KIRTLAND AIR FORCE BASE OUTPATIENT FORMULARY …

Alphabetical Listing by Name

This document is current as of . The availability of formulary items is subject to change.

OUTPATIENT FORMULARYFORCE BASEKIRTLAND AIR

July 25, 2019

Kirtland AFB Outpatient Formulary

Alphabetical Drug Listing Available Dosage Forms

Abacavir, Lamivudine, and

Zidovudine

Tablet, Oral:

Trizivir: Abacavir sulfate 300 mg, lamivudine 150 mg, and zidovudine 300 mg

Acetaminophen Solution, Oral:

Pain & Fever Childrens: 160 mg/5 mL (118 mL) [alcohol free, aspirin free, sugar free; contains

polyethylene glycol, propylene glycol, sodium benzoate; cherry flavor]

Suppository, Rectal:

Acephen: 120 mg (12 ea)

Generic: 650 mg (12s)

Tablet, Oral:

Generic: 325 mg, 500 mg

Acetaminophen and Codeine Solution, Oral [C-V]:

Generic: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 mL (118 mL) [BCF]

Tablet, Oral [C-III]:

Generic: Acetaminophen 300 mg and codeine phosphate 30 mg [BCF]

Generic: Acetaminophen 300 mg and codeine phosphate 60 mg

AcetaZOLAMIDE Tablet, Oral:

Generic: 250 mg

Acetic Acid (Otic) Solution, Otic:

Generic: 2% (15 mL)

Acetic Acid, Propylene Glycol

Diacetate, and Hydrocortisone

Solution, otic [drops]:

VoSol® HC: Acetic acid 2%, propylene glycol diacetate 3%, and hydrocortisone 1% (10 mL)

[contains benzethonium chloride]

Acyclovir (Systemic) Capsule, Oral:

Generic: 200 mg [BCF]

Suspension, Oral:

Generic: 200 mg/5 mL (473 mL) [BCF]

Tablet, Oral:

Generic: 400 mg [BCF], 800 mg [BCF]

Acyclovir (Topical) Cream, External:

Zovirax: 5% (5 g) [contains cetostearyl alcohol, propylene glycol]

Ointment, External:

Generic: 5% (15 g)

Adalimumab Pen-injector Kit, Subcutaneous [preservative free]:

Humira Pen: 40 mg/0.8 mL (1 ea) [contains polysorbate 80] [BCF]

Prefilled Syringe Kit, Subcutaneous [preservative free]:

Humira: 10 mg/0.2 mL (1 ea) [BCF]; 20 mg/0.4 mL (1 ea) [BCF]; 40 mg/0.8 mL (1 ea) [BCF]

[contains polysorbate 80]

Adapalene Cream, External:

Differin: 0.1% (45 g)

Albendazole Tablet, Oral:

Albenza: 200 mg [contains saccharin sodium]

Albiglutide Pen-injector, Subcutaneous [preservative free]:

Tanzeum: 30 mg (1 ea); 50 mg (1 ea) [contains polysorbate 80]

Albuterol Aerosol Solution, Inhalation:

ProAir HFA: 108 (90 Base) mcg/actuation (8.5 g) [BCF]

Nebulization Solution, Inhalation:

Generic: 0.083% [2.5 mg/3 mL] (30s) [BCF]

Generic: 0.5% (5 mg/mL) (20 mL)

Alcohol (Isopropyl) Pad:

BD Swab Single Use: 100/box

Alendronate Tablet, Oral:

Generic: 5 mg [BCF], 10 mg [BCF], 35 mg [BCF], 70 mg [BCF]

1


Alfuzosin Tablet Extended Release 24 Hour, Oral, as hydrochloride:


Allopurinol Tablet, Oral, as sodium:


ALPRAZolam Tablet, Oral:

Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg

Aluminum Chloride Hexahydrate Solution, External:

Hypercare: 20% (35 mL)

Aluminum Hydroxide,

Magnesium Hydroxide, and

Simethicone

Suspension, Oral:

Generic: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg

per 5 mL (355 mL)

Amantadine Capsule, Oral, as hydrochloride:


Syrup, Oral, as hydrochloride:


Amiodarone Tablet, Oral, as hydrochloride:

Pacerone: 100 mg, 200 mg [scored] [BCF]

Amitriptyline Tablet, Oral, as hydrochloride:


AmLODIPine Tablet, Oral:

Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

Amlodipine and Benazepril Capsule, Oral:

Lotrel: 2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF]

Lotrel: 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF]

Generic:

2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF]

5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF]





Amoxicillin Capsule, Oral:


Suspension Reconstituted, Oral:

Generic: 125 mg/5 mL (100 mL); 250 mg/5 mL (150 mL) [BCF]; 400 mg/5 mL (50 mL) [BCF]

Tablet, Oral:

Generic: 875 mg

Amoxicillin and Clavulanate Powder for suspension, Oral:

Augmentin: 125: Amoxicillin 125 mg and clavulanate potassium 31.25 mg per 5 mL (75 mL)

[contains potassium 0.16 mEq/5 mL] [BCF]

Generic:

200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (100 mL) [BCF]

250: Amoxicillin 250 mg and clavulanate potassium 62.5 mg per 5 mL (75 mL) [BCF]

400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (100 mL) [BCF]

ES-600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (125 mL) [BCF]

Tablet, Oral:

Generic:

250: Amoxicillin 250 mg and clavulanate potassium 125 mg [BCF]



Anastrozole Tablet, Oral:

Generic: 1 mg

2


Apixaban Tablet, Oral:

Eliquis: 2.5 mg, 5 mg

ARIPiprazole Tablet, Oral:

Abilify: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg

Artificial Tears Ointment, Ophthalmic [preservative free]:

Artificial Tears: 83-15 % (3.5 g)

Solution, Ophthalmic:

Artificial Tears: 1.4% (15 mL) [contains benzalkonium chloride, edetate disodium]

Aspirin Tablet Delayed Release, Oral:

Aspirin EC Low Dose: 81 mg

Generic: 325 mg

Aspirin and Dipyridamole Capsule, variable release:

Aggrenox®: Aspirin 25 mg [immediate release] and dipyridamole 200 mg [extended release]

[contains lactose, sucrose]

Atenolol Tablet, Oral:

Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

AtoMOXetine Capsule, Oral:

Strattera: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg

AtorvaSTATin Tablet, Oral:


Atovaquone and Proguanil Tablet, Oral:

Generic: Atovaquone 250 mg and proguanil hydrochloride 100 mg

Atropine (Ophthalmic) Ointment, Ophthalmic, as sulfate:

Generic: 1% (3.5 g)

Solution, Ophthalmic, as sulfate:

Generic: 1% (5 mL)

AzaTHIOprine Tablet, Oral:

Generic: 50 mg

Azelastine (Nasal) Solution, Nasal, as hydrochloride:

Generic: 137 mcg/spray (30 mL)

Azithromycin (Systemic) Packet, Oral, as dihydrate [strength expressed as base]:

Generic: 1 g [BCF]

Suspension Reconstituted, Oral, as dihydrate [strength expressed as base]:

Generic: 100 mg/5 mL (15 mL) [BCF]; 200 mg/5 mL (15 mL)

Tablet, Oral, as dihydrate [strength expressed as base]:

ZPak: 250 mg [BCF]

Tablet, Oral, as monohydrate [strength expressed as base]:


Bacitracin and Polymyxin B

(Ophthalmic)

Ointment, ophthalmic:

Generic: Bacitracin 500 units and polymyxin B 10,000 units per g (3.5 g)

Bacitracin, Neomycin, and

Polymyxin B (Ophthalmic)

Ointment, Ophthalmic:

Generic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units per g (3.5 g)

[BCF]

Baclofen Tablet, Oral:


Benazepril Tablet, Oral, as hydrochloride:

Generic: 5 mg, 10 mg, 20 mg, 40 mg

Benzonatate Capsule, Oral:


3


Benzoyl Peroxide Gel, External:

Acne-Clear: 10% (42.5 g)

Generic: 5% (60 g)

Liquid, External:

Benzoyl Peroxide Wash: 5% (148 g) [contains cetyl alcohol, edetate disodium, propylene

glycol]

Benzoyl Peroxide Wash: 10% (227 g) [contains edetate disodium]

Benztropine Tablet, Oral, as mesylate:


Betamethasone and

Clotrimazole

Cream, External:

Generic: Betamethasone dipropionate 0.05% (base) and clotrimazole 1% (15 g)

Betamethasone (Topical) Cream, External, as dipropionate [strength expressed as base]:

Generic: 0.05% (15 g)

Cream, External, as dipropionate augmented [strength expressed as base]:

Generic: 0.05% (15 g)

Bicalutamide Tablet, Oral:


Bimatoprost Solution, Ophthalmic:

Lumigan: 0.01% (5 mL) [contains benzalkonium chloride]

Bisacodyl Suppository, Rectal:

Biscolax: 10 mg (12 ea)

Tablet Delayed Release, Oral:

Bisacodyl EC: 5 mg

Bismuth Subsalicylate Tablet Chewable, Oral, as subsalicylate:

Bismatrol: 262 mg [contains aspartame]

Bisoprolol and

Hydrochlorothiazide

Tablet, Oral:

Generic:

2.5/6.25: Bisoprolol fumarate 2.5 mg and hydrochlorothiazide 6.25 mg

5/6.25: Bisoprolol fumarate 5 mg and hydrochlorothiazide 6.25 mg

10/6.25: Bisoprolol fumarate 10 mg and hydrochlorothiazide 6.25 mg

Brimonidine and Timolol Solution, Ophthalmic:

Combigan: Brimonidine tartrate 0.2% and timolol 0.5% (10 mL) [contains benzalkonium

chloride]

Brimonidine (Ophthalmic) Solution, Ophthalmic, as tartrate:

Generic: 0.15% (5 mL) [BCF]; 0.2% (5 mL, 10 mL) [BCF]

Bromfenac Solution, Ophthalmic:

Prolensa: 0.07% (3 mL) [contains benzalkonium chloride, edetate disodium, sodium sulfite]

Generic: 0.09% (1.7 mL)

Brompheniramine,

Dextromethorphan, and

Phenylephrine

This medication is nonformulary. For formulary alternatives, refer to Therapeutic Category.

Budesonide (Oral Inhalation) Suspension, Inhalation:

Pulmicort: 0.25 mg/2 mL (2 mL); 0.5 mg/2 mL (2 mL) [contains disodium edta, polysorbate 80]

Budesonide (Systemic) Capsule Extended Release 24 Hour, Oral:

Generic: 3 mg

Bumetanide Tablet, Oral:

Generic: 0.5 mg, 1 mg, 2 mg

BuPROPion Tablet, Oral, as hydrochloride:


Tablet Extended Release 12 Hour, Oral, as hydrochloride:

Generic: 100 mg [BCF], 150 mg [BCF], 200 mg

Tablet Extended Release 24 Hour, Oral, as hydrochloride:


4


BusPIRone Tablet, Oral, as hydrochloride:


Butalbital, Acetaminophen, and

Caffeine

Tablet, Oral:

Generic: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg [BCF]

Butalbital, Aspirin, and Caffeine Tablet, Oral:

Generic: Butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg

Calcipotriene Cream, External:

Generic: 0.005% (60 g)

Calcitriol (Systemic) Capsule, Oral:

Generic: 0.25 mcg

Calcium and Vitamin D Tablet, Oral:

Generic: Oyster Shell Calcium 500 mg and D3 400 units

Candesartan Tablet, Oral, as cilexetil:

Atacand: 4 mg, 8 mg, 16 mg, 32 mg [scored]

Capecitabine Tablet, Oral:

Xeloda: 500 mg

Captopril Tablet, Oral:

Generic: 12.5 mg [BCF], 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

CarBAMazepine Suspension, Oral:


Tablet, Oral:


Tablet, Chewable, Oral:


Tablet Extended Release 12 Hour, Oral:

TEGretol-XR: 400 mg [BCF]


Carbamide Peroxide Solution, Otic:

Ear Drops Earwax Aid: 6.5% (15 mL) [contains propylene glycol, trolamine (triethanolamine)]

Carbidopa and Levodopa Tablet, Oral:

Generic:

10/100: Carbidopa 10 mg and levodopa 100 mg [BCF]



Tablet Extended Release, Oral:

Generic: 25/100: Carbidopa 25 mg and levodopa 100 mg

Generic: 50/200: Carbidopa 50 mg and levodopa 200 mg

Carboxymethylcellulose Solution, Ophthalmic, as sodium:

Refresh Plus: 0.5% (30 ea)

Carvedilol Tablet, Oral:

Generic: 3.125 mg [BCF], 6.25 mg [BCF], 12.5 mg [BCF], 25 mg [BCF]

Cefdinir Suspension Reconstituted, Oral:

Generic: 125 mg/5 mL (60 mL)

Cefpodoxime Tablet, Oral:

Generic: 100 mg

Cefprozil Suspension Reconstituted, Oral:

Generic: 125 mg/5 mL (100 mL); 250 mg/5 mL (50 mL)

Tablet, Oral:

Generic: 250 mg

Cefuroxime Tablet, Oral, as axetil [strength expressed as base]:


Celecoxib Capsule, Oral:

CeleBREX: 100 mg, 200 mg

5


Cephalexin Capsule, Oral:


Suspension Reconstituted, Oral:


Cetirizine and Pseudoephedrine Tablet, extended release:

Generic: Cetirizine hydrochloride 5 mg and pseudoephedrine hydrochloride 120 mg

Cetirizine (Systemic) Syrup, Oral, as hydrochloride:

Cetirizine HCl Childrens Allergy: 1 mg/mL (118 mL) [contains methylparaben, propylene glycol,

propylparaben; grape flavor]

Tablet, Oral, as hydrochloride:


Chlorhexidine Gluconate (Oral) Solution, Mouth/Throat:

Generic: 0.12% (473 mL) [BCF]

Chloroquine Tablet, Oral, as phosphate:

Generic: 500 mg [equivalent to chloroquine base 300 mg]

Chlorpheniramine Syrup, Oral, as maleate:

Aller-Chlor: 2 mg/5 mL (118 mL) [contains alcohol, usp, menthol, methylparaben, propylene

glycol, propylparaben; fruit flavor]

Tablet, Oral, as maleate:

Aller-Chlor: 4 mg [scored]

Chlorthalidone Tablet, Oral:


Cholecalciferol Liquid, Oral:

D-Vi-Sol: 400 units/mL (50 mL) [gluten free, lactose free, sugar free; contains polysorbate 80]

Tablet, Oral:

Generic: 1000 units

Cholestyramine Resin Packet, Oral:

Generic: 4 g (60 ea)

Ciclopirox Solution, External:

Generic: 8% (6.6 mL)

Cimetidine Solution, Oral, as hydrochloride [strength expressed as base]:


Ciprofloxacin and

Dexamethasone

Suspension, Otic:

Ciprodex: Ciprofloxacin 0.3% and dexamethasone 0.1% (7.5 mL) [contains benzalkonium

chloride, edetate disodium, tyloxapol]

Ciprofloxacin (Ophthalmic) Ointment, Ophthalmic, as hydrochloride:

Ciloxan: 0.3% (3.5 g)

Solution, Ophthalmic, as hydrochloride:

Ciloxan: 0.3% (5 mL) [contains benzalkonium chloride, edetate disodium]

Ciprofloxacin (Systemic) Suspension Reconstituted, Oral:

Cipro: 250 mg/5 mL (100 mL) [BCF]

Tablet, Oral, as hydrochloride [strength expressed as base]:


Citalopram Solution, Oral:


Tablet, Oral:


Clarithromycin Tablet, Oral:



Generic: 250 mg

Clindamycin and Benzoyl

Peroxide

Gel, External:

BenzaClin: Clindamycin phosphate 1% and benzoyl peroxide 5% (25 g)

Generic: Clindamycin phosphate 1.2% and benzoyl peroxide 5% (45 g)

6


Clindamycin (Systemic) Capsule, Oral, as hydrochloride [strength expressed as base]:

Cleocin HCl: 300 mg


Solution Reconstituted, Oral, as palmitate hydrochloride [strength expressed as base]:


Clindamycin (Topical) Cream, Vaginal, as phosphate [strength expressed as base]:

Generic: 2% (40 g) [BCF]

Solution, External, as phosphate [strength expressed as base]:

Cleocin T: 1% (60 mL) [contains isopropyl alcohol 50%] [BCF]

Clobetasol Cream, External, as propionate:

Generic: 0.05% (15 g) [BCF]

Foam, External, as propionate:

Generic: 0.05% (50 g, 100 g)

Gel, External, as propionate:

Generic: 0.05% (15 g)

Ointment, External, as propionate:


ClomiPHENE Tablet, Oral, as citrate:

Generic: 50 mg

ClomiPRAMINE Capsule, Oral, as hydrochloride:

Generic: 50 mg

ClonazePAM Tablet, Oral:

Generic: 0.5 mg [BCF], 1 mg, 2 mg

CloNIDine Patch Weekly, Transdermal:

Generic: 0.1 mg/24 hr (4 ea); 0.2 mg/24 hr (4 ea); 0.3 mg/24 hr (4 ea)


Generic: 0.1 mg [BCF], 0.2 mg [BCF], 0.3 mg [BCF]

Clopidogrel Tablet, Oral:


Clotrimazole (Oral) Lozenge, Mouth/Throat:

Generic: 10 mg (70 ea)

Troche, Mouth/Throat:

Generic: 10 mg

Clotrimazole (Topical) Cream, External:

Clotrimazole Anti-Fungal: 1% (28.35 g) [contains benzyl alcohol]

Solution, External:

Generic: 1% (30 mL) [BCF]

Codeine Tablet, Oral, as sulfate:

Generic: 30 mg

Colchicine Tablet, Oral:

Colcrys: 0.6 mg [scored]

Colestipol Tablet, Oral, as hydrochloride:

Colestid: 1 g

Cromolyn (Ophthalmic) Solution, Ophthalmic, as sodium:

Generic: 4% (10 mL)

Cyanocobalamin Solution, Injection:

Generic: 1000 mcg/mL (1 mL)

Cyclobenzaprine Tablet, Oral, as hydrochloride:

Generic: 5 mg, 10 mg [BCF]

Cyclopentolate Solution, Ophthalmic, as hydrochloride:

Cyclogyl: 1% (5 mL); 2% (5 mL)

CycloSPORINE (Ophthalmic) Emulsion, Ophthalmic [preservative free]:

Restasis: 0.05% (1 ea) [contains polysorbate 80]

7


CycloSPORINE (Systemic) Capsule, Oral:

Gengraf: 25 mg, 100 mg [contains cremophor el]

Neoral: 25 mg, 100 mg [contains alcohol, usp]

SandIMMUNE: 25 mg [contains alcohol, usp]

SandIMMUNE: 100 mg

Cyproheptadine Syrup, Oral, as hydrochloride:



Generic: 4 mg [BCF]

Dabigatran Etexilate Capsule, Oral:

Pradaxa: 75 mg, 150 mg

Desmopressin Solution, Nasal, as acetate:

DDAVP: 0.01% (5 mL)

Tablet, Oral, as acetate:

DDAVP: 0.1 mg [scored]

Desonide Cream, External:

Generic: 0.05% (15 g)

Dexamethasone (Systemic) Elixir, Oral:

Generic: 0.5 mg/5 mL (237 mL)

Tablet, Oral:

Generic: 0.5 mg, 0.75 mg, 1 mg, 4 mg

Dexmethylphenidate Tablet, Oral, as hydrochloride:


Dextroamphetamine Tablet, Oral, as sulfate:

Generic: 5 mg

8


Dextroamphetamine and

Amphetamine

Capsule, Extended release, Oral:

Adderall XR: 5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate 1.25

mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sulfate 1.25 mg (equivalent

to amphetamine base 3.1 mg)] [BCF]


mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate 2.5 mg (equivalent to

amphetamine base 6.3 mg)] [BCF]

Adderall XR: 15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccharate

3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine sulfate 3.75 mg

(equivalent to amphetamine base 9.4 mg)] [BCF]

Adderall XR: 20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate 5 mg,

amphetamine aspartate monohydrate 5 mg, amphetamine sulfate 5 mg (equivalent to


Adderall XR: 25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine saccharate

6.25 mg, amphetamine aspartate monohydrate 6.25 mg, amphetamine sulfate 6.25 mg

(equivalent to amphetamine base 15.6 mg)] [BCF]


mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sulfate 7.5 mg (equivalent to


Tablet, oral:

10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate 2.5 mg,

amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate 2.5 mg (equivalent to

amphetamine base 6.3 mg)]




20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate 5 mg, amphetamine

aspartate monohydrate 5 mg, amphetamine sulfate 5 mg (equivalent to amphetamine base

12.6 mg)]




Diabetic Supplies Glucose meter:

Freestyle Freedom Lite Monitor [BCF]

Precision Xtra Blood Glucose Monitoring System

Lancet:

Accu-Chek Soft Touch (100s)

Syringe and needle:

BD™ Insulin Syringe Ultrafine: 30 G x 1/2" (0.3 mL): 100s

BD™ Insulin Syringe Ultrafine: 30 G x 1/2" (0.5 mL): 100s

BD™ Insulin Syringe Ultrafine: 30 G x 1/2" (1 mL): 100s

NovoFine Pen Needle (30 gauge - 8 mm)

Test Strips/Kit:

Freestyle Lite Test Strips [BCF]

DiazePAM Gel, Rectal:

Diastat AcuDial: 10 mg (1 ea); 20 mg (1 ea) [contains alcohol, usp, benzoic acid, sodium

benzoate]

Tablet, Oral:

Generic: 2 mg, 5 mg [BCF], 10 mg

Dibucaine Ointment, External:

Generic: 1% (28 g)

Diclofenac (Ophthalmic) Solution, Ophthalmic, as sodium:

Generic: 0.1% (5 mL)

Diclofenac (Systemic) Tablet Delayed Release, Oral, as sodium:


9


Diclofenac (Topical) Gel, Transdermal, as sodium:

Voltaren: 1% (100 g) [contains isopropyl alcohol, propylene glycol]

Dicloxacillin Capsule, Oral:


Dicyclomine Capsule, Oral, as hydrochloride:


Solution, Oral, as hydrochloride:




Digoxin Tablet, Oral:

Lanoxin: 0.125 mg [BCF], 0.25 mg [BCF] [scored]

Generic: 0.125 mg [BCF], 0.25 mg [BCF]

DilTIAZem Capsule Extended Release 24 Hour, Oral, as hydrochloride:

Tiazac: 180 mg [BCF], 420 mg [BCF]

Generic: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF], 300 mg [BCF], 360 mg [BCF], 420 mg

[BCF]


Generic: 60 mg

DiphenhydrAMINE (Systemic) Capsule, Oral, as hydrochloride:

Generic: 25 mg

Liquid, Oral, as hydrochloride:

Q-Dryl: 12.5 mg/5 mL (118 mL) [alcohol free; contains saccharin sodium, sodium benzoate;

cherry flavor]

Diphenoxylate and Atropine Tablet, Oral:

Generic: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate 0.025 mg

Disulfiram Tablet, Oral:

Generic: 250 mg

Docusate Capsule, Oral, as sodium:

Stool Softener: 100 mg

Donepezil Tablet, Oral, as hydrochloride:


Dorzolamide Solution, Ophthalmic:

Generic: 2% (10 mL)

Dorzolamide and Timolol Solution, Ophthalmic:

Generic: Dorzolamide 2% and timolol 0.5% (10 mL)

Doxazosin Tablet, Oral:

Generic: 2 mg, 4 mg, 8 mg

Doxepin (Systemic) Capsule, Oral:


Concentrate, Oral:

Generic: 10 mg/mL (118 mL) [BCF]

Doxycycline Capsule, Oral, as hyclate [strength expressed as base]:


Capsule Delayed Release, Oral, as monohydrate [strength expressed as base]:

Oracea: 40 mg

Tablet, Oral, as hyclate [strength expressed as base]:


Tablet, Oral, as monohydrate [strength expressed as base]:

Generic: 100 mg

Dulaglutide Solution Pen-injector, Subcutaneous [preservative free]:

Trulicity: 0.75 mg/0.5 mL (0.5 mL); 1.5 mg/0.5 mL (0.5 mL) [contains polysorbate 80]

DULoxetine Capsule Delayed Release Particles, Oral:


10


Econazole Cream, External, as nitrate:

Generic: 1% (15 g, 30 g)

Efavirenz Capsule, Oral:

Sustiva: 50 mg, 200 mg

Tablet, Oral:

Sustiva: 600 mg

Efavirenz, Emtricitabine, and

Tenofovir

Tablet, oral:

Atripla®: Efavirenz 600 mg, emtricitabine 200 mg, and tenofovir disoproxil fumarate 300 mg

Eletriptan Tablet, Oral:

Relpax: 20 mg, 40 mg

Emollients Cream, External:

Hydrocerin: (454 g)

Vanicream: (453 g)

Lotion, External:

Hydrocerin: (472 mL)

Ointment, External:

Aquaphor: (396 g)

Empagliflozin Tablet, Oral:

Jardiance: 10 mg, 25 mg

Emtricitabine and Tenofovir Tablet:

Truvada: Emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg

Enalapril Tablet, Oral, as maleate:


Enoxaparin Solution, Subcutaneous, as sodium [preservative free]:

Generic: 30 mg/0.3 mL (0.3 mL) [BCF]; 40 mg/0.4 mL (0.4 mL) [BCF]; 60 mg/0.6 mL (0.6 mL)

[BCF]; 80 mg/0.8 mL (0.8 mL) [BCF]; 100 mg/mL (1 mL) [BCF]; 120 mg/0.8 mL (0.8 mL) [BCF];

150 mg/mL (1 mL) [BCF]

Entecavir Tablet, Oral:

Generic: 0.5 mg

EPINEPHrine (Systemic) Device, Injection:

EpiPen 2-Pak: 0.3 mg/0.3 mL (2 ea) [latex free; contains sodium metabisulfite]

EpiPen Jr 2-Pak: 0.15 mg/0.3 mL (2 ea) [contains sodium metabisulfite]

Epoetin Alfa Solution, Injection:

Epogen: 20,000 units/mL (1 mL) [contains benzyl alcohol]

Procrit: 20,000 units/mL (1 mL) [contains benzyl alcohol]

Solution, Injection [preservative free]:

Epogen: 2000 units/mL (1 mL); 3000 units/mL (1 mL); 4000 units/mL (1 mL); 10,000 units/mL

(1 mL)

Procrit: 2000 units/mL (1 mL); 3000 units/mL (1 mL); 4000 units/mL (1 mL); 10,000 units/mL (1

mL); 40,000 units/mL (1 mL)

Erenumab Solution Auto-injector, Subcutaneous [preservative free]:

Aimovig 140 Dose: 70 mg/mL (1 mL) [contains polysorbate 80]

Ergocalciferol Capsule, Oral:

Generic: 50,000 units

Erlotinib Tablet, Oral:

Tarceva: 25 mg, 100 mg, 150 mg

Erythromycin and Benzoyl

Peroxide

Gel, External:

Generic: Erythromycin 30 mg and benzoyl peroxide 50 mg per g (23.3 g)

Erythromycin (Ophthalmic) Ointment, Ophthalmic:

Generic: 0.5% (3.5 g) [BCF]

11


Erythromycin (Systemic) Suspension Reconstituted, Oral, as ethylsuccinate:

E.E.S. Granules: 200 mg/5 mL (100 mL) [BCF]

Tablet, Oral, as stearate:

Erythrocin Stearate: 250 mg [BCF]

Tablet Delayed Release, Oral, as base:

Ery-Tab: 250 mg [BCF]

PCE: 333 mg

Erythromycin (Topical) Gel, External:


Solution, External:


Escitalopram Tablet, Oral:


Estradiol (Systemic) Patch Weekly, Transdermal:

Vivelle-Dot: 0.025 mg/24 hr (8 ea); 0.0375 mg/24 hr (8 ea); 0.05 mg/24 hr (8 ea); 0.075 mg/24

hr (8 ea); 0.1 mg/24 hr (8 ea)

Generic: 0.025 mg/24 hours (4s) [BCF]; 0.0375 mg/24 hours (4s) [BCF]; 0.05 mg/24 hours

(4s) [BCF]; 0.06 mg/24 hours (4s) [BCF]; 0.075 mg/24 hours (4s) [BCF]; 0.1 mg/24 hours (4s)

[BCF]

Tablet, Oral:

Generic: 1 mg, 2 mg

Estradiol (Topical) Cream, Vaginal:

Estrace: 0.1 mg/g (42.5 g)

Ring, Vaginal, as base:

Estring: 2 mg (1 ea)

Tablet, Vaginal, as base:

Vagifem: 10 mcg

Estrogens (Conjugated/Equine)

and Medroxyprogesterone

Tablet, Oral:

Prempro: 0.3/1.5: Conjugated estrogens 0.3 mg and medroxyprogesterone acetate 1.5 mg

[BCF]

Prempro: 0.45/1.5: Conjugated estrogens 0.45 mg and medroxyprogesterone acetate 1.5 mg

[BCF]

Prempro: 0.625/2.5: Conjugated estrogens 0.625 mg and medroxyprogesterone acetate 2.5

mg [BCF]

Prempro: 0.625/5: Conjugated estrogens 0.625 mg and medroxyprogesterone acetate 5 mg

[BCF]

Estrogens (Conjugated/Equine,

Systemic)

Tablet, Oral:

Premarin: 0.3 mg [BCF], 0.45 mg [BCF], 0.625 mg [BCF], 0.9 mg, 1.25 mg [BCF]

Estrogens (Conjugated/Equine,

Topical)

Cream, Vaginal:

Premarin: 0.625 mg/g (30 g) [BCF]

Estrogens (Esterified) and

Methyltestosterone

Tablet, Oral:

Covaryx: Esterified estrogen 1.25 mg and methyltestosterone 2.5 mg

Covaryx HS: Esterified estrogen 0.625 mg and methyltestosterone 1.25 mg

Eszopiclone Tablet, Oral:

Lunesta: 1 mg, 2 mg, 3 mg

Ethambutol Tablet, Oral, as hydrochloride:

Myambutol: 400 mg [scored] [BCF]


12


Ethinyl Estradiol and

Desogestrel

Tablet, oral [low dose formulation]:

Mircette:

Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 white tablets]

Day 22-23: 2 inactive green tablets

Day 24-28: Ethinyl estradiol 0.01 mg [5 yellow tablets] (28s)

Tablet, oral [monophasic formulation]:

Ortho-Cept 28: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 light orange tablets and

7 green inactive tablets] (28s)

Tablet, oral [triphasic formulation]:

Cyclessa:

Day 1-7: Ethinyl estradiol 0.025 mg and desogestrel 0.1 mg [7 light yellow tablets]

Day 8-14: Ethinyl estradiol 0.025 mg and desogestrel 0.125 mg [7 orange tablets]

Day 15-21: Ethinyl estradiol 0.025 mg and desogestrel 0.15 mg [7 red tablets]

Day 22-28: 7 green inactive tablets (28s)


Drospirenone

Tablet, Oral:

Yasmin: Ethinyl estradiol 0.03 mg and drospirenone 3 mg [21 yellow active tablets and 7 white

inactive tablets] (28s) [BCF]

Yaz: Ethinyl estradiol 0.02 mg and drospirenone 3 mg [24 light pink active tablets and 4 white


Ethinyl Estradiol and Ethynodiol

Diacetate

Tablet, oral [monophasic formulation]:

Zovia® 1/35-28: Ethinyl estradiol 0.035 mg and ethynodiol diacetate 1 mg [21 light pink tablets

and 7 white inactive tablets] (28s)


Etonogestrel

Ring, vaginal:

NuvaRing®: Ethinyl estradiol 0.015 mg/day and etonogestrel 0.12 mg/day (3s) [3-week

duration]


Levonorgestrel

Tablet, Oral [low dose formulation]:

Sronyx: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 white tablets and 7

peach inactive tablets] [BCF]

Tablet, Oral [monophasic formulation]:

Levora: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (28s) [21 white tablets and 7

peach inactive tablets] [BCF]

Tablet, Oral [extended cycle regimen]:

Jolessa: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 pink tablets and 7 white


Tablet, oral [triphasic formulation]:

Trivora:

Day 1-6: Ethinyl estradiol 0.03 mg and levonorgestrel 0.05 mg [6 blue tablets]

Day 7-11: Ethinyl estradiol 0.04 mg and levonorgestrel 0.075 mg [5 white tablets]

Day 12-21: Ethinyl estradiol 0.03 mg and levonorgestrel 0.125 mg [10 pink tablets]

Day 22-28: 7 peach inactive tablets (28s)


Norelgestromin

Patch Weekly, Transdermal:

Ortho Evra®: Ethinyl estradiol 0.75 mg and norelgestromin 6 mg [releases ethinyl estradiol 20

mcg and norelgestromin 150 mcg per day] (1s)

13



Norethindrone


Loestrin 21 1/20: Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg [light yellow

tablets] (21s)

Loestrin Fe 1.5/30: Ethinyl estradiol 0.03 mg and norethindrone acetate 1.5 mg [21 pink

tablets] and ferrous fumarate 75 mg [7 brown tablets] (28s)

Necon 1/35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg (28s) [21 dark yellow tablets

and 7 white inactive tablets] [BCF]

Tablet, oral [biphasic formulation]:

Cyclafem 7/7/7:

Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [7 white tablets]

Day 8-14: Ethinyl estradiol 0.035 mg and norethindrone 0.75 mg [7 light pink tablets]

Day 15-21: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [7 pink tablets]

Day 22-28: 7 light green inactive tablets (28s)


Norgestimate


MonoNessa: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 blue tablets and 7

green inactive tablets] [BCF]

Tablet, Oral [triphasic formulation]:

Ortho Tri-Cyclen Lo [BCF]:

Day 1-7: Ethinyl estradiol 0.025 mg and norgestimate 0.18 mg [7 white tablets]

Day 8-14: Ethinyl estradiol 0.025 mg and norgestimate 0.215 mg [7 light blue tablets]

Day 15-21: Ethinyl estradiol 0.025 mg and norgestimate 0.25 mg [7 dark blue tablets]

Day 22-28: 7 dark green inactive tablets

TriNessa [BCF]:

Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 white tablets]

Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light blue tablets]

Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 blue tablets]

Day 22-28: 7 green inactive tablets

Ethinyl Estradiol and Norgestrel Tablet, Oral:

Low-Ogestrel: Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [21 white tablets and 7 peach

inactive tablets] (28s)

Etodolac Tablet, Oral:

Generic: 400 mg

Exenatide Solution, Subcutaneous:

Byetta 10 MCG Pen: 10 mcg/0.04 mL (2.4 mL) [contains metacresol]

Byetta 5 MCG Pen: 5 mcg/0.02 mL (1.2 mL) [contains metacresol]

Ezetimibe Tablet, Oral:

Zetia: 10 mg

Famciclovir Tablet, Oral:


Famotidine Tablet, Oral:


Felodipine Tablet Extended Release 24 Hour, Oral:


Fenofibrate and Derivatives Tablet, Oral, as fenofibrate:

Tricor: 145 mg [BCF] [contains soybean lecithin]


FentaNYL Patch, Transdermal, as base:

Generic: 12 [delivers 12.5 mcg/hr] (5s); 50 [delivers 50 mcg/hr] (5s)

Ferrous Sulfate Solution, Oral:

Fer-Iron: 75 (15 Fe) MG/ML (50 mL) [contains sodium metabisulfite]

Tablet, Oral:

Generic: 325 (65 Fe) MG

14


Fexofenadine Suspension, Oral, as hydrochloride:

Allegra Allergy Childrens: 30 mg/5 mL (120 mL)



Filgrastim Solution, Injection:

Neupogen: 300 mcg/mL (1 mL); 480 mcg/1.6 mL (1.6 mL) [contains polysorbate 80]

Solution, Injection [preservative free]:

Neupogen: 300 mcg/0.5 mL (0.5 mL); 480 mcg/0.8 mL (0.8 mL) [contains polysorbate 80]

Finasteride Tablet, Oral:

Generic: 5 mg [BCF]

Flecainide Tablet, Oral, as acetate:


Fluconazole Suspension Reconstituted, Oral:

Generic: 10 mg/mL (35 mL)

Tablet, Oral:

Diflucan: 150 mg [BCF], 200 mg


Flunisolide (Nasal) Solution, Nasal:

Generic: 25 MCG/ACT (0.025%) (25 mL)

Fluocinolone (Topical) Oil, External, as acetonide:

Generic: 0.01% (118.28 mL)

Fluocinonide Cream, External:

Generic: 0.05% (15 g, 30 g) [BCF]

Gel, External:

Generic: 0.05% (15 g)

Ointment, External:


Solution, External:


Fluoride Cream, Dental, as sodium:

PreviDent 5000 Plus: 1.1% (51 g) [spearmint flavor]

Gel, Dental, as sodium:

PreviDent: 1.1% (56 g) [berry flavor]

Paste, Dental, as sodium:

Clinpro 5000: 1.1% (113 g) [contains saccharin sodium; vanilla mint flavor]

Solution, oral, as sodium [drops]:

Generic: 1.1 mg/mL (50 mL) [equivalent to fluoride 0.5 mg/mL]

Fluorometholone Ointment, Ophthalmic, as base:

FML: 0.1% (3.5 g) [contains phenylmercuric acetate]

Suspension, Ophthalmic, as base:


Fluorouracil (Topical) Cream, External:

Generic: 5% (40 g)

FLUoxetine Capsule, Oral:


Solution, Oral:


Tablet, Oral:

Generic: 60 mg

Flutamide Capsule, Oral:

Generic: 125 mg

15


Fluticasone and Salmeterol Aerosol, for Oral Inhalation:

Advair HFA: 45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg per inhalation (12

g) [chlorofluorocarbon free; 120 metered actuations] [BCF]





Powder, for Oral Inhalation:

Advair Diskus: 100/50: Fluticasone propionate 100 mcg and salmeterol 50 mcg (60s) [contains

lactose] [BCF]


lactose] [BCF]


lactose] [BCF]

Fluticasone (Nasal) Suspension, Nasal, as propionate:

Generic: 50 mcg/inhalation (16 g) [BCF]

Fluticasone (Oral Inhalation) Aerosol, Inhalation, as propionate:

Flovent HFA: 44 mcg/inhalation (10.6 g) [chlorofluorocarbon free; 120 metered actuations]

[BCF]

Flovent HFA: 110 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations]

[BCF]

Flovent HFA: 220 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations]

[BCF]

Aerosol Powder Breath Activated, Inhalation, as propionate:

Flovent Diskus: 50 mcg (60s) [contains lactose] [BCF]

Flovent® Diskus: 100 mcg (60s) [contains lactose] [BCF]

Flovent® Diskus: 250 mcg (60s) [contains lactose] [BCF]

Fluticasone, Umeclidinium, and

Vilanterol

Aerosol Powder Breath Activated, Inhalation:

Trelegy Ellipta: Fluticasone furoate 100 mcg, umeclidinium 62.5 mcg, and vilanterol 25 mcg

(28 ea, 60 ea) [contains lactose monohydrate]

Folic Acid Tablet, Oral:

Generic: 1 mg [BCF]

Fosinopril Tablet, Oral, as sodium:


Furosemide Solution, Oral:


Tablet, Oral:


Gabapentin Capsule, Oral:


Tablet, Oral:


Gemfibrozil Tablet, Oral:


Gentamicin (Ophthalmic) Ointment, Ophthalmic:

Gentak®: 0.3% (3.5 g) [BCF]

Solution, Ophthalmic [drops]:


Glatiramer Acetate Kit, Subcutaneous:

Copaxone: 20 mg/mL [contains mannitol]

Solution Prefilled Syringe, Subcutaneous:

Copaxone: 40 mg/mL (1 mL)

Glimepiride Tablet, Oral:

Generic: 2 mg, 4 mg

16


GlipiZIDE Tablet, Oral:




Glucagon Kit, Injection:

Glucagon Emergency: 1 mg

GlyBURIDE Tablet, Oral:

Glynase: 1.5 mg [BCF], 3 mg [BCF], 6 mg [BCF] [scored]

Generic: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF], 6 mg

Glyburide and Metformin Tablet, oral:

Generic:

1.25 mg/250 mg: Glyburide 1.25 mg and metformin hydrochloride 250 mg

2.5 mg/500 mg: Glyburide 2.5 mg and metformin hydrochloride 500 mg

5 mg/500 mg: Glyburide 5 mg and metformin hydrochloride 500 mg

Goserelin Implant, Subcutaneous:

Zoladex: 3.6 mg (1s) [1 month implant] [BCF]

Zoladex: 10.8 mg (1s) [3 month implant] [BCF]

Griseofulvin Suspension, Oral:


Tablet, Oral:


GuaiFENesin Tablet, Oral:

Generic: 200 mg


Generic: 600 mg

Guaifenesin and Codeine Solution, Oral:

Generic: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (118 mL)

Guaifenesin and

Dextromethorphan

Syrup, Oral:

Generic: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (118 mL)

[cherry flavor]

GuanFACINE Tablet, Oral:

Generic: 1 mg



HydrALAZINE Tablet, Oral, as hydrochloride:


HydroCHLOROthiazide Capsule, Oral:

Generic: 12.5 mg [BCF]

Tablet, Oral:


Hydrochlorothiazide and

Triamterene

Capsule, Oral:

Generic: Hydrochlorothiazide 25 mg and triamterene 37.5 mg

Tablet, Oral:

Generic:

Hydrochlorothiazide 25 mg and triamterene 37.5 mg [BCF]

Hydrochlorothiazide 50 mg and triamterene 75 mg [BCF]

Hydrocodone and

Acetaminophen

Tablet, Oral:

Generic:

Hydrocodone bitartrate 5 mg and acetaminophen 325 mg

Hydrocodone bitartrate 7.5 mg and acetaminophen 325 mg

Hydrocodone bitartrate 10 mg and acetaminophen 325 mg

Hydrocortisone (Systemic) Tablet, Oral, as base:

Generic: 10 mg

17


Hydrocortisone (Topical) Cream, External, as base:

Proctozone-HC 2.5%™: 2.5% (30 g) [BCF]

Generic: 1% (28.35 g)

Cream, External, as valerate:

Generic: 0.2% (15 g)

Ointment, External, as valerate:


Suppository, Rectal, as acetate:

Anucort-HC: 25 mg (24s) [BCF]

HYDROmorphone Tablet, Oral, as hydrochloride:

Generic: 2 mg

Hydroxychloroquine Tablet, Oral, as sulfate:

Generic: 200 mg

Hydroxyurea Capsule, Oral:

Generic: 500 mg

HydrOXYzine Capsule, Oral, as pamoate:






Hyoscyamine Tablet Dispersible, Oral, as sulfate:

Generic: 0.125 mg

Tablet Extended Release 12 Hour, Oral, as sulfate:

Symax-SR: 0.375 mg [scored]

Hyoscyamine, Atropine,

Scopolamine, and Phenobarbital

Tablet, Oral:

Donnatal: 16.2 mg

Ibandronate Tablet, Oral:

Generic: 150 mg

Ibuprofen Suspension, Oral:


Tablet, Oral:


Imatinib Tablet, Oral:

Gleevec: 100 mg, 400 mg [scored]

Imipramine Capsule, Oral, as pamoate:




Imiquimod Cream, External:

Generic: 5% (12 ea)

Indomethacin Capsule, Oral:


Capsule Extended Release, Oral:

Generic: 75 mg

Inhalation Devices Holding chamber:

AeroChamber® Plus

Holding chamber with mask:

AeroChamber Plus Flo-Vu: Small, Medium, Large

18


Insulin Aspart Solution, Subcutaneous:

NovoLOG: 100 units/mL (10 mL) [contains metacresol, phenol] [BCF]

Solution Cartridge, Subcutaneous:

NovoLOG Penfill: 100 units/mL (3 mL) [contains metacresol, phenol] [BCF]

Solution Pen-injector, Subcutaneous:

NovoLOG FlexPen: 100 units/mL (3 mL) [contains metacresol, phenol] [BCF]

Insulin Aspart Protamine and

Insulin Aspart

Suspension, Subcutaneous:

NovoLOG Mix 70/30: Insulin aspart protamine suspension 70% [intermediate acting] and

insulin aspart solution 30% [rapid acting]: 100 units/mL (10 mL) [BCF]

NovoLOG Mix 70/30 FlexPen: Insulin aspart protamine suspension 70% [intermediate acting]

and insulin aspart solution 30% [rapid-acting]: 100 units/mL (3 mL) [contains metacresol,

phenol] [BCF]

Insulin Detemir Solution, Subcutaneous:

Levemir: 100 units/mL (10 mL) [contains metacresol, phenol]

Insulin Glargine Solution, Subcutaneous:

Lantus: 100 units/mL (10 mL) [contains metacresol] [BCF]

Lantus Solostar: 100 units/mL (3 mL) [prefilled pen] [BCF]

Insulin NPH Suspension, Subcutaneous:

NovoLIN N: 100 units/mL (10 mL) [contains metacresol, phenol] [BCF]

Insulin NPH and Insulin Regular Suspension, Subcutaneous:

NovoLIN 70/30: Insulin NPH suspension 70% [intermediate acting] and insulin regular solution

30% [short acting]: 100 units/mL (10 mL) [contains metacresol, phenol] [BCF]

Insulin Regular Solution, Injection:

NovoLIN R: 100 units/mL (10 mL) [contains metacresol] [BCF]

Interferon Beta-1a Kit, Intramuscular:

Avonex Prefilled: 30 mcg/0.5 mL

Solution, Subcutaneous [preservative free]:

Rebif: 22 mcg/0.5 mL (0.5 mL); 44 mcg/0.5 mL (0.5 mL) [contains albumin human]

Interferon Beta-1b Kit, Subcutaneous:

Betaseron: 0.3 mg [contains albumin human]

Ipratropium and Albuterol Aerosol Solution, Inhalation:

Combivent Respimat: Ipratropium bromide 20 mcg and albuterol (base) 100 mcg per

inhalation (4 g) [contains benzalkonium chloride, edetate disodium]

Solution, for nebulization:

Generic: Ipratropium bromide 0.5 mg and albuterol (base) 2.5 mg per 3 mL (30s) [BCF]

Ipratropium (Nasal) Solution, Nasal, as bromide:

Atrovent: 0.03% (30 mL); 0.06% (15 mL)

Ipratropium (Oral Inhalation) Aerosol Solution, Inhalation, as bromide:

Atrovent HFA: 17 mcg/actuation (12.9 g) [chlorofluorocarbon free; 200 metered actuations]

[BCF]

Solution, Inhalation, as bromide [preservative free]:

Generic: 0.02% (2.5 mL)

Isoniazid Syrup, Oral:


Tablet, Oral:


Isosorbide Dinitrate Capsule Extended Release, Oral:

Dilatrate-SR: 40 mg

Tablet, Oral:


Isosorbide Mononitrate Tablet Extended Release 24 Hour, Oral:


Ketoconazole (Systemic) Tablet, Oral:

Generic: 200 mg

19


Ketoconazole (Topical) Cream, External:

Generic: 2% (15 g)

Shampoo, External:

Generic: 2% (120 mL)

Ketorolac (Ophthalmic) Solution, Ophthalmic, as tromethamine:


Labetalol Tablet, Oral, as hydrochloride:


Lacosamide Tablet, Oral:

Vimpat: 50 mg, 100 mg, 150 mg, 200 mg

Lactic Acid and Ammonium

Hydroxide

Lotion, External:

AmLactin: Lactic acid 12% with ammonium hydroxide (225 g)

Lactobacillus Solution, Oral

Gerber Soothe: Lactobacillus reuteri 100 million cell/5 drops

Lactulose Solution, Oral:

Generic: 10 g/15 mL (237 mL) [BCF]

Lamivudine and Zidovudine Tablet, Oral:

Combivir: Lamivudine 150 mg and zidovudine 300 mg [scored]

LamoTRIgine Tablet, Oral:


Tablet Chewable, Oral:

Generic: 5 mg


LaMICtal XR: 50 mg, 100 mg, 200 mg, 300 mg [contains polysorbate 80]

Lansoprazole Tablet Dispersible, Oral:

Prevacid SoluTab: 15 mg, 30 mg

Lapatinib Tablet, Oral:

Tykerb: 250 mg

Latanoprost Solution, Ophthalmic:

Generic: 0.005% (2.5 mL) [BCF]

Leflunomide Tablet, Oral:


Letrozole Tablet, Oral:

Generic: 2.5 mg

Leuprolide Kit, Intramuscular, as acetate [preservative free]:

Lupron Depot: 3.75 mg [latex free; contains polysorbate 80]

LevETIRAcetam Solution, Oral:


Tablet, Oral:


LevoFLOXacin (Systemic) Solution, Oral:


Tablet, Oral:


Levonorgestrel (Systemic) Tablet, Oral:

Plan B One-Step: 1.5 mg

Levothyroxine Tablet, Oral, as sodium:

Generic: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg [BCF], 100 mcg [BCF], 112

mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150 mcg [BCF], 175 mcg [BCF], 200 mcg [BCF],

300 mcg [BCF]

Lidocaine and Prilocaine Cream, External [preservative free]:

Generic: Lidocaine 2.5% and prilocaine 2.5% (30 g)

20


Lidocaine (Topical) Gel, External, as hydrochloride:

Generic: 2% (30 mL)

Ointment, External:

Generic: 5% (50 g)

Patch, External:

Lidoderm: 5% (30 ea) [contains disodium edta, methylparaben, propylene glycol,

propylparaben]

Viscous Solution, Mouth/Throat, as hydrochloride:

Generic: 2% (100 mL)

Lifitegrast Solution, Ophthalmic:

Xiidra: 5% (5 ea)

LinaCLOtide Capsule, Oral:

Linzess: 145 mcg, 290 mcg

Liothyronine Tablet, Oral:

Generic: 5 mcg, 25 mcg

Liraglutide Solution Pen-injector, Subcutaneous:

Victoza: 18 mg/3 mL (3 mL) [contains phenol, propylene glycol]

Lisinopril Tablet, Oral:

Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg [BCF], 40 mg [BCF]

Lisinopril and

Hydrochlorothiazide

Tablet, Oral:

Generic:

10/12.5: Lisinopril 10 mg and hydrochlorothiazide 12.5 mg [BCF]

20/12.5: Lisinopril 20 mg and hydrochlorothiazide 12.5 mg [BCF]

20/25: Lisinopril 20 mg and hydrochlorothiazide 25 mg [BCF]

Lithium Capsule, Oral, as carbonate:


Solution, Oral, as citrate:

Generic: 8 mEq/5 mL (500 mL) [BCF]

Tablet Extended Release, Oral, as carbonate:

Lithobid: 300 mg

Loperamide Capsule, Oral, as hydrochloride:

Generic: 2 mg [BCF]

Loratadine Syrup, Oral:

Childrens Loratadine: 5 mg/5 mL (120 mL) [fruit flavor]

Tablet, Oral:

Generic: 10 mg

Loratadine and

Pseudoephedrine


Claritin-D 12 Hour: Loratadine 5 mg and pseudoephedrine sulfate 120 mg


Claritin-D 24 Hour: Loratadine 10 mg and pseudoephedrine sulfate 240 mg

LORazepam Tablet, Oral:


Losartan Tablet, Oral, as potassium:


Losartan and

Hydrochlorothiazide

Tablet, Oral:

Hyzaar 50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg [contains

potassium 4.24 mg (0.108 mEq)] [BCF]

Hyzaar 100/12.5: Losartan potassium 100 mg and hydrochlorothiazide 12.5 mg [contains


Hyzaar 100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg [contains


21


Loteprednol Gel, Ophthalmic, as etabonate:

Lotemax: 0.5% (5 g) [contains benzalkonium chloride, edetate disodium dihydrate, propylene

glycol]

Suspension, Ophthalmic, as etabonate:

Lotemax: 0.5% (5 mL)

Lovastatin Tablet, Oral:


Magnesium Citrate Solution, Oral:

Generic: 1.745 g/30 mL (296 mL)

Mebendazole Capsule, Oral, as hydrochloride:

Generic: 100 mg

Meclizine Tablet Chewable, Oral, as hydrochloride:

Travel Sickness: 25 mg [scored; contains aspartame; raspberry flavor]

MedroxyPROGESTERone Tablet, Oral, as acetate:


Mefloquine Tablet, Oral, as hydrochloride:

Generic: 250 mg

Megestrol Tablet, Oral, as acetate:

Generic: 40 mg

Meloxicam Tablet, Oral:

Generic: 7.5 mg [BCF], 15 mg [BCF]

Memantine Capsule Extended Release 24 Hour, Oral, as hydrochloride:

Namenda XR: 28 mg


Namenda: 5 mg,10 mg

Namenda Titration Pak: 5 mg (28 ea) and 10 mg (21 ea)

Meperidine Tablet, Oral, as hydrochloride:

Generic: 50 mg

Mercaptopurine Tablet, Oral:

Generic: 50 mg

Mesalamine Capsule Delayed Release, Oral:

Delzicol: 400 mg

Kit, Rectal:

Generic: 4 g

Suppository, Rectal:

Canasa: 1000 mg (30 ea)


Lialda: 1.2 g [BCF]

Metaxalone Tablet, Oral:

Generic: 800 mg

MetFORMIN Tablet, Oral, as hydrochloride:


Methadone Tablet, Oral, as hydrochloride:

Generic: 10 mg

MethazolAMIDE Tablet, Oral:

Generic: 50 mg

MethIMAzole Tablet, Oral:


Methocarbamol Tablet, Oral:

Generic: 500 mg [BCF], 750 mg

Methotrexate Solution, Injection:


Tablet, Oral:


22


Methylergonovine Tablet, Oral, as maleate:

Generic: 0.2 mg

Methylphenidate Capsule Extended Release 24 Hour, Oral, as hydrochloride:

Ritalin LA: 10 mg [BCF], 40 mg [BCF]




Tablet Extended Release, Oral, as hydrochloride:


MethylPREDNISolone Tablet, Oral:

Medrol (Pak): 4 mg [scored]

Generic: 4 mg

Metoclopramide Solution, Oral:


Tablet, Oral:


MetOLazone Tablet, Oral:

Generic: 2.5 mg, 5 mg

Metoprolol Tablet, Oral, as tartrate:


Tablet Extended Release 24 Hour, Oral, as succinate:


MetroNIDAZOLE (Systemic) Tablet, Oral:


MetroNIDAZOLE (Topical) Gel, External:

Metrogel: 1% (60 g) [contains methylparaben, propylparaben]

Gel, Vaginal:


Miconazole (Topical) Cream, External, as nitrate:

Antifungal: 2% (28 g) [contains benzoic acid]

Cream, Vaginal, as nitrate:

Generic: 2% (45 g)

Mineral Oil Oil, Oral:

Generic: (473 mL)

Minocycline Capsule, Oral:


Mirabegron Tablet Extended Release 24 Hour, Oral:

Myrbetriq: 25 mg, 50 mg

Mirtazapine Tablet, Oral:


MiSOPROStol Tablet, Oral:

Generic: 100 mcg, 200 mcg

Modafinil Tablet, Oral:


Mometasone (Oral Inhalation) This medication is nonformulary. For formulary alternatives, refer to Therapeutic Category.

Montelukast Packet, Oral:

Singulair: 4 mg/packet (30s) [BCF]

Tablet, Oral:




23


Morphine (Systemic) Tablet, Oral, as sulfate:

Generic: 15 mg

Tablet Extended Release, Oral, as sulfate:


Mouthwash, Magic Solution: Extemporaneously prepared by pharmacy

Suspension, mouth/throat:

First Mouthwash BLM Kit: Diphenhydramine-Lidocaine-Aluminum Hydroxide-Magnesium

Hydroxide-Simethicone

Moxifloxacin (Ophthalmic) Solution, Ophthalmic:

Vigamox: 0.5% (3 mL)

Moxifloxacin (Systemic) Tablet, Oral:

Avelox: 400 mg

Mupirocin Cream, External, as calcium [strength expressed as base]:

Generic: 2% (15 g)

Ointment, External:


Mycophenolate Capsule, Oral, as mofetil:

Generic: 250 mg

Tablet, Oral, as mofetil:

CellCept: 500 mg

Tablet Delayed Release, Oral, as mycophenolic acid:

Myfortic: 180 mg, 360 mg

Nabumetone Tablet, Oral:


Naloxegol Tablet, Oral:

Movantik: 12.5 mg, 25 mg

Naloxone Liquid, Nasal [spray]:

Narcan: 4 mg/0.1 mL (1 ea) [contains benzalkonium chloride, edetate disodium] [BCF]

Naltrexone Tablet, Oral, as hydrochloride:

Generic: 50 mg

Naphazoline and Pheniramine Solution, Ophthalmic:

Naphcon-A: Naphazoline hydrochloride 0.025% and pheniramine maleate 0.3% (5 mL)

[contains benzalkonium chloride]

Naproxen Suspension, Oral:


Tablet, Oral:

Generic: 250 mg [BCF], 375 mg, 500 mg [BCF]

Nefazodone Tablet, Oral, as hydrochloride:

Generic: 150 mg

Neomycin Tablet, Oral, as sulfate:

Generic: 500 mg

Neomycin, Polymyxin B, and

Dexamethasone


Maxitrol: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexamethasone 0.1% per g

(3.5 g) [contains methylparaben, propylparaben]

Suspension, ophthalmic [drops]:

Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexamethasone 0.1% per 1

mL (5 mL)


Gramicidin

Solution, Ophthalmic [drops]:

Generic: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin 0.025 mg per 1 mL (10

mL) [BCF]

24



Hydrocortisone (Otic)

Solution, Otic:

Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone 10 mg per 1 mL (10

mL)

Suspension, Otic:

Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone 10 mg per 1 mL (10

mL) [BCF]

Nepafenac Suspension, Ophthalmic:

Nevanac: 0.1% (3 mL) [contains edentate disodium benzalkonium chloride]

Niacin Tablet, Oral:



Niaspan: 500 mg [BCF], 750 mg [BCF], 1000 mg [BCF]

Nicotine Gum, Mouth/Throat, as polacrilex:

Generic: 2 mg (110 ea) [BCF]; 4 mg (110 ea) [BCF]

Patch 24 Hour, Transdermal:

Generic: 7 mg/24 hr (14 ea) [BCF]; 14 mg/24 hr (14 ea) [BCF]; 21 mg/24 hr (14 ea) [BCF]

NIFEdipine Capsule, Oral:

Generic: 10 mg



Nitrofurantoin Capsule, Oral:

Macrodantin: 50 mg [BCF]


Macrobid: 100 mg [BCF]


Suspension, Oral:


Nitroglycerin Ointment, Rectal:

Rectiv: 0.4% (30 g) [contains propylene glycol]

Patch 24 Hour, Transdermal:

Nitro-Dur: 0.3 mg/hour (30s) [BCF]; 0.8 mg/hour (30s) [BCF]

Generic: 0.1 mg/hour (30s) [BCF]; 0.2 mg/hour (30s) [BCF]; 0.4 mg/hour (30s) [BCF]; 0.6

mg/hour (30s) [BCF]

Solution, Translingual:

Generic: 0.4 mg/spray (4.9 g) [BCF]

Tablet, Sublingual:

Nitrostat: 0.4 mg [BCF]

Norethindrone Tablet, Oral:

Nor-QD: 0.35 mg [BCF]


Tablet, Oral, as acetate:

Generic: 5 mg

Norethindrone and Mestranol Tablet, Oral:

Norinyl 1+50 (28): Norethindrone 1 mg and mestranol 0.05 mg [21 white tablets and 7 orange

inactive tablets]

Nortriptyline Capsule, Oral:


Nystatin and Triamcinolone Cream, External:

Generic: Nystatin 100,000 units and triamcinolone acetonide 0.1% (30 g)

Nystatin (Oral) Suspension, Mouth/Throat:

Generic: 100,000 units/mL (60 mL) [BCF]

Tablet, Oral:

Generic: 500,000 units

25


Nystatin (Topical) Cream, External:

Generic: 100,000 units/g (30 g) [BCF]

Ointment, External:

Generic: 100,000 units/g (30 g) [BCF]

Powder, External:

Nystop: 100,000 units/g (15 g)

Ofloxacin (Ophthalmic) Solution, Ophthalmic:


Ofloxacin (Otic) Solution, Otic:


OLANZapine Tablet, Oral:


Olopatadine (Ophthalmic) Solution, Ophthalmic:

Pazeo: 0.7% (2.5 mL) [contains benzalkonium chloride]

Omega-3 Fatty Acids Capsule, Oral:

Generic: 1 g

Omeprazole Capsule Delayed Release, Oral:


Ondansetron Tablet, Oral:

Generic: 4 mg, 8 mg

Tablet Dispersible, Oral:

Generic: 4 mg, 8 mg

Orphenadrine Tablet Extended Release 12 Hour, Oral, as citrate:

Generic: 100 mg

Oseltamivir Capsule, Oral, as phosphate:

Tamiflu: 75 mg

Suspension Reconstituted, Oral, as base:

Tamiflu: 6 mg/mL (60 mL) [contains saccharin sodium, sodium benzoate; tutti-frutti flavor]

OXcarbazepine Tablet, Oral:


Oxybutynin Tablet, Oral, as chloride:

Generic: 5 mg

Tablet Extended Release 24 Hour, Oral, as chloride:


OxyCODONE Tablet, Oral, as hydrochloride:


Tablet ER 12 Hour Abuse-Deterrent, Oral, as hydrochloride:

OxyCONTIN: 10 mg, 20 mg, 30 mg, 40 mg, 80 mg

Oxycodone and Acetaminophen Tablet, Oral:

Generic:

5/325: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg [BCF]

7.5/325: Oxycodone hydrochloride 7.5 mg and acetaminophen 325 mg

10/325: Oxycodone hydrochloride 10 mg and acetaminophen 325 mg

Oxymetazoline (Nasal) Solution, Nasal, as hydrochloride:


Pantoprazole Tablet Delayed Release, Oral:


PARoxetine Tablet, Oral, as hydrochloride [strength expressed as base]:


Peginterferon Alfa-2a Kit, Subcutaneous [preservative free]:

Pegasys: 180 mcg/0.5 mL [contains benzyl alcohol]

Solution, Subcutaneous [preservative free]:

Pegasys: 180 mcg/mL (1 mL) [contains benzyl alcohol]

Pegasys: 180 mcg/0.5 mL (0.5 mL) [contains benzyl alcohol, polysorbate 80]

26


Peginterferon Alfa-2b Kit, Subcutaneous:

Peg-Intron: 50 mcg/0.5 mL, 80 mcg/0.5 mL, 120 mcg/0.5 mL, 150 mcg/0.5 mL

Penicillin V Potassium Solution Reconstituted, Oral:

Generic: 125 mg/5 mL (100 mL) [BCF]; 250 mg/5 mL (100 mL) [BCF]

Tablet, Oral:


Permethrin Cream, External:


Phenazopyridine Tablet, Oral, as hydrochloride:


PHENobarbital Elixir, Oral:


Tablet, Oral:

Generic: 32.4 mg

Phenytoin Capsule, Oral, as sodium:


Suspension, Oral:




Phytonadione Tablet, oral:

Mephyton®: 5 mg [scored]

Pilocarpine (Ophthalmic) Solution, Ophthalmic, as hydrochloride:

Generic: 1% (15 mL) [BCF]; 2% (15 mL) [BCF]; 4% (15 mL) [BCF]

Pilocarpine (Systemic) Tablet, Oral, as hydrochloride:

Salagen: 5 mg

Pimecrolimus Cream, External:

Elidel: 1% (30 g, 60 g, 100 g) [contains benzyl alcohol, cetyl alcohol, propylene glycol] [BCF]

Pioglitazone Tablet, Oral:


Piroxicam (Systemic) Capsule, Oral:

Generic: 20 mg

Polyethylene Glycol 3350 Powder, Oral:

MiraLax: (527 g)

Polyethylene Glycol-Electrolyte

Solution

Solution Reconstituted, Oral:

Generic: 240 g (4000 mL)

Polysaccharide-Iron Complex Liquid, Oral:

NovaFerrum Pediatric Drops: 15 mg/mL (120 mL) [alcohol free, dye free, gluten free, lactose

free, sodium free, sugar free; contains sodium benzoate; raspberry-grape flavor]

Potassium Chloride Capsule Extended Release, Oral:

Generic: 10 mEq [BCF]

Liquid, Oral:

Generic: 20 mEq/15 mL (10%) (473 mL)

Packet, Oral:

Klor-Con: 20 mEq/packet (30s) [sugar free] [BCF]


Generic: 8 mEq, 10 mEq [BCF], 20 mEq [BCF]

Potassium Citrate Tablet Extended Release, Oral:

Generic: 10 mEq (1080 mg)

Pramipexole Tablet, Oral, as dihydrochloride monohydrate:

Generic: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 1.5 mg

Prasugrel Tablet, Oral:

Effient: 10 mg

27


Pravastatin Tablet, Oral, as sodium:


Prazosin Capsule, Oral:


PrednisoLONE (Ophthalmic) Suspension, Ophthalmic, as acetate:

Pred Mild: 0.12% (5 mL) [BCF]

Generic: 1% (5 mL,) [BCF]

PrednisoLONE (Systemic) Solution, Oral, as base:

Generic: 5 mg/5 mL (120 mL); 15 mg/5 mL (480 mL)

Solution, Oral, as sodium phosphate [strength expressed as base]:



Orapred ODT: 15 mg

PredniSONE Tablet, Oral:

Generic: 1 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 50 mg

Primaquine Tablet, Oral, as phosphate:

Generic: 26.3 mg

Primidone Tablet, Oral:

Generic: 50 mg

Probenecid Tablet, Oral:

Generic: 500 mg

Probiotic Product

Prochlorperazine Suppository, Rectal:

Generic: 25 mg (12 ea)

Tablet, Oral, as maleate [strength expressed as base]:

Generic: 10 mg

Progesterone Capsule, Oral:


Promethazine Suppository, Rectal, as hydrochloride:

Generic: 12.5 mg (12s) [BCF]; 25 mg (12s) [BCF]


Generic: 6.25 mg/5 mL (118 mL) [BCF]


Generic: 12.5 mg, 25 mg [BCF]

Promethazine and Codeine Syrup, Oral:

Generic: Promethazine hydrochloride 6.25 mg and codeine phosphate 10 mg per 5 mL (118

mL)

Propranolol Capsule Extended Release 24 Hour, Oral, as hydrochloride:



Generic: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg

Propylthiouracil Tablet, Oral:


Pseudoephedrine Liquid, Oral, as hydrochloride:

Nasal Decongestant: 30 mg/5 mL (118 mL) [contains methylparaben, saccharin sodium,

sodium benzoate; raspberry flavor]


SudoGest: 30 mg

Pyrazinamide Tablet, Oral:


Pyridoxine Tablet, Oral, as hydrochloride [preservative free]:

Generic: 50 mg

28


QUEtiapine Tablet, Oral:

Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF], 300 mg [BCF], 400 mg

[BCF]


SEROquel XR: 50 mg [BCF], 150 mg [BCF], 200 mg [BCF], 300 mg [BCF], 400 mg [BCF]

Raloxifene Tablet, Oral, as hydrochloride:

Evista: 60 mg [BCF]

Raltegravir Tablet, Oral:

Isentress: 400 mg [contains polyethylene glycol]

Ramipril Capsule, Oral:

Generic: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

RaNITIdine Syrup, Oral:


Tablet, Oral:


Ribavirin (Systemic) Capsule, Oral:

Generic: 200 mg [ECF]

RifAMPin Capsule, Oral:


RifAXIMin Tablet, Oral:

Xifaxan: 550 mg [contains edetate disodium]

Riluzole Tablet, Oral:

Generic: 50 mg

RisperiDONE Solution, Oral:


Tablet, Oral:

Generic: 0.25 mg [BCF], 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF], 3 mg [BCF], 4 mg [BCF]

Ritonavir Capsule, Oral:

Norvir: 100 mg [contains alcohol, usp]

Rivaroxaban Tablet, Oral:

Xarelto: 10 mg, 15 mg, 20 mg

Rizatriptan Tablet, Oral:

Maxalt: 5 mg [BCF], 10 mg [BCF]


Maxalt-MLT: 5 mg [BCF], 10 mg [BCF] [contains aspartame; peppermint flavor]

ROPINIRole Tablet, Oral:

Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg

Rosuvastatin Tablet, Oral:


Salicylic Acid Solution, External:

Duofilm: 17% (9.8 mL)

Salmeterol Aerosol Powder Breath Activated, Inhalation:

Serevent Diskus: 50 mcg (60s) [contains lactose] [BCF]

Salsalate Tablet, Oral:


Scopolamine (Systemic) Patch 72 Hour, Transdermal:

Transderm-Scop: 1.5 mg

Selenium Sulfide Lotion, External:


Sertraline Concentrate, Oral:


Tablet, Oral:


29


Sevelamer Tablet, Oral, as carbonate:

Renvela: 800 mg

Sildenafil Tablet, Oral:

Revatio: 20 mg [BCF]

Viagra: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Silver Sulfadiazine Cream, External:

Generic: 1% (20 g, 85 g, 454 g) [BCF]

Simethicone Suspension, Oral:

Gas Relief: 20 mg/0.3 mL (30 mL) [dye free; contains sodium benzoate; fruit flavor]


Generic: 80 mg

Simvastatin Tablet, Oral:

Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg

Sirolimus Tablet, Oral:

Rapamune: 0.5 mg, 1 mg

SITagliptin Tablet, Oral:

Januvia: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Sitagliptin and Metformin Tablet, Oral:

Janumet 50/500: Sitagliptin 50 mg and metformin hydrochloride 500 mg [BCF]

Janumet 50/1000: Sitagliptin 50 mg and metformin hydrochloride 1000 mg [BCF]

Tablet, Extended Release, Oral:

Janumet XR: 50/500: Sitagliptin 50 mg and metformin hydrochloride 500 mg [BCF]



Sodium Chloride Nebulization Solution, Inhalation:



Generic: 5% (3.5 g)

Packet, Nasal:

NeilMed Sinus Rinse Kit

Solution, Nasal:

Deep Sea Nasal Spray: 0.65% (44 mL) [contains benzalkonium chloride]


Generic: 5% (15 mL)

Sodium Phosphates Enema, Rectal:

Fleet Enema: Fleet Enema: Monobasic sodium phosphate monohydrate 19 g and dibasic

sodium phosphate heptahydrate 7 g per 118 mL delivered dose (133 mL) [contains sodium 4.4

g/118 mL]

Fleet Pediatric: Monobasic sodium phosphate monohydrate 9.5 g and dibasic sodium

phosphate heptahydrate 3.5 g per 59 mL delivered dose (66 mL) [contains sodium 2.2 g/59

mL]

Solifenacin Tablet, Oral, as succinate:

VESIcare: 5 mg, 10 mg

Somatropin Solution, Subcutaneous:

Norditropin NordiFlex Pen: 30 mg/3 mL (3 mL) [contains phenol] [ECF]

Nutropin: 5 mg/mL

Nutropin AQ Pen: 10 mg/2 mL (2 mL) [contains phenol]

Spironolactone Tablet, Oral:

Generic: 25 mg [BCF], 50 mg, 100 mg

Sucralfate Suspension, Oral:

Carafate: 1 g/10 mL (420 mL) [contains methylparaben; cherry flavor]

Tablet, Oral:

Generic: 1 g

30


Sulfacetamide and Prednisolone Ointment, Ophthalmic:

Blephamide S.O.P.: Sulfacetamide sodium 10% and prednisolone acetate 0.2% (3.5 g)

[contains phenylmercuric acetate]

Suspension, Ophthalmic:

Blephamide: Sulfacetamide sodium 10% and prednisolone acetate 0.2% (5 mL)

Sulfacetamide (Ophthalmic) Solution, Ophthalmic, as sodium:


Sulfamethoxazole and

Trimethoprim

Suspension, Oral:

Generic: Sulfamethoxazole 200 mg and trimethoprim 40 mg per 5 mL (473 mL) [BCF]

Tablet, Oral:

Generic: Sulfamethoxazole 400 mg and trimethoprim 80 mg [BCF]

Generic: Sulamethoxazole 800 mg and trimethoprim 160 mg [BCF]

SulfaSALAzine Tablet, Oral:

Sulfazine: 500 mg [scored] [BCF]



Sulfazine EC: 500 mg [BCF]


SUMAtriptan Solution, Subcutaneous, as succinate [strength expressed as base]:

Imitrex STATdose Refill: 6 mg/0.5 mL [2 inj/cartridge] [BCF]

Generic: 6 mg/0.5 mL [2 inj/cartridge] [BCF]

Tablet, Oral, as succinate [strength expressed as base]:


Surgical Lubricant Gel, External:

Surgilube: 3 g

Tacrolimus (Systemic) Capsule, Oral:

Prograf: 0.5 mg, 1 mg, 5 mg

Tacrolimus (Topical) Ointment, External:

Protopic: 0.1% (30 g)

Tamoxifen Tablet, Oral:


Tamsulosin Capsule, Oral, as hydrochloride:


Telaprevir Tablet, Oral:

Incivek: 375 mg

Telmisartan Tablet, Oral:

Micardis: 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]


Telmisartan and

Hydrochlorothiazide

Tablet, Oral:

Micardis HCT: 40/12.5: Telmisartan 40 mg and hydrochlorothiazide 12.5 mg [BCF]

Micardis HCT: 80/12.5: Telmisartan 80 mg and hydrochlorothiazide 12.5 mg [BCF]

Micardis HCT: 80/25: Telmisartan 80 mg and hydrochlorothiazide 25 mg [BCF]

Temazepam Capsule, Oral:

Generic: 7.5 mg, 15 mg [BCF], 30 mg [BCF]

Terazosin Capsule, Oral:


Terbinafine (Systemic) Tablet, Oral:

Generic: 250 mg

Terbinafine (Topical) Cream, External, as hydrochloride:

Generic: 1% (30 g)

Terconazole Cream, Vaginal:


31


Testosterone Gel, Transdermal:

Fortesta: 10 mg/actuation (60 g) [contains ethanol; 0.5 g gel/actuation; 120 metered

actuations] [BCF]

Generic: 50 mg/5 g (1%) (5 g)

Oil, Intramuscular, as cypionate:


Thalidomide Capsule, Oral:

Thalomid: 50 mg, 100 mg, 200 mg

Theophylline Capsule Extended Release 24 Hour, Oral:

Theo-24: 100 mg, 200 mg, 300 mg [BCF], 400 mg [BCF]

Solution, Oral:



Generic: 100 mg, 200 mg [BCF], 300 mg [BCF]



Thyroid, Desiccated Tablet, Oral:

Armour Thyroid: 15 mg, 30 mg, 60 mg, 90 mg, 120 mg, 180 mg, 240 mg, 300 mg

Ticagrelor Tablet, Oral:

Brilinta: 60 mg, 90 mg

Timolol (Ophthalmic) Gel Forming Solution, Ophthalmic, as maleate [strength expressed as base]:

Generic: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF]

Solution, Ophthalmic, as maleate [strength expressed as base]:

Generic: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF]

Tiotropium Aerosol Solution, Inhalation:

Spiriva Respimat: 1.25 mcg/actuation (4 g); 2.5 mcg/actuation (4 g) [contains benzalkonium

chloride, disodium edta] [BCF]

Capsule, Inhalation:

Spiriva HandiHaler: 18 mcg [contains milk protein] [BCF]

Tiotropium and Olodaterol Aerosol Solution, Inhalation:

Stiolto Respimat: Tiotropium 2.5 mcg and olodaterol 2.5 mcg per actuation (4 g) [contains

benzalkonium chloride, edetate disodium]

TiZANidine Tablet, Oral:

Generic: 2 mg, 4 mg

Tobramycin and

Dexamethasone


TobraDex: Tobramycin 0.3% and dexamethasone 0.1% (3.5 g)

Suspension, Ophthalmic:

Generic: Tobramycin 0.3% and dexamethasone 0.1% (2.5 mL)

Tobramycin (Ophthalmic) Ointment, Ophthalmic:

Tobrex: 0.3% (3.5 g)



Tolterodine Capsule Extended Release 24 Hour, Oral, as tartrate:


Topiramate Tablet, Oral:


TraMADol Tablet, Oral, as hydrochloride:


TraZODone Tablet, Oral, as hydrochloride:


32


Tretinoin (Topical) Cream, External:

Generic: 0.025% (20 g) [BCF]; 0.05% (15 g) [BCF]; 0.1% (20 g)

Gel, External:

Generic: 0.01% (15 g)

Gel, External [microphere]:

Generic: 0.01% (120 g)

Triamcinolone (Topical) Cream, External, as acetonide:

Generic: 0.1% (15 g, 80 g, 454 g) [BCF]; 0.5% (15 g)

Ointment, External, as acetonide:

Generic: 0.025% (15 g); 0.1% (15 g, 454 g) [BCF]; 0.5% (15 g)

Paste, Mouth/Throat, as acetonide:

Generic: 0.1% (5 g)

Triazolam Tablet, Oral:

Generic: 0.125 mg, 0.25 mg

Trifluridine Solution, Ophthalmic:

Generic: 1% (7.5 mL)

Trihexyphenidyl Elixir, Oral, as hydrochloride:

Generic: 0.4 mg/mL (473 mL) [BCF]



Trimethoprim and Polymyxin B Solution, Ophthalmic:

Generic: Trimethoprim 1 mg and polymyxin B sulfate 10,000 units per 1 mL (10 mL) [BCF]

Ulipristal Tablet, Oral, as acetate:

Ella: 30 mg

Umeclidinium and Vilanterol Aerosol Powder Breath Activated, Inhalation:

Anoro Ellipta: Umeclidinium 62.5 mcg and vilanterol 25 mcg per inhalation (60 ea) [contains

milk protein]

Ursodiol Capsule, Oral:

Generic: 300 mg

ValACYclovir Tablet, Oral:

Generic: 500 mg, 1 g

Valproic Acid and Derivatives Capsule Sprinkle, Oral, as divalproex sodium:


Syrup, Oral, as valproate sodium:


Tablet Delayed Release, Oral, as divalproex sodium:


Tablet Extended Release 24 Hour, Oral, as divalproex sodium:


Valsartan Tablet, Oral:

Diovan: 40 mg [scored] [BCF], 80 mg [BCF], 160 mg [BCF], 320 mg [BCF]

Valsartan and

Hydrochlorothiazide

Tablet, Oral:

Generic:

80 mg/12.5 mg: Valsartan 80 mg and hydrochlorothiazide 12.5 mg [BCF]


160 mg/25 mg: Valsartan 160 mg and hydrochlorothiazide 25 mg [BCF]


320 mg/25 mg: Valsartan 320 mg and hydrochlorothiazide 25 mg [BCF]

Varenicline Tablet, Oral:

Chantix Continuing Month Pak: 1 mg

Chantix Starting Month Pak: 0.5 mg x 11 & 1 mg x 42

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Venlafaxine Capsule Extended Release 24 Hour, Oral:


Tablet, Oral:

Generic: 25 mg [BCF], 37.5 mg [BCF], 50 mg [BCF], 75 mg [BCF], 100 mg [BCF]



Verapamil Tablet, Oral, as hydrochloride:

Generic: 80 mg

Tablet Extended Release, Oral, as hydrochloride:


Vitamins (Multiple/Pediatric) Solution, Oral:

Poly-Vi-Sol: (50 mL)

Poly-Vi-Sol/Iron: (50 mL)

Tri-Vit/Fluoride: 0.25 mg/mL (50 mL) [contains polysorbate 80; fruit flavor]

Vitamins (Multiple/Prenatal) Tablet, Oral:

Prenatal Plus: 27-1 MG

Warfarin Tablet, Oral, as sodium:

Generic: 1 mg [BCF], 2 mg [BCF], 2.5 mg [BCF], 3 mg [BCF], 4 mg [BCF], 5 mg [BCF], 6 mg

[BCF], 7.5 mg [BCF], 10 mg [BCF]

Zaleplon Capsule, Oral:


Zinc Oxide Ointment, External:

Generic: 20% (454 g)

Ziprasidone Capsule, Oral, as hydrochloride:


ZOLMitriptan Tablet, Oral:

Generic: 2.5 mg, 5 mg


Zomig ZMT: 2.5 mg, 5 mg [contains aspartame; orange flavor]

Zolpidem Tablet, Oral, as tartrate:


Tablet Extended Release, Oral, as tartrate:

Generic: 6.25 mg, 12.5 mg

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KIRTLAND AIR FORCE BASE OUTPATIENT FORMULARY …

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