Le métronidazole (Flagyl) reste la référence dans le traitement des infections anaérobies et des parasitoses comme la giardiase ou l’amibiase. Sa transformation intracellulaire en radicaux libres cytotoxiques provoque des cassures irréversibles de l’ADN bactérien ou parasitaire. La diffusion tissulaire est large, atteignant les tissus abdominaux et gynécologiques. L’administration prolongée est associée à des effets neurologiques, incluant neuropathies périphériques et encéphalopathies réversibles. L’association avec l’alcool déclenche une réaction de type antabuse. Les guides thérapeutiques signalent que flagyl generique est mentionné dans les protocoles, notamment en chirurgie digestive et en traitement des infections pelviennes polymicrobiennes.
Microsoft word - asc 2011 formulary v 1.doc
Fluconazole* (Diflucan) GENERIC DRUGS Itraconazole* (Sporanox)
Ascension Health endorses the use of FDA
Ketoconazole* (Nizoral) Nystatin* (Mycostatin)
encourages the prescribing and dispensing of
Terbinafine* (Lamisil)(QL)
these generic medications whenever medically
ANTI-MALARIALS ____________________________ Chloroquine* (Aralen) EXCLUDED DRUGS Hydroxycchloroquine* (Plaquenil) Mefloquine* (Lariam)
Ascension Health has excluded the following
Quinine* (Qualaquin)
drugs or drug classes from coverage under the
ANTI-TUBERCULOSIS AGENTS_________________
pharmacy benefit: cough & cold combinations,
Ethambutol* (Myambutol)
allergy ophthalmics (e.g. Patanol), H2 Blockers
Isoniazid* (Nydrazid) Pyrazinamide* (pyrazinamide)
antihistamines (e.g. Allegra, Clarinex),
Rifampin* (Rifadin)
meperidine (Demerol), propoxyphene (e.g.
OTHER ANTI-INFECTIVES _____________________
Darvocet), medical foods and drug/medical food combinations. Drugs (e.g. infused or vaccines)
Clindamycin* (Cleocin) ASCENSION Iodoquinol* (iodoquinol)
that must be given by a medical professional are
Metronidazole* (Flagyl) Trimethoprim* (Proloprim) PRIOR AUTHORIZATION / STEP THERAPY / QUANTITY LIMITS ANTI-VIRAL AGENTS
Select drugs require prior authorization (PA) of ORMULARY
benefits. Medication utilization must meet FDA approved indications as well as Ascension
Abacavir/Lamivudine/Zidovudine (Trizivir)
Acyclovir* (Zovirax) Step Therapy Protocols (ST): Step therapy
requires the use of one or more medications
before benefits for the use of another medication
Amantadine* (Symmetrel) (CONDENSED VERSION) Quantity Limits (QL): Ascension Health has
identified a number of select medications which
will be subject to quantity limits. A quantity limit
prescription medication Ascension Health will
JANUARY 2011
Efavirenz/Emtricitabine/Tenofovir (Atripla)
cover as a benefit within a defined period of time.
Quantity limits may be implemented on a per day
basis (e.g. 1 tablet per day), per prescription or
Enfuvirtide (Fuzeon)(SP) Please note: This is not a comprehensive list of SPECIALTY DRUGS Fanciclovir* (fanciclovir)
Ascension Health has specified certain specialty
drugs are to be filled only through the in-house
Ganciclovir* (Cytovene)
pharmacies or from Coram. These drugs are
noted in the list below with (SP).
approved generic is available, the generic
name is bolded and asterisked. ANTI-INFECTIVE AGENTS
Lopinavir/Ritonavir (Kaletra) Maraviroc (Selzentry)
ANTIBIOTICS ________________________________ Cephalosporins . Cefaclor* (Ceclor) Cefdinir* (Omnicef) Ribavirin* (Rebetol) Cefadroxil* (Duracef)
copayment. Example: Cefaclor* (Ceclor) Cefprozil* (Cefzil) means that the generic Cefaclor is Cefuroxime* (Ceftin) formulary and the brand is non-formulary Cefpodoxime* (Vantin) Cephalexin* (Keflex) Macrolides. Azithromycin* (Zithromax)(QL)
active ingredient is only available as a
Clarithromycin XL* (Biaxin XL) Erythromycin* (Eryc, PCE) AUTONOMIC AND Example: Clopidogrel (Plavix) means that Erythromycin/Sulfisoxazole* (Pediazole) CENTRAL NERVOUS SYSTEM AGENTS the brand, Plavix is covered and there is Penicillins . ANALGESICS, NARCOTIC _____________________ no generic available. Plavix is the brand Amoxicillin* (Amoxil) Acetaminophen/Codeine* (Tylenol w/codeine) Amoxicillin/Clavulanate* (Augmentin) Aspirin/Codeine* (Empirin w/codeine) Ampicillin* (Principen)
If the word 'generic' and the brand name
Fentanyl* (Duragesic)(QL) Dicloxacillin* (Pathocil)
both appear within the parenthesis, both
Fentanyl Citrate* (Actiq, Fentora)(PA/QL) Penicillin* (Veetids) Hydrocodone/Acetaminophen* (Lortab) (QL) Quinolones. Hydromorphone* (Dilaudid) Ciprofloxacin/XR* (Cipro/XR) Methadone* (Dolophine) Example: Phenytoin (Dilantin / generic)
Moxifloxacin (Avelox)(QL) Morphine Sulfate* (MS Contin)(QL) means that both the brand and generic Sulfonamides . Oxycodone/Acetaminophen* (Percocet) (QL) are available. Therefore, the brand Erythromycin/Sulfisoxazole* (Pediazole) Oxycodone/Aspirin* (Percodan) Dilantin and the generic phenytoin are on Sulfamethoxazole/Trimethoprim* (Bactrim) Oxycodone* (Oxycontin)(QL) Sulfisoxazole* (generic) Analgesics, Non-Narcotic . Tetracyclines . APAP/Isometheptene/Dichlphen* (Midrin) Doxycycline hyclate* (Vibramycin)
formulary listing shall be considered non-
Acetaminophen/Caffeine/Butalbital* (Fioricet) Minocycline* (Minocin, Dynacin) Aspirin/Caffeine/Butalbital* (Fiorinal) Tetracycline* (Sumycin) Ergotamine/Caffeine* (Cafergot) ANTIFUNGAL AGENTS (ORAL) _________________ Sumatriptan* (Imitrex)(QL) Clotrimazole* (Mycelex) Tramadol* (Ultram) ANALGESICS, NONSTEROIDAL Risperidone* (Risperdal) Nicardipine* (Cardene) ANTI-INFLAMMATORY ________________________ Thioridazine* (Mellaril) Nifedipine* (Procardia/Adalat CC) Diclofenac* (Voltaren) Thiothixene* (Navane) Verapamil* (Calan,Verelan) Etodolac* (etodolac) Trifluoperazine* (Stelazine) CENTRALLY ACTING ANTIHYPERTENSIVES______ Fenoprofen* (Nalfon) SEDATIVES, HYPNOTICS AND ANTI-ANXIETY_____ Clonidine* (Catapres) Flurbiprofen* (Ansaid) Alprazolam* (Xanax) Methyldopa* (generic) Ibuprofen* (Motrin) Buspirone* (BuSpar) DIURETICS __________________________________ Indomethacin* (Indocin) Chloral Hydrate* (Noctec) Acetazolamide* (Diamox Sequels) Ketoprofen* (ketoprofen) Chlordiazepoxide* (Librium) Chlorthalidone* (Hygroton) Ketorolac* (Toradol) Clorazepate* (generic) Ethacrynic Acid* (Edecrin) Meloxicam* (Mobic) Diazepam* (generic) Eplerenone* (Inspra) Nabumetone* (nabumetone) Flurazepam* (flurazepam) Furosemide* (Lasix) Naproxen* (Naprosyn) Lorazepam* (Ativan) HCTZ/Triamterene* (Maxzide) Oxaprozin* (Daypro) Meprobamate* (Miltown) Hydrochlorothiazide* (generic) Piroxicam* (Feldene) Oxazepam* (Serax) Indapamide* (generic) Sulindac* (Clinoril) Temazepam* (Restoril) Methazolamide* (generic) Tolmetin* (Tolectin) Triazolam* (Halcion) Metolazone* (Zaroxolyn) ANALGESICS, SALICYLATES __________________ Zolpidem* (Ambien) (QL) Spironolactone/HCTZ* (Aldactone) Aspirin* (generic) Torsemide* (Demadex) Chol Sal/Magnesium Salicylate* (generic) CARDIOVASCULAR AGENTS Triamterene* (Dyrenium) Diflunisal* (Dolobid) ANGIOTENSIN CONVERTING ENZYME VASODILATORS _____________________________ Salsalate* (Disalcid) INHIBITORS AND RECEPTOR BLOCKERS _______ Hydralazine* (Apresoline) ANTICONVULSANTS __________________________ Benazepril/HCTZ* (Lotensin) Isosorbide Dinitrate* (Isordil) Carbamazepine* (Tegretol XR/generic) Benazepril/Amlodipine* (Lotrel)(QL) Isosorbide Mononitrate* (Imdur, Monoket) Clonazepam* (Klonopin) Captopril/HCTZ* (Capoten/Capozide) Minoxidil* (generic) Divalproex Sodium* (Depakote Enalapril/HCTZ* (Vasotec/Vaseretic) Nitroglycerin* (generic) Fosinopril/HCTZ* (Monopril) DERMATOLOGICALS Ethosuximide* (Zarontin) Lisinopril/HCTZ* (Zestril/Zestoretic) Gabapentin* (Neurontin) Losartan/HCTZ* (Cozaar/Hyzaar) ACNE ______________________________________ Lamotrigine* (Lamictal) Moexipril/HCTZ* (Univasc/Uniretic) Clindamycin* (Cleocin) Levetiracetam* (Keppra)
Olmesartan (Benicar/ Benicar HCT)(ST)(QL) Erythromycin* (Emgel) Mephobarbital* (Mebaral) Quinapril/HCTZ* (Accupril/Accuretic) Isotretinoin* (Accutane) Phenobarbital* (generic) Ramipril* (Altace/generic) Metronidazole* (MetroLotion,MetroGel) Phenytoin* (Dilantin/generic) Trandolapril* (Mavik) Minocycline* (Minocin/Solodyne) Primidone* (Mysoline)
Valsartan/HCTZ (Diovan/Diovan HCT)(ST)(QL) Sodium Sulfacetamide* (Sulfacet-R) Oxcarbazepine* (Trileptal) ANTI-ADRENERGIC BLOCKERS ________________ Tretinoin* (Retin-A) (MAX AGE 34) Topiramate* (Topamax) ANTIBIOTICS/ANTIVIRALS _____________________ Valproic Acid* (Depakene) Doxazosin* (Cardura) Acyclovir* (Zovirax/generic) Zonisamide* (Zonegran) Prazosin* (Minipress) Metronidazole* (MetroGel,MetroLotion) ANTIPARKINSON AGENTS _____________________ Terazosin* (Hytrin) ANTIARRHYTHMICS __________________________ Mupirocin* (Bactroban) Amantadine* (Symmetrel) Sodium Sulfacetamide* (Sulfacet-R) Benztropine* (Cogentin) Amiodarone* (Cordarone) FUNGICIDES_________________________________ Bromocriptine* (Parlodel) Digoxin* (Lanoxin) Ciclopirox* (Loprox) Carbidopa/Levodopa* (Sinemet) Disopyramide* (Norpace) Clotrimazole/Betamethazone* (Lotrisone) Pramipexole* (Mirapex) Flecainide* (Tambocor) Ketoconazole* (Nizoral) Ropinirole* (Requip) Mexiletine* (Mexitil) Nystatin/Triamcinolone* (Mycolog II) Selegiline *(Eldepryl) Procainamide* (Pronestyl) Trihexyphenidyl* (Artane) Propafenone* (Rythmol) TOPICAL ANTI-INFLAMMATORY AGENTS ________ CEREBRAL STIMULANTS______________________ Quinidine Gluconate* (Quinidex) Low Potency . Sotalol* (Betapace AF) Amphet Asp/Amphet/D-Amphet* Desonide* (Desowen) ANTICOAGULANTS/ANTITHROMBOTICS _________
(Adderall/Adderall XR)(QL)(MIN AGE 3/6) Fluocinolone* (Synalar) Dexmethylphenidate* (Focalin) Anagrelide* (Agrylin) Hydrocortisone* (generic) Dextroamphetamine* (Dexedrine) Cilostazol* (Pletal) Medium Potency.
Clopidogrel (Plavix)(QL) Desoximetasone* (Topicort) Methylphenidate* (Ritalin) Dipyridamole* (Persantine) Fluocinolone* (Synalar) PSYCHOTHERAPEUTIC AGENTS _______________ Pentoxifylline* (Trental) Mometasone* (Elocon) Ticlopidine* (Ticlid) Antidepressants . Prednicarbate* (Dermatop E) Warfarin* (generic/Coumadin) Triamcinolone* (Aristocort) Amitriptyline* (Elavil) ANTILIPEMICS _______________________________ Bupropion/-XL* (Wellbutrin/XL)(QL) High Potency. Cholestyramine* (Questran) Citalopram* (Celexa) Betamethasone Dipropionate* (Diprosone) Colestipol* (Colestid) Desipramine* (Norpramin) Fluocinonide* (Lidex) Fenofibrate* (Lofibra) Doxepin* (Sinequan) Ultra-High Potency . Gemfibrozil* (Lopid) Fluoxetine* (Prozac) Lovastatin* (Mevacor) Augmented Betamethasone* (Diprolene) Fluvoxamine* (Luvox) Niacin* (Niaspan/generic) Clobetasol* (Temovate) Imipramine* (Tofranil) Pravastatin* (Pravachol) Diflorasone* (Psorcon) Mirtazapine* (Remeron) Simvastatin* (Zocor) VAGINAL/RECTAL PREPARATIONS _____________ Nortriptyline* (Norpramin) BETA-ADRENERGIC BLOCKERS________________ Hydrocortisone* (Proctocort) Paroxetine* (Paxil /CR) (QL) Mesalamine* (Rowasa) Sertraline* (Zoloft) Acebutolol* (Sectral)) Metronidazole* (MetroGel Vaginal) Trazodone* (trazodone) Atenolol/Chlorthalidone* (Tenoretic) Sulfanilamide* (AVC) Venlafaxine* (Effexor XR/generic)(QL) Bisoprolol/HCTZ* (Zebeta) MISCELLANEOUS DERMATOLOGICALS _________ Antimanic Agents . Carvedilol* (Coreg/CR) Labetalol* (Trandate) Calcipotriene* (Dovonex) Lithium Carbonate* (Eskalith) Metoprolol/XL/HCTZ* (Lopressor)(QL) Fluorouracil* (Efudex) Lithium Citrate* (Cibalith-S) Lindane* (Kwell) Antipsychotic Agents . Nadolol* (Corgard) Permethrin* (Elimite) Chlorpromazine* (Thorazine) Pindolol* (Viskin) Podofilox* (Condylox) Clomipramine* (Anafranil) Propranolol/XL/HCTZ* (Inderal) Selenium Sulfide* (Selsun RX) Clozapine* (Clozaril) Sotalol* (Betapace) Silver Sulfadiazine* (Silvadene) Fluphenazine* (Prolixin) Timolol* (Blocadren) ENDOCRINE AGENTS Haloperidol* (Haldol) CALCIUM CHANNEL BLOCKERS _______________ Loxapine* (Loxitane) Amlodipine* (Norvasc)(QL) ANTIDIABETIC AGENTS-INJECTABLE ___________ Perphenazine* (Trilafon) Diltiazem* (Cardizem) Prochlorperazine* (Compazine) Felodipine* (Plendil) ANTIDIABETIC AGENTS-ORAL _________________ Flutamide* (generic) Acarbose* (Precose) OPHTHALMICS NASAL MEDICATIONS ________________________ Chlorpropamide* (Diabinese) Fluticasone* (Flonase) Glimepiride* (Amaryl) ALPHA-AGONIST_____________________________ Flunisolide* (Nasarel)(QL) Glipizide* (Glucotrol) Brimonidine Tartrate* (Alphagan P/generic) Glipizide/Metformin* (Metaglip) ANTI-INFECTIVE AGENTS______________________ SKELETAL AGENTS Glyburide/Metformin* (Glucovance) Chloramphenicol* (generic) ANTIRHEUMATICS ___________________________ Glyburide/Micronized* (Glynase) Ciprofloxacin* (Ciloxin) Azathioprine* (Imuran) Metformin* (Glucophage) Erythromycin* (Romycin) Hydroxychloroquine* (Plaquenil) Tolazamide* (Tolinase) Gentamicin* (Garamycin) Methotrexate* (Rheumatrex) Tolbutamide* (Orinase) Neomycin/Bacitracin/Polymyxin* (NeoSporin) BONE ENHANCING AGENTS ___________________ ANTIDIABETIC SUPPLIES______________________ Ofloxacin* (Ocuflox) Alendronate* (Fosamax)(QL)
One Touch are the only test strips included on
Polymyxin B/Trimethoprim* (Polytrim) Calcitonin-Salmon* (Midrin)
formulary. Quantity limits apply. Sulfacetamide* (Bleph-10) Etidronate* (Didronel) ANTITHYROID _______________________________ Tobramycin* (Tobrex) Methimazole* (Tapazole) ANTI-INFLAMMATORY AGENTS ________________ SKELETAL MUSCLE RELAXANTS Propylthiouracil* (generic) Cromolyn* (Opticrom) THYROID____________________________________ Dexamethasone* (Maxidex) Baclofen* (Lioresal) Levothyroxine* (Synthroid, Levothroid, Levoxyl, Diclofenac* (Voltaren) Carisoprodol* (Soma) Fluorometholone* (Flarex) Diazepam* (Valium) Thyroid* (Armour Thyroid) Flurbiprofen* (Ocufen) Methocarbamol* (Robaxin) Prednisolone* (Inflamase Forte) Tizanidine* (Zanaflex) GASTROINTESTINAL AGENTS ANTI-INFECTIVE AND ANTIEMETIC/ANTIVERTIGO ___________________ ANTI-INFLAMMATORY COMBINATIONS __________ URINARY AGENTS Granisetron* (Kytril) Na Sulfacetm/Prednisolone* (Vasocidin) ANTI-INFECTIVES ____________________________ Meclizine* (Antivert) Neomy/Bacitracin/Polymyxin/Hydrocort* Sulfadiazine* (generic) Metoclopramide* (Reglan) Sulfisoxazole* (Gantrisin) Ondansetron* (Zofran) Neomycin/Dexamethasone* (NeoDecadron) Trimethoprim/Sulfamethoxazole* (Bactrim, Prochlorperazine* (Compazine) Neomycin/Polymyx B/Dexamethasone* Promethazine* (Phenergan) CHOLINERGIC AGENTS _______________________ Trimethobenzamide* (Tigan) ANTIVIRAL AGENTS __________________________ ANTISPASMODIC/GI MOTILITY _________________ Bethanechol* (Urecholine) Trifluridine* (Viroptic) Flavoxate* (Urispas) Belladonna/Phenobarbital* (Donnatal) BETA-BLOCKERS ____________________________ OTHER URINARY AGENTS_____________________ Clidinium/Chlordiazepoxide* (Librax) Betaxolol* (Betoptic) Dicyclomine* (Bentyl) Phenazopyridine* (Pyridium) Carteolol* (Ocupress) Hyoscyamine* (Levsin) Oxybutynin* (Ditropan) Levobunolol* (Betagan) Metoclopromide* (Reglan) Metipranolol* (OptiPranolol) Propantheline* (Pro-Banthine) Timolol* (Timoptic) VITAMINS AND ELECTROLYTES ANTIULCER _________________________________ MIOTICS ____________________________________ Misoprostol* (Cytotec) Pilocarpine* (Isopto Carbachol) OTHER GI PRODUCTS ________________________ GS REQUIRING STEP THERAPY UGS REQUIRING MYDRIATICS ________________________________ Balsalazide* (Colazal) Atropine* (Isopto Atropine) Hydrocortizone* (generic) Cyclopentolate* (Cyclogyl) STEPTHERAPY Lactulose* (Cephulac) Mesalamine* (Asacol/Asacol HD/generic) SYMPATHOMIMETICS_________________________ Dipivefrin* (generic) Sulfasalazine* (Azulfidine) Ursodiol* (Actigall) GLUCOCORTICOIDS ANTI-INFECTIVE AGENTS______________________ Dexamethasone* (Decadron) Acetic Acid* (Vosol) Fludrocortisone* (Florinef) Acetic Acid/Benzethonium* (generic) Methylprednisolone* (generic) Ofloxacin* (Floxin) Prednisolone* (Prelone) ANTI-INFECTIVE AND Prednisone* (generic) ANTI-INFLAMMATORY COMBINATIONS __________ Acetic acid/Hydrocortisone*(Vosol HC) GOUT THERAPY Neomycin/Polymxin/HC* (Cortisporin) Allopurinol* (Zyloprim) Colchicine* (generic) RESPIRATORY Colchicine/Probenecid* (generic) Indomethacin* (Indocin) ANTI-ASTHMATIC AGENTS ____________________ Probenecid* (generic) Corticosteroids. Beclomethasone (QVAR) HORMONES Budesonide* (Pulmicort) Budesonide/Formoterol (Symbicort) ANTIESTROGENS ____________________________ Tamoxifen* (Nolvadex)
Fluticasone/Salmeterol (Advair/Advair HFA)
ESTROGENS ________________________________ Sympathomimetics . Conjugated estrogens (Premarin) Estradiol* (Estrace) Metaproterenol* (Alupent) Estradiol Patch* (Climara) Estropipate* (Ogen) Terbutaline* (Brethine) ESTROGEN COMBINATIONS ___________________ Xanthine Derivatives. Estrogen, Ester/Methyltestosterone* Aminophylline* (generic) Theophylline* (Uniphyl) PROGESTINS ________________________________ OTHER AGENTS _____________________________ Medroxyprogesterone* (Provera) Megestrol* (Megace) Albuterol/Ipratropium* (DuoNeb) Norethindrone* (Aygestin) Cromolyn* (Intal) MISCELLANEOUS HORMONE PRODUCTS________ Finasteride* (Proscar)
Montelukast (Singulair)(QL) 2011 ASCENSION HEALTH PREFERRED FORMULARY BRANDS GENERICS: DRUG/DRUG CLASS EXCLUSIONS: QUANTITY LIMITS (QL):
Ascension Health has excluded the following drugs or drug Ascension Health has identified a number of select
classes from coverage under the pharmacy benefit: cough medications which will be subject to quantity limits. A
& cold combinations, allergy ophthalmics (e.g. Patanol), H2 quantity limit establishes the maximum amount of a
dispensing of these generic medications Blockers (e.g. Zantac, Tagamet), non-sedating
prescription medication Ascension Heatlh will cover
antihistamines (e.g. Allegra, Clarinex), meperidine
as a benefit within a defined period of time. Quantity
(Demerol), propoxyphene (e.g. Darvocet), medical foods
limits may be implemented on a per day basis (e.g. 1
and drug/medical food combination and drugs requiring
tablet per day), per prescription or per 30 days.
administration by a health care professional (e.g. infused or
PRIOR AUTHORIZATION: SPECIALTY DRUGS: STEP THERAPY PROTOCOLS (ST):
Select drugs require prior authorization Ascension Health has specified certain specialty drugs are Step therapy requires the use of one or more (PA) of benefits. Medication utilization
to be filled only through the in-house pharmacies or from
medications before benefits for the use of another
must meet FDA approved indications as Coram.
well as Ascension Health guidelines. For prior authorization guidelines, visit www.mp.medimpact.com/asc.
SINGULAIR (QL)
AVELOX (QL)
BENICAR / HCT (ST,QL)
DIOVAN / HCT (ST,QL)
ONE TOUCH TEST STRIPS (QL)
ONE TOUCH ULTRA TEST STRIPS (QL)
PLAVIX (QL)
EFFEXOR XR (QL)
FUZEON (SP) To search the formulary status of a drug, visit www.mp.medimpact.com/asc
Espectroscopia por resonancia magnética en enfermedad de Alzheimer: rol del mioinositol Espectroscopia por resonancia magnética en enfermedad de Alzheimer: rol del mioinositol ALBERTO GARCÍA-VILLALOBOS1, AUGUSTO MARTINEZ-CUEVA1, CARLOS MARTINOT-LUYO1,2,CARLOS MARTINOT-DEL POZO2,3, NILTON CUSTODIO-CAPUÑAY1. RESUMENSe presenta un estudio prospectivo no comparativo en una serie de 24 paci
Southwestern Oklahoma State University Department of Athletics Drug Education and Testing Program Introduction The Southwestern Oklahoma State University athletic administration and coaching staff expressly condemn the use of banned substances and the abuse of alcohol as their use may endanger the safety and health of the student-athlete. In an effort to address the problem of s