Datawindow

Drug List - By Category/Sub-Category - Formulary
1 ANALGESIC/ANTI-INFLAMMATORY
1 ANTI-MIGRAINE
ASA-APAP-CAFFEINE (EXCEDRIN MIGRAINE) PLUS PO (18225) ***ABORTIVE THERAPY FOR MILD TO MODERATE MIGRAINE HA.
SUMATRIPTAN (SUMATRIPTAN SUCCINATE TAB) 50MG PO (16814) 2 CORTICOSTEROIDS, SYSTEMIC
DEXAMETHASONE (DECADRON) 0.5 MG PO (15705) DEXAMETHASONE (DECADRON) 4 MG/ML IV (15708) FLUDROCORTISONE (FLORINEF) 0.1 MG PO (15878) HYDROCORTISONE (SOLU-CORTEF) 100 MG IV (16029) METHYLPREDNISOLONE (SOLU-MEDROL) 1 GM IV (16779) METHYLPREDNISOLONE (SOLU-MEDROL) 40 MG IV (17956) METHYLPREDNISOLONE (DEPO-MEDROL) 40MG/ML IM (16265) PREDNISONE (PREDNISONE) 2.5 MG PO (16601) PREDNISONE (PREDNISONE TAB 20 MG) 20MG PO (16599) PREDNISONE (PREDNISONE TAB 5 MG) 5MG PO (16597) SOLU-MEDROL (METHYLPREDNISOLONE SODIUM) 125MG IV (16778) TRIAMCINOLONE ACETONIDE (KENALOG-40) 40 MG/ML IM (17009) 3 NARCOTICS
APAP/CODEINE (ACETAMINOPHEN W/ CODEINE) 300-30MG PO (17710) ***ALL NARCOTICS ARE RESTRICTED FOR DENTISTS EXCEPT FOR MULTIPLE EXTRACTIONS OREXTENSIVE MANDIBULAR OR MAXILLARY BONY INVOLVEMENT HYDROCO/APAP (VICODIN) 5-500MG PO (16021) MORPHINE CARPUJECT (MORPHINE SULFATE) 10 MG/ML IV (16302) MORPHINE SUL (MS CONTIN) 15MG ER PO (16309) MORPHINE SUL (MS CONTIN) 30MG ER PO (16310) MORPHINE SUL (MS CONTIN) 60MG ER PO (18239) OXYCOD/APAP (PERCOCET) 5-325MG PO (16483) 4 NON-STEROIDAL ANTI-INFLAMMATORY
IBUPROFEN SUSP (MOTRIN SUSP) 100/5ML PO-BULK (16053) KETOROLAC (TORADOL VIAL **2ML**) 60MG/2ML IM (17378) ***INDICATED FOR SHORT TERM USE ONLY (< OR = 5 DAYS). NOT INDICATED FOR TREATMENT OFMINOR/CHRONIC PAIN. ADJUST DOSE FOR PTS > OR = 65YRS OR WT <50KG 5 SALICYLATES
ASPIRIN EC (LOW DOSE) (ASPIRIN TAB DELAYED RELEA) 81MG EC PO (17920) 6 SKELETAL MUSCLE RELAXANTS
METHOCARBAMOL (ROBAXIN) 750 MG PO (16257) Drug List - By Category/Sub-Category - Formulary
2 ANTI-COAGULANT/ANTI-PLATELET
1 INJECTABLE ANTI-COAGULANT/ANTI-PLATELET
ENOXAPARIN (LOVENOX) 100 MG/ML SC (17227) ENOXAPARIN (LOVENOX) 40 MG/0.4 ML SC (17476) ENOXAPARIN (LOVENOX) 60 MG/0.6 ML SC (17686) ENOXAPARIN (LOVENOX) 80 MG/0.8 ML SC (15810) HEPARIN (HEPARIN) 5000 U/ML 10 ML IV (17724) HEPARIN LOCK (HEPARIN SODIUM (PORCINE)) 10 U/ML IV (18035) HEPARIN LOCK 30ML (HEPARIN LOCK) 100 U/ML IV (17916) HEPARIN LOCK FLUSH (HEPARIN SODIUM (PORCINE)) 100/ML IV (15992) HEPARIN SOD (HEPARIN SODIUM (PORCINE)) 1000/ML IV (15996) 2 ORAL ANTI-COAGULANT/ANTI-PLATELET
DIPYRIDAMOLE (PERSANTINE) 50 MG PO (15759) 3 ANTI-CONVULSANT
1 ANTI-CONVULSANTS
PHENOBARB (PHENOBARBITAL TAB 30 MG) 30MG PO (18307) PHENOBARBITAL (PHENOBARB 64.8MG) 64.8 MG PO (17662) PHENOBARBITAL TAB 100 MG (PHENOBARBITAL TAB 100 MG) 100 MG PO (16535) PHENOBARBITAL TAB 15 MG (PHENOBARBITAL TAB 15 MG) 15 MG PO (16536) PHENYTOIN SUSP (DILANTIN SUSP) 125/5ML PO-BULK (16550) PHENYTOIN ER (DILANTIN ER) 100MG PO (16545) 2 EMERGENCY ANTI-CONVULSANTS
DIAZEPAM (VALIUM INJ 5 MG/ML) 5 MG/ML IV (15722) ***RESTRICTED TO THE MANAGEMENT OF STATUS EPILEPTICUS ONLY 4 ANTI-GOUT
1 ANTI-GOUT
5 ANTI-HYPERTENSIVE
1 ACE INHIBITORS
LISINOPRIL (LISINOPRIL TAB 20 MG) 20MG PO (16172) Drug List - By Category/Sub-Category - Formulary
5 ANTI-HYPERTENSIVE
2 ALPHA 2 ADRENERGIC AGONISTS
3 BETA ADRENERGIC AGENTS
METOPROLOL (LOPRESSOR) 1 MG/ML IV (17549) METOPROLOL TARTRATE (LOPRESSOR) 100MG PO (16272) METOPROLOL TARTRATE (LOPRESSOR) 25MG PO (17706) METOPROLOL TARTRATE (LOPRESSOR) 50MG PO (16271) 4 CALCIUM CHANNEL BLOCKERS
AMLODIPINE BESYLATE (NORVASC) 10MG PO (18097) AMLODIPINE BESYLATE (NORVASC) 5MG PO (16435) DILTIAZEM SR (CARDIZEM CD) 180MG ER PO (15523) DILTIAZEM SR (CARDIZEM CD) 120MG/24 PO (15524) VERAPAMIL (CALAN TAB CR 120) 120MG ER PO (18314) 5 DIURETICS
CHLORTHALIDONE (CHLORTHALIDONE) 25 MG PO (18006) CHLORTHALIDONE (CHLORTHALIDONE TAB 50 MG) 50 MG PO (15581) HYDROCHLOROTHIAZIDE (HCTZ) 12.5MG PO (17375) HYDROCHLOROTHIAZIDE (HCTZ) 25MG PO (15983) SPIRONOLACTONE (ALDACTONE) 25MG PO (16787) 6 ANTI-INFECTIVES
1 ANTI-FUNGALS
CLOTRIMAZOLE (MYCELEX TROCHES) 10 MG PO (16325) FLUCONAZOLE (1-TIME DOSE) (DIFLUCAN (1-TIME DOSE)) 150 MG PO (18063) NYSTATIN 100000 U/ML (NYSTATIN SUSP 100000 UNIT) 100000 PO (18298) 2 ANTI-PROTOZOALS
MEPRON SUSP (ATOVAQUONE SUSP) 750 MG PO-BULK (17296) ***2777795 1 BOX OF 42 SACHETS OF 5ML EACH DISPENSE AS 1 BOX.
3 ANTI-TUBERCULARS
ISONIAZID (ISONIAZID TAB 300 MG) 300MG PO (16085) Drug List - By Category/Sub-Category - Formulary
6 ANTI-INFECTIVES
3 ANTI-TUBERCULARS
PYRAZINAMIDE (PYRAZINAMIDE TAB 500 MG) 500 MG PO (16668) 4 INJECTABLE ANTIBIOTICS
AMPICILLIN & SULBACTAM (UNASYN (ADD-VANTAGE)) 3 GM IV (18091) ***NORMAL DAILY DOSE/FREQUENCY: 3 GM EVERY 6 HOURS AMPICILLIN/SULBACTAM (UNASYN) 1 GM/.5 GM IV (17051) AMPICILLIN/SULBACTAM (UNASYN) 2 GM/1 GM IV (17574) BICILLIN L-A (BICILLIN L-A) 2400000 IM (15469) CEFAZOLIN (CEFAZOLIN SODIUM FOR INJ) 1 GM IV (15537) CEFAZOLIN (ADD-VANTAGE) (ANCEF ADD-VANTAGE) 1GM IV (18084) ***NORMAL DAILY DOSE/FREQUENCY: 1 GRAM EVERY 6-8 HOURS; RENAL DOSING EVERY 8 HOURS CEFTRIAXONE ADD-VANTAGE (ROCEPHIN (ADD-VANTAGE)) 1 GM IV (18085) ***NORMAL DAILY DOSE / FREQUENCY: 1-2 GRAMS DAILY(OR IN EQUALLY DIVIDED DOSES BID) CEFTRIAXONE ADD-VANTAGE (ROCEPHIN (ADD-VANTAGE)) 2 GM IV (18086) ***NORMAL DAILY DOSE / FREQUENCY: 1-2 GRAMS DAILY(OR IN EQUALLY DIVIDED DOSES BID) GENTAMICIN SULFATE INJ (GARAMYCIN INJ) 80 MG/2 ML IV (15935) NAFCILLIN IV (NAFCIN (ADD-VANTAGE)) 1 GM IV (18087) ***NORMAL DAILY DOSE/FREQUENCY: 500 MG EVERY 4 HOURS, SEVERE INFECTION: 1 GRAM EVERY4 HOURS PENICILLIN G BENZATHINE (BICILLIN L-A) 1.2 MU IM (15468) UNASYN (AMPICILLIN & SULBACTAM SO) 1.5GM IV (18090) ***NORMAL DAILY DOSE/FREQUENCY: 1.5 GM EVERY 6 HOURS VANCOMYCIN (ADD-VANTAGE) (VANCOCIN (ADD-VANTAGE)) 1 GM IV (18089) ***NORMAL DAILY DOSE/FREQUENCY: 1 GRAM EVERY 12 HOURS VANCOMYCIN (ADD-VANTAGE) (VANCOCIN (ADD-VANTAGE)) 500 MG IV (17068) 5 ORAL ANTIBIOTICS
AMOXICILLIN (TRIHYDRATE) (AMOXIL) 500MG PO (15343) AMOXICILLIN/CLAVULANATE (AUGMENTIN) 875MG PO (17198) AZITHROMYCIN (ZITHROMAX) 250MG PO (17154) CIPROFLOXACIN HCL (CIPRO) 750MG PO (15593) CIPROFLOXACN HCL (CIPRO) 500MG PO (15592) DICLOXACILLIN (DYNAPEN) 500 MG PO (15730) DOXYCYCLINE (DOXYCYCLINE) 100 MG PO (15786) LEVOFLOXACIN (LEVAQUIN) 500 MG PO (18286) NITROFURANTOIN MONOHYD (MACROBID) 100MG PO (18043) PENICILLIN VK (PENICILLIN V POTASSIUM FO) 250 MG/5 ML PO (16502) PENICILLN VK (PENICILLIN V POTASSIUM TA) 500MG PO (16501) SMZ/TMP DS (BACTRIM DS) 800-160 PO (16807) SULFAMETHOXAZOLE-TRIMET (BACTRIM SUSP) NAC PO-BULK (16809) Drug List - By Category/Sub-Category - Formulary
7 ANTI-PARKINSON
1 ANTI-PARKINSON
BROMOCRIPTINE MESYLATE (PARLODEL) 2.5MG PO (15485) CARBIDOPA/LEVODOPA (SINEMET) 25-100MG PO (15518) CARBIDOPA/LEVODOPA (SINEMET) 25-250MG PO (17460) CARBIDOPA/LEVODOPA ER (SINEMET CR) 25-100MG PO (18036) CARBIDOPA/LEVODOPA ER (SINEMET CR) 50-200MG PO (17211) 8 ANTI-REJECTION
1 ANTI-REJECTION
9 ANTI-RETROVIRAL HIV
1 CCR5 ANTAGONISTS
2 COMBINATION HIV CLASS
ATRIPLA (EFAVIRENZ/EMTRIC/TENOFOVI) 600/200/300 MG OB (17891) 3 FUSION INHIBITOR
ENFUVIRTIDE INJ (FUZEON INJ) 90 MG IM (17808) 4 INTEGRASE INHIBITORS
ISENTRESS (RALTEGRAVIR) 400 MG OB (18026) 5 MISCELLANEOUS HIV
6 NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS
7 NUCLEOSIDE/NUCLEOTIDE REV. TRANSCRIPTASE INHIBITOR
ABACAVIR/LAMIVUDINE/ZID (TRIZIVIR) 300-150-300 OB (17387) COMBIVIR (LAMIVUDINE-ZIDOVUDINE TAB) OB (15642) EMTRIVA (EMTRICITABINE) 200 MG OB (17813) EPIVIR *SOLN* (LAMIVUDINE SOLN) 10 MG/ML OB (17510) EPZICOM (ABACAVIR SULF-LAMIVUDINE) 600/300MG OB (17776) LAMIVUDINE (LAMIVUDINE TAB 150 MG) 150MG OB (15820) LAMIVUDINE (LAMIVUDINE) 300 MG OB (18051) TRUVADA (EMTRICITABINE/TENOFOVIR) 200/300 MG OB (17720) Drug List - By Category/Sub-Category - Formulary
9 ANTI-RETROVIRAL HIV
7 NUCLEOSIDE/NUCLEOTIDE REV. TRANSCRIPTASE INHIBITOR
8 PROTEASE INHIBITORS
KALETRA (LOPINAVIR/RITONAVIR) 200 MG/50 MG OB (17845) NELFINAVIR MESYLATE (VIRACEPT) 250 MG OB (17097) NELFINAVIR MESYLATE (VIRACEPT) 625 MG OB (17784) 10 ANTI-RHEUMATIC
1 ANTI-RHEUMATICS
HYDROXYCHLOROQUINE (PLAQUENIL) 200MG PO (16039) METHOTREXATE (RHEUMATREX) 2.5MG PO (16259) METHOTREXATE INJ (METHOTREXATE SODIUM INJ P) 50MG/2ML IV (17293) 11 ANTI-VIRAL
1 HEPATITIS C TREATMENT
PEGINTERFERON ALFA-2A (PEGASYS KIT) 180 MCG/ .5 ML SC (18110) PEGINTERFERON ALFA-2A (PEGASYS INJ) 180 MCG/1 ML SC (17577) RIBAVIRIN (RIBAVIRIN CAP 200 MG) 200MG PO (17507) 2 NON-SPECIFIC ANTI-VIRAL
***FOR PATIENTS AT HIGH RISK FOR COMPLICATIONS OF FLU. PLEASE CALL PHARMACY FORDISPENSING.
ZANAMIVIR AERO POWDER (RELENZA) DISKHALE PO (18169) ***FOR PATIENTS AT HIGH RISK FOR COMPLICATIONS OF FLU. PLEASE CALL PHARMACY FORDISPENSING.
12 CARDIOVASCULAR
1 ACE II INHIBITORS
2 ALPHA ADRENERGIC BLOCKERS
***RESTRICTED TO TREATMENT OF PTSD NIGHTMARES (PSYCH USE ONLY) ***RESTRICTED TO TREATMENT OF PTSD NIGHTMARES (PSYCH USE ONLY) ***RESTRICTED TO TREATMENT OF PTSD NIGHTMARES (PSYCH USE ONLY) Drug List - By Category/Sub-Category - Formulary
12 CARDIOVASCULAR
3 ANTI-ANGINALS
ISOSORB MONO (IMDUR SR) 30MG ER PO (17560) ISOSORB MONO (IMDUR SR) 60MG ER PO (16092) ISOSORBIDE DINITRATE (ISORDIL) 5 MG PO (16090) ISOSORBIDE MONONITRAT SR (IMDUR SR) 120 MG PO (17561) NITROGLYCERIN SL (NITROSTAT SL) 0.4MG PO-BULK (16415) NITROGLYCERIN TD PATCH (TRANSDERM-NITRO) 0.1MG/HR TO (16410) NITROGLYCERIN TD PATCH (TRANSDERM-NITRO) 0.2 MG/HR TO (16408) NITROGLYCERIN TD PATCH (TRANSDERM-NITRO) 0.3 MG/HR TO (16412) NITROGLYCERIN TD PATCH (TRANSDERM-NITRO) 0.4 MG/HR TO (16409) 4 ANTI-ARRHYTHMICS
AMIODARONE HCL (CORDARONE) 200MG PO (15331) DIGOXIN INJ (LANOXIN) 0.25 MG/ML IV (15741) 5 ANTI-HYPERLIPIDEMICS
CHOLESTYRAMINE (QUESTRAN) 4 GM PO-BULK (15585) NIACIN TR (NIACIN CAP CR 500 MG) 500MG SR PO (16392) PRAVASTATIN (PRAVASTATIN SODIUM TAB 20) 20MG PO (16588) PRAVASTATIN (PRAVASTATIN SODIUM TAB 40) 40MG PO (18171) 6 HEMATOPOIETIC PRODUCTS
EPOGEN (EPOETIN ALFA) 10000/ML SC (16629) 7 POTASSIUM SUPPLEMENTS
POTASSIUM CHL POWDER (KLOR-CON 20 POWDER) 20 MEQ PO-BULK (16578) POTASSIUM CHLORIDE (KLOR-CON 10) 10MEQ ER PO (16577) 8 VASODILATORS
HYDRALAZINE (APRESOLINE) 100MG PO (17615) 13 CENTRAL NERVOUS SYSTEM AGENTS
1 CHOLINESTERASE INHIBITOR
PYRIDOSTIGMINE BROMIDE (MESTINON) 60MG PO (16245) 14 COLD/COUGH/ALLERGY
1 ANTIHISTAMINES
Drug List - By Category/Sub-Category - Formulary
15 EMERGENCY/BIOLOGICAL/IMMUNOLOGIC/MISCELLANEOUS
1 BIOLOGIC/IMMUNOLOGIC AGENTS
HEP B VACCINE (ENGERIX-B) 20MCG/ML IM (15991) HEPATITIS A VACCINE (HAVRIX) 1440 U/ML IM (15997) PNEUMOCOCCAL VACCINE (PNEUMOVAX 23) 25MCG/0.5ML IM (16565) TETANUS/DIPH/PERTUSSIS (ADACEL) NA IM (18004) TETANUS-DIPHTHERIA TOX (DECAVAC) 5-2LF IM (16929) TUBERCULIN PPD (APLISOL TB PPD) 5/0.1ML ID (17704) 2 EMERGENCY MEDICATIONS
ACTIVATED CHARCOAL SUSP (ACTIDOSE W/SORBITOL) 50 MG PO-BULK (17838) ADENOSINE IV (ADENOCARD IV) 3 MG/ML IV (15297) AMIODARONE (AMIODARONE INJ) 50 MG/ML IV (17466) ***RESTRICTED TO INFIRMARY CRASH CARTS ONLY. NOT FOR CLINIC CRASH CART USE.
AMMONIA AROMATIC INH (AMMONIA INHALANT) NA XX (15338) ATROPINE ABBOJECT (ATROPINE SULFATE INJ) 0.1 MG/ML IV (17473) ATROPINE INJ (ATROPINE INJ) 1 MG/ML IV (15386) BACTER WATER 30ML (WATER FOR INJECT, BACTERI) NA IM (15405) DEXTROSE 50ML (DEXTROSE INJ 50%) 50% IV (15716) EPINEPHRINE (EPINEPHRINE) 1:1000 (1MG/ML) IM (15815) EPINEPHRINE 1:10000 (EPINEPHRINE HCL INJ 0.1 M) 0.1MG/ML IM (15814) FLUMAZENIL (ROMAZICON INJ) 1 MG/10 ML IV (17506) ***BENZODIAZEPINE ANTAGONIST-FOR MGMT OF BZD OVERDOSE FUROSEMIDE (LASIX INJ.) 10MG/ML IV (15924) GLUCAGON EMERG KIT (GLUCAGON FOR INJECTION) 1 MG IM (15946) GLUCOSE CHEW TAB (GLUCOSE TABLETS) ORANGE PO-BULK (18178) LIDOCAINE IV INF (LIDOCAINE 20%) 2 GM/10 ML IV (17492) LIDOCAINE SYR *** (LIDOCAINE SYR) 20 MG/ML IV (16156) PROCAINAMIDE (PROCAINAMIDE) 100 MG/ML IV (16620) ***RESTRICTED TO INFIRMARY CRASH CART ONLY. NOT FOR CLINIC CRASH CART USE.
SOD BICARB 50ML (SODIUM BICARBONATE INJ 7.) 7.5% IV (16768) ***RESTRICTED TO INFIRMARY CRASH CARTS ONLY. NOT FOR CLINIC CRASH CART USE.
3 MISCELLANEOUS
ALENDRONATE SODIUM TAB (FOSAMAX) 70MG PO-BULK (18034) HYDROCORTISONE ENEMA (COLOCORT) 100 MG PR (16028) PODOPHYLLUM RESIN (PODOCON) 25% TO (16567) SOD CHLOR ADD-VANTAG (SOD CHLOR IV SOL 100ML) 0.9% 100ML IV (18116) SOD CHLOR ADD-VANTAG (SOD CHLOR IV SOL 250ML) 0.9% 250ML IV (18117) SOD CHLOR BACT 30ML (SOD CHLORIDE) 0.9% IV (16769) SOD CHLORIDE (SOD CHLORIDE INJ 20ML) 0.9% IV (16772) SODIUM FERRIC GLUCONATE (NULECIT) 12.5MG/ML IV (18283) STERILE WATER (WATER FOR INJECTION) NA IV (17115) TRIAMCINOLONE/ORABASE (KENALOG IN ORABASE) 0.1% TO (17003) Drug List - By Category/Sub-Category - Formulary
16 ENDOCRINE
1 ANTI-DIABETICS
GLYB/METFORM (GLUCOVANCE) 2.5-500 PO (17331) GLYBURIDE/METFORMIN (GLUCOVANCE) 5/500 MG PO (17330) 2 HORMONES
DELESTROGEN (ESTRADIOL VALERATE IM IN) 40MG/ML IM (18315) ESTROGENS, CONJUGATED (PREMARIN VAG CREAM) 0.625 MG/GM PV (16607) LEVONORGEST/ETH EST (LESSINA) 0.1/0.02MG PO-BULK (17363) LEVONORGESTREL-ETH EST (TRIVORA) TRIPHASIC PO-BULK (17034) LOW-OGESTREL (NORGESTREL & ETHINYL ESTR) PO-BULK (16178) MEDROXYPROGESTERONE (PROVERA) 10MG PO (16224) MEDROXYPROGESTERONE (DEPO-PROVERA) 150MG/ML IM (16228) ***FORMULARY FOR CONTRACEPTIVE USE; RESTRICTED FOR SEX OFFENDER TREATMENT--MUSTMEET PROTOCOL MEDROXYPROGESTERONE (PROVERA) 2.5MG PO (16225) MEDROXYPROGESTERONE (DEPO-PROVERA) 400 MG/ML IM (16227) ***RESTRICTED FOR SEX OFFENDER TREATMENT; MUST MEET SEX OFFENDER TREATMENTPROTOCOL NORETHIND & ESTRAD (NORTREL) 1 MG/0.035 MG PO-BULK (16425) 3 INSULINS
HUMALOG INSULIN (LISPRO INSULIN) 100 U/ML SC (17250) LANTUS INSULIN (GLARGINE INSULIN) 100 U/ML SC (17459) NOVOLIN 70/30 INSULIN (ISOPHANE/REG INSULIN) 70/30 SC (16071) NPH INSULIN (HUMULIN-N) 100 U/ML SC (16070) REG INSULIN (SLIDE SCALE) (SLIDING SCALE (INSULIN R)) U-100 SC (18273) REGULAR INSULIN (HUMULIN-R) 100 U/ML SC (16072) 4 THYROID AGENTS
LEVOTHYROXINE (LEVOTHYROXINE) 100 MCG PO (16115) LEVOTHYROXINE (LEVOTHYROXINE SODIUM TAB) 112MCG PO (16119) LEVOTHYROXINE (LEVOTHYROXINE SODIUM TAB) 125MCG PO (16114) LEVOTHYROXINE (LEVOTHYROXINE SODIUM TAB) 150MCG PO (16113) LEVOTHYROXINE (LEVOTHYROXINE) 175 MCG PO (16122) LEVOTHYROXINE (LEVOTHYROXINE) 25 MCG PO (16112) LEVOTHYROXINE (LEVOTHYROXINE) 50 MCG PO (16117) LEVOTHYROXINE (LEVOTHYROXINE) 75 MCG PO (16118) 17 GASTROINTESTINAL
1 ANTI-DIARRHEALS
BISMUTH SUBSALICYLATE (PEPTO-BISMOL TAB) 262MG OB (16519) ***RESTRICTED TO H PYLORI USE--ANY OTHER USE IS NON-FORMULARY Drug List - By Category/Sub-Category - Formulary
17 GASTROINTESTINAL
1 ANTI-DIARRHEALS
2 ANTI-EMETIC/ANTI-VERTIGO
MECLIZINE (MECLIZINE HCL CHEW TAB 25) 25MG PO (16219) ***RESTRICTED TO INFIRMARY USE ONLY FOR CANCER AND HIV PATIENTS ***RESTRICTED TO INFIRMARY USE ONLY FOR CANCER AND HIV PATIENTS PROCHLORPERAZINE (COMPAZINE) 5 MG PO (16624) PROCHLORPERAZINE 2 ML (COMPAZINE INJ) 5 MG/ML IM (18222) PROCHLORPERAZINE SUPP (COMPAZINE SUPP) 25MG PR (16627) 3 ANTI-SPASMODIC/ANTICHOLINERGIC
4 DIGESTIVE ENZYMES
CREON (PANCRELIPASE (LIP-PROT-AM) 24000 UNITS OB (18292) PANCRELIPASE (PANCRELIPASE - DELAYED-R) 5000 UNIT PO (18207) 5 H2 ANTAGONIST/PROTON PUMP INHIBITOR
RANITIDINE (RANITIDINE HCL TAB 150 MG) 150MG PO (16677) ***300MG BID IS NOT CONSIDERED ANY MORE EFFECTIVE THAN 150MG BID. ORDERS SHOULDREFLECT 150MG DOSING.
6 LAXATIVES
BISACODYL SUPP (DULCOLAX SUPP) 10MG PR (15473) CITROMA (MAGNESIUM CITRATE SOLN) LEMON PO-BULK (15595) LACTULOSE (LACTULOSE SOLUTION 10 GM/) 10GM/15 PO-BULK (17725) MAGNESIUM HYDROXIDE (MILK OF MAGNESIA) 400MG/5ML PO-BULK (17442) MINERAL OIL (MINERAL OIL) PO-BULK (16288) ***RESTRICTED TO ORAL USE AS LAXATIVE ONLY--NON-FORMULARY FOR TOPICAL USE POLYETHYLENE GLYCOL (MIRALAX) 3350 NF PO (17764) PSYLLIUM FIBER (REGULOID) 0.52 GM PO-BULK (18241) SODIUM PHOSPHATE EMEMA (FLEETS ENEMA) PR (15872) SORBITOL 16 OZ (SORBITOL) 70% PO-BULK (16780) 7 REFLUX/COATING AGENTS
8 ULCERATIVE COLITIS AGENTS
MESALAMINE (ASACOL) 400 MG DR PO-BULK (16243) SULFASALAZINE (AZULFIDINE) 500MG PO (16805) 18 NASAL PRODUCTS
1 NASAL STEROIDS
FLUNISOLIDE (NASALIDE NASAL SOLN) 0.025% NA (16356) 19 NON-PRESCRIPTION ITEMS
1 NON-PRESCRIPTION ANALGESICS
Drug List - By Category/Sub-Category - Restrictrive
20 NUTRITIONAL SUPPLEMENTS
1 NUTRITIONAL SUPPLEMENTS
CALCITRIOL (ROCALTROL) 1 MCG/ML IV (17728) CALCIUM CARB W/ VITAMIN D (OYST-CAL D) 500MG/200IU PO (17709) CALCIUM CHLORIDE (CALCIUM CHLORIDE INJ 10%) 10% IV (15502) CYANOCOBALAMIN INJ (VIT B 12 INJ) 1000 MCG IM (15671) FERRIC GLUC CMPLX IN SUC (FERRLECIT) 62.5 MG IV (17564) FERROUS SULFATE (FERROUS SULFATE TAB 325 M) 325MG PO (15865) FOLIC ACID (FOLIC ACID TAB 1 MG) 1MG PO (15916) LEUCOVORIN (WELLCOVORIN) 10 MG PO (16143) PHYTONADIONE INJ (VITAMIN K1 INJ) 10 MG/ML IV (17111) VITAMIN B-1 (THIAMINE HCL TAB 100 MG) 100MG PO (16944) VITAMIN B-1 (THIAMINE HCL TAB 50 MG) 50MG PO (16943) 2 VITAMIN/MINERAL COMBOS
CALCIUM CITRATE W/ VIT D (CITRACAL + D) 250 MG PO (17940) 21 OPHTHALMIC
1 EYE WASH
OPHTHALMIC IRRIGATION (EYE WASH) 4 OZ (118 ML) OU (17984) 2 MYDRIATICS
ATROPINE SULFATE OP SOLN (ATROPINE SULFATE) 1% OU (15390) TROPICAMIDE OPHTH SOLN (MYDRIACYL OPHTH SOLN) 0.5% OP OU (16329) TROPICAMIDE OPHTH SOLN (MYDRIACYL OPHTH SOLN) 1% OP OU (16330) 3 OPHTHALMIC ANESTHETIC
PROPARACAINE (OPHTHETIC) 0.5% OP OU (16463) 4 OPHTHALMIC ANTI-INFECTIVES
GENTAMICIN OPHTH SOLN (GENTAK OPHTH SOLN) 0.3% OP OU (15934) GENTAMICIN OPHTH OINT (GENTAK OPHTH OINT) 0.3% TO (15936) NEOMYCIB/BSC/POLYMIX OINT (NEPSPORIN OPHTH OINT) OP TO (17036) OFLOXACIN OPHTH SOLN (OCUFLOX OPHTH SOL) 0.3% OU (16457) SULFACET SOD (SULFACETAMIDE SODIUM OPHT) 10% OP OU (16801) TOBRAMYCIN OPHTH SOLN (TOBREX OPHTH DOLN) 0.3% OP OU (16980) 5 OPHTHALMIC ANTI-INFLAMMATORYS
PREDNISOLONE (PRED FORTE SUSP) 1% OP OU (16596) 22 OPHTHALMIC-ANTI-GLAUCOMA
1 OPHTHALMIC ALPHA-ADRENERGICS
BRIMONIDINE TARTRATE OPH (ALPHAGAN "P" OPHT SOLN) 0.15% OU (17551) 2 OPHTHALMIC BETA-ADRENERGICS
TIMOLOL MAL (TIMOLOL MALEATE OPHTH SOL) 0.25% OP OU (16970) TIMOLOL MAL (TIMOPTIC OPHTH SOL) 0.5% OP OU (16972) 3 OPHTHALMIC CARBONIC ANHYDRASE INHIBITORS
DORZOLAMIDE (TRUSOPT OP SOLN) 2% OP OU (17041) 4 OPHTHALMIC PROSTAGLANDINS
LUMIGAN (BIMATOPROST OPHTH SOLN) 0.01% OU (18318) Drug List - By Category/Sub-Category - Formulary
23 OTIC
1 EAR WAX EMULSIFIER
CARBAMIDE PEROXIDE (DEBROX OTIC SOLN) 6.5% AU (15516) 2 OTIC ANALGESICS
BENZOCAINE-ANTIPYRINE OTI (AURODEX OTIC) OTIC AU (15364) 3 OTIC ANTI-INFECTIVE
ACETIC ACID OTIC SOLN 2% (VOL-SOL OTIC) 2% AU (15285) NEO/POLY/DEX (MAXITROL SUSP) 0.1% OP OU (16218) 24 PSYCHOTROPIC
1 ANTI-ANXIETY
2 ANTI-DEPRESSANTS
AMITRIPTYLINE HCL (ELAVIL) 25MG PO (15333) BUPROPION HCL (WELLBUTRIN) 100MG PO (17116) ***MANDATORY CRUSH AND FLOAT UNLESS PROVIDER OVERRIDES FOR SPECIFIC PATIENT BUPROPION HCL (WELLBUTRIN) 75MG PO (17117) ***MANDATORY CRUSH AND FLOAT UNLESS PROVIDER OVERRIDES FOR SPECIFIC PATIENT ***DOSE RESTRICTED: MAXIMUM DOSE IS 40 MG/DAY--HIGHER DOSE REQUIRES NON-FORMAPPROVAL BY CHIEF PSYCHIATRIST Drug List - By Category/Sub-Category - Restrictrive
24 PSYCHOTROPIC
2 ANTI-DEPRESSANTS
3 ANTI-MANICS
CARBAMAZEPINE (TEGRETOL CHEW TABS) 100MG PO (15514) CARBAMAZEPINE (TEGRETOL) 200 MG PO (15513) DIVALPROEX DR (DEPAKOTE DR) 250 MG PO (15765) DIVALPROEX DR (DEPAKOTE DR) 500 MG PO (15767) LITHIUM CARB (LITHIUM CARBONATE CAP 300) 300 MG PO (16174) LITHIUM CARB (ESKALITH) 450MG ER PO (15831) LITHIUM CITRATE SOLN (LITHIUM CITRATE SOLN) 8 MEQ/5 ML PO (16175) 4 ANTI-PSYCHOTICS
CHLORPROMAZINE (THORAZINE) 25 MG/ML IM (15579) CHLORPROMAZINE HCL (THORAZINE) 10 MG PO (15576) CHLORPROMAZINE HCL (THORAZINE) 100 MG PO (15573) CHLORPROMAZINE HCL (THORAZINE) 200MG PO (15575) CHLORPROMAZINE HCL (THORAZINE) 25MG PO (15572) CHLORPROMAZINE HCL (THORAZINE) 50MG PO (15574) FLUPHENAZINE CONC (PROLIXIN CONC) 5 MG/ML PO (15904) FLUPHENAZINE DEC INJ (PROLIXIN DEC INJ) 25 MG/ML IM (15906) FLUPHENAZINE INJ (PROLIXIN INJ) 2.5 MG/ML IM (17749) ***RESTRICTED TREATMENT TO PSYCHOSES OTHER USES REQUIRES NON-FORMULARY ***RESTRICTED TREATMENT TO PSYCHOSES OTHER USES REQUIRES NON-FORMULARY ***RESTRICTED TREATMENT OF PSYCHOSIS OTHER USES REQUIRE NON-FORMULARY ***RESTRICTED TREATMENT OF PSYCHOSES OTHER USES REQUIRE NON-FORMULARY HALOPER DEC INJ (HALDOL DEC INJ.) 100MG/ML IM (15974) ***PLEASE USE 5 MG FOR 10 MG DOSING.
HALOPERIDOL CONC (HALDOL CONC) 2 MG/ML PO-BULK (15972) HALOPERIDOL INJ. (HALDOL INJ.) 5MG/ML IM (17730) Drug List - By Category/Sub-Category - Formulary
24 PSYCHOTROPIC
4 ANTI-PSYCHOTICS
LOXAPINE (LOXAPINE SUCCINATE CAP 10) 10 MG PO (16191) ***RESTRICTION: FOR TAPER USE ONLY--NOT FOR SLEEP 5 MISCELLANEOUS ANTI-CHOLINERGICS
BENZTROPINE MESYLATE (COGENTIN) 0.5MG PO (15442) BENZTROPINE MESYLATE (COGENTIN) 1 MG PO (15441) BENZTROPINE MESYLATE (COGENTIN) 2MG PO (15440) BENZTROPINE MESYLATE INJ (COGENTIN INJ) 1MG/ML IM (15443) 25 RESPIRATORY
1 ANTIHISTAMINES
DIPHENHYDRAMINE INJ (BENADRYL INJ) 50 MG/ML IV (15753) ***RESTRICTED TO ACUTE ALLERGIC REACTIONS ONLY FOR A MAXIMUM OF 3 DAYS 2 BRONCHODILATOR/INHALED CORTICOSTEROIDS
ALBUTEROL NEB SOLUTION (ALBUTEROL SULFATE SOLN NE) 0.083% ON (15307) IPRATROPIUM NEB SOLN (ATROVENT NED SOLN) INHAL ON (16081) IPRATROPIUM HFA INHALER (ATROVENT HFA INHALER) 17 MCG PO-BULK (17841) VENTOLIN HFA INH (ALBUTEROL HFA INH) 90 MCG PO-BULK (17854) 3 EXPECTORANT
GUAIFENESIN (GUAIFENESIN) 200 MG PO (18015) 4 RESPIRATORY
SODIUM CHLORIDE NEB SOL (SODIUM CHLORIDE) 0.9% ON (17737) 26 TOPICAL
1 ANORECTAL PREPARATIONS
DIBUCAINE OINT (NUPERCAINAL) 1% TO (15725) HYDROCORTISONE ACET SU (ANUSOL-HC SUPP.) 25MG PR (15365) 2 ANTI-SEBORRHEICS
MG217 COAL TAR SHAMPOO (COAL TAR SHAMPOO) 3% TO (18017) 3 MISCELLANEOUS TOPICAL AGENTS
PRAMOXINE/CALAMINE LOTIO (CALDYPHEN) 1-8% LOTION TO (15497) SALICYCLIC ACID PLASTER (MEDIPLAST) 40% TO (16727) SELENIUM SUL (SELENIUM SULFIDE LOTION 2) 2.5% TO (16746) Drug List - By Category/Sub-Category - Formulary
26 TOPICAL
4 SCABICIDE/PEDICULOCIDES
PERMETHRIN CREAM (ELIMITE CREAM 60 GM) 5% TO (15807) 5 TOPICAL ANTI-INFECTIVES
SILVER SULFADIAZINE CREAM (SILVADENE CREAM-50 GM) 1% TO (16791) 6 TOPICAL/LOCAL ANESTHETICS
BUPIVACAINE (SENSORCAINE) 0.5% (5MG/ML) IV (17229) LIDO/EPI 30ML (LIDOCAINE INJ 2% W/ EPINE) 2% IV (16151) LIDOCAINE VISCOUS (LIDOCAINE HCL VISCOUS SOL) 2% VISC PO (16162) LIDOCAINE 1% LOCAL (XYLOCAINE 1% LOCAL) 10 MG/ML IV (17588) LIDOCAINE 2% LOCAL (XYLOCAINE 2% LOCAL) 20 MG/ML IV (17587) LIDOCAINE OINT (XYLOCAINE OINT) 5% TO (16158) LIDOCAINE W/EPI LOCAL (LIDOCAINE INJ 1% W/ EPINE) 1:100000 (1%) IM (16150) 7 VAGINAL ANTI-FUNGALS
CLOTRIMAZOLE VAGINAL CR (GYNE LOTRIMIN VAGINAL CR) 1% PV (15629) 27 TOPICAL STEROIDS
1 HIGH POTENCY TOPICAL STEROID
BETAMETHASONE CR -45GM (DIPROSONE CREAM-45GM) 0.05% TO (15447) BETAMETHASONE DIPROPION (DIPROSONE LOTION) 0.05% TO (18082) 2 MODERATE POTENCY TOPICAL STEROIDS
CLOBETASOL PROPION OINT (TEMOVATE OINT 45 GM) 0.05% TO (15611) TRIAMCINOLONE CREAM (KENALOG CREAM-30 GM) 0.1% TO (18078) TRIAMCINOLONE OINT (KENALOG OINT-80 GM) 0.1% TO (18080) 28 URINARY TRACT/BPH
1 BPH AGENTS
***MEN'S FACILITIES ONLY. WEAR GLOVES WHEN HANDLING; HAZARD TO WOMEN OF CHILDBEARINGAGE OR PREGNANT.
2 URINARY TRACT AGENTS
PHENAZOPYRIDINE (PYRIDIUM) 100MG PO (16530)

Source: http://www.correctionalhealthpartners.com/Content/pdf/cdoc_downloads/DOC_Drug_Formulary_3.19.12.pdf