HealthPAC Formulary - Alameda County, California

HealthPAC Formulary Current as of July 2019

Brand Name Generic Name Strength Class I Class II

Aclovate Alclometasone Cream 45 gm Anti-inflammatory Agents

Aclovate Alclometasone Ointment 45 gm Anti-inflammatory Agents

Actigall Ursodiol 300 mg GI

Actos Pioglitazone hydrochloride 15 mg Diabetes Thiazolidinediones



Adderall XR Dextroamphetamine/amphetamine 10 mg Psychiatric Stimulant




Advair Diskus Fluticasone/Salmeterol 100/50 mcg Respiratory

Beta2-Adrenergic

Agonist, Long-Acting;

Corticosteroid


Beta2-Adrenergic


Corticosteroid


Beta2-Adrenergic


Corticosteroid

Alaway Ketotifen 0.025% Ophthalmic

Aldactone Spironolactone 25 mg Cardiovascular Diuretics



Aldomet Methyldopa 250 mg Cardiovascular Central Alpha Agonist

Aldomet Methyldopa 500 mg Cardiovascular Central Alpha Agonist

Alphagan Brimonidine tartrate solution 0.2% Ophthalmic Glaucoma

Amikin Amikacin 1000 mg/4 ml (4 cc) Antimicrobials Aminoglycoside

Amikin Amikacin 500 mg/2 ml (2 cc) Antimicrobials Aminoglycoside

Ambien Zolpidem 10 mg Psychiatric Hypnotic

Ambien Zolpidem 5 mg Psychiatric Hypnotic

Amoxil Amoxicillin 125 mg/5 ml (80 cc) Antimicrobials Penicillins

Amoxil Amoxicillin 250 mg Antimicrobials Penicillins

Amoxil Amoxicillin 250 mg/5 ml (150 cc) Antimicrobials Penicillins

Disclaimer: Doses / routes of administration are the responsibility of the prescribing provider based on the medical home's practice guidelines. Page 1 of 26



Amoxil Amoxicillin 400 mg/5 ml Antimicrobials Penicillins

Amoxil Amoxicillin 500 mg Antimicrobials Penicillins

Anafranil Clomipramine 25 mg Psychiatric Antidepressant



AndroGel Testosterone20.25 mg/actuation

(1.62%) gel pump 75 gHormone Replacement

Antivert Meclizine 25 mg tabs Neurologic Misc

Apresoline Hydralazine 10 mg Cardiovascular Other Vasodilators




Artane Trihexyphenidyl 2 mg Neurologic Parkinson

Artane Trihexyphenidyl 2 mg/5 ml Neurologic Parkinson

Artane Trihexyphenidyl 5 mg Neurologic Parkinson

Artificial Tears Polyvinyl Alcohol 1.4% Ophthalmic

Asacol Mesalamine 400 mg GI Anti-inflammatory bowel

Atarax Hydroxyzine HCL 10 mg Cold, Cough, Allergy Antihistamine

Atarax Hydroxyzine HCL 10 mg/5 ml (120 cc) Cold, Cough, Allergy Antihistamine



Ativan Lorazepam (SCH IV) 0.5 mg Psychiatric Benzos

Ativan Lorazepam (SCH IV) 1 mg Psychiatric Benzos

Ativan Lorazepam (SCH IV) 2 mg Psychiatric Benzos

Atrovent Ipratropium MDI 18mcg/dose MDI (14gm) Respiratory Asthma

Atrovent Inh Sol Ipratropium bromide 0.02% 500 mcg (3 cc/amp) Respiratory Nebulizer soln

Augmentin Amoxicillin-clavulanate 200 mg/5 ml (100 cc) Antimicrobials Penicillins

Augmentin Amoxicillin-clavulanate 500 mg-125 mg Antimicrobials Penicillins

Augmentin Amoxicillin-clavulanate 875 mg-125 mg Antimicrobials Penicillins

AuralganAntipyrene, Benzocaine, Glycerine

dehyd10 ml drops Otic

Avelox Moxifloxacin 400 mg Antimicrobials Quinolones

Aygestin Norethindrone 5 mg Hormone Replacement Progestins




Azopt Brinzolamide 1% suspension Ophthalmic Glaucoma

Azulfidine Sulfasalazine 500 mg GI Anti-inflammatory bowel

Bactrim Sulfamethxzl Trimethoprim 40mg / 5ml - 200mg / 5-

ml (60 ml)Antimicrobials Sulfas

Bactroban Mupirocin 2% ointment Derm Antimicrobial

Benadryl Diphenhydramine 12.5 mg/ 5ml Cold, Cough, Allergy Antihistamine

Benadryl Diphenhydramine 25, 50 mg capsules Cold, Cough, Allergy Antihistamine

Benadryl Diphenhydramine 50 mg/ml (inj) Cold, Cough, Allergy Antihistamine

Benemid Probenecid 500 mg Gout

Bentyl Dicyclomine 10 mg GI Antispasmodics

Bentyl Dicyclomine 20 mg GI Antispasmodics

Biaxin Clarithromycin 500 mg Antimicrobials

BiktarvyBictegravir, Emtricitabine, and

Tenofovir Alafenamide50-200-25 mg Antiretrovirals

Reverse Transcriptase

Inhibitor,

Nucleoside/Nucleotide

Biltricide Praziquantel 600 mg Anthelmintics

BuSpar Buspirone HCI 10 mg Psychiatric Other




Butrans Buprenorphine 10 mcg/hr Analgesic Opiate Agonist



Butrans Buprenorphine 7.5 mcg/hr Analgesic Opiate Agonist

Byetta Exenatide 10 mcg/0.04 mL (2.4 mL) Diabetes GLP-1 Receptor Agonist

Byetta Exenatide 5 mcg/0.02 mL (1.2 mL) Diabetes GLP-1 Receptor Agonist

Calan SR Verapamil SR 120 mg CardiovascularCalcium Channel

Blockers


Blockers


Blockers

Calciferol Vitamin D 1,000 units Vitamin






Campral Acamprosate 333 mg Chemical DependenceGABA Agonist/

Glutamate Antagonist

Capoten Captopril 100 mg Cardiovascular ACE Inhibitor

Capoten Captopril 12.5 mg Cardiovascular ACE Inhibitor



Carafate Sucralfate 1 Gm GI

Cardizem Diltiazem 120 mg CardiovascularCalcium Channel

Blockers

Cardizem CD Diltiazem CD 120 mg CardiovascularCalcium Channel

Blockers


Blockers


Blockers


Blockers


Blockers


Blockers


Blockers


Blockers

Cardizem CD,

Dilacor Xr, Cartia

XL, Dilt-CD

Diltiazem 60 mg CardiovascularCalcium Channel

Blockers

Cardizem CD,

Dilacor Xr, Cartia

XL, Dilt-CD

Diltiazem 90 mg CardiovascularCalcium Channel

Blockers




Cardizem LA Dilitiazem HCI 180 mg CardiovascularCalcium Channel

Blockers

Cardizem SR Diltiazem SR 120 mg CardiovascularCalcium Channel

Blockers


Blockers


Blockers


Blockers

Cardura Doxazosin mesylate 1 mg Cardiovascular Alpha-1 blocker




Catapres Clonidine HCI tabs 0.1 mg Cardiovascular Central Alpha Agonist



Celebrex Celecoxib 100 mg Analgesic NSAID




Celexa Citalopram Hydrobromide 10 mg Psychiatric Antidepressant

Celexa Citalopram Hydrobromide 10 mg/5 ml Psychiatric Antidepressant



Ciloxan Ciprofloxacin eye drop 0.3% Ophthalmic

Cipro Ciprofloxacin 250 mg Antimicrobials Quinolones

Cipro Ciprofloxacin 500 mg Antimicrobials Quinolones

Ciprodex Ciprofloxacin/Dexamethasone 0.3/0.1% OticAntimicrobial/

Corticosteroid

Claritin Loratadine 10 mg Antihistamine

Cleocin Clindamycin 150 mg Antimicrobials Misc

Cleocin Clindamycin 300 mg Antimicrobials Misc




Cleocin Clindamycin topical gel, lotion 1% Derm Acne

Cleocin-T Clindamycin topical solution 1% (60 ml) Derm Acne

Clinoril Sulindac 150 mg Analgesic NSAID

Clinoril Sulindac 200 mg Analgesic NSAID

Cogentin Benztropine mesylate 0.5 mg Neurologic Parkinson

Cogentin Benztropine mesylate 1 mg Neurologic Parkinson

Cogentin Benztropine mesylate 1 mg/ml (inj) Neurologic Parkinson

Cogentin Benztropine mesylate 2 mg Neurologic Parkinson

Colace Docusate 100 mg GI Stool Softener

Colace Docusate 250 mg GI Stool Softener

Colcrys Colchicine 0.6 mg Gout

Combivent MDI Albuterol-ipratropium Inhaler Respiratory

Compazine Prochlorperazine 10 mg GI Antiemetic

Compazine Prochlorperazine 25 mg supp GI Antiemetic

Compazine Prochlorperazine 5 mg GI Antiemetic

Cordarone Amiodarone 200 mg Cardiovascular Antiarrythmic

Cordarone Amiodarone 400 mg Cardiovascular Antiarrythmic

Coreg Carvedilol 12.5 mg Cardiovascular Beta Blockers

Coreg Carvedilol 25 mg Cardiovascular Beta Blockers



Cortizone Hydrocortisone cream 2.5% Derm Antiinflammatory

Cortizone Hydrocortisone ointment 2.5% Derm Antiinflammatory

Cortizone Hydrocortisone Suppositories 25 mg GI Antiinflammatory

Cosopt Dorzolamide/Timolol 22.3-6.8 mg/ml Ophthalmic Glaucoma

Coumadin Warfarin sodium 1 mg Cardiovascular Anticoagulants



Coumadin Warfarin sodium 2.5 mg Cardiovascular Anticoagulants








Coumadin Warfarin sodium 7.5 mg Cardiovascular Anticoagulants

Cozaar Losartan 100 mg Cardiovascular Angiotensin II Blocker



Cymbalta Duloxetine 20 mg Psychiatric Antidepressant




Cytotec Misoprostol 100 mg GI

Cytotec Misoprostol 200 mg GI

Deltasone Prednisone 1 mg Endocrine Glucocorticoids


Deltasone Prednisone 2.5 mg Endocrine Glucocorticoids




Depakote DR Divalproex sodium 125 mg Psychiatric Mood Stabilizer



Depakote ER Divalproex sodium 250 mg Psychiatric Mood Stabilizer

Depakote ER Divalproex sodium 500 mg Psychiatric Mood Stabilizer

Depo Testosterone Testosterone Inj 100 mg/ml Hormone Replacement

Depo Testosterone Testosterone Inj 200 mg/ml Hormone Replacement

Desyrel Trazodone 100 mg Psychiatric Antidepressant



Diflucan Fluconazole 100 mg Antimicrobials Antifungals



Dilantin Phenytoin 100 mg Neurologic Anticonvulsant

Dilantin Phenytoin 50 mg Neurologic Anticonvulsant

Ditropan Oxybutynin 5 mg Genitourinary

Donnatal Belladonna alkaloids, phenobarbital 16.2 mg GI Antispasmodics




Doryx Vibramycin Doxycycline 100 mg Antimicrobials Tetracyclines

Doryx Vibramycin Doxycycline 50 mg Antimicrobials Tetracyclines

Dovonex Calcipotriene0.005% crm (Use Brand

Product)Derm Topical

Duphalac Lactulose 10g / 15 ml syrup GI Laxatives

Dynapen Dicloxacillin 250 mg Antimicrobials Penicillins

Dynapen Dicloxacillin 500 mg Antimicrobials Penicillins

Effexor IR Venlafaxine 25 mg Psychiatric Antidepressant

Effexor XR Venlafaxine XR 100 mg Psychiatric Antidepressant

Effexor XR Venlafaxine XR 37.5 mg Psychiatric Antidepressant

Effexor XR Venlafaxine XR 75 mg Psychiatric Antidepressant

Elavil Amitriptyline 10 mg Psychiatric Antidepressant





Elimite Permethrin cream 5% (60 Gm) Derm Scabicide and Lice

Erygel Erythromycin gel or solution 2% Derm Acne

Ery-Tab Erythromycin stearate 250 mg Antimicrobials Macrolides



Esidrix Hydrochlorothiazide 25 mg Cardiovascular Diuretics

Esidrix Hydrochlorothiazide 50 mg Cardiovascular Diuretics

Eskalith CR Lithium carbonate 150 mg Psychiatric Mood Stabilizer

Eskalith CR Lithium carbonate 300 mg Psychiatric Mood Stabilizer

Eskalith SR Lithium carbonate 300 mg Psychiatric Mood Stabilizer

Eskalith SR Lithium carbonate 450 mg Psychiatric Mood Stabilizer

Estrace Estradiol 0.5 mg Hormone Replacement

Estrace Estradiol 1 mg Hormone Replacement

Estrace Estradiol 2 mg Hormone Replacement

Fioricet Butalbital/APAP/Caffeine 50 mg-325 mg-40 mg Analgesic Misc

Flagyl Metronidazole 250 mg Antimicrobials Misc

Flagyl Metronidazole 500 mg Antimicrobials Misc




Flexeril Cyclobenzaprine 10 mg Analgesic Muscle Relaxant

Flint SSD,

SilvadeneSilver sulfadiazine 1% crm Derm Other

Flomax Tamsulosin 0.4 mg Genitourinary Alpha-blockers

Flonase Fluticasone propionate 50 mcg/spray Respiratory Nasal Inhaler

Florinef Fludrocortisone 0.1 mg Endocrine

Florinef Fludrocortisone 0.2 mg Adrenals

Flovent Diskus Fluticasone propionate 100 mcg Respiratory Corticosteroid, Inhalant



Flovent HFA Fluticasone propionate 110 mcg Respiratory Corticosteroid, Inhalant



Floxin Ofloxacin 0.3% Otic Quinolones

Fosamax Alendronate 35 mg Osteoporosis

Fosamax Alendronate 70 mg Osteoporosis

Garamycin Gentamicin eye drops 0.3% (5 ml) Ophthalmic

Glucophage Metformin 1000 mg Diabetes Biguanides



Glucophage XR Metformin ER 1000 mg Diabetes Biguanides



Glucotrol Glipizide 10 mg Diabetes Sulfonylureas

Glucotrol Glipizide 5 mg Diabetes Sulfonylureas

Grifulvin V Griseofulvin micro liquid 125 mg/5 mL (120 ml) Antimicrobials Antifungals

Grisactin Fulvicin Griseofulvin ultramicro 125 mg Antimicrobials Antifungals

Grisactin Fulvicin Griseofulvin ultramicro 250 mg Antimicrobials Antifungals

Haldol Haloperidol 0.5 mg Psychiatric Antipsychotic

Haldol Haloperidol 1 mg Psychiatric Antipsychotic



Haldol Haloperidol 2 mg/ml (120 cc) Psychiatric Antipsychotic




Haldol Haloperidol 2 mg/ml (15 cc) Psychiatric Antipsychotic



Haldol Haloperidol decanoate 100 mg/ml (inj) Psychiatric Antipsychotic

Haldol Haloperidol decanoate 50 mg/ml (inj) Psychiatric Antipsychotic

HC Hydrocortisone 10 mg Derm Antiinflammatory

HC Hydrocortisone 2.5% lotion Derm Antiinflammatory



Helidacbismuth subsalicylate-

metronidazole-tetracyclineHelicobacter pylori agent

Humalog Insulin Lispro 100U/mL Diabetes Insulin Product

Humulin N Insulin NPH U100 (10 ml) Diabetes Insulin Product

Humulin R Insulin Regular U100 (10 ml) Diabetes Insulin Product

Humulin R Insulin Regular U500 Diabetes Insulin Product

Humulin R Kwikpen Insulin Regular U500 Diabetes Insulin Product

Humulin, Novolin Insulin 70/30 U100 (10 ml) Diabetes Insulin Product

Hytrin Terazosin HCL 1 mg Genitourinary




Hyzaar Losartan/Hctz 100 mg-12.5 mg Cardiovascular Antihypertensive

Hyzaar Losartan/Hctz 100 mg-25 mg Cardiovascular Antihypertensive

Hyzaar Losartan/Hctz 50 mg-12.5 mg Cardiovascular Antihypertensive

Imdur Isosorbide mononitrate IR, SR 10 mg Cardiovascular Nitrate Vasodilators





Imitrex Sumatriptan 100 mg Neurologic Migraine



Imuran Azathioprine 50 mg Immunosupressive




Inderal Propranolol HCL 10 mg Cardiovascular Beta Blockers





Indocin Indomethacin 25 mg Analgesic NSAID

Indocin Indomethacin 50 mg Analgesic NSAID

INH Isoniazid 10 mg / ml Antimicrobials Antitubercular

INH Isoniazid 100 mg Antimicrobials Antitubercular

INH Isoniazid 300 mg Antimicrobials Antitubercular

Intal Cromolyn inhaler 14.2 Gm Respiratory

Isoptin Verapamil 120 mg CardiovascularCalcium Channel

Blockers

Isoptin Verapamil LA 180 mg CardiovascularCalcium Channel

Blockers

Isordil Isosorbide dinitrate 10 mg Cardiovascular Nitrate Vasodilators




Januvia Sitagliptin 100 mg DiabetesDipeptidyl Peptidase 4

(DPP-4) Inhibitor


(DPP-4) Inhibitor


(DPP-4) Inhibitor

Jardiance Empagliflozin 10 mg Diabetes

Sodium-Glucose

Cotransporter 2

(SGLT2) Inhibitor

Jardiance Empagliflozin 25 mg Diabetes

Sodium-Glucose

Cotransporter 2

(SGLT2) Inhibitor

Keflex Cephalexin 125 mg/5 ml (200 cc) Antimicrobials Cephalosporins

Keflex Cephalexin 250 mg Antimicrobials Cephalosporins




Keflex Cephalexin 250 mg/5 ml (100 cc) Antimicrobials Cephalosporins

Keflex Cephalexin 500 mg Antimicrobials Cephalosporins

Kenalog, AristocortTriamcinolone cream, ointment, or

lotion0.025% Derm Antiinflammatory

Kenalog, AristocortTriamcinolone cream, ointment, or

lotion0.10% Derm Antiinflammatory

Keppra Levetiracetam 1000 mg Neurologic



Klonopin Clonazepam (SCH IV) 0.5 mg Psychiatric Benzos

Klonopin Clonazepam (SCH IV) 1 mg Psychiatric Benzos

Klonopin Clonazepam (SCH IV) 2 mg Psychiatric Benzos

K-Tab, K-Dur, Slow-

K, Klor-conPotassium chloride tabs 10 mEq Cardiovascular Potassium Supplement

K-Tab, K-Dur, Slow-


K-Tab, K-Dur, Slow-


Lamictal Lamotrigine 100 mg tab Neurologic Anticonvulsant




Lanoxin Digoxin 0.125 mg Cardiovascular Glycosides

Lanoxin Digoxin 0.25 mg Cardiovascular Glycosides

Lantus Insulin glargine 100 IU/mL Diabetes Insulin Product

Lasix Furosemide 20 mg Cardiovascular Diuretics



Levaquin Levofloxacin 250 mg Antimicrobials Quinolones



Levoxyl Levothyroxine 0.025 mg Endocrine Thyroid















Lexapro Escitalopram 10 mg Psychiatric Antidepressant



Lidex Fluocinonide 0.05% solution 60 ml Derm Antiinflammatory

Lidex Fluocinonide 0.05% gel (60 gm) Derm Antiinflammatory

Lidex Fluocinonide 0.05% cream (30 gm) Derm Antiinflammatory

Lidex Fluocinonide 0.05% cream (60 gm) Derm Antiinflammatory

Lidex Fluocinonide 0.05% oint (15 gm) Derm Antiinflammatory



Lidoderm Lidocaine 5% patch Analgesic Anesthetic, Topical

Lioresal Baclofen 10 mg Analgesic Muscle Relaxant

Lioresal Baclofen 20 mg Analgesic Muscle Relaxant

Lipitor Atorvastatin 10 mg CardiovascularCholesterol Lowering

Agents


Agents


Agents


Agents

Lomotil Diphenoxylate-atropine 2.5 mg-0.025 mg GI Antidiarrhea




Lomotil Diphenoxylate-atropine (SCH V)2.5 mg-0.025 mg/5 ml

(60 ml)GI Antidiarrhea

Lopid Gemfibrozil 600 mg CardiovascularCholesterol Lowering

Agents

Lopressor Metoprolol tartrate 100 mg Cardiovascular Beta Blockers



Lotrimin Clotrimazole 1% crm Antimicrobials Antifungals

Loxitane Loxapine 5, 10, 25, 50 mg Psychiatric Antipsychotic

Lyrica Pregabalin 100 mg NeurologicAnticonvulsant; GABA

Analog


Analog


Analog

Macrobid Nitrofurantoin monohydrate 100 mg Antimicrobials Misc

Macrodantin Nitrofurantoin macrocryst 100 mg Antimicrobials Misc

Macrodantin Nitrofurantoin macrocryst 50 mg Antimicrobials Misc

Maxzide Triamterene/Hctz 37.5 mg/25 mg Cardiovascular Diuretics

Maxzide Triamterene/Hctz 75 mg/50 mg Cardiovascular Diuretics

Metrocream Metronidazole cream 0.075% Antimicrobials Misc

Metrocream Metronidazole cream 0.75% Derm Acne

Metrogel Metronidazole topical gel 0.75% Derm Acne

Mevacor Lovastatin 10, 20, 40 mg CardiovascularCholesterol Lowering

Agents

Micronase Diabeta Glyburide 1.25 mg Diabetes Sulfonylureas

Micronase Diabeta Glyburide 2.5 mg Diabetes Sulfonylureas

Micronase Diabeta Glyburide 5 mg Diabetes Sulfonylureas

Microzide Hydrochlorothiazide 12.5 mg cap Cardiovascular Diuretics

Minipress Prazosin 1 mg Cardiovascular Alpha-blockers



Miralax Polyethylene glycol 238 g GI




Miralax Polyethylene glycol 510 g GI

Mix GolytelyPolyethylene glycol electrolyte

solution240 g GI Prep

Mobic Meloxicam 7.5 mg Analgesic NSAID

Motrin Ibuprofen 400 mg Analgesic NSAID



MS Morphine sulfate liquid 20 mg/5 ml Analgesic Narcotic

MS Morphine sulfate short acting 15 mg Analgesic Narcotic

MS Morphine sulfate short acting 30 mg Analgesic Narcotic

Myambutol Ethambutol 100 mg Antimicrobials Antitubercular

Myambutol Ethambutol 400 mg Antimicrobials Antitubercular

Mysoline Primidone 250 mg Neurologic Anticonvulsant

Mysoline Primidone 50 mg Neurologic Anticonvulsant

Naprosyn Naproxen 250 mg Analgesic NSAID



Narcan Naloxone 0.4 mg/ml Toxicology Agents Opiate Antagonists

Narcan Naloxone 1 mg/ml Toxicology Agents Opiate Antagonists

Nasarel Flunisolide 25 mcg/spray (0.025%) Cold, Cough, Allergy Nasal Steroids

Navane Thiothixene 1 mg Psychiatric Antipsychotic





Navane Thiothixene 5 mg/ ml Psychiatric Antipsychotic

Neurontin Gabapentin 100 mg Neurologic Anticonvulsant




NicoDerm Nicotine Patches- 28 weeks 14 mg Smoking deterrents






Nitrostat Nitroglycerine SL 0.4 mg Cardiovascular Nitrate Vasodilators

Nizoral Ketoconazole 2% crm (15 Gm) Antimicrobials Antifungals



Nizoral Ketoconazole 2% shampoo Antimicrobials Antifungals

Nizoral Ketoconazole 200 mg (tabs) Antimicrobials Antifungals

Norco Acetaminophen/Hydrocodone 325/10 mg Analgesic Narcotic

Norco Acetaminophen/Hydrocodone 325/5 mg Analgesic Narcotic

Norco Acetaminophen/Hydrocodone 325/7.5 mg Analgesic Narcotic

Norvasc Amlodipine 10 mg CardiovascularCalcium Channel

Blockers

Norvasc Amlodipine 2.5 mg CardiovascularCalcium Channel

Blockers

Norvasc Amlodipine 5 mg CardiovascularCalcium Channel

Blockers

Oramorph SR Morphine sulfate SR 100 mg Analgesic Narcotic




Pamelor Nortriptyline 10 mg Psychiatric Antidepressant




Parlodel Bromocriptine 2.5mg Hypoprolactinemic

Paser Aminosalicylic acid 4 g Antimicrobials Antitubercular

Paxil Paroxetine 10 mg Psychiatric Antidepressant

Paxil Paroxetine 10 mg/5 ml Psychiatric Antidepressant




Pennsaid Diclofenac 2% sol Derm NSAID

Pepcid Famotidine 20 mg GI H2 Antagonists

Pepcid Famotidine 40 mg GI H2 Antagonists




Percocet Acetaminophen/Oxycodone 325 mg/10 mg Analgesic Narcotic

Percocet Acetaminophen/Oxycodone 325 mg/5 mg Analgesic Narcotic

Persantine Dipyridamole 25 mg Cardiovascular Anticoagulants



Phenergan Promethazine HCI 12.5 mg GI Antiemetic

Phenergan Promethazine HCI 12.5 mg supp GI Antiemetic

Phenergan Promethazine HCI 25 mg GI Antiemetic

Phenergan Promethazine HCI 50 mg GI Antiemetic

Phenergan Promethazine HCI 25 mg supp GI Antiemetic

Phenergan syrup Promethazine HCI 6.25 mg/5 ml (120 ml) GI Antiemetic

Phoslo Calcium acetate 667 mg Phosphate binder

Phytonadione Vitamin K 5 mg tab Vitamin

Plaquenil Hydroxychloroquine 200 mg Rheumatology

Plavix Clopidogrel 75 mgPlatelet aggregation

inhibitor

Polytrim Polymyxin b- trimethoprim 10 mL drops Ophthalmic

Polytrim Polymyxin b- trimethoprim 3.5 gm ointment Ophthalmic

Pravachol Pravastatin 20, 40, 80 mg tabs CardiovascularCholesterol Lowering

Agents

Prelone Prednisolone 15mg/5ml oral sol Endocrine Glucocorticoids

Premarin Conjugated Estrogen Cream 0.625 mg/g crm (43 Gm) Hormone Replacement

Priftin Rifapentine 150 mg Antimicrobials Antitubercular

Prilosec Omeprazole 20 mg GI PPI

Prinivil, Zestril Lisinopril 10 mg Cardiovascular ACE Inhibitor

Prinivil, Zestril Lisinopril 2.5 mg Cardiovascular ACE Inhibitor





Procardia, Adalat

CC, NifediacNifedipine SR 30 mg Cardiovascular

Calcium Channel

Blockers




Procardia, Adalat


Calcium Channel

Blockers

Procardia, Adalat


Calcium Channel

Blockers

Prolixin Fluphenazine 0.5 mg/ml Psychiatric Antipsychotic

Prolixin Fluphenazine 1 mg Psychiatric Antipsychotic

Prolixin Fluphenazine 10 mg Psychiatric Antipsychotic

Prolixin Fluphenazine 2.5 mg Psychiatric Antipsychotic

Prolixin Fluphenazine 5 mg / cc Psychiatric Antipsychotic

Prolixin Fluphenazine decanoate 25 mg/ml (inj) Psychiatric Antipsychotic

Proscar Finasteride 5 mg Genitourinary5-alpha reductase

inhibitor

Proventil Albuterol solution neb 5 mg/ml (20 ml bottle) Respiratory Nebulizer soln

Proventil Albuterol Unit Dose 0.83 mg/ml Respiratory

Proventil HFA (IDP)Albuterol HFA (IDP) tablet, MDI,

solution, UD90 mcg Respiratory Inhaler

Provera Medroxyprogesterone 10 mg Hormone Replacement

Provera Medroxyprogesterone 2.5 mg Hormone Replacement

Provera Medroxyprogesterone 5 mg Hormone Replacement

Prozac Fluoxetine 10 mg Psychiatric Antidepressant


Prozac Fluoxetine 20 mg / 5 ml Psychiatric Antidepressant


PTU Propylthiouracil 50 mg Endocrine Thyroid

Pyridium Phenazopyridine HCL 100 mg Genitourinary

Pyridium Phenazopyridine HCL 200 mg Genitourinary

Reglan Metoclopramide 10 mg GI Antiemetic

Reglan Metoclopramide hcl 5 mg GI Antiemetic

Relafen Nabumetone 750 mg Analgesic NSAID

Remeron Mirtazapine 15 mg Psychiatric Antidepressant






Restoril Temazepam (SCH IV) 15 mg Psychiatric Hypnotic

Restoril Temazepam (SCH IV) 30 mg Psychiatric Hypnotic

Retin-A Tretinoin0.01%, 0.025%, 0.05%,

0.1% cream, gelDerm Acne

Rheumatrex Methotrexate 2.5 mg Chemotherapy

Rifadin Rifampin 150 mg Antimicrobials Antitubercular

Rifadin Rifampin 300 mg Antimicrobials Antitubercular

Risperdal Risperidone 0.5 mg Psychiatric Antipsychotic

Risperdal Risperidone 1 mg Psychiatric Antipsychotic

Risperdal Risperidone 1 mg/ml solution Psychiatric Antipsychotic




Ritalin Methylphenidate short acting 10 mg Psychiatric Stimulant



Ritalin LA Methylphenidate long-acting 10 mg Psychiatric Stimulant




Robafen Guaifenesin 100 mg/5 ml Cold, Cough, Allergy Antitussive

Robafen DM Guaifenesin DM 100 mg-10 mg/5 ml Cold, Cough, Allergy Antitussive

Robaxin Methocarbamol 500 mg Analgesic Muscle Relaxant

Robaxin Methocarbamol 750 mg Analgesic Muscle Relaxant

Robitussin AC Guaifenesin/Codeine 100 mg-10 mg/5 ml Cold, Cough, Allergy Antitussive

Rocaltrol Calcitriol 0.25 mcg Vitamin

Rocaltrol Calcitriol 0.5 mcg Vitamin

Selsun Selenium sulfide lotion 2.50% Derm Anti-seborrhea

Senna Sennoside 8.6 mg GI Laxatives

Septra Sulfamethxzl Trimethoprim 80 / 400 mg Antimicrobials Sulfas

Septra Sulfamethxzl Trimethoprim DS 160 / 800 mg Antimicrobials Sulfas




Serevent Diskus Salmeterol xinafoate 50 mcg RespiratoryBeta2-Adrenergic

Agonist, Long-Acting

Seromycin Cycloserine 250 mg Antimicrobials Antitubercular

Seroquel Quetiapine fumarate 100 mg Psychiatric Antipsychotic






Sinemet Carbidopa - levodopa 10 mg - 100 mg Neurologic Parkinson



Sinemet CR Carbidopa - levodopa LA 25 mg - 100 mg Neurologic Parkinson

Sinemet CR Carbidopa - levodopa LA 50 mg - 200 mg Neurologic Parkinson

Sinequan Doxepin HCL 10 mg Psychiatric Antidepressant






Singulair Montelukast 10 mg Respiratory

Singulair Montelukast 5 mg chew Respiratory

Soltamox Tamoxifen 10 mg Hormone Replacement

Soma Carisoprodol 250 mg Muscle Relaxant

Spectazole Econazole 1% crm 30 Gm (30 Gm) Antimicrobials Antifungals



Stelazine Trifluoperazine 10 mg Psychiatric Antipsychotic



Suboxone Buprenorphine/naloxone 2 mg-0.5 mg AnalgesicMixed Opiate

Agonist/Antagonist




Suboxone Buprenorphine/naloxone 8 mg-2 mg AnalgesicMixed Opiate

Agonist/Antagonist

Subutex Buprenorphine 2 mg Analgesic Opiate Agonist

Sulamyd Sulfacetamide sodium eye drop sol 10% Ophthalmic

Sulamyd Sulfacetamide sodium eye ointment 10% Ophthalmic

Sumycin Tetracycline 250 mg Antimicrobials Tetracyclines

Sumycin Tetracycline 500 mg Antimicrobials Tetracyclines

Symmetrel Amantadine 100 mg Neurologic Parkinson

Symmetrel Amantadine 50 mg / 5 ml (120 ml) Neurologic Parkinson

Synalar Fluocinolone acetonide 0.01% cream Derm Antiinflammatory

Synalar Fluocinolone acetonide 0.01% ointment Derm Antiinflammatory

Synalar Fluocinolone acetonide 0.025% cream Derm Antiinflammatory

Synalar Fluocinolone acetonide 0.025% ointment Derm Antiinflammatory

Synalar Fluocinolone acetonide0.025%, 0.01% solution,

60 mlDerm Antiinflammatory

Tagamet Cimetidine 400 mg GI H2 blockers

Tamiflu Oseltamivir 12mg/ml Antimicrobials Antiviral

Tamiflu Oseltamivir 75 mg Antimicrobials Antiviral

Tapazole Methimazole 10 mg Endocrine Thyroid

Tapazole Methimazole 5 mg Endocrine Thyroid

Tegretol Carbamazepine 100 mg Psychiatric Mood Stabilizer

Tegretol Carbamazepine 100 mg / 5 cc Psychiatric Mood Stabilizer

Tegretol Carbamazepine 200 mg Psychiatric Mood Stabilizer

Temovate Clobetasol lotion 0.05% Derm Antiinflammatory

Temovate Clobetasol propionate 0.05% crm (15 Gms) Derm Antiinflammatory

Temovate Clobetasol propionate 0.05% oint (15 Gms) Derm Antiinflammatory

Temovate Clobetasol propionate 0.05% oint (30 Gms) Derm Antiinflammatory

Tenormin Atenolol 100 mg Cardiovascular Beta Blockers



Tessalon Benzonatate 100 mg Cold, Cough, Allergy Antitussive

Tessalon Benzonatate 200 mg Cold, Cough, Allergy Antitussive

Thalitone Chlorthalidone 25 mg Cardiovascular Diuretics




Thalitone Chlorthalidone 50 mg Cardiovascular Diuretics

Theo-Dur Theophylline 200 mg Respiratory

Theo-Dur Theophylline 300 mg Respiratory

Thorazine Chlorpromazine 10 mg Psychiatric Antipsychotic


Thorazine Chlorpromazine 100 mg/ml Psychiatric Antipsychotic



Thorazine Chlorpromazine 30 mg/ml Psychiatric Antipsychotic


Ticlid Ticlopidine 250 mgPlatelet aggregation

inhibitor

Tivicay Dolutegravir 10 mg Antiretrovirals Integrase Inhibitor



Tofranil Imipramine 10 mg Psychiatric Antidepressant



Toprol XL Metoprolol succinate 100 mg Cardiovascular Beta Blockers



Trandate Labetalol HCL 100 mg Cardiovascular Beta Blockers



Trecator Ethionamide 250 mg Antimicrobials Antitubercular

Trental Pentoxifylline ER 400 mg Hemorrheologic Agents

Tricor Fenofibrate 145 mg CardiovascularCholesterol Lowering

Agents

Tricor Fenofibrate 48 mg CardiovascularCholesterol Lowering

Agents

Trilafon Perphenazine 16 mg Psychiatric Antipsychotic

Trilafon Perphenazine 16 mg / 5 cc (120 ml) Psychiatric Antipsychotic







TruvadaEmtricitabine and tenofovir

disoproxil fumarate200-300 mg Antiretrovirals

Reverse Transcriptase

Inhibitor,

Nucleoside/Nucleotide

Tylenol Acetaminophen 325 mg Analgesic Acetaminophen



Tylenol #3 Acetaminophen/Codeine #3 300 mg-30 mg Analgesic Narcotic

Ultram, Rybix Tramadol 50 mg Analgesic Misc

Valium Diazepam (SCH IV) 10 mg Psychiatric Benzos



Vaseretic Enalapril maleate/Hctz 10 mg-25 mg Cardiovascular Antihypertensive

Vaseretic Enalapril maleate/Hctz 5 mg-12.5 mg Cardiovascular Antihypertensive

Vasotec Enalapril maleate 10 mg Cardiovascular ACE Inhibitor

Vasotec Enalapril maleate 2.5 mg Cardiovascular ACE Inhibitor



Veetids Penicillin VK 125 mg/5 ml (200 cc) Antimicrobials Penicillins

Veetids Penicillin VK 250 mg Antimicrobials Penicillins



Veetids Penicillin VK 500 mg Antimicrobials Penicillins

Ventolin Albuterol liquid 2 mg/5 ml (120 cc) Respiratory

VicodinAcetaminophen/Hydrocodone

bitartrate500 mg-5 mg Analgesic Narcotic

Vitamin B5 Pyridoxine 25 mg Vitamin

Vitamin B6 Pyridoxine 100 mg Vitamin

Voltaren Diclofenac1% gel (Use Brand

Product)Derm NSAID

Voltaren Diclofenac 50 mg Analgesic NSAID

Voltaren Diclofenac 75 mg Analgesic NSAID




Vosol Acetic acid 15 ml drops Otic

Vosol HC Acetic acid/Hydrocortisone 2%-1% Otic

Wellbutrin SR Buproprion IR, SR 100 mg Psychiatric Antidepressant





Wellbutrin XL Bupropion XL 150 mg Psychiatric Antidepressant

Wellbutrin XL Bupropion XL 300 mg Psychiatric Antidepressant

Xalatan Latanoprost 0.005% Ophthalmic

Xarelto Rivaroxaban 10 mg Cardiovascular Anticoagulants



Xylocaine Lidocaine 2% jelly Derm Anesthetic

Zantac Ranitidine 150 mg GI H2 blockers

Zantac Ranitidine 300 mg GI H2 blockers

Zaroxolyn Metolazone 10 mg Cardiovascular Diuretics

Zaroxolyn Metolazone 2.5 mg Cardiovascular Diuretics

Zaroxolyn Metolazone 5 mg Cardiovascular Diuretics

Zestoretic Lisinopril/Hctz 10 mg - 12.5 mg Cardiovascular Antihypertensive

Zestoretic Lisinopril/Hctz 20 mg - 12.5 mg Cardiovascular Antihypertensive

Zestoretic Lisinopril/Hctz 20 mg - 25 mg Cardiovascular Antihypertensive

Zithromax Azithromycin 250 mg Antimicrobials Macrolides

Zithromax Azithromycin 600 mg Antimicrobials Macrolides

Zocor Simvastatin 10 mg CardiovascularCholesterol Lowering

Agents


Agents


Agents

Zoloft Sertraline 100 mg Psychiatric Antidepressant

Zoloft Sertraline 20 mg/ml Psychiatric Antidepressant






Zovirax Acyclovir 200 mg Antimicrobials Antiviral



Zyloprim Allopurinol 100 mg Gout

Zyloprim Allopurinol 300 mg Gout

Zyprexa Olanzapine 2.5mg Psychiatric Antipsychotic

Zyprexa Olanzapine 5 mg Psychiatric Antipsychotic

Zyvox Linezolid 600 mg Antimicrobials Oxazolidinone

Aspirin (acetylsalicylic acid, ASA) 325 mg Analgesic Salicylates

Aspirin (acetylsalicylic acid, ASA) 81 mg Analgesic Salicylates

Capsaicin 0.025% cream Derm Analgesic



Cortisporin otic soln1%-0.35%-10000u/mL

(10 ml)Otic

Cortisporin otic susp drops (10 ml) Otic

Diabetes supplies - glucometer Diabetes

Diabetes supplies - lancets Diabetes

Diabetes supplies - syringes/

needlesDiabetes

Diabetes supplies - test strips Diabetes

Diabetes supplies - testing control

solutionDiabetes

Erythromycin eye ointment 5 mg / Gm (3.5 Gm) Ophthalmic

Folic Acid 1 mg Vitamin

Lidocaine 4% cream Derm Anesthetic

Lidocaine 4% solution Derm Anesthetic

Lidocaine 5% cream Derm Anesthetic

Lidocaine 5% ointment Derm Anesthetic

Methadone 10 mg Analgesic Narcotic

Methadone 5 mg Analgesic Narcotic

Niacin IR & ER tabs only 100 mg Cardiovascular






Nicotine Gum 2 mg Smoking deterrents

Nicotine Gum 4 mg Smoking deterrents

Nicotine Lozenge 2 mg Smoking deterrents

Nicotine Lozenge 4 mg Smoking deterrents

Nystatin (cream or ointment) Derm Antifungals

Nystatin oral suspension 100,000 units/ml Antimicrobials Antifungals

Phenobarbital (SCH IV) 100 mg Neurologic Anticonvulsant




Potassium chloride 10% (480 cc) Cardiovascular Potassium Supplement

Prednisolone ophth solu or susp 1% Ophthalmic

Prenatal Vitamin 27/0.8 mg Vitamin

Promethazine/VC/DM Cold, Cough, Allergy Antitussive

Pyrazinamide 500 mg Antimicrobials Antitubercular

Salsalate 500 mg Analgesic Salicylates

Salsalate 750 mg Analgesic Salicylates

Timolol Maleate eye drops 0.25% Ophthalmic Glaucoma

Timolol Maleate eye drops 0.5% Ophthalmic Glaucoma

Tobramycin ophthal soln. 0.3% Ophthalmic

Vitamin B6 50 mg Vitamin


Documents

HealthPAC Formulary - Alameda County, California