Drugs: Contract Drugs List Part 4 – Therapeutic ......prazosin hcl propranolol ramipril...

Drugs: Contract Drugs List Part 4 – drugs cdl p4

Therapeutic Classifications 1

2 – Drugs: Contract Drugs List Part 4 Pharmacy 878 Therapeutic Classifications August 2016

This section provides a quick reference to common drug classifications. The referenced pages include a staggered list that organizes drugs with respect to their use or form. Refer to the Contract Drugs List sections in this manual for a full list of drugs and their specific utilization controls. Page ADRENERGIC AGENTS (SYMPATHOMIMETICS) ............................ 10 ADRENERGIC BLOCKING AGENTS (SYMPATHOLYTICS) ................................. 10 AMEBACIDE ................................................. 5 AMYOTROPHIC LATERAL SCLEROSIS AGENT ................................... 19 ANALGESICS .............................................. 10 ANDROGENS ............................................. 14 ANTACIDS AND ADSORBENTS ................ 14 ANTHELMINTICS .......................................... 5 ANTI-ALCOHOLISM .................................... 19 ANTIANXIETY ............................................. 11 ANTIASTHMATICS ....................................... 9 ANTIBIOTICS ................................................ 5 ANTICHOLINERGIC AGENTS ................... 10 (PARASYMPATHOLYTICS) ANTICOAGULANT ANTAGONIST ............. 10 ANTICOAGULANTS .................................... 10 ANTICONVULSANTS ................................. 11

Page ANTIDEPRESSANTS ................................. 11 ANTI-DIARRHEA AGENTS ......................... 14 ANTI-EMETICS ............................................. 9 ANTI-FUNGALS ............................................ 5 ANTI-GLAUCOMA AGENTS ....................... 16 ANTI-GOUT ................................................. 19 ANTIHISTAMINE AND DECONGESTANT COMBINATIONS.......... 19 ANTIHISTAMINE CONTAINING COMBINATIONS ........................................... 9 ANTIHISTAMINES ........................................ 9 ANTI-HYPERKINETICS .............................. 11 ANTIHYPERTENSIVES .............................. 12 ANTI-INFECTIVES ........................................ 5 ANTI-INFLAMMATORY ............................. 10 ANTI-LIPIDEMIC AGENTS ......................... 20 ANTI-MALARIALS ......................................... 5 ANTI-NEOPLASTICS .................................... 7

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Page ANTI-PARKINSONISM .................................. 9 ANTI-PLATELET………………………… ..... 10 ANTI-PLATELET AGENTS………………… 20 ANTI-PROTOZOAL ....................................... 6 ANTIPRURITICS ........................................... 9 ANTI-TUBERCULARS .................................. 6 ANTI-VIRALS ................................................ 6 APPETITE STIMULANT .............................. 12 AUTONOMIC DRUGS ................................... 9 BILE ACID MODIFIER ................................. 14 BISPHOSPHONATES ................................. 20 BLOOD MODIFIERS ................................... 10 BRONCHO-PULMONARY SECRETION MODIFIERS .......................... 20 CALCIMIMETIC AGENT ............................. 20 CALCIUM SUPPLEMENTS AND VITAMIN D ANALOGS ....................... 16 CARDIAC DRUGS ...................................... 13 CENTRAL NERVOUS SYSTEM DRUGS ........................................................ 11

Page CHELATING AGENT .................................. 20 CHOLINERGIC AGENTS (PARASYMPATHOMIMETICS) .................. 10 CONTRACEPTIVES ................................... 15 DECONGESTANTS .................................... 20 DERMATOLOGICAL PREPARATIONS ..... 18 DIGESTANT PREPARATIONS ................... 14 DIURETICS ................................................. 13 DIURETICS AND CARDIO-VASCULARS ............................... 12 ELECTROLYTE SOLUTIONS ..................... 20 ESTROGENS AND COMBINATIONS ........ 15 EXPECTORANTS AND COUGH PREPARATIONS ....................................... 20 FLUORIDE .................................................. 16 GALLSTONE DISSOLVING AGENT .......... 20 GASTRO-INTESTINAL DRUGS ................. 14 G.I. STIMULANT ......................................... 14 GLUCOCORTICOIDS ................................. 15 GOLD COMPOUNDS ................................. 21

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2 – Drugs: Contract Drugs List Part 4 Pharmacy 892 Therapeutic Classifications March 2017

Page H + /K + ATPase ENZYME SYSTEM INHIBITORS ................................ 14 HEMATINICS .............................................. 10 HEMATOPOIETIC ....................................... 10 HEMORHEOLOGIC AGENTS .................... 21 HISTAMINE H2-RECEPTOR ANTAGONISTS ........................................... 14 HORMONES ............................................... 14 HYPOGLYCEMICS ..................................... 15 HYPOGLYCEMIC SHOCK .......................... 16 HYPOPROLACTINEMIC AGENT ............... 21 IMMUNOMODULATORS ............................ 21 IMMUNOSUPPRESSIVE AGENT ............... 21 INTERSTITIAL CYSTITIS AGENT .............. 21 INTRAVENOUS SOLUTIONS ..................... 21 IRRIGATING SOLUTIONS ............................ 7 LAXATIVES ................................................. 14 LOCAL ANESTHETIC INJECTION ............. 21 METABOLIC SUPPLEMENTS .................... 16 MIGRAINE ..................................................... 9 MISCELLANEOUS ...................................... 19 MISCELLANEOUS (CENTRAL NERVOUS SYSTEM DRUGS) ....................................... 12

Page NARCOTIC ANTAGONISTS ....................... 11 NARCOTICS ............................................... 11 NASAL ANTI-INFLAMMATORIES .............. 21 NON-NARCOTICS ...................................... 11 OPHTHALMIC ANESTHETIC ..................... 17 OPHTHALMIC ANTIBIOTICS ..................... 17 OPHTHALMIC ANTIHISTAMINES .............. 17 OPHTHALMIC ANTI-INFLAMMATORIES ........................... 17 OPHTHALMIC ANTI-VIRALS ...................... 17 OPHTHALMIC MAST CELL STABILIZERS .............................................. 17 OPHTHALMIC MIOTICS ............................. 17 OPHTHALMIC MISCELLANEOUS ............. 17 OPHTHALMIC MYDRIATICS ...................... 17 OPHTHALMIC PREPARATIONS ................ 16 OPHTHALMIC SULFONAMIDE .................. 17 OPHTHALMIC VASOCONSTRICTORS AND COMBINATIONS ................................ 17 OTIC PREPARATIONS ............................... 18 OXYTOCICS ............................................... 21

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Page PARASYMPATHOLYTIC AGENTS (ANTICHOLINERGIC) ................................. 10 PARASYMPATHOMIMETIC AGENTS (CHOLINERGIC) ......................................... 10 PARATHYROID ........................................... 16 PHOSPHATE BINDERS ............................. 21 PITUITARY .................................................. 16 POTASSIUM SUPPLEMENT ...................... 16 PROGESTINS AND COMBINATIONS ....... 16 PROSTAGLANDIN ANALOG ...................... 14 PROSTATE AGENTS ................................. 21 PSYCHOTROPICS ..................................... 12 RECTAL PREPARATIONS ......................... 18 SEDATIVES AND HYPNOTICS .................. 12 SKELETAL MUSCLE RELAXANTS ............ 21 SMOKING DETERRENTS .......................... 21 SULFONAMIDES .......................................... 7 SYMPATHOLYTIC AGENTS (ADRENERGIC BLOCKING) ...................... 10 SYMPATHOMIMETIC AGENTS (ADRENERGIC) .......................................... 10

Page THROMBOCYTOPENIC ............................. 10 THYROID AND ANTITHYROID .................. 16 TOPICAL AND LOCAL PREPARATIONS ........................................ 18 TRICHOMONACIDE ..................................... 7 ULCER ADHERENT ................................... 14 URINARY TRACT ANTI-INFECTIVES ......... 7 URINARY TRACT ANTISPASMODICS ...... 21 VACCINES .................................................. 18 VAGINAL PREPARATIONS ........................ 19 VASODILATING AGENTS .......................... 13 VITAMINS .................................................... 16

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2 – Drugs: Contract Drugs List Part 4 Pharmacy 952 Therapeutic Classifications September 2019

ANTI-INFECTIVES AMEBACIDE

PAROMOMYCIN ANTHELMINTICS

MEBENDAZOLE PYRANTEL PAMOATE ANTIBIOTICS

AMIKACIN SULFATE AMOXICILLIN AMOXICILLIN/CLAVULANATE POTASSIUM AMOXICILLIN TRIHYDRATE AMPICILLIN AZITHROMYCIN BENZATHINE PENCILLIN G CEFACLOR CEFAZOLIN CEFDINIR CEFIXIME CEFPODOXIME PROXETIL CEFTAZIDIME CEFTRIAXONE SODIUM CEPHALEXIN CHLORAMPHENICOL CIPROFLOXACIN CIPROFLOXACIN HCL CLARITHROMYCIN CLINDAMYCIN DICLOXACILLIN DOXYCYCLINE DOXYCYCLINE HYCLATE ERYTHROMYCIN BASE ERYTHROMYCIN ETHYLSUCCINATE ERYTHROMYCIN STEARATE GENTAMICIN

ANTI-INFECTIVES (continued) ANTIBIOTICS (continued)

GRISEOFULVIN LEVOFLOXACIN METRONIDAZOLE MOXIFLOXACIN NAFCILLIN NEOMYCIN NYSTATIN OFLOXACIN PENICILLIN G PENICILLIN G PROCAINE PENICILLIN V (K) PIPERACILLIN SODIUM SECNIDAZOLE STREPTOMYCIN TETRACYCLINE TINIDAZOLE TOBRAMYCIN VANCOMYCIN ANTI-FUNGALS

AMPHOTERICIN B BUTOCONAZOLE NITRATE CLOTRIMAZOLE ECONAZOLE NITRATE FLUCONAZOLE ITRACONAZOLE KETOCONAZOLE MICONAZOLE NITRATE NYSTATIN TERBINAFINE HCL TERCONAZOLE ANTI-MALARIALS

CHLOROQUINE HYDROXYCHLOROQUINE PRIMAQUINE PYRIMETHAMINE

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2 – Drugs: Contract Drugs List Part 4 Pharmacy 944 Therapeutic Classifications May 2019

ANTI-INFECTIVES (continued) ANTI-PROTOZOAL

ATOVAQUONE PENTAMIDINE PYRIMETHAMINE ANTI-TUBERCULARS

AZITHROMYCIN CLARITHROMYCIN CYCLOSERINE ETHAMBUTOL ETHIONAMIDE ISONIAZID PYRAZINAMIDE RIFABUTIN RIFAMPIN RIFAMPIN AND ISONIAZID RIFAMPIN, ISONIAZID AND

PYRAZINAMIDE RIFAPENTINE STREPTOMYCIN ANTI-VIRALS

ABACAVIR SULFATE ABACAVIR SULFATE AND LAMIVUDINE ABACAVIR SULFATE/DOLUTEGRAVIR/

LAMIVUDINE ABACAVIR SULFATE, LAMIVUDINE

AND ZIDOVUDINE ACYCLOVIR AMANTADINE ATAZANAVIR/COBICISTAT ATAZANAVIR SULFATE BICTEGRAVIR/EMTRICITABINE/

TENOFOVIR ALAFENAMIDE CIDOFOVIR COBICISTAT COBICISTAT/DARUNAVIR DARUNAVIR DARUNAVIR/COBICISTAT/

EMTRICITABINE/TENOFOVIR ALAFENAMIDE

DELAVIRIDINE MESYLATE DIDANOSINE DOLUTEGRAVIR DOLUTEGRAVIR/LAMIVUDINE DOLUTEGRAVIR/RILPIVIRINE DORAVIRINE DORAVIRINE/LAMIVUDINE/TENOFOVIR

DISOPROXIL FUMARATE

ANTI-INFECTIVES (continued) ANTI-VIRALS (continued)

EFAVIRENZ EFAVIRENZ, EMTRICITABINE AND

TENOFOVIR DISOPROXIL FUMARATE EFAVIRENZ/LAMIVUDINE/TENOFOVIR

DISOPROXIL FUMARATE ELBASVIR/GRAZOPREVIR ELVITEGRAVIR ELVITEGRAVIR/COBICISTAT/

EMTRICITABINE/TENOFOVIR ALAFENAMIDE

ELVITEGRAVIR/COBICISTAT/ EMTRICITABINE/TENOFOVIR DISOPROXIL FUMARATE

EMTRICITABINE EMTRICITABINE/RILPIVIRINE/

TENOFOVIR ALAFENAMIDE EMTRICITABINE/RILPIVIRINE/

TENOFOVIR DISOPROXIL FUMARATE EMTRICITABINE/TENOFOVIR

ALAFENAMIDE ENTECAVIR ETRAVIRINE FOSAMPRENAVIR CALCIUM FOSCARNET SODIUM GANCICLOVIR GANCICLOVIR SODIUM GLECAPREVIR/PIBRENTASVIR IBALIZUMAB-UIYK INDINAVIR SULFATE LAMIVUDINE LAMIVUDINE AND ZIDOVUDINE LAMIVUDINE/TENOFOVIR DISOPROXIL

FUMARATE LEDIPASVIR/SOFOSBUVIR LOPINAVIR AND RITONAVIR MARAVIROC NELFINAVIR MESYLATE NEVIRAPINE OMBITASVIR/PARITAPREVIR/

RITONAVIR AND DASABUVIR OSELTAMIVIR PHOSPHATE PEGINTERFERON ALFA-2A PEGINTERFERON ALFA-2B RALTEGRAVIR RIBAVIRIN RILPIVIRINE RITONAVIR SAQUINAVIR

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2 – Drugs: Contract Drugs List Part 4 Pharmacy 970 Therapeutic Classifications June 2020

ANTI-INFECTIVES (continued) ANTI-VIRALS (continued)

SAQUINAVIR MESYLATE SOFOSBUVIR SOFOSBUVIR/VELPATASVIR STAVUDINE TENOFOVIR ALAFENAMIDE TENOFOVIR DISOPROXIL FUMARATE TIPRANAVIR VALACYCLOVIR HCL VALGANCICLOVIR HCL ZANAMIVIR ZIDOVUDINE IRRIGATING SOLUTIONS

ACETIC ACID NEOMYCIN AND POLYMYXIN SODIUM CHLORIDE SULFONAMIDES

DAPSONE SULFADIAZINE SULFASALAZINE TRIMETHOPRIM AND SULFAMETHOXAZOLE TRICHOMONACIDE

METRONIDAZOLE URINARY TRACT ANTI-INFECTIVES

METHENAMINE HIPPURATE METHENAMINE MANDELATE NITROFURANTOIN TRIMETHOPRIM TRIMETHOPRIM AND SULFAMETHOXAZOLE ANTI-NEOPLASTICS ABEMACICLIB ABIRATERONE ACETATE ACALABRUTINIB ADO-TRASTUZUMAB EMTANSINE AFATINIB ALDESLEUKIN ALECTINIB ALITRETINOIN ALPELISIB

ANTI-NEOPLASTICS (continued) ALTRETAMINE ANASTROZOLE APALUTAMIDE ARSENIC TRIOXIDE ATEZOLIZUMAB AVAPRITINIB AVELUMAB AXITINIB BENDAMUSTINE HCL BEVACIZUMAB BEXAROTENE BICALUTAMIDE BINIMETINIB BLEOMYCIN SULFATE BORTEZOMIB BOSUTINIB BRIGATINIB BUSULFAN CABAZITAXEL CABOZANTINIB S-MALATE CAPECITABINE CAPMATINIB CARBOPLATIN CARMUSTINE CEMIPLIMAB-RWLC CERITINIB CETUXIMAB CHLORAMBUCIL CISPLATIN CLADRIBINE COBIMETINIB COPANLISIB CRIZOTINIB CYCLOPHOSPHAMIDE CYTARABINE DABRAFENIB DACARBAZINE DACOMITINIB DARATUMUMAB DARATUMUMAB AND HYALURONIDASE

-FIHJ DAROLUTAMIDE DASATINIB DAUNORUBICIN CITRATE LIPOSOME DAUNORUBICIN HCL DECITABINE DEGARELIX DOCETAXEL DOXORUBICIN HCL

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2 – Drugs: Contract Drugs List Part 4 Pharmacy 970 Therapeutic Classifications June 2020

ANTI-NEOPLASTICS (continued) DOXORUBICIN HCL LIPOSOME DURVALUMAB DUVELISIB ELOTUZUMAB ENCORAFENIB ENTRECTINIB ENZALUTAMIDE EPIRUBICIN HCL ERDAFITINIB ERIBULIN MESYLATE ERLOTINIB ESTRADIOL ESTRAMUSTINE PHOSPHATE ETOPOSIDE ETOPOSIDE PHOSPHATE EVEROLIMUS EXEMESTANE FAM-TRASTUZUMAB DERUXTECAN-

NXKI FLOXURIDINE FLUDARABINE PHOSPHATE FLUOROURACIL FLUOXYMESTERONE FLUTAMIDE FULVESTRANT GEFITINIB GEMCITABINE HCL GEMTUZUMAB OZOGAMICIN GILTERITINIB GLASDEGIB GOSERELIN ACETATE HYDROXYUREA IBRUTINIB IDELALISIB IFOSFAMIDE IFOSFAMIDE WITH MESNA IMATINIB MESYLATE INOTUZUMAB OZOGAMCIN INTERFERON ALFA-2A INTERFERON ALFA-2B IPILIMUMAB IRINOTECAN HCL IRINOTECAN LIPOSOME ISATUXIMAB-IRFC IVOSIDENIB IXABEPILONE IXAZOMIB LANREOTIDE ACETATE LAPATINIB LAROTRECTINIB

ANTI-NEOPLASTICS (continued) LENVATINIB LETROZOLE LEUPROLIDE ACETATE LOMUSTINE LORLATINIB MECHLORETHAMINE HCL MEDROXYPROGESTERONE

ACETATE MEGESTROL ACETATE MELPHALAN MERCAPTOPURINE MIDOSTAURIN MITOMYCIN MITOTANE MITOXANTRONE MOXETUMOMAB PASUDOTOX-TDFK NECITUMUMAB NELARABINE NILOTINIB NILUTAMIDE NIRAPARIB NIVOLUMAB OBINUTUZUMAB OFATUMUMAB OLAPARIB OLARATUMAB OMACETAXINE MEPESUCCINATE OSIMERTINIB OXALIPLATIN PACLITAXEL PALBOCICLIB PANOBINOSTAT PAZOPANIB HCL PEGASPARGASE PEGINTERFERON ALFA-2B PEMBROLIZUMAB PEMETREXED PENTOSTATIN PERTUZUMAB PEXIDARTINIB POLATUZUMAB VEDOTIN-PIIQ PONATINIB PORFIMER SODIUM PROCARBAZINE RAMUCIRUMAB REGORAFENIB RIBOCICLIB RIBOCICLIB AND LETROZOLE RITUXIMAB

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2 – Drugs: Contract Drugs List Part 4 Pharmacy 972 Therapeutic Classifications July 2020

ANTI-NEOPLASTICS (continued) RITUXIMAB AND HYALURONIDASE

HUMAN SELPERCATINIB SONIDEGIB SORAFENIB STREPTOZOCIN SUNITINIB MALATE TALAZOPARIB TAMOXIFEN CITRATE TAZEMETOSTAT TEMOZOLOMIDE TEMSIROLIMUS TENIPOSIDE TESTOSTERONE THIOGUANINE THIOTEPA TOPOTECAN HCL TRABECTEDIN TRAMETINIB TRASTUZUMAB TRASTUZUMAB AND

HYALURONIDASE-OYSK TRETINOIN TRIPTORELIN PAMOATE VANDETANIB VEMURAFENIB VENETOCLAX VINBLASTINE SULFATE VINCRISTINE SULFATE VINORELBINE TARTRATE VISMODEGIB VORINOSTAT ZANUBRUTINIB ZIV-AFLIBERCEPT AUTONOMIC DRUGS ANTIASTHMATICS

ALBUTEROL SULFATE AMINOPHYLLINE BECLOMETHASONE DIPROPIONATE BUDESONIDE BUDESONIDE/FORMOTEROL

FUMARATE DIHYDRATE CROMOLYN SODIUM EPINEPHRINE FLUNISOLIDE FLUTICASONE FUROATE FLUTICASONE PROPIONATE

AUTONOMIC DRUGS (continued) ANTIASTHMATICS (continued) FLUTICASONE PROPIONATE

AND SALMETEROL GLYCOPYRROLATE AND FORMOTEROL

FUMARATE IPRATROPIUM BROMIDE AND

ALBUTEROL SULFATE METAPROTERENOL

MOMETASONE FUROATE MONOHYDRATE

MOMETASONE FUROATE AND FORMOTEROL FUMARATE DIHYDRATE

MONTELUKAST SODIUM SALMETEROL XINAFOATE TERBUTALINE THEOPHYLLINE TIOTROPIUM BROMIDE TRIAMCINOLONE ANTI-EMETICS

APREPITANT CHLORPROMAZINE DIPHENHYDRAMINE DOLASETRON MESYLATE DOXYLAMINE/PYRIDOXINE HCL GRANISETRON HCL MECLIZINE HCL ONDANSETRON PALONOSETRON HCL PERPHENAZINE PROCHLORPERAZINE PROMETHAZINE ANTIHISTAMINE CONTAINING COMBINATIONS see Expectorants and Cough Preparations ANTIHISTAMINES

AZELASTINE HCL BROMPHENIRAMINE MALEATE CETIRIZINE HCL CHLORPHENIRAMINE MALEATE DEXBROMPHENIRAMINE MALEATE DIPHENHYDRAMINE HCL LORATADINE OLOPATADINE HCL PROMETHAZINE TRIPROLIDINE

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AUTONOMIC DRUGS (continued) ANTI-PARKINSONISM (continued)

AMANTADINE BENZTROPINE MESYLATE CARBIDOPA AND LEVODOPA CARBIDOPA AND LEVODOPA AND

ENTACAPONE DIPHENHYDRAMINE HCL ENTACAPONE PRAMIPEXOLE DIHYDROCHLORIDE ROPINIROLE HCL SELEGILINE HCL TRIHEXYPHENIDYL HCL ANTIPRURITICS – also see Antihistamines

DIPHENHYDRAMINE HYDROCHLORIDE

HYDROXYZINE PROMETHAZINE MIGRAINE

ERGOTAMINE TARTRATE AND CAFFEINE

ISOMETHEPTENE MUCATE, DICHLORALPHENAZONE AND APAP

GALCANEZUMAB-GNLM RIMEGEPANT RIZATRIPTAN SUMATRIPTAN SUMATRIPTAN SUCCINATE PARASYMPATHOLYTIC (ANTICHOLINERGIC) AGENTS

ATROPINE DICYCLOMINE GLYCOPYRROLATE PROPANTHELINE BROMIDE PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS – also see Ophthalmic Miotics

BETHANECHOL CHLORIDE DONEPEZIL HCL GALANTAMINE HYDROBROMIDE PILOCARPINE PYRIDOSTIGMINE RIVASTIGMINE RIVASTIGMINE TARTRATE

AUTONOMIC DRUGS (continued) SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS

ERGOTAMINE TARTRATE AND CAFFEINE PROPRANOLOL SYMPATHOMIMETIC (ADRENERGIC) AGENTS – also see Ophthalmic Vasoconstrictors

EPINEPHRINE BLOOD MODIFIERS ANTICOAGULANT ANTAGONIST

PHYTONADIONE ANTICOAGULANTS

APIXABAN ENOXAPARIN SODIUM HEPARIN HEPARIN LOCK FLUSH SOLUTION RIVAROXABAN WARFARIN SODIUM ANTI-PLATELET

CLOPIDOGREL PRASUGREL TICAGRELOR HEMATINICS

FERROUS SULFATE IRON DEXTRAN INJECTION HEMATOPOIETIC

EPOETIN ALFA THROMBOCYTOPENIC

ANAGRELIDE HYDROCHLORIDE ANALGESICS ANTI-INFLAMMATORY – also see Glucocorticoids

ASPIRIN CELECOXIB COLCHICINE DICLOFENAC SODIUM DIFLUNISAL FENOPROFEN

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ANALGESICS (continued) FLURBIPROFEN IBUPROFEN INDOMETHACIN MELOXICAM NABUMETONE NAPROXEN PIROXICAM SALSALATE SULINDAC TOLMETIN NARCOTIC ANTAGONISTS

BUPRENORPHINE BUPRENORPHINE/NALOXONE NALOXONE HCL NALTREXONE HCL NARCOTICS

CODEINE AND ACETAMINOPHEN FENTANYL HYDROCODONE AND ACETAMINOPHEN HYDROMORPHONE LEVORPHANOL TARTRATE MEPERIDINE HCL MORPHINE SULFATE OXYCODONE AND ACETAMINOPHEN OXYCODONE HCL OXYCODONE HCL AND ASPIRIN OXYMORPHONE NON-NARCOTICS

ACETAMINOPHEN ASPIRIN LIDOCAINE PHENAZOPYRIDINE HCL TRAMADOL HCL

CENTRAL NERVOUS SYSTEM DRUGS

ANTIANXIETY

BUSPIRONE HYDROXYZINE HCL HYDROXYZINE PAMOATE LORAZEPAM

ANTICONVULSANTS

CARBAMAZEPINE CLONAZEPAM

CENTRAL NERVOUS SYSTEM DRUGS (continued) ANTICONVULSANTS (continued)

DIAZEPAM DIVALPROEX SODIUM ESLICARBAZEPINE ACETATE ETHOSUXIMIDE GABAPENTIN LAMOTRIGINE OXCARBAZEPINE PHENOBARBITAL PHENYTOIN PRIMIDONE TIAGABINE HCL TOPIRAMATE VALPROIC ACID ZONISAMIDE ANTIDEPRESSANTS

AMITRIPTYLINE AMITRIPTYLINE HCL,

PERPHENAZINE BUPROPION HCL CITALOPRAM HBR CLOMIPRAMINE HCL DESIPRAMINE HCL DESVENLAFAXINE SUCCINATE DOXEPIN DULOXETINE HCL ESCITALOPRAM OXALATE FLUOXETINE HCL FLUVOXAMINE MALEATE IMIPRAMINE MIRTAZAPINE NORTRIPTYLINE HCL PAROXETINE HCL PROTRIPTYLINE SERTRALINE HCL TRAZODONE VENLAFAXINE HCL VORTIOXETINE ANTI-HYPERKINETICS

ATOMOXETINE HCL DEXMETHYLPHENIDATE HCL DEXTROAMPHETAMINE SULFATE GUANFACINE HCL EXTENDED-RELEASE LISDEXAMFETAMINE DIMESYLATE

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CENTRAL NERVOUS SYSTEM DRUGS (continued) APPETITE STIMULANT

DRONABINOL MISCELLANEOUS

MILNACIPRAN HCL PSYCHOTROPICS

ARIPIPRAZOLE ASENAPINE CHLORPROMAZINE CLOZAPINE FLUPHENAZINE HALOPERIDOL ILOPERIDONE LITHIUM CARBONATE LITHIUM CITRATE LOXAPINE LURASIDONE HYDROCHLORIDE MOLINDONE HYDROCHLORIDE OLANZAPINE PERPHENAZINE QUETIAPINE FUMARATE RISPERIDONE THIORIDAZINE THIOTHIXENE TRIFLUOPERAZINE ZIPRASIDONE HCL SEDATIVES AND HYPNOTICS The Department of Health Care Services (DHCS) recommends that a patient’s use of a hypnotic in insomnia therapy be occasional rather than continuous.

FLURAZEPAM PENTOBARBITAL PHENOBARBITAL TEMAZEPAM TRIAZOLAM ZOLPIDEM TARTRATE

DIURETICS AND CARDIOVASCULARS ANTIHYPERTENSIVES – also see Diuretics

ACEBUTOLOL AMLODIPINE/BENAZEPRIL HCL AMLODIPINE BESYLATE AMLODIPINE/VALSARTAN AMLODIPINE/VALSARTAN HYDROCHLOROTHIAZIDE ATENOLOL BENAZEPRIL HCL BENAZEPRIL HCL AND HYDROCHLOROTHIAZIDE BISOPROLOL FUMARATE CAPTOPRIL CLONIDINE HYDROCHLORIDE DILTIAZEM HCL DOXAZOSIN MESYLATE ENALAPRIL MALEATE GUANFACINE HCL HYDRALAZINE ISRADIPINE LABETALOL HCL LISINOPRIL LISINOPRIL AND

HYDROCHLOROTHIAZIDE LOSARTAN LOSARTAN AND HYDROCHLOROTHIAZIDE METHYLDOPA METHYLDOPA WITH HYDROCHLOROTHIAZIDE METOPROLOL SUCCINATE METOPROLOL TARTRATE

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DIURETICS AND CARDIOVASCULARS (continued) ANTIHYPERTENSIVES – also see Diuretics (continued)

NICARDIPINE NISOLDIPINE PENBUTOLOL SULFATE PINDOLOL PRAZOSIN HCL PROPRANOLOL RAMIPRIL TELMISARTAN TELMISARTAN AND

HYDROCHLOROTHIAZIDE TERAZOSIN HYDROCHLORIDE TIMOLOL MALEATE VALSARTAN VALSARTAN/HYDROCHLOROTHIAZIDE VERAPAMIL HCL CARDIAC DRUGS

AMIODARONE BETAXOLOL CAPTOPRIL CARVEDILOL CARVEDILOL PHOSPHATE DIGOXIN ENALAPRIL MALEATE METOPROLOL SUCCINATE METOPROLOL TARTRATE MEXILETINE HYDROCHLORIDE PROCAINAMIDE PROPRANOLOL QUINIDINE GLUCONATE QUINIDINE SULFATE SOTALOL HCL TIMOLOL MALEATE

DIURETICS AND CARDIOVASCULARS (continued) DIURETICS

ACETAZOLAMIDE CHLORTHALIDONE ETHACRYNIC ACID FUROSEMIDE HYDROCHLOROTHIAZIDE INDAPAMIDE METHAZOLAMIDE METOLAZONE SPIRONOLACTONE SPIRONOLACTONE WITH

HYDROCHLOROTHIAZIDE TRIAMTERENE TRIAMTERENE WITH HYDROCHLOROTHIAZIDE VASODILATING AGENTS

AMLODIPINE BESYLATE AND ATORVASTATIN CALCIUM

DILTIAZEM HCL ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE AND

HYDRALAZINE HYDROCHLORIDE ISOSORBIDE MONONITRATE NIACIN NICARDIPINE NIFEDIPINE NITROGLYCERIN VERAPAMIL HCL

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GASTRO-INTESTINAL DRUGS ANTACIDS AND ADSORBENTS

ALUMINUM AND MAGNESIUM HYDROXIDE GEL

ALUMINUM HYDROXIDE AND MAGNESIUM TRISILICATE GEL

ALUMINUM HYDROXIDE GEL ALUMINUM HYDROXIDE, MAGNESIUM

HYDROXIDE, AND SIMETHICONE CALCIUM CARBONATE AND

MAGNESIUM CARBONATE ANTI-DIARRHEA AGENTS

BISMUTH SUBSALICYLATE DIPHENOXYLATE HCL WITH

ATROPINE SULFATE PAREGORIC PAREGORIC AND PROTECTIVE ANTI-INFLAMMATORY AGENTS

BALSALAZIDE DISODIUM SULFASALAZINE BILE ACID MODIFIER

URSODIOL DIGESTANT PREPARATIONS

PANCRELIPASE (AMYLASE/ LIPASE/ PROTEASE)

G.I. STIMULANT

METOCLOPRAMIDE HCL

GASTRO-INTESTINAL DRUGS (continued) H + /K + ATPase ENZYME SYSTEM INHIBITORS

DEXLANSOPRAZOLE ESOMEPRAZOLE MAGNESIUM OMEPRAZOLE HISTAMINE H2-RECEPTOR ANTAGONISTS

CIMETIDINE FAMOTIDINE RANITIDINE HCL LAXATIVES

BISACODYL DOCUSATE SODIUM NALOXEGOL OXALATE POLYETHYLENE GLYCOL 3350 POLYETHYLENE GLYCOL 3350 AND

ELECTROLYTES PROSTAGLANDIN ANALOG

MISOPROSTOL ULCER ADHERENT

SUCRALFATE HORMONES ANDROGENS

FLUOXYMESTERONE METHYL TESTOSTERONE TESTOSTERONE

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HORMONES (continued) CONTRACEPTIVES

DESOGESTREL AND ETHINYL ESTRADIOL

DROSPIRENONE AND ETHINYL ESTRADIOL

ESTRADIOL VALERATE AND DIENOGEST

ETHYNODIOL DIACETATE AND ETHINYL ESTRADIOL ETONOGESTREL AND ETHINYL

ESTRADIOL LEVONORGESTREL LEVONORGESTREL AND ETHINYL ESTRADIOL NONOXYNOL 9 NORELGESTROMIN AND ETHINYL ESTRADIOL NORETHINDRONE NORETHINDRONE AND ETHINYL ESTRADIOL NORETHINDRONE AND MESTRANOL NORGESTIMATE AND ETHINYL ESTRADIOL NORGESTREL AND ETHINYL ESTRADIOL ULIPRISTAL ACETATE ESTROGENS AND COMBINATIONS

ESTRADIOL ESTROGENS, CONJUGATED ESTROGENS, CONJUGATED AND MEDROXYPROGESTERONE ACETATE ESTROGENS, ESTERIFIED GLUCOCORTICOIDS

CORTISONE DEXAMETHASONE

HORMONES (continued) GLUCOCORTICOIDS (continued)

FLUDROCORTISONE ACETATE HYDROCORTISONE METHYLPREDNISOLONE PREDNISOLONE PREDNISOLONE SODIUM PHOSPHATE PREDNISONE TRIAMCINOLONE HYPOGLYCEMICS

ACARBOSE ALOGLIPTIN ALOGLIPTIN/METFORMIN HCL ALOGLIPTIN/PIOGLITAZONE CHLORPROPAMIDE DAPAGLIFLOZIN DAPAGLIFLOZIN/METFORMIN

HCL EXTENDED-RELEASE DULAGLUTIDE EMPAGLIFLOZIN EXENATIDE GLIMEPIRIDE GLIPIZIDE GLYBURIDE GLYBURIDE AND METFORMIN HCL INSULIN INSULIN ASPART PROTAMINE/ INSULIN

ASPART, (rDNA ORIGIN) INSULIN GLARGINE (rDNA origin) INSULIN LISPRO PROTAMINE/INSULIN

LISPRO (rDNA ORIGIN) LINAGLIPTIN LINAGLIPTIN/METFORMIN HCL METFORMIN HCI MIGLITOL NATEGLINIDE PIOGLITAZONE HCL PIOGLITAZONE HCL/GLIMEPIRIDE PIOGLITAZONE HCL/METFORMIN HCL PRAMLINTIDE ACETATE ROSIGLITAZONE MALEATE

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HORMONES (continued) HYPOGLYCEMICS (continued)

SAXAGLIPTIN SAXAGLIPTIN/METFORMIN HCL

EXTENDED-RELEASE SITAGLIPTIN SITAGLIPTIN/METFORMIN HCL TOLAZAMIDE TOLBUTAMIDE HYPOGLYCEMIC SHOCK

GLUCAGON (r-DNA ORIGIN) GLUCAGON (synthetic) PARATHYROID

CALCITONIN-SALMON PITUITARY

DESMOPRESSIN ACETATE PROGESTINS AND COMBINATIONS

MEDROXYPROGESTERONE ACETATE NORETHINDRONE ACETATE AND

ETHINYL ESTRADIOL PROGESTERONE THYROID AND ANTITHYROID

LEVOTHYROXINE SODIUM METHIMAZOLE PROPYLTHIOURACIL

THYROID METABOLIC SUPPLEMENTS CALCIUM SUPPLEMENTS AND VITAMIN D ANALOGS

CALCITRIOL CALCIUM ACETATE CALCIUM CARBONATE CALCIUM GLUCONATE CALCIUM LACTATE DOXERCALCIFEROL ERGOCALCIFEROL

METABOLIC SUPPLEMENTS (continued) FLUORIDE

SODIUM FLUORIDE POTASSIUM SUPPLEMENT

POTASSIUM BICARBONATE/CITRIC ACID

POTASSIUM CHLORIDE POTASSIUM CITRATE VITAMINS

CYANOCOBALAMIN FOLIC ACID LEUCOVORIN CALCIUM LEVOCARNITINE NIACIN PYRIDOXINE THIAMINE HYDROCHLORIDE VITAMINS A, D, C VITAMINS A, D, C, WITH IRON VITAMINS A, D, C, WITH SODIUM FLUORIDE VITAMINS – MINERALS,

COMBINATION PRODUCTS, PRENATAL ONLY, NONPRESCRIPTION ONLY OPHTHALMIC PREPARATIONS ANTI-GLAUCOMA AGENTS

ACETAZOLAMIDE APRACLONIDINE HCL BETAXOLOL HCL BIMATOPROST BRIMONIDINE TARTRATE BRIMONIDINE TARTRATE/TIMOLOL MALEATE BRINZOLAMIDE BRINZOLAMIDE/BRIMONIDINE TARTRATE CARTEOLOL HCL DORZOLAMIDE HCL DORZOLAMIDE HCL AND TIMOLOL MALEATE METHAZOLAMIDE NETARSUDIL NETARSUDIL/LATANOPROST TIMOLOL MALEATE TRAVOPROST

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OPHTHALMIC PREPARATIONS (continued) OPHTHALMIC ANESTHETIC

PROPARACAINE HCL OPHTHALMIC ANTIBIOTICS

AZITHROMYCIN BACITRACIN CHLORAMPHENICOL CIPROFLOXACIN HCL ERYTHROMYCIN OPHTHALMIC

OINTMENT GENTAMICIN MOXIFLOXACIN HCL NATAMYCIN NEOMYCIN, BACITRACIN AND

POLYMYXIN NEOMYCIN, POLYMYXIN AND

GRAMICIDIN OFLOXACIN POLYMYXIN, BACITRACIN TOBRAMYCIN TRIMETHOPRIM SULFATE AND

POLYMYXIN B SULFATE OPHTHALMIC ANTIHISTAMINES

ALCAFTADINE AZELASTINE HCL OLOPATADINE HCL OPHTHALMIC ANTI-INFLAMMATORIES

BROMFENAC DEXAMETHASONE DEXAMETHASONE WITH NEOMYCIN

AND POLYMYXIN DEXAMETHASONE WITH TOBRAMYCIN DICLOFENAC SODIUM FLUOROMETHOLONE KETOROLAC TROMETHAMINE LOTEPREDNOL ETABONATE LOTEPREDNOL

ETABONATE/TOBRAMYCIN PREDNISOLONE PREDNISOLONE WITH

SULFACETAMIDE RIMEXOLONE

OPHTHALMIC PREPARATIONS (continued) OPHTHALMIC ANTI-VIRALS

GANCICLOVIR TRIFLURIDINE OPHTHALMIC MAST CELL STABILIZERS

CROMOLYN SODIUM LODOXAMIDE OPHTHALMIC MIOTICS

ECHOTHIOPHATE PILOCARPINE OPHTHALMIC MISCELLANEOUS

SODIUM CHLORIDE TYLOXAPOL WITH BENZALKONIUM CHLORIDE

OPHTHALMIC MYDRIATICS

ATROPINE CYCLOPENTOLATE PHENYLEPHRINE TROPICAMIDE OPHTHALMIC SULFONAMIDE

SULFACETAMIDE SODIUM OPHTHALMIC VASOCONSTRICTORS AND COMBINATIONS

NAPHAZOLINE HCL PHENYLEPHRINE

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OTIC PREPARATIONS ACETIC ACID WITH ALUMINUM ACETATE ACETIC ACID WITH HYDROCORTISONE CIPROFLOXACIN HCL/

DEXAMETHASONE CIPROFLOXACIN HYDROCHLORIDE/ HYDROCORTISONE HYDROCORTISONE WITH POLYMYXIN B AND NEOMYCIN OFLOXACIN TOPICAL AND LOCAL PREPARATIONS DERMATOLOGICAL PREPARATIONS

ALCLOMETASONE DIPROPIONATE ALITRETINOIN ALUMINUM ACETATE BACITRACIN TOPICAL OINTMENT BENZOYL PEROXIDE GEL BUTENAFINE HCL CALAMINE LOTION CALCIPOTRIENE CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION CLOTRIMAZOLE COLLAGENASE CROTAMITON ECONAZOLE NITRATE ERYTHROMYCIN TOPICAL

SOLUTION FLUOCINOLONE FLUOCINONIDE HYDROCORTISONE TOPICAL IVERMECTIN KETOCONAZOLE MALATHION MICONAZOLE NITRATE NYSTATIN

TOPICAL AND LOCAL PREPARATIONS (continued) DERMATOLOGICAL PREPARATIONS (continued)

PERMETHRIN PODOFILOX POLYMYXIN, BACITRACIN TOPICAL OINTMENT PREDNICARBATE PYRETHRINS, PIPERONYL BUTOXIDE, PETROLEUM DISTILLATE SILVER SULFADIAZINE CREAM SPINOSAD TAZAROTENE TOLNAFTATE TRIAMCINOLONE RECTAL PREPARATIONS

HYDROCORTISONE ACETATE RECTAL FOAM HYDROCORTISONE RETENTION ENEMA MESALAMINE VACCINES

DIPHTHERIA/PERTUSSIS/TETANUS VACCINE

HEPATITIS A VIRUS VACCINE HEPATITIS A & B VIRUS VACCINE HEPATITIS B VIRUS VACCINE HUMAN PAPILLOMAVIRUS VACCINE INFLUENZA VIRUS VACCINE MEASLES, MUMPS, AND RUBELLA VIRUS

VACCINE MENINGOCOCCAL GROUP B VACCINE MENINGOCOCCAL OLIGOSACCHARIDE

DIPHTHERIA CONJUGATE VACCINE MENINGOCOCCAL POLYSACCHARIDE

DIPHTHERIA CONJUGATE VACCINE MENINGOCOCCAL POLYSACCHARIDE

VACCINE

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VACCINES (continued)

PNEUMOCOCCAL VACCINE, 13-VALENT, CONJUGATED

PNEUMOCOCCAL VACCINE, 23-VALENT, NON-CONJUGATED

RABIES VACCINE TETANUS AND DIPHTHERIA TOXOIDS

ADSORBED VACCINE VARICELLA VIRUS VACCINE VARICELLA ZOSTER VACCINE ZOSTER VACCINE VAGINAL PREPARATIONS

BUTOCONAZOLE NITRATE CLOTRIMAZOLE METRONIDAZOLE MICONAZOLE NITRATE NYSTATIN TERCONAZOLE MISCELLANEOUS AMYOTROPHIC LATERAL SCLEROSIS AGENT

RILUZOLE ANTI-ALCOHOLISM

ACAMPROSATE CALCIUM DISULFIRAM ANTI-GOUT

ALLOPURINOL COLCHICINE PROBENECID PROBENECID WITH COLCHICINE

MISCELLANEOUS (continued) ANTIHISTAMINE AND DECONGESTANT COMBINATIONS

PHENYLEPHRINE HYDROCHLORIDE BROMPHENIRAMINE MALEATE

PHENYLEPHRINE HYDROCHLORIDE CHLORPHENIRAMINE MALEATE

PHENYLEPHRINE HYDROCHLORIDE DIPHENHYDRAMINE HYDROCHLORIDE

PHENYLEPHRINE HYDROCHLORIDE DOXYLAMINE SUCCINATE

PHENYLEPHRINE HYDROCHLORIDE PYRILAMINE MALEATE

PHENYLEPHRINE HYDROCHLORIDE TRIPROLIDINE

PSEUDOEPHEDRINE HYDROCHLORIDE BROMPHENIRAMINE MALEATE

PSEUDOEPHEDRINE HYDROCHLORIDE CHLORPHENIRAMINE MALEATE

PSEUDOEPHEDRINE HYDROCHLORIDE DEXBROMPHENIRAMINE MALEATE

PSEUDOEPHEDRINE HYDROCHLORIDE DOXYLAMINE SUCCINATE

PSEUDOEPHEDRINE HYDROCHLORIDE TRIPROLIDINE HYDROCHLORIDE

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MISCELLANEOUS (continued) ANTI-LIPIDEMIC AGENTS

ATORVASTATIN CALCIUM ATORVASTATIN CALCIUM AND

AMLODIPINE BESYLATE CHOLESTYRAMINE COLESEVELAM HCL COLESTIPOL HYDROCHLORIDE EZETIMIBE EZETIMIBE/SIMVASTATIN FENOFIBRATE FENOFIBRIC ACID FLUVASTATIN GEMFIBROZIL NIACIN PRAVASTATIN ROSUVASTATIN CALCIUM SIMVASTATIN ANTI-PLATELET AGENTS

ASPIRIN ASPIRIN/EXTENDED-RELEASE DIPYRIDAMOLE BISPHOSPHONATES

ALENDRONATE SODIUM ALENDRONATE

SODIUM/CHOLECALCIFEROL IBANDRONATE SODIUM PAMIDRONATE DISODIUM RISEDRONATE SODIUM ZOLEDRONIC ACID BRONCHO-PULMONARY SECRETION MODIFIERS

ACETYLCYSTEINE PROPYLENE GLYCOL SODIUM CHLORIDE SOLUTION

MISCELLANEOUS (continued) CALCIMIMETIC AGENT

CINACALCET HCL CHELATING AGENT

SODIUM POLYSTYRENE SULFATE SUCCIMER DECONGESTANTS

PHENYLEPHRINE HYDROCHLORIDE PSEUDOEPHEDRINE HYDROCHLORIDE ELECTROLYTE SOLUTIONS

ELECTROLYTES, ORAL MAINTENANCE SOLUTIONS EXPECTORANTS AND COUGH PREPARATIONS

BENZONATATE CHLORPHENIRAMINE MALEATE WITH PSEUDOEPHEDRINE HCL AND CODEINE GUAIFENESIN WITH CODEINE POTASSIUM IODIDE SATURATED SOLUTION (S.S.K.I.) PROMETHAZINE WITH CODEINE PROMETHAZINE WITH DEXTROMETHORPHAN PROMETHAZINE WITH PHENYLEPHRINE PROMETHAZINE WITH PHENYLEPHRINE AND CODEINE GALLSTONE DISSOLVING AGENT

URSODIOL

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MISCELLANEOUS (continued) GOLD COMPOUNDS

AURANOFIN HEMORHEOLOGIC AGENTS

CILOSTAZOL PENTOXIFYLLINE HYPOPROLACTINEMIC AGENT

BROMOCRIPTINE MESYLATE IMMUNOMODULATORS

LEFLUNOMIDE IMMUNOSUPPRESSIVE AGENT

AZATHIOPRINE CYCLOSPORINE, MODIFIED MYCOPHENOLATE MOFETIL SIROLIMUS TACROLIMUS INTERSTITIAL CYSTITIS AGENT

PENTOSAN POLYSULFATE SODIUM INTRAVENOUS SOLUTIONS INTRAVENOUS SOLUTIONS OF OTHER

UNLISTED DRUGS INTRAVENOUS SOLUTIONS OF

UNLISTED ANTIBIOTICS PARENTERAL NUTRITION SOLUTIONS

(TPN OR HYPERALIMENTATION) SEPARATELY ADMINISTERED

INTRAVENOUS LIPIDS SIMPLE INTRAVENOUS SOLUTIONS LAXATIVES

LACTULOSE LOCAL ANESTHETIC INJECTION

LIDOCAINE HYDROCHLORIDE NASAL ANTI-INFLAMMATORIES

MOMETASONE FUROATE MONOHYDRATE OXYTOCICS

METHYLERGONOVINE MALEATE

MISCELLANEOUS (continued) PROSTATE AGENTS

ALFUZOSIN HCL DOXAZOSIN MESYLATE DUTASTERIDE PRAZOSIN HCL TAMSULOSIN HCL TERAZOSIN HYDROCHLORIDE PHOSPHATE BINDERS

ALUMINUM HYDROXIDE GEL CALCIUM ACETATE CALCIUM CARBONATE SEVELAMER HYDROCHLORIDE SKELETAL MUSCLE RELAXANTS

BACLOFEN CYCLOBENZAPRINE DANTROLENE SODIUM METHOCARBAMOL TIZANIDINE

SMOKING DETERRENTS

BUPROPION HCL NICOTINE NICOTINE POLACRILEX VARENICLINE TARTRATE URINARY TRACT ANTISPASMODICS

FESOTERODINE FUMARATE OXYBUTYNIN OXYBUTYNIN CHLORIDE SOLIFENACIN SUCCINATE TOLTERODINE TARTRATE

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