99th MDG NELLIS PHARMACY FORMULARY
Mike O’ Callaghan Federal Hospital
***The brand names in the listings below are for reference use only and do not signify the product dispensed*** effective May 2008
Cephalosporins
Cefuroxime Axetil (Ceftin) Tabs 250mg; Susp 250mg / 5mlCepodoxime Proxetil (Vantin) Tabs 200mg; Susp 100mg / 5ml
Ceprozil (Cefzil) Susp 250mg / 5ml
Cephalexin (Keflex) Caps 250mg, 500mg; Susp 250mg / 5ml
Fluoroquinolones
Ciprofloxacin (Cipro) Tabs 500mgLevofloxacin (Levaquin) Tabs 250mg, 500mg, 750mg
Moxifloxacin (Avelox) Tabs 400mg
Macrolides
Azithromycin (Zithromax) Susp 200mg / 5mlAzithromycin (Zithromax, Z-pak) Tabs 250mg, 500mg TRI-paks
Azithromycin 1 gram packets (Zithromax) (restricted to MOFH providers only)
Clarithromycin XL (Biaxin XL) Tabs 500mg
Erythromycin (Ery-Tab) Tabs 333mg
Erythromycin (EryPed 200) Susp 200mg / 5ml
Penicillins
Amoxicillin (Trimox) Susp 250mg / 5ml, 400mg / 5mlAmoxicillin (Trimox) Caps 250mg, 500mg
Amoxicillin / Clav (Augmentin) Tabs 500-125mg, 875-125mg
Amoxicillin / Clav (Augmentin) Chew Tabs 400-57mg
Amoxicillin / Clav (Augmentin) Susp 400-57.5mg / 5ml, ES 600-42mg / 5ml
Dicloxacillin (Dynapen) Caps 250mg
Penicillin V Potassium (Pen VK) Tabs 250mg
Penicillin V Potassium (Pen VK) Oral Susp 250mg / 5ml
Sulfonamides
Sulfisoxazole (Gantrisin) Oral Susp 500mg / 5mLSulfamethoxazole 800mg / Trimethoprim 160mg (Bactrim DS) Tabs
Sulfamethoxazole 200mg / Trimethoprim 40mg (Bactrim Pediatric) Susp
Tetracyclines
Doxycycline (Vibramycin) Tabs 100mgMinocycline (Minocin) Caps 100mg
Tetracycline (Achromycin) Caps 250mg
OtherClindamycin (Cleocin) Caps 150mg
Dapsone (Avlosufon) Tabs 25mg
Metronidazole (Flagyl) Tabs 250mg
Nitrofurantoin (Macrodantin) Caps 50mg
Nitrofurantoin (Macrobid) Caps 100mg
Nitrofurantoin (Furadantin) Oral Susp 25mg / 5ml
Anti-fungals
Fluconazole (Diflucan) Tabs 100mg, 150mg, 200mgGentian Violet 1% Top Soln
Griseofulvin (Gris-PEG) Tabs 125mg (ultra-microsized)
Griseofulvin (Grifulvin-V) Oral Susp 125mg / 5ml (microsized)
Nystatin (Mycostatin) Oral Susp 100,000u / ml
**For Topical Items, see IV. Dermatologic Agents
Anti-viral
Amantadine (Symmetrel) Caps 100mgAcyclovir (Zovirax) Susp 200mg / 5ml
Acyclovir (Zovirax) Caps 200mg
Acyclovir (Zovirax) Tabs 800mgValacyclovir (Valtrex) Tabs 500mg, 1gm /
Anti-parasitic
Hydroxychloroquine (Plaquenil) Tabs 200mgMebendazole (Vermox) Chewtabs 100mg
Metronidazole (Flagyl) Tabs 250mg
Metronidazole (Metrogel) Vaginal 1% gel
Anti-tubercular Agents
Ethambutol (Myambutol) Tabs 100mg, 40 mg
Isoniazid (INH) Tabs 100mg, 300mg
Isoniazid (INH) Syrup 50mg / 5ml
Pyrazinamide Tabs 500mg
Rifampin (Rifadin) Caps 300mg
Anti-anginalsNitroglycerin SL Tabs 0.3mg, 0.4mg, 0.6mg
Nitroglycerin Linqual Pump Spray
Nitroglycerin (Nitro-Dur) Transdermal Patches 0.2mg/hr, 0.4mg/hr
Isosorbide Dinitrate (Isordil) Tabs 10mg, 40mg SR
Isosorbide Monohydrate (Imdur) Tabs 30mg, 60mg
Anti-hyperlipemics
Colestipol (Colestid) Tabs 1gm, 5gm granulesEzetimibe (Zetia) Tabs 10mg
Ezetimibe/Simvastatin (Vytorin) Tabs 10-20mg, 10-40mg, 10-80mg
Fenofibrate (Triglide) Tabs 50mg, 160mg
Gemfibrozil (Lopid) Tabs 600mg
Nicotinic Acid (Niacin, Vitamin B3) Tab 50mg
Niaspan ER Tabs 500mg, 750mg, 1000mg
Pravastatin (Pravachol) Tabs 10mg, 20mg, 40mg, 80mg
Simvastatin (Zocor) Tabs 5mg, 10mg, 20mg, 40mg, 80mg
Anti-hypertensives
Amlodipine (Norvasc) Tabs 5mg, 10mgAmlodipine/Benazepril (Lotrel) Caps 2.5-10mg, 5-10mg, 5-20mg, 5-40mg,
10-20mg, 10-40mg
Atenolol (Tenormin) Tabs 50mg
Captopril (Capoten) Tabs 25mg
Carvedilol (Coreg) Tab 3.125mg, 6.25mg, 12.5mg, 25mg
Clonidine (Catapres) Tabs 0.1mg, Patches 0.1mg/24hr, 0.2mg/24hr, 0.3mg/24hr
Diltiazem (Cardizem) Tabs 60mg
Diltiazem (Tiazac SR) Caps 120mg, 180mg, 240mg, 300mg
Doxazosin (Cardura) Tabs 2mg, 8mgFelodipine (Plendil) Tabs 2.5mg, 5mg, 10mg
Hydralazine (Apresoline) Tabs 10mg, 25mg
Labetalol (Trandate) Tabs 200mg
Lisinopril (Prinivil, Zestril) Tabs 5mg, 10mg, 20mg, 40mg
Lisinopril/Hydrochlorothiazide Tabs 10-12.5mg, 10-25mg, 20-12.5mg, 20-25mg
Methyldopa (Aldomet) Tabs 250mg
Metoprolol Succinate (Toprol XL) Tabs 25mg, 50mg, 100mg, 200mg
Metoprolol Tartrate (Lopressor) Tabs 50mg
Nifedipine SR (Adalat CC) Tabs 30mg, 60mg, 90 mg
Prazosin (Minipress) Caps 1mg, 2mg, 5mg
Propranolol (Inderal) Tabs 10mg, 40mg
Propranolol (Inderal LA) Caps 80mg
Telmisartan (Micardis) 20mg, 40mg, 80mg
Telmisartan/hydroclorothiazide (Micardis HCT) 40-12.5mg, 80-12.5mg, 80-25mg
Terazosin (Hytrin) Caps 1mg, 2mg, 5mg, 10mg
Verapamil (Calan) Tabs 80mg, 120mg
Verapamil (Calan) SR Tabs 180mg, 240mg
Anti-hypertensives for Diabetes Mellitus
Losartan Potassium (Cozaar) Tabs 25mg, 50mg, 100mg (for MOFH providers, must have comment of diabetetic patient with hypertension in comment field; for Civilian scripts – comment on script of diabetic patient with hypertension)Anti-hypertensives for Coronary Heart Failure
Candesartan Cilexetil (Atacand) Tabs 16mg, 32mg (for MOFH providers, must have comment of Congestive Heart Failure Patient in comment field; for Civilian scripts – comment on script of Congestive Heart Failure Patient) /Anti-platelets / Anti-coagulants
Aspirin Enteric Coated (Ecotrin) Tabs 81mg, 325mgAspirin / Dipyridamole (Aggrenox) Caps 200-25mg
Clopidogrel (Plavix) Tabs 75mg
Warfarin (Coumadin) Tabs 1mg, 2mg, 2.5mg, 5mg, 7.5mg, 10mg
Diuretics
Acetazolamide (Diamox) Tabs 250mg; 500mg Sequels
Furosemide (Lasix) Tabs 40mg; Oral Soln 10mg / ml
Hydrochlorothiazide (HCTZ) Caps 12.5mg; Tabs 25 mg, 50 mg
Hydrochlorothiazide/Triamterene (Maxzide) Tabs 25-37.5mg, 50-75mg
Spironolactone (Aldactone) Tabs 25mg
Anti-arrhythmics
Amiodarone (Cordarone, Pacerone) Tabs 200mg
Digoxin (Lanoxin) Tabs 0.125mg, 0.25mg
Digoxin (Lanoxin Ped elixir) 50mg / ml
Procainamide (Pronestyl) Caps 250mg
Procainamide (Procan SR) Tabs 500mg
Quinidine Gluconate (Quinaglute) Tabs 324mg
Sotalol (Betapace) Tabs 80mg, 120mg
Anti-convulsantsCarbamazepine (Tegretol) Chewtabs 100mg; Tabs 200mg
Carbamazepine (Tegretol) Susp 100mg / 5ml
Carbamazepine XR (Tegretol XR) Tabs 100mg, 200mg, 400mg
Clonazepam (Klonopin) Tabs 0.5mg, 1mg
Diazepam (Valium) Tabs 5mg
Divalproex Sodium (Depakote) Tabs 125mg, 250mg
Divalproex Sodium (Depakote ER) Tabs 250mg, 500mg
Ethosuximide (Zarontin) Caps 250mg
Gabapentin (Neurontin) Caps 100mg, 300mg, 400mg; Tabs 600mg
Lamotrigine (Lamictal) Tabs 100mg, 200mg
Oxcarbazepine (Trileptal) Tabs 300mg, 600mg
Phenobarbital Tabs 30mg
Phenobarbital Elixir 20mg / 5ml
Phenytoin (Dilantin) Caps 100mg
Phenytoin (Dilantin Infatabs) Chewtabs 50mg
Phenytoin (Dilantin) Oral Susp 125mg / 5ml
Primidone (Mysoline) Tabs 50mg, 250mg
Topiramate (Topamax) Tab 25mg, 100mg
Valproic Acid (Depakene) Syrup 250mg / 5ml
Valproic Acid Caps 250mg
Anti-depressantsAmitriptyline (Elavil) Tabs 10mg, 25mg
Bupropion (Wellbutrin) Tabs SR 100mg, 150mg
Buspirone (Buspar) Tabs 5mg, 10mg
Citalopram (Celexa) Tabs 20mg, 40mg
Clomipramine (Anafranil) Caps 25mg
Desipramine (Norpramin) Tabs 10mg, 50mg
Doxepin (Sinequan, Adapin) Caps 25mg
Fluoxetine (Prozac) Caps 10 mg, 20 mg
Imipramine (Tofranil) Tabs 10mg, 25mgNortriptyline (Pamelor) Caps 10mg, 25mg
Paroxetine (Paxil) Tabs 20mg, 40mg
Sertraline (Zoloft) Tabs 25mg, 50mg, 100mg
Trazodone (Desyrel) Tabs 100mg
Venlafaxine XR (Effexor XR) Caps 37.5mg, 75mg, 150mg
Mood Stabilizer / Neuroleptics
Lithium Carbonate (Eskalith) Caps 300mg
Haloperidone (Haldol) Tabs 1mg, 5mg
Olanzapine (Zyprexa) Tabs 5mg, 10mg (restricted to psych providers)
Risperidone (Risperdal) Tabs 1mg, 2mg, 3mg
Quetiapine (Seroquel) 25 mg, 100 mg (restricted to psych providers)
Ziprasidone (Geodon) 20mg, 40mg, 80mg (restricted to psych providers) / Anti- Parkinson’s Agents
Amantadine (Symmetrel) Caps 100mg
Benztropine (Cogentin) Tabs 2mg
Bromocriptine (Parlodel) Tabs 2.5 mg; Caps 5mg
Carbidopa / Levodopa (Sinemet) Tabs 10-100mg, 25-100mg, 25-250mg
Carbidopa / Levodopa CR (Sinemet CR) Tabs 50-200mg
Selegiline (Eldepryl) Caps 5mg
Trihexphenidyl (Artane) Tabs 2mg
Anxiolytics / Sedatives / Hypnotics
Alprazolam (Xanax) Tabs 0.5mgClonazepam (Klonopin) Tabs 0.5mg, 1mg
Diazepam (Valium) Tabs 5mg
Lorazepam (Ativan) Tabs 1mg
Temazepam (Restoril) Caps 15mg, 30mg
Zolpidem (Ambien) Tabs 10mgCentral Nervous System Stimulants
Atomoxetine (Strattera) Caps 10mg, 18mg, 25mg, 40mg, 60mg
Dextroamphetamine (Dexedrine) Tabs 5mg
Dextroamphetamine / Amphetamine (Adderall) Tabs 10mg
Dextroamphetamine / Amphetamine (Adderall XR) Caps 10mg, 20mg, 30mg
Methylphenidate (Ritalin) Tabs 5mg, 10mg
Methylphenidate SR (Ritalin SR) Tabs SR 20mg
Methylphenidate (Concerta) Tabs Extended release 18mg, 27mg, 36mg, 54mg
Migraine Agents
Acetaminophen 325mg / Butalbital 50mg / Caffeine 40mg (Fiorcet) Tabs
Acetaminophen / Isometheptene / Dichloralphenazone (Midrin) Caps
Aspirin 325mg / Butalbital 50mg / Caffeine 40mg (Fiorinal) Tabs
Ergotamine 1mg / Caffeine 100mg (Wigraine, Cafergot) Tabs
Sumatriptan (Imitrex) Injection 6mg
Sumatriptan (Imitrex) Nasal Spray 20mgZolmitriptan (Zomig ZMT) Oral Disintegrating Tablet 2.5mg & 5 mg
Acne ProductsAdapalene (Differin) Gel 0.1%Benzoyl Peroxide Gel 5%
Tretinoin (Retin A) Cream 0.025%, 0.05%, 0.1%; Gel 0.025%
Antibiotics – Topicals
Bacitracin Oint
Clindamycin (Cleocin T) Soln 1%
Erythromycin Soln 2%
Metronidazole (Metrogel) Gel 1%
Silver Sulfadiazine (Silvadene) Cream 1%
Anti-fungals – Topicals
Clotrimazole (Lotrimin) Cream 1%; Soln 1%
Ketoconazole (Nizoral) Cream 2%
Miconazole (Monistat Derm) Cream 2%
Nystatin (Mycostatin) 100,000 units / gm Cream; Oint
Anti-parasitic - Topical
Crotamiton (Eurax) Cream 10%
Permethrin (Elimite) Cream 5%
Pyrethrins (Rid) Shampoo 2oz (restricted to MOFH providers only)
Anti-psoriatics- Topical
Calcipotriene (Dovonex) Cream 0.005%; Soln 0.005%
Pimecrolimus (Elidel) Cream 1%
Selenium sulfide (Selsun) Shampoo 2.5%
Tacrolimus (Protopic) Oint 0.1% (restricted to Dermatologists)
Corticosteroids-Topical
Azelaic acid (Azelex) Cream 20%
Betamethasone Dipropionate Augmented (Diprolene) Oint 0.05%
Betamethasone Valerate (Valisone) Lotion 0.1%
Clobetasol Propionate (Temovate) 0.05%; Cream; Oint; Soln
Desonide (Desowen) 0.05% Cream, Oint
Desoximetasone (Topicort) Oint 0.25%; Gel 0.05%
Fluocinolone (Synalar) Cream, Oint 0.025%, 0.01%; Soln 0.01%
Fluocinonide (Lidex) 0.05%; Cream; Gel; Oint
Hydrocortisone 1% Cream; Oint; Lotion
Triamcinolone (Kenalog) Cream 0.1%, 0.5%; Oint 0.025%, 0.1%, 0.5%
Local Anesthetics-topical
Dibucaine (Nupercainal) Oint 1%
Lidocaine (Xylocaine) Oint 5%; Jelly 2%
Lidocaine/Prilocaine (Emla) Cream 2.5% / 2.5%
Misc-Topical
Aluminum chloride (Drysol) Soln 20%
Fluorouracil (Efudex) Cream 5%
Hydroquinone (Eldoquin Forte) Cream 4%
Imiquimod (Aldara) Cream 5%
Mupirocin (Bactroban) Oint 2%
Ointment Base (Absorbase)
Pimecrolimus (Elidel) Cream 1%
Salicylic Acid Liquid (Duofilm) 17%
Salicylic Acid Plaster (Medi-Plast) 40%
Tacrolimus (Protopic) Oint 0.1% (restricted to Dermatologists)
Urea (Carmol-20) Cream 20%
Zinc Oxide Oint
Hyoscyamine/Atropine/Phenobarbital/Scopalamine (Donnatal) Tabs, Elixir
Bisacodyl (Dulcolax) Tabs 5mg; Supps 10mg
Bismuth Subsalicylate (Pepto-Bismol) Chewtabs 262mg
Bowel Evacuation Kit
Cimetidine (Tagamet) Tabs 400mg
Co-lyte / Golytely Oral Solution
Dicyclomine (Bentyl) Tabs 20mg
Docusate Sodium (Colace) Caps 100mg
Diphenoxylate 2.5mg /Atropine 0.025mg (Lomotil) Tabs
Esomeprazole Magnesium (Nexium) Caps 20mg, 40mg
Fleets Enema
Fleets Oral Saline Laxative (Fleet Phospha Soda)
Hydrocortisone (Cortenema) Enema 100mg / 60ml
Hyoscyamine (Levsin) Tabs 0.125mg
Hyoscyamine SR (LevBID) Tabs 0.375mg
Lactulose (Cephulac) Syrup 10mg / 15ml
Loperamide (Imodium) Caps 2mg
Magnesium Citrate Oral Soln
Mesalamine (Asacol) Tabs 400mg delayed release
Metoclopramide (Reglan) Tabs 10mg
Misoprostol (Cytotec) Tabs 100mcg, 200mcg
Omeprazole (Prilosec) Caps 20mg
Pancreatic Enzymes (Pancrease) Caps (Amylase/Lipase/Protease)
Polyethylene Glycol 3350 (Glycolax/Miralax) Oral Powder 17g/dose
Ranitidine (Zantac) Tabs 150mg; Syrup 15mg / mL
Sulfasalazine (Azulfidine) Tabs 500mg
Anti-emetics
Meclizine (Antivert) Tabs 25mg
Metoclopramide (Reglan) Tabs 10mg
Prochlorperazine (Compazine) Tabs 5mg
Prochlorperazine (Compazine) Supps 25mg
Promethazine (Phenergan) Tabs 25mg
Promethazine (Phenergan) Supps 12.5mg, 25mg / Urinary Tract AgentsFinasteride (Proscar) Tabs 5mg
Oxybutynin (Ditropan) Tabs 5mg
Phenazopyridine (Pyridium) Tabs 100mg
Tolterodine (Detrol LA) Caps 4mg
Alfuzosin (Uroxatrol ) Tabs 10mg
AndrogensDanocrine (Danazol) Caps 200mg
Methyltestosterone (Android) Caps 10mg
Testosterone Cypionate Injection 200mg / ml
Corticosteroids
Cortisone Acetate Tabs 25mg
Dexamethasone (Decadron) Tabs 0.5mg, 4mg
Fludrocortisone Acetate (Florinef) Tabs 0.1mg
Hydrocortisone (Cortef) Tabs 10mg
Methylprednisolone (Medrol) Tabs 4mg, Dosepak 4mg
Prednisolone (Prelone) Oral liquid 15mg / 5ml
Prednisone (Deltasone) Tabs 1mg, 5mg, 20mg, 50mg
Diabetic Supplies
Glucose Test Strips (Precision Xtra)
Lancets
Syringes, Insulin 0.5ml (Lo-Dose) (1/2cc); 1ml (1cc)
Alcohol, Isopropyl Pads 70%
Gout AgentsAllopurinol (Zyloprim) Tabs 100mg, 300mg
Colchicine Tabs 0.6mg
Indomethacin (Indocin) Caps 25mg
Probenecid (Benemid) Tabs 500mg
Hormone Replacement Therapy
Estradiol (Alora) Patch 0.05mg, 0.1mg
Estradiol (Vagifem) Vaginal Tabs 25mcg
Estrogen Conjugated (Premarin) Tabs 0.3mg, 0.45mg, 0.625mg, 1.25mg
Estrogen Conjugated 0.45mg/Medroxyprogesterone 1.25mg (PremPro) Tabs
Estrogen Conjugated 0.625mg/Medroxyprogesterone 2.5mg (PremPro) Tabs
Estrogen Conjugated 0.625mg/Medroxyprogesterone 5mg (PremPro) Tabs
Estrogen Conjugated (Premarin) Vaginal Cream
Medroxyprogesterone (Provera) Tabs 2.5mg, 10mg
Norethindrone Acetate (Aygestin) Tabs 5mg
Hypoglycemic Agents
Glipizide (Glucotrol) Tabs 5mg
Glucagon Emergency Kit 1 mg Vial Injection
Glyburide (Diabeta, Micronase) Tabs 5mg
Glyburide, micronized (Glynase) Tabs 3mg
Insulin NPH (Novolin N)
Insulin NPH/Regular 70/30 (Novolin 70/30)
Insulin Glargine (Lantus)
Insulin Aspartate (Novolog)
Insulin Regular (Novolin R)
Metformin (Glucophage) Tabs 500mg, 850mg, 1000mg
Metformin XR (Glucophage XR) Tabs 500mg
Metformin/Rosiglitazone (Avandamet) Tabs 2-500mg, 4-500mg
Rosglitazone (Avandia) Tabs 4 mg, 8mg
/ Oral Contraceptives---MonophasicDrospirenone 3mg/Ethinyl Estradiol 0.02mg (YAZ) 28sDrospirenone 3mg/Ethinyl Estradiol 0.03mg (YASMIN) 28s
Ethinyl Estradiol 35mcg/Ethynodiol 1mg (Demulen 1/35) 28s
Ethinyl Estradiol 0.02mg/ Levonorgestrel 0.1mg (Lessina) (Levlite) 28s
Ethinyl Estradiol 0.03mg/ Levonorgestrel 0.15mg (Levora) (Nordette) 28s
Ethinyl Estradiol 20mcg/Norethindrone 1mg (Loestrin Fe) 1/20 28s
Ethinyl Estradiol 20mcg/Norethindrone 1mg (Loestrin) 1/20 21s
Ethinyl Estradiol 30mcg/Norgestrel 0.3mg (Lo-Ovral) 28s
Ethinyl Estradiol 35mcg/Norgestimate 0.25mg (Ortho Cyclen) 28s
Ethinyl Estradiol 50mcg/Norgestrel 0.5mg (Ovral) 28s
Ethinyl Estradiol 35mcg/Norethindrone 1mg (Ortho Novum 1/35) (Norinyl 1/35) 28sMestranol 50mcg/Northindrone 1mg (Norinyl 1+50) (Ortho Novum 1/50) 28s
Oral Contraceptives---Triphasic
Ethinyl Estradiol 30/40/30mcg/Levonorgestrel 0.05/0.075/0.125mg (Trivora) 28s
Ethinyl Estradiol 35mcg/Norethindrone 0.5/0.75/1mg (Ortho Novum 7-7-7) 28s
Ethinyl Estradiol 25mcg/Norgestimate 0.18/0.215/0.25mg (Ortho Tri-Cyclen LO) 28s
Ethinyl Estradiol 35mcg/Norgestimate 0.18/0.215/0.25mg (Ortho Tri-Cyclen) (TriNessa ) 28s
Oral Contraceptives---Progestin Only
Norethindrone 0.35mg (Nor QD) 28s
Contraceptives-Other
Ethinyl Estradiol 20mcg/Norelgestromin 150mcg/24 Hrs (Ortho Evra) Patches
Levonorgestrel (Plan B) Tabs 0.75mg 2s
Thyroid Agents
Levothyroxine (Synthroid) Tab 0.025mg, 0.05mg, 0.075mg, 0.088mg, 0.1mg, 0.112mg, 0.125mg, 0.137mg, 0.15mg, 0.175mg, 0.2mgLiothyronine (Cytomel) Tabs 25mcg
Methimazole (Tapazole) Tabs 10mg
Propylthiouracil (PTU) Tabs 50mg
Analgesics NSAIDS
Acetaminophen (Tylenol) Tabs 325mg
Acetaminophen (Tylenol) Infant Drops 80mg / 0.8mL
Acetaminophen (Tylenol) Elixir 160mg / 5mL
Ibuprofen (Motrin) Tabs 400mg, 600mg, 800mg; Susp 100mg / 5ml
Indomethacin (Indocin) Caps 25mg
Meloxicam (Mobic) Tabs 15mg
Naproxen (Naprosyn) Tabs 500mgPiroxicam (Feldene) Caps 20mg
Salsalate (Disalcid) Tabs 750mg
Sulindac (Clinoril)Tabs 150mg
Tramadol (Ultram) Tabs 50mg
Analgesics Opioids
Acetaminophen 300mg / Codeine 30mg (Tylenol #3) Tabs
Acetaminophen 120mg / Codeine 12mg / 5mL Elixir
Acetaminophen 500mg / Hydrocodone 5mg (Lortab/Vicodin) Tabs
Acetaminophen 500mg / Hydrocodone 7.5mg (Lortab) Tabs
Acetaminophen 500mg / Hydrocodone 7.5mg / 15ml (Lortab) Soln (maximum 473ml per script with up to 5 refills)
Acetaminophen 325mg / Oxycodone 5mg (Percocet) Tabs
Acetaminophen 650mg / Propoxyphene 100mg (Darvocet N-100) Tabs
Codeine Sulfate Tabs 30mg
Fentanyl (Duragesic) Patch 25mcg, 50mcg, 75mcg, 100mcg
Hydromorphone (Dilaudid) Tabs 4mg
Meperidine (Demerol) Tabs 50mg
Meperidine (Demerol) Syrup 50mg / 5mL
Methadone (Dolophine) Tabs 10mg
Morphine Sulfate (MSIR) Tabs 15mg, 30mg
Morphine Sulfate Oral Soln 10mg / 5ml, 20mg / 5ml
Morphine Sulfate SR (MS Contin, Oramorph) Tabs 15mg, 30mg, 60mg
Oxycodone CR (Oxycontin) Tabs 10mg, 40mg
Anti-rheumatic Agents
Azathioprine (Imuran) Tabs 50mgHydroxychloroquine (Plaquenil) Tabs 200mg
Leucovorin Calcium (Wellcovorin) Tabs 5mg
Methotrexate (Rhematrex) Tabs 2.5mg
Penicillamine (Cuprimine) Caps 250mg
Sulfasalazine (Azulfidine) Tabs 500mg / Skeletal Muscle Relaxants
Baclofen (Lioresal) Tabs 10mg
Carisoprodol (Soma) Tabs 350mg
Cyclobenzaprine (Flexeril) Tabs 10mg
Methocarbamol (Robaxin) Tabs 500mg
Tizanidine (Zanaflex) Tabs 4mg
Misc
Alendronate (Fosamax) Tabs 10mg, 35mg, 70mg
Alendronate/Vitamin D (Fosamax D) Tabs 70mg-2800unitsPyridostigmine (Mestinon) 60mg Tabs, 180mg Timespan/SR Tabs
Raloxifene (Evista) Tabs 60mg
Anti-Infectives
Ciprofloxacin (Ciloxin) Soln 0.3%
Dexamethasone / Neomycin / Polymyxin B (Maxitrol) Oint
Erythromycin Ophth Oint
Gentamicin (Garamycin) Oint 0.3%; Soln 0.3%
Neomycin / Polymyxin B / Bacitracin (Neosporin) Oint
Neomycin / Polymyxin B / Gramicidin (Neosporin) Soln
Polymyxin B / Bacitracin (Polysporin) Oint
Polymyxin B / Trimethoprim (Polytrim) Soln
Prednisolone Acetate 0.2% / Sulfacetamide Sodium 10% (Blephamide) Oint
Prednisolone Acetate 0.2% / Sulfacetamide Sodium 10% (Blephamide) Soln
Sulfacetamide Sodium (Sulamyd, Bleph-10) Soln 10%
Tobramcyin / Dexamethasone (Tobradex) Soln (restricted to Optometrists/Ophthalmologists)
Anti-Inflammatory / Allergy
Fluoromethalone (FML) Soln 0.1%
Pheniramine 0.3% / Naphazoline 0.025% (Naphcon A/Visine A) Soln
Ketorolac (Acular LS) 0.4% Soln (restricted to Optometrists/Ophthalmologists)
Lodoxamide (Alomide) Soln 0.1%
Olopatadine (Patanol) Soln 0.1%
Prednisolone (Pred-Forte) Soln 1%
Mydriatics
Cyclopentolate (Cyclogyl) Soln 1%
Isopto-Homatropine Soln 5%
Glaucoma
Betaxolol S (Betoptic S) Susp 0.25%
Bimatoprost (Lumigan) Soln 0.03% (restricted to Optometrists/Ophthalmologists)
Brimonidine (Alphagan P) Drops 0.15%
Dipivefrin (Propine) Soln 0.1%
Dorzolamide 2% / Timolol 0.5% (Cosopt) Drops (restricted to Optometrists/Ophthalmologists)
Dorzolamide (Trusopt) Soln 2%
Latanoprost (Xalatan) Soln 0.05%
Levobunolol (Betagan) Soln 0.5%
Medrysone (HMS) Soln 1%
Pilocarpine (Isoptocarpine) Soln 1%, 2%, 3%, 4%
Pilocarpine (Pilopine HS) Gel 4%
Timolol (Timoptic) Soln 0.25%, 0.5%
Timolol (Timoptic XE) Gel Forming Soln 0.5%
Misc
Cyclosporine (Restasis) Dropperettes 0.05% (restricted to Optometrists/Ophthalmologists – 1 Box only with up to 5 refills )
Lacri-lube Oint (Generic EQ.)
LiquiTears Soln (various Artificial Tears) (Not Preservative Free)
Sodium Chloride (Muro 128) Oint 5%; Soln 5%
Acetic Acid (Domeboro) Soln 2%
Antipyrine/Benzocaine (Auralgan/Aurodex) Soln
Ciprofloxacin 0.3% / Dexamethasone 0.1% (Ciprodex) Soln
Bacitracin / Neomycin / Polymyxin B / Hydrocortisone (Cortisporin) Susp
Ofloxacin (Floxin) Soln 0.3%
Anti-histamines / Decongestants / Cough / Cold / AllergyBenzonatate (Tessalon) Gelcaps 100mg
Cetirizine HCl (Zyrtec) Tabs 10mg
Chlorpheniramine (CTM) Tabs 4mg ; Syrup 2mg / 5ml
Chlorpheniramine 8mg/Pseudoephedrine 120mg (Deconamine SR) Caps
Cyproheptadine (Periactin) Tabs 4mg
Diphenhydramine (Benadryl) Caps 25mg
Diphenhydramine (Benadryl) Elixir 12.5mg / 5ml
Guaifenesin 100mg / Codeine 10mg / 5ml Syrup (Robitussin AC)
Guaifenesin 100mg / Dextromethorphan 10mg / 5ml Syrup (Robitussin DM)
Hydroxyzine Pamoate (Vistaril) Caps 25mg
Hydroxyzine HCl (Atarax) Tabs 10mg, 25mg; Syrup 10mg / 5ml
Loratadine (Claritin) Tabs 10mg; Syrup 5mg / 5ml