Kaiser Permanente: Maintenance Medication Exclusion List

Kaiser Permanente

Maintenance Medication Exclusion List

The following is a list of drugs that are excluded as maintenance medications. Medications which are listed

here cannot be filled through the mail order pharmacy for the mail order incentive.

This list includes both formulary/preferred and non-formulary/non-preferred medications, and does not

provide information regarding the specific coverage, limitations, exclusions or quotas an individual

member may have. Some dosage forms and strengths of a particular drug may be considered maintenance

medications, whereas others may not.

This list is sorted alphabetically by generic drug name. Generic drug names are written in lower case letters.

Brand drug names (or some generic drugs with a trade name) are written in CAPITAL letters. Some drugs do not

have a brand name available, in such cases the generic name is listed in the “Brand Name” column.

This list of drugs should not be used to determine pharmacy benefits, such as prescription

copay/coinsurance amounts or formulary status. If you have questions about the formulary status of a

medication, or your prescription benefits, please call our Member Services Department at 1-888-681-7878

(toll free). For the hearing or speech impaired: 1-800-521-4874 (toll free TTY).

The medications on this list are subject to change at any time.

Exclusions: Any formulation that is required to be administered by a skilled medical professional or in a medical

office, drugs infused in the home or in an infusion center, drugs that may have other quantity restrictions, any

state law that may prohibit the mailing of certain dosage formulation of a drug, drugs that have a high potential

for waste and diversion, drugs that require temperature control upon mailing and drugs that require refrigeration.

Kaiser Permanente Mail Order Pharmacy Maintenance Medication Exclusion List

Medications listed are not considered 'Maintenance Drugs' and cannot be provided under the mail order incentive. Revision date: December 2011 Page 2 of 26

Generic Name Product Description

acetaminophen w/ codeine acetaminophen/codeine #2 tab 300-15mg



acetaminophen w/ codeine acetaminophen/codeine sol 120-12/5

acetaminophen w/ codeine CAPITAL/CODEINE SUS 120-12/5

acetaminophen w/ codeine COCET PLUS TAB 650-60MG

acetaminophen w/ codeine COCET TAB 650-30MG

acetaminophen-caff-dihydrocod acetaminophen/caffeine/dihydrocodeine bitartrate tab

hydrocod

acetaminophen-caff-dihydrocod TREZIX CAP

acetaminophen-isometheptene-caffeine MIGRALAM CAP

acetaminophen-isometheptene-caffeine PRODRIN TAB

acetaminophen-isometheptene-dichloralphenazone MIDRIN CAP

acetaminophen-magnesium salicylate-

phenyltoloxamine-caffeine CAFGESIC FORTE TAB

acetaminophen-phenyltoloxamine-caffeine FLEXTRA CAP

acetaminophen-salicylamide-phenyltoloxamine DOLOREX CAP

acetaminophen-salicylamide-phenyltoloxamine-

caffeine CAFGESIC CAP

acrivastine & pseudoephedrine SEMPREX-D CAP 8-60MG

alfentanil alfentanil inj 500/ml

almotriptan malate AXERT TAB 12.5MG

almotriptan malate AXERT TAB 6.25MG

alprazolam alprazolam ER tab 0.5mg

alprazolam alprazolam ER tab 1mg



alprazolam alprazolam intensol con 1 mg/ml

alprazolam alprazolam ODT tab 0.25mg

alprazolam alprazolam ODT tab 0.5mg

alprazolam alprazolam ODT tab 1mg

alprazolam alprazolam ODT tab 2mg

alprazolam alprazolam tab 0.25mg

alprazolam alprazolam tab 0.5mg

alprazolam alprazolam tab 1mg

alprazolam alprazolam tab 2mg

alprazolam-dietary management product GABAZOLAMINE PAK

amobarbital sodium AMYTAL SODIUM INJ 500MG

armodafinil NUVIGIL TAB 150MG



aspirin w/ codeine aspirin/codeine tab 325-30mg

aspirin w/ codeine aspirin/codeine tab 325-60mg

aspirin-apap-salicyl-caff LEVACET TAB

benzonatate benzonatate cap 100mg




benzonatate benzonatate cap 200mg

benzonatate ZONATUSS CAP 150MG

brompheniramine & phenyleph ALACOL DRO 0.4-1MG

brompheniramine & phenyleph ALACOL SYP 2-5MG

brompheniramine & phenyleph bpm pe liq

brompheniramine & phenyleph BROMAX D TAB

brompheniramine & phenyleph BROVEX PEB LIQ

brompheniramine & phenyleph ENTRE-B SUS 6-10MG/5

brompheniramine & phenyleph phenylephrine hydrochlori de/brompheniramine

maleate cap 15-12mg

brompheniramine & phenyleph phenylephrine hydrochlori de/brompheniramine

maleate cap 7.5-6mg

brompheniramine & phenyleph VAZOTAB CHW

brompheniramine & pseudoeph ANDEHIST NR SYP 4-45MG/M

brompheniramine & pseudoeph bpm pseudo tab 6-45mg

brompheniramine & pseudoeph brompheniramine/pse cap 9-90mg

brompheniramine & pseudoeph BROVEX PSB LIQ

brompheniramine & pseudoeph BROVEX PSE TAB 4-40MG

brompheniramine & pseudoeph HISTEX SR TAB 10-120MG

brompheniramine & pseudoeph J-TAN D PD DRO 1-7.5MG

brompheniramine & pseudoeph LODRANE 24D CAP 12-90MG

brompheniramine & pseudoeph pse bpm liq

brompheniramine & pseudoeph RESPAHIST CAP 6-60MGCR

brompheniramine maleate BROMSPIRO LIQ 2MG/5ML

brompheniramine maleate J-TAN PD DRO 1MG/ML

brompheniramine maleate LODRANE 24 CAP

brompheniramine maleate LOHIST-12 TAB 12 HOUR

brompheniramine maleate RESPA-BR TAB 11MG

brompheniramine tannate BROVEX CT CHW 12MG

brompheniramine tannate BROVEX SUS 12MG/5ML

brompheniramine tannate J-TAN SUS

brompheniramine tannate P-TEX SUS 10MG/5ML

brompheniramine tannate TANACOF-XR SUS 8MG/5ML

brompheniramine tannate-phenylephrine tannate brompheniramine tann/phenylephrine tann sus 4-5mg

brompheniramine tannate-phenylephrine tannate brompheniramine/phenylephrine tannate sus tann

brompheniramine tannate-phenylephrine tannate BROVEX ADT SUS 12-10

brompheniramine tannate-phenylephrine tannate C-TAN D PLUS SUS

brompheniramine tannate-phenylephrine tannate J-TAN D SUS

brompheniramine tannate-phenylephrine tannate RELHIST CHW

brompheniramine tannate-phenylephrine tannate TANABID CHW 2.2-1.58

brompheniramine tannate-pseudoephedrine tannate BROVEX PD SUS

brompheniramine tannate-pseudoephedrine tannate LODRANE D SUS

brompheniramine w/ dm-gg TRISPEC SFX LIQ

brompheniramine w/ dm-gg TUSNEL CAP




brompheniramine-diphenhydramine ALA-HIST TAB 6-25MG

brompheniramine-diphenhydramine-phenylephrine ALA-HIST D TAB 6-25-20

bromphen-pseudoephed-chlorphen-phenyleph-

methscopolamine SYMPAK II MIS

buprenorphine BUTRANS DIS 10MCG/HR



buprenorphine hcl BUPRENEX INJ 0.3MG/ML

buprenorphine hcl buprenorphine hcl inj 0.3mg/ml

buprenorphine hcl buprenorphine hcl sub 2mg

buprenorphine hcl buprenorphine hcl sub 8mg

buprenorphine hcl-naloxone hcl dihydrate SUBOXONE MIS 2-0.5MG

buprenorphine hcl-naloxone hcl dihydrate SUBOXONE MIS 8-2MG

buprenorphine hcl-naloxone hcl dihydrate SUBOXONE SUB 2-0.5MG

buprenorphine hcl-naloxone hcl dihydrate SUBOXONE SUB 8-2MG

buspirone hcl buspirone hcl tab 10mg




buspirone hcl buspirone hcl tab 7.5mg

butabarbital sodium BUTISOL SODIUM ELX 30MG/5ML

butabarbital sodium BUTISOL SODIUM TAB 30MG

butabarbital sodium BUTISOL SODIUM TAB 50MG

butalbital-acetaminophen butalbital/acetaminophen tab 50-325

butalbital-acetaminophen PHRENILIN FORTE CAP FORTE

butalbital-acetaminophen PROMACET TAB 50-650MG

butalbital-acetaminophen-caffeine ALAGESIC LQ SOL

butalbital-acetaminophen-caffeine butalbital/acetaminophen/caffeine tab

butalbital-acetaminophen-caffeine butalbital/apap/caffeine cap

butalbital-acetaminophen-caffeine DOLGIC PLUS TAB

butalbital-acetaminophen-caffeine ORBIVAN CAP

butalbital-acetaminophen-caffeine ZEBUTAL CAP

butalbital-acetaminophen-caffeine w/ codeine butalbital/acetaminophen/caffeine/codeine cap

codeine

butalbital-aspirin-caffeine butalbital/asa/caffeine cap

butalbital-aspirin-caffeine butalbital/aspirin/caffeine tab

butalbital-aspirin-caffeine w/cod ASCOMP/CODEINE CAP 30MG

butorphanol tartrate butorphanol tartrate inj 1mg/ml

butorphanol tartrate butorphanol tartrate inj 2mg/ml

butorphanol tartrate butorphanol tartrate sol 10mg/ml

carbetapentane citrate-carbetapentane tannate-pe hcl-

pe tan CARBATUSS-12 SUS

carbetapentane citrate-guaifenesin tannate RESPI-TANN G SUS

carbetapentane citrate-pseudoephedrine hcl tannate ALLRES PD SUS

carbetapentane citrate-pseudoephedrine hcl tannate RESPI-TANN CHW




carbetapentane citrate-pseudoephedrine hcl tannate RESPI-TANN PD SUS PD

carbetapentane citrate-pseudoephedrine hcl tannate RESPI-TANN SUS

carbetapentane tannate SOLOTUSS SUS 30MG/5ML

carbetapentane tannate-pyrilamine tannate PYRLEX CB SUS

carbetapentane-guaifenesin CARBA-XP LIQ

carbetapentane-guaifenesin DYNEX VR CAP

carbetapentane-guaifenesin EXALL LIQ 10-100MG

carbetapentane-guaifenesin EXPECTUSS LIQ 20-75MG/

carbetapentane-guaifenesin TUSSO-ZMR CAP 8-200MG

carbetapentane-guaifenesin TUSSO-ZR SYP 7.5-150

carbetapentane-pseudoephedrine CORZALL LIQ 20-30MG

carbinoxamine maleate carbinoxamine maleate liq 4mg/5ml

carbinoxamine maleate carbinoxamine maleate tab 4mg

cetirizine hcl cetirizine hcl syp 1mg/ml

chlophedianol-triprolidine PROHIST CF LIQ

chloral hydrate CHLORAL HYDRATE SUP 500MG

chloral hydrate CHLORAL HYDRATE SYP 500/5ML

chloral hydrate SOMNOTE CAP 500MG

chlordiazepoxide hcl chlordiazepoxide hcl cap 10mg



chlordiazepoxide hcl LIBRIUM INJ 100MG

chlorphen tan & pseudoeph tan DICEL SUS

chlorpheniramine & phenylephrine ACCUHIST DRO 1-2.5MG

chlorpheniramine & phenylephrine CENTERGY DRO 1-2MG/ML

chlorpheniramine & phenylephrine C-PHEN DRO

chlorpheniramine & phenylephrine DALLERGY JR CAP 4-20MG

chlorpheniramine & phenylephrine HISTEX SR TAB 6-15MG

chlorpheniramine & phenylephrine NOHIST TAB 8-20MG

chlorpheniramine & phenylephrine SILDEC-PE SYP

chlorpheniramine & pseudoeph chlorpheniramine/pseudoephedrine cr cap 8-120 cr

chlorpheniramine & pseudoeph chlorpheniramine/pseudoephedrine syp

chlorpheniramine & pseudoeph DECONAMINE TAB 4-60MG

chlorpheniramine & pseudoeph DURATUSS DA CAP 12-100MG

chlorpheniramine & pseudoeph LOHIST-D LIQ

chlorpheniramine & pseudoeph NEUTRAHIST DRO 0.8-9MG

chlorpheniramine & pseudoeph SUDAHIST TAB 12-120MG

chlorpheniramine maleate chlorpheniramine maleate cap 12mg ER

chlorpheniramine maleate chlorpheniramine maleate cap 8mg ER

chlorpheniramine maleate CPM CAP 12MG CR

chlorpheniramine maleate tannate PEDIOX-S SUS 4MG/5ML

chlorpheniramine maleate-pseudoephedrine hcl

tannate SUDAL 12 TANNATE CHW 4-30MG

chlorpheniramine mal-phenylephrine hcl-methscop AH-CHEW ULTRA SUS ULTRA




nit tannate

chlorpheniramine tannate AHIST TAB 12MG

chlorpheniramine tannate ED CHLORPED SUS 2MG/ML

chlorpheniramine tannate ED-CHLOR-TAN TAB 8MG

chlorpheniramine tannate PEDIAPHYL SUS 8MG/5ML

chlorpheniramine tannate-carbetapentane tannate C-TANNA 12 SUS 4-30MG/5

chlorpheniramine tannate-carbetapentane tannate TUSSI-12 TAB 5-60MG

chlorpheniramine tannate-carbetapentane tannate TUSTAN 12S SUS

chlorpheniramine tannate-methscopolamine DEXODRYL CHW 2-1.5MG

chlorpheniramine tannate-methscopolamine DEXODRYL SUS

chlorpheniramine tannate-phenylephrine tan-

methscopolamine AH-CHEW ULTRA CHW ULTRA


methscopolamine REDUR-PCM SUS


methscopolamine SYMPAK PDX MIS

chlorpheniramine tannate-phenylephrine tannate ALLERX SUS

chlorpheniramine tannate-phenylephrine tannate DALLERGY-JR SUS

chlorpheniramine tannate-phenylephrine tannate ED CHLORPED D SUS D

chlorpheniramine tannate-phenylephrine tannate P-TANN D SUS

chlorpheniramine tannate-phenylephrine tannate R-TANNA PEDIATRIC SUS PEDI

chlorpheniramine tannate-phenylephrine tannate R-TANNA TAB 9-25MG

chlorpheniramine tannate-phenylephrine tannate RYNATAN PEDIATRIC CHW 4.5-5MG

chlorpheniramine tan-pyrilamine tan-phenylephrine

tan CONAL SUS

chlorpheniramine tan-pyrilamine tan-phenylephrine

tan NALEX-A 12 SUS

chlorpheniramine w/ codeine COTAB A TAB 4-10MG

chlorpheniramine w/ codeine COTAB AX TAB 4-20MG

chlorpheniramine w/ codeine ENDACOF-C LIQ 2-10MG/5

chlorpheniramine w/ codeine ZODRYL AC 50 SUS



chlorpheniramine w/ codeine Z-TUSS AC LIQ 2-9/5ML

chlorpheniramine w/ dm-gg ALLFEN DMA TAB 4-20-400

chlorpheniramine-methscopolamine RELCOF CPM TAB 8-2.5MG

chlorpheniramine-methscopolamine RESPIVENT DF MIS

chlorpheniramine-methscopolamine RYNEZE LIQ

chlorpheniramine-phenylephrine-acetaminophen PROTID TAB CR

chlorpheniramine-phenylephrine-methscopolamine AEROKID SYP

chlorpheniramine-phenylephrine-methscopolamine AH-CHEW II CHW

chlorpheniramine-phenylephrine-methscopolamine ALLERX PE MIS

chlorpheniramine-phenylephrine-methscopolamine CHLOR-MES D SYP LIQUID

chlorpheniramine-phenylephrine-methscopolamine cpm 8/pe 20/msc 1.25 tab

chlorpheniramine-phenylephrine-methscopolamine DALLERGY CHW




chlorpheniramine-phenylephrine-methscopolamine DALLERGY PE SYP

chlorpheniramine-phenylephrine-methscopolamine DALLERGY PE TAB

chlorpheniramine-phenylephrine-methscopolamine DALLERGY SYP

chlorpheniramine-phenylephrine-methscopolamine DALLERGY TAB

chlorpheniramine-phenylephrine-methscopolamine DALLERGY TAB ER

chlorpheniramine-phenylephrine-methscopolamine DEHISTINE SYP

chlorpheniramine-phenylephrine-methscopolamine OMNIHIST II LA TAB

chlorpheniramine-phenylephrine-methscopolamine phenylephrine cm tab

chlorpheniramine-phenylephrine-methscopolamine RE-DRYLEX JR TAB

chlorpheniramine-phenylephrine-methscopolamine RELCOF DN PE MIS

chlorpheniramine-phenylephrine-methscopolamine RELCOF PE TAB

chlorpheniramine-phenylephrine-methscopolamine RESCON TAB

chlorpheniramine-phenylephrine-methscopolamine &

homeopathic ZINX KIDS SNEEZE KIT

chlorpheniramine-phenyltoloxamine-phenylephrine-

apap NOREL SR TAB

chlorpheniramine-pseudoephedrine & belladonna

alkaloids RESPA-A.R. TAB

chlorpheniramine-pseudoephedrine & homeopathic

product ZINX ALLERGY KIT

chlorpheniramine-pseudoephedrine &

methscopolamine COLDAMINE TAB 8-90-2.5


methscopolamine DALLERGY PSE TAB


methscopolamine DRYMAX SYP


methscopolamine pcm la tab


methscopolamine RELCOF DN PSE MIS


methscopolamine RELCOF PSE TAB


methscopolamine TIME-HIST QD TAB


methscopolamine VISRX DOSE PACK TAB

chlorpheniramine-pyrilamine & phenylephrine MYHIST-PD LIQ

chlorpheniramine-pyrilamine & phenylephrine PHENA-PLUS TAB

chlorpheniramine-pyrilamine & phenylephrine PHENA-S LIQ

chlorpheniramine-pyrilamine & phenylephrine RU-HIST FORTE TAB

chlorpheniramine-pyrilamine tan-phenyleph hcl-

phenyleph tan PHENA-S 12 SUS

chlorphen-phenyltolox-pe chlorpheniramine/phenylto loxamine/phenylephrine

liq pe

chlorphen-phenyltolox-pe RHINACON A TAB

chlorphen-pse-atropine-hyoscyamine-scopolamine RU-TUSS TAB




choriogonadotropin alfa OVIDREL INJ

chorionic gonadotropin chorionic gonadotropin inj 10000unt

clemastine fumarate clemastine fumarate syp 0.5/5ml

clemastine fumarate clemastine fumarate tab 2.68mg

clorazepate dipotassium clorazepate dipotassium tab 15mg

clorazepate dipotassium clorazepate dipotassium tab 3.75mg

clorazepate dipotassium clorazepate dipotassium tab 7.5mg

clorazepate dipotassium TRANXENE-SD TAB 11.25MG

clorazepate dipotassium TRANXENE-SD TAB 22.5MG

codeine phosphate codeine phosphate inj 30mg/2ml

codeine phosphate codeine phosphate inj 60mg/2ml

codeine sulfate codeine sulfate tab 15mg



codeine-brompheniramine BROVEX CB TAB 10-4MG

codeine-brompheniramine BROVEX CBX TAB 20-4MG

codeine-brompheniramine NALEX AC SYP

codeine-chlorcyclizine NOTUSS-NX LIQ

codeine-chlorpheniramine-acetaminophen COTABFLU TAB 20-4-500

codeine-phenylephrine-chlorcyclizine NASOTUSS LIQ

codeine-pseudoephedrine-chlorcyclizine NOTUSS-NXD LIQ

codeine-pyrilamine PRO-CLEAR AC SYP

cyproheptadine hcl cyproheptadine hcl syp 2mg/5ml

cyproheptadine hcl cyproheptadine hcl tab 4mg

desloratadine CLARINEX REDITABS TAB 2.5MG

desloratadine CLARINEX REDITABS TAB 5MG

desloratadine CLARINEX SYP 0.5MG/ML

desloratadine CLARINEX TAB 5MG

desloratadine-pseudoephedrine CLARINEX-D 12 HOUR TAB 2.5-120

desloratadine-pseudoephedrine CLARINEX-D 24 HOUR TAB 5-240MG

dexbrompheniramine tannate-pyrilamine maleate POLY TAN SUS

dexbrompheniramine tan-pyrilamine mal-

phenylephrine tan POLY TAN D SUS

dexchlorpheniramine maleate dexchlorpheniramine maleate syp 2mg/5ml

dexchlorpheniramine maleate dexchlorpheniramine maleate tab 6mg cr

dexchlorpheniramine tannate & pseudoephedrine

tannate SUTAN SUS

dexchlorpheniramine-phenylephrine NALDEX TAB

dexchlorpheniramine-phenylephrine RESCON-JR TAB

dexchlorpheniramine-phenylephrine RESCON-MX TAB

dexchlorpheniramine-phenylephrine-

methscopolamine DEXPHEN M SOL

dexchlorpheniramine-pseudoephedrine-

methscopolamine DURAHIST D TAB

dexmedetomidine hcl PRECEDEX INJ 100MCG




dextromethorphan hbr-guaifenesin tannate DURATUSS DM 12 SUS DM 12

dextromethorphan-chlorpheniramine-

methscopolamine EXTENDRYL DM TAB

dextromethorphan-guaifenesin ALLFEN DM TAB 400-20MG

dextromethorphan-guaifenesin dm/guai liq 10-300mg

dextromethorphan-guaifenesin DURATUSS DM ELX

dextromethorphan-guaifenesin GANI-TUSS DM NR LIQ 100-10/5

dextromethorphan-guaifenesin NORTUSS-EX LIQ 200-20/5

dextromethorphan-guaifenesin SU-TUSS DM ELX 200-20/5

dextromethorphan-guaifenesin TRISPEC DMX LIQ

dextromethorphan-potassium guaiacolsulfonate GUIADEX DM LIQ

dextromethorphan-potassium guaiacolsulfonate PROLEX DMX LIQ

diazepam diazepam inj 5mg/ml

diazepam diazepam intensol con 5mg/ml

diazepam diazepam sol 1mg/ml

diazepam diazepam tab 10mg



diazepam (anticonvulsant) DIASTAT ACUDIAL GEL 12.5-20

diazepam (anticonvulsant) DIASTAT ACUDIAL GEL 5-10MG

diazepam (anticonvulsant) DIASTAT PEDIATRIC GEL 2.5M

dihydrocodeine compound SYNALGOS-DC CAP

dihydrocodeine-guaifenesin J-MAX DHC LIQ

dihydroergotamine mesylate dihydroergotamine mesylate inj 1mg/ml

dihydroergotamine mesylate MIGRANAL SPR 4MG/ML

diphenhydramine & pseudoephed TEKRAL TAB

diphenhydramine hcl diphenhydramine hcl cap 25mg

diphenhydramine hcl diphenhydramine hcl cap 50mg

diphenhydramine hcl diphenhydramine hcl elx 12.5/5ml

diphenhydramine hcl diphenhydramine hcl inj 50mg/ml

diphenhydramine hcl DYTUSS SYP 12.5/5ML

diphenhydramine hcl-phenylephrine hcl tannate ALDEX-CT CHW 12.5-5MG

diphenhydramine tannate BEN-TANN SUS 25MG/5ML

diphenhydramine tannate DYTAN CHW 25MG

diphenhydramine tannate-carbetapentane tannate D-TANN AT SUS

diphenhydramine tannate-phenylephrine tannate D-TANN CHW 25-10MG

diphenhydramine tannate-phenylephrine tannate D-TANN SUS 25-7.5MG

diphenhydramine-phenylephrine ZODEN PD LIQ 25-7.5

doxylamine succinate DOXYTEX LIQ

doxylamine succinate tannate ALDEX AN SUS

droperidol droperidol inj 2.5mg/ml

eletriptan hydrobromide RELPAX TAB 20MG

eletriptan hydrobromide RELPAX TAB 40MG

ephedrine-guaifenesin BRONCHOLATE SYP 6.25-100




ergoloid mesylates ergoloid mesylates tab 1mg oral

ergotamine tartrate ERGOMAR SUB 2MG

ergotamine w/ caffeine ergotamine tartrate/caffeine tab 1/100

ergotamine w/ caffeine MIGERGOT SUP 2/100

estazolam estazolam tab 1mg

estazolam estazolam tab 2mg

eszopiclone LUNESTA TAB 1MG



fentanyl fentanyl dis 100mcg/h

fentanyl fentanyl dis 12mcg/hr




fentanyl citrate ABSTRAL SUB 100MCG






fentanyl citrate fentanyl citrate inj 0.05mg/1

fentanyl citrate fentanyl citrate oral transmucosal loz 1200mcg






fentanyl citrate FENTORA TAB 100MCG






fentanyl citrate ONSOLIS MIS 1200MCG





fexofenadine hcl ALLEGRA ODT TAB 30MG

fexofenadine hcl ALLEGRA SUS 30MG/5ML

fexofenadine hcl fexofenadine hcl tab 180mg



fexofenadine-pseudoephedrine fexofenadine/pseudoephedr ine tab 24 hour




fexofenadine-pseudoephedrine fexofenadine/pseudoephedr ine tab 60-120mg

flurazepam hcl flurazepam hcl cap 15mg

flurazepam hcl flurazepam hcl cap 30mg

follitropin alfa GONAL-F INJ 1050UNIT

follitropin alfa GONAL-F INJ 450UNIT

follitropin alfa GONAL-F RFF INJ 75UNIT

follitropin alfa GONAL-F RFF PEN INJ 300



follitropin beta FOLLISTIM AQ INJ 150UNIT





frovatriptan succinate FROVA TAB 2.5MG

guaifenesin-chlorpheniramine maleate ALLFEN A TAB 400-4MG

guaifenesin-codeine ALLFEN CD TAB 400-10MG

guaifenesin-codeine ALLFEN CDX LIQ

guaifenesin-codeine ALLFEN CDX TAB 400-20MG

guaifenesin-codeine BRONTEX LIQ

guaifenesin-codeine BRONTEX TAB

guaifenesin-codeine DEX-TUSS LIQ

guaifenesin-codeine guaifenesin ac syp ac

guaifenesin-codeine MAR-COF CG EXPECTORANT LIQ EXPECT

guaifenesin-codeine M-CLEAR WC LIQ

guaifenesin-codeine PRO-CLEAR CAP 200-9MG

guaifenesin-codeine TUSSO-C LIQ 200-10MG

hydrocodone polistirex-chlorpheniramine polistirex hydrocodone polistirex/chlorpheniramine polistirex

liq

hydrocodone polistirex-chlorpheniramine polistirex TUSSICAPS CAP 10-8MG

hydrocodone polistirex-chlorpheniramine polistirex TUSSICAPS CAP 5-4MG

hydrocodone w/ homatropine HYDROMET SYP 5-1.5/5

hydrocodone w/ homatropine TUSSIGON TAB 5MG

hydrocodone-acetaminophen HYCET SOL 7.5-325

hydrocodone-acetaminophen hydrocodone bitartrate/acetaminophen tab 10-300mg



hydrocodone-acetaminophen hydrocodone bitartrate/acetaminophen tab 7.5-300

hydrocodone-acetaminophen HYDROCODONE/ACETAMINOPHEN SOL 10-

325MG

hydrocodone-acetaminophen hydrocodone/acetaminophen sol apap

hydrocodone-acetaminophen hydrocodone/acetaminophen tab 10-325mg







hydrocodone-acetaminophen hydrocodone/acetaminophen tab 2.5-500







hydrocodone-acetaminophen STAGESIC CAP 500-5MG

hydrocodone-acetaminophen ZAMICET SOL 10-325MG

hydrocodone-acetaminophen ZOLVIT SOL 10-300MG

hydrocodone-acetaminophen ZYDONE TAB 10-400MG

hydrocodone-acetaminophen ZYDONE TAB 5-400MG

hydrocodone-acetaminophen ZYDONE TAB 7.5-400

hydrocodone-acetaminophen-dietary management

product THERACODOPHEN-325 PAK -325


product THERACODOPHEN-650 PAK -650


product THERACODOPHEN-LOW-90 PAK -LOW-90

hydrocodone-ibuprofen IBUDONE TAB 10-200MG

hydrocodone-ibuprofen REPREXAIN TAB 2.5-200

hydrocodone-ibuprofen REPREXAIN TAB 5-200MG

hydrocodone-ibuprofen VICOPROFEN TAB

hydromorphone hcl DILAUDID-5 LIQ 1MG/ML

hydromorphone hcl DILAUDID-HP INJ 10MG/ML

hydromorphone hcl DILAUDID-HP INJ 250MG

hydromorphone hcl EXALGO TAB 12MG



hydromorphone hcl hydromorphone hcl dosette inj 2mg/ml

hydromorphone hcl hydromorphone hcl inj 1mg/ml



hydromorphone hcl hydromorphone hcl inj 500/50ml

hydromorphone hcl hydromorphone hcl sup 3mg

hydromorphone hcl hydromorphone hcl tab 2mg



hydromorphone hcl-sodium chloride hydromorphone/sodium chloride inj /nacl

hydroxyzine hcl hydroxyzine hcl inj 25mg/ml

hydroxyzine hcl hydroxyzine hcl inj 50mg/ml

hydroxyzine hcl hydroxyzine hcl syp 10mg/5ml

hydroxyzine hcl hydroxyzine hcl tab 10mg






hydroxyzine pamoate hydroxyzine pamoate cap 100mg



iodine strong (lugol's) IODINE STRONG SOL STRONG

levocetirizine dihydrochloride levocetirizine dihydrochl oride tab dhcl 5mg

levocetirizine dihydrochloride XYZAL SOL

levorphanol tartrate LEVO DROMORAN INJ 2MG/ML

levorphanol tartrate LEVORPHANOL TARTRATE TAB 2MG

lorazepam lorazepam inj 2mg/ml

lorazepam lorazepam inj 4mg/ml

lorazepam lorazepam intensol con 2mg/ml

lorazepam lorazepam tab 0.5mg

lorazepam lorazepam tab 1mg

lorazepam lorazepam tab 2mg

lutropin alfa LUVERIS INJ 75UNIT

mecasermin INCRELEX INJ 40MG/4ML

mecasermin rinfabate (rdna) IPLEX INJ 36/0.6ML

menotropins MENOPUR INJ 75UNIT

menotropins REPRONEX INJ 75UNIT

meperidine hcl DEMEROL INJ 100/2ML

meperidine hcl DEMEROL INJ 100MG/ML

meperidine hcl DEMEROL INJ 25MG/0.5



meperidine hcl DEMEROL INJ 75MG/1.5


meperidine hcl meperidine hcl inj 100mg/ml





meperidine hcl meperidine hcl sol 50mg/5ml

meperidine hcl meperidine hcl tab 50mg

meperidine hcl meperitab tab 100mg

meperidine w/ promethazine meperidine/promethazine cap prometh

mephobarbital MEBARAL TAB 100MG



meprobamate meprobamate tab 200mg

meprobamate meprobamate tab 400mg

meprobamate-aspirin EQUAGESIC TAB 200-325

methadone hcl methadone hcl inj 10mg/ml

methadone hcl methadone hcl sol 10mg/5ml




methadone hcl methadone hcl sol 5mg/5ml

methadone hcl methadone hcl tab 10mg

methadone hcl methadone hcl tab 5mg

methadone hcl METHADOSE SUGAR-FREE CON 10MG/ML

methadone hcl METHADOSE TAB 40MG

midazolam hcl midazolam hcl inj 1mg/ml

midazolam hcl midazolam hcl inj 2mg/2ml

midazolam hcl midazolam hcl inj 5mg/ml

midazolam hcl midazolam hcl syp 2mg/ml

modafinil PROVIGIL TAB 100MG

modafinil PROVIGIL TAB 200MG

morphine sulfate DURAMORPH INJ 0.5MG/ML

morphine sulfate DURAMORPH INJ 1MG/ML

morphine sulfate KADIAN CAP 100MG CR








morphine sulfate morphine sulfate dilute-a-jet inj 25mg/ml

morphine sulfate morphine sulfate ER tab 100mg





morphine sulfate morphine sulfate inj 0.5mg/ml

morphine sulfate morphine sulfate inj 10/0.7ml

morphine sulfate morphine sulfate inj 10mg/ml

morphine sulfate morphine sulfate inj 150/30ml









morphine sulfate morphine sulfate sol 10/0.5ml

morphine sulfate morphine sulfate sol 10mg/5ml

morphine sulfate morphine sulfate sol 20mg/5ml

morphine sulfate morphine sulfate sol 20mg/ml

morphine sulfate morphine sulfate sol 5/0.25ml




morphine sulfate morphine sulfate sup 10mg




morphine sulfate morphine sulfate tab 15mg

morphine sulfate morphine sulfate tab 30mg

morphine sulfate beads AVINZA CAP 120MG






morphine sulfate for continuous microinfusion INFUMORPH 200 INJ 10MG/ML

morphine sulfate for continuous microinfusion INFUMORPH 500 INJ 25MG/ML

morphine sulfate in dextrose morphine sulfate in dextrose 5% inj 1mg/ml

morphine sulfate liposome DEPODUR INJ 10MG/ML

morphine sulfate liposome DEPODUR INJ 15/1.5ML

morphine-naltrexone EMBEDA CAP 100-4MG

morphine-naltrexone EMBEDA CAP 20-0.8MG


morphine-naltrexone EMBEDA CAP 50-2MG



nafarelin acetate SYNAREL SOL 2MG/ML

nalbuphine hcl nalbuphine hcl inj 10mg/ml

nalbuphine hcl nalbuphine hcl inj 20mg/ml

nalmefene hcl REVEX INJ 100MCG

nalmefene hcl REVEX INJ 1MG/ML

naloxone hcl naloxone hcl inj 0.4mg/ml

naloxone hcl naloxone hcl inj 1mg/ml

naltrexone VIVITROL INJ 380MG

naltrexone hcl naltrexone hcl tab 50mg

naratriptan hcl naratriptan hcl tab 1mg

naratriptan hcl naratriptan hcl tab 2.5mg

nicotine NICOTROL INHALER INH

nicotine NICOTROL NS SPR 10MG/ML

orphenadrine w/ aspirin & caff ORPHENADRINE COMPOUND DS TAB DS

orphenadrine w/ aspirin & caff orphenadrine/asa/caffeine tab

oxazepam oxazepam cap 10mg



oxycodone hcl DAZIDOX TAB 10MG

oxycodone hcl ETH-OXYDOSE CON 20MG/ML

oxycodone hcl oxycodone hcl cap 5mg




oxycodone hcl oxycodone hcl con 20mg/ml

oxycodone hcl oxycodone hcl sol 5mg/5ml

oxycodone hcl oxycodone hcl tab 15mg




oxycodone hcl OXYCONTIN TAB 10MG CR







oxycodone w/ acetaminophen MAGNACET TAB 10-400MG

oxycodone w/ acetaminophen MAGNACET TAB 2.5-400

oxycodone w/ acetaminophen MAGNACET TAB 5-400MG

oxycodone w/ acetaminophen MAGNACET TAB 7.5-400

oxycodone w/ acetaminophen oxycodone/acetaminophen cap 5-500mg

oxycodone w/ acetaminophen oxycodone/acetaminophen tab 10-325mg


oxycodone w/ acetaminophen oxycodone/acetaminophen tab 2.5-325




oxycodone w/ acetaminophen PRIMALEV TAB 2.5-300

oxycodone w/ acetaminophen PRIMLEV TAB 10-300MG

oxycodone w/ acetaminophen PRIMLEV TAB 5-300MG

oxycodone w/ acetaminophen PRIMLEV TAB 7.5-300

oxycodone w/ acetaminophen ROXICET SOL 5-325/5

oxycodone w/ acetaminophen ROXICET TAB 5-500MG

oxycodone w/ acetaminophen XOLOX TAB 10-500MG

oxycodone w/ aspirin ENDODAN TAB

oxycodone w/ aspirin oxycodone/aspirin tab

oxycodone-ibuprofen oxycodone/ibuprofen tab 5-400mg

oxymorphone hcl OPANA ER TAB 10MG






oxymorphone hcl OPANA ER TAB 7.5MG

oxymorphone hcl OPANA INJ 1MG/ML

oxymorphone hcl oxymorphone hydrochloride tab hcl 10mg

oxymorphone hcl oxymorphone hydrochloride tab hcl 5mg




palifermin KEPIVANCE INJ 6.25MG

pegvisomant SOMAVERT INJ 10MG



pentazocine lactate TALWIN INJ 30MG/ML

pentazocine w/ naloxone pentazocine/naloxone hcl tab naloxone

pentazocine-acetaminophen pentazocine/acetaminophen tab 25-650mg

pentobarbital sodium NEMBUTAL INJ 50MG/ML

phenyleph hcl-diphenhyd hcl-dextromethorphan hbr

tannate DURATUSS AC 12 SUS AC 12

phenyleph hcl-pyrilamine mal-dextromethorphan hbr

tannate DECONSAL DM CHW

phenyleph tan-dexbromphen tan-pyrilamine maleate-

dm tan POLY TAN DM SUS

phenyleph tannate-bromphen tannate-

dextromethorphan tannate BROMATAN-DM SUS

phenyleph tannate-bromphen tannate-

dextromethorphan tannate NEO DM SUS

phenyleph tannate-chlorphen tannate-carbetapentane

tannate CARBAPHEN 12 PED SUS


tannate CARBAPHEN 12 PED SUS


tannate CARBAPHEN 12 SUS

phenyleph tannate-chlorphen tannate-

dextromethorphan tannate MAXIPHEN ADT TAB

phenyleph tannate-diphenhyd tannate-carbetapentane

tannate D-TANN CT SUS


tannate D-TANN CT TAB


tannate DYTAN-CD SUS

phenyleph tannate-diphenhyd tannate-

dextromethorphan tannate LIVETAN DM SUS

phenyleph tannate-pyrilamine tannate-carbetapentane

tannate TUSSI-12D S SUS

phenyleph tannate-pyrilamine tannate-carbetapentane

tannate TUSSI-12D TAB 10-40-60

phenyleph tannate-pyrilamine tannate-

dextromethorphan tan ALLANVAN-DM SUS


dextromethorphan tan SINADEX 12 SUS


dextromethorphan tan VIRATAN-DM CHW 25-30-25

phenyleph-dm-pyril-pot guai-sod cit-citric acid ALBATUSSIN NN LIQ NN

phenyleph-promethazine w/ cod promethazine vc/codeine syp codeine




phenylephrine hcl-dextromethorphan hbr-guaifenesin

tannate TUSSO-XR SUS

phenylephrine tan-carbetapentane tan & homeopathic

product ZINX COLD KIT

phenylephrine tan-dexchlorphenir tan-

dextromethorphan tan DONATUSSIN DM SUS DM

phenylephrine tannate-carbetapentane tannate carb/phenyl-12 sus

phenylephrine tannate-carbetapentane tannate carb/phenyl-12 sus

phenylephrine tannate-carbetapentane tannate DYNEX 12 SUS

phenylephrine tannate-carbetapentane tannate L-ALL 12 NF SUS 25-30MG

phenylephrine tannate-carbetapentane tannate LEVALL-12 SUS 25-30MG

phenylephrine tannate-guaifenesin SINA-12X SUS

phenylephrine tannate-guaifenesin SINA-12X TAB 25-200MG

phenylephrine tannate-pyrilamine tannate-

guaifenesin RYNA-12X SUS 5-30-100

phenylephrine tannate-pyrilamine tannate-

guaifenesin RYNA-12X TAB

phenylephrine w/ codeine ALAHIST AC LIQ 7.5-10

phenylephrine w/ codeine NOTUSS-PE LIQ

phenylephrine w/ codeine-gg GILTUSS PED-C LIQ PED-C

phenylephrine w/ codeine-gg MAXIPHEN CD TAB

phenylephrine w/ codeine-gg MAXIPHEN CDX TAB

phenylephrine w/ dm-gg BIOTUSS LIQ

phenylephrine w/ dm-gg BRONCOTRON-D SUS

phenylephrine w/ dm-gg DESPEC DM SYP

phenylephrine w/ dm-gg GILTUSS LIQ

phenylephrine w/ dm-gg GILTUSS PEDIATRIC LIQ

phenylephrine w/ dm-gg GILTUSS TR CAP 7-14-288

phenylephrine w/ dm-gg GILTUSS TR TAB

phenylephrine w/ dm-gg MAXIPHEN DM TAB

phenylephrine w/ dm-gg NORTUSS-DE DRO

phenylephrine w/ dm-gg pdm gg syp 10-30-20

phenylephrine w/ dm-gg SINUTUSS DM TAB

phenylephrine w/ dm-gg TRITUSS SYP

phenylephrine w/ dm-gg TUSSAFED EX LIQ

phenylephrine w/ dm-gg TUSSI-PRES PEDIATRIC LIQ

phenylephrine w/ dm-gg Z-DEX SYP

phenylephrine w/ dm-gg ZOTEX PEDIATRIC DRO

phenylephrine w/ dm-gg ZOTEX-D SYP

phenylephrine w/ dm-gg ZOTEX-EX TAB

phenylephrine w/ dm-gg ZOTEX-G SYP

phenylephrine w/hydrocodone-gg GILTUSS HC LIQ

phenylephrine-brompheniramine w/ codeine BROVEX PB C TAB 10-4-10

phenylephrine-brompheniramine w/ codeine BROVEX PB CX TAB 10-4-20

phenylephrine-brompheniramine w/ codeine M-END PE LIQ




phenylephrine-brompheniramine w/ codeine POLY-TUSSIN AC LIQ AC

phenylephrine-brompheniramine-carbetapentane TREXBROM LIQ

phenylephrine-brompheniramine-carbetapentane VAZOTAN SUS

phenylephrine-brompheniramine-carbetapentane V-COF SUS

phenylephrine-brompheniramine-dextromethorphan-

guaifenesin BROMHIST-PDX SYP

phenylephrine-brompheniramine-dihydrocodeine POLY-TUSSIN DHC LIQ DHC

phenylephrine-brompheniramine-dm ALACOL DM DRO

phenylephrine-brompheniramine-dm ALAHIST DM LIQ 7.5-4-15

phenylephrine-brompheniramine-dm bpm pe dm syp 5-2-10mg

phenylephrine-brompheniramine-dm brompheniramine/phenyleph rine/dm liq 4-10-20

phenylephrine-brompheniramine-guaifenesin DECON-G DRO 2-1-40MG

phenylephrine-carbetapentane-guaifenesin AQUATAB C TAB

phenylephrine-carbetapentane-guaifenesin CARBETAPLEX SYP

phenylephrine-carbetapentane-guaifenesin EXTENDRYL GCP SOL GCP

phenylephrine-carbetapentane-guaifenesin phencarb gg syp

phenylephrine-carbetapentane-guaifenesin &

homeopathic prod ZINX COUGH KIT

phenylephrine-carbetapentane-potassium

guaiacolsulfonate CARBATUSS-CL LIQ

phenylephrine-chlorphen-dm ACCUHIST PDX DRO PDX

phenylephrine-chlorphen-dm CENTERGY DM DRO

phenylephrine-chlorphen-dm c-phen dm dro

phenylephrine-chlorphen-dm de-chlor dm syp liquid

phenylephrine-chlorphen-dm de-chlor dr syp liquid

phenylephrine-chlorphen-dm ED-A-HIST DM LIQ

phenylephrine-chlorphen-dm NEO DM DRO

phenylephrine-chlorphen-dm NEOTUSS PLUS LIQ

phenylephrine-chlorphen-dm pe-hist dm syp 5-2-15mg

phenylephrine-chlorphen-dm SILDEC PE-DM SYP

phenylephrine-chlorphen-dm ZODEN DM DRO

phenylephrine-chlorphen-dm ZOTEX-12D TAB

phenylephrine-chlorphen-gg p chlor gg sol drops

phenylephrine-chlorpheniramine w/ codeine CAPCOF SYP

phenylephrine-chlorpheniramine w/ codeine ENDAL CD SYP

phenylephrine-chlorpheniramine w/ dm-gg CHLORDEX GP SYP

phenylephrine-chlorpheniramine w/ dm-gg DONATUSSIN SYP

phenylephrine-chlorpheniramine w/ dm-gg ZOTEX-DM SYP

phenylephrine-chlorpheniramine-carbetapentane CARBAPHEN 12 LIQ

phenylephrine-chlorpheniramine-carbetapentane CARBAPHEN 12 PED SUS

phenylephrine-chlorpheniramine-dihydrocodeine BALTUSSIN SYP 20-5-3

phenylephrine-chlorpheniramine-dihydrocodeine DESPEC-PDC LIQ

phenylephrine-chlorpheniramine-dihydrocodeine DIHYDRO-PE SYP

phenylephrine-chlorpheniramine-dihydrocodeine DUOHIST DH LIQ 5-2-7.25

phenylephrine-chlorpheniramine-dihydrocodeine NOVAHISTINE DH LIQ DH




phenylephrine-chlorpheniramine-dm-gg-

methscopolamine SYMPAK DM MIS

phenylephrine-codeine-guaifenesin-acetaminophen PHENFLU CD TAB

phenylephrine-codeine-guaifenesin-acetaminophen PHENFLU CDX TAB

phenylephrine-dexbrompheniramine-

dextromethorphan DEXALL SYP 10-2-20

phenylephrine-dexbrompheniramine-

dextromethorphan TUSSALL-ER TAB 20-6-30

phenylephrine-dexbrompheniramine-dm-guaifenesin PANATUSS DXP PEDIATRIC LIQ PEDIATRI

phenylephrine-dexchlorpheniramine-carbetapentane CORZALL-PE LIQ

phenylephrine-dexchlorpheniramine-codeine VANACOF CD LIQ

phenylephrine-dexchlorpheniramine-pyrilamine-dm CORYZA-DM SYP

phenylephrine-dihydrocodeine ALAHIST DHC LIQ 7.5-3

phenylephrine-dihydrocodeine-guaifenesin DONATUSS DC SYP

phenylephrine-dihydrocodeine-guaifenesin POLY-TUSSIN EX SYP EX

phenylephrine-diphenhydramine-codeine AIRACOF SYP

phenylephrine-diphenhydramine-dm w/ apap RESPA C&C IR TAB

phenylephrine-diphenhydramine-dm w/ apap RESPA C&C TAB

phenylephrine-dm-gg w/ apap PHENFLU DM TAB

phenylephrine-dm-gg w/ apap PHENFLU G TAB

phenylephrine-ephedrine-chlorpheniramine w/

carbetapentane

QUAD-TUSS TANNATE PEDIATR IC SUS

TANN/PED

phenylephrine-ephedrine-chlorpheniramine w/

carbetapentane RYNATUSS TAB

phenylephrine-guaifenesin GILPHEX TR TAB 10-388MG

phenylephrine-guaifenesin guaifenesin/phenylephrine hcl syp

phenylephrine-guaifenesin MAXIPHEN TAB 10-400MG

phenylephrine-guaifenesin NAZARIN LIQ

phenylephrine-guaifenesin PHENAVENT PED CAP 7.5-200

phenylephrine-guaifenesin phenylephrine/guaifenesin dro 1.5-20mg

phenylephrine-guaifenesin QUINTEX SYP 7.5-100

phenylephrine-guaifenesin SINUVENT PE TAB 15-600MG

phenylephrine-guaifenesin SITREX PD LIQ 7.5-75MG

phenylephrine-guaifenesin ZOTEX -GP TAB

phenylephrine-guaifenesin-chlorpheniramine-

methscopolamine SYMPAK MIS

phenylephrine-methscopolamine EXTENDRYL PEM TAB

phenylephrine-pyrilamine w/cod PRO-RED AC SYP

phenylephrine-pyrilamine w/cod ZOTEX-C SYP

phenylephrine-pyrilamine-dihydrocodeine POLY HIST DHC LIQ

phenylephrine-pyrilamine-dm POLY HIST DM LIQ

phenylephrine-pyrilamine-dm PYRIL DM SUS

phenylephrine-triprolidine-chlophedianol PROHIST CD LIQ

phenyltoloxamine-acetaminophen ACUFLEX TAB

phenyltoloxamine-acetaminophen BIOGESIC TAB 30-500MG




phenyltoloxamine-acetaminophen BP POLY-650 TAB

phenyltoloxamine-acetaminophen DOLOGESIC LIQ 30-500MG

phenyltoloxamine-acetaminophen RELAGESIC LIQ 5-160MG

phenyltoloxamine-acetaminophen RELAGESIC TAB 50-650MG

phenyltoloxamine-acetaminophen RHINOFLEX TAB 50-500MG

phenyltoloxamine-acetaminophen STAFLEX TAB 55-500MG

phenyltoloxamine-acetaminophen ZGESIC TAB 66-600MG

potassium guaiacolsulfonate YODEFAN-NF LIQ 300MG/5

promethazine & phenylephrine promethazine vc plain syp plain

promethazine hcl promethazine hcl inj 25mg/ml

promethazine hcl promethazine hcl inj 50mg/ml

promethazine hcl promethazine hcl syp 6.25/5ml

promethazine hcl promethazine hcl tab 12.5mg

promethazine hcl promethazine hcl tab 25mg

promethazine hcl promethazine hcl tab 50mg

promethazine hcl promethegan sup 12.5mg

promethazine hcl promethegan sup 25mg

promethazine hcl promethegan sup 50mg

promethazine w/codeine promethazine/codeine syp 6.25-10

promethazine-dm promethazine/dextromethor phan syp dm

propoxyphene hcl propoxyphene hcl cap 65mg

propoxyphene hcl w/ acetaminophen propoxyphene/acetaminophen tab 65-650mg

propoxyphene napsylate DARVON-N TAB 100MG

propoxyphene-n w/ acetaminophen propoxyphene napsylate/acetaminophen tab 100-325

propoxyphene-n w/ acetaminophen propoxyphene-n/acetaminophen tab 100-500

propoxyphene-n w/ acetaminophen propoxyphene-n/acetaminophen tab 100-650

propoxyphene-n w/ acetaminophen propoxyphene-n/acetaminophen tab 50/325

pseudoeph hcl-pyrilamine mal-dextromethorphan hbr

tannate VIRAVAN-PDM SUS 15-15-15

pseudoeph-chlorphen w/ cod PHENYLHISTINE DH LIQ DH

pseudoeph-chlorphen w/ cod ZODRYL DAC 50 SUS



pseudoephed hcl-chlorphen mal-dm hbr tannate chlorpheniramine/pseudo/dm tannate sus

pseudoephed-bromphen-dm ALLANHIST PDX DRO

pseudoephed-bromphen-dm ANDEHIST DM NR SYP

pseudoephed-bromphen-dm BROMFED DM SYP

pseudoephed-bromphen-dm BROVEX PSB DM LIQ

pseudoephed-bromphen-dm BROVEX PSE DM TAB

pseudoephed-bromphen-dm DELTUSS DMX LIQ

pseudoephed-bromphen-dm PBM ALLERGY SYP

pseudoephed-bromphen-dm PEDIAHIST DM DRO 15-1-4MG

pseudoephed-bromphen-dm pse brom dm syp

pseudoephed-bromphen-dm RESPERAL-DM DRO 12-1-5MG




pseudoephed-bromphen-dm TGQ 50PSE/3BRM/30DM SYP

pseudoephed-methscop & chlorphen-phenyleph-

methscop ALLERX DOSE PACK MIS

pseudoephedrine hcl-dextromethorphan hbr-

guaifenesin tannate Z-COF 12DM SUS

pseudoephedrine tan-bromphen tan-

dextromethorphan tan ANAPLEX DMX SUS

pseudoephedrine tan-chlorphen tan-

dextromethorphan tan DICEL DM SUS

pseudoephedrine tan-dexchlorphen tan-

dextromethorphan tan DUR-TANN FORTE SUS


dextromethorphan tan SUTAN-DM SUS


dextromethorphan tan TANAFED DMX SUS

pseudoephedrine tannate-carbetapentane tannate PSEUDACARB CHW 75-25MG

pseudoephedrine w/ codeine ENDACOF-DC LIQ

pseudoephedrine w/ codeine NUCOFED CAP

pseudoephedrine w/ codeine-gg AMBIFED CD TAB

pseudoephedrine w/ codeine-gg AMBIFED CDX TAB

pseudoephedrine w/ codeine-gg AMBIFED-G CD TAB

pseudoephedrine w/ codeine-gg AMBIFED-G CDX TAB

pseudoephedrine w/ codeine-gg CHERATUSSIN DAC SOL DAC

pseudoephedrine w/ codeine-gg LORTUSS EX LIQ

pseudoephedrine w/ codeine-gg MAXIFED CD TAB

pseudoephedrine w/ codeine-gg MAXIFED CDX TAB

pseudoephedrine w/ codeine-gg MAXIFED-G CD TAB

pseudoephedrine w/ codeine-gg MAXIFED-G CDX TAB CDX

pseudoephedrine w/ codeine-gg TUSNEL PED-C SYP

pseudoephedrine w/ codeine-gg ZODRYL DEC 50 SUS



pseudoephedrine w/ dm-gg ALDEX GS DM TAB

pseudoephedrine w/ dm-gg AMBI 60PSE/400GFN/20DM TAB

pseudoephedrine w/ dm-gg DONATUSS XP SUS

pseudoephedrine w/ dm-gg DONATUSSIN DM SYP

pseudoephedrine w/ dm-gg pseudo cough liq

pseudoephedrine w/ dm-gg pseudoephedrine/dextromethorphan/guaifenesin syp

40-15-10

pseudoephedrine w/ dm-gg RU-TUSS DM SYP

pseudoephedrine w/ dm-gg SUDATEX-DM TAB

pseudoephedrine w/ dm-gg TL-DEX DM LIQ

pseudoephedrine w/ dm-gg TRISPEC PSE LIQ

pseudoephedrine w/ dm-gg TUSNEL LIQ

pseudoephedrine w/ dm-gg TUSNEL PEDIATRIC LIQ




pseudoephedrine w/ dm-gg TUSNEL-DM PEDIATRIC LIQ DRO

pseudoephedrine w/ dm-gg Z-COF 8DM SUS

pseudoephedrine w/ dm-gg Z-COF I SUS

pseudoephedrine-brompheniramine-codeine CPB WC LIQ

pseudoephedrine-brompheniramine-codeine MAR-COF BP LIQ

pseudoephedrine-brompheniramine-codeine MESEHIST WC LIQ

pseudoephedrine-brompheniramine-dihydrocodeine J-COF DHC LIQ

pseudoephedrine-brompheniramine-dm-gg BROMHIST-DM PEDIATRIC SYP

pseudoephedrine-carbetapentane-guaifenesin EXALL-D LIQ

pseudoephedrine-chlorphen-dm ACCUHIST PDX DRO

pseudoephedrine-chlorphen-dm HDC DM SYP

pseudoephedrine-chlorphen-dm MESEHIST DM LIQ

pseudoephedrine-chlorphen-dm TUSSAFED LIQ

pseudoephedrine-chlorpheniramine w/ dm-gg NEOTUSS-D LIQ

pseudoephedrine-chlorpheniramine-dihydrocodeine DIHYDRO-CP SYP

pseudoephedrine-codeine-guaifenesin-

acetaminophen MAXIFLU CD TAB

pseudoephedrine-codeine-guaifenesin-

acetaminophen MAXIFLU CDX TAB

pseudoephedrine-dexbrompheniramine w/ dm-gg DEKA LIQ

pseudoephedrine-dihydrocodeine-guaifenesin DESPEC-EXP SYP

pseudoephedrine-dm-gg w/ apap DURAFLU TAB

pseudoephedrine-dm-gg w/ apap MAXIFLU DM TAB

pseudoephedrine-dm-gg w/ apap MAXIFLU-G TAB

pseudoephedrine-guaifenesin ALDEX GS TAB 30-190MG

pseudoephedrine-guaifenesin AMBI 40PSE/400GFN TAB

pseudoephedrine-guaifenesin AMBI 60/580 TAB

pseudoephedrine-guaifenesin MAXIFED TAB 60-400MG

pseudoephedrine-guaifenesin PSEUDOEPHEDRINE/GUAIFENES IN SYP 40-

200MG

pseudoephedrine-guaifenesin PSEUDOVENT 400 CAP

pseudoephedrine-guaifenesin PSEUDOVENT CAP CR

pseudoephedrine-guaifenesin PSEUDOVENT PED CAP PED CR

pseudoephedrine-guaifenesin RESPAIRE-30 CAP

pseudoephedrine-guaifenesin TENAR PSE LIQ

pseudoephedrine-guaifenesin TUSNEL PEDIATRIC DRO 5-10MG/M

pseudoephedrine-methscopolamine RESPIVENT-D TAB

pseudoephedrine-pyrilamine-carbetapentane CORZALL PLUS LIQ

pseudoephedrine-pyrilamine-codeine NEO AC SYP

pseudoephedrine-pyrilamine-dextromethorphan VIRAVAN-PDM LIQ

pseudoeph-triprolidine w/ cod POLY HIST NC LIQ

pseudoeph-triprolidine-dm PEDIATEX TDM SUS

pyrilamine maleate-phenylephrine hcl tannate DECONSAL CT CHW 16-10MG

pyrilamine maleate-phenylephrine hcl tannate PYRIL D SUS 16-5MG/5

pyrilamine maleate-pseudoephedrine hcl tannate VIRAVAN-P SUS 15-15MG




pyrilamine tannate PYRLEX SUS 12MG/5ML

pyrilamine tannate-phenylephrine tannate ALLANVAN-S SUS 30-12.5

pyrilamine tannate-phenylephrine tannate PYRLEX PD SUS 12-9MG

pyrilamine tannate-phenylephrine tannate RYNA-12 TAB 60-25MG

pyrilamine tannate-phenylephrine tannate RYNESA 12S SUS

pyrilamine-pseudoephedrine VIRAVAN-P LIQ

quazepam DORAL TAB 15MG

ramelteon ROZEREM TAB 8MG

remifentanil hcl ULTIVA INJ 1MG



rizatriptan benzoate MAXALT TAB 10MG

rizatriptan benzoate MAXALT TAB 5MG

rizatriptan benzoate MAXALT-MLT TAB 10MG

rizatriptan benzoate MAXALT-MLT TAB 5MG

secobarbital sodium SECONAL CAP 100MG

somatropin GENOTROPIN INJ 12MG

somatropin GENOTROPIN INJ 5MG

somatropin GENOTROPIN MINIQUICK INJ 0.2MG








somatropin GENOTROPIN MINIQUICK INJ 1MG

somatropin GENOTROPIN MINIQUICK INJ 2MG

somatropin HUMATROPE COMBO PACK INJ 5MG

somatropin HUMATROPE INJ 12MG



somatropin NORDITROPIN CARTRIDGE INJ 15/1.5ML

somatropin NORDITROPIN FLEXPRO INJ 10/1.5ML

somatropin NORDITROPIN FLEXPRO INJ 5/1.5ML

somatropin NORDITROPIN NORDIFLEX PEN INJ 15/1.5ML

somatropin NORDITROPIN NORDIFLEX PEN INJ 30/3ML

somatropin NUTROPIN AQ INJ 10MG/2ML

somatropin NUTROPIN AQ NUSPIN 5 INJ NUSPIN 5

somatropin NUTROPIN AQ PEN INJ 10MG/2ML

somatropin NUTROPIN AQ PEN INJ 20MG/2ML

somatropin NUTROPIN INJ 10MG

somatropin NUTROPIN INJ 5MG

somatropin OMNITROPE INJ 10/1.5ML




somatropin OMNITROPE INJ 5.8MG

somatropin OMNITROPE INJ 5/1.5ML

somatropin (non-refrigerated) SAIZEN CLICK.EASY INJ 8.8MG

somatropin (non-refrigerated) SAIZEN INJ 8.8MG

somatropin (non-refrigerated) SEROSTIM INJ 6MG

sufentanil citrate sufentanil citrate inj 50mcg/ml

sumatriptan SUMATRIPTAN SPR 20MG/ACT

sumatriptan SUMATRIPTAN SPR 5MG/ACT

sumatriptan succinate ALSUMA KIT 6MG/0.5

sumatriptan succinate IMITREX STATDOSE SYSTEM KIT 4MG/0.5

sumatriptan succinate SUMATRIPTAN SUCCINATE INJ 4MG/0.5

sumatriptan succinate sumatriptan succinate inj 6mg/0.5

sumatriptan succinate SUMATRIPTAN SUCCINATE KIT 6MG/0.5

sumatriptan succinate SUMATRIPTAN SUCCINATE REFILL KIT

4MG/0.5

sumatriptan succinate SUMATRIPTAN SUCCINATE REFILL KIT

6MG/0.5

sumatriptan succinate sumatriptan succinate tab 100mg



sumatriptan succinate SUMAVEL DOSEPRO INJ 6MG/0.5

sumatriptan-naproxen sodium TREXIMET TAB 85-500MG

tapentadol hcl NUCYNTA TAB 100MG



temazepam temazepam cap 15mg

temazepam temazepam cap 22.5mg

temazepam temazepam cap 30mg

temazepam temazepam cap 7.5mg

temazepam-dietary management product STRAZEPAM PAK

tesamorelin acetate EGRIFTA INJ 1MG

tramadol hcl RYBIX ODT TAB 50MG

tramadol hcl RYZOLT TAB 100MG



tramadol hcl tramadol hcl ER tab 100mg

tramadol hcl tramadol hcl ER tab 200mg

tramadol hcl tramadol hcl tab 50mg

tramadol hcl ULTRAM ER TAB 300MG

tramadol hcl-dietary management product THERATRAMADOL-60 PAK -60

tramadol-acetaminophen tramadol hydrochloride/acetaminophen tab 37.5-325

triazolam triazolam tab 0.125mg

triazolam triazolam tab 0.25mg

triprolidine & pseudoephedrine PEDIATEX TD LIQ




triprolidine & pseudoephedrine ZYMINE-D LIQ 1.25-45

triprolidine hcl TRIPOHIST LIQ 1.25/5ML

triprolidine tannate ZYMINE XR SUS 2.5MG

triprolidine tannate-pseudoephedrine tannate ZYMINE DXR SUS 2.5-45MG

triprolidine-phenylephrine PROHIST LQ LIQ

urofollitropin purified BRAVELLE INJ 75UNIT

varenicline tartrate CHANTIX PAK 0.5& 1MG

varenicline tartrate CHANTIX PAK 1MG

varenicline tartrate CHANTIX TAB 0.5MG

zaleplon zaleplon cap 10mg

zaleplon zaleplon cap 5mg

ziconotide acetate PRIALT INJ 100MCG

ziconotide acetate PRIALT INJ 25MCG/ML

zolmitriptan ZOMIG SPR 5MG

zolmitriptan ZOMIG TAB 2.5MG

zolmitriptan ZOMIG TAB 5MG

zolmitriptan ZOMIG ZMT TAB 2.5 MG

zolmitriptan ZOMIG ZMT TAB 5MG

zolpidem tartrate EDLUAR SUB 10MG

zolpidem tartrate EDLUAR SUB 5MG

zolpidem tartrate zolpidem tartrate ER tab 12.5mg

zolpidem tartrate zolpidem tartrate ER tab 6.25mg

zolpidem tartrate zolpidem tartrate tab 10mg

zolpidem tartrate zolpidem tartrate tab 5mg

zolpidem tartrate ZOLPIMIST SPR 5MG

Documents

Kaiser Permanente: Maintenance Medication Exclusion List