Buckley Air Force Base Outpatient Formulary

1

Alphabetical Listing by Name

This do cument is cu rrent as of The availability of formulary items is subject to chan

December 10, 2019.ge.

AcetaminophenOutpatient Dosage FormsLiquid, Oral:Generic: 160 mg/5 mL (120 mL)

Tablet, Oral:Generic: 325 mg

Acetaminophen and CodeineOutpatient Dosage FormsSolution, Oral [C-V]:Generic: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 mL(5 mL)

Tablet, Oral [C-III]:Generic: Acetaminophen 300 mg and codeine phosphate 30 mg [BCF]

AcetaZOLAMIDEOutpatient Dosage FormsTablet, Oral:Generic: 250 mg

Acyclovir (Systemic)Outpatient Dosage FormsCapsule, 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)Outpatient Dosage FormsOintment, External:Generic: 5% (15 g)

AdalimumabOutpatient Dosage FormsPen-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: 40 mg/0.8 mL (1 ea) [BCF] [contains polysorbate 80]

AlbendazoleOutpatient Dosage FormsTablet, oral:Albenza: 200 mg [contains saccharin sodium]

AlbuterolOutpatient Dosage FormsAerosol, for oral inhalation:ProAir HFA: 90 mcg/inhalation (8.5 g) [chlorofluorocarbon free; 200 meteredactuations] [BCF]

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

AlendronateOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF] [restricted]Generic: 35 mg [BCF], 70 mg [BCF]

AlfuzosinOutpatient Dosage FormsTablet, Extended Release, Oral, as hydrochloride:Generic: 10 mg [BCF]

AliskirenOutpatient Dosage FormsTablet, Oral:Tekturna: 100 mg

AllopurinolOutpatient Dosage FormsTablet, Oral:Generic: 100 mg [BCF], 300 mg [BCF]

ALPRAZolamOutpatient Dosage FormsTablet, Oral:Generic: 0.25 mg, 0.5 mg, 1 mg

Aluminum Chloride HexahydrateOutpatient Dosage FormsSolution, External:Drysol: 20% (60 mL)

AmantadineOutpatient Dosage FormsCapsule, oral, as hydrochloride:Generic: 100 mg [BCF]

Syrup, oral, as hydrochloride:Generic: 50 mg/5 mL (473 mL) [BCF] [restricted]

AmiodaroneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 200 mg [BCF]

AmitriptylineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF] [restricted]

AmLODIPineOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

Amlodipine and BenazeprilOutpatient Dosage FormsCapsule, oral:2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF]5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF]5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF]5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF]10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF]10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF]

AmoxicillinOutpatient Dosage FormsCapsule, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

Suspension Reconstituted, Oral:Generic: 250 mg/5 mL (80 mL, 100 mL, 150 mL) [BCF]; 400 mg/5 mL (50 mL,75 mL, 100 mL) [BCF]

Tablet, Oral:Generic: 875 mg

Amoxicillin and ClavulanateOutpatient Dosage FormsPowder for Suspension, Oral:200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (50mL) [BCF]

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

600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (75mL) [BCF]

Tablet, Oral:250: Amoxicillin 250 mg and clavulanate potassium 125 mg [BCF]500: Amoxicillin 500 mg and clavulanate potassium 125 mg [BCF]875: Amoxicillin 875 mg and clavulanate potassium 125 mg [BCF]

AnastrozoleOutpatient Dosage FormsTablet, Oral:Generic: 1 mg

ApixabanOutpatient Dosage FormsTablet, Oral:Eliquis: 2.5 mg, 5 mg

ARIPiprazoleOutpatient Dosage FormsTablet, Oral:Generic: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg

Artificial TearsOutpatient Dosage FormsOintment, Ophthalmic [preservative free]:Systane Nighttime: Petrolatum 94% and mineral oil 3% (3.5 g)

Solution, Ophthalmic:Natural Balance Tears: (15 mL)

Solution, Ophthalmic [preservative free]:Systane Preservative Free: Polyethylene glycol 400 0.4% and propyleneglycol 0.3% per 0.4 mL (28 ea)

AspirinOutpatient Dosage FormsTablet, Chewable, Oral:Generic: 81 mg

Tablet, Enteric Coated, oral:Generic: 81 mg

Aspirin and DipyridamoleOutpatient Dosage FormsCapsule, variable release:Aggrenox®: Aspirin 25 mg [immediate release] and dipyridamole 200 mg[extended release] [contains lactose, sucrose]

ACETAMINOPHEN

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AtenololOutpatient Dosage FormsTablet, Oral:Generic: 25 mg [BCF], 50 mg [scored] [BCF], 100 mg [BCF]

AtoMOXetineOutpatient Dosage FormsCapsule, oral:Strattera®: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg

AtorvaSTATinOutpatient Dosage FormsTablet, Oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]

Atovaquone and ProguanilOutpatient Dosage FormsTablet, Oral:Generic: Atovaquone 250 mg and proguanil hydrochloride 100 mg

AzaTHIOprineOutpatient Dosage FormsTablet, Oral:Generic: 50 mg

Azelastine (Nasal)Outpatient Dosage FormsSolution, Nasal, as hydrochloride:Generic: 0.1% (30 mL)

Azelastine (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic, as hydrochloride [drops]:Generic: 0.05% (6 mL)

Azithromycin (Systemic)Outpatient Dosage FormsPowder for Suspension, Oral, as dihydrate [strength expressed as base]:Zithromax: 100 mg/5 mL (15 mL) [contains sodium 3.7 mg/5 mL; cherry-crèmede vanilla-banana flavor] [BCF]

Zithromax: 200 mg/5 mL (30 mL) [contains sodium 7.4 mg/5 mL; cherry-crèmede vanilla-banana flavor]

Generic: 100 mg/5 mL (15 mL) [BCF]Tablet, Oral, as monohydrate [strength expressed as base]:Generic: 250 mg [BCF]

Bacitracin and Polymyxin B (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Generic: Bacitracin 500 units and polymyxin B 10,000 units per g (3.5 g)

Bacitracin, Neomycin, and Polymyxin B (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Generic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 unitsper g (3.5 g) [BCF] [restricted]

Bacitracin (Ophthalmic)Outpatient Dosage FormsOintment, ophthalmic: 500 units/g (3.5 g)

BaclofenOutpatient Dosage FormsTablet, oral: 10 mg

BenzocaineOutpatient Dosage FormsLozenge, oral:Cepacol® Sore Throat: 15 mg (16s) [contains cetylpyridinium, menthol]

BenzonatateOutpatient Dosage FormsCapsule, Softgel, Oral:Generic: 100 mg, 200 mg

Benzoyl PeroxideOutpatient Dosage FormsLiquid, topical [wash]:Generic: 10% (148 g)

BenztropineOutpatient Dosage FormsTablet, oral, as mesylate:Generic: 0.5 mg [BCF]

Betamethasone and ClotrimazoleOutpatient Dosage FormsCream, External:Generic: Betamethasone dipropionate 0.05% (base) and clotrimazole 1%(15 g, 45 g)

Betamethasone (Topical)Outpatient Dosage FormsCream, External, as valerate [strength expressed as base]:Generic: 0.1% (15 g)

Ointment, External, as valerate [strength expressed as base]:Generic: 0.1% (15 g)

BicalutamideOutpatient Dosage FormsTablet, Oral:Generic: 50 mg [BCF]

BisacodylOutpatient Dosage FormsSuppository, Rectal:Generic: 10 mg (100s)

Tablet, Enteric Coated, Oral:Generic: 5 mg

Brimonidine and TimololOutpatient Dosage FormsSolution, Ophthalmic [drops]:Combigan: Brimonidine tartrate 0.2% and timolol 0.5% (5 mL) [containsbenzalkonium chloride]

Brimonidine (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as tartrate [drops]:Alphagan P: 0.15% (10 mL)Generic: 0.15% (10 mL) [BCF]; 0.2% (5 mL) [BCF]

Budesonide (Oral Inhalation)Outpatient Dosage FormsSuspension, for Nebulization:Generic: 0.25 mg/2 mL (30s); 0.5 mg/2 mL (30s); 1 mg/2 mL (30s)

Budesonide (Systemic)Outpatient Dosage FormsCapsule, Enteric Coated, Oral:Generic: 3 mg

BuPROPionOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 75 mg [BCF], 100 mg [BCF]

Tablet Extended Release 12 Hour, Oral, as hydrochloride:Generic: 100 mg [BCF], 150 mg [BCF]

Tablet Extended Release 24 Hour, Oral, as hydrochloride:Generic: 150 mg [BCF], 300 mg [BCF]

BusPIRoneOutpatient Dosage FormsTablet, oral, as hydrochloride: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF]

Butalbital, Acetaminophen, and CaffeineOutpatient Dosage FormsTablet, Oral:Generic: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg [BCF]

Butalbital, Aspirin, and CaffeineOutpatient Dosage FormsCapsule, Oral:Generic: Butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg

CalcipotrieneOutpatient Dosage FormsCream, topical: 0.005% (60 g)

CalcitoninOutpatient Dosage FormsSolution, intranasal [calcitonin-salmon/rDNA origin/spray]:Fortical: 200 units/actuation (3.7 mL) [contains benzyl alcohol; delivers 30doses]

Calcitriol (Systemic)Outpatient Dosage FormsCapsule, softgel, oral:Generic: 0.25 mcg

Calcium and Vitamin DOutpatient Dosage FormsTablet, oral: Calcium 600 mg and vitamin D 400 units

CaptoprilOutpatient Dosage FormsTablet, Oral:Generic: 25 mg [BCF] [restricted], 50 mg [BCF]

CAPTOPRIL

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CarBAMazepineOutpatient Dosage FormsSuspension, Oral:Generic: 100 mg/5 mL (450 mL) [BCF] [restricted]

Tablet, Oral:Generic: 200 mg [BCF]

Tablet, Chewable, Oral:Generic: 100 mg [BCF]

Tablet, Extended Release, Oral:Generic: 100 mg, 200 mg, 400 mg [BCF] [restricted]

Carbidopa and LevodopaOutpatient Dosage FormsTablet, Oral:10/100: Carbidopa 10 mg and levodopa 100 mg [BCF]25/100: Carbidopa 25 mg and levodopa 100 mg [BCF]25/250: Carbidopa 25 mg and levodopa 250 mg [BCF]

Tablet, Extended Release:25/100: Carbidopa 25 mg and levodopa 100 mg50/200: Carbidopa 50 mg and levodopa 200 mg

CarboxymethylcelluloseOutpatient Dosage FormsSolution, Ophthalmic, as sodium:Lubricating Plus Eye Drops: 0.5% (30 ea)

Solution, Ophthalmic, as sodium [preservative free]:Refresh Celluvisc: 1% (30 ea)

CarvedilolOutpatient Dosage FormsTablet, Oral:Generic: 3.125 mg [BCF], 6.25 mg [BCF], 12.5 mg [BCF], 25 mg [BCF]

CefdinirOutpatient Dosage FormsCapsule, Oral:Generic: 300 mg

Suspension Reconstituted, Oral:Generic: 250 mg/5 mL (100 mL)

CefprozilOutpatient Dosage FormsSuspension Reconstituted, Oral:Generic: 250 mg/5 mL (100 mL)

CefuroximeOutpatient Dosage FormsTablet, Oral, as axetil [strength expressed as base]:Generic: 250 mg

CelecoxibOutpatient Dosage FormsCapsule, oral:Generic: 100 mg, 200 mg

CephalexinOutpatient Dosage FormsCapsule, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

Suspension Reconstituted, Oral:Generic: 250 mg/5 mL (100 mL) [BCF]

Cetirizine (Systemic)Outpatient Dosage FormsSyrup, oral, as hydrochloride:Generic: 5 mg/5 mL (118 mL)

Tablet, Oral, as hydrochloride:Generic: 10 mg

Chlorhexidine Gluconate (Oral)Outpatient Dosage FormsSolution, Mouth/Throat:Generic: 0.12% (473 mL) [BCF]

ChlorthalidoneOutpatient Dosage FormsTablet, oral: 25 mg [BCF], 50 mg [BCF]

Cholestyramine ResinOutpatient Dosage FormsPowder for Suspension, Oral:

Generic: Cholestyramine resin 4 g/9 g of powder (378 g)

CiclopiroxOutpatient Dosage FormsSolution, External:Generic: 8% (6.6 mL)

Ciprofloxacin (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as hydrochloride [drops]:Generic: 3.5 mg/mL (5 mL) [equivalent to ciprofloxacin base 0.3%]

Ciprofloxacin (Systemic)Outpatient Dosage FormsSuspension Reconstituted, Oral:Generic: 250 mg/5 mL (100 mL) [BCF]

Tablet, oral, as hydrochloride [strength expressed as base]:Generic: 250 mg [BCF], 500 mg [BCF], 750 mg [restricted]

CitalopramOutpatient Dosage FormsSolution, Oral:Generic: 10 mg/5 mL (240 mL) [BCF] [restricted]

Tablet, Oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]

ClarithromycinOutpatient Dosage FormsTablet, Oral:Generic: 500 mg

Clidinium and ChlordiazepoxideOutpatient Dosage FormsCapsule, Oral:Librax: Clidinium bromide 2.5 mg and chlordiazepoxide hydrochloride 5 mg

Clindamycin and Benzoyl PeroxideOutpatient Dosage FormsGel, Topical:Generic: Clindamycin phosphate 1.2% and benzoyl peroxide 5% (45 g)

Clindamycin (Systemic)Outpatient Dosage FormsCapsule, oral, as hydrochloride [strength expressed as base]: 150 mg [BCF],300 mg

Solution reconstituted, oral, as palmitate hydrochloride [strength expressed asbase]: 75 mg/5 mL (100 mL)

Clindamycin (Topical)Outpatient Dosage FormsCream, Vaginal, as phosphate [strength expressed as base]:Generic: 2% (40 g) [BCF]

Gel, External, as phosphate [strength expressed as base]:Generic: 1% (30 g)

Lotion, External, as phosphate [strength expressed as base]:Generic: 1% (60 mL)

Solution, External, as phosphate [strength expressed as base]:Generic: 1% (30 mL, 60 mL) [BCF]

ClobetasolOutpatient Dosage FormsAerosol, Foam, External, as propionate:Generic: 0.05% (100 g)

Cream, External, as propionate:Generic: 0.05% (15 g, 60 g)

Ointment, External, as propionate:Generic: 0.05% (15 g, 60 g)

Solution, topical, as propionate [for scalp application]:Generic: 0.05% (25 mL)

ClomiPHENEOutpatient Dosage FormsTablet, Oral, as citrate:Generic: 50 mg

ClonazePAMOutpatient Dosage FormsTablet, Oral:Generic: 0.5 mg [BCF], 1 mg, 2 mg

CloNIDineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 0.1 mg [BCF], 0.2 mg [BCF]

ClopidogrelOutpatient Dosage FormsTablet, Oral:Generic: 75 mg [BCF], 300 [BCF] [restricted]

Clotrimazole (Oral)Outpatient Dosage FormsTroche, oral: 10 mg

CARBAMAZEPINE

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Clotrimazole (Topical)Outpatient Dosage FormsCream, External:Clotrimazole Anti-Fungal: 1% (28.35 g) [contains benzyl alcohol, cetyl alcohol]

Solution, External:Generic: 1% (10 mL) [BCF] [restricted]

ColchicineOutpatient Dosage FormsTablet, oral:Colcrys®: 0.6 mg [scored]

ColestipolOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 1 g

CyanocobalaminOutpatient Dosage FormsSolution, Injection:Generic: 1000 mcg/mL (1 mL, 10 mL, 30 mL)

Tablet, Oral:Generic: 500 mcg, 1000 mcg

CyclobenzaprineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg [BCF]

CycloSPORINE (Ophthalmic)Outpatient Dosage FormsEmulsion, ophthalmic [drops, preservative free]:Restasis®: 0.05% (0.4 mL) [contains castor oil]

CyproheptadineOutpatient Dosage FormsSyrup, Oral, as hydrochloride:Generic: 2 mg/5 mL (473 mL) [BCF] [restricted]

Tablet, Oral, as hydrochloride:Generic: 4 mg [BCF]

Dabigatran EtexilateOutpatient Dosage FormsCapsule, Oral:Pradaxa: 75 mg, 150 mg

DesipramineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 50 mg

DesmopressinOutpatient Dosage FormsTablet, Oral, as acetate:Generic: 0.1 mg

DesonideOutpatient Dosage FormsCream, External:Generic: 0.05% (15 g, 60 g)

Ointment, External:Generic: 0.05% (15 g, 60 g)

DesoximetasoneOutpatient Dosage FormsCream, External:Generic: 0.25% (15 g)

DexAMETHasone (Systemic)Outpatient Dosage FormsTablet, oral: 0.5 mg, 4 mg

DextroamphetamineOutpatient Dosage FormsCapsule, extended release, oral, as sulfate: 10 mg, 15 mgCapsule, sustained release, oral, as sulfate:Dexedrine® Spansule®: 10 mg, 15 mg

Tablet, oral, as sulfate: 5 mg

Dextroamphetamine and AmphetamineOutpatient Dosage FormsTablet, Oral:5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sul-fate 1.25 mg (equivalent to amphetamine base 3.13 mg)]

10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate2.5 mg (equivalent to amphetamine base 6.3 mg)]

15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccharate3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine sul-fate 3.75 mg (equivalent to amphetamine base 9.4 mg)]

20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate5 mg (equivalent to amphetamine base 12.6 mg)]

Capsule, extended release, oral:5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sul-fate 1.25 mg (equivalent to amphetamine base 3.1 mg)] [BCF]

10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate2.5 mg (equivalent to amphetamine base 6.3 mg)] [BCF]

15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccharate3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine sul-fate 3.75 mg (equivalent to amphetamine base 9.4 mg)] [BCF]

20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate5 mg (equivalent to amphetamine base 12.5 mg)] [BCF]

25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine saccharate6.25 mg, amphetamine aspartate monohydrate 6.25 mg, amphetamine sul-fate 6.25 mg (equivalent to amphetamine base 15.6 mg)] [BCF]

30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sulfate7.5 mg (equivalent to amphetamine base 18.8 mg)] [BCF]

Diabetic SuppliesOutpatient Dosage FormsGlucometer:FreeStylePrecision Xtra Monitor

Insulin Syringes:U-100 (0.3 cc); U-100 (0.5 cc); U-100 (1 cc)

Lancet:Ultra Thin Miscellaneous: 100/box

Test Strips:FreeStyle Lite: 50/boxPrecision Xtra: 100/box

DiazePAMOutpatient Dosage FormsGel, Rectal:Generic: 10 mg (1 ea)

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

Diclofenac (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as sodium [drops]:Generic: 0.1% (5 mL)

Diclofenac (Systemic)Outpatient Dosage FormsTablet, delayed release, enteric coated, oral, as sodium: 50 mg, 75 mg

Diclofenac (Topical)Outpatient Dosage FormsGel, External, as sodium:Voltaren Gel: 1% (100 g) [contains isopropyl alcohol]

DicloxacillinOutpatient Dosage FormsCapsule, oral: 250 mg [BCF]

DicyclomineOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 10 mg [BCF]

Tablet, Oral, as hydrochloride:Generic: 20 mg [BCF]

DifluprednateOutpatient Dosage FormsEmulsion, Ophthalmic:Durezol: 0.05% (5 mL) [contains edetate sodium (tetrasodium), polysor-bate 80]

DigoxinOutpatient Dosage FormsTablet, Oral:Generic: 125 mcg [BCF], 250 mcg [BCF]

DilTIAZemOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as hydrochloride:Cardizem CD: 120 mg, 180 mg, 240 mg, 360 mg [contains brilliant blue fcf(fd&c blue #1)]

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

DILTIAZEM

5

Tablet, Oral, as hydrochloride:Generic: 60 mg, 120 mg [restricted]

DiphenhydrAMINE (Systemic)Outpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 25 mg

Liquid, oral, as hydrochloride:Q-Dryl: 12.5 mg/5 mL (118 mL)

Diphenoxylate and AtropineOutpatient Dosage FormsTablet, Oral:Generic: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate 0.025 mg

DisulfiramOutpatient Dosage FormsTablet,Oral:Generic: 250 mg

DocusateOutpatient Dosage FormsCapsule, Oral, as sodium:Generic: 100 mg

DonepezilOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg

DorzolamideOutpatient Dosage FormsSolution, Ophthalmic [drops]:Generic: 2% (10 mL)

Dorzolamide and TimololOutpatient Dosage FormsSolution, Ophthalmic [drops]:Generic: Dorzolamide 2% and timolol 0.5% (10 mL)

DoxazosinOutpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2 mg, 4 mg, 8 mg

Doxepin (Systemic)Outpatient Dosage FormsCapsule, oral: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mgSolution, oral [concentrate]: 10 mg/mL (118 mL, 120 mL) [BCF] [restricted]

DoxycyclineOutpatient Dosage FormsCapsule, Oral, as hyclate [strength expressed as base]:Generic: 50 mg

Tablet, Oral, as hyclate [strength expressed as base]:Generic: 100 mg [BCF]

Tablet, Oral, as monohydrate [strength expressed as base]:Generic: 50 mg

DronedaroneOutpatient Dosage FormsTablet, Oral:Multaq: 400 mg

DulaglutideOutpatient Dosage FormsSolution 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 poly-sorbate 80]

DULoxetineOutpatient Dosage FormsCapsule Delayed Release Particles, Oral:Generic: 20 mg, 30 mg, 60 mg

EletriptanOutpatient Dosage FormsTablet, oral:Relpax: 40 mg

EmollientsOutpatient Dosage FormsOintment, External:Hydrophor: 454 g

Liquid, External [cleanser]:Cetaphil

EmpagliflozinOutpatient Dosage FormsTablet, Oral:Jardiance: 10 mg, 25 mg

EnoxaparinOutpatient Dosage FormsSolution, Injection, as sodium:Generic: 100 mg/mL (3 mL) [BCF]

Solution, Injection, 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]; 150 mg/mL (1 mL) [BCF]

EPINEPHrine (Systemic)Outpatient Dosage FormsSolution, Injection:EpiPen 2-Pak: 0.3 mg/0.3 mL (2 mL) [contains sodium metabisulfite; 1:1000solution; delivers 0.3 mg per injection]

EpiPen Jr 2-Pak: 0.15 mg/0.3 mL (2 mL) [contains sodium metabisulfite;1:2000 solution; delivers 0.15 mg per injection]

ErgocalciferolOutpatient Dosage FormsCapsule, oral: 50,000 units [1.25 mg]

Erythromycin (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Generic: 5 mg/g (3.5 g) [BCF]

Erythromycin (Systemic)Outpatient Dosage FormsSuspension Reconstituted, Oral, as ethylsuccinate:EryPed: 200 mg/5 mL (100 mL) [contains sodium 117.5 mg (5.1 mEq)/5 mL;fruit flavor] [BCF]

Tablet, Oral, as ethylsuccinate:E.E.S.: Erythromycin activity 400 mg [contains potassium 10 mg (0.3 mEq)/tablet, sodium 47 mg (2 mEq)/tablet]

Generic: Erythromycin activity 400 mg

Erythromycin (Topical)Outpatient Dosage FormsGel, topical: 2% (30 g, 60 g)Ointment, topical:Akne-mycin®: 2% (25 g)

Solution, topical: 2% (60 mL)

EscitalopramOutpatient Dosage FormsTablet, Oral:Generic: 5 mg, 10 mg, 20 mg

Estradiol (Systemic)Outpatient Dosage FormsPatch, Transdermal [once-weekly patch]:Generic: 0.025 mg/24 hours (4s) [BCF]; 0.0375 mg/24 hours (4s) [BCF];0.05 mg/24 hours (4s) [BCF]; 0.075 mg/24 hours (4s) [BCF]; 0.1 mg/24hours (4s) [BCF] [restricted]

Ring, Vaginal, as acetate:Femring: 0.05 mg/24 hours (1s) [total estradiol 12.4 mg; releases 0.05 mg/24hours over 3 months]

Tablet, Oral [micronized]:Generic: 0.5 mg, 1 mg, 2 mg

Estradiol (Topical)Outpatient Dosage FormsCream, 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 MedroxyprogesteroneOutpatient Dosage FormsTablet, oral:Prempro®: 0.3/1.5: Conjugated estrogens 0.3 mg and medroxyprogesteroneacetate 1.5 mg [BCF]

Prempro®: 0.45/1.5: Conjugated estrogens 0.45 mg and medroxyprogester-one acetate 1.5 mg [BCF]

Prempro®: 0.625/2.5: Conjugated estrogens 0.625 mg and medroxyproges-terone acetate 2.5 mg [BCF]

Prempro®: 0.625/5: Conjugated estrogens 0.625 mg and medroxyprogester-one acetate 5 mg [BCF]

Estrogens (Conjugated/Equine, Systemic)Outpatient Dosage FormsTablet, oral:Premarin®: 0.3 mg [BCF], 0.45 mg [BCF], 0.625 mg [BCF], 0.9 mg,1.25 mg [BCF]

DILTIAZEM

6

Estrogens (Conjugated/Equine, Topical)Outpatient Dosage FormsCream, vaginal:Premarin®: 0.625 mg/g (30 g) [BCF]

Estrogens (Esterified) and MethyltestosteroneOutpatient Dosage FormsTablet, Oral:Covaryx H.S.: Esterified estrogens 0.625 mg and methyltestosterone 1.25[contains tartrazine]

Covaryx: Esterified estrogens 1.25 mg and methyltestosterone 2.5 mg [con-tains tartrazine]

EszopicloneOutpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2 mg, 3 mg

EthambutolOutpatient Dosage FormsTablet, Oral, as hydrochloride:Myambutol: 400 mg [scored] [BCF]Generic: 100 mg [BCF] [restricted]

Ethinyl Estradiol and DesogestrelOutpatient Dosage FormsTablet, Oral [low dose formulation]:Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 tablets]; Ethinyl estra-diol 0.01 mg [5 tablets]; 2 inactive tablets (28s)

Tablet, oral [monophasic formulation]:Reclipsen: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 whitetablets and 7 green inactive tablets] (28s)

Ethinyl Estradiol and DrospirenoneOutpatient Dosage FormsTablet, Oral:Ocella: Ethinyl estradiol 0.03 mg and drospirenone 3 mg [21 yellow activetablets and 7 white inactive tablets] (28s) [BCF]

Yaz: Ethinyl estradiol 0.02 mg and drospirenone 3 mg [24 light pink activetablets and 4 white inactive tablets] (28s) [BCF]

Ethinyl Estradiol and Ethynodiol DiacetateOutpatient Dosage FormsTablet, Oral [monophasic formulation]:Zovia 1/35-28: Ethinyl estradiol 0.035 mg and ethynodiol diacetate 1 mg [21light pink tablets and 7 white inactive tablets] (28s)

Ethinyl Estradiol and EtonogestrelOutpatient Dosage FormsRing, vaginal:NuvaRing®: Ethinyl estradiol 0.015 mg/day and etonogestrel 0.12 mg/day(3s) [3-week duration]

Ethinyl Estradiol and LevonorgestrelOutpatient Dosage FormsTablet, Oral [low dose formulation]:Orsythia: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 pinktablets and 7 light green inactive tablets] [BCF]

Tablet, Oral [monophasic formulation]:Generic: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [21 tablets and7 inactive tablets] (28s)

Tablet, Oral [extended cycle regimen]:Jolessa: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 pink tabletsand 7 white inactive tablets] (91s) [BCF]

Tablet, Oral [triphasic formulation]:Trivora

Ethinyl Estradiol and NorelgestrominOutpatient Dosage FormsPatch, transdermal:Xulane: Ethinyl estradiol 0.53 mg and norelgestromin 4.86 mg [releasesethinyl estradiol 35 mcg and norelgestromin 150 mcg per day] (3s)

Ethinyl Estradiol and NorethindroneOutpatient Dosage FormsTablet, Oral:femhrt 1/5: Ethinyl estradiol 0.005 mg and norethindrone acetate 1 mg [whitetablets] (28s, 90s)

Jinteli: Ethinyl estradiol 0.005 mg and norethindrone acetate 1 mg [whitetablets] (28s, 90s)

Tablet, Oral [monophasic formulation]:Microgestin 1/20: Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg[white tablets] (21s)

Microgestin Fe 1/20: Ethinyl estradiol 0.02 mg and norethindrone acetate1 mg [21 white tablets] and ferrous fumarate 75 mg [7 brown tablets] (28s)

Microgestin Fe 1.5/30: Ethinyl estradiol 0.03 mg and norethindrone acetate1.5 mg [21 green tablets] and ferrous fumarate 75 mg [7 brown tablets] (28s)

Norinyl 1+35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg (28s) [21yellow-green tablets and 7 orange inactive tablets] [BCF]

Tablet, Oral [triphasic formulation]: Necon 7/7/7

Ethinyl Estradiol and NorgestimateOutpatient Dosage FormsTablet, Oral [monophasic formulation]:MonoNessa: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 bluetablets and 7 green inactive tablets] [BCF]

Tablet, Oral [triphasic formulation]:TriNessa [BCF]Tri-Lo-Sprintec

Ethinyl Estradiol and NorgestrelOutpatient Dosage FormsTablet, Oral [monophasic formulation]:Cryselle 28: Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [21 white tabletsand 7 light green inactive tablets] (28s)

EtodolacOutpatient Dosage FormsCapsule, Oral:Generic: 200 mg, 300 mg

Tablet, Oral:Generic: 400 mg

ExemestaneOutpatient Dosage FormsTablet, Oral:Generic: 25 mg

ExenatideOutpatient Dosage FormsAuto-injector, Subcutaneous:Bydureon BCise: 2 mg/0.85 mL (0.85 mL) [BCF]

Pen-injector, Subcutaneous:Bydureon: 2 mg (1 ea) [BCF]

Suspension Reconstituted, Subcutaneous:Bydureon: 2 mg (1 ea) [BCF]

EzetimibeOutpatient Dosage FormsTablet, oral:Zetia®: 10 mg

FelodipineOutpatient Dosage FormsTablet, extended release, oral: 2.5 mg, 5 mg, 10 mg

Fenofibrate and DerivativesOutpatient Dosage FormsTablet, Oral:TriCor: 48 mg [BCF], 145 mg [BCF] [contains soybean lecithin]Generic: 160 mg

Ferrous SulfateOutpatient Dosage FormsSolution, Oral:Generic: 75 (15 Fe) mg/mL (50 mL)

Tablet, Oral:Generic: 325 mg [elemental iron 65 mg]

FexofenadineOutpatient Dosage FormsSuspension, Oral, as hydrochloride:Allegra Allergy Childrens: 30 mg/5 mL (120 mL)

Tablet, Oral, as hydrochloride:Generic: 60 mg, 180 mg

FinasterideOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF]

FluconazoleOutpatient Dosage FormsSuspension Reconstituted, Oral:Diflucan: 10 mg/mL (35 mL)

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

FludrocortisoneOutpatient Dosage FormsTablet, oral, as acetate: 0.1 mg

Fluocinolone (Topical)Outpatient Dosage FormsCream, External, as acetonide:Generic: 0.01% (15 g)

Ointment, External, as acetonide:Generic: 0.025% (15 g)

Solution, External, as acetonide:Generic: 0.01% (60 mL)

FLUOCINOLONE (TOPICAL)

7

FluocinonideOutpatient Dosage FormsCream, External, anhydrous, emollient:Generic: 0.05% (15 g, 60 g) [BCF]

Gel, External:Generic: 0.05% (15 g)

Ointment, External:Generic: 0.05% (15 g, 60 g)

Solution, External:Generic: 0.05% (60 mL)

FluorideOutpatient Dosage FormsCream, Oral, as sodium [toothpaste]:PreviDent 5000 Plus: 1.1% (51 g)

Gel, Oral, as sodium [toothpaste]:PreviDent 5000 Booster: 1.1% (100 mL)

FluorometholoneOutpatient Dosage FormsSuspension, ophthalmic, as base [drops]:Generic: 0.1% (5 mL)

Fluorouracil (Topical)Outpatient Dosage FormsCream, External:Generic: 5% (40 g)

FLUoxetineOutpatient Dosage FormsCapsule, oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]

Solution, Oral:Generic: 20 mg/5 mL (120 mL) [BCF] [restricted]

Fluticasone and SalmeterolOutpatient Dosage FormsAerosol, for oral inhalation:Advair HFA: 45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg perinhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]

Advair HFA: 115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcgper inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]

Advair HFA: 230/21: Fluticasone propionate 230 mcg and salmeterol 21 mcgper inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]

Powder, for oral inhalation:Advair Diskus: 100/50: Fluticasone propionate 100 mcg and salmeterol 50mcg (60s) [contains lactose] [BCF]

Advair Diskus: 250/50: Fluticasone propionate 250 mcg and salmeterol 50mcg (60s) [contains lactose] [BCF]

Advair Diskus: 500/50: Fluticasone propionate 500 mcg and salmeterol 50mcg (60s) [contains lactose] [BCF]

Fluticasone (Nasal)Outpatient Dosage FormsSuspension, intranasal, as propionate [spray]:Generic: 50 mcg/inhalation (16 g) [BCF]

Fluticasone (Oral Inhalation)Outpatient Dosage FormsAerosol, for oral inhalation, as propionate:Flovent® HFA: 44 mcg/inhalation (10.6 g) [chlorofluorocarbon free; 120metered actuations] [BCF]

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

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

Powder, for oral 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]

Folic AcidOutpatient Dosage FormsTablet, oral: 1 mg [BCF]

FosfomycinOutpatient Dosage FormsPacket, Oral:Monurol: 3 g (1 ea) [orange flavor]

FosinoprilOutpatient Dosage FormsTablet, oral, as sodium: 10 mg, 20 mg, 40 mg

FurosemideOutpatient Dosage FormsTablet, Oral:Generic: 20 mg [BCF], 40 mg [BCF]

GabapentinOutpatient Dosage FormsCapsule, Oral:Generic: 100 mg [BCF], 300 mg [BCF], 400 mg [BCF]

Tablet, Oral:Generic: 600 mg [BCF], 800 mg [BCF]

GemfibrozilOutpatient Dosage FormsTablet, Oral:Generic: 600 mg [BCF]

Gentamicin (Ophthalmic)Outpatient Dosage FormsOintment, ophthalmic:Gentak: 0.3% (3.5 g) [BCF]

Solution, Ophthalmic [drops]:Generic: 0.3% (5 mL) [BCF]

GlimepirideOutpatient Dosage FormsTablet, Oral:Generic: 2 mg, 4 mg

GlipiZIDEOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF]

Tablet, Extended Release, Oral:Generic: 2.5 mg, 5 mg, 10 mg

GlucagonOutpatient Dosage FormsKit, Injection:Glucagon Emergency Kit: 1 mg [contains glycerin (in diluent), lactose 49 mg;equivalent to 1 unit]

GlyBURIDEOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg [BCF], 5 mg [BCF] [scored]

Tablet, Oral [micronized]:Generic: 1.5 mg [BCF], 6 mg [BCF]

Glyburide and MetforminOutpatient Dosage FormsTablet, Oral:2.5 mg/500 mg: Glyburide 2.5 mg and metformin hydrochloride 500 mg5 mg/500 mg: Glyburide 5 mg and metformin hydrochloride 500 mg

GriseofulvinOutpatient Dosage FormsSuspension, Oral [microsize]:Generic: 125 mg/5 mL (120 mL) [BCF]

Tablet, Oral [ultramicrosize]:Gris-PEG: 125 mg [BCF], 250 mg [BCF]

GuaiFENesinOutpatient Dosage FormsTablet, Extended Release, Oral:Mucinex: 600 mg

Guaifenesin and CodeineOutpatient Dosage FormsSyrup, Oral:Generic: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL(118 mL)

Guaifenesin and DextromethorphanOutpatient Dosage FormsLiquid, oral: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mgper 5 mL (118 mL)

Tablet, extended release, oral:Mucinex® DM: Guaifenesin 600 mg and dextromethorphan hydrobro-mide 30 mg

GuanFACINEOutpatient Dosage FormsTablet, Oral:Generic: 1 mg

Tablet Extended Release 24 Hour, Oral:Generic: 1 mg, 2 mg

HydrALAZINEOutpatient Dosage FormsTablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

FLUOCINONIDE

8

HydroCHLOROthiazideOutpatient Dosage FormsTablet, Oral:Generic: 12.5 mg,25 mg [BCF], 50 mg [BCF]

Hydrochlorothiazide and TriamtereneOutpatient Dosage FormsTablet, Oral:Hydrochlorothiazide 25 mg and triamterene 37.5 mg [BCF]Hydrochlorothiazide 50 mg and triamterene 75 mg [BCF]

Hydrocodone and AcetaminophenOutpatient Dosage FormsTablet, oral:Hydrocodone bitartrate 5 mg and acetaminophen 325 mgHydrocodone bitartrate 7.5 mg and acetaminophen 325 mgHydrocodone bitartrate 10 mg and acetaminophen 325 mg

Hydrocodone and IbuprofenOutpatient Dosage FormsTablet, Oral:Hydrocodone bitartrate 7.5 mg and ibuprofen 200 mg

Hydrocortisone (Systemic)Outpatient Dosage FormsTablet, Oral, as base:Generic: 5 mg

Hydrocortisone (Topical)Outpatient Dosage FormsCream, External, as base:Generic: 1% (28.4 g); 2.5% (28 g)

Cream, Rectal, as base:Proctosol HC: 2.5% (28.35 g)

Ointment, External, as base:Generic: 1% (30 g); 2.5% (20 g)

Suppository, Rectal, as acetate:Anucort-HC®: 25 mg (24s) [BCF]

HYDROmorphoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 2 mg, 4 mg, 8 mg

HydroquinoneOutpatient Dosage FormsCream, Time Release External:Generic: 4% (30 g)

HydroxychloroquineOutpatient Dosage FormsTablet, Oral, as sulfate:Generic: 200 mg [equivalent to 155 mg base]

HydroxyureaOutpatient Dosage FormsCapsule, Oral:Generic: 500 mg

HydrOXYzineOutpatient Dosage FormsCapsule, Oral, as pamoate:Generic: 25 mg

Syrup, Oral, as hydrochloride:Generic: 10 mg/5 mL (473 mL) [BCF]

Tablet, Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF] , 50 mg [BCF]

HyoscyamineOutpatient Dosage FormsTablet, Oral, as sulfate:Generic: 0.125 mg

IbandronateOutpatient Dosage FormsTablet, oral: 150 mg

IbuprofenOutpatient Dosage FormsSuspension, Oral:Generic: 100 mg/5 mL (120 mL)

Tablet, Oral:Generic: 400 mg [BCF], 600 mg [BCF], 800 mg [BCF]

ImipramineOutpatient Dosage FormsTablet,Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF]

ImiquimodOutpatient Dosage FormsCream, External:Generic: 5% (12s)

IndomethacinOutpatient Dosage FormsCapsule, oral: 25 mg [BCF], 50 mg [BCF]

Inhalation DevicesOutpatient Dosage FormsHolding chamber [without mask]:AeroChamber Plus

Holding chamber [with mask]:AeroChamber Plus: Small, medium, large

Insulin AspartOutpatient Dosage FormsInjection, solution:NovoLOG®: 100 units/mL (10 mL) [vial] [BCF]NovoLOG® FlexPen®: 100 units/mL (3 mL) [BCF]NovoLOG® Penfill®: 100 units/mL (3 mL) [cartridge] [BCF]

Insulin Aspart Protamine and Insulin AspartOutpatient Dosage FormsInjection, suspension:NovoLOG® Mix 70/30 FlexPen®: 100 units/mL: Insulin aspart protaminesuspension 70% [intermediate acting] and insulin aspart solution 30%[rapid-acting] (3 mL) [BCF]

Insulin DetemirOutpatient Dosage FormsSolution, Subcutaneous:Levemir: 100 units/mL (10 mL)

Insulin GlargineOutpatient Dosage FormsSolution, Subcutaneous:Lantus: 100 units/mL (10 mL) [vial] [BCF]

Insulin LisproOutpatient Dosage FormsInjection, solution:HumaLOG: 100 units/mL (3 mL) [cartridge]HumaLOG: 100 units/mL (10 mL) [vial]HumaLOG KwikPen: 100 units/mL (3 mL)

Insulin NPHOutpatient Dosage FormsInjection, suspension:NovoLIN® N: 100 units/mL (10 mL) [vial] [BCF]

Insulin NPH and Insulin RegularOutpatient Dosage FormsInjection, suspension:NovoLIN® 70/30: Insulin NPH suspension 70% [intermediate acting] andinsulin regular solution 30% [short acting]: 100 units/mL (10 mL) [vial] [BCF]

Insulin RegularOutpatient Dosage FormsInjection, solution:NovoLIN® R: 100 units/mL (10 mL) [BCF]

Ipratropium and AlbuterolOutpatient Dosage FormsSolution, for Nebulization:Generic: Ipratropium bromide 0.5 mg and albuterol (base) 2.5 mg per 3mL (30s)

Solution, for Oral Inhalation [spray]:Combivent Respimat: Ipratropium bromide 20 mcg and albuterol (base) 100mcg per inhalation (4 g) [contains benzalkonium chloride]

Ipratropium (Nasal)Outpatient Dosage FormsSolution, Nasal, as bromide [spray]:Generic: 0.03% (30 mL); 0.06% (15 mL)

Ipratropium (Oral Inhalation)Outpatient Dosage FormsAerosol Solution, Inhalation, as bromide:Atrovent HFA: 17 mcg/actuation (12.9 g) [chlorofluorocarbon free; 200metered actuations] [BCF]

Solution, for Nebulization, as bromide:Generic: 0.02% [500 mcg/2.5 mL] (30s)

IsoniazidOutpatient Dosage FormsTablet, oral: 300 mg [BCF]

ISONIAZID

9

Isosorbide DinitrateOutpatient Dosage FormsTablet, Oral:Generic: 10 mg [BCF]

Tablet, Extended Release, Oral:Generic: 40 mg [BCF]

Isosorbide MononitrateOutpatient Dosage FormsTablet, Extended Release, Oral:Generic: 30 mg [BCF], 60 mg [BCF], 120 mg [BCF]

ISOtretinoin (Systemic)Outpatient Dosage FormsCapsule, Oral:Claravis: 10 mg, 20 mg, 40 mg [contains soybean oil]

ItraconazoleOutpatient Dosage FormsCapsule, Oral:Generic: 100 mg

Ketoconazole (Topical)Outpatient Dosage FormsCream, External:Generic: 2% (30 g)

Shampoo, External:Generic: 2% (120 mL)

Ketorolac (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as tromethamine [drops]:Generic: 0.4% (5 mL); 0.5% (5 mL)

Ketorolac (Systemic)Outpatient Dosage FormsTablet, oral, as tromethamine: 10 mg

LabetalolOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 100 mg, 200 mg

Lactic Acid and Ammonium HydroxideOutpatient Dosage FormsCream, External:AmLactin: Lactic acid 12% with ammonium hydroxide (140 g)Generic: Lactic acid 12% with ammonium hydroxide (140 g)

Lotion, External:Lactic acid 12% with ammonium hydroxide (227 g)

LactuloseOutpatient Dosage FormsSolution, Oral:Generic: 10 g/15 mL (473 mL) [BCF]

LamoTRIgineOutpatient Dosage FormsTablet, Oral:Generic: 25 mg, 100 mg, 150 mg, 200 mg

LansoprazoleOutpatient Dosage FormsSuspension, Oral:First-Lansoprazole: 3 mg/mL (150 mL)

LatanoprostOutpatient Dosage FormsSolution, Ophthalmic [drops]:Generic: 0.005% (2.5 mL) [BCF]

LetrozoleOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg

LevalbuterolOutpatient Dosage FormsNebulization Solution, Inhalation, as hydrochloride [strength expressed asbase]:Generic: 0.63 mg/3 mL (3 mL); 1.25 mg/3 mL (3 mL)

LevETIRAcetamOutpatient Dosage FormsTablet, Oral:Generic: 250 mg, 500 mg, 750 mg

LevoFLOXacin (Systemic)Outpatient Dosage FormsSolution, Oral:Generic: 25 mg/mL (100 mL, 200 mL, 480 mL) [BCF]

Tablet, Oral:Generic: 250 mg [BCF], 500 mg [BCF], 750 mg [BCF]

Levonorgestrel (Systemic)Outpatient Dosage FormsTablet, Oral:Plan B: 0.75 mg [BCF], 1.5 mgGeneric: 0.75 mg [BCF]

LevothyroxineOutpatient Dosage FormsTablet, Oral, as sodium:Generic: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg [BCF], 100mcg [BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150 mcg[BCF], 175 mcg [BCF], 200 mcg [BCF]

Lidocaine and PrilocaineOutpatient Dosage FormsCream, External:Generic: Lidocaine 2.5% and prilocaine 2.5% (30 g)

Lidocaine (Topical)Outpatient Dosage FormsGel, External, as hydrochloride:Generic: 2% (30 mL)

Ointment, External:Generic: 5% (35.4 g)

Patch, External:Generic: 5% (30 ea)

Solution, Viscous, Oral Topical, as hydrochloride:Generic: 2% [20 mg/mL] (100 mL)

LifitegrastOutpatient Dosage FormsSolution, Ophthalmic:Xiidra: 5% (5 ea)

LindaneOutpatient Dosage FormsShampoo, topical: 1% (60 mL)

LiothyronineOutpatient Dosage FormsTablet, Oral:Generic: 5 mcg

LisinoprilOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg[BCF], 40 mg [BCF]

Lisinopril and HydrochlorothiazideOutpatient Dosage FormsTablet, Oral: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]

LithiumOutpatient Dosage FormsCapsule, Oral, as carbonate:Generic: 150 mg [BCF], 300 mg [BCF]

Tablet, Extended Release, Oral, as carbonate:Generic: 300 mg, 450 mg

LoperamideOutpatient Dosage FormsCapsule, oral, as hydrochloride: 2 mg [BCF]

LoratadineOutpatient Dosage FormsSyrup, Oral:Generic: 5 mg/5 mL (120 mL)

Tablet, Oral:Generic: 10 mg

LORazepamOutpatient Dosage FormsTablet, Oral:Generic: 0.5 mg, 1 mg, 2 mg

LosartanOutpatient Dosage FormsTablet, Oral, as potassium:Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

ISOSORBIDE DINITRATE

10

Losartan and HydrochlorothiazideOutpatient Dosage FormsTablet, oral:50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg [BCF]100/12.5: Losartan potassium 100 mg and hydrochlorothiazide12.5 mg [BCF]

100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg [BCF]

LoteprednolOutpatient Dosage FormsSuspension, Ophthalmic, as etabonate:Alrex: 0.2% (5 mL)

LubiprostoneOutpatient Dosage FormsCapsule, softgel, oral:Amitiza®: 24 mcg

Magnesium CitrateOutpatient Dosage FormsSolution, Oral:Generic: 290 mg/5 mL (296 mL)

MedroxyPROGESTERoneOutpatient Dosage FormsTablet, Oral, as acetate:Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

MefloquineOutpatient Dosage FormsTablet, oral, as hydrochloride: 250 mg [equivalent to mefloquine base 228 mg]

MegestrolOutpatient Dosage FormsTablet, oral, as acetate: 40 mg

MeloxicamOutpatient Dosage FormsTablet, Oral:Generic: 7.5 mg [BCF], 15 mg [BCF]

MemantineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg

MesalamineOutpatient Dosage FormsTablet, delayed release, enteric coated, oral:Lialda®: 1.2 g [BCF]

MetaxaloneOutpatient Dosage FormsTablet, Oral:Generic: 800 mg

MetFORMINOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 500 mg [BCF], 850 mg [BCF], 1000 mg [BCF]

Tablet, Extended Release, Oral, as hydrochloride:Generic: 500 mg [BCF], 750 mg [BCF]

MethadoneOutpatient Dosage FormsTablet, oral, as hydrochloride: 10 mg

MethIMAzoleOutpatient Dosage FormsTablet, Oral:Generic: 5 mg, 10 mg

MethocarbamolOutpatient Dosage FormsTablet, Oral:Generic: 500 mg [BCF], 750 mg

MethotrexateOutpatient Dosage FormsTablet, oral: 2.5 mg [BCF]

MethylphenidateOutpatient Dosage FormsCapsule, Extended Release, Oral, as hydrochloride [bi-modal release]:Generic: 10 mg [generic for Ritalin LA], 20 mg [generic for Ritalin LA], 30 mg[generic for Ritalin LA], 40 mg [generic for Ritalin LA]

Tablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg, 20 mg

Tablet Extended Release, Oral, as hydrochloride:Generic: 18 mg [BCF], 20 mg [BCF], 27 mg [BCF], 36 mg [BCF],54 mg [BCF]

MethylPREDNISoloneOutpatient Dosage FormsTablet, Oral:Generic: 4 mg

Tablet Therapy Pack, Oral:Generic: 4 mg (21 ea)

MetoclopramideOutpatient Dosage FormsTablet, Oral:Generic: 10 mg [BCF]

MetOLazoneOutpatient Dosage FormsTablet, Oral:Generic: 5 mg

MetoprololOutpatient Dosage FormsTablet, Oral, as tartrate:Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Tablet, Extended Release, Oral, as succinate [expressed as mg equivalent totartrate]:Toprol-XL: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF]Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

MetroNIDAZOLE (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

MetroNIDAZOLE (Topical)Outpatient Dosage FormsCream, External:Generic: 0.75% (45 g)

Gel, External:Generic: 1% (60 g)

Gel, Vaginal:Vandazole: 0.75% (70 g) [BCF]Generic: 0.75% (70 g) [BCF]

MidodrineOutpatient Dosage FormsTablet, oral, as hydrochloride: 2.5 mg, 10 mg

Minocycline (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 50 mg, 100 mg

MirabegronOutpatient Dosage FormsTablet Extended Release 24 Hour, Oral:Myrbetriq: 25 mg, 50 mg

MirtazapineOutpatient Dosage FormsTablet, Oral:Generic: 15 mg, 30 mg

MiSOPROStolOutpatient Dosage FormsTablet, Oral:Generic: 200 mcg

ModafinilOutpatient Dosage FormsTablet, Oral:Generic: 100 mg, 200 mg

MontelukastOutpatient Dosage FormsPacket, Oral:Singulair: 4 mg (30 ea) [restricted]

Tablet, Oral:Generic: 10 mg [BCF]

Tablet, Chewable, Oral:Generic: 4 mg [BCF], 5 mg [BCF]

Morphine (Systemic)Outpatient Dosage FormsTablet, oral, as sulfate: 15 mg, 30 mgTablet, extended release, oral, as sulfate: 15 mg [BCF], 30 mg [BCF], 60 mg[BCF], 100 mg [BCF], 200 mg [BCF]MS Contin®: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF],200 mg [BCF]

MORPHINE (SYSTEMIC)

11

Moxifloxacin (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic [drops]:Vigamox®: 0.5% (3 mL)

MupirocinOutpatient Dosage FormsOintment, External:Generic: 2% (22 g) [BCF]

MycophenolateOutpatient Dosage FormsCapsule, Oral, as mofetil:Generic: 250 mg

Tablet, Oral, as mofetil:Generic: 500 mg

NaloxoneOutpatient Dosage FormsLiquid, Nasal:Narcan: 4 mg/0.1 mL (1 ea) [contains benzalkonium chloride, edetatedisodium]

NaproxenOutpatient Dosage FormsSuspension, Oral:Generic: 125 mg/5 mL (500 mL) [BCF] [restricted]

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

Neomycin, Polymyxin B, and DexamethasoneOutpatient Dosage FormsOintment, Ophthalmic:Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame-thasone 0.1% per g (3.5 g)

Suspension, Ophthalmic [drops]:Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame-thasone 0.1% per 1 mL (5 mL)

Neomycin, Polymyxin B, and GramicidinOutpatient Dosage FormsSolution, Ophthalmic [drops]:Generic: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin0.025 mg per 1 mL (10 mL) [BCF] [restricted]

Neomycin, Polymyxin B, and Hydrocortisone (Otic)Outpatient Dosage FormsSolution, Otic:Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone10 mg per 1 mL (10 mL) [contains potassium metabisulfite]

Suspension, Otic:Cortomycin: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone10 mg per 1 mL (10 mL) [contains thimerosal] [BCF]

Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone10 mg per 1 mL (10 mL) [BCF]

NepafenacOutpatient Dosage FormsSuspension, ophthalmic [drops]:Nevanac®: 0.1% (3 mL) [contains benzalkonium chloride]

NiacinOutpatient Dosage FormsTablet, Oral:Generic: 500 mg

Tablet, Extended Release, Oral:Generic: 500 mg [BCF], 1000 mg [BCF]

NicotineOutpatient Dosage FormsLozenge, Mouth/Throat, as polacrilex:Generic: 2 mg (24 ea); 4 mg (24 ea)

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]

NIFEdipineOutpatient Dosage FormsTablet, Extended Release, Oral:Generic: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF]

NitrofurantoinOutpatient Dosage FormsCapsule, Oral [macrocrystal]:Generic: 50 mg [BCF]

Capsule, Oral [macrocrystal/monohydrate]:Generic: 100 mg [BCF]

Suspension, Oral:Generic: 25 mg/5 mL (230 mL) [restricted]

NitroglycerinOutpatient Dosage FormsPatch 24 Hour, Transdermal:Generic: 0.1 mg/hour (30s) [BCF] [restricted]; 0.2 mg/hour (30s) [BCF];0.4 mg/hour (30s) [BCF]; 0.6 mg/hour (30s) [BCF] [restricted]

Solution, Translingual:Generic: 0.4 mg/spray (12 g) [BCF]

Tablet, Sublingual:Nitrostat: 0.4 mg [BCF]

NorethindroneOutpatient Dosage FormsTablet, Oral:Jolivette: 0.35 mg [BCF]Nora-BE: 0.35 mg [BCF]Generic: 0.35 mg [BCF]

Tablet, Oral, as acetate:Generic: 5 mg [BCF]

NortriptylineOutpatient Dosage FormsCapsule, Oral:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

Nystatin and TriamcinoloneOutpatient Dosage FormsCream: Nystatin 100,000 units and triamcinolone acetonide 0.1% (15 g, 30 g,60 g)

Ointment: Nystatin 100,000 units and triamcinolone acetonide 0.1% (15 g,30 g, 60 g)

Nystatin (Oral)Outpatient Dosage FormsSuspension, oral: 100,000 units/mL (5 mL, 60 mL, 473 mL) [BCF]Tablet, oral: 500,000 units

Nystatin (Topical)Outpatient Dosage FormsCream, External:Generic: 100,000 units/g (15 g) [BCF]

Ointment, External:Generic: 100,000 units/g (15 g)

Powder, External:Generic: 100,000 units/g (15 g)

Ofloxacin (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic [drops]:Generic: 0.3% (5 mL)

Ofloxacin (Otic)Outpatient Dosage FormsSolution, otic [drops]: 0.3% (5 mL, 10 mL)

OLANZapineOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg, 5 mg, 7.5 mg, 10 mg

Olopatadine (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic [drops]:Patanol: 0.1% (5 mL) [contains benzalkonium chloride] [BCF]Pazeo: 0.7% (2.5 mL) [contains benzalkonium chloride]

Omega-3 Fatty AcidsOutpatient Dosage FormsCapsule, Oral:Generic: 1000 mg, 1 g

OmeprazoleOutpatient Dosage FormsCapsule, delayed release, oral: 10 mg [BCF], 20 mg [BCF], 40 mg

OndansetronOutpatient Dosage FormsTablet, Oral:Generic: 4 mg, 8 mg

Tablet Dispersible, Oral:Generic: 4 mg, 8 mg

OXcarbazepineOutpatient Dosage FormsTablet, Oral:Generic: 150 mg, 300 mg, 600 mg

OxybutyninOutpatient Dosage FormsTablet, Oral, as chloride:Generic: 5 mg

MOXIFLOXACIN (OPHTHALMIC)

12

Tablet, Extended Release, Oral, as chloride:Generic: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF]

OxyCODONEOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg

Tablet, controlled release, oral, as hydrochloride:OxyCONTIN: 10 mg, 15 mg, 20 mg, 30 mg, 60 mg, 80 mgGeneric: 40 mg

Oxycodone and AcetaminophenOutpatient Dosage FormsTablet, oral:5/325: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg [BCF]7.5/325: Oxycodone hydrochloride 10 mg and acetaminophen 325 mg10/325: Oxycodone hydrochloride 10 mg and acetaminophen 325 mg

Oxymetazoline (Nasal)Outpatient Dosage FormsSolution, Intranasal, as hydrochloride [spray]:Generic: 0.05% (15 mL)

PalivizumabOutpatient Dosage FormsSolution, Intramuscular [preservative free]:Synagis: 50 mg/0.5 mL (0.5 mL) [contains glycine, histidine]Synagis: 100 mg/mL (1 mL)

PancrelipaseOutpatient Dosage FormsCapsule, Delayed Release, Enteric Coated Microspheres, Oral [porcinederived]:Creon: Lipase 3000 USP units, protease 9500 USP units, and amylase 15,000USP units [BCF] [restricted]

Creon: Lipase 6000 USP units, protease 19,000 USP units, and amylase30,000 USP units [BCF] [restricted]

Creon: Lipase 12,000 USP units, protease 38,000 USP units, and amylase60,000 USP units [BCF] [restricted]

Creon: Lipase 24,000 USP units, protease 76,000 USP units, and amylase120,000 USP units [BCF]

Creon: Lipase 36,000 USP units, protease 114,000 USP units, and amylase180,000 USP units [BCF] [restricted]

PantoprazoleOutpatient Dosage FormsTablet, delayed release, oral: 20 mg, 40 mg

PARoxetineOutpatient Dosage FormsTablet, Oral, as hydrochloride [strength expressed as base]:Generic: 10 mg, 20 mg, 30 mg, 40 mg

Penicillin V PotassiumOutpatient Dosage FormsSolution Reconstituted, Oral:Generic: 250 mg/5 mL (200 mL) [BCF]

Tablet, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

PentoxifyllineOutpatient Dosage FormsTablet, Extended Release, Oral:Generic: 400 mg

PermethrinOutpatient Dosage FormsCream, External:Generic: 5% (60 g) [BCF]

PhenazopyridineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 100 mg [BCF]

PHENobarbitalOutpatient Dosage FormsElixir, Oral:Generic: 20 mg/5 mL (473 mL) [BCF] [restricted]

Tablet, Oral:Generic: 32.4 mg

PhenytoinOutpatient Dosage FormsCapsule, Extended Release, Oral, as sodium:Generic: 100 mg [BCF]

Suspension, Oral:Generic: 125 mg/5 mL (237 mL) [BCF] [restricted]

Tablet Chewable, Oral:Generic: 50 mg [BCF]

Pilocarpine (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as hydrochloride [drops]:Generic: 1% (15 mL) [BCF]; 2% (15 mL) [BCF]; 4% (15 mL) [BCF]

Pilocarpine (Systemic)Outpatient Dosage FormsTablet, oral, as hydrochloride: 5 mgSalagen®: 5 mg

PimecrolimusOutpatient Dosage FormsCream, External:Elidel: 1% (30 g) [BCF] [contains benzyl alcohol]

PioglitazoneOutpatient Dosage FormsTablet, Oral:Generic: 15 mg, 30 mg, 45 mg

PodofiloxOutpatient Dosage FormsSolution, External:Generic: 0.5% (3.5 mL)

Polyethylene Glycol 3350Outpatient Dosage FormsPowder, Oral:Generic: 17 g/dose (510 g)

Polyethylene Glycol-Electrolyte SolutionOutpatient Dosage FormsPowder, for Solution, Oral:Generic: PEG 3350 240 g, sodium sulfate 22.72 g, sodium bicarbonate6.72 g, sodium chloride 5.84 g, and potassium chloride 2.98 g (4000 mL)

Potassium ChlorideOutpatient Dosage FormsSolution, Oral:Generic: 20 mEq/15 mL (473 mL) [BCF]

Tablet, Extended Release, Oral:Generic: 10 mEq [BCF]

Tablet, Extended Release, Microencapsulated, Oral:Generic: 20 mEq [BCF]

Potassium CitrateOutpatient Dosage FormsTablet, Extended Release, Oral:Urocit-K: 540 mg [5 mEq]Urocit-K: 1080 mg [10 mEq]

PramipexoleOutpatient Dosage FormsTablet, Oral, as dihydrochloride monohydrate:Generic: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 1.5 mg

Pramoxine and HydrocortisoneOutpatient Dosage FormsAerosol, foam, rectal:ProctoFoam® HC: Pramoxine hydrochloride 1% and hydrocortisone acetate1% (10 g)

PravastatinOutpatient Dosage FormsTablet, Oral, as sodium:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]

PrazosinOutpatient Dosage FormsCapsule, Oral:Generic: 1 mg, 2 mg, 5 mg

PrednisoLONE (Ophthalmic)Outpatient Dosage FormsSuspension, Ophthalmic, as acetate [drops]:Generic: 1% (5 mL) [BCF]

PrednisoLONE (Systemic)Outpatient Dosage FormsSolution, Oral, as sodium phosphate [strength expressed as base]:Generic: 15 mg/5 mL (237 mL) [BCF]

PredniSONEOutpatient Dosage FormsTablet, Oral:Generic: 1 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 50 mg

PrimaquineOutpatient Dosage FormsTablet, oral, as phosphate: 26.3 mg [15 mg base]

PRIMAQUINE

13

PrimidoneOutpatient Dosage FormsTablet, Oral:Generic: 50 mg, 250 mg

ProbenecidOutpatient Dosage FormsTablet, oral: 500 mg [BCF]

ProchlorperazineOutpatient Dosage FormsTablet, Oral, as maleate [strength expressed as base]:Generic: 5 mg, 10 mg

ProgesteroneOutpatient Dosage FormsCapsule, Oral [micronized]:Generic: 100 mg

PromethazineOutpatient Dosage FormsSuppository, Rectal, as hydrochloride:Generic: 25 mg (12s) [BCF]

Syrup, Oral, as hydrochloride:Generic: 6.25 mg/5 mL (473 mL) [BCF] [restricted]

Tablet, Oral, as hydrochloride:Generic: 25 mg [BCF]

Promethazine and CodeineOutpatient Dosage FormsSyrup, Oral:Generic: Promethazine hydrochloride 6.25 mg and codeine phosphate 10 mgper 5 mL (118 mL)

PropafenoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 150 mg

PropranololOutpatient Dosage FormsCapsule, Sustained Release, Oral, as hydrochloride:Generic: 60 mg, 80 mg, 120 mg

Tablet, Oral, as hydrochloride:Generic: 10 mg, 20 mg, 40 mg

PropylthiouracilOutpatient Dosage FormsTablet, oral: 50 mg [BCF]

PseudoephedrineOutpatient Dosage FormsTablet, Oral, as hydrochloride:SudoGest: 30 mg

Tablet, Extended Release, Oral, as hydrochloride:SudoGest 12 Hour: 120 mg

PyridoxineOutpatient Dosage FormsTablet, oral, as hydrochloride: 50 mg

QUEtiapineOutpatient Dosage FormsTablet, Oral:Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF]

Tablet, Extended Release, Oral:SEROquel XR: 50 mg [BCF]SEROquel XR: 150 mg [BCF], 200 mg [BCF], 300 mg [BCF], 400 mg [BCF][restricted]

RABEprazoleOutpatient Dosage FormsTablet Delayed Release, Oral, as sodium:Generic: 20 mg

RaloxifeneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 60 mg [BCF]

RamiprilOutpatient Dosage FormsCapsule, Oral:Generic: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF][restricted]

RaNITIdineOutpatient Dosage FormsSyrup, oral: 15 mg/mL (473 mL) [BCF]Tablet, oral: 150 mg [BCF], 300 mg

RifAMPinOutpatient Dosage FormsCapsule, Oral:Generic: 300 mg [BCF]

RifAXIMinOutpatient Dosage FormsTablet, oral:Xifaxan®: 550 mg

RisperiDONEOutpatient Dosage FormsTablet, Oral:Generic: 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF], 3 mg [BCF]

RivaroxabanOutpatient Dosage FormsTablet, oral:Xarelto: 10 mg, 15 mg, 20 mg

RivastigmineOutpatient Dosage FormsPatch 24 Hour, Transdermal:Generic: 4.6 mg/24 hr (30 ea); 9.5 mg/24 hr (30 ea)

RizatriptanOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF]

Tablet Dispersible, Oral:Generic: 5 mg [BCF], 10 mg [BCF]

ROPINIRoleOutpatient Dosage FormsTablet, Oral:Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg

RosuvastatinOutpatient Dosage FormsTablet, Oral:Generic: 5 mg, 10 mg, 20 mg, 40 mg

Salicylic AcidOutpatient Dosage FormsGel, External:Sal-Plant: 17% (14 g)

SalmeterolOutpatient Dosage FormsAerosol Powder Breath Activated, Inhalation:Serevent Diskus: 50 mcg (60 ea) [contains lactose] [BCF]

SalsalateOutpatient Dosage FormsTablet, oral: 500 mg [BCF], 750 mg [BCF]

Scopolamine (Systemic)Outpatient Dosage FormsPatch 72 Hour, Transdermal:Transderm-Scop (1.5 MG): 1 MG/3DAYS (24 ea)

Selenium SulfideOutpatient Dosage FormsLotion, External:Generic: 2.5% (120 mL) [BCF]

SertralineOutpatient Dosage FormsSolution, Oral [concentrate]:Generic: 20 mg/mL (60 mL) [BCF] [restricted]

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

SildenafilOutpatient Dosage FormsTablet, oral:Viagra®: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Silver SulfadiazineOutpatient Dosage FormsCream, External:Generic: 1% (50 g) [BCF]

SimvastatinOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg

PRIMIDONE

14

SITagliptinOutpatient Dosage FormsTablet, oral:Januvia®: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Sitagliptin and MetforminOutpatient Dosage FormsTablet, Oral:Janumet 50/500: Sitagliptin 50 mg and metformin hydrochloride500 mg [BCF]

Janumet 50/1000: Sitagliptin 50 mg and metformin hydrochloride1000 mg [BCF]

Tablet, Extended Release, Oal:Janumet XR: 50/500: Sitagliptin 50 mg [immediate release] and metforminhydrochloride 500 mg [extended release] [BCF]

Janumet XR: 50/1000: Sitagliptin 50 mg and metformin hydrochloride1000 mg [BCF]

Janumet XR: 100/1000: Sitagliptin 100 mg and metformin hydrochloride1000 mg [BCF]

Sodium ChlorideOutpatient Dosage FormsOintment, Ophthalmic:Generic: 5% (3.5 g)

Solution, Intranasal [spray]:Deep Sea Nasal Spray: 0.65% (44 mL)

Solution, Ophthalmic [drops]:Generic: 5% (15 mL)

Sodium Sulfate, Potassium Sulfate, and Magnesium SulfateOutpatient Dosage FormsSolution, oral:Suprep® Bowel Prep Kit: Sodium sulfate 17.5 g, potassium sulfate 3.13 g, andmagnesuim sulfate 1.6 g per 180 mL (180 mL) [contains sodium benzoate]

SolifenacinOutpatient Dosage FormsTablet, oral, as succinate:VESIcare®: 5 mg, 10 mg

SotalolOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 80 mg

SpironolactoneOutpatient Dosage FormsTablet, Oral:Generic: 25 mg [BCF], 50 mg

SucralfateOutpatient Dosage FormsTablet, Oral:Generic: 1 g

Sulfacetamide (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as sodium [drops]:Bleph-10: 10% (5 mL) [contains benzalkonium chloride] [BCF]

Sulfamethoxazole and TrimethoprimOutpatient Dosage FormsSuspension, Oral:Generic: Sulfamethoxazole 200 mg and trimethoprim 40 mg per 5 mL(480 mL)

Tablet, Oral:Generic: Sulfamethoxazole 400 mg and trimethoprim 80 mg [BCF]

Tablet, Double Strength, Oral:Generic: Sulamethoxazole 800 mg and trimethoprim 160 mg [BCF]

SulfaSALAzineOutpatient Dosage FormsTablet, Oral:Generic: 500 mg [scored] [BCF]

Tablet, Delayed Release, Enteric Coated, Oral:Generic: 500 mg [BCF]

SulindacOutpatient Dosage FormsTablet, Oral:Generic: 150 mg, 200 mg [scored]

SUMAtriptanOutpatient Dosage FormsSolution, Injection, as succinate [strength expressed as base]:Generic: 6 mg/0.5 mL (0.5 mL) [BCF]

Solution, Intranasal [spray]:Generic: 20 mg/0.1 mL (6 ea)

Tablet, Oral, as succinate [strength expressed as base]:Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Tacrolimus (Topical)Outpatient Dosage FormsOintment, External:Generic: 0.1% (60 g)

TamoxifenOutpatient Dosage FormsTablet, oral: 10 mg [BCF]

TamsulosinOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 0.4 mg [BCF]

TelmisartanOutpatient Dosage FormsTablet, Oral:Micardis: 20 mg, 40 mg, 80 mgGeneric: 20 mg, 40 mg, 80 mg

Telmisartan and HydrochlorothiazideOutpatient Dosage FormsTablet, oral:Micardis HCT: 40/12.5: Telmisartan 40 mg and hydrochlorothiazide 12.5 mgMicardis HCT: 80/12.5: Telmisartan 80 mg and hydrochlorothiazide 12.5 mgMicardis HCT: 80/25: Telmisartan 80 mg and hydrochlorothiazide 25 mg

TemazepamOutpatient Dosage FormsCapsule, Oral:Generic: 15 mg [BCF], 30 mg [BCF]

TerazosinOutpatient Dosage FormsCapsule, oral: 1 mg [BCF], 2 mg [BCF], 5 mg [BCF], 10 mg [BCF]

Terbinafine (Systemic)Outpatient Dosage FormsTablet, OralGeneric: 250 mg

TerconazoleOutpatient Dosage FormsCream, Vaginal:Generic: 0.4% (45 g); 0.8% (20 g)

TestosteroneOutpatient Dosage FormsGel, External:Fortesta: 10 mg/actuation (60 g) [contains ethanol; 0.5 g gel/actuation; 120metered actuations] [BCF]

Injection, Oil, as cypionate:Generic:: 200 mg/mL (1 mL)

Tetracycline (Systemic)Outpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 250 mg [BCF], 500 mg [BCF] [restricted]

TheophyllineOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral:Theo-24: 200 mg [contains fd&c yellow #10 (quinoline yellow)]

Solution, Oral:Elixophyllin Elixir: 80 mg/15 mL (473 mL) [contains ethanol 20%; mixed fruitflavor] [BCF] [restricted]

Tablet Extended Release 12 Hour, Oral:Generic: 200 mg [BCF], 300 mg [BCF] [restricted]

Tablet Extended Release 24 Hour, Oral:Generic: 400 mg [restricted]

Thyroid, DesiccatedOutpatient Dosage FormsTablet, oral:Armour® Thyroid: 15 mg, 30 mg, 60 mg, 90 mg

Timolol (Ophthalmic)Outpatient Dosage FormsGel Forming Solution, Ophthalmic, as maleate [strength expressed as base,drops]:Generic: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF] [restricted]

Solution, Ophthalmic, as maleate [strength expressed as base, drops]:Generic: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF]

TiotropiumOutpatient Dosage FormsAerosol Solution, Inhalation:Spiriva Respimat: 2.5 mcg/actuation (4 g) [contains benzalkonium chloride,disodium edta]

TIOTROPIUM

15

Powder, for Oral Inhalation:Spiriva HandiHaler: 18 mcg/capsule (30 ea) [contains lactose] [BCF]

TiZANidineOutpatient Dosage FormsTablet, oral: 2 mg, 4 mgZanaflex®: 4 mg [scored]

Tobramycin and DexamethasoneOutpatient Dosage FormsOintment, Ophthalmic:TobraDex: Tobramycin 0.3% and dexamethasone 0.1% (3.5 g) [containschlorobutanol]

Suspension, Ophthalmic:Generic: Tobramycin 0.3% and dexamethasone 0.1% (5 mL)

Tobramycin (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic [drops]:Generic: 0.3% (5 mL)

TolterodineOutpatient Dosage FormsCapsule, extended release, oral, as tartrate:Detrol® LA: 2 mg [BCF], 4 mg [BCF]

TopiramateOutpatient Dosage FormsTablet, Oral:Generic: 25 mg, 50 mg, 100 mg

TraMADolOutpatient Dosage FormsTablet, oral, as hydrochloride: 50 mg [BCF]Ultram®: 50 mg [scored] [BCF]

TraZODoneOutpatient Dosage FormsTablet, oral, as hydrochloride: 50 mg [BCF], 100 mg [BCF], 150 mg [BCF]

Tretinoin (Topical)Outpatient Dosage FormsCream, External:Generic: 0.025% (20 g) [BCF]; 0.05% (20 g) [BCF]; 0.1% (45 g)

Gel, External:Generic: 0.025% (15 g)

Triamcinolone (Topical)Outpatient Dosage FormsCream, External, as acetonide:Generic: 0.025% (15 g); 0.1% (15 g, 80 g, 454 g) [BCF]; 0.5% (15 g)

Ointment, External, as acetonide:Generic: 0.025% (15 g, 454 g); 0.1% (15 g, 80 g, 454 g); 0.5% (15 g)

Paste, Oral External, as acetonide:Generic: 0.1% (5 g)

TriazolamOutpatient Dosage FormsTablet, Oral:Generic: 0.25 mg

TrihexyphenidylOutpatient Dosage FormsElixir, oral, as hydrochloride: 2 mg/5 mL (473 mL) [BCF] [restricted]Tablet, oral, as hydrochloride: 2 mg [BCF] [restricted]

Trimethoprim and Polymyxin BOutpatient Dosage FormsSolution, Ophthalmic [drops]:Generic: Trimethoprim 1 mg and polymyxin B sulfate 10,000 units per 1 mL(10 mL) [BCF]

TrospiumOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as chloride:Generic: 60 mg

Tablet, Oral, as chloride:Generic: 20 mg

Urea (Topical)Outpatient Dosage FormsCream, External:Generic: 40% (85 g)

ValACYclovirOutpatient Dosage FormsTablet, oral: 500 mg, 1 g

Valproic Acid and DerivativesOutpatient Dosage FormsCapsule Sprinkle, Oral, as divalproex sodium:Generic: 125 mg [BCF]

Tablet Delayed Release, Oral, as divalproex sodium:Generic: 125 mg [BCF], 250 mg [BCF], 500 mg [BCF]

Tablet Extended Release 24 Hour, Oral, as divalproex sodium:Generic: 250 mg [BCF], 500 mg [BCF]

ValsartanOutpatient Dosage FormsTablet, Oral:Generic: 40 mg [BCF], 80 mg [BCF], 160 mg [BCF], 320 mg [BCF]

Valsartan and HydrochlorothiazideOutpatient Dosage FormsTablet, Oral:80 mg/12.5 mg: Valsartan 80 mg and hydrochlorothiazide 12.5 mg [BCF]160 mg/12.5 mg: Valsartan 160 mg and hydrochlorothiazide 12.5 mg [BCF]160 mg/25 mg: Valsartan 160 mg and hydrochlorothiazide 25 mg [BCF]320 mg/12.5 mg: Valsartan 320 mg and hydrochlorothiazide 12.5 mg [BCF]320 mg/25 mg: Valsartan 320 mg and hydrochlorothiazide 25 mg [BCF]

VareniclineOutpatient Dosage FormsTablet, Oral:Chantix: 0.5 mg

VenlafaxineOutpatient Dosage FormsCapsule, Extended Release, Oral:Generic: 37.5 mg [BCF], 75 mg [BCF], 150 mg [BCF]

Tablet, Oral:Generic: 37.5 mg [BCF], 75 mg [BCF]

VerapamilOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 80 mg, 120 mg

Tablet, Extended Release, Oral, as hydrochloride:Generic: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF]

Vitamins (Multiple/Oral)Outpatient Dosage FormsContent varies depending on product used.

Vitamins (Multiple/Pediatric)Outpatient Dosage FormsContent varies depending on product used.Solution, oral [drops]: 50 mLSolution, oral [drops, with iron]: 50 mL

Vitamins (Multiple/Prenatal)Outpatient Dosage FormsContent varies depending on product used.Tablet, oral [BCF]

WarfarinOutpatient Dosage FormsTablet, 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]

ZaleplonOutpatient Dosage FormsCapsule, oral: 5 mg, 10 mg

ZiprasidoneOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 40 mg, 60 mg

ZOLMitriptanOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg, 5 mg

Tablet Dispersible, Oral:Generic: 2.5 mg, 5 mg

ZolpidemOutpatient Dosage FormsTablet, Oral, as tartrate:Generic: 5 mg [BCF], 10 mg [BCF]

Tablet, Extended Release, Oral, as tartrate:Generic: 6.25 mg, 12.5 mg

TIOTROPIUM

16

Therapeutic Category Index

17

Acetylcholinesterase Inhibitor (Central)Donepezil ..................................................................................................6Rivastigmine ...........................................................................................14

Acne ProductsBenzoyl Peroxide ..................................................................................... 3Clindamycin and Benzoyl Peroxide ......................................................... 4Erythromycin (Topical) ..............................................................................6ISOtretinoin (Systemic) .......................................................................... 10Salicylic Acid .......................................................................................... 14Tretinoin (Topical) ...................................................................................16

Adrenergic Agonist AgentOxymetazoline (Nasal) ...........................................................................13

Aldehyde Dehydrogenase InhibitorDisulfiram ..................................................................................................6

Alkalinizing Agent, OralPotassium Citrate ...................................................................................13

Alpha1 AgonistMidodrine ................................................................................................11

Alpha1 BlockerAlfuzosin ...................................................................................................2Doxazosin .................................................................................................6Prazosin ..................................................................................................13Tamsulosin ............................................................................................. 15Terazosin ................................................................................................ 15

Alpha2-Adrenergic AgonistCloNIDine ................................................................................................. 4GuanFACINE ............................................................................................8TiZANidine ..............................................................................................16

Alpha2 Agonist, OphthalmicBrimonidine and Timolol ...........................................................................3Brimonidine (Ophthalmic) .........................................................................3

Alpha/Beta AgonistEPINEPHrine (Systemic) ..........................................................................6Pseudoephedrine ................................................................................... 14

5 Alpha-Reductase InhibitorFinasteride ................................................................................................7

AmebicideMetroNIDAZOLE (Systemic) .................................................................. 11

Aminoquinoline (Antimalarial)Hydroxychloroquine ..................................................................................9Primaquine ............................................................................................. 13

5-Aminosalicylic Acid DerivativeMesalamine ............................................................................................ 11SulfaSALAzine ........................................................................................15

Ammonium DetoxicantLactulose ................................................................................................ 10

Analgesic Combination (Opioid)Acetaminophen and Codeine ...................................................................2Hydrocodone and Acetaminophen ...........................................................9Hydrocodone and Ibuprofen .................................................................... 9Oxycodone and Acetaminophen ............................................................13

Analgesic, NonopioidAcetaminophen .........................................................................................2Aspirin .......................................................................................................2Butalbital, Acetaminophen, and Caffeine .................................................3Celecoxib ..................................................................................................4Diclofenac (Systemic) ...............................................................................5Etodolac ....................................................................................................7Ibuprofen .................................................................................................. 9Indomethacin ............................................................................................9Ketorolac (Systemic) .............................................................................. 10Meloxicam ...............................................................................................11Naproxen ................................................................................................12Sulindac ..................................................................................................15

Analgesic, OpioidAcetaminophen and Codeine ...................................................................2Hydrocodone and Acetaminophen ...........................................................9HYDROmorphone .................................................................................... 9Methadone ..............................................................................................11Morphine (Systemic) ...............................................................................11OxyCODONE ......................................................................................... 13Oxycodone and Acetaminophen ............................................................13Promethazine and Codeine ................................................................... 14TraMADol ............................................................................................... 16

Analgesic, TopicalBenzocaine ...............................................................................................3Lidocaine (Topical) ................................................................................. 10

Analgesic, UrinaryPhenazopyridine .....................................................................................13

AndrogenTestosterone ...........................................................................................15

Anesthetic/CorticosteroidPramoxine and Hydrocortisone ..............................................................13

Angiotensin II Receptor BlockerLosartan ..................................................................................................10Losartan and Hydrochlorothiazide ..........................................................11Telmisartan ............................................................................................. 15Telmisartan and Hydrochlorothiazide .....................................................15Valsartan .................................................................................................16Valsartan and Hydrochlorothiazide ........................................................ 16

Angiotensin-Converting Enzyme (ACE) InhibitorAmlodipine and Benazepril ...................................................................... 2Captopril ................................................................................................... 3Fosinopril ..................................................................................................8Lisinopril ................................................................................................. 10Lisinopril and Hydrochlorothiazide ......................................................... 10Ramipril .................................................................................................. 14

AnthelminticAlbendazole ..............................................................................................2

Antianginal AgentAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 2Atenolol .....................................................................................................3DilTIAZem .................................................................................................5Isosorbide Dinitrate ................................................................................ 10Isosorbide Mononitrate ...........................................................................10Metoprolol ...............................................................................................11NIFEdipine ..............................................................................................12Nitroglycerin ............................................................................................12Propranolol ............................................................................................. 14Verapamil ............................................................................................... 16

Antianxiety Agent, MiscellaneousBusPIRone ............................................................................................... 3

Antiarrhythmic Agent, Class IcPropafenone ...........................................................................................14

Antiarrhythmic Agent, Class IIPropranolol ............................................................................................. 14Sotalol .....................................................................................................15

Antiarrhythmic Agent, Class IIIAmiodarone .............................................................................................. 2Dronedarone .............................................................................................6Sotalol .....................................................................................................15

Antiarrhythmic Agent, Class IVDilTIAZem .................................................................................................5Verapamil ............................................................................................... 16

Antiarrhythmic Agent, MiscellaneousDigoxin ......................................................................................................5

Antibiotic, AminoglycosideGentamicin (Ophthalmic) ..........................................................................8Tobramycin (Ophthalmic) ....................................................................... 16

Antibiotic, Cephalosporin (First Generation)Cephalexin ................................................................................................4

Antibiotic, Cephalosporin (Second Generation)Cefprozil ................................................................................................... 4Cefuroxime ............................................................................................... 4

Antibiotic, Cephalosporin (Third Generation)Cefdinir ..................................................................................................... 4

Antibiotic/Corticosteroid, OphthalmicNeomycin, Polymyxin B, and Dexamethasone ......................................12Tobramycin and Dexamethasone .......................................................... 16

Antibiotic/Corticosteroid, OticNeomycin, Polymyxin B, and Hydrocortisone (Otic) ..............................12

Antibiotic, FluoroquinoloneCiprofloxacin (Ophthalmic) .......................................................................4Ciprofloxacin (Systemic) ...........................................................................4LevoFLOXacin (Systemic) ......................................................................10Moxifloxacin (Ophthalmic) ......................................................................12

ACETYLCHOLINESTERASE INHIBITOR (CENTRAL)

18

Ofloxacin (Ophthalmic) ...........................................................................12Ofloxacin (Otic) .......................................................................................12

Antibiotic, LincosamideClindamycin (Systemic) ............................................................................4Clindamycin (Topical) ............................................................................... 4

Antibiotic, MacrolideAzithromycin (Systemic) ...........................................................................3Clarithromycin ...........................................................................................4Erythromycin (Ophthalmic) .......................................................................6Erythromycin (Systemic) .......................................................................... 6Erythromycin (Topical) ..............................................................................6

Antibiotic, MiscellaneousFosfomycin ............................................................................................... 8MetroNIDAZOLE (Systemic) .................................................................. 11Nitrofurantoin ..........................................................................................12Sulfamethoxazole and Trimethoprim ..................................................... 15

Antibiotic, OphthalmicBacitracin and Polymyxin B (Ophthalmic) ................................................3Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) ............................ 3Bacitracin (Ophthalmic) ............................................................................3Ciprofloxacin (Ophthalmic) .......................................................................4Erythromycin (Ophthalmic) .......................................................................6Gentamicin (Ophthalmic) ..........................................................................8Moxifloxacin (Ophthalmic) ......................................................................12Neomycin, Polymyxin B, and Gramicidin ...............................................12Ofloxacin (Ophthalmic) ...........................................................................12Sulfacetamide (Ophthalmic) ...................................................................15Tobramycin (Ophthalmic) ....................................................................... 16Trimethoprim and Polymyxin B .............................................................. 16

Antibiotic, Oral RinseChlorhexidine Gluconate (Oral) ............................................................... 4

Antibiotic, OticNeomycin, Polymyxin B, and Hydrocortisone (Otic) ..............................12Ofloxacin (Otic) .......................................................................................12

Antibiotic, PenicillinAmoxicillin .................................................................................................2Amoxicillin and Clavulanate ..................................................................... 2Dicloxacillin ...............................................................................................5Penicillin V Potassium ............................................................................13

Antibiotic, Respiratory FluoroquinoloneLevoFLOXacin (Systemic) ......................................................................10

Antibiotic, Sulfonamide DerivativeSulfamethoxazole and Trimethoprim ..................................................... 15

Antibiotic, Tetracycline DerivativeDoxycycline .............................................................................................. 6Minocycline (Systemic) ...........................................................................11Tetracycline (Systemic) .......................................................................... 15

Antibiotic, TopicalErythromycin (Topical) ..............................................................................6MetroNIDAZOLE (Topical) ......................................................................11Mupirocin ................................................................................................12Silver Sulfadiazine ..................................................................................14

Anticholinergic AgentBenztropine .............................................................................................. 3Dicyclomine .............................................................................................. 5Hyoscyamine ............................................................................................9Ipratropium and Albuterol .........................................................................9Ipratropium (Nasal) ...................................................................................9Ipratropium (Oral Inhalation) .................................................................... 9Scopolamine (Systemic) .........................................................................14Solifenacin ..............................................................................................15Tiotropium ...............................................................................................15Tolterodine ..............................................................................................16Trihexyphenidyl ...................................................................................... 16Trospium .................................................................................................16

Anticholinergic Agent, Long-ActingTiotropium ...............................................................................................15

AnticoagulantApixaban ...................................................................................................2Dabigatran Etexilate .................................................................................5Enoxaparin ............................................................................................... 6Rivaroxaban ........................................................................................... 14Warfarin .................................................................................................. 16

Anticoagulant, Direct Thrombin InhibitorDabigatran Etexilate .................................................................................5

Anticoagulant, Factor Xa InhibitorApixaban ...................................................................................................2Rivaroxaban ........................................................................................... 14

Anticoagulant, Low Molecular Weight HeparinEnoxaparin ............................................................................................... 6

Anticoagulant, Vitamin K AntagonistWarfarin .................................................................................................. 16

Anticonvulsant, BarbituratePHENobarbital ........................................................................................13

Anticonvulsant, BenzodiazepineClonazePAM .............................................................................................4DiazePAM .................................................................................................5LORazepam ........................................................................................... 10

Anticonvulsant, HydantoinPhenytoin ................................................................................................13

Anticonvulsant, MiscellaneousAcetaZOLAMIDE ......................................................................................2CarBAMazepine ....................................................................................... 4Gabapentin ...............................................................................................8LamoTRIgine ..........................................................................................10LevETIRAcetam ..................................................................................... 10OXcarbazepine .......................................................................................12Primidone ............................................................................................... 14Topiramate ..............................................................................................16Valproic Acid and Derivatives ................................................................ 16

Antidepressant, Alpha-2 AntagonistMirtazapine ............................................................................................. 11

Antidepressant, Dopamine/Norepinephrine-Reuptake InhibitorBuPROPion .............................................................................................. 3

Antidepressant, Selective Serotonin Reuptake InhibitorCitalopram ................................................................................................ 4Escitalopram .............................................................................................6FLUoxetine ............................................................................................... 8PARoxetine .............................................................................................13Sertraline ................................................................................................ 14

Antidepressant, Serotonin/Norepinephrine Reuptake InhibitorDULoxetine ...............................................................................................6Venlafaxine .............................................................................................16

Antidepressant, Serotonin Reuptake Inhibitor/AntagonistTraZODone .............................................................................................16

Antidepressant, Tricyclic (Secondary Amine)Desipramine ............................................................................................. 5Nortriptyline ............................................................................................ 12

Antidepressant, Tricyclic (Tertiary Amine)Amitriptyline ..............................................................................................2Doxepin (Systemic) .................................................................................. 6Imipramine ................................................................................................9

Antidiabetic Agent, BiguanideGlyburide and Metformin ..........................................................................8MetFORMIN ............................................................................................11Sitagliptin and Metformin ....................................................................... 15

Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) InhibitorSITagliptin ...............................................................................................15Sitagliptin and Metformin ....................................................................... 15

Antidiabetic Agent, Glucagon-Like Peptide-1 (GLP-1) ReceptorAgonist

Dulaglutide ................................................................................................6Exenatide ..................................................................................................7

Antidiabetic Agent, Sodium-Glucose Cotransporter 2 (SGLT2)Inhibitor

Empagliflozin ............................................................................................ 6

Antidiabetic Agent, SulfonylureaGlimepiride ............................................................................................... 8GlipiZIDE .................................................................................................. 8GlyBURIDE ...............................................................................................8Glyburide and Metformin ..........................................................................8

Antidiabetic Agent, ThiazolidinedionePioglitazone ............................................................................................13

AntidiarrhealDiphenoxylate and Atropine .....................................................................6Loperamide .............................................................................................10

AntidoteCalcitonin ..................................................................................................3

ANTIDOTE

19

Glucagon .................................................................................................. 8Naloxone ................................................................................................ 12

Antidote, ExtravasationNitroglycerin ............................................................................................12

Antidote, HypoglycemiaGlucagon .................................................................................................. 8

AntiemeticDexAMETHasone (Systemic) ...................................................................5HydrOXYzine ............................................................................................9Metoclopramide ...................................................................................... 11Ondansetron ...........................................................................................12Prochlorperazine .................................................................................... 14Promethazine ......................................................................................... 14

Antifungal Agent, Azole DerivativeItraconazole ............................................................................................10Terconazole ............................................................................................ 15

Antifungal Agent, Imidazole DerivativeClotrimazole (Oral) ................................................................................... 4Clotrimazole (Topical) ...............................................................................5Ketoconazole (Topical) ...........................................................................10

Antifungal Agent, OralFluconazole .............................................................................................. 7Griseofulvin ...............................................................................................8Itraconazole ............................................................................................10Terbinafine (Systemic) ............................................................................15

Antifungal Agent, Oral NonabsorbedClotrimazole (Oral) ................................................................................... 4

Antifungal Agent, Oral Nonabsorbed/Partially AbsorbedClotrimazole (Topical) ...............................................................................5Nystatin (Oral) ........................................................................................ 12

Antifungal Agent, ParenteralFluconazole .............................................................................................. 7

Antifungal Agent, TopicalBetamethasone and Clotrimazole ............................................................3Ciclopirox ..................................................................................................4Clotrimazole (Topical) ...............................................................................5Ketoconazole (Topical) ...........................................................................10Nystatin and Triamcinolone ....................................................................12Nystatin (Topical) ....................................................................................12

Antifungal Agent, VaginalClotrimazole (Topical) ...............................................................................5Terconazole ............................................................................................ 15

Antigout AgentAllopurinol .................................................................................................2Colchicine .................................................................................................5

Antihemophilic AgentDesmopressin ...........................................................................................5

Antihemorrhoidal AgentHydrocortisone (Topical) .......................................................................... 9

AntihypertensiveAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 2Atenolol .....................................................................................................3Captopril ................................................................................................... 3Carvedilol ..................................................................................................4Chlorthalidone .......................................................................................... 4CloNIDine ................................................................................................. 4DilTIAZem .................................................................................................5Doxazosin .................................................................................................6Felodipine .................................................................................................7Fosinopril ..................................................................................................8Furosemide ...............................................................................................8GuanFACINE ............................................................................................8HydrALAZINE ...........................................................................................8HydroCHLOROthiazide ............................................................................ 9Hydrochlorothiazide and Triamterene ...................................................... 9Labetalol .................................................................................................10Lisinopril ................................................................................................. 10Lisinopril and Hydrochlorothiazide ......................................................... 10Losartan ..................................................................................................10Losartan and Hydrochlorothiazide ..........................................................11Metoprolol ...............................................................................................11NIFEdipine ..............................................................................................12Prazosin ..................................................................................................13Propranolol ............................................................................................. 14Ramipril .................................................................................................. 14Spironolactone ....................................................................................... 15

Telmisartan ............................................................................................. 15Telmisartan and Hydrochlorothiazide .....................................................15Terazosin ................................................................................................ 15Valsartan .................................................................................................16Valsartan and Hydrochlorothiazide ........................................................ 16Verapamil ............................................................................................... 16

Anti-inflammatory AgentDexAMETHasone (Systemic) ...................................................................5

Antilipemic Agent, 2-AzetidinoneEzetimibe ..................................................................................................7

Antilipemic Agent, Bile Acid SequestrantCholestyramine Resin .............................................................................. 4Colestipol ..................................................................................................5

Antilipemic Agent, Fibric AcidFenofibrate and Derivatives ..................................................................... 7Gemfibrozil ............................................................................................... 8

Antilipemic Agent, HMG-CoA Reductase InhibitorAtorvaSTATin ............................................................................................3Pravastatin ..............................................................................................13Rosuvastatin ...........................................................................................14Simvastatin .............................................................................................14

Antilipemic Agent, MiscellaneousNiacin ......................................................................................................12

Antilipemic Agent, Omega-3 Fatty AcidsOmega-3 Fatty Acids ............................................................................. 12

Antimalarial AgentAtovaquone and Proguanil .......................................................................3Hydroxychloroquine ..................................................................................9Mefloquine .............................................................................................. 11Primaquine ............................................................................................. 13

Antimanic AgentLithium ....................................................................................................10OLANZapine ...........................................................................................12RisperiDONE ..........................................................................................14Valproic Acid and Derivatives ................................................................ 16

Antimigraine AgentEletriptan .................................................................................................. 6Rizatriptan .............................................................................................. 14SUMAtriptan ........................................................................................... 15ZOLMitriptan ...........................................................................................16

Antineoplastic Agent, AntiandrogenBicalutamide .............................................................................................3

Antineoplastic Agent, AntimetaboliteFluorouracil (Topical) ................................................................................8

Antineoplastic Agent, Antimetabolite (Antifolate)Methotrexate ...........................................................................................11

Antineoplastic Agent, Antimetabolite (Pyrimidine Analog)Fluorouracil (Topical) ................................................................................8

Antineoplastic Agent, Aromatase InhibitorAnastrozole ...............................................................................................2Exemestane ..............................................................................................7Letrozole .................................................................................................10

Antineoplastic Agent, Estrogen Receptor AntagonistTamoxifen ............................................................................................... 15

Antineoplastic Agent, HormoneMegestrol ................................................................................................11

Antineoplastic Agent, MiscellaneousHydroxyurea ............................................................................................. 9

Antineoplastic Agent, Retinoic Acid DerivativeISOtretinoin (Systemic) .......................................................................... 10

Antiparasitic Agent, TopicalLindane ...................................................................................................10Permethrin ..............................................................................................13

Anti-Parkinson Agent, AnticholinergicBenztropine .............................................................................................. 3Trihexyphenidyl ...................................................................................... 16

Anti-Parkinson Agent, Decarboxylase InhibitorCarbidopa and Levodopa .........................................................................4

Anti-Parkinson Agent, Dopamine AgonistAmantadine .............................................................................................. 2Pramipexole ............................................................................................13ROPINIRole ............................................................................................14

ANTIDOTE

20

Anti-Parkinson Agent, Dopamine PrecursorCarbidopa and Levodopa .........................................................................4

Antiplatelet AgentAspirin .......................................................................................................2Aspirin and Dipyridamole ......................................................................... 2Clopidogrel ............................................................................................... 4

Antiplatelet Agent, ThienopyridineClopidogrel ............................................................................................... 4

Antiprotozoal, NitroimidazoleMetroNIDAZOLE (Systemic) .................................................................. 11

Antirheumatic, Disease ModifyingAdalimumab ..............................................................................................2Methotrexate ...........................................................................................11

Antiseborrheic Agent, TopicalSelenium Sulfide .................................................................................... 14

Antispasmodic Agent, GastrointestinalClidinium and Chlordiazepoxide .............................................................. 4

Antispasmodic Agent, UrinaryOxybutynin ..............................................................................................12

Antithyroid AgentMethIMAzole ...........................................................................................11Propylthiouracil .......................................................................................14

Antitubercular AgentEthambutol ............................................................................................... 7Isoniazid ................................................................................................... 9RifAMPin .................................................................................................14

AntitussiveBenzonatate ............................................................................................. 3Guaifenesin and Codeine ........................................................................ 8Guaifenesin and Dextromethorphan ........................................................ 8Promethazine and Codeine ................................................................... 14

Antiviral AgentAcyclovir (Systemic) .................................................................................2Amantadine .............................................................................................. 2ValACYclovir ...........................................................................................16

Antiviral Agent, AdamantaneAmantadine .............................................................................................. 2

Antiviral Agent, OralValACYclovir ...........................................................................................16

Antiviral Agent, TopicalAcyclovir (Topical) .................................................................................... 2

Appetite StimulantMegestrol ................................................................................................11

BarbiturateButalbital, Acetaminophen, and Caffeine .................................................3Butalbital, Aspirin, and Caffeine ...............................................................3PHENobarbital ........................................................................................13Primidone ............................................................................................... 14

BenzodiazepineALPRAZolam ............................................................................................2Clidinium and Chlordiazepoxide .............................................................. 4ClonazePAM .............................................................................................4DiazePAM .................................................................................................5LORazepam ........................................................................................... 10Temazepam ............................................................................................15Triazolam ................................................................................................16

Beta2-Adrenergic AgonistIpratropium and Albuterol .........................................................................9

Beta2-Adrenergic Agonist, Long-ActingFluticasone and Salmeterol ..................................................................... 8Salmeterol .............................................................................................. 14

Beta2 AgonistAlbuterol ................................................................................................... 2Fluticasone and Salmeterol ..................................................................... 8Levalbuterol ............................................................................................10Salmeterol .............................................................................................. 14

Beta3 AgonistMirabegron ..............................................................................................11

Beta-Adrenergic Blocker, NonselectiveDorzolamide and Timolol ......................................................................... 6Propranolol ............................................................................................. 14Sotalol .....................................................................................................15

Beta-Blocker, Beta-1 SelectiveAtenolol .....................................................................................................3Metoprolol ...............................................................................................11

Beta-Blocker, NonselectiveBrimonidine and Timolol ...........................................................................3Timolol (Ophthalmic) .............................................................................. 15

Beta-Blocker With Alpha-Blocking ActivityCarvedilol ..................................................................................................4Labetalol .................................................................................................10

Bisphosphonate DerivativeAlendronate .............................................................................................. 2Ibandronate .............................................................................................. 9

Blood Viscosity Reducer AgentPentoxifylline .......................................................................................... 13

Calcineurin InhibitorCycloSPORINE (Ophthalmic) ...................................................................5Pimecrolimus ..........................................................................................13Tacrolimus (Topical) ............................................................................... 15

Calcium Channel BlockerAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 2DilTIAZem .................................................................................................5Felodipine .................................................................................................7NIFEdipine ..............................................................................................12Verapamil ............................................................................................... 16

Calcium Channel Blocker, DihydropyridineAmLODIPine .............................................................................................2Amlodipine and Benazepril ...................................................................... 2Felodipine .................................................................................................7NIFEdipine ..............................................................................................12

Calcium Channel Blocker, NondihydropyridineDilTIAZem .................................................................................................5Verapamil ............................................................................................... 16

Calcium SaltCalcium and Vitamin D ............................................................................ 3

Carbonic Anhydrase InhibitorAcetaZOLAMIDE ......................................................................................2

Carbonic Anhydrase Inhibitor (Ophthalmic)Dorzolamide ............................................................................................. 6Dorzolamide and Timolol ......................................................................... 6

Cardiac GlycosideDigoxin ......................................................................................................5

Central Nervous System StimulantDextroamphetamine ................................................................................. 5Dextroamphetamine and Amphetamine .................................................. 5Methylphenidate ..................................................................................... 11Modafinil ................................................................................................. 11

Chloride Channel ActivatorLubiprostone ...........................................................................................11

Cholinergic AgonistPilocarpine (Systemic) ............................................................................13

ContraceptiveEthinyl Estradiol and Desogestrel ............................................................7Ethinyl Estradiol and Drospirenone ......................................................... 7Ethinyl Estradiol and Ethynodiol Diacetate ..............................................7Ethinyl Estradiol and Etonogestrel ...........................................................7Ethinyl Estradiol and Levonorgestrel ....................................................... 7Ethinyl Estradiol and Norelgestromin .......................................................7Ethinyl Estradiol and Norethindrone ........................................................ 7Ethinyl Estradiol and Norgestimate ..........................................................7Ethinyl Estradiol and Norgestrel .............................................................. 7Levonorgestrel (Systemic) ......................................................................10MedroxyPROGESTERone ..................................................................... 11Norethindrone .........................................................................................12

Corticosteroid, Inhalant (Oral)Budesonide (Oral Inhalation) ................................................................... 3Fluticasone and Salmeterol ..................................................................... 8Fluticasone (Oral Inhalation) ....................................................................8

Corticosteroid, NasalFluticasone (Nasal) .................................................................................. 8

Corticosteroid, OphthalmicDifluprednate ............................................................................................ 5Fluorometholone .......................................................................................8

CORTICOSTEROID, OPHTHALMIC

21

Loteprednol .............................................................................................11PrednisoLONE (Ophthalmic) ..................................................................13

Corticosteroid, OticNeomycin, Polymyxin B, and Hydrocortisone (Otic) ..............................12

Corticosteroid, RectalHydrocortisone (Topical) .......................................................................... 9

Corticosteroid, SystemicBudesonide (Systemic) ............................................................................ 3DexAMETHasone (Systemic) ...................................................................5Fludrocortisone .........................................................................................7Hydrocortisone (Systemic) ....................................................................... 9MethylPREDNISolone ............................................................................ 11PrednisoLONE (Systemic) ..................................................................... 13PredniSONE ...........................................................................................13

Corticosteroid, TopicalBetamethasone and Clotrimazole ............................................................3Betamethasone (Topical) ......................................................................... 3Clobetasol .................................................................................................4Desonide .................................................................................................. 5Desoximetasone .......................................................................................5Fluocinolone (Topical) .............................................................................. 7Fluocinonide ............................................................................................. 8Hydrocortisone (Topical) .......................................................................... 9Nystatin and Triamcinolone ....................................................................12Triamcinolone (Topical) .......................................................................... 16

DecongestantOxymetazoline (Nasal) ...........................................................................13Pseudoephedrine ................................................................................... 14

Depigmenting AgentHydroquinone ........................................................................................... 9

Diagnostic AgentGlucagon .................................................................................................. 8

Direct Oral Anticoagulant (DOAC)Apixaban ...................................................................................................2Dabigatran Etexilate .................................................................................5Rivaroxaban ........................................................................................... 14

Diuretic, Carbonic Anhydrase InhibitorAcetaZOLAMIDE ......................................................................................2

Diuretic, LoopFurosemide ...............................................................................................8

Diuretic, Potassium-SparingHydrochlorothiazide and Triamterene ...................................................... 9Spironolactone ....................................................................................... 15

Diuretic, ThiazideHydroCHLOROthiazide ............................................................................ 9Hydrochlorothiazide and Triamterene ...................................................... 9Lisinopril and Hydrochlorothiazide ......................................................... 10Losartan and Hydrochlorothiazide ..........................................................11Telmisartan and Hydrochlorothiazide .....................................................15Valsartan and Hydrochlorothiazide ........................................................ 16

Diuretic, Thiazide-RelatedChlorthalidone .......................................................................................... 4MetOLazone ........................................................................................... 11

Electrolyte Supplement, OralCalcium and Vitamin D ............................................................................ 3Potassium Chloride ................................................................................ 13

Electrolyte Supplement, ParenteralPotassium Chloride ................................................................................ 13Sodium Chloride .....................................................................................15

EnzymePancrelipase ...........................................................................................13

Estrogen and Androgen CombinationEstrogens (Esterified) and Methyltestosterone ........................................7

Estrogen and Progestin CombinationEstrogens (Conjugated/Equine) and Medroxyprogesterone ....................6Ethinyl Estradiol and Desogestrel ............................................................7Ethinyl Estradiol and Drospirenone ......................................................... 7Ethinyl Estradiol and Ethynodiol Diacetate ..............................................7Ethinyl Estradiol and Etonogestrel ...........................................................7Ethinyl Estradiol and Levonorgestrel ....................................................... 7Ethinyl Estradiol and Norelgestromin .......................................................7Ethinyl Estradiol and Norethindrone ........................................................ 7Ethinyl Estradiol and Norgestimate ..........................................................7Ethinyl Estradiol and Norgestrel .............................................................. 7

Estrogen DerivativeEstradiol (Systemic) ................................................................................. 6Estradiol (Topical) .....................................................................................6Estrogens (Conjugated/Equine, Systemic) .............................................. 6Estrogens (Conjugated/Equine, Topical) ..................................................7

Ethanolamine DerivativeDiphenhydrAMINE (Systemic) ..................................................................6

ExpectorantGuaiFENesin ............................................................................................ 8Guaifenesin and Codeine ........................................................................ 8Guaifenesin and Dextromethorphan ........................................................ 8

First Generation (Typical) AntipsychoticProchlorperazine .................................................................................... 14

GABA AnalogGabapentin ...............................................................................................8

Gastrointestinal Agent, MiscellaneousAdalimumab ..............................................................................................2Lubiprostone ...........................................................................................11Sucralfate ............................................................................................... 15

Gastrointestinal Agent, ProkineticMetoclopramide ...................................................................................... 11

Genitourinary IrrigantSodium Chloride .....................................................................................15

Hemostatic AgentAluminum Chloride Hexahydrate ............................................................. 2Desmopressin ...........................................................................................5

Histamine H1 AntagonistAzelastine (Nasal) .................................................................................... 3Azelastine (Ophthalmic) ........................................................................... 3Cetirizine (Systemic) ................................................................................ 4Cyproheptadine ........................................................................................ 5DiphenhydrAMINE (Systemic) ..................................................................6Fexofenadine ............................................................................................7HydrOXYzine ............................................................................................9Loratadine ...............................................................................................10Olopatadine (Ophthalmic) ...................................................................... 12Promethazine ......................................................................................... 14Promethazine and Codeine ................................................................... 14

Histamine H1 Antagonist, First GenerationCyproheptadine ........................................................................................ 5DiphenhydrAMINE (Systemic) ..................................................................6HydrOXYzine ............................................................................................9Promethazine ......................................................................................... 14Promethazine and Codeine ................................................................... 14

Histamine H1 Antagonist, Second GenerationAzelastine (Nasal) .................................................................................... 3Azelastine (Ophthalmic) ........................................................................... 3Cetirizine (Systemic) ................................................................................ 4Fexofenadine ............................................................................................7Loratadine ...............................................................................................10Olopatadine (Ophthalmic) ...................................................................... 12

Histamine H2 AntagonistRaNITIdine ............................................................................................. 14

Histone Deacetylase InhibitorValproic Acid and Derivatives ................................................................ 16

HormoneCalcitonin ..................................................................................................3

Hormone, Posterior PituitaryDesmopressin ...........................................................................................5

Hypnotic, MiscellaneousEszopiclone .............................................................................................. 7Zaleplon ..................................................................................................16Zolpidem .................................................................................................16

Imidazoline DerivativeOxymetazoline (Nasal) ...........................................................................13

Immunosuppressant AgentAzaTHIOprine ...........................................................................................3CycloSPORINE (Ophthalmic) ...................................................................5Methotrexate ...........................................................................................11Mycophenolate ....................................................................................... 12Pimecrolimus ..........................................................................................13Tacrolimus (Topical) ............................................................................... 15

Inhalation, MiscellaneousInhalation Devices ....................................................................................9

CORTICOSTEROID, OPHTHALMIC

22

Insulin, CombinationInsulin Aspart Protamine and Insulin Aspart ........................................... 9Insulin NPH and Insulin Regular ..............................................................9

Insulin, Intermediate-ActingInsulin NPH .............................................................................................. 9

Insulin, Long-ActingInsulin Detemir ......................................................................................... 9Insulin Glargine ........................................................................................ 9

Insulin, Rapid-ActingInsulin Aspart ............................................................................................9Insulin Lispro ............................................................................................ 9

Insulin, Short-ActingInsulin Regular ......................................................................................... 9

Iron PreparationsFerrous Sulfate .........................................................................................7

IrrigantSodium Chloride .....................................................................................15

Keratolytic AgentPodofilox .................................................................................................13Salicylic Acid .......................................................................................... 14Urea (Topical) .........................................................................................16

Laxative, OsmoticLactulose ................................................................................................ 10Polyethylene Glycol 3350 ...................................................................... 13Polyethylene Glycol-Electrolyte Solution ............................................... 13Sodium Sulfate, Potassium Sulfate, and Magnesium Sulfate ............... 15

Laxative, SalineMagnesium Citrate ................................................................................. 11

Laxative, StimulantBisacodyl .................................................................................................. 3

Leukotriene-Receptor AntagonistMontelukast ............................................................................................ 11

Local AnestheticBenzocaine ...............................................................................................3Lidocaine and Prilocaine ........................................................................10Lidocaine (Topical) ................................................................................. 10

Lubricant, OcularSodium Chloride .....................................................................................15

Lymphocyte Function-Associated Antigen 1 (LFA-1) AntagonistLifitegrast ................................................................................................10

Magnesium SaltMagnesium Citrate ................................................................................. 11

Mineralocorticoid (Aldosterone) Receptor AntagonistsSpironolactone ....................................................................................... 15

Miscellaneous ProductDiabetic Supplies ......................................................................................5

Monoclonal AntibodyAdalimumab ..............................................................................................2Palivizumab ............................................................................................ 13

N-Methyl-D-Aspartate (NMDA) Receptor AntagonistMemantine ..............................................................................................11

Nonsteroidal Anti-inflammatory Drug (NSAID)Diclofenac (Ophthalmic) ...........................................................................5Diclofenac (Systemic) ...............................................................................5Diclofenac (Topical) ..................................................................................5

Nonsteroidal Anti-inflammatory Drug (NSAID), COX-2 SelectiveCelecoxib ..................................................................................................4

Nonsteroidal Anti-inflammatory Drug (NSAID), OphthalmicDiclofenac (Ophthalmic) ...........................................................................5Ketorolac (Ophthalmic) ...........................................................................10Nepafenac .............................................................................................. 12

Nonsteroidal Anti-inflammatory Drug (NSAID), OralAspirin .......................................................................................................2Diclofenac (Systemic) ...............................................................................5Etodolac ....................................................................................................7Hydrocodone and Ibuprofen .................................................................... 9Ibuprofen .................................................................................................. 9Indomethacin ............................................................................................9Ketorolac (Systemic) .............................................................................. 10Meloxicam ...............................................................................................11Naproxen ................................................................................................12Sulindac ..................................................................................................15

Nonsteroidal Anti-inflammatory Drug (NSAID), ParenteralIbuprofen .................................................................................................. 9Indomethacin ............................................................................................9Ketorolac (Systemic) .............................................................................. 10

Nonsteroidal Anti-inflammatory Drug (NSAID), TopicalDiclofenac (Topical) ..................................................................................5

Norepinephrine Reuptake Inhibitor, SelectiveAtoMOXetine ............................................................................................ 3

Nutritional SupplementFluoride .....................................................................................................8

Ophthalmic Agent, AntiglaucomaAcetaZOLAMIDE ......................................................................................2Brimonidine and Timolol ...........................................................................3Brimonidine (Ophthalmic) .........................................................................3Dorzolamide ............................................................................................. 6Dorzolamide and Timolol ......................................................................... 6Latanoprost .............................................................................................10Pilocarpine (Ophthalmic) ........................................................................13Timolol (Ophthalmic) .............................................................................. 15

Ophthalmic Agent, MioticPilocarpine (Ophthalmic) ........................................................................13

Ophthalmic Agent, MiscellaneousArtificial Tears ...........................................................................................2Carboxymethylcellulose ............................................................................4

Opioid AntagonistNaloxone ................................................................................................ 12

Ovulation StimulatorClomiPHENE ............................................................................................4

Partial Nicotine AgonistVarenicline ..............................................................................................16

PediculocideLindane ...................................................................................................10Permethrin ..............................................................................................13

Phenothiazine DerivativeProchlorperazine .................................................................................... 14Promethazine ......................................................................................... 14Promethazine and Codeine ................................................................... 14

Phosphodiesterase-5 Enzyme InhibitorSildenafil .................................................................................................14

Phosphodiesterase Enzyme Inhibitor, NonselectiveTheophylline ........................................................................................... 15

Piperazine DerivativeCetirizine (Systemic) ................................................................................ 4HydrOXYzine ............................................................................................9

Piperidine DerivativeCyproheptadine ........................................................................................ 5Fexofenadine ............................................................................................7Loratadine ...............................................................................................10Olopatadine (Ophthalmic) ...................................................................... 12

ProgestinLevonorgestrel (Systemic) ......................................................................10MedroxyPROGESTERone ..................................................................... 11Megestrol ................................................................................................11Norethindrone .........................................................................................12Progesterone ..........................................................................................14

ProstaglandinMiSOPROStol .........................................................................................11

Prostaglandin, OphthalmicLatanoprost .............................................................................................10

Proton Pump InhibitorLansoprazole ..........................................................................................10Omeprazole ............................................................................................12Pantoprazole .......................................................................................... 13RABEprazole ..........................................................................................14

Renin InhibitorAliskiren ....................................................................................................2

Retinoic Acid DerivativeISOtretinoin (Systemic) .......................................................................... 10Tretinoin (Topical) ...................................................................................16

RifamycinRifAMPin .................................................................................................14RifAXIMin ................................................................................................14

RIFAMYCIN

23

SalicylateAspirin .......................................................................................................2Salsalate .................................................................................................14

Scabicidal AgentLindane ...................................................................................................10Permethrin ..............................................................................................13

Second Generation (Atypical) AntipsychoticARIPiprazole .............................................................................................2OLANZapine ...........................................................................................12QUEtiapine ............................................................................................. 14RisperiDONE ..........................................................................................14Ziprasidone .............................................................................................16

Selective 5-HT3 Receptor AntagonistOndansetron ...........................................................................................12

Selective Estrogen Receptor Modulator (SERM)ClomiPHENE ............................................................................................4Raloxifene ...............................................................................................14Tamoxifen ............................................................................................... 15

Serotonin 5-HT1B, 1D Receptor AgonistEletriptan .................................................................................................. 6Rizatriptan .............................................................................................. 14SUMAtriptan ........................................................................................... 15ZOLMitriptan ...........................................................................................16

Serotonin 5-HT4 Receptor AgonistMetoclopramide ...................................................................................... 11

Skeletal Muscle RelaxantBaclofen ....................................................................................................3Cyclobenzaprine .......................................................................................5Metaxalone ............................................................................................. 11Methocarbamol .......................................................................................11

Skin and Mucous Membrane AgentImiquimod .................................................................................................9

Skin and Mucous Membrane Agent, MiscellaneousEmollients .................................................................................................6

Smoking Cessation AidBuPROPion .............................................................................................. 3Nicotine ...................................................................................................12Varenicline ..............................................................................................16

Sodium-Glucose Cotransporter 2 (SGLT2) InhibitorEmpagliflozin ............................................................................................ 6

Sodium SaltSodium Chloride .....................................................................................15

Stool SoftenerDocusate .................................................................................................. 6

Substituted BenzimidazoleLansoprazole ..........................................................................................10Omeprazole ............................................................................................12Pantoprazole .......................................................................................... 13RABEprazole ..........................................................................................14

ThioamideMethIMAzole ...........................................................................................11Propylthiouracil .......................................................................................14

Thyroid ProductLevothyroxine ......................................................................................... 10Liothyronine ............................................................................................10Thyroid, Desiccated ................................................................................15

Topical Skin ProductAluminum Chloride Hexahydrate ............................................................. 2Benzoyl Peroxide ..................................................................................... 3Calcipotriene .............................................................................................3Clindamycin and Benzoyl Peroxide ......................................................... 4Emollients .................................................................................................6Erythromycin (Topical) ..............................................................................6Fluorouracil (Topical) ................................................................................8Imiquimod .................................................................................................9Lactic Acid and Ammonium Hydroxide ..................................................10Pimecrolimus ..........................................................................................13Podofilox .................................................................................................13Selenium Sulfide .................................................................................... 14Tacrolimus (Topical) ............................................................................... 15Urea (Topical) .........................................................................................16

Topical Skin Product, AcneBenzoyl Peroxide ..................................................................................... 3Clindamycin and Benzoyl Peroxide ......................................................... 4Clindamycin (Topical) ............................................................................... 4

Erythromycin (Topical) ..............................................................................6

Salicylic Acid .......................................................................................... 14

Tretinoin (Topical) ...................................................................................16

Tumor Necrosis Factor (TNF) Blocking Agent

Adalimumab ..............................................................................................2

Uricosuric Agent

Probenecid ............................................................................................. 14

Vasodilator

HydrALAZINE ...........................................................................................8

Isosorbide Dinitrate ................................................................................ 10

Isosorbide Mononitrate ...........................................................................10

Nitroglycerin ............................................................................................12

Vasopressin Analog, Synthetic

Desmopressin ...........................................................................................5

Vitamin

Vitamins (Multiple/Oral) ..........................................................................16

Vitamins (Multiple/Pediatric) ...................................................................16

Vitamins (Multiple/Prenatal) ................................................................... 16

Vitamin D Analog

Calcipotriene .............................................................................................3

Calcitriol (Systemic) ..................................................................................3

Ergocalciferol ............................................................................................6

Vitamin, Fat Soluble

Calcium and Vitamin D ............................................................................ 3

Vitamin, Water Soluble

Cyanocobalamin .......................................................................................5

Folic Acid ..................................................................................................8

Niacin ......................................................................................................12

Pyridoxine ...............................................................................................14

Xanthine Oxidase Inhibitor

Allopurinol .................................................................................................2

SALICYLATE

24