpatientDosageForms
Suspension,oral:200mg/5mL(473mL)[BCF] Capsule,oral,ashydrochloride:100mg[BCF]
Tablet,oral:400mg[BCF],800mg[BCF] Syrup,oral,ashydrochloride:50mg/5mL(10mL,473mL,480mL)[BCF]
Zovirax®:400mg
Zovirax®:800mg[scored] AMILoride
OutpatientDosageForms
Adalimumab
Tablet,oral,ashydrochloride:5mg
OutpatientFormularyBrandsAvailableHumira
OutpatientDosageForms Amiodarone
Kit,Subcutaneous[preservativefree]: OutpatientDosageForms
Humira:20mg/0.4mL,40mg/0.8mL[containspolysorbate80][BCF] Tablet,oral,ashydrochloride:200mg[BCF]
Adapalene Amitriptyline
OutpatientFormularyBrandsAvailableDifferin® OutpatientDosageForms
OutpatientDosageForms Tablet,oral,ashydrochloride:10mg[BCF],25mg[BCF],50mg[BCF],75mg
Cream,topical:0.1%(45g) [BCF]
Differin®:0.1%(15g)
AmLODIPine
Gel,topical:0.1%(45g)
Differin®:0.1%(45g)[ethanolfree] OutpatientFormularyBrandsAvailableNorvasc®
OutpatientDosageForms
Aflibercept(Ophthalmic) Tablet,oral:2.5mg[BCF],5mg[BCF],10mg[BCF]
OutpatientFormularyBrandsAvailableEylea Norvasc®:2.5mg,5mg,10mg
2
AZITHROMYCIN(SYSTEMIC)
AmlodipineandBenazepril Aspirin
OutpatientFormularyBrandsAvailableLotrel® OutpatientDosageForms
OutpatientDosageForms Tablet,oral:325mg
Capsule,oral: Tablet,chewable,oral:81mg
2.5/10:Amlodipine2.5mgandbenazeprilhydrochloride10mg[BCF] Tablet,entericcoated,oral:325mg
5/10:Amlodipine5mgandbenazeprilhydrochloride10mg[BCF]
5/20:Amlodipine5mgandbenazeprilhydrochloride20mg[BCF] AspirinandDipyridamole
10/20:Amlodipine10mgandbenazeprilhydrochloride20mg[BCF] OutpatientFormularyBrandsAvailableAggrenox®
Lotrel®: OutpatientDosageForms
2.5/10:Amlodipine2.5mgandbenazeprilhydrochloride10mg[BCF] Capsule,variablerelease,oral:
5/10:Amlodipine5mgandbenazeprilhydrochloride10mg[BCF] Aggrenox®: Aspirin 25mg [immediate release] and dipyridamole 200mg
5/20:Amlodipine5mgandbenazeprilhydrochloride20mg[BCF] [extendedrelease]
5/40:Amlodipine5mgandbenazeprilhydrochloride40mg[BCF]
10/20:Amlodipine10mgandbenazeprilhydrochloride20mg[BCF] Atazanavir
10/40:Amlodipine10mgandbenazeprilhydrochloride40mg[BCF] OutpatientFormularyBrandsAvailableReyataz®
OutpatientDosageForms
AmlodipineandValsartan
Capsule,oral,assulfate:
OutpatientFormularyBrandsAvailableExforge
Reyataz®:200mg,300mg
OutpatientDosageForms
Tablet,Oral: Atenolol
Exforge: OutpatientDosageForms
5/160:Amlodipine5mgandvalsartan160mg Tablet,oral:25mg[BCF],50mg[BCF],100mg[BCF]
10/160:Amlodipine10mgandvalsartan160mg
10/320:Amlodipine10mgandvalsartan320mg AtoMOXetine
OutpatientFormularyBrandsAvailableStrattera®
Amlodipine,Valsartan,andHydrochlorothiazide
OutpatientDosageForms
OutpatientFormularyBrandsAvailableExforgeHCT
Capsule,oral:
OutpatientDosageForms
Strattera®:10mg,18mg,25mg,40mg,60mg
Tablet,Oral:
ExforgeHCT: AtorvaSTATin
Amlodipine5mg,valsartan160mg,andhydrochlorothiazide12.5mg OutpatientFormularyBrandsAvailableLipitor®
Amlodipine10mg,valsartan320mg,andhydrochlorothiazide25mg
OutpatientDosageForms
Amoxicillin Tablet,oral:
OutpatientDosageForms Lipitor®:10mg[BCF],20mg[BCF],40mg[BCF],80mg[BCF]
Capsule,oral:250mg[BCF],500mg[BCF] AtovaquoneandProguanil
Powderforsuspension,oral:250mg/5mL(80mL,100mL,150mL)[BCF];
OutpatientFormularyBrandsAvailableMalarone®
400mg/5mL(50mL,75mL,100mL)[BCF]
Tablet,oral:875mg OutpatientDosageForms
Tablet,oral:
AmoxicillinandClavulanatePotassium Malarone®:Atovaquone250mgandproguanilhydrochloride100mg
OutpatientFormularyBrandsAvailableAugmentinXR®;Augmentin®
Atropine(Ophthalmic)
OutpatientDosageForms
Powderforsuspension,oral: OutpatientDosageForms
200:Amoxicillin200mgandclavulanatepotassium28.5mgper5mL(50mL, Solution,ophthalmic,assulfate[drops]:1%(15mL)
75mL,100mL)[containsphenylalanine][BCF]
AzaTHIOprine
400:Amoxicillin400mgandclavulanatepotassium57mgper5mL(50mL,
75mL,100mL)[containsphenylalanine][BCF] OutpatientDosageForms
600:Amoxicillin600mgandclavulanatepotassium42.9mgper5mL(75mL, Tablet,oral:50mg
125mL,200mL)[BCF]
AzelaicAcid
Augmentin®:
125:Amoxicillin125mgandclavulanatepotassium31.25mgper5mL(75 OutpatientFormularyBrandsAvailableAzelex®;Finacea®
mL, 100 mL, 150 mL) [contains potassium 0.16 mEq/5 mL; banana OutpatientDosageForms
flavor][BCF] Cream,topical:
200:Amoxicillin200mgandclavulanatepotassium28.5mgper5mL(50 Azelex®:20%(30g,50g)[containsbenzoicacid]
mL, 75 mL, 100 mL) [contains phenylalanine 7mg/5 mL and potassium Gel,topical:
0.14mEq/5mL;orangeflavor][BCF] Finacea®:15%(50g)[containsbenzoicacid]
250:Amoxicillin250mgandclavulanatepotassium62.5mgper5mL(75
Azelastine(Nasal)
mL, 100 mL, 150 mL) [contains potassium 0.32 mEq/5 mL; orange
flavor][BCF] OutpatientFormularyBrandsAvailableAstelin®
400:Amoxicillin400mgandclavulanatepotassium57mgper5mL(50mL, OutpatientDosageForms
75mL,100mL)[containsphenylalanine7mg/5mLandpotassium0.29 Solution,intranasal,ashydrochloride[spray]:0.1%[137mcg/spray](30mL)
mEq/5mL;orangeflavor][BCF] Astelin®:0.1%[137mcg/spray](30mL)[containsbenzalkoniumchloride;200
Tablet,oral: meteredsprays]
Amoxicillin250mgandclavulanatepotassium125mg[BCF]
Amoxicillin500mgandclavulanatepotassium125mg[BCF] Azithromycin(Ophthalmic)
Amoxicillin875mgandclavulanatepotassium125mg[BCF] OutpatientFormularyBrandsAvailableAzaSite®
Augmentin XR®: 1000: Amoxicillin 1000mg and clavulanate potassium OutpatientDosageForms
62.5mg[scored;containspotassium12.6mg/tablet,sodium29.3mg/tablet] Solution,ophthalmic[drops]:
AzaSite®:1%(2.5mL)[containsbenzalkoniumchloride]
Anastrozole
OutpatientFormularyBrandsAvailableArimidex® Azithromycin(Systemic)
OutpatientDosageForms OutpatientFormularyBrandsAvailableZithromax®;Zithromax®Z-PAK®
Tablet,oral: OutpatientDosageForms
Arimidex®:1mg Powder for suspension, oral, as dihydrate [strength expressed as base]:
Apixaban 100mg/5mL(15mL)[BCF];1g/packet(3s)[BCF]
Zithromax®: 100mg/5 mL (15 mL) [contains sodium 3.7mg/5 mL; cherry-
OutpatientFormularyBrandsAvailableEliquis
crèmedevanilla-bananaflavor]
OutpatientDosageForms
Zithromax®:200mg/5mL(22.5mL)[containssodium7.4mg/5mL;cherry-
Tablet,Oral:
crèmedevanilla-bananaflavor]
Eliquis:2.5mg,5mg
Zithromax®:1g/packet(10s)[containssodium37mg/packet;banana-cherry
ARIPiprazole flavor]
OutpatientFormularyBrandsAvailableAbilify® Tablet, oral, as dihydrate [strength expressed as base]: 250mg [BCF],
OutpatientDosageForms 500mg[BCF]
Tablet,oral: Zithromax®:250mg[containssodium0.9mg/tablet]
Abilify®:2mg,5mg,10mg,15mg,20mg,30mg Zithromax®Z-PAK®:250mg[containssodium0.9mg/tablet]
3
BACITRACIN,NEOMYCIN,ANDPOLYMYXINB(OPHTHALMIC)
Bacitracin,Neomycin,andPolymyxinB(Ophthalmic) Bisoprolol
OutpatientDosageForms OutpatientDosageForms
Ointment,ophthalmic:Bacitracin400units,neomycin3.5mg,andpolymyxinB Tablet,Oral,asfumarate:
10,000unitsperg(3.5g)[BCF] Generic:5mg
Bacitracin(Ophthalmic) BrimonidineandTimolol
OutpatientDosageForms OutpatientFormularyBrandsAvailableCombigan™
Ointment,Ophthalmic: OutpatientDosageForms
Generic:500units/g(3.5g]) Solution,ophthalmic[drops]:
Combigan™: Brimonidine tartrate 0.2% and timolol maleate 0.5% (5 mL)
Bacitracin(Topical) [containsbenzalkoniumchloride]
OutpatientDosageForms
Brimonidine(Ophthalmic)
Ointment,External,aszinc[strengthexpressedasbase]:
Generic:500units/g(15g) OutpatientFormularyBrandsAvailableAlphaganP
OutpatientDosageForms
Baclofen Solution,Ophthalmic,astartrate[drops]:
OutpatientDosageForms AlphaganP:0.1%(5mL,);0.15%(10mL)[containsPurite]
Tablet,oral:10mg Generic: 0.15% (5 mL, 10 mL, 15 mL) [BCF]; 0.2% (5 mL, 10 mL, 15
mL)[BCF]
Balsalazide
OutpatientFormularyBrandsAvailableColazal® Bromocriptine
OutpatientDosageForms OutpatientFormularyBrandsAvailableParlodel®SnapTabs®
Capsule,oral,asdisodium: OutpatientDosageForms
Colazal®:750mg[containssodium~86mg/capsule] Tablet,oral:
Parlodel®SnapTabs®:2.5mg[scored]
Barium
Budesonide(OralInhalation)
OutpatientFormularyBrandsAvailableReadi-Cat®2
OutpatientDosageForms
OutpatientDosageForms
Suspension,Inhalation:
Suspension,oral,assulfate:
Pulmicort: 0.25mg/2 mL (2 mL); 0.5mg/2 mL (2 mL); 1mg/2 mL (2 mL)
Readi-Cat®2:2.1%w/v(450mL)[containsbenzoicacid,sodiumbenzoate;
[containsdisodiumedta,polysorbate80]
applesmoothieflavor]
Readi-Cat®2:2.1%w/v(250mL,450mL)[containsbenzoicacid,sodium Budesonide(Systemic)
benzoate;bananasmoothieflavor] OutpatientDosageForms
Readi-Cat®2:2.1%w/v(450mL)[containsbenzoicacid,sodiumbenzoate; Capsule,oral:
berrysmoothieflavor] Endocort®EC:3mg
BelladonnaandOpium Bumetanide
OutpatientDosageForms OutpatientFormularyBrandsAvailableBumex
Suppository,rectal:Belladonnaextract16.2mgandopium60mg(12s) OutpatientDosageForms
Tablet,Oral:
Benzonatate
Bumex: 0.5mg [contains fd&c blue #1 aluminum lake, fd&c yellow #10
OutpatientDosageForms aluminumlake]
Capsule,softgel,oral:100mg Bumex:1mg[containsfd&cyellow#10(quinolineyellow)]
BenzoylPeroxide Bupivacaine(Liposomal)
OutpatientDosageForms OutpatientDosageForms
Gel,topical:5%(45g);10%(45g) Suspension,Injection:
Wash,topical:10%(227g) Exparel:1.3%(20mL)
Benztropine BuPROPion
OutpatientDosageForms Outpatient Formulary Brands Available WellbutrinSR®; WellbutrinXL®;
Tablet,oral,asmesylate:0.5mg[BCF],1mg[BCF],2mg[BCF] Zyban®
OutpatientDosageForms
Betamethasone(Topical)
Tablet,oral,ashydrochloride:75mg[BCF],100mg[BCF]
OutpatientFormularyBrandsAvailableLuxíq® Tablet,extendedrelease,oral,ashydrochloride:100mg[BCF],150mg[BCF]
OutpatientDosageForms WellbutrinXL®:300mg[BCF]
Aerosol,topical,asvalerate[strengthexpressedasbase,foam]: Tablet,sustainedrelease,oral,ashydrochloride:
Luxíq®:0.12%(50g)[containsethanol60.4%] WellbutrinSR®:100mg[BCF],150mg[BCF]
Zyban®:150mg[BCF]
Betaxolol(Ophthalmic)
OutpatientFormularyBrandsAvailableBetopticS® BusPIRone
OutpatientDosageForms OutpatientDosageForms
Suspension,ophthalmic[drops]: Tablet,oral,ashydrochloride:5mg[BCF],10mg[BCF],15mg[BCF]
BetopticS®:0.25%(15mL)[containsbenzalkoniumchloride]
Butalbital,Acetaminophen,andCaffeine
Bicalutamide OutpatientDosageForms
OutpatientFormularyBrandsAvailableCasodex® Tablet, oral: Butalbital 50mg, acetaminophen 325mg, and caffeine 40mg
OutpatientDosageForms [BCF]
Tablet,oral: Butalbital,Aspirin,andCaffeine
Casodex®:50mg
OutpatientDosageForms
Bimatoprost Tablet,oral:Butalbital50mg,aspirin325mg,andcaffeine40mg
OutpatientFormularyBrandsAvailableLumigan® Calcipotriene
OutpatientDosageForms OutpatientFormularyBrandsAvailableDovonex®
Solution,ophthalmic[drops]: OutpatientDosageForms
Lumigan®:0.01%(5mL)[containsbenzalkoniumchloride] Cream,topical:
Bisacodyl Dovonex®:0.005%(60g)
Solution,topical:
OutpatientDosageForms
Dovonex®:0.005%(60mL)
Suppository,rectal:10mg(50s)
Tablet,entericcoated,oral:5mg Calcitriol(Systemic)
OutpatientDosageForms
BismuthSubsalicylate
Capsule,softgel,oral:
OutpatientFormularyBrandsAvailablePepticRelief[OTC] Generic:0.25mcg
OutpatientDosageForms
Tablet,chewable,oral,assubsalicylate: CalciumAcetate
PepticRelief:262mg OutpatientFormularyBrandsAvailablePhosLo®
4
CIMETIDINE
OutpatientDosageForms Cefprozil
Gelcap,oral: OutpatientFormularyBrandsAvailableCefzil®
PhosLo®:667mg[equivalenttoelementalcalcium169mg(8.45mEq)] OutpatientDosageForms
CalciumCarbonate Powderforsuspension,oral,asanhydrous:
Cefzil®:250mg/5mL(100mL)[containsphenylalanine28mg/5mL,sodium
OutpatientFormularyBrandsAvailableCalcarb600[OTC]
benzoate;bubblegumflavor]
OutpatientDosageForms
Tablet,oral,asanhydrous:
Tablet,oral:
Cefzil®:250mg,500mg
Calcarb600:1500mg[scored;sugarfree;equivalenttoelementalcalcium
600mg] Celecoxib
Candesartan OutpatientFormularyBrandsAvailableCeleBREX®
OutpatientFormularyBrandsAvailableAtacand® OutpatientDosageForms
OutpatientDosageForms Capsule,oral:
Tablet,oral,ascilexetil: CeleBREX®:100mg,200mg
Atacand®:4mg,8mg,16mg,32mg[scored] Cephalexin
Capecitabine OutpatientDosageForms
OutpatientFormularyBrandsAvailableXeloda® Capsule,oral:250mg[BCF],500mg[BCF]
OutpatientDosageForms Powderforsuspension,oral:250mg/5mL(100mL,200mL)[BCF]
Tablet,oral:
Cetirizine(Systemic)
Xeloda®:500mg
OutpatientFormularyBrandsAvailableZyrTECAllergy;ZyrTECChildren's
Captopril Allergy
OutpatientDosageForms OutpatientDosageForms
Tablet,oral:12.5mg[BCF],25mg[BCF],50mg[BCF],100mg[BCF] Syrup,oral,ashydrochloride:5mg/5mL(120mL)
ZyrTECChildren'sAllergy:5mg/5mL(118mL)[containspropyleneglycol;
CarBAMazepine
banana-grapeflavor]
OutpatientFormularyBrandsAvailableCarbatrol;TEGretol Tablet,oral,ashydrochloride:5mg,10mg
OutpatientDosageForms ZyrTECAllergy:10mg
CapsuleExtendedRelease12Hour,Oral:
Carbatrol:100mg,200mg,300mg ChlorhexidineGluconate(Oral)
Suspension,Oral: OutpatientDosageForms
Generic:100mg/5mL(5mL,10mL,450mL)[BCF] Solution,Mouth/Throat:
Tablet,Oral: Generic:0.12%(473mL)[BCF]
Generic:200mg[BCF]
Tablet,Chewable,Oral: ChlorhexidineGluconate(Topical)
TEGretol:100mg[scored] OutpatientDosageForms
Generic:100mg[BCF] Liquid,External[surgicalscrub]:
TabletExtendedRelease12Hour,Oral: Hibiclens:4%(946mL)[containsisopropylalcohol]
Generic:400mg[BCF]
Chloroquine
CarbamidePeroxide
OutpatientFormularyBrandsAvailableAralen®
OutpatientDosageForms OutpatientDosageForms
Solution,otic[drops]:6.5%(15mL) Tablet,oral,asphosphate:500mg[equivalenttochloroquinebase300mg]
CarbidopaandLevodopa Aralen®:500mg[equivalenttochloroquinebase300mg]
OutpatientFormularyBrandsAvailableSinemet®CR Chlorpheniramine
OutpatientDosageForms OutpatientDosageForms
Tablet,oral: Tablet,oral,asmaleate:4mg
10/100:Carbidopa10mgandlevodopa100mg[BCF]
25/100:Carbidopa25mgandlevodopa100mg[BCF] ChlorproMAZINE
25/250:Carbidopa25mgandlevodopa250mg[BCF] OutpatientDosageForms
Tablet,sustainedrelease,oral: Tablet,oral,ashydrochloride:25mg
Sinemet®CR:50/200:Carbidopa50mgandlevodopa200mg[scored]
Chlorthalidone
Carboxymethylcellulose
OutpatientDosageForms
OutpatientFormularyBrandsAvailableRefreshCelluvisc;RefreshOptive;
Tablet,oral:25mg[BCF],50mg[BCF]
RefreshTears
OutpatientDosageForms Cholecalciferol
Solution,ophthalmic,assodium[drops]: OutpatientDosageForms
RefreshOptive:0.5%(15mL,30mL) Tablet,Oral:
Solution,ophthalmic,assodium[drops,preservativefree]: Generic:2000units
RefreshCelluvisc:1%
RefreshTears:0.5% CholestyramineResin
OutpatientFormularyBrandsAvailableQuestran®Light
Carteolol(Ophthalmic)
OutpatientDosageForms
OutpatientDosageForms
Powderforsuspension,oral:Cholestyramineresin4g/5gofpowder(210g);
Solution,Ophthalmic,ashydrochloride:
Cholestyramineresin4g/5.7gofpowder(239.4g);Cholestyramineresin4g/
Generic:1%(5mL,10mL)
9gofpowder(378g);Cholestyramineresin4g/5gpacket(60s);Cholestyr-
Carvedilol amineresin4g/5.7gpacket(60s);Cholestyramineresin4g/9gpacket(60s)
OutpatientFormularyBrandsAvailableCoregCR®;Coreg® Questran®Light:Cholestyramineresin4g/5gofpowder(210g);Cholestyr-
OutpatientDosageForms amineresin4g/5gpacket(60s)[containsphenylalanine14mg/5g;orange
Capsule,extendedrelease,oral,asphosphate: flavor]
CoregCR®:10mg,20mg,40mg,80mg
Ciclopirox
Tablet,oral:3.125mg[BCF],6.25mg[BCF],12.5mg[BCF],25mg[BCF]
Coreg®:3.125mg,6.25mg,12.5mg,25mg OutpatientDosageForms
Solution,External:
Cefadroxil Generic:8%(6.6mL)
OutpatientDosageForms
Cilostazol
Capsule,oral,asmonohydrate[strengthexpressedasbase]:500mg
OutpatientFormularyBrandsAvailablePletal®
Cefdinir OutpatientDosageForms
OutpatientFormularyBrandsAvailableOmnicef® Tablet,oral:
OutpatientDosageForms Pletal®:100mg
Capsule,oral:300mg
Powderforsuspension,oral: Cimetidine
Omnicef®:125mg/5mL(100mL);250mg/5mL(100mL)[containssodium OutpatientDosageForms
benzoate,sucrose2.86g/5mL;strawberryflavor] Tablet,oral:400mg
5
CINACALCET
Cinacalcet Ointment,External,aspropionate:
OutpatientFormularyBrandsAvailableSensipar Temovate:0.05%(15g,30g,45g[DSC])
OutpatientDosageForms Generic:0.05%(45g)
Tablet,Oral: Shampoo,External,aspropionate:
Sensipar:30mg,60mg,90mg Clobex:0.05%(118mL)[containsalcohol,usp]
Solution,External,aspropionate:
CiprofloxacinandDexamethasone
Temovate:0.05%(50mL)
OutpatientFormularyBrandsAvailableCiprodex® Generic:0.05%(50mL)
OutpatientDosageForms
Suspension,otic: ClomiPHENE
Ciprodex®:Ciprofloxacin0.3%anddexamethasone0.1%(7.5mL)[contains OutpatientFormularyBrandsAvailableClomid®
benzalkoniumchloride] OutpatientDosageForms
Ciprofloxacin(Systemic) Tablet,oral,ascitrate:
Clomid®:50mg[scored]
OutpatientFormularyBrandsAvailableCipro®
OutpatientDosageForms ClonazePAM
Microcapsulesforsuspension,oral: OutpatientDosageForms
Cipro®:250mg/5mL(100mL)[strawberryflavor][BCF]
Tablet,oral:0.5mg[BCF],1mg,2mg
Tablet,oral,ashydrochloride[strengthexpressedasbase]:100mg,250mg
[BCF],500mg[BCF],750mg CloNIDine
Citalopram Outpatient Formulary Brands Available Catapres-TTS®-1; Catapres-
TTS®-2;Catapres-TTS®-3;Kapvay®
OutpatientDosageForms
OutpatientDosageForms
Solution,oral:10mg/5mL(240mL)[BCF]
Tablet,oral:10mg[BCF],20mg[BCF],40mg[BCF] Patch,transdermal[once-weeklypatch]:
Catapres-TTS®-1:0.1mg/24hours(4s)
Clarithromycin Catapres-TTS®-2:0.2mg/24hours(4s)
OutpatientFormularyBrandsAvailableBiaxin®;Biaxin®XL;Biaxin®XL Catapres-TTS®-3:0.3mg/24hours(4s)
Pac Tablet,oral,ashydrochloride:0.1mg[BCF],0.2mg[BCF],0.3mg[BCF]
OutpatientDosageForms Tablet,extendedrelease,oral,ashydrochloride:
Tablet,oral: Kapvay®:0.1mg
Biaxin®:500mg
Tablet,extendedrelease,oral: Clopidogrel
Biaxin®XL:500mg OutpatientFormularyBrandsAvailablePlavix®
Biaxin®XLPac[7-day]:500mg(14tablets) OutpatientDosageForms
ClidiniumandChlordiazepoxide Tablet,Oral:
OutpatientFormularyBrandsAvailableLibrax Plavix:75mg[BCF],300mg[BCF]
OutpatientDosageForms Generic:75mg[BCF],300mg[BCF]
Capsule,Oral: Clotrimazole(Oral)
Librax:Clidiniumbromide2.5mgandchlordiazepoxidehydrochloride5mg
OutpatientFormularyBrandsAvailableMycelex®
ClindamycinandBenzoylPeroxide OutpatientDosageForms
OutpatientFormularyBrandsAvailableBenzaClin Troche,oral:
OutpatientDosageForms Mycelex®:10mg
Gel,External:
Clotrimazole(Topical)
BenzaClin:Clindamycin1%andbenzoylperoxide5%(25g)
Generic:Clindamycin1.2%andbenzoylperoxide5%(45g)[BCF] OutpatientDosageForms
Cream,topical:1%(30g)
Clindamycin(Systemic) Solution,topical:1%(10mL,30mL)[BCF]
OutpatientFormularyBrandsAvailableCleocinHCl®;CleocinPediatric®
OutpatientDosageForms Codeine
Capsule,oral,ashydrochloride[strengthexpressedasbase]:150mg[BCF] OutpatientDosageForms
CleocinHCl®:300mg Tablet,oral,assulfate:30mg
Granulesforsolution,oral,aspalmitatehydrochloride[strengthexpressedas
Colchicine
base]:
CleocinPediatric®:75mg/5mL(100mL)[cherryflavor] OutpatientDosageForms
Tablet,oral:0.6mg
Clindamycin(Topical)
OutpatientFormularyBrandsAvailableCleocin Colestipol
OutpatientDosageForms OutpatientFormularyBrandsAvailableColestid®
Cream,Vaginal,asphosphate[strengthexpressedasbase]: OutpatientDosageForms
Cleocin:2%(40g)[containsbenzylalcohol,mineraloil] Tablet,oral,ashydrochloride[micronized]:
Generic:2%(40g)[BCF] Colestid®:1g
Gel,External,asphosphate:
Generic:1%(30g)[BCF] Collagenase(Topical)
Lotion,External,asphosphate: OutpatientFormularyBrandsAvailableSantyl®
Generic:1%(60g)[BCF] OutpatientDosageForms
Solution,External,asphosphate[strengthexpressedasbase]: Ointment,topical:
Generic:1%(30mL,60mL)[BCF] Santyl®:250units/g(15g,30g)
CloBAZam CopperIUD
OutpatientDosageForms
OutpatientFormularyBrandsAvailableParaGard
Suspension,Oral:
OutpatientDosageForms
Onfi:2.5mg/mL(120mL)[containsmethylparaben,polysorbate80,propylene
Device:
glycol,propylparaben;berryflavor]
ParaGard:(1ea)
Clobetasol
Cromolyn(Ophthalmic)
Outpatient Formulary Brands Available Clobex; Clobex Spray; Olux;
Temovate;TemovateE OutpatientFormularyBrandsAvailableCrolom®
OutpatientDosageForms OutpatientDosageForms
Cream,External,aspropionate: Solution,ophthalmic,assodium[drops]:
TemovateE:0.05%(30g[DSC],60g) Crolom®:4%(10mL)[containsbenzalkoniumchloride]
Generic:0.05%(30g)
Cyanocobalamin
Foam,External,aspropionate:
Olux:0.05%(100g)[containscetylalcohol,propyleneglycol] OutpatientDosageForms
Liquid,External,aspropionate: Injection,solution:1000mcg/mL(1mL)
ClobexSpray:0.05%(125mL)[containsalcohol,usp] Tablet,oral:1000mcg
6
DIABETICSUPPLIES
OutpatientDosageForms
Solution,oral:0.5mg/5mL(240mL,500mL)
Cyclobenzaprine Solution,oral[concentrate]:
OutpatientFormularyBrandsAvailableFlexeril® DexamethasoneIntensol™:1mg/mL(30mL)[dyefree,sugarfree;contains
OutpatientDosageForms benzoicacid,ethanol30%,propyleneglycol]
Tablet,oral,ashydrochloride:10mg[BCF] Tablet,oral:0.75mg,4mg
Flexeril®:5mg Decadron®:0.5mg[DSC][scored]
Cyclopentolate Dexmethylphenidate
OutpatientFormularyBrandsAvailableAK-Pentolate™;Cyclogyl® OutpatientFormularyBrandsAvailableFocalin
OutpatientDosageForms OutpatientDosageForms
Solution,ophthalmic,ashydrochloride[drops]: Tablet,Oral,ashydrochloride:
AK-Pentolate™:1%(15mL)[containsbenzalkoniumchloride] Focalin:2.5mg,5mg,10mg
Cyclogyl®:0.5%(15mL)[containsbenzalkoniumchloride]
Dextroamphetamine
CyclopentolateandPhenylephrine OutpatientFormularyBrandsAvailableDexedrine®Spansule®
OutpatientFormularyBrandsAvailableCyclomydril® OutpatientDosageForms
OutpatientDosageForms Capsule,sustainedrelease,oral,assulfate:
Solution,ophthalmic[drops]: Dexedrine®Spansule®:5mg[scored;containstartrazine]
Cyclomydril®:Cyclopentolatehydrochloride0.2%andphenylephrinehydro-
DextroamphetamineandAmphetamine
chloride1%(2mL)[containsbenzalkoniumchloride]
OutpatientFormularyBrandsAvailableAdderall;AdderallXR
CycloSPORINE(Ophthalmic) OutpatientDosageForms
OutpatientFormularyBrandsAvailableRestasis® Capsule,ExtendedRelease,Oral:
OutpatientDosageForms 5mg [dextroamphetamine sulfate 1.25mg, dextroamphetamine saccharate
Emulsion,ophthalmic[drops,preservativefree]: 1.25mg,amphetamineaspartatemonohydrate1.25mg,amphetaminesul-
Restasis®:0.05%(0.4mL)[containscastoroil] fate1.25mg(equivalenttoamphetaminebase3.1mg)][BCF]
10mg [dextroamphetamine sulfate 2.5mg, dextroamphetamine saccharate
CycloSPORINE(Systemic)
2.5mg,amphetamineaspartatemonohydrate2.5mg,amphetaminesulfate
OutpatientFormularyBrandsAvailableNeoral® 2.5mg(equivalenttoamphetaminebase6.3mg)][BCF]
OutpatientDosageForms 15mg[dextroamphetaminesulfate3.75mg,dextroamphetaminesaccharate
Capsule,softgel,oral[modified]:25mg,100mg 3.75mg,amphetamineaspartatemonohydrate3.75mg,amphetaminesul-
Neoral®:25mg,100mg[containscornoil,dehydratedethanol11.9%] fate3.75mg(equivalenttoamphetaminebase9.4mg)][BCF]
Cyproheptadine 20mg [dextroamphetamine sulfate 5mg, dextroamphetamine saccharate
5mg, amphetamine aspartate monohydrate 5mg, amphetamine sulfate
OutpatientDosageForms
5mg(equivalenttoamphetaminebase12.5mg)][BCF]
Syrup,oral,ashydrochloride:2mg/5mL(473mL,480mL)[BCF]
25mg[dextroamphetaminesulfate6.25mg,dextroamphetaminesaccharate
Tablet,oral,ashydrochloride:4mg[BCF]
6.25mg,amphetamineaspartatemonohydrate6.25mg,amphetaminesul-
DabigatranEtexilate fate6.25mg(equivalenttoamphetaminebase15.6mg)][BCF]
OutpatientFormularyBrandsAvailablePradaxa 30mg [dextroamphetamine sulfate 7.5mg, dextroamphetamine saccharate
OutpatientDosageForms 7.5mg,amphetamineaspartatemonohydrate7.5mg,amphetaminesulfate
Capsule,Oral: 7.5mg(equivalenttoamphetaminebase18.8mg)][BCF]
Pradaxa:75mg,150mg AdderallXR
5mg[dextroamphetaminesulfate1.25mg,dextroamphetaminesaccharate
Dapsone(Systemic) 1.25mg, amphetamine aspartate monohydrate 1.25mg, amphetamine
OutpatientDosageForms sulfate1.25mg(equivalenttoamphetaminebase3.1mg)]
Tablet,oral:25mg 10mg[dextroamphetaminesulfate2.5mg,dextroamphetaminesaccharate
2.5mg, amphetamine aspartate monohydrate 2.5mg, amphetamine sul-
DarbepoetinAlfa fate2.5mg(equivalenttoamphetaminebase6.3mg)]
OutpatientFormularyBrandsAvailableAranesp®;Aranesp®SingleJect® 15mg [dextroamphetamine sulfate 3.75mg, dextroamphetamine saccha-
OutpatientDosageForms rate 3.75mg, amphetamine aspartate monohydrate 3.75mg, amphet-
Injection,solution[preservativefree]: aminesulfate3.75mg(equivalenttoamphetaminebase9.4mg)]
Aranesp®:60mcg/0.3mL(0.3mL[DSC]);200mcg/0.4mL(0.4mL[DSC]) 20mg [dextroamphetamine sulfate 5mg, dextroamphetamine saccharate
[containsalbumin(human)] 5mg, amphetamine aspartate monohydrate 5mg, amphetamine sulfate
Aranesp®SingleJect®:25mcg/0.42mL(0.42mL);60mcg/0.3mL(0.3mL); 5mg(equivalenttoamphetaminebase12.5mg)]
100mcg/0.5mL(0.5mL);200mcg/0.4mL(0.4mL)[containsnaturalrubber/ 25mg [dextroamphetamine sulfate 6.25mg, dextroamphetamine saccha-
naturallatexinpackaging,polysorbate80] rate 6.25mg, amphetamine aspartate monohydrate 6.25mg, amphet-
aminesulfate6.25mg(equivalenttoamphetaminebase15.6mg)]
Darunavir
30mg[dextroamphetaminesulfate7.5mg,dextroamphetaminesaccharate
OutpatientFormularyBrandsAvailablePrezista 7.5mg, amphetamine aspartate monohydrate 7.5mg, amphetamine sul-
OutpatientDosageForms fate7.5mg(equivalenttoamphetaminebase18.8mg)]
Tablet,oral: Tablet,Oral:
Prezista:600mg,800mg 5mg [dextroamphetamine sulfate 1.25mg, dextroamphetamine saccharate
Desmopressin 1.25mg,amphetamineaspartatemonohydrate1.25mg,amphetaminesul-
fate1.25mg(equivalenttoamphetaminebase3.13mg)]
OutpatientFormularyBrandsAvailableDDAVP®
10mg [dextroamphetamine sulfate 2.5mg, dextroamphetamine saccharate
OutpatientDosageForms
2.5mg,amphetamineaspartatemonohydrate2.5mg,amphetaminesulfate
Solution,intranasal,asacetate[spray]:
2.5mg(equivalenttoamphetaminebase6.3mg)]
DDAVP®: 0.1mg/mL (5 mL) [contains benzalkonium chloride; delivers 10
20mg [dextroamphetamine sulfate 5mg, dextroamphetamine saccharate
mcg/spray]
5mg, amphetamine aspartate monohydrate 5mg, amphetamine sulfate
Tablet,oral,asacetate:
5mg(equivalenttoamphetaminebase12.6mg)]
DDAVP®:0.1mg,0.2mg[scored]
Adderall:
Desonide 5mg [scored; dextroamphetamine sulfate 1.25mg, dextroamphetamine
OutpatientDosageForms saccharate 1.25mg, amphetamine aspartate monohydrate 1.25mg,
Cream,topical:0.05%(60g) amphetaminesulfate1.25mg(equivalenttoamphetaminebase3.13mg)]
Lotion,topical:0.05%(60mL) 10mg [scored; dextroamphetamine sulfate 2.5mg, dextroamphetamine
Ointment,topical:0.05%(60g) saccharate2.5mg,amphetamineaspartatemonohydrate2.5mg,amphet-
aminesulfate2.5mg(equivalenttoamphetaminebase6.3mg)]
Devices 20mg[scored;dextroamphetaminesulfate5mg,dextroamphetaminesac-
OutpatientDosageForms charate5mg,amphetamineaspartatemonohydrate5mg,amphetamine
PillCutter sulfate5mg(equivalenttoamphetaminebase12.6mg)]
PeakFlowMeter 30mg[dextroamphetaminesulfate7.5mg,dextroamphetaminesaccharate
Syringe:1mL25gaugex5/8" 7.5mg, amphetamine aspartate monohydrate 7.5mg, amphetamine sul-
fate7.5mg(equivalenttoamphetaminebase18.8mg)]
Dexamethasone(Systemic)
Outpatient Formulary Brands Available Decadron® [DSC]; Dexametha- DiabeticSupplies
soneIntensol™ OutpatientFormularyBrandsAvailableFreeStyle
7
DIABETICSUPPLIES
OutpatientDosageForms Docusate
Glucosemeter: Outpatient Formulary Brands Available Colace® [OTC]; Surfak® Liqui-
FreeStyle Gels®
Glucosesolution: OutpatientDosageForms
FreeStyleGlucoseControlSolution(2s)
Capsule,liquid-filled:
Lancet:
Surfak®Liqui-Gels®:240mg
FreeStyle
Capsule,softgel,oral,ascalcium:240mg
LancingDevice:
Liquid,oral,assodium:50mg/5mL(473mL)
FreeStyle
Colace®:50mg/5mL
Syringeandneedle:
BDSyringe0.5mL(Ultra-FineII)31gaugex5/16"[BCF] DocusateandSenna
BDSyringe1mL(Ultra-FineII)31gaugex5/16"[BCF] OutpatientFormularyBrandsAvailableSenokot-S®[OTC]
TestStrips/Kit:
OutpatientDosageForms
FreeStyle
Tablet,oral:
DiazePAM Senokot-S®: Docusate sodium 50mg and sennosides 8.6mg [sugar free;
Outpatient Formulary Brands Available Diastat®; Diastat® AcuDial™; containssodium4mg/tablet]
Valium®
Dolutegravir
OutpatientDosageForms
OutpatientFormularyBrandsAvailableTivicay
Gel,rectal[pediatricrectaltip(4.4cm)]:
OutpatientDosageForms
Diastat®:5mg/mL(0.5mL)[containsbenzoicacid,benzylalcohol,ethanol
10%,propyleneglycol,sodiumbenzoate] Tablet,Oral:
Gel,rectal[pediatric/adultrectaltip(4.4cm)]: Tivicay:50mg
Diastat® AcuDial™: 10mg (2 mL) [contains benzoic acid, benzyl alcohol, Donepezil
ethanol 10%, propylene glycol, sodium benzoate; 5mg/mL (delivers set
OutpatientDosageForms
dosesof5mg,7.5mg,and10mg)]
Tablet,oral:5mg[BCF] Tablet,oral,ashydrochloride:5mg,10mg
Diclofenac(Systemic) Dorzolamide
OutpatientDosageForms OutpatientFormularyBrandsAvailableTrusopt®
Tablet,Oral,aspotassium: OutpatientDosageForms
Generic:50mg Solution,ophthalmic[drops]:
TabletDelayedRelease,Oral,assodium: Trusopt®:2%(10mL)[containsbenzalkoniumchloride]
Generic:25mg,75mg
DorzolamideandTimolol
TabletExtendedRelease24Hour,Oral,assodium:
Generic:100mg OutpatientFormularyBrandsAvailableCosopt®
OutpatientDosageForms
Diclofenac(Topical) Solution,ophthalmic[drops]:
OutpatientFormularyBrandsAvailableVoltaren Cosopt®:Dorzolamidehydrochloride2% [strengthexpressedas base]and
OutpatientDosageForms timolol maleate 0.5% mg [strength expressed as base] (10 mL) [contains
Gel,Transdermal,assodium: benzalkoniumchloride]
Voltaren:1%(100g)[containsisopropylalcohol,propyleneglycol]
Doxazosin
Dicloxacillin OutpatientFormularyBrandsAvailableCardura®
OutpatientDosageForms OutpatientDosageForms
Capsule,oral:250mg[BCF],500mg[BCF] Tablet,oral:2mg,4mg,8mg
Dicyclomine Cardura®:1mg,2mg,4mg,8mg[scored]
OutpatientDosageForms Doxepin(Systemic)
Capsule,oral,ashydrochloride:10mg[BCF] OutpatientDosageForms
Injection,solution,ashydrochloride:10mg/mL(2mL)[BCF] Capsule, oral, as hydrochloride: 10mg [BCF], 25mg [BCF], 50mg [BCF],
Syrup,oral,ashydrochloride: 75mg[BCF]
Bentyl®:10mg/5mL(480mL)[containspropyleneglycol][BCF]
Solution,oral,ashydrochloride[concentrate]:10mg/mL(120mL)[BCF]
Tablet,oral,ashydrochloride:20mg[BCF]
Doxycycline
Difluprednate
OutpatientFormularyBrandsAvailableVibramycin
OutpatientFormularyBrandsAvailableDurezol®
OutpatientDosageForms
OutpatientDosageForms
Capsule,Oral,ashyclate[strengthexpressedasbase]:
Emulsion,ophthalmic[drops]:
Generic:50mg,100mg[BCF]
Durezol®:0.05%(5mL)[containssorbicacid]
Tablet,Oral,ashyclate[strengthexpressedasbase]:
Digoxin Generic:20mg,100mg[BCF]
OutpatientFormularyBrandsAvailableLanoxin® Dronedarone
OutpatientDosageForms
OutpatientFormularyBrandsAvailableMultaq®
Tablet,oral:125mcg[BCF],250mcg[BCF]
OutpatientDosageForms
DilTIAZem Tablet,oral:
OutpatientFormularyBrandsAvailableTiazac Multaq®:400mg
OutpatientDosageForms
DULoxetine
CapsuleExtendedRelease24Hour,Oral,ashydrochloride:
Tiazac:120mg,180mg,240mg,300mg,360mg OutpatientFormularyBrandsAvailableCymbalta
Generic: 120mg [BCF], 180mg [BCF], 240mg [BCF], 300mg [BCF], OutpatientDosageForms
360mg[BCF],420mg[BCF] CapsuleDelayedReleaseParticles,Oral:
Tablet,Oral,ashydrochloride: Generic:20mg,30mg,60mg
Generic:30mg,60mg,90mg
Edoxaban
DiphenhydrAMINE(Systemic) OutpatientFormularyBrandsAvailableSavaysa
OutpatientFormularyBrandsAvailableBenadryl®;Diphenhist®[OTC] OutpatientDosageForms
OutpatientDosageForms Tablet,Oral:
Capsule,oral,ashydrochloride:25mg,50mg Savaysa:15mg,30mg,60mg
Benadryl®Allergy:25mg[containscalcium35mg/capsule
Efavirenz
Elixir,oral,ashydrochloride:12.5mg/5mL
OutpatientFormularyBrandsAvailableSustiva®
DiphenoxylateandAtropine OutpatientDosageForms
OutpatientFormularyBrandsAvailableLomotil® Tablet,oral:
OutpatientDosageForms Sustiva®:600mg
Tablet,oral:
Lomotil®:2.5/0.025:Diphenoxylatehydrochloride2.5mgandatropinesulfate Efavirenz,Emtricitabine,andTenofovir
0.025mg OutpatientFormularyBrandsAvailableAtripla®
8
ESTROGENS(CONJUGATED/EQUINE,SYSTEMIC)
OutpatientDosageForms OutpatientDosageForms
Tablet,oral: Granulesforsuspension,oral,asethylsuccinate[strengthexpressedasbase]:
Atripla®: Efavirenz 600mg, emtricitabine 200mg, and tenofovir disoproxil E.E.S.®: 200mg/5 mL (100 mL, 200 mL) [contains sodium 25.9mg (1.1
fumarate300mg mEq)/5mL;cherryflavor][BCF]
Tablet,oral,asstearate[strengthexpressedasbase]:
Elvitegravir,Cobicistat,Emtricitabine,andTenofovir
Erythrocin®: 250mg [contains potassium 5mg (0.1 mEq)/tablet, sodium
OutpatientFormularyBrandsAvailableStribild
56.7mg(2.5mEq)/tablet][BCF]
OutpatientDosageForms
Tablet,delayedrelease,entericcoated,oral,asbase:
Tablet,oral:
Ery-Tab®:250mg[containssodium8.3mg(0.4mEq)/tablet][BCF]
Stribild: Elvitegravir 150mg, cobicistat 150mg, emtricitabine 200mg, and
tenofovirdisoproxilfumarate300mg Erythromycin(Topical)
OutpatientDosageForms
Emollients
Gel,topical:2%(30g,60g)[BCF]
OutpatientFormularyBrandsAvailableBiafine®;Vanicream®
Solution,topical:2%(60mL)[BCF]
OutpatientDosageForms
Cream,topical: Escitalopram
Vanicream® OutpatientDosageForms
Emulsion,topical: Tablet,Oral:
Biafine®:(90g)
Generic:5mg,10mg,20mg
EmtricitabineandTenofovir
Esomeprazole
OutpatientFormularyBrandsAvailableTruvada®
OutpatientFormularyBrandsAvailableNexIUM®
OutpatientDosageForms
OutpatientDosageForms
Tablet,oral:
Capsule,delayedrelease,oral,asmagnesium[strengthexpressedasbase]:
Truvada®: Emtricitabine 200mg and tenofovir disoproxil fumarate 300mg
NexIUM®:20mg[BCF],40mg[BCF]
[glutenfree;equivalentto245mgtenofovirdisoproxil]
EstradiolandLevonorgestrel
Enalapril
OutpatientFormularyBrandsAvailableClimaraPro®
OutpatientDosageForms
OutpatientDosageForms
Tablet,Oral,asmaleate:
Generic:2.5mg,5mg,10mg,20mg Patch,transdermal:
ClimaraPro®:Estradiol0.045mgandlevonorgestrel0.015mgper24hours
Enoxaparin (4s)[22cm2;containsestradiol4.4mgandlevonorgestrel1.39mg]
OutpatientFormularyBrandsAvailableLovenox®
Estradiol(Systemic)
OutpatientDosageForms
Injection,solution,assodium[preservativefree]: OutpatientFormularyBrandsAvailableClimara;Divigel;Estrogel;Femring
Lovenox®: 30mg/0.3 mL (0.3 mL) [BCF]; 40mg/0.4 mL (0.4 mL) [BCF]; OutpatientDosageForms
60mg/0.6mL(0.6mL)[BCF];80mg/0.8mL(0.8mL)[BCF];100mg/mL(1 Gel,Transdermal:
mL)[BCF];120mg/0.8mL(0.8mL)[BCF];150mg/mL(1mL)[BCF] Divigel: 0.25mg/0.25g (1 ea); 0.5mg/0.5g (1 ea); 1mg/g (1g) [contains
propyleneglycol,trolamine(triethanolamine)]
Entacapone
Estrogel:0.06%(50g)[containsalcohol,usp,trolamine(triethanolamine)]
OutpatientFormularyBrandsAvailableComtan® PatchWeekly,Transdermal:
OutpatientDosageForms Climara:0.025mg/24hours(4s)[6.5cm2,totalestradiol2.04mg]
Tablet,oral: Climara:0.05mg/24hours(4s)[12.5cm2,totalestradiol3.8mg]
Comtan®:200mg Climara:0.075mg/24hours(4s)[18.75cm2,totalestradiol5.7mg]
Entecavir Climara:0.1mg/24hours(4s)[25cm2,totalestradiol7.6mg]
Generic: 0.025mg/24 hours (4s) [BCF]; 0.0375mg/24 hours (4s) [BCF];
OutpatientFormularyBrandsAvailableBaraclude
0.05mg/24 hours (4s) [BCF]; 0.06mg/24 hours (4s) [BCF]; 0.075mg/24
OutpatientDosageForms
hours(4s)[BCF];0.1mg/24hours(4s)[BCF]
Tablet,Oral:
Ring,Vaginal,asacetate:
Baraclude:0.5mg
Femring:0.05mg/24hours(1s)[totalestradiol12.4mg;releases0.05mg/24
EPINEPHrine(Systemic) hoursover3months]
OutpatientFormularyBrandsAvailableEpiPen®;EpiPen®Jr. Femring: 0.1mg/24 hours (1s) [total estradiol 24.8mg; releases 0.1mg/24
OutpatientDosageForms hoursover3months]
Injection,solution: Tablet,Oral:
0.15mg/0.15mL(1.1mL)[1:1000solution;delivers0.15mgperinjection] Generic:1mg
0.3mg/0.3mL(1.1mL)[1:1000solution;delivers0.3mgperinjection]
Estradiol(Topical)
EpiPen®: 0.3mg/0.3 mL (2 mL) [contains sodium metabisulfite; 1:1000
solution;delivers0.3mgperinjection] OutpatientFormularyBrandsAvailableEstrace®;Estring®;Vagifem®
EpiPen®Jr.:0.15mg/0.3mL(2mL)[containssodiummetabisulfite;1:2000 OutpatientDosageForms
solution;delivers0.15mgperinjection] Cream,vaginal:
Estrace®:0.1mg/g(42.5g)
Eplerenone Ring,vaginal,asbase:
OutpatientDosageForms Estring®:2mg(1s)[totalestradiol2mg;releases7.5mcg/dayover90days]
Tablet,oral:25mg,50mg Tablet,vaginal,asbase:
Vagifem®:10mcg
EpoetinAlfa
OutpatientFormularyBrandsAvailableProcrit® Estrogens(Conjugated/Equine)andMedroxyprogesterone
OutpatientDosageForms OutpatientFormularyBrandsAvailablePremphase®;Prempro®
Injection,solution: OutpatientDosageForms
Procrit®:20,000 units/mL (1 mL [DSC]) [contains albumin (human), benzyl Tablet,oral:
alcohol] Prempro®:
Injection,solution[preservativefree]: 0.3/1.5: Conjugated estrogens 0.3mg and medroxyprogesterone acetate
Procrit®:40,000units/mL(1mL)[containsalbumin(human)]
1.5mg(28s)[BCF]
Ergocalciferol 0.45/1.5:Conjugatedestrogens0.45mgandmedroxyprogesteroneacetate
OutpatientFormularyBrandsAvailableDrisdol® 1.5mg(28s)[BCF]
0.625/2.5:Conjugatedestrogens0.625mgandmedroxyprogesteroneace-
OutpatientDosageForms
tate2.5mg(28s)[BCF]
Capsule,oral:
Drisdol®:50,000int.units[containssoybeanoil,tartrazine;1.25mg] 0.625/5:Conjugatedestrogens0.625mgandmedroxyprogesteroneacetate
5mg(28s)[BCF]
Erythromycin(Ophthalmic) Tablet,oral[therapypackcontainstwoseparatetabletformulations]:
OutpatientDosageForms Premphase® [therapy pack contains 2 separate tablet formulations]: Con-
Ointment,Ophthalmic: jugatedestrogens0.625mg[14maroontablets]andconjugatedestrogen
Generic:5mg/g(3.5g)[BCF] 0.625mg/medroxyprogesteroneacetate5mg[14lightbluetablets](28s)
Erythromycin(Systemic) Estrogens(Conjugated/Equine,Systemic)
OutpatientFormularyBrandsAvailableEry-Tab®;EryPed® OutpatientFormularyBrandsAvailablePremarin
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ESTROGENS(CONJUGATED/EQUINE,SYSTEMIC)
OutpatientDosageForms OutpatientDosageForms
Tablet,Oral: Patch,transdermal:
Premarin: 0.3mg [BCF], 0.45mg [BCF], 0.625mg [BCF], 0.9mg, Ortho Evra®: Ethinyl estradiol 0.75mg and norelgestromin 6mg (1s)
1.25mg[BCF] [releasesethinylestradiol20mcgandnorelgestromin150mcgperday]
Estrogens(Conjugated/Equine,Topical) EthinylEstradiolandNorethindrone
OutpatientFormularyBrandsAvailablePremarin® Outpatient Formulary Brands Available Loestrin Fe 1.5/30; Loestrin Fe
OutpatientDosageForms 1/20;Necon1/35;Norinyl1+35;Ortho-Novum1/35;Ortho-Novum7/7/7
Cream,vaginal: OutpatientDosageForms
Premarin®:0.625mg/g(42.5g)[BCF] Tablet,oral[monophasicformulation]:
Norinyl1+35:Ethinylestradiol0.035mgandnorethindrone1mg[21yellow-
Estrogens(Esterified)andMethyltestosterone
greentabletsand7orangeinactivetablets](28ea)[BCF]
OutpatientFormularyBrandsAvailableCovaryx Ortho-Novum 1/35: Ethinyl estradiol 0.035mg and norethindrone 1mg [21
OutpatientDosageForms peachtabletsand7greeninactivetablets](28ea)[BCF]
Tablet,Oral: Loestrin Fe 1.5/30: Ethinyl estradiol 0.03mg and norethindrone acetate
Covaryx:Esterifiedestrogens1.25mgandmethyltestosterone2.5mg[con- 1.5mg[21pinktablets]andferrousfumarate75mg[7browntablets](28ea)
tainstartrazine] LoestrinFe1/20:Ethinylestradiol0.02mgandnorethindroneacetate1mg
Eszopiclone [21lightyellowtablets]andferrousfumarate75mg[7browntablets](28ea)
Necon 1/35: Ethinyl estradiol 0.035mg and norethindrone 1mg [21 dark
OutpatientDosageForms
yellowtabletsand7whiteinactivetablets](28ea)
Tablet,oral:1mg,2mg,3mg
Tablet,oral[triphasicformulation]:
Ethambutol Ortho-Novum7/7/7:
OutpatientFormularyBrandsAvailableMyambutol® Day 1-7: Ethinyl estradiol 0.035mg and norethindrone 0.5mg [7 white
OutpatientDosageForms tablets]
Day 8-14: Ethinyl estradiol 0.035mg and norethindrone 0.75mg [7 light
Tablet,oral,ashydrochloride:100mg[BCF],400mg[BCF]
peachtablets]
Myambutol®:400mg[scored]
Day 15-21: Ethinyl estradiol 0.035mg and norethindrone 1mg [7 peach
EthinylEstradiolandDesogestrel tablets]
OutpatientFormularyBrandsAvailableMircette;Reclipsen Day22-28:7greeninactivetablets(28ea)
OutpatientDosageForms
EthinylEstradiolandNorgestimate
Tablet,Oral[lowdoseformulation]:
Outpatient Formulary Brands Available Ortho Tri-Cyclen®; Ortho Tri-
Mircette:
Cyclen®Lo;Ortho-Cyclen®
Day1-21:Ethinylestradiol0.02mganddesogestrel0.15mg[21whitetablets]
OutpatientDosageForms
Day22-23:2inactivegreentablet
Tablet,oral,monophasicformulations:
Day24-28:Ethinylestradiol0.01mg[5yellowtablets](28s)
Ortho-Cyclen®:Ethinyl estradiol 0.035mg and norgestimate 0.25mg (28s)
Tablet,Oral[monophasicformulation]:
[21bluetabletsand7greeninactivetablets][BCF]
Reclipsen:Ethinylestradiol0.03mganddesogestrel0.15mg[21rosetablets
and7whiteinactivetablets](28s) Tablet,oral[triphasicformulation]:
Ortho Tri-Cyclen®: Day 1-7: Ethinyl estradiol 0.035mg and norgestimate
EthinylEstradiolandDrospirenone 0.18mg[7whitetablets]
OutpatientFormularyBrandsAvailableYasmin®;Yaz® Day8-14:Ethinylestradiol0.035mgandnorgestimate0.215mg[7lightblue
OutpatientDosageForms tablets]
Tablet,oral: Day 15-21: Ethinyl estradiol 0.035mg and norgestimate 0.25mg [7 blue
Yasmin®:Ethinylestradiol0.03mganddrospirenone3mg(28s)[21yellow tablets]
activetabletsand7whiteinactivetablets][BCF] Day22-28:7greeninactivetablets[DSC]
Yaz®:Ethinylestradiol0.02mganddrospirenone3mg(28s)[24lightpink OrthoTri-Cyclen®Lo:Day1-7:Ethinylestradiol0.025mgandnorgestimate
tabletsand4whiteinactivetablets][BCF] 0.18mg[7whitetablets]
Day8-14:Ethinylestradiol0.025mgandnorgestimate0.215mg[7lightblue
EthinylEstradiolandEthynodiolDiacetate tablets]
OutpatientFormularyBrandsAvailableDemulen®1/35-28 Day 15-21: Ethinyl estradiol 0.025mg and norgestimate 0.25mg [7 dark
OutpatientDosageForms bluetablets]
Tablet,oral: Day22-28:7darkgreeninactivetablets
Demulen®1/35-28:Ethinylestradiol0.035mgandethynodioldiacetate1mg
EthinylEstradiolandNorgestrel
[21whitetabletsand7blueinactivetablets][DSC]
OutpatientFormularyBrandsAvailableLo/Ovral®-28;Ogestrel®
EthinylEstradiolandEtonogestrel OutpatientDosageForms
OutpatientFormularyBrandsAvailableNuvaRing® Tablet,oral:
OutpatientDosageForms Ogestrel®:Ethinylestradiol0.05mgandnorgestrel0.5mg
Ring,vaginal: Tablet,oral[monophasicformulation]:
NuvaRing®: Ethinyl estradiol 0.015mg/day and etonogestrel 0.12mg/day Lo/Ovral®-28:Ethinylestradiol0.03mgandnorgestrel0.3mg[DSC]
(1s)[3-weekduration]
Exenatide
EthinylEstradiolandLevonorgestrel OutpatientFormularyBrandsAvailableBydureon;BydureonBCise
OutpatientFormularyBrandsAvailableAviane;Jolessa;Lessina;Levlite; OutpatientDosageForms
Levora;Nordette;Orsythia Auto-injector,Subcutaneous:
OutpatientDosageForms BydureonBCise:2mg/0.85mL(0.85mL)
Tablet,Oral[lowdoseformulation]: Pen-injector,Subcutaneous:
Aviane 28: Ethinyl estradiol 0.02mg and levonorgestrel 0.1mg (28s) [21 Bydureon:2mg(1ea)
orangetabletsand7lightgreeninactivetablets][BCF]
Lessina28:Ethinylestradiol0.02mgandlevonorgestrel0.1mg(28s)[21pink Ezetimibe
tabletsand7whiteinactivetablets][BCF] OutpatientFormularyBrandsAvailableZetia®
Levlite28:Ethinylestradiol0.02mgandlevonorgestrel0.1mg(28s)[21pink OutpatientDosageForms
tabletsand7whiteinactivetablets][BCF] Tablet,oral:
Orsythia:Ethinylestradiol0.02mgandlevonorgestrel0.1mg[21pinktablets Zetia®:10mg
and7lightgreeninactivetablets](28s)
Famciclovir
Tablet,Oral[monophasicformulation]:
Levora 28: Ethinyl estradiol 0.03mg and levonorgestrel 0.15mg (28s) [21 OutpatientFormularyBrandsAvailableFamvir®
whitetabletsand7peachinactivetablets][BCF] OutpatientDosageForms
Nordette28:Ethinylestradiol0.03mgandlevonorgestrel0.15mg(28s)[21 Tablet,oral:
lightorangetabletsand7pinkinactivetablets][BCF] Famvir®:250mg,500mg
Tablet,Oral[extendedcycleregimen]:
Famotidine
Jolessa:Ethinylestradiol0.03mgandlevonorgestrel0.15mg(91s)[84pink
tabletsand7whiteinactivetablets][BCF] OutpatientFormularyBrandsAvailablePepcid
OutpatientDosageForms
EthinylEstradiolandNorelgestromin Tablet,Oral:
OutpatientFormularyBrandsAvailableOrthoEvra® Pepcid:40mg[containscornstarch]
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