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N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
FORMULARY: ALPHABETICAL LISTING* *Most current Formulary List of Drugs can be found:
1. DUH intranet [click on DRH (Duke Regional Hospital), Departments and Services, Pharmacy, then Lincoln Community Health Center Formulary] https://intranet.dm.duke.edu/hospitals/drh/pharmacy/Document%20Library/LCHC%20Formulary.pdf
2. LCHC website (http://www.lincolnchc.org/secondary/drug-formulary.html) 3. PADC website (http://www.projectaccessdurham.org/), then click on the Lincoln Pharmacy formulary. 4. LCHC Intranet/ Pharmacy Department/ Formulary of Drugs. Use Ctrl-F to quickly search the listing for a specific item.
Rx Pathways Plan Pfizer drugs are available to uninsured patients who are at or below 400% of the federal poverty
level. Only a dispensing fee is charged. NOTE: These medications are labeled as “RxP”.
Patient Assistance Program Patients who meet specific eligibility requirements may receive formulary medications through manufacturer-sponsored patient assistance programs (PAPs). Medications labeled as “PAP” are available to eligible patients through manufacturer-sponsored PAPs. These medications may not be readily available and may require up to an 8-week processing period.
HIV Patient Assistance Program EI Clinic may access medications through for qualified patients. For patients that do not qualify for
ADAP, HIV medications may be obtained from manufacturer programs. http://epi.publichealth.nc.gov/cd/hiv/docs/ADAPProgrammanual.pdf
Project Access Durham County Project Access Durham County (PADC) serves eligible low-income, uninsured Durham residents
who have specialty medical care needs. PADC enrolls members based on referrals from a primary care provider at Lincoln Community Health Center (LCHC). PADC patients are eligible for LCHC formulary medications.
Lab Monitoring Some formulary drugs require laboratory monitoring and are labeled as “LAB” (See Section VII.4.
Drugs Requiring Lab Monitoring pg 80) Safety in Lactation Lactation safety data from American Academy of Pediatrics (www.aap.org)
Medicaid Preferred Drug List http://www.ncdhhs.gov/dma/pharmacy/PDL.pdf
Medicaid Prior Authorizations https://www.nctracks.nc.gov/content/public/providers.html
Hazardous Drugs Drugs identified by National Institute of Occupational Safety and Health as hazardous are labeled as “HD”. Use caution when handling. (http://www.cdc.gov/niosh/docs/2014-138/pdfs/2014-138.pdf)
7
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Acetaminophen/Codeine Tab 300mg/30mg
Tylenol With Codeine #3
ANALGESICS AND ANTIPYRETICS
Opioid C - + L
Acetaminophen Suspension 160mg/5mL
Tylenol Susp ANALGESICS AND ANTIPYRETICS
Miscellaneous 120 mL B + L
Acetaminophen Tablet 325mg
Tylenol ANALGESICS AND ANTIPYRETICS
Miscellaneous #100 tabs B + + L
Acetazolamide Tablet 500mg ER 12 hr
Diamox Sequels
CARDIOVASCULAR DRUGS
Carbonic Anhydrase Inhibitor
C - + K/L
Acyclovir Capsule 200mg Zovirax ANTI-INFECTIVES Diuretic B + - K/L
Acyclovir Suspension 200mg/5mL
Zovirax ANTI-INFECTIVES Antiviral B + K/L
Adalimumab Injection 40mg Patient Assistance Program, LAB
Humira RHEUMATOLOGY Tumor Necrosis Factor Blocking Agent
90 day supply PAP
B - - ?
Albendazole Tablet 200mg
Albenza ANTI-INFECTIVES Antihelmintic C ? + K
Albuterol MDI Proventil, Ventolin, ProAir
RESPIRATORY AGENTS
Bronchodilator, Beta2-Adrenergic Agonist
6.7 gm C ?
Albuterol Nebulizer Solution 0.083%
Proventil, Ventolin
RESPIRATORY AGENTS
Bronchodilator, Beta2-Adrenergic Agonist
#25 C ?
Alendronate Tablet 4mg Fosamax ENDOCRINE AND METABOLIC AGENTS
Biphosphonates, Osteoporosis
#4 tabs C - - K
Allopurinol Tablet 100mg, 300 mg
Zyloprim ENDOCRINE AND METABOLIC AGENTS
Gout, Xanthine Oxidase Inhibitors
C + + K
8
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Amiodarone Tablet 200mg LAB
Cordarone CARDIOVASCULAR DRUGS
Antiarrhythmic D - + + L
Amitriptyline Tablet 25mg, 50 mg
Elavil ANTIDEPPRESSANT AGENTS
Tricyclic D - + +
Amlodipine Tablets 5mg, 10mg
Norvasc CARDIOVASCULAR DRUGS
Calcium Channel Blocker
C ? + L
Amoxicillin Capsule 250mg
Amoxil ANTI-INFECTIVES Penicillin B + - K
Amoxicillin Suspension 250mg/5mL
Amoxil ANTI-INFECTIVES Penicillin B + K
Amoxicillin/Clavulanic Acid Tablets 875mg/125mg
Augmentin ANTI-INFECTIVES Penicillin B ? + K/L
Anastrozole Tablet 1mg Patient Assistance Program, LAB, HD
Arimidex ANTINEOPLASTIC AGENTS
Aromatase Inhibitor 90 day supply PAP
X -
Apixaban Tablets 2.5mg, 5 mg Patient Assistance Program
Eliquis CARDIOVASCULAR Direct Oral Anticoagulant
90 day supply PAP
B - + K
Artificial Tear Drops Artificial Tears
EYE, EAR, NOSE, AND THROAT
Lubricant 15 mL + +
Artificial Tear Ointment Duratears EYE, EAR, NOSE, AND THROAT
Lubricant 3.5 gm + +
Aspirin Tablet 81mg, 325 mg (enteric coated)
Ecotin CARDIOVASCULAR DRUGS
Salicylate #100 tablets
D ? - K/L
9
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Atenolol Tablet 50mg, 100mg
Tenormin CARDIOVASCULAR DRUGS
Beta Blocker D - - K
Atorvastatin Tablet 10mg, 20mg, 40mg, 80mg LAB
Lipitor CARDIOVASCULAR DRUGS
Antihyperlipidemic, HMG-CoA Reductase Inhibitor
X - + L
Atropine Ophth Soln 1% Atropine EYE, EAR, NOSE, AND THROAT
Mydriatic 15 mL C +
Azithromycin Suspension 200mg/5mL
Zithromax ANTI-INFECTIVES Macrolide B ? K/L
Azithromycin Tablet 250mg
Zithromax ANTI-INFECTIVES Macrolide B ? + K/L
Bacitracin Ointment 500 units/gm
SKIN AND MUCOUS MEMBRANE AGENTS
Antibiotic, Topical 15 gm B ?
Baclofen Tablet 10mg Lioresal SKELETAL MUSCLE RELAXANT
Skeletal Muscle Relaxant
C + + K
Beclomethasone 40mcg, 80 mcg MDI
QVAR RESPIRATORY AGENTS
Corticosteroids, Inhalant
8.7 gm C ?
Benzonatate Capsule 100mg
Tessalon Perles
RESPIRATORY AGENTS
Antitussive #20 caps C ? -
Benzoyl Peroxide Gel 5% Panoxyl SKIN AND MUCOUS MEMBRANE AGENTS
Acne 42.5 gm C ?
Bisacodyl Tablet 5mg Dulcolax GASTROINTESTINAL DRUGS
Laxative, Diphenylmethane
C ? - K
Bismuth Subsalicylate Tablet 262mg
Pepto-Bismol GASTROINTESTINAL DRUGS
Antidiarrheal #30 tabs D ? +
Brimonidine 0.2% ophth drops
Alphagan EYE, EAR, NOSE, AND THROAT
Antiglaucoma, Alpha2 Agonist
10 mL B ?
10
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Buprenorphine/Naloxone SL Tablet 2mg/ 0.5mg, 8mg/ 2mg
Zubsolv ANALGESICS AND ANTIPYRETICS
Opioid C ? + K/L
Bupropion Tablet 100mg Wellbutrin ANTIDEPPRESSANT AGENTS
Dopamine Reuptake Inhibitor
C - + + seizures/ epilepsy1
K/L
Buspirone Tablet 15mg Buspar ANXIOLYTICS, SEDATIVES, HYPNOTICS
Antianxiety Agent B - + K/L
Butalbital, Acetaminophen and Caffeine Tablet 50mg/325mg/40mg
Note: Fioricet changed strength April 2014 and no longer has a generic
MIGRAINE AGENTS Migraine Combinations
C - + + K/L
Calcitriol Capsule 0.5mcg Rocaltrol NEPHROLOGY Vitamin D Analog C ? -
Calcium (elemental) Tablet 500mg
Calcium NUTRIENTS AND NUTRITIONAL AGENTS
Calcium Supplement #60 tabs per bottle
+ (? 1st trimester)
? + K
Calcium Acetate Capsule 667mg
PhosLo NEPHROLOGY Calcium, Phosphate Binder
C ? -
Capsaicin 0.025% Cream Capzasin ANALGESICS AND ANTIPYRETICS
Transient Receptor Potential Vanilloid 1 (TRPV1) Agonist
60 gm B +
Carbamazepine Tablet 200mg LAB, HD
Tegretol ANTICONVULSANT AGENTS
Miscellaneous D + + K/L
Carbamide Peroxide Otic Drops 6.5%
Debrox EYE, EAR, NOSE, AND THROAT
Cerumenolytic 15 mL ? ?
1 Bupropion may lower seizure threshold
11
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Carbidopa/Levodopa Tablet 25mg/100mg
Sinemet ANTIPARKINSON AGENTS
Dopamine Agonist C - + K/L
Carvedilol Tablet 3.125mg, 12.5mg, 25mg
Coreg CARDIOVASCULAR DRUGS
Beta Blocker w/ alpha blocking activity
C ? + L
Cefdinir Suspension 250mg/5mL
Omnicef ANTI-INFECTIVES Cephalosporin, 3rd gen
B ? K
Cefuroxime Tablet 250 mg Ceftin ANTI-INFECTIVES Cephalosporin, 2nd gen
Celecoxib Capsule 200mg RxP
Celebrex ANALGESICS AND ANTIPYRETICS
NSAID, COX-2 Inhibitor
C (D in 3rd trimester)
? - + HF2 K/L
Cephalexin Capsule 250mg
Keflex ANTI-INFECTIVES Cephalosporin B ? - K
Cephalexin Suspension 250mg/5ml
Keflex ANTI-INFECTIVES Cephalosporin B ? K
Cetirizine Solution 1mg/mL
Zyrtec RESPIRATORY AGENTS
Antihistamine 120 mL B - K
Cetirizine Tablet 10mg Zyrtec RESPIRATORY AGENTS
Antihistamine #30 tablets B - + K
Chlorhexidine Oral Rinse 0.12%
Peridex EYE, EAR, NOSE, AND THROAT
Anti-infective 480 mL B ?
Ciprofloxacin Ophth Soln 0.3%
Cipro ANTI-INFECTIVES Quinolone 5 mL bottle C (not likely
teratogen)
?
Ciprofloxacin Tablets 500mg
Cipro ANTI-INFECTIVES Quinolone C (not likely
teratogen)
? + K/L
2 Celecoxib may promote fluid retention in elderly and worsen heart failure
12
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Clarithromycin Tablet 500mg
Biaxin ANTI-INFECTIVES Macrolide C ? + K
Clindamycin Capsule 150mg
Cleocin ANTI-INFECTIVES Miscellaneous B ? + K
Clindamycin Solution 75mg/5mL
Cleocin ANTI-INFECTIVES Miscellaneous 100 mL B ? K
Clindamycin Topical Solution 1%
Cleocin-T ANTI-INFECTIVES Miscellaneous 60 mL B ?
Clobetasol Ointment 0.05%
Temovate SKIN AND MUCOUS MEMBRANE AGENTS
Corticosteroid 15 gm C ?
Clobetasol Solution 0.05%
Temovate SKIN AND MUCOUS MEMBRANE AGENTS
Corticosteroid 50mL C ?
Clonidine Tablet 0.1mg, 0.2mg, 0.3mg
Catapres CARDIOVASCULAR DRUGS
Alpha2 Adrenergic Agonist
C ? + + K
Clopidogrel Tablet 75mg Plavix CARDIOVASCULAR DRUGS
Antiplatelet B ? + L
Colchicine Tablet 0.6mgHD
Colcrys ENDOCRINE AND METABOLIC AGENTS
Gout C ? + K/L
Cyanocobalamin Tablets 500mcg
Vitamin B12 NUTRIENTS AND NUTRITIONAL AGENTS
Vitamin #130 tabs C + +
Cyclobenzaprine Tablets 5mg
Flexeril SKELETAL MUSCLE RELAXANT
Centrally Acting B ? + + L
Dextroamphetamine /Amphetamine Tabs 10mg
Adderall STIMULANT ADHD, Narcolepsy C - + +3 K
3 May worsen insomnia
13
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Diazepam Tablets 5mg Valium ANXIOLYTICS, SEDATIVES, HYPNOTICS
Benzodiazepine D - + + L
Dicyclomine Capsules 10mg
Bentyl GASTROINTESTINAL DRUGS
Anticholinergic B - - +
Digoxin Tablets 0.125mg, 0.25mg LAB
Lanoxin CARDIOVASCULAR DRUGS
Antiarrhythmic C + + + K
Diltiazem HCl XR 180mg, 240mg Capsule
Cardizem CD CARDIOVASCULAR DRUGS
Calcium Channel Blocker
C + - +4
Diphenhydramine Capsule 25mg, 50mg
Benadryl ANTIDOTE Antihistamine B - - +
Diphenhydramine Elixer 12.5ml/5mL
Benadryl ANTIDOTE Antihistamine B - +
Diphenoxylate/Atropine Sulf Tablets 2.5/0.025mg
Lomotil; Lonox
GASTROINTESTINAL DRUGS
Antidiarrheal C - - K/L
Disulfiram Tablet 250mg Antabuse ANTIDOTE Aldehyde Dehydrogenase Inhibitor
C ? +
Divalproex Sodium Tablet 250mg LAB, HD
Depakote ANTICONVULSANT AGENTS
Miscellaneous X ? - L
Docusate Sodium Capsule 100mg
Colace GASTROINTESTINAL DRUGS
Stool Softener #100 caps C ? - (taste)
Donepezil Tablet 10mg Aricept ALZHEIMER DISEASE Acetylcholinesterase Inhibitor (Central)
C ? +
Dorzolamide 2% Trusopt EYE, EAR, NOSE, AND THROAT
Antiglaucoma, Carbonic Anhydrase Inhibitor
10 mL C -
4 Diltiazem may promote fluid retention in elderly and worsen heart failure
14
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Doxazosin Tablet 2mg, 8mg
Cardura CARDIOVASCULAR DRUGS
Alpha1 Blocker C ? + + L
Doxepin Capsule 25mg, 50mg
Sinequan ANTIDEPPRESSANT AGENTS
Tricyclic C - - +
Doxycycline Tablet 100mg Vibramycin ANTI-INFECTIVES Tetracycline D ? +
Duloxetine Capsule 20mg, 30mg, 60mg Patient Assistance Program
Cymbalta ANTIDEPPRESSANT AGENTS
Serotonin/ Norepinephrine Reuptake Inhibitor
120 day supply PAP
C ? - (Mix w/ apple-sauce, NOT choc-olate)
K/L
Electrolyte Solution Pedialyte/ Infalyte
ELECTROLYTE SUPPLEMENT
Treatment of Dehydration
1,000 mL ? ?
Eletriptan Tablet 40mg RxP
Relpax MIGRAINE AGENTS Serotonin 5-HT1 Receptor Agonist
6 tabs per box
C ? + L
Empagliflozin Tablet 10mg, 25mg Patient Assistance Program
Jardiance ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, SGLT-2 Inhibitor
90 day supply PAP
C - + K
Enoxaparin SQ Injection 30mg, 40mg, 60mg, 80mg, 100mg, 120mg, 150mg Patient Assistance Program, LAB
Lovenox CARDIOVASCULAR DRUGS
Anticoagulant B + K
Epinephrine IM Injection 0.15mg/0.15mL, 0.3mg/0.3mL
EpiPen ANTIDOTE Alpha/Beta Adrenergic Agonist
2 Auto-Injectors
C -
Erythromycin 5mg/gm Ilotycin EYE, EAR, NOSE, AND THROAT
Anti-infective 3.5 gm B +
15
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Estrogens, conjugated Cream 0.625mg/gmHD
Premarin SKIN AND MUCOUS MEMBRANE AGENTS
Estrogen 30 gm X - +
Estrogens, conjugated Tablet 0.625mg HD
Premarin ENDOCRINE AND METABOLIC AGENTS
Estrogen X - + +
Ezetimibe tablet 10mg Patient Assistance Program
Zetia CARDIOVASCULAR DRUGS
Antihyperlipidemic, 2-Azetidinone
90 day supply PAP
C ? + L
Ferrous Sulfate Drops 75mg/mL (15mg/mL elemental)
ANTIANEMIA AGENTS
Iron Preparations 50mL + +
Ferrous Sulfate Elixer 220mg/5mL (44mg/5mL elemental)
ANTIANEMIA AGENTS
Iron Preparations 480mL + +
Ferrous Sulfate Tablet 325mg (65mg elemental)
ANTIANEMIA AGENTS
Iron Preparations #100 tabs + + +
Finasteride Tablet 5mgHD Proscar ENDOCRINE AND METABOLIC AGENTS
Androgen Hormone Inhibitor, 5 Alpha-Reductase Inhibitor
X - - (HD)
L
Fluconazole Tablet 200mg Diflucan ANTI-INFECTIVES Antifungal C (single dose vag candida),
D all other indications
+ + K
Fluocinonide Cream 0.05%
Lidex SKIN AND MUCOUS MEMBRANE AGENTS
Corticosteroid 30 gm C -
Fluoxetine Capsule 20mg Prozac ANTIDEPPRESSANT AGENTS
Selective Serotonin Reuptake Inhibitor
C (- in 3rd trimester)
- - +5 L
5 SSRIs may increase risk of falls
16
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Fluticasone Propionate MDI 44mcg, 110mcg, 220mcg/puff
Flovent RESPIRATORY AGENTS
Corticosteroids, Inhalant
C ?
Fluticasone Propionate Nasal Spray 50mcg/spray
Flonase EYE, EAR, NOSE, AND THROAT
Corticosteroid 16 gm C ?
Fluticasone Propionate/Salmeterol Diskus 100/50, 250/50, 500/50
Advair Diskus RESPIRATORY AGENTS
Beta2 Adrenergic Agonist/ Corticosteroid, Inhalant
C ?
Folic Acid Tablet 1mg NUTRIENTS AND NUTRITIONAL AGENTS
Vitamin A + +
Furosemide Tablet 40mg Lasix CARDIOVASCULAR DRUGS
Diuretic, Loop C ? + K/L
Gabapentin Capsule 100mg, 300mg
Neurontin ANALGESICS AND ANTIPYRETICS
Anticonvulsant, Neuropathic pain (unlabeled)
C ? - K
Gemfibrozil Tablet 600mg Lopid CARDIOVASCULAR DRUGS
Antihyperlipidemic, Fibric Acid
C ? + K
Glipizide ER Tablet 5mg, 10mg
Glucotrol XL ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Sulfonylurea
C ? - L
Glycerin 1 gm suppository Pedia-Lax Rectal
GASTROINTESTINAL DRUGS
Laxative, Osmotic A + +
Glycerin 1 gm suppository Sani-Supp Adult Rectal
GASTROINTESTINAL DRUGS
Laxative, Osmotic A + +
Griseofulvin Susp 125mg/5mL
Grifulvin ANTI-INFECTIVES Antifungal C ?
Guaifenesin Tablet 200mg Humibid RESPIRATORY Expectorant #100 tabs C + +
17
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
AGENTS
Haloperidol Tablet 1mg, 2mg
Haldol ANTIPSYCHOTIC AGENTS
Typical, D2 Antagonist
C - + +
Hydralazine Tablet 25mg, 50mg
Apresoline CARDIOVASCULAR DRUGS
Vasodilator C + + K
Hydrochlorothiazide Tablet 25mg, 50mg
Hydrodiuril CARDIOVASCULAR DRUGS
Diuretic, Thiazide B (D is used in
pregnancy-induced
HTN)
+ + K
Hydrocodone and Acetaminophen Tab 5mg/325mg
Norco ANALGESICS AND ANTIPYRETICS
Opioid C ? + L
Hydrocortisone Cream 1%, 2.5 %
SKIN AND MUCOUS MEMBRANE AGENTS
Corticosteroid 30gm (1%) 20gm (2.5%)
C ?
Hydrocortisone Ointment 1%
SKIN AND MUCOUS MEMBRANE AGENTS
Corticosteroid 30 gm
Hydrocortisone Suppository 25mg
Anusol-HC SKIN AND MUCOUS MEMBRANE AGENTS
Corticosteroid #12 per box C ?
Hydroxychloroquine Tablet 200mg
Plaquenil ANTI-INFECTIVES Antimalarial C + + K/L
Hydroxyzine HCL Syrup 10mg/5mL
Atarax ANXIOLYTICS, SEDATIVES, HYPNOTICS
Antihistamine C - + K/L
Hydroxyzine HCL Tablet 25mg, 50mg
Atarax ANXIOLYTICS, SEDATIVES, HYPNOTICS
Antihistamine C - + + K/L
18
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Ibuprofen Suspension 100mg/5mL
Motrin ANALGESICS AND ANTIPYRETICS
NSAID B (D in 3rd trimester)
+ + K
Ibuprofen Tablet 400mg Motrin ANALGESICS AND ANTIPYRETICS
NSAID B (D in 3rd trimester)
+ + (taste)
+ K
Imipramine Tablet 10mg, 25mg
Tofranil ANTIDEPPRESSANT AGENTS
Tricyclic D - + +
Imiquimod Cream 5% Aldara SKIN AND MUCOUS MEMBRANE AGENTS
#12 single-use packets
C ?
Indomethacin Capsule 25mg, 50mg
Indocin ANALGESICS AND ANTIPYRETICS
NSAID B (D in 3rd trimester)
+ - + K
Insulin Aspart 100units/mL, Rapid-Acting
NovoLog ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Insulin B/C + + Sliding Scale
Insulin Lispro 100units/mL, Rapid-Acting
Humalog ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Insulin Insured only B/C + + Sliding Scale
Insulin Regular 100units/mL, Short-Acting
Novolin Regular
ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Insulin B/C + + Sliding Scale
Insulin Aspart Protamine/ Insulin Aspart, Combination
NovoLog Mix 70/30
ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Insulin B/C +
Insulin Lispro Protamine/ Insulin Lispro 100units/mL, Combination
Humalog Mix 75/25
ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Insulin Insured only B/C +
Insulin NPH and Insulin Regular 100units/mL, Combination
Novolin 70/30 ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Insulin B/C +
Insulin NPH 100units/mL, Intermediate-Acting
Novolin NPH ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Insulin B/C +
19
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Insulin Detemir 100units/mL, Long-Acting
Levemir ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Insulin B/C +
Insulin Glargine 100units/mL Patient Assistance Program, Long-Acting
Lantus ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Insulin 90 day supply PAP
B/C +
Insulin Glulisine 100units/mL Patient Assistance Program, Rapid-Acting
Apidra ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Insulin 90 day supply PAP
B/C + + Sliding Scale
Ipratropium Bromide MDI 17mcg/actuation Patient Assistance Program
Atrovent RESPIRATORY AGENTS
Bronchodilator, Anticholinergic
MDI: 90 day supply PAP
B ?
Ipratropium Bromide Nebulizer Soln 0.02%
Atrovent RESPIRATORY AGENTS
Bronchodilator, Anticholinergic
25 vials per box
B ?
Isosorbide Dinitrate Tablet 10mg, 20mg, 40mg
Isordil CARDIOVASCULAR DRUGS
Vasodilator C ? +
Ketoconazole 2% Shampoo
Nizoral SKIN AND MUCOUS MEMBRANE AGENTS
Antifungal 120 mL C ?
Ketorolac 0.5% Ophth Soln
Acular EYE, EAR, NOSE, AND THROAT
Corticosteroid 5 mL C ?
Ketotifen 0.025% Ophth Soln
Zaditor EYE, EAR, NOSE, AND THROAT
Antihistamine, Mast Cell Stabilizer
5 mL C ?
Lactulose Syrup 10gm/15mL
Duphalac Syrup
GASTROINTESTINAL DRUGS
Constipation, Chronic
B ?
Lamotrigine Tablet 25mg, 100mg (50mg, 200mg PAP)
Lamictal ANTICONVULSANT AGENTS
Miscellaneous C - + L
20
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Latanoprost Ophth Sol 0.005%
Xalatan EYE, EAR, NOSE, AND THROAT
Antiglaucoma, Prostaglandin Inhibitor
2.5 mL C ?
Ledaspasvir/sofosbuvir Tablet 90 mg/ 400mg Patient Assistance Program
Harvoni ANTI-INFECTIVES Antihepaciviral, NS5A Inhibitor; Antihepaciviral, Polymerase Inhibitor
90 day supply PAP
B ? - (taste)
L
Leuprolide IM Injection 11.25mg, 22mg, 30mg Patient Assistance Program, LAB, HD
Lupron ENDOCRINE AND METABOLIC AGENTS
Gonadotropin Releasing Hormone Agonist
90 day supply PAP
X -
Levofloxacin Tablet 500mg
Levaquin ANTI-INFECTIVES Anti-Infective C ? + K
Levonorgestrel Plan B One-Step
ENDOCRINE AND METABOLIC AGENTS
Postcoital contraception
X + +
Levothyroxine 0.088mg, 0.1mg, 0.112mg, 0.125mg, 0.15mg, 0.175mg, 0.2mg Tablet LAB
Levoxyl ENDOCRINE AND METABOLIC AGENTS
Thyroid A + +
Lidocaine (Viscous) Oral Solution 2%
Xylocaine EYE, EAR, NOSE, AND THROAT
Analgesic 100 mL B +
Liraglutide 18mg/3mL Pen Injector Patient Assistance Program
Victoza ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, GLP-1 Agonist
#4 month supply PAP
C -
Lisinopril Tablet 5mg, 10mg, 20mg, 40mg LAB
Zestril CARDIOVASCULAR DRUGS
ACE-Inhibitor D ? + K
Lisinopril/HCTZ Tablet 20/12.5mg, 20/25mg LAB
Zestoretic CARDIOVASCULAR DRUGS
ACE-Inhibitor/ Diuretic, Thiazide
D ? + K
21
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Lithium Carbonate Capsule 300mg LAB
Eskalith ANTIPSYCHOTIC AGENTS
Bipolar Disorder D - - + K
Loperamide Tablet 2mg Imodium GASTROINTESTINAL DRUGS
Antidiarrheal #12 tabs C + +
Loratadine Tablet 10mg Claritin RESPIRATORY AGENTS
Antihistamine #30 tabs B + + K
Losartan Tablet 25mg, 50mg, 100mg
Cozaar CARDIOVASCULAR DRUGS
Angiotensin Receptor Blocker
D ? + L
Lubiprostone Capsule 24mcg Patient Assistance Program
Amitiza GASTROINTESTINAL DRUGS
Constipation, IBS 90 day supply PAP
C ? - L
Lurasidone Tablet 20mg, 40mg, 60mg, 80mg, 120mg Patient Assistance Program
Latuda ANTIPSYCHOTIC AGENTS
Atypical, mixed serotonin-dopamine antagonist
90 day supply PAP
B ? + + K/L
Magnesium Oxide Tablet 400mg (240mg elemental)
MagOx NUTRIENTS AND NUTRITIONAL AGENTS
Hypomagnesemia #120 A + + L
Magnesium/Aluminum/ Simethicone Suspension
Maalox Max Strength
GASTROINTESTINAL DRUGS
Antacid 480 mL C ? K
Meclizine Tablet 12.5mg Antivert ANTIEMETIC/ANTI-VERTIGO AGENTS
Anticholinergic, Antihistamine
B ? + +
Medroxyprogesterone Acetate Tablet 10mgHD
Provera ENDOCRINE AND METABOLIC AGENTS
Contraceptive Hormone, Progestin
X + + L
Megestrol Acetate Susp 40mg/mLHD
Megace ENDOCRINE AND METABOLIC AGENTS
Progestin D ? + K
Melatonin Tablet 3mg ANXIOLYTICS, SEDATIVES, HYPNOTICS
Neurohormone, indole
#120 - -
22
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Memantine extended release tablet 7mg, 14mg, 21mg, 28mg Patient Assistance Program
Namenda XR ALZHEIMER DISEASE N-Methyl-D-Aspartate Receptor Antagonist
90 day supply PAP
B ? - K
Metformin Tablet 1000mg LAB
Glucophage ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Biguanide
B ? + K/L
Methimazole Tablet 10mg Tapazole ENDOCRINE AND METABOLIC AGENTS
Thyroid D + +
Methocarbamol Tablet 500mg
Robaxin SKELETAL MUSCLE RELAXANT
Centrally Acting C ? + + L
Methotrexate Tablet 2.5mg LAB, HD
Rheumatrex RHEUMATOLOGY Disease Modifying Antirheumatic Drug (DMARD)
X - + K/L
Methyldopa Tablet 250mg
Aldomet CARDIOVASCULAR DRUGS
Alpha Adrenergic Inhibitor, Alpha2 Adrenergic Agonist
B + + + K/L
Methylphenidate HCl Tablet 5mg
Ritalin STIMULANT ADHD, Narcolepsy C ? + +6
Metoclopramide Tablet 10mg
Reglan GASTROINTESTINAL DRUGS
Prokinetic B ? + + K
Metoprolol Tartrate Tablet 25mg, 50mg
Lopressor CARDIOVASCULAR DRUGS
Beta Blocker C ? + L
Metronidazole Gel 0.05% (Topical)
Metrogel SKIN AND MUCOUS MEMBRANE AGENTS
Miscellaneous 45 gm B ?
6 May worsen insomnia
23
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Metronidazole Tablet 500mg
Flagyl ANTI-INFECTIVES Miscellaneous B ? + K/L
Miconazole Cream 2% Micatin SKIN AND MUCOUS MEMBRANE AGENTS
Antifungal 30 gm + ?
Mirtazapine Tablet 30mg Remeron ANTIDEPPRESSANT AGENTS
Alpha2 Antagonist C ? + K/L
Moisturizing Cream Eucerin SKIN AND MUCOUS MEMBRANE AGENTS
Moisturizing 120 gm + +
Montelukast Chewable Tablet 4mg, 5mg
Singulair RESPIRATORY AGENTS
Leukotriene Inhibitor
B ? + L
Montelukast Tablet 10mg Singulair RESPIRATORY AGENTS
Leukotriene Inhibitor
B ? + L
Multivitamin Drops with Iron
Poly-vi-sol NUTRIENTS AND NUTRITIONAL AGENTS
Vitamin 50 mL + +
Multivitamin Tablet, Adult
Centrum NUTRIENTS AND NUTRITIONAL AGENTS
Vitamin #100 tabs + + +
Multivitamin tablet, Children
Flinstones NUTRIENTS AND NUTRITIONAL AGENTS
Vitamin #100 tabs + + +
Mupirocin 2% Ointment Bactroban SKIN AND MUCOUS MEMBRANE AGENTS
Antibiotic, Topical 22 gm B ?
Naloxone 4mg/ 0.1mL Nasal Spray
Narcan ANTIDOTE Opioid antagonist 2 devices C ?
Naltrexone Tablets 50mg ReVia; Vivitrol
ANTIDOTE Opioid antagonist C ?
Naphazoline/Pheniramine Ophth Soln 0.025%/0.3%
Vasocon-A EYE, EAR, NOSE, AND THROAT
Vasoconstrictor/ Antihistamine
15 mL C ?
24
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Naproxen Sodium Tablet 500mg
Naprosyn ANALGESICS AND ANTIPYRETICS
NSAID B (D in 3rd trimester)
+ + + K
Nasal Aspirator DEVICE + +
Nasal Irrigation Kit Neti Pot DEVICE + +
Neomycin/Polymyxin B /Hydrocortisone Otic Susp
Cortisporin Otic
EYE, EAR, NOSE, AND THROAT
Anti-infective, Corticosteroid
Otic 10mL ? ?
Nicotine Gum 2mg, 4mg Nicorette Gum
SMOKING CESSATION
Nicotine Product 110 pieces C - K/L
Nicotine Transdermal Patch 7mg, 14mg, 21mg
Nicoderm CQ SMOKING CESSATION
Nicotine Product #14 patches D - K/L
Nifedipine XL Tablet 30mg, 60mg, 90mg
Procardia XL CARDIOVASCULAR DRUGS
Calcium Channel Blocker
C - - L
Nitrofurantoin Capsule 100mg
Macrobid ANTI-INFECTIVES Urinary B +? + K/L
Nitroglycerin SL Tablet 0.4mg
Nitrostat CARDIOVASCULAR DRUGS
Vasodilator #100 tabs C ?
Nitroglycerin Transdermal Patch 0.2mg/hr, 0.4mg/hr, 0.6mg/hr
Transderm Nitro
CARDIOVASCULAR DRUGS
Vasodilator #30 patches C ? -
Norethindrone Tablet 0.35mgHD
Nor-Q-D ENDOCRINE AND METABOLIC AGENTS
Contraceptive Hormone, Progestin
#28 tabs X - (may start 6
wks after preg)
+ + L
Norethindrone/ E. Estradiol (triphasic) Tablet 0.5-0.75-1mg/0.035mgHD
Ortho-Novum 7/7/7
ENDOCRINE AND METABOLIC AGENTS
Contraceptive Hormone, Combination
#28 tabs X/D - + + L
25
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Norgestrol / E. Estradiol Tablet 0.3mg/0.03mg HD
Lo-Ovral ENDOCRINE AND METABOLIC AGENTS
Contraceptive Hormone, Combination
#28 tabs X - + + L
Nortriptyline Tablet 25mg Pamelor ANTIDEPPRESSANT AGENTS
Tricyclic D + + + K/L
Nystatin Cream 100,000 units/gm
Mycostatin ANTI-INFECTIVES Antifungal 15 gm C ?
Nystatin Suspension 100,000 units/mL
Nilstat ANTI-INFECTIVES Antifungal 60 mL bottle C ?
Omega-3 Fatty Acids (180 EPA / 120 DHA)
Fish Oil NUTRIENTS AND NUTRITIONAL AGENTS
Vitamins #100 caps C ? - L
Omeprazole Capsule 20mg
Prilosec GASTROINTESTINAL DRUGS
Proton Pump Inhibitor
C ? - + L
Ondansetron Tablet 4mg Zofran ANTIEMETIC/ANTI-VERTIGO AGENTS
5-HT3 Receptor Antagonist
B ? + L
Oxazepam Capsule 15mg Serax ANXIOLYTICS, SEDATIVES, HYPNOTICS
Benzodiazepine D - - +
Oxybutynin Chloride Tablet 5mg
Ditropan GENITOURINARY AGENTS
Antispasmodic, Urinary
B ? + +7 K/L
Oxymetazoline Nasal Spray 0.05%
Afrin RESPIRATORY AGENTS
Decongestant (topical)
15 mL C ?
7 Oxybutynin may worsen delirium in older adults
26
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Pancreatic Enzymes Capsule Lipase/Protease/Amylase 6k/19k/30k, 12k/38k/60k, 24k/76k/120k Patient Assistance Program
Creon GASTROINTESTINAL DRUGS
Pancreatic Enzymes 90 day supply PAP
C ? - (can open and give w/ apple-
sauce or pudding)
K
Paricalcitol Capsule 1mcg, 2mcg, 4mcg Patient Assistance Program
Zemplar NEPHROLOGY Vitamin D Analog 90 day supply PAP
C ? -
Peak Flow Meter DEVICE + +
Penicillin VK Suspension 250mg/5mL
Pen-Vee K ANTI-INFECTIVES Penicillin VK B ? K
Penicillin VK Tablet 500mg
Veetids ANTI-INFECTIVES Penicillin VK B ? + K
Permethrin Cream 5% Elimite SKIN AND MUCOUS MEMBRANE AGENTS
Antiparasitic Agent, Scabicidal
60 gm B ?
Phenazopyridine Tablet 100mg
Pyridium GENITOURINARY AGENTS
Analgesic, Urinary B ? + K
Phenobarbital Tablet 30mg
ANTICONVULSANT AGENTS
Barbiturate D - + + K/L
Phenytoin Sodium Chewable tablet 50g 100mg LAB
Dilantin Infatabs
ANTICONVULSANT AGENTS
Hydantoin D + + L
Pill Box DEVICE + +
Pilocarpine Ophth Soln 4%
Pilocar EYE, EAR, NOSE, AND THROAT
Antiglaucoma, Cholinergic Agent
15 mL C ?
Pioglitazone Tablet 15mg, 30mg LAB
Actos ENDOCRINE AND METABOLIC AGENTS
Antidiabetic, Thiazolidinedione
C ? + L
Piperonyl Butoxide and Pyrethrum Extract Kit
Rid Shampoo SKIN AND MUCOUS MEMBRANE AGENTS
Antiparasitic Agent, Pediculocide
120 mL C ?
27
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Polyethylene Glycol MiraLax GASTROINTESTINAL DRUGS
Laxative, Osmotic 255 gm C ?
Polyethylene Glycol with Electrolytes
GoLytely GASTROINTESTINAL DRUGS
Laxative, Osmotic (for Bowel Prep)
4,000 mL C ?
Polymyxin/Trimethoprim Ophth Soln 10,000 units-1mg/mL
Polytrim EYE, EAR, NOSE, AND THROAT
Anti-infective 10 mL C ?
Potassium Chloride Tablet 8mEq
Klor-Con ELECTROLYTE SUPPLEMENT
Treatment of Hypokalemia
C ? - K
Prazosin Capsule 1mg, 2mg, 5mg
Minipress CARDIOVASCULAR DRUGS
Alpha 1 Blocker, Antihypertensive
C ? - + L
Prednisolone Acetate Ophth Soln 1%
Pred Forte EYE, EAR, NOSE, AND THROAT
Corticosteroid 15 mL C ?
Prednisolone Syrup 15mg/mL
Prelone ENDOCRINE AND METABOLIC AGENTS
Glucocorticoids C + K/L
Prednisone Tablet 5mg, 20mg
Deltasone ENDOCRINE AND METABOLIC AGENTS
Glucocorticoids C + + +8 K/L
Pregabalin Capsule 75mg, 150mg RxP
Lyrica ANALGESICS AND ANTIPYRETICS
Anticonvulsant, Analgesic
C ? - K
Prenatal Vitamins Natalins RX NUTRIENTS AND NUTRITIONAL AGENTS
Vitamin #100 tablets + + +
Promethazine Suppository 25mg
Phenergan ANTIEMETIC/ANTI-VERTIGO AGENTS
Antidopaminergic, Phenothiazine
C - + L
Promethazine Tablet 25mg
Phenergan ANTIEMETIC/ANTI-VERTIGO AGENTS
Antidopaminergic, Phenothiazine
C - + L
8 Prednisone and other oral corticosteroids may worsen delirium in older adults
28
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Propranolol Tablet 10mg, 40mg
Inderal CARDIOVASCULAR DRUGS
Beta Blocker C + + K/L
Pseudoephedrine Syrup 30mg/5mL
Sudafed RESPIRATORY AGENTS
Decongestant (Alpha/Beta Adrenergic Agonist)
C + +9 K
Pseudoephedrine Tablet 30mg, 60mg
Sudafed RESPIRATORY AGENTS
Decongestant (Alpha/Beta Adrenergic Agonist)
#24 tabs C + + +9 K
Psyllium Hydrophilic Powder
Metamucil GASTROINTESTINAL DRUGS
Laxative, Bulk 284 gm + ?
Quetiapine 25mg50mg, 100mg, 200mg, 300mg LAB
Seroquel ANTIPSYCHOTIC AGENTS
Atypical, Serotonin/Dopamine Receptor Antagonist
C - + + K
Ranitidine Syrup 15mg/mL
Zantac GASTROINTESTINAL DRUGS
Histamine H2 Antagonist
B ? +10 K/L
Ranitidine Tablet 150mg, 300mg
Zantac GASTROINTESTINAL DRUGS
Histamine H2 Antagonist
B ? + +10 K/L
Risperidone Tablet 0.5mg, 1mg, 2mg LAB
Risperdal ANTIPSYCHOTIC AGENTS
Atypical, Serotonin/Dopamine Receptor Antagonist
C - + + K/L
Rivaroxaban Tablet 10 mg, 15mg, 20mg Patient Assistance Program
Xarelto CARDIOVASCULAR Anticoagulant 30-day supply prescription card PAP
C - + K/L
9 Oral decongestants may worsen insomnia 10 Ranitidine and other H2 receptor antagonists may worsen delirium, dementia, or cognitive impairment in older adults
29
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Saline Nose Spray Saline Spray EYE, EAR, NOSE, AND THROAT
Irrigation 45 mL + +
Selenium Sulfide Lotion 2.5%
Selsun SKIN AND MUCOUS MEMBRANE AGENTS
Tinea Versicolor; Dandruff; Seborrheic Dermatitis
120 mL C ?
Sertraline Tablet 50mg, 100mg
Zoloft ANTIDEPPRESSANT AGENTS
Selective Serotonin Reuptake Inhibitor
C (- in 3rd trimester)
+ + +11 L
Silver Sulfadiazine Silvadene SKIN AND MUCOUS MEMBRANE AGENTS
Anti-infective 20 gm B -
Simethicone Drops 40mg/0.6mL
Mylicon GASTROINTESTINAL DRUGS
Antiflatulent 30 mL C but + ?
Sitagliptin Tablet 25mg, 50mg, 100mg
Januvia ENDOCRINE AND METABOLIC AGENTS
Anti-diabetic, Dipeptidyl Peptidase IV (DPP-IV) Inhib
90 day supply PAP
B ? - K/L
Sodium Polystyrene Sulfonate Susp 15gm/60mL
Kayexalate NEPHROLOGY Treatment of Hyperkalemia
60 mL per bottle
C ?
Sofosbuvir/ velpatasvir Tablet 400 mg/ 100 mg Patient Assistance Program
Epclusa ANTI-INFECTIVES Antihepaciviral, NS5A Inhibitor; Antihepaciviral, Polymerase Inhibitor
84 day supply PAP
B ? - (taste)
Spacer Aerochamber DEVICE + +
Spacer, with mask Aerochamber, DEVICE + +
Spironolactone Tablet 25mg
Aldactone CARDIOVASCULAR DRUGS
Diuretic, Potassium Sparing
D + + K
Spironolactone/HCTZ Tablet 25mg/25mg
Aldactazide CARDIOVASCULAR DRUGS
Diuretic, Potassium Sparing / Thiazide
D + + K
11 SSRIs may increase risk of falls
30
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Sulfamethoxazole/ Trimethoprim Suspension 200mg-40mg/5mL
Septra Suspension
ANTI-INFECTIVES Sulfonamide C +
Sulfamethoxazole/ Trimethoprim Tablet 800mg/160mg
Septra DS ANTI-INFECTIVES Sulfonamide C + K/L
Sulfasalazine Tablet 500mg
Sulfazine, Azulfadine
ANTI-INFECTIVES Sulfonamide D - + K/L
Sulfur/Salicylic Acid Shampoo 2%/2%
Sebulex SKIN AND MUCOUS MEMBRANE AGENTS
Dandruff 120 mL C -
Syringes 31G 5/16" 0.5mL, 1mL
Monoject DEVICE + +
Tablet Cutter DEVICE + +
Tamoxifen Tablet 10mg LAB, HD
Nolvadex ANTINEOPLASTIC AGENTS
Anti-estrogen D - -
Tamsulosin 0.4mg Capsule
Flomax Alpha1 Blocker B + -
Terbinafine Cream 1% LAB
Lamisil AT ANTI-INFECTIVES Antifungal 15 gm B ?
Terbinafine Tablet 250mg LAB
Lamisil ANTI-INFECTIVES Antifungal B - + K/L
Terconazole Vaginal Cream 0.8%
Terazol-3 SKIN AND MUCOUS MEMBRANE AGENTS
Antifungal 20 gm C -
Thiamine Tablet 100mg Various NUTRIENTS AND NUTRITIONAL AGENTS
Nutritional Supplement
#100 tabs A + +
Timolol Maleate Ophth Soln 0.5%
Timoptic EYE, EAR, NOSE, AND THROAT
Antiglaucoma, Beta-Adrenergic Blocker
5mL C +
31
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Tiotropium Bromide Cap for inhalation 18mcg
Spiriva RESPIRATORY AGENTS
Bronchodilator, Anticholinergic
30 capsules C - -
Tolterodine Tartrate extended release tablet 4mg RxP
Detrol LA GENITOURINARY AGENTS
Anticholinergic, Urinary
C - - +12 K/L
Topiramate Tablet 25mg, 100mg LAB, HD
Topamax ANTICONVULSANT AGENTS
Miscellaneous D ? - (taste) K/L
Tramadol Tablet 50mg Ultram ANALGESICS AND ANTIPYRETICS
Opioid Analgesic C - + + seizure/ epilepsy
13
K/L
Trazadone Tablet 50mg Desyrel ANTIDEPPRESSANT AGENTS
Serotonin Reuptake Inhibitor/Antagonist
C - + K/L
Tretinoin Cream 0.05%HD Retin-A SKIN AND MUCOUS MEMBRANE AGENTS
Acne 45 gm D -
Triamcinolone Acetonide Cream 0.1%
Aristocort; Kenalog
SKIN AND MUCOUS MEMBRANE AGENTS
Steroid 15 gm, 80 gm
C ?
Triamcinolone Acetonide Dental Paste 0.1%
Oralone SKIN AND MUCOUS MEMBRANE AGENTS
Steroid 5 gm C ?
Trifluoperazine Tablet 2mg
Stelazine ANTIPSYCHOTIC AGENTS
Typical, D2 Antagonist
C - + +14 L
Trihexphenidyl Tablet 2mg
Artane ANTIPARKINSON AGENTS
Anticholinergic C - + + K/L
12 Tolterodine may worsen delirium in older adults 13 Tramadol may lower seizure threshold 14 Trifluoperazine may worsen delirium in older adults
32
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
Medication Brand Name Therapeutic Category
Pharmacologic Category
Package Size Preg Cat Safety in Lactation
Crush/ Split
BEERS LIST
Dose Adjust
K=Kidney L=Liver
Triprolidine/ Pseudoephedrine Tablet 2.5mg/60mg
Actifed RESPIRATORY AGENTS
Antihistamine and Decongestant (Alpha/Beta Adrenergic Agonist)
#24 tabs - (1st trimester),
C
? + +
Varenicline Tablet Starter Pack, Continuing Pack RxP
Chantix SMOKING CESSATION
Partial Nicotine Agonist
C - + K
Verapamil SR Tablet 180mg, 240mg
Calan SR CARDIOVASCULAR DRUGS
Calcium Channel Blocker
C - + split/- crush
+Error!
Bookmark not
defined.
K/L
Vitamin D3 Tablet 400 IU, 1000 IU
NUTRIENTS AND NUTRITIONAL AGENTS
Vitamin #100 tabs C Avoid high
doses
Vitamin D3 Capsule 50,000 IU
NUTRIENTS AND NUTRITIONAL AGENTS
Vitamin C Avoid high
doses
-
Warfarin Tablet 5mg LAB Coumadin CARDIOVASCULAR DRUGS
Anticoagulant - (1st trimester),
C
Use caution
+ K/L
Zinc Oxide Ointment 20% Desitin SKIN AND MUCOUS MEMBRANE AGENTS
Protectant 30 gm + +
Updated: February 28th, 2018
33
N:\LCHC_Pharm\Formulary Management\Formulary of Drugs book\2018\7. Formulary of Drugs (alph) pp6,33.docx
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