Keesler_january 1.32

KEESLER AFB
OUTPATIENT FORMULARY
Alphabetical Listing by Name
This document is current as of January 10, 2014.
The availability of formulary items is subject to change.
ABACAVIR AND LAMIVUDINE
Abacavir and Lamivudine
Outpatient Dosage Forms
Outpatient Formulary Brands Available Epzicom®
Outpatient Dosage Forms
Fosamax®: 70 mg/75 mL (75 mL) [raspberry flavor] [BCF]
Tablet, oral: 5 mg [BCF], 10 mg [BCF], 35 mg [BCF], 70 mg [BCF]
Epzicom®: 600/300: Abacavir 600 mg and lamivudine 300 mg Alendronate and Cholecalciferol
Acetaminophen
Outpatient Formulary Brands Available Fosamax Plus D®
Outpatient Dosage Forms
Outpatient Dosage Forms
Solution, oral [drops]: 80 mg/0.8 mL (15 mL) Fosamax Plus D®: 70/2800: Alendronate 70 mg and cholecalciferol 2800 int.
Suppository, rectal: 120 mg (12s); 650 mg (12s) Fosamax Plus D®: 70/5600: Alendronate 70 mg and cholecalciferol 5600 int.
units [BCF]
Acetaminophen and Codeine
Alfuzosin
Outpatient Formulary Brands Available Tylenol® with Codeine No. 3
Outpatient Formulary Brands Available Uroxatral®
Outpatient Dosage Forms
Outpatient Dosage Forms
Solution, oral [C-V]: Acetaminophen 120 mg and codeine phosphate 12 mg per Tablet, extended release, oral, as hydrochloride: 5 mL (5 mL, 10 mL, 12.5 mL, 15 mL, 120 mL, 480 mL) [contains alcohol 7%] Uroxatral®: 10 mg [BCF]
Tablet, oral [C-III]: Acetaminophen 300 mg and codeine phosphate 30 mg [BCF]
Aliskiren
Acetaminophen and Tramadol
Outpatient Formulary Brands Available Tekturna®
Outpatient Formulary Brands Available
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral: Acetaminophen 325 mg and tramadol hydrochloride 37.5 mg Ultracet®: Acetaminophen 325 mg and tramadol hydrochloride 37.5 mg Allopurinol
Acetaminophen, Caffeine, and Isometheptene Mucate
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral: 100 mg [BCF], 300 mg [BCF]
Capsule, oral: Acetaminophen 500 mg, caffeine 20 mg, isometheptene mucate ALPRAZolam
Outpatient Formulary Brands Available Xanax®
AcetaZOLAMIDE
Outpatient Dosage Forms
Outpatient Formulary Brands Available Diamox® Sequels®
Outpatient Dosage Forms
Alprostadil
Outpatient Formulary Brands Available Edex®; Muse®
Outpatient Dosage Forms
Acetic Acid
Outpatient Dosage Forms
Acyclovir (Systemic)
Outpatient Formulary Brands Available Zovirax®
Aluminum Chloride Hexahydrate
Outpatient Dosage Forms
Outpatient Formulary Brands Available Drysol™
Capsule, oral: 200 mg [BCF]
Outpatient Dosage Forms
Suspension, oral: 200 mg/5 mL (473 mL) [BCF]
Drysol™: 20% (37.5 mL) [contains ethanol 93%] Tablet, oral: 400 mg [BCF], 800 mg [BCF]
Amantadine
Outpatient Dosage Forms
Adalimumab
Capsule, oral, as hydrochloride: 100 mg [BCF]
Syrup, oral, as hydrochloride: 50 mg/5 mL (10 mL, 473 mL, 480 mL) [BCF]
Outpatient Formulary Brands Available Humira®
Outpatient Dosage Forms
Amcinonide
Outpatient Dosage Forms
Humira®: 40 mg/0.8 mL (0.8 mL) [contains natural rubber/natural latex in packaging, polysorbate 80] [ECF]
Injection, solution [pediatric, preservative free]: Humira®: 20 mg/0.4 mL (0.4 mL) [contains natural rubber/natural latex in AMILoride
packaging, polysorbate 80] [ECF]
Outpatient Dosage Forms
Adapalene
Outpatient Formulary Brands Available Differin®
Amiodarone
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 200 mg [BCF]
Amitriptyline
Outpatient Dosage Forms
Albendazole
Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg
Outpatient Formulary Brands Available
Outpatient Dosage Forms
AmLODIPine
Outpatient Formulary Brands Available Norvasc®
Outpatient Dosage Forms
Albuterol
Tablet, oral: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]
Outpatient Formulary Brands Available Ventolin® HFA
Outpatient Dosage Forms
Amlodipine and Benazepril
Outpatient Formulary Brands Available Lotrel®
Ventolin® HFA: 90 mcg/inhalation (18 g) [chlorofluorocarbon free; 200 metered actuations] [BCF]
Outpatient Dosage Forms
Solution, for nebulization: 0.083% [2.5 mg/3 mL] (25s, 30s, 60s) [BCF]; 0.5%
2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF]
5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF]
Alendronate
5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF]
Outpatient Formulary Brands Available Fosamax®
10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF]
Atenolol
2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF]
Outpatient Dosage Forms
5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF]
Tablet, oral: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]
5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF]
5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF]
AtoMOXetine
10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF]
Outpatient Formulary Brands Available Strattera®
10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF]
Outpatient Dosage Forms
Amoxicillin
Strattera®: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg Outpatient Dosage Forms
Capsule, oral: 250 mg [BCF], 500 mg [BCF]
AtorvaSTATin
Powder for suspension, oral: 250 mg/5 mL (80 mL, 100 mL, 150 mL) [BCF];
Outpatient Formulary Brands Available Lipitor®
400 mg/5 mL (50 mL, 75 mL, 100 mL) [BCF]
Outpatient Dosage Forms
Lipitor®: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]
Amoxicillin and Clavulanate Potassium
Outpatient Formulary Brands Available Augmentin XR®; Augmentin®
Atovaquone and Proguanil
Outpatient Dosage Forms
Outpatient Formulary Brands Available Malarone®
Outpatient Dosage Forms
200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (50 mL, 75 mL, 100 mL) [contains phenylalanine] [BCF]
Malarone®: Atovaquone 250 mg and proguanil hydrochloride 100 mg 400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (50 mL, 75 Atropine
mL, 100 mL) [contains phenylalanine] [BCF]
600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (75 mL, Outpatient Dosage Forms
125 mL, 200 mL) [BCF]
Solution, ophthalmic, as sulfate [drops]: 1% (15 mL) AzaTHIOprine
125: Amoxicillin 125 mg and clavulanate potassium 31.25 mg per 5 mL (75 Outpatient Dosage Forms
mL, 100 mL, 150 mL) [contains potassium 0.16 mEq/5 mL; banana flavor] [BCF]
200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (50 Azelaic Acid
mL, 75 mL, 100 mL) [contains phenylalanine 7 mg/5 mL and potassium 0.14 Outpatient Formulary Brands Available Azelex®; Finacea®
mEq/5 mL; orange flavor] [BCF]
Outpatient Dosage Forms
250: Amoxicillin 250 mg and clavulanate potassium 62.5 mg per 5 mL (75 mL, 100 mL, 150 mL) [contains potassium 0.32 mEq/5 mL; orange fla- Azelex®: 20% (30 g, 50 g) [contains benzoic acid] vor] [BCF]
400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (50 mL, Finacea®: 15% (50 g) [contains benzoic acid] 75 mL, 100 mL) [contains phenylalanine 7 mg/5 mL and potassium 0.29
mEq/5 mL; orange flavor] [BCF]
Azelastine (Nasal)
Outpatient Formulary Brands Available Astelin®
Amoxicillin 250 mg and clavulanate potassium 125 mg [BCF]
Outpatient Dosage Forms
Amoxicillin 500 mg and clavulanate potassium 125 mg [BCF]
Solution, intranasal, as hydrochloride [spray]: 0.1% [137 mcg/spray] (30 mL) Amoxicillin 875 mg and clavulanate potassium 125 mg [BCF]
Astelin®: 0.1% [137 mcg/spray] (30 mL) [contains benzalkonium chloride; 200 Augmentin XR®: 1000: Amoxicillin 1000 mg and clavulanate potassium 62.5 mg [scored; contains potassium 12.6 mg/tablet, sodium 29.3 mg/tablet] Azithromycin (Ophthalmic)
Anastrozole
Outpatient Formulary Brands Available AzaSite®
Outpatient Formulary Brands Available Arimidex®
Outpatient Dosage Forms
Outpatient Dosage Forms
AzaSite®: 1% (2.5 mL) [contains benzalkonium chloride] Azithromycin (Systemic)
Antipyrine and Benzocaine
Outpatient Formulary Brands Available Zithromax®; Zithromax® Z-PAK®
Outpatient Dosage Forms
Outpatient Dosage Forms
Solution, otic [drops]: Antipyrine 5.4% and benzocaine 1.4% (10 mL, 15 mL) Powder for suspension, oral, as dihydrate [strength expressed as base]: 100 mg/5 mL (15 mL) [BCF]; 1 g/packet (3s) [BCF]
Zithromax®: 100 mg/5 mL (15 mL) [contains sodium 3.7 mg/5 mL; cherry-
ARIPiprazole
Outpatient Formulary Brands Available Abilify®
Zithromax®: 200 mg/5 mL (22.5 mL) [contains sodium 7.4 mg/5 mL; cherry- Outpatient Dosage Forms
Zithromax®: 1 g/packet (10s) [contains sodium 37 mg/packet; banana-cherry Abilify®: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg Tablet, oral, as dihydrate [strength expressed as base]: 250 mg [BCF],
Artificial Tears
500 mg [BCF]
Outpatient Formulary Brands Available Systane® Ultra
Zithromax®: 250 mg [contains sodium 0.9 mg/tablet] Outpatient Dosage Forms
Zithromax® Z-PAK®: 250 mg [contains sodium 0.9 mg/tablet] Bacitracin
Systane® Ultra: Polyethylene glycol 400 0.4% and propylene glycol 0.3% Outpatient Dosage Forms
Ointment, ophthalmic: 500 units/g (3.5 g]) Ointment, topical, as zinc [strength expressed as base]: 500 units/g (15 g) Outpatient Dosage Forms
Bacitracin, Neomycin, and Polymyxin B
Outpatient Dosage Forms
Ointment, ophthalmic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units per g (3.5 g) [BCF]
Aspirin and Dipyridamole
Baclofen
Outpatient Formulary Brands Available Aggrenox®
Outpatient Dosage Forms
Outpatient Dosage Forms
Aggrenox®: Aspirin 25 mg [immediate release] and dipyridamole 200 mg Balsalazide
Outpatient Formulary Brands Available Colazal®
Outpatient Dosage Forms
Atazanavir
Outpatient Formulary Brands Available Reyataz®
Colazal®: 750 mg [contains sodium ~86 mg/capsule] Outpatient Dosage Forms
Outpatient Formulary Brands Available Readi-Cat® 2
Outpatient Dosage Forms
Budesonide (Systemic, Oral Inhalation)
Outpatient Formulary Brands Available Endocort® EC; Pulmicort
Readi-Cat® 2: 2.1% w/v (450 mL) [contains benzoic acid, sodium benzoate; Outpatient Dosage Forms
Readi-Cat® 2: 2.1% w/v (250 mL, 450 mL) [contains benzoic acid, sodium Readi-Cat® 2: 2.1% w/v (450 mL) [contains benzoic acid, sodium benzoate; Belladonna and Opium
Bupivacaine (Liposomal)
Outpatient Dosage Forms
Outpatient Dosage Forms
Suppository, rectal: Belladonna extract 16.2 mg and opium 60 mg (12s) Benzonatate
Outpatient Dosage Forms
BuPROPion
Outpatient Formulary Brands Available Wellbutrin SR®; Wellbutrin XL®;
Benzoyl Peroxide
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 75 mg [BCF], 100 mg [BCF]
Tablet, extended release, oral, as hydrochloride: 100 mg [BCF], 150 mg [BCF]
Wellbutrin XL®: 300 mg [BCF]
Tablet, sustained release, oral, as hydrochloride: Benztropine
Wellbutrin SR®: 100 mg [BCF], 150 mg [BCF]
Outpatient Dosage Forms
Zyban®: 150 mg [BCF]
Tablet, oral, as mesylate: 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF]
BusPIRone
Betamethasone
Outpatient Dosage Forms
Outpatient Formulary Brands Available Luxíq®
Tablet, oral, as hydrochloride: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF]
Outpatient Dosage Forms
Aerosol, topical, as valerate [strength expressed as base, foam]: Butalbital, Acetaminophen, and Caffeine
Luxíq®: 0.12% (50 g) [contains ethanol 60.4%] Outpatient Dosage Forms
Tablet, oral: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg Betaxolol (Ophthalmic)
Outpatient Formulary Brands Available Betoptic S®
Outpatient Dosage Forms
Butalbital, Aspirin, and Caffeine
Outpatient Dosage Forms
Betoptic S®: 0.25% (15 mL) [contains benzalkonium chloride] Tablet, oral: Butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg Bicalutamide
Calcipotriene
Outpatient Formulary Brands Available Casodex®
Outpatient Formulary Brands Available Dovonex®
Outpatient Dosage Forms
Outpatient Dosage Forms
Bimatoprost
Outpatient Formulary Brands Available Lumigan®
Calcitriol
Outpatient Dosage Forms
Outpatient Dosage Forms
Lumigan®: 0.01% (5 mL) [contains benzalkonium chloride] Bisacodyl
Calcium Acetate
Outpatient Dosage Forms
Outpatient Formulary Brands Available PhosLo®
Outpatient Dosage Forms
Suppository, rectal: 10 mg (50s)Tablet, enteric coated, oral: 5 mg PhosLo®: 667 mg [equivalent to elemental calcium 169 mg (8.45 mEq)] Calcium Carbonate
Outpatient Formulary Brands Available Peptic Relief [OTC]
Outpatient Formulary Brands Available Calcarb 600 [OTC]
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, chewable, oral, as subsalicylate: Calcarb 600: 1500 mg [scored; sugar free; equivalent to elemental calcium Brimonidine and Timolol
Outpatient Formulary Brands Available Combigan™
Candesartan
Outpatient Dosage Forms
Outpatient Formulary Brands Available Atacand®
Outpatient Dosage Forms
Combigan™: Brimonidine tartrate 0.2% and timolol maleate 0.5% (5 mL) Atacand®: 4 mg, 8 mg, 16 mg, 32 mg [scored] Brimonidine (Ophthalmic)
Capecitabine
Outpatient Formulary Brands Available Alphagan® P
Outpatient Formulary Brands Available Xeloda®
Outpatient Dosage Forms
Outpatient Dosage Forms
Solution, ophthalmic, as tartrate [drops]: 0.15% (5 mL, 10 mL, 15 mL) [BCF];
0.2% (5 mL, 10 mL, 15 mL) [BCF]
Alphagan® P: 0.15% (10 mL) [contains Purite®] Captopril
Bromocriptine
Outpatient Dosage Forms
Outpatient Formulary Brands Available Parlodel® SnapTabs®
Tablet, oral: 12.5 mg [BCF], 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]
Outpatient Dosage Forms
CarBAMazepine
Outpatient Formulary Brands Available Carbatrol®; TEGretol®
Outpatient Dosage Forms
Budesonide and Formoterol
Outpatient Formulary Brands Available Symbicort®
Outpatient Dosage Forms
Suspension, oral: 100 mg/5 mL (5 mL, 10 mL, 450 mL) [BCF]
Tablet, oral: 200 mg [BCF]
Symbicort®: 80/4.5: Budesonide 80 mcg and formoterol fumarate dehydrate Tablet, chewable, oral: 100 mg [BCF]
4.5 mcg per actuation (10.2 g); 160/4.5: Budesonide 160 mcg and formoterol fumarate dehydrate 4.5 mcg per actuation (10.2 g) [120 metered inhalations] Tablet, extended release, oral: 400 mg [BCF]
CLINDAMYCIN (SYSTEMIC)
Carbamide Peroxide
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral, as phosphate: 500 mg [equivalent to chloroquine base 300 mg] Aralen®: 500 mg [equivalent to chloroquine base 300 mg] Carbidopa and Levodopa
Chlorpheniramine
Outpatient Formulary Brands Available Sinemet® CR
Outpatient Dosage Forms
Outpatient Dosage Forms
Chlorpheniramine and Phenylephrine
10/100: Carbidopa 10 mg and levodopa 100 mg [BCF]
25/100: Carbidopa 25 mg and levodopa 100 mg [BCF]
Outpatient Formulary Brands Available C-Phen
25/250: Carbidopa 25 mg and levodopa 250 mg [BCF]
Outpatient Dosage Forms
Sinemet® CR: 50/200: Carbidopa 50 mg and levodopa 200 mg [scored] C-Phen: Chlorpheniramine maleate 4 mg and phenylephrine hydrochloride 12.5 mg per 5 mL (118 mL) [ethanol free, sugar free; contains sodium Carboxymethylcellulose
Outpatient Formulary Brands Available Optive™; Refresh Tears®
ChlorproMAZINE
Outpatient Dosage Forms
Outpatient Dosage Forms
Optive™: 0.5% (15 mL, 30 mL) [contains glycerin] Solution, ophthalmic, as sodium [drops, preservative free]: Chlorthalidone
Outpatient Dosage Forms
Carteolol (Ophthalmic)
Tablet, oral: 25 mg [BCF], 50 mg [BCF]
Outpatient Dosage Forms
Cholestyramine Resin
Solution, ophthalmic, as hydrochloride [drops]: 1% (5 mL) [contains benzalko- Outpatient Formulary Brands Available Questran® Light
Outpatient Dosage Forms
Carvedilol
Powder for suspension, oral: Cholestyramine resin 4 g/5 g of powder (210 g); Outpatient Formulary Brands Available Coreg CR®; Coreg®
Cholestyramine resin 4 g/5.7 g of powder (239.4 g); Cholestyramine resin 4 g/ Outpatient Dosage Forms
9 g of powder (378 g); Cholestyramine resin 4 g/5 g packet (60s); Cholestyr- Capsule, extended release, oral, as phosphate: amine resin 4 g/5.7 g packet (60s); Cholestyramine resin 4 g/9 g packet (60s) Questran® Light: Cholestyramine resin 4 g/5 g of powder (210 g); Cholestyr- Tablet, oral: 3.125 mg [BCF], 6.25 mg [BCF], 12.5 mg [BCF], 25 mg [BCF]
amine resin 4 g/5 g packet (60s) [contains phenylalanine 14 mg/5 g; orange Coreg®: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg Cefadroxil
Cilostazol
Outpatient Dosage Forms
Outpatient Formulary Brands Available Pletal®
Capsule, oral, as monohydrate [strength expressed as base]: 500 mg Outpatient Dosage Forms
Cefdinir
Outpatient Formulary Brands Available Omnicef®
Outpatient Dosage Forms
Cimetidine
Outpatient Dosage Forms
Omnicef®: 125 mg/5 mL (100 mL); 250 mg/5 mL (100 mL) [contains sodium Cinacalcet
benzoate, sucrose 2.86 g/5 mL; strawberry flavor] Outpatient Formulary Brands Available Sensipar®
Cefprozil
Outpatient Dosage Forms
Outpatient Formulary Brands Available Cefzil®
Outpatient Dosage Forms
Powder for suspension, oral, as anhydrous: Ciprofloxacin and Dexamethasone
Cefzil®: 250 mg/5 mL (100 mL) [contains phenylalanine 28 mg/5 mL, sodium Outpatient Formulary Brands Available Ciprodex®
Outpatient Dosage Forms
Ciprodex®: Ciprofloxacin 0.3% and dexamethasone 0.1% (7.5 mL) [contains Celecoxib
Outpatient Formulary Brands Available CeleBREX®
Ciprofloxacin (Systemic)
Outpatient Dosage Forms
Outpatient Formulary Brands Available Cipro®
Outpatient Dosage Forms
Cephalexin
Cipro®: 250 mg/5 mL (100 mL) [strawberry flavor] [BCF]
Outpatient Dosage Forms
Tablet, oral, as hydrochloride [strength expressed as base]: 100 mg, 250 mg Capsule, oral: 250 mg [BCF], 500 mg [BCF]
[BCF], 500 mg [BCF], 750 mg
Powder for suspension, oral: 250 mg/5 mL (100 mL, 200 mL) [BCF]
Citalopram
Cetirizine
Outpatient Dosage Forms
Outpatient Formulary Brands Available ZyrTEC® Allergy; ZyrTEC® Child-
Solution, oral: 10 mg/5 mL (240 mL) [BCF]
Tablet, oral: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]
Outpatient Dosage Forms
Clarithromycin
Syrup, oral, as hydrochloride: 5 mg/5 mL (120 mL) ZyrTEC® Children's Allergy 5 mg/5 mL (120 mL) [contains propylene glycol; Outpatient Formulary Brands Available Biaxin®; Biaxin® XL; Biaxin® XL
Tablet, oral, as hydrochloride: 5 mg, 10 mg Outpatient Dosage Forms
ChlordiazePOXIDE
Outpatient Dosage Forms
Capsule, oral, as hydrochloride: 10 mg, 25 mg Biaxin® XL Pac [7-day]: 500 mg (14 tablets) Chlorhexidine Gluconate
Clindamycin and Benzoyl Peroxide
Outpatient Dosage Forms
Outpatient Formulary Brands Available BenzaClin®
Liquid, oral [rinse]: 0.12% (473 mL, 480 mL) [BCF]
Outpatient Dosage Forms
Hibiclens®: 4% (946 mL) [contains isopropyl alcohol 4%] BenzaClin®: Clindamycin 1% and benzoyl peroxide 5% (25 g) Chloroquine
Clindamycin (Systemic)
Outpatient Formulary Brands Available Aralen®
Outpatient Formulary Brands Available Cleocin HCl®; Cleocin Pediatric®
CLINDAMYCIN (SYSTEMIC)
Outpatient Dosage Forms
Outpatient Dosage Forms
Capsule, oral, as hydrochloride [strength expressed as base]: 150 mg [BCF]
Crolom®: 4% (10 mL) [contains benzalkonium chloride] Granules for solution, oral, as palmitate hydrochloride [strength expressed as Cyanocobalamin
Cleocin Pediatric®: 75 mg/5 mL (100 mL) [cherry flavor] Outpatient Dosage Forms
Clindamycin (Topical)
Outpatient Formulary Brands Available Cleocin®
Outpatient Dosage Forms
Cyclobenzaprine
Cream, vaginal, as phosphate [strength expressed as base]: 2% (40 g) [BCF]
Outpatient Formulary Brands Available Flexeril®
Cleocin®: 2% (40 g) [contains benzyl alcohol, mineral oil] Outpatient Dosage Forms
Solution, topical, as phosphate [strength expressed as base]: 1% (30 mL, 60 Tablet, oral, as hydrochloride: 10 mg [BCF]
mL) [BCF]
Clobetasol
Cyclopentolate
Outpatient Formulary Brands Available Olux®; Temovate E®; Temovate®
Outpatient Formulary Brands Available AK-Pentolate™; Cyclogyl®
Outpatient Dosage Forms
Outpatient Dosage Forms
Solution, ophthalmic, as hydrochloride [drops]: Olux®: 0.05% (100 g) [contains ethanol 60%; for scalp application] AK-Pentolate™: 1% (15 mL) [contains benzalkonium chloride] Cream, topical, as propionate [emollient-based]: 0.05% (30 g) Cyclogyl®: 0.5% (15 mL) [contains benzalkonium chloride] Ointment, topical, as propionate: 0.05% (45 g) Cyclopentolate and Phenylephrine
Temovate®: 0.05% (15 g, 30 g, 45 g [DSC]) Outpatient Formulary Brands Available Cyclomydril®
Solution, topical, as propionate [for scalp application]: 0.05% (50 mL) Outpatient Dosage Forms
Temovate®: 0.05% (50 mL) [contains isopropyl alcohol 39.3%] ClomiPHENE
Cyclomydril®: Cyclopentolate hydrochloride 0.2% and phenylephrine hydro- Outpatient Formulary Brands Available Clomid®
chloride 1% (2 mL) [contains benzalkonium chloride] Outpatient Dosage Forms
CycloSPORINE (Ophthalmic)
Outpatient Formulary Brands Available Restasis®
Outpatient Dosage Forms
ClonazePAM
Emulsion, ophthalmic [drops, preservative free]: Outpatient Dosage Forms
Restasis®: 0.05% (0.4 mL) [contains castor oil] Tablet, oral: 0.5 mg [BCF], 2 mg
CycloSPORINE (Systemic)
CloNIDine
Outpatient Formulary Brands Available Neoral®
Outpatient Formulary Brands Available Catapres-TTS®-1; Catapres-TTS®-
Outpatient Dosage Forms
Capsule, softgel, oral [modified]: 25 mg, 100 mg Outpatient Dosage Forms
Neoral®: 25 mg, 100 mg [contains corn oil, dehydrated ethanol 11.9%] Cyproheptadine
Outpatient Dosage Forms
Syrup, oral, as hydrochloride: 2 mg/5 mL (473 mL, 480 mL) [BCF]
Tablet, oral, as hydrochloride: 0.1 mg [BCF], 0.2 mg [BCF], 0.3 mg [BCF]
Tablet, oral, as hydrochloride: 4 mg [BCF]
Tablet, extended release, oral, as hydrochloride: Dabigatran Etexilate
Outpatient Formulary Brands Available Pradaxa
Clopidogrel
Outpatient Dosage Forms
Outpatient Formulary Brands Available Plavix®
Outpatient Dosage Forms
Plavix®: 75 mg [BCF], 300 mg [BCF]
Dantrolene
Generic: 75 mg [BCF], 300 mg [BCF]
Outpatient Formulary Brands Available Dantrium®
Clotrimazole (Oral)
Outpatient Dosage Forms
Outpatient Formulary Brands Available Mycelex®
Outpatient Dosage Forms
Dapsone (Systemic)
Outpatient Dosage Forms
Clotrimazole (Topical)
Outpatient Dosage Forms
Darbepoetin Alfa
Cream, topical: 1% (30 g)
Solution, topical: 1% (10 mL, 30 mL) [BCF]
Outpatient Formulary Brands Available Aranesp®; Aranesp® SingleJect®
Outpatient Dosage Forms
Outpatient Dosage Forms
Aranesp®: 60 mcg/0.3 mL (0.3 mL [DSC]); 200 mcg/0.4 mL (0.4 mL [DSC]) Aranesp® SingleJect®: 25 mcg/0.42 mL (0.42 mL); 60 mcg/0.3 mL (0.3 mL); Colchicine
100 mcg/0.5 mL (0.5 mL); 200 mcg/0.4 mL (0.4 mL) [contains natural rubber/ Outpatient Dosage Forms
natural latex in packaging, polysorbate 80] Darunavir
Colestipol
Outpatient Formulary Brands Available Prezista®
Outpatient Formulary Brands Available Colestid®
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral, as hydrochloride [micronized]: Collagenase (Topical)
Desmopressin
Outpatient Formulary Brands Available
Outpatient Formulary Brands Available DDAVP®
Outpatient Dosage Forms
Outpatient Dosage Forms
Solution, intranasal, as acetate [spray]: DDAVP®: 0.1 mg/mL (5 mL) [contains benzalkonium chloride; delivers 10 mcg/ Cromolyn (Ophthalmic)
Outpatient Formulary Brands Available Crolom®
DOCUSATE
20 mg [scored; dextroamphetamine sulfate 5 mg, dextroamphetamine sac- charate 5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine Desonide
sulfate 5 mg (equivalent to amphetamine base 12.6 mg)] Outpatient Dosage Forms
Diabetic Supplies
Cream, topical: 0.05% (60 g)Lotion, topical: 0.05% (60 mL) Outpatient Formulary Brands Available Accu-Chek® Aviva; Accu-Chek®
Outpatient Dosage Forms
Outpatient Dosage Forms
Accu-Chek® Aviva Diabetes Monitoring Kit Accu-Chek® Aviva Glucose Control Solution (2s) Dexamethasone (Systemic)
Outpatient Formulary Brands Available Decadron® [DSC]; Dexamethasone
Outpatient Dosage Forms
BD Syringe 0.5 mL (Ultra-Fine II) 31 gauge x 5/16" [BCF]
Solution, oral: 0.5 mg/5 mL (240 mL, 500 mL) BD Syringe 1 mL (Ultra-Fine II) 31 gauge x 5/16" [BCF]
Dexamethasone Intensol™: 1 mg/mL (30 mL) [dye free, sugar free; contains benzoic acid, ethanol 30%, propylene glycol] Diazepam
Outpatient Formulary Brands Available Diastat®; Diastat® AcuDial™;
Dextroamphetamine
Outpatient Formulary Brands Available Dexedrine® Spansule®
Outpatient Dosage Forms
Outpatient Dosage Forms
Gel, rectal [pediatric rectal tip (4.4 cm)]: Capsule, sustained release, oral, as sulfate: Diastat®: 5 mg/mL (0.5 mL) [contains benzoic acid, benzyl alcohol, ethanol Dexedrine® Spansule®: 5 mg [scored; contains tartrazine] Gel, rectal [pediatric/adult rectal tip (4.4 cm)]: Dextroamphetamine and Amphetamine
Diastat® AcuDial™: 10 mg (2 mL) [contains benzoic acid, benzyl alcohol, Outpatient Formulary Brands Available Adderall XR®; Adderall®
ethanol 10%, propylene glycol, sodium benzoate; 5 mg/mL (delivers set Outpatient Dosage Forms
Tablet, oral: 5 mg [BCF]
5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate Diclofenac (Topical)
1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sul-
fate 1.25 mg (equivalent to amphetamine base 3.1 mg)] [BCF]
Outpatient Formulary Brands Available Voltaren
10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate Outpatient Dosage Forms
2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate 2.5 mg (equivalent to amphetamine base 6.3 mg)] [BCF]
Voltaren: 1% (100 g) [contains isopropyl alcohol, propylene glycol] 15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccharate Dicloxacillin
3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine sul-
fate 3.75 mg (equivalent to amphetamine base 9.4 mg)] [BCF]
Outpatient Dosage Forms
20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate Capsule, oral: 250 mg [BCF], 500 mg [BCF]
5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate Dicyclomine
5 mg (equivalent to amphetamine base 12.5 mg)] [BCF]
Outpatient Dosage Forms
25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine saccharate Capsule, oral, as hydrochloride: 10 mg [BCF]
6.25 mg, amphetamine aspartate monohydrate 6.25 mg, amphetamine sul- Injection, solution, as hydrochloride: 10 mg/mL (2 mL) [BCF]
fate 6.25 mg (equivalent to amphetamine base 15.6 mg)] [BCF]
30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate Bentyl®: 10 mg/5 mL (480 mL) [contains propylene glycol] [BCF]
7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sulfate Tablet, oral, as hydrochloride: 20 mg [BCF]
7.5 mg (equivalent to amphetamine base 18.8 mg)] [BCF]
Difluprednate
5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate Outpatient Formulary Brands Available Durezol®
1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine Outpatient Dosage Forms
sulfate 1.25 mg (equivalent to amphetamine base 3.1 mg)] 10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate Durezol®: 0.05% (5 mL) [contains sorbic acid] 2.5 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 saccharate Outpatient Formulary Brands Available Lanoxin®
3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine Outpatient Dosage Forms
sulfate 3.75 mg (equivalent to amphetamine base 9.4 mg)] Tablet, oral: 125 mcg [BCF], 250 mcg [BCF]
20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate 5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate Diltiazem
5 mg (equivalent to amphetamine base 12.5 mg)] Outpatient Formulary Brands Available Tiazac®
25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine saccharate Outpatient Dosage Forms
6.25 mg, amphetamine aspartate monohydrate 6.25 mg, amphetamine Capsule, extended release, oral, as hydrochloride [once-daily dosing]: 120 mg sulfate 6.25 mg (equivalent to amphetamine base 15.6 mg)] [BCF], 180 mg [BCF], 240 mg [BCF], 300 mg [BCF], 360 mg [BCF], 420 mg
30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate 7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sulfate Tiazac®: 120 mg, 180 mg, 240 mg, 300 mg, 360 mg 7.5 mg (equivalent to amphetamine base 18.8 mg)] DiphenhydrAMINE (Systemic)
5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate Outpatient Formulary Brands Available Benadryl®; Diphenhist® [OTC]
1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sul- Outpatient Dosage Forms
fate 1.25 mg (equivalent to amphetamine base 3.13 mg)] Capsule, oral, as hydrochloride: 25 mg, 50 mg 10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate Benadryl® Allergy: 25 mg [contains calcium 35 mg/capsule 2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate Elixir, oral, as hydrochloride: 12.5 mg/5 mL 2.5 mg (equivalent to amphetamine base 6.3 mg)] 20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate Diphenoxylate and Atropine
5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate Outpatient Formulary Brands Available Lomotil®
5 mg (equivalent to amphetamine base 12.6 mg)] Outpatient Dosage Forms
5 mg [scored; dextroamphetamine sulfate 1.25 mg, dextroamphetamine sac- Lomotil®: 2.5/0.025: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate charate 1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphet- amine sulfate 1.25 mg (equivalent to amphetamine base 3.13 mg)] 10 mg [scored; dextroamphetamine sulfate 2.5 mg, dextroamphetamine sac- Docusate
charate 2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphet- Outpatient Formulary Brands Available Colace® [OTC]; Surfak® Liqui-
amine sulfate 2.5 mg (equivalent to amphetamine base 6.3 mg)] DOCUSATE
Outpatient Dosage Forms
Outpatient Dosage Forms
Truvada®: Emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg Capsule, softgel, oral, as calcium: 240 mg [gluten free; equivalent to 245 mg tenofovir disoproxil] Liquid, oral, as sodium: 50 mg/5 mL (473 mL) Enoxaparin
Outpatient Formulary Brands Available Lovenox®
Docusate and Senna
Outpatient Dosage Forms
Outpatient Formulary Brands Available Senokot-S® [OTC]
Injection, solution, as sodium [preservative free]: Outpatient Dosage Forms
Lovenox®: 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
Senokot-S®: Docusate sodium 50 mg and sennosides 8.6 mg [sugar free; (1 mL) [BCF]; 120 mg/0.8 mL (0.8 mL) [BCF]; 150 mg/mL (1 mL) [BCF]
Entacapone
Donepezil
Outpatient Formulary Brands Available Comtan®
Outpatient Formulary Brands Available Aricept®
Outpatient Dosage Forms
Outpatient Dosage Forms
Aricept®: 5 mg [ECF], 10 mg [ECF]
EPINEPHrine (Systemic, Oral Inhalation)
Dorzolamide
Outpatient Formulary Brands Available EpiPen®; EpiPen® Jr.
Outpatient Formulary Brands Available Trusopt®
Outpatient Dosage Forms
Outpatient Dosage Forms
0.15 mg/0.15 mL (1.1 mL) [1:1000 solution; delivers 0.15 mg per injec- Trusopt®: 2% (10 mL) [contains benzalkonium chloride] tion] [BCF]
0.3 mg/0.3 mL (1.1 mL) [1:1000 solution; delivers 0.3 mg per injection] [BCF]
Dorzolamide and Timolol
EpiPen®: 0.3 mg/0.3 mL (2 mL) [contains sodium metabisulfite; 1:1000 sol- Outpatient Formulary Brands Available Cosopt®
Outpatient Dosage Forms
EpiPen® Jr.: 0.15 mg/0.3 mL (2 mL) [contains sodium metabisulfite; 1:2000 solution; delivers 0.15 mg per injection] Cosopt®: Dorzolamide hydrochloride 2% [strength expressed as base] and timolol maleate 0.5% mg [strength expressed as base] (10 mL) [contains Epoetin Alfa
Outpatient Formulary Brands Available Procrit®
Outpatient Dosage Forms
Doxazosin
Outpatient Formulary Brands Available Cardura®
Procrit®: 20,000 units/mL (1 mL [DSC]) [contains albumin (human), benzyl Outpatient Dosage Forms
Cardura®: 1 mg, 2 mg, 4 mg, 8 mg [scored] Procrit®: 40,000 units/mL (1 mL) [contains albumin (human)] Doxepin (Systemic)
Ergocalciferol
Outpatient Dosage Forms
Outpatient Formulary Brands Available Drisdol®
Capsule, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF],
Outpatient Dosage Forms
75 mg [BCF]
Solution, oral, as hydrochloride [concentrate]: 10 mg/mL (120 mL) [BCF]
Drisdol®: 50,000 int. units [contains soybean oil, tartrazine; 1.25 mg] Doxycycline
Erythromycin (Ophthalmic)
Outpatient Formulary Brands Available Vibramycin®
Outpatient Dosage Forms
Outpatient Dosage Forms
Ointment, ophthalmic [preservative free]: 0.5% [5 mg/g] (3.5 g) [BCF]
Capsule, oral, as hyclate: 50 mg, 100 mg [strength expressed as base] [BCF]
Tablet, oral, as hyclate: 100 mg [strength expressed as base] [BCF]
Erythromycin (Systemic)
Outpatient Formulary Brands Available Ery-Tab®; EryPed®
Doxylamine
Outpatient Dosage Forms
Outpatient Formulary Brands Available Aldex® AN
Granules for suspension, oral, as ethylsuccinate [strength expressed as base]: Outpatient Dosage Forms
E.E.S.®: 200 mg/5 mL (100 mL, 200 mL) [contains sodium 25.9 mg (1.1 mEq)/ 5 mL; cherry flavor] [BCF]
Tablet, oral, as stearate [strength expressed as base]: Erythrocin®: 250 mg [contains potassium 5 mg (0.1 mEq)/tablet, sodium Dronedarone
56.7 mg (2.5 mEq)/tablet] [BCF]
Outpatient Formulary Brands Available Multaq®
Tablet, delayed release, enteric coated, oral, as base: Outpatient Dosage Forms
Ery-Tab®: 250 mg [contains sodium 8.3 mg (0.4 mEq)/tablet] [BCF]
Erythromycin (Topical)
Outpatient Dosage Forms
Efavirenz
Gel, topical: 2% (30 g, 60 g) [BCF]
Outpatient Formulary Brands Available Sustiva®
Solution, topical: 2% (60 mL) [BCF]
Outpatient Dosage Forms
Escitalopram
Outpatient Dosage Forms
Efavirenz, Emtricitabine, and Tenofovir
Outpatient Formulary Brands Available Atripla®
Outpatient Dosage Forms
Esomeprazole
Outpatient Formulary Brands Available NexIUM®
Atripla®: Efavirenz 600 mg, emtricitabine 200 mg, and tenofovir disoproxil Outpatient Dosage Forms
Capsule, delayed release, oral, as magnesium [strength expressed as base]: NexIUM®: 20 mg [BCF], 40 mg [BCF]
Emollients
Outpatient Formulary Brands Available Biafine®; Vanicream®
Estradiol and Levonorgestrel
Outpatient Dosage Forms
Outpatient Formulary Brands Available ClimaraPro®
Outpatient Dosage Forms
ClimaraPro®: Estradiol 0.045 mg and levonorgestrel 0.015 mg per 24 hours (4s) [22 cm2; contains estradiol 4.4 mg and levonorgestrel 1.39 mg] Emtricitabine and Tenofovir
Estradiol (Systemic)
Outpatient Formulary Brands Available Truvada®
Outpatient Formulary Brands Available Climara®; Femring®
ETHINYL ESTRADIOL AND NORGESTIMATE
Outpatient Dosage Forms
Outpatient Dosage Forms
Patch, transdermal [once-weekly patch]: 0.025 mg/24 hours (4s) [BCF];
0.0375 mg/24 hours (4s) [BCF]; 0.05 mg/24 hours (4s) [BCF]; 0.06 mg/24
Demulen® 1/35-28: Ethinyl estradiol 0.035 mg and ethynodiol diacetate 1 mg hours (4s) [BCF]; 0.075 mg/24 hours (4s) [BCF]; 0.1 mg/24 hours (4s) [BCF]
[21 white tablets and 7 blue inactive tablets] [DSC] Climara®: 0.025 mg/24 hours (4s) [6.5 cm2, total estradiol 2.04 mg]Climara®: 0.05 mg/24 hours (4s) [12.5 cm2, total estradiol 3.8 mg] Ethinyl Estradiol and Etonogestrel
Climara®: 0.075 mg/24 hours (4s) [18.75 cm2, total estradiol 5.7 mg] Outpatient Formulary Brands Available NuvaRing®
Climara®: 0.1 mg/24 hours (4s) [25 cm2, total estradiol 7.6 mg] Outpatient Dosage Forms
Femring®: 0.05 mg/24 hours (1s) [total estradiol 12.4 mg; releases 0.05 mg/24 NuvaRing®: Ethinyl estradiol 0.015 mg/day and etonogestrel 0.12 mg/day (1s) Femring®: 0.1 mg/24 hours (1s) [total estradiol 24.8 mg; releases 0.1 mg/24 Ethinyl Estradiol and Levonorgestrel
Outpatient Formulary Brands Available Aviane™; Jolessa™; Lessina®;
Estradiol (Topical)
Outpatient Dosage Forms
Outpatient Formulary Brands Available Estrace®; Estring®; Vagifem®
Outpatient Dosage Forms
Aviane™ 28: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 orange tablets and 7 light green inactive tablets] [BCF]
Lessina® 28: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 pink tablets and 7 white inactive tablets] [BCF]
Estring®: 2 mg (1s) [total estradiol 2 mg; releases 7.5 mcg/day over 90 days] Levlite™ 28: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 pink tablets and 7 white inactive tablets] [BCF]
Levora® 28: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (28s) [21 Estramustine
white tablets and 7 peach inactive tablets] [BCF]
Outpatient Formulary Brands Available Emcyt®
Nordette® 28: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (28s) [21 Outpatient Dosage Forms
light orange tablets and 7 pink inactive tablets] [BCF]
Jolessa™: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (91s) [84 pink tablets and 7 white inactive tablets] [BCF]
Estrogens (Conjugated/Equine) and Medroxyprogesterone
Ethinyl Estradiol and Norelgestromin
Outpatient Formulary Brands Available Premphase®; Prempro®
Outpatient Formulary Brands Available Ortho Evra®
Outpatient Dosage Forms
Outpatient Dosage Forms
Ortho Evra®: Ethinyl estradiol 0.75 mg and norelgestromin 6 mg (1s) [releases 0.3/1.5: Conjugated estrogens 0.3 mg and medroxyprogesterone acetate ethinyl estradiol 20 mcg and norelgestromin 150 mcg per day] 1.5 mg (28s) [BCF]
0.45/1.5: Conjugated estrogens 0.45 mg and medroxyprogesterone acetate Ethinyl Estradiol and Norethindrone
1.5 mg (28s) [BCF]
Outpatient Formulary Brands Available femhrt®; Loestrin® Fe 1.5/30;
0.625/2.5: Conjugated estrogens 0.625 mg and medroxyprogesterone ace- Loestrin® Fe 1/20; Necon® 1/35; Ortho-Novum® 7/7/7 tate 2.5 mg (28s) [BCF]
Outpatient Dosage Forms
0.625/5: Conjugated estrogens 0.625 mg and medroxyprogesterone acetate 5 mg (28s) [BCF]
Norinyl® 1+35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg (28s) [21 Tablet, oral [therapy pack contains two separate tablet formulations]: yellow green tablets and 7 orange inactive tablets] [BCF]
Premphase® [therapy pack contains 2 separate tablet formulations]: Conju- Ortho-Novum® 1/35-28: Ethinyl estradiol 0.035 mg and norethindrone 1 mg gated estrogens 0.625 mg [14 maroon tablets] and conjugated estrogen (28s) [21 peach tablets and 7 green inactive tablets] [BCF]
0.625 mg/medroxyprogesterone acetate 5 mg [14 light blue tablets] (28s) Loestrin® Fe 1.5/30: Ethinyl estradiol 0.03 mg and norethindrone acetate Estrogens (Conjugated/Equine, Systemic)
Ferrous fumarate 75 mg [7 brown tablets] [DSC] Outpatient Formulary Brands Available Premarin®
Loestrin® Fe 1/20: Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg Outpatient Dosage Forms
[21 light yellow tablets] and ferrous fumarate 75 mg [7 brown tablets] Necon® 1/35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 dark Premarin®: 0.3 mg [BCF], 0.45 mg [BCF], 0.625 mg [BCF], 0.9 mg,
yellow tablets and 7 white inactive tablets] 1.25 mg [BCF]
femhrt®: 1/5: Ethinyl estradiol 0.005 mg and norethindrone acetate 1 mg [white Estrogens (Conjugated/Equine, Topical)
Outpatient Formulary Brands Available Premarin®
Outpatient Dosage Forms
Ortho-Novum® 7/7/7: Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone Premarin®: 0.625 mg/g (42.5 g) [BCF]
Day 8-14: Ethinyl estradiol 0.035 mg and norethindrone 0.75 mg [7 light Ethambutol
Day 15-21: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [7 peach Outpatient Formulary Brands Available Myambutol®
Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 100 mg [BCF], 400 mg [BCF]
Ethinyl Estradiol and Norgestimate
Outpatient Formulary Brands Available Ortho Tri-Cyclen®; Ortho Tri-
Ethinyl Estradiol and Desogestrel
Outpatient Formulary Brands Available Mircette®
Outpatient Dosage Forms
Outpatient Dosage Forms
Ortho-Cyclen®: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg (28s) [21 blue tablets and 7 green inactive tablets] [BCF]
Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 white tablets] Ortho Tri-Cyclen®: Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate Day 24-28: Ethinyl estradiol 0.01 mg [5 yellow tablets] (28s) 0.18 mg [7 white tablets]Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light blue Ethinyl Estradiol and Drospirenone
Outpatient Formulary Brands Available Yasmin®; Yaz®
Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 blue Outpatient Dosage Forms
Day 22-28: 7 green inactive tablets [DSC] Yasmin®: Ethinyl estradiol 0.03 mg and drospirenone 3 mg (28s) [21 yellow Ortho Tri-Cyclen® Lo: Day 1-7: Ethinyl estradiol 0.025 mg and norgestimate active tablets and 7 white inactive tablets] [BCF]
Yaz®: Ethinyl estradiol 0.02 mg and drospirenone 3 mg (28s) [24 light pink Day 8-14: Ethinyl estradiol 0.025 mg and norgestimate 0.215 mg [7 light blue tablets and 4 white inactive tablets] [BCF]
Day 15-21: Ethinyl estradiol 0.025 mg and norgestimate 0.25 mg [7 dark blue Ethinyl Estradiol and Ethynodiol Diacetate
Outpatient Formulary Brands Available Demulen® 1/35-28
ETHINYL ESTRADIOL AND NORGESTREL
Ethinyl Estradiol and Norgestrel
Outpatient Dosage Forms
Outpatient Formulary Brands Available Lo/Ovral®-28; Ogestrel®
Outpatient Dosage Forms
Fluconazole
Ogestrel®: Ethinyl estradiol 0.05 mg and norgestrel 0.5 mg Outpatient Formulary Brands Available Diflucan®
Lo/Ovral®-28: Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [DSC] Outpatient Dosage Forms
Tablet, oral: 150 mg [BCF]
Etidronate
Outpatient Dosage Forms
Fludrocortisone
Outpatient Formulary Brands Available Florinef® [DSC]
Outpatient Dosage Forms
Exenatide
Outpatient Formulary Brands Available Bydureon™; Byetta®
Outpatient Dosage Forms
Injection, microspheres for suspension, extended release: Flunisolide (Nasal)
Bydureon™: 2 mg [contains polylactide-co-glycolide, sucrose 0.8 mg/vial; Outpatient Dosage Forms
Solution, intranasal [spray]: 25 mcg/actuation (25 mL) Byetta®: 250 mcg/mL (2.4 mL) [10 mcg/0.04 mL; 60 doses] Fluocinolone (Topical)
Byetta®: 250 mcg/mL (1.2 mL) [5 mcg/0.02 mL; 60 doses] Outpatient Formulary Brands Available Capex®; Derma-Smoothe/FS®
Outpatient Dosage Forms
Ezetimibe
Outpatient Formulary Brands Available Zetia®
Derma-Smoothe/FS®: 0.01% (120 mL) [contains peanut oil] Outpatient Dosage Forms
Fluocinonide
Ezetimibe and Simvastatin
Outpatient Dosage Forms
Outpatient Formulary Brands Available Vytorin®
Cream, anhydrous, emollient, topical: 0.05% (15 g, 30 g, 60 g, 120 g) [BCF]
Outpatient Dosage Forms
10/10: Ezetimibe 10 mg and simvastatin 10 mg10/20: Ezetimibe 10 mg and simvastatin 20 mg Fluoride
10/40: Ezetimibe 10 mg and simvastatin 40 mg Outpatient Formulary Brands Available Fluorabon™ [DSC]; Gel-Kam®;
10/80: Ezetimibe 10 mg and simvastatin 80 mg PreviDent® 5000 Dry Mouth; PreviDent® 5000 Plus® Outpatient Dosage Forms
Famciclovir
Outpatient Formulary Brands Available Famvir®
PreviDent® 5000 Plus®: 1.1% (51 g) [contains sodium benzoate; spearmint Outpatient Dosage Forms
flavor; equivalent to fluoride 2.5 mg/dose] PreviDent® 5000 Dry Mouth: 1.1% (100 mL) [mint flavor; equivalent to fluoride Fenofibrate and Derivatives
Outpatient Formulary Brands Available
Gel-Kam®: 0.4% (129 mL) [fruit & berry flavor] Outpatient Dosage Forms
Fluorabon™: 2.21 mg [DSC] [scored; sugar free; raspberry flavor; equivalent to TriCor®: 48 mg [BCF], 145 mg [BCF] [contains soybean lecithin]
Triglide®: 50 mg, 160 mg [contains egg lecithin] FentaNYL
Fluorometholone
Outpatient Formulary Brands Available
Outpatient Formulary Brands Available
Outpatient Dosage Forms
Outpatient Dosage Forms
Patch, transdermal, as base: 12.5 mcg/hour (5s) Suspension, ophthalmic, as base [drops]: 0.1% (5 mL, 10 mL, 15 mL) Duragesic®: 25 mcg/hour (5s) [contains ethanol 0.1 mL/10 cm2; 10 cm2] FML®: 0.1% (5 mL, 10 mL, 15 mL) [contains benzalkonium chloride] Duragesic®: 50 mcg/hour (5s) [contains ethanol 0.1 mL/10 cm2; 20 cm2] Fluorouracil (Topical)
Duragesic®: 75 mcg/hour (5s) [contains ethanol 0.1 mL/10 cm2; 30 cm2] Outpatient Formulary Brands Available Efudex®
Duragesic®: 100 mcg/hour (5s) [contains ethanol 0.1 mL/10 cm2; 40 cm2] Outpatient Dosage Forms
Ferrous Sulfate
Outpatient Formulary Brands Available Fer-iron [OTC]
Outpatient Dosage Forms
FLUoxetine
Fer-iron: 75 mg/mL (50 mL) [contains ethanol 0.2%, sodium bisulfite; lemon Outpatient Dosage Forms
Capsule, oral: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]
Tablet, oral: 325 mg [elemental iron 65 mg] Solution, oral: 20 mg/5 mL (120 mL) [BCF]
Fexofenadine
Flurandrenolide
Outpatient Formulary Brands Available Allegra®
Outpatient Formulary Brands Available Cordran®
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 60 mg, 180 mg Fexofenadine and Pseudoephedrine
Flurbiprofen (Ophthalmic)
Outpatient Formulary Brands Available Allegra-D® 24-Hour
Outpatient Formulary Brands Available Ocufen®
Outpatient Dosage Forms
Outpatient Dosage Forms
Allegra-D® 24-Hour: 180/240: Fexofenadine hydrochloride 180 mg and pseu- Flutamide
Finasteride
Outpatient Formulary Brands Available Eulexin® [DSC]
Outpatient Formulary Brands Available Proscar®
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral: 5 mg [BCF]
Eulexin®: 125 mg [DSC] [contains benzyl alcohol] Flecainide
Fluticasone and Salmeterol
Outpatient Formulary Brands Available Tambocor™
Outpatient Formulary Brands Available Advair Diskus®; Advair® HFA
GUAIFENESIN AND PSEUDOEPHEDRINE
Outpatient Dosage Forms
Gentamicin (Ophthalmic)
Outpatient Formulary Brands Available Gentak®
Outpatient Dosage Forms
45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg per inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]
115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcg per inhalation Gentak®: 0.3% [3 mg/g] (3.5 g) [BCF]
(12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]
Solution, ophthalmic [drops]: 0.3% (5 mL) [BCF]
230/21: Fluticasone propionate 230 mcg and salmeterol 21 mcg per inhala- Glimepiride
tion (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]
Outpatient Formulary Brands Available Amaryl®
Outpatient Dosage Forms
100/50: Fluticasone propionate 100 mcg and salmeterol 50 mcg ((14s, 60s) [contains lactose] [BCF]
250/50: Fluticasone propionate 250 mcg and salmeterol 50 mcg (60s) [contains lactose] [BCF]
GlipiZIDE
500/50: Fluticasone propionate 500 mcg and salmeterol 50 mcg (60s) Outpatient Formulary Brands Available Glucotrol XL®
[contains lactose] [BCF]
Outpatient Dosage Forms
Fluticasone (Nasal)
Tablet, oral: 5 mg [BCF], 10 mg [BCF]
Tablet, extended release, oral: 2.5 mg [DSC]
Outpatient Formulary Brands Available Flonase®
Outpatient Dosage Forms
Suspension, intranasal, as propionate [spray]: Glucagon
Flonase®: 50 mcg/inhalation (16 g) [contains benzalkonium chloride; 120 Outpatient Formulary Brands Available Glucagon Emergency Kit
metered actuations] [BCF]
Outpatient Dosage Forms
Fluticasone (Oral Inhalation)
Outpatient Formulary Brands Available Flovent® HFA
Glucagon Emergency Kit: 1 mg [contains glycerin (in diluent), lactose 49 mg; Outpatient Dosage Forms
Aerosol, for oral inhalation, as propionate: GlyBURIDE
44 mcg/inhalation (10.6 g) [chlorofluorocarbon free; 120 metered actua- Outpatient Dosage Forms
tions] [BCF]
Tablet, oral: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF]
110 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actua- Tablet, oral [micronized]: 1.5 mg [BCF], 3 mg [BCF], 6 mg [BCF]
tions] [BCF]
220 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actua- Glyburide and Metformin
tions] [BCF]
Outpatient Formulary Brands Available Glucovance®
Powder, for oral inhalation, as propionate: Outpatient Dosage Forms
Flovent® Diskus®: 50 mcg (60s) [contains lactose] [BCF]; 100 mcg (60s)
[contains lactose] [BCF]; 250 mcg (60s) [contains lactose] [BCF]
1.25/250: Glyburide 1.25 mg and metformin hydrochloride 250 mg Folic Acid
5/500: Glyburide 5 mg and metformin hydrochloride 500 mg Outpatient Dosage Forms
Glucovance®: 2.5/500: Glyburide 2.5 mg and metformin hydrochloride 500 mg Tablet, oral: 1 mg [BCF]
Goserelin
Fosamprenavir
Outpatient Formulary Brands Available Zoladex®
Outpatient Formulary Brands Available Lexiva®
Outpatient Dosage Forms
Outpatient Dosage Forms
Lexiva®: 700 mg [equivalent to amprenavir ~600 mg] 3.6 mg (1s) [1 month implant] [BCF]
Fosinopril
10.8 mg (1s) [3 month implant] [BCF]
Outpatient Dosage Forms
Griseofulvin
Outpatient Formulary Brands Available Grifulvin V®; Gris-PEG®
Fructose, Dextrose, and Phosphoric Acid
Outpatient Dosage Forms
Outpatient Formulary Brands Available Emetrol® [OTC]
Suspension, oral [microsize]: 125 mg/5 mL (120 mL) [BCF]
Outpatient Dosage Forms
Gris-PEG®: 125 mg [BCF], 250 mg [BCF] [scored]
Emetrol®: Fructose 1.87 g, dextrose 1.87 g, and phosphoric acid 21.5 mg per GuaiFENesin
Outpatient Formulary Brands Available Mucinex® [OTC]
Furosemide
Outpatient Dosage Forms
Outpatient Dosage Forms
Solution, oral: 10 mg/mL (4 mL, 60 mL, 120 mL) [BCF]
Tablet, oral: 20 mg [BCF], 40 mg [BCF], 80 mg
Guaifenesin and Codeine
Gabapentin
Outpatient Dosage Forms
Outpatient Formulary Brands Available Neurontin®
Outpatient Dosage Forms
Solution, oral: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (5 Capsule, oral: 100 mg [BCF], 300 mg [BCF], 400 mg [BCF]
Tablet, oral: 600 mg [BCF], 800 mg [BCF]
Guaifenesin and Dextromethorphan
Outpatient Formulary Brands Available Robitussin® Cough & Chest Con-
Ganciclovir (Ophthalmic)
Outpatient Formulary Brands Available Zirgan®
Outpatient Dosage Forms
Outpatient Dosage Forms
Syrup, oral: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg Zirgan®: 0.15% (5 g) [contains benzalkonium chloride] Robitussin® Cough & Chest Congestion DM: Guaifenesin 100 mg and dextro- Gatifloxacin
methorphan hydrobromide 10 mg per 5 mL (120 mL, 240 mL, 360 mL) Outpatient Formulary Brands Available
[ethanol free; contains propylene glycol, sodium 7 mg/5 mL, sodium ben- Outpatient Dosage Forms
Guaifenesin and Pseudoephedrine
Zymaxid™: 0.5% (2.5 mL) [contains benzalkonium chloride] Outpatient Formulary Brands Available Mucinex® D [OTC]
Gemfibrozil
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral: 600 mg [BCF]
Mucinex® D: Guaifenesin 600 mg and pseudoephedrine hydrochloride 60 mg GUAIFENESIN AND PSEUDOEPHEDRINE
Outpatient Dosage Forms
GuanFACINE
Outpatient Formulary Brands Available Intuniv™; Tenex®
HydrOXYzine
Outpatient Dosage Forms
Outpatient Dosage Forms
Syrup, oral, as hydrochloride: 10 mg/5 mL (118 mL, 473 mL) [BCF]
Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]
Hyoscyamine
Homatropine
Outpatient Formulary Brands Available Levsin®
Outpatient Dosage Forms
Outpatient Formulary Brands Available Isopto® Homatropine
Solution, oral, as sulfate [drops]: 0.125 mg/mL (15 mL) Outpatient Dosage Forms
Levsin®: 0.125 mg/mL (15 mL [DSC]) [contains ethanol 5%; orange flavor] Solution, ophthalmic, as hydrobromide [drops]: Isopto® Homatropine: 5% (5 mL) [contains benzalkonium chloride] Hyoscyamine, Atropine, Scopolamine, and Phenobarbital
Outpatient Dosage Forms
HydrALAZINE
Elixir, oral: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, scopol- Outpatient Dosage Forms
amine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg per 5 mL (473 Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]
Hydrochlorothiazide
Tablet, oral: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, scopolamine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg Outpatient Dosage Forms
Capsule, oral: 12.5 mg [BCF]
Ibandronate
Tablet, oral: 25 mg [BCF], 50 mg [BCF]
Outpatient Formulary Brands Available Boniva®
Hydrochlorothiazide and Triamterene
Outpatient Dosage Forms
Outpatient Dosage Forms
Boniva®: 150 mg [once-monthly formulation] [BCF]
Hydrochlorothiazide 25 mg and triamterene 37.5 mg [BCF]
Ibuprofen
Hydrochlorothiazide 50 mg and triamterene 75 mg [BCF]
Outpatient Formulary Brands Available Motrin® Children's
Outpatient Dosage Forms
Hydrocodone and Acetaminophen
Suspension, oral: 100 mg/5 mL (5 mL, 10 mL, 120 mL, 480 mL) Outpatient Dosage Forms
Solution, oral: Hydrocodone bitartrate 7.5 mg and acetaminophen 500 mg per Tablet, oral: 400 mg [BCF], 600 mg [BCF], 800 mg [BCF]
Tablet, oral: Hydrocodone bitartrate 5 mg and acetaminophen 500 mg; hydro- Imipramine
codone bitartrate 7.5 mg and acetaminophen 500 mg Outpatient Dosage Forms
Capsule, oral, as pamoate: 75 mg [BCF]
Hydrocodone and Chlorpheniramine
Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]
Outpatient Formulary Brands Available Tussionex® Pennkinetic®
Outpatient Dosage Forms
Imiquimod
Outpatient Formulary Brands Available Aldara®
Tussionex® Pennkinetic®: Hydrocodone polistirex [equivalent to hydrocodone Outpatient Dosage Forms
bitartrate 10 mg] and chlorpheniramine polistirex [equivalent to chlorphenir- amine maleate 8 mg] per 5 mL (473 mL) [contains propylene glycol] Aldara®: 5% (12s [DSC], 24s) [contains benzyl alcohol] Hydrocodone and Ibuprofen
Indomethacin
Outpatient Formulary Brands Available Vicoprofen®
Outpatient Dosage Forms
Outpatient Dosage Forms
Capsule, oral: 25 mg [BCF], 50 mg [BCF]
Ingenol Mebutate
Vicoprofen®: 7.5/200: Hydrocodone bitartrate 7.5 mg and ibuprofen 200 mg Outpatient Formulary Brands Available Picato®
Hydrocortisone (Systemic)
Outpatient Dosage Forms
Outpatient Formulary Brands Available Cortef®
Outpatient Dosage Forms
Picato®: 0.015% (3s); 0.05% (2s) [contains benzyl alcohol, isopropyl alcohol] Inhalation Devices
Outpatient Dosage Forms
Hydrocortisone (Topical)
AeroChamber™, AeroChamber™ with mask (small, medium) Outpatient Formulary Brands Available Proctozone-HC 2.5%™
Insulin Aspart
Outpatient Dosage Forms
Outpatient Formulary Brands Available NovoLOG®; NovoLOG® FlexPen®
Cream, topical, as base: 1% (15 g); 2.5% (20 g, 28 g, 28.35 g, 30 g, 454 g) Outpatient Dosage Forms
NovoLOG®: 100 units/mL (3 mL) [FlexPen® prefilled syringe or PenFill® prefilled cartridge] [BCF]; (10 mL) [vial] [BCF]
Ointment, topical, as base: 1% (30 g)Ointment, topical, as valerate: 0.2% (15 g) Insulin Aspart Protamine and Insulin Aspart
Suppository, rectal, as acetate: 25 mg (12s, 24s) [BCF]
Outpatient Formulary Brands Available NovoLOG® Mix 70/30 FlexPen®
Outpatient Dosage Forms
HYDROmorphone
Outpatient Formulary Brands Available Dilaudid®
NovoLOG® Mix 70/30: Insulin aspart protamine suspension 70% [intermediate Outpatient Dosage Forms
acting] and insulin aspart solution 30% [rapid acting]: 100 units/mL (3 mL) [FlexPen® prefilled syringe] [BCF]; (10 mL) [vial] [BCF]
Dilaudid®: 4 mg [contains sodium metabisulfite (may have trace amounts)] Insulin Glargine
Hydroquinone
Outpatient Formulary Brands Available Lantus®; Lantus® Solostar®
Outpatient Formulary Brands Available Solaquin Forte® [DSC]
Outpatient Dosage Forms
Outpatient Dosage Forms
Lantus®: 100 units/mL (3 mL, 10 mL) [BCF]
Solaquin Forte®: 4% (28.4 g [DSC]) [contains sunscreen] Lantus® Solostar®: 100 units/mL (3 mL) [prefilled pen] Hydroxychloroquine
Insulin NPH
Outpatient Dosage Forms
Outpatient Formulary Brands Available HumuLIN® N; NovoLIN® N
Tablet, oral, as sulfate: 200 mg [equivalent to 155 mg base] Outpatient Dosage Forms
Hydroxyurea
HumuLIN® N: 100 units/mL (3 mL, 10 mL) [BCF]
Outpatient Formulary Brands Available Hydrea®
NovoLIN® N: 100 units/mL (10 mL) [BCF]
LEVETIRACETAM
Insulin NPH and Insulin Regular
Ketoconazole (Topical)
Outpatient Formulary Brands Available HumuLIN® 70/30; NovoLIN® 70/30
Outpatient Dosage Forms
Outpatient Dosage Forms
HumuLIN® 70/30: Insulin NPH suspension 70% [intermediate acting] and Ketorolac (Ophthalmic)
insulin regular solution 30% [short acting]: 100 units/mL (3 mL) [disposable
pen] [BCF]; (10 mL) [vial] [BCF]
Outpatient Formulary Brands Available Acuvail®
NovoLIN® 70/30: Insulin NPH suspension 70% [intermediate acting] and Outpatient Dosage Forms
insulin regular solution 30% [short acting]: 100 units/mL (10 mL) [BCF]
Solution, ophthalmic, as tromethamine [drops, preservative free]: Insulin Regular
Outpatient Formulary Brands Available HumuLIN® R; NovoLIN® R
Labetalol
Outpatient Dosage Forms
Outpatient Dosage Forms
HumuLIN® R: 100 units/mL (3 mL, 10 mL) [BCF]
Lactic Acid and Ammonium Hydroxide
NovoLIN® R: 100 units/mL (10 mL) [BCF]
Outpatient Formulary Brands Available AmLactin® [OTC]
Interferon Beta-1a
Outpatient Dosage Forms
Outpatient Formulary Brands Available Avonex®
Outpatient Dosage Forms
AmLactin®: Lactic acid 12% with ammonium hydroxide (225 g) Lactobacillus
Avonex®): 30 mcg/0.5 mL (0.5 mL) [albumin free; prefilled syringe; syringe cap Outpatient Formulary Brands Available Culturelle® Digestive Health; Cul-
contains latex; packaged with alcohol wipes, gauze pad, and adhesive bandages] [ECF]
Outpatient Dosage Forms
Interferon Beta-1b
Outpatient Formulary Brands Available Betaseron®
Culturelle® Digestive Health: Lactobacillus GG 10 billion cells per capsule Outpatient Dosage Forms
Culturelle® for Kids: Lactobacillus GG 1 billion cells per packet Betaseron®: 0.3 mg [~9.6 million int. units] [contains albumin (human)] Lactulose
Ipecac Syrup
Outpatient Dosage Forms
Outpatient Dosage Forms
Solution, oral: 10 g/15 mL (15 mL, 30 mL, 237 mL, 240 mL, 473 mL, 480 mL, 500 mL, 946 mL, 960 mL) [BCF]
Ipratropium and Albuterol
LamiVUDine
Outpatient Formulary Brands Available
Outpatient Formulary Brands Available
Outpatient Dosage Forms
Outpatient Dosage Forms
Solution for nebulization: Ipratropium bromide 0.5 mg and albuterol (base) DuoNeb®: Ipratropium bromide 0.5 mg and albuterol (base) 2.5 mg per 3 mL Lamivudine and Zidovudine
Outpatient Formulary Brands Available Combivir®
Combivent® Respimat®: Ipratropium bromide 20 mcg and albuterol (base) 100 Outpatient Dosage Forms
mcg per inhalation (4 g) [contains benzalkonium chloride; 120 metered actuations] [BCF]
Combivir®: 300/150: Zidovudine 300 mg and lamivudine 150 mg Ipratropium (Nasal)
LamoTRIgine
Outpatient Formulary Brands Available Atrovent®
Outpatient Formulary Brands Available LaMICtal®
Outpatient Dosage Forms
Outpatient Dosage Forms
Solution, intranasal, as bromide [spray]: Atrovent®: 0.03% (30 mL) [contains benzalkonium chloride; delivers 21 mcg/ LaMICtal®: 25 mg, 100 mg, 150 mg, 200 mg [scored] Latanoprost
Ipratropium (Oral Inhalation)
Outpatient Formulary Brands Available Xalatan®
Outpatient Formulary Brands Available Atrovent® HFA
Outpatient Dosage Forms
Outpatient Dosage Forms
Aerosol, for oral inhalation, as bromide: Xalatan®: 0.005% (2.5 mL) [contains benzalkonium chloride] [BCF]
Atrovent® HFA: 17 mcg/actuation (12.9 g) [chlorofluorocarbon free] [BCF]
Solution, for nebulization, as bromide: 0.02% [500 mcg/2.5 mL] (25s, 30s, 60s) Letrozole
Outpatient Formulary Brands Available Femara®
Isoniazid
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral: 100 mg [BCF], 300 mg [BCF]
Isosorbide Dinitrate
Leucovorin Calcium
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg [BCF]
Tablet, oral [strength expressed as base]: 5 mg Tablet, extended release, oral: 40 mg [BCF]
Leuprolide
Isosorbide Mononitrate
Outpatient Formulary Brands Available Lupron Depot®
Outpatient Formulary Brands Available Imdur®
Outpatient Dosage Forms
Outpatient Dosage Forms
Injection, powder for reconstitution, as acetate [depot formulation]: Lupron Depot®: 3.75 mg, 7.5 mg [contains polylactide-co-glycolide, polysor- Tablet, extended release, oral: 30 mg [BCF], 60 mg [BCF], 120 mg [BCF]
Levalbuterol
ISOtretinoin
Outpatient Formulary Brands Available Xopenex HFA™
Outpatient Formulary Brands Available Amnesteem®; Claravis™; Sotret®
Outpatient Dosage Forms
Outpatient Dosage Forms
Aerosol, for oral inhalation, as tartrate [strength expressed as base]: Xopenex HFA™: 45 mcg/actuation (15 g) [chlorofluorocarbon free; 200 actua- Claravis™: 40 mg [contains soybean oil] Amnesteem®: 40 mg [contains soybean oil] LevETIRAcetam
Sotret®: 40 mg [contains parabens, soybean oil] Outpatient Formulary Brands Available Keppra XR™; Keppra®
LEVETIRACETAM
Outpatient Dosage Forms
Outpatient Dosage Forms
Keppra®: 100 mg/mL (480 mL) [dye free; grape flavor] Kaletra®: Lopinavir 200 mg and ritonavir 50 mg Keppra®: 500 mg, 750 mg [scored; gluten free] Loratadine
Outpatient Formulary Brands Available Claritin®
Outpatient Dosage Forms
Levofloxacin (Systemic)
Claritin®: 1 mg/mL (473 mL [DSC]) [contains sodium benzoate; fruit flavor] Outpatient Formulary Brands Available Levaquin®
Outpatient Dosage Forms
LORazepam
Levaquin®: 25 mg/mL (480 mL) [contains benzyl alcohol, propylene gly- Outpatient Dosage Forms
col] [BCF]
Levaquin®: 250 mg [BCF], 500 mg [BCF], 750 mg [BCF]
Losartan
Outpatient Formulary Brands Available Cozaar®
Levonorgestrel
Outpatient Dosage Forms
Outpatient Formulary Brands Available Next Choice™
Outpatient Dosage Forms
Cozaar®: 25 mg [contains potassium 2.12 mg (0.054 mEq)] [BCF]
Cozaar®: 50 mg [contains potassium 4.24 mg (0.108 mEq)] [BCF]
Cozaar®: 100 mg [contains potassium 8.48 mg (0.216 mEq)] [BCF]
Plan B One-Step: 1.5 mg [BCF]
Losartan and Hydrochlorothiazide
Levothyroxine
Outpatient Formulary Brands Available Hyzaar®
Outpatient Formulary Brands Available Synthroid®
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral, as sodium: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg
Hyzaar® 50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg [BCF], 100 mcg [BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150
[contains potassium 4.24 mg (0.108 mEq)] [BCF]
mcg [BCF], 175 mcg [BCF], 200 mcg [BCF], 300 mcg [BCF]
Hyzaar® 100/12.5: Losartan potassium 100 mg and hydrochlorothiazide Synthroid®: 25 mcg, 75 mcg, 88 mcg, 100 mcg, 125 mcg, 137 mcg, 150 mcg, 12.5 mg [contains potassium 8.48 mg (0.216 mEq)] [BCF]
Hyzaar® 100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg [contains potassium 8.48 mg (0.216 mEq)] [BCF]
Lidocaine, Maalox®, Diphenhydramine
Magnesium Citrate
Outpatient Dosage Forms
Outpatient Dosage Forms
Suspension, oral [mouthwash 1:1:1]: 1 part Lidocaine viscous 2%, 1 part Maalox®, and 1 part diphenhydramine elixir 12.5 mg/5 mL per 120 mL Magnesium Gluconate
Lidocaine (Topical)
Outpatient Dosage Forms
Outpatient Formulary Brands Available L-M-X® 4; Lidoderm®
Tablet, oral: 500 mg [equivalent to elemental magnesium 27 mg (2.4 mEq)] Outpatient Dosage Forms
Magnesium Hydroxide
L-M-X® 4: 4% (5 g, 15 g, 30 g) [contains benzyl alcohol] Outpatient Formulary Brands Available Milk of Magnesia [OTC]
Jelly, topical, as hydrochloride [preservative free]: 2% (10 mL) Outpatient Dosage Forms
Linezolid
Outpatient Formulary Brands Available Zyvox®
Magnesium Oxide
Outpatient Dosage Forms
Outpatient Formulary Brands Available Mag-Ox® 400 [OTC]
Outpatient Dosage Forms
Zyvox®: 100 mg/5 mL (150 mL) [contains phenylalanine 20 mg/5 mL, sodium 8.52 mg (0.4 mEq)/5 mL, sodium benzoate; orange flavor] Mag-Ox® 400: 400 mg [scored; equivalent to elemental magnesium 240 mg Zyvox®: 600 mg [contains sodium 2.92 mg (0.1 mEq)/tablet] Meclizine
Liothyronine
Outpatient Dosage Forms
Outpatient Formulary Brands Available Cytomel®
Outpatient Dosage Forms
MedroxyPROGESTERone
Outpatient Dosage Forms
Depo-Provera® Contraceptive: 150 mg/mL (1 mL) Lisinopril
Tablet, oral, as acetate: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]
Outpatient Formulary Brands Available Zestril®
Outpatient Dosage Forms
Mefloquine
Tablet, oral: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg
Outpatient Dosage Forms
[BCF], 40 mg [BCF]
Tablet, oral, as hydrochloride: 250 mg [scored; equivalent to mefloquine base Lisinopril and Hydrochlorothiazide
Megestrol
Outpatient Dosage Forms
Outpatient Formulary Brands Available Megace®
Outpatient Dosage Forms
10/12.5: Lisinopril 10 mg and hydrochlorothiazide 12.5 mg [BCF]
20/12.5: Lisinopril 20 mg and hydrochlorothiazide 12.5 mg [BCF]
Megace®: 40 mg/mL (240 mL) [contains ethanol 0.06%, sodium benzoate; 20/25: Lisinopril 20 mg and hydrochlorothiazide 25 mg [BCF]
Outpatient Dosage Forms
Melatonin
Capsule, oral, as carbonate: 150 mg [BCF], 300 mg [BCF]
Outpatient Dosage Forms
Solution, oral, as citrate: 300 mg/5 mL (5 mL, 473 mL, 500 mL) [equivalent to amount of lithium in lithium carbonate] [BCF]
Syrup, oral, as citrate: 300 mg/5 mL [BCF]
Meloxicam
Outpatient Dosage Forms
Loperamide
Outpatient Dosage Forms
Mobic®: 7.5 mg [BCF], 15 mg [BCF]
Capsule, oral, as hydrochloride: 2 mg [BCF]
Generic: 7.5 mg [BCF], 15 mg [BCF]
Lopinavir and Ritonavir
Melphalan
Outpatient Formulary Brands Available Kaletra®
Outpatient Formulary Brands Available Alkeran®
MISOPROSTOL
Outpatient Dosage Forms
Tablet, extended release, oral, as hydrochloride [bi-modal release]: 18 mg [4 mg immediate release, 14 mg extended release] [BCF]
27 mg [6 mg immediate release, 21 mg extended release] [BCF]
Memantine
36 mg [8 mg immediate release, 28 mg extended release] [BCF]
Outpatient Formulary Brands Available Namenda®
54 mg [12 mg immediate release, 42 mg extended release] [BCF]
Outpatient Dosage Forms
Tablet, sustained release, oral, as hydrochloride: 20 mg MethylPREDNISolone
Meperidine
Outpatient Dosage Forms
Outpatient Formulary Brands Available Demerol®
Outpatient Dosage Forms
Metoclopramide
Outpatient Dosage Forms
Solution, oral: 5 mg/5 mL (10 mL, 473 mL) [BCF]
Mercaptopurine
Tablet, oral: 10 mg [BCF]
Outpatient Formulary Brands Available Purinethol®
Outpatient Dosage Forms
Metolazone
Outpatient Formulary Brands Available Zaroxolyn®
Outpatient Dosage Forms
Mesalamine
Outpatient Formulary Brands Available Canasa®; Lialda®; Pentasa®;
Metoprolol
Outpatient Dosage Forms
Outpatient Formulary Brands Available Toprol-XL®
Outpatient Dosage Forms
Tablet, oral, as tartrate: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]
Tablet, extended release, oral, as succinate: 25 mg [BCF], 50 mg [BCF],
Canasa®: 1000 mg (30s) [contains saturated vegetable fatty esters] 100 mg [BCF], 200 mg [BCF] [expressed as mg equivalent to tartrate]
Toprol-XL®: 25 mg, 50 mg, 100 mg, 200 mg [scored; expressed as mg equiv- Rowasa®: 4 g/60 mL (7s, 28s) [contains potassium metabisulfite, sodium Tablet, delayed release, enteric coated, oral: MetroNIDAZOLE (Systemic)
Outpatient Dosage Forms
Metaxalone
Tablet, oral: 250 mg [BCF], 500 mg [BCF]
Outpatient Formulary Brands Available Skelaxin®
MetroNIDAZOLE (Topical)
Outpatient Dosage Forms
Outpatient Formulary Brands Available MetroCream®; MetroGel-Vaginal®;
Outpatient Dosage Forms
MetFORMIN
MetroCream®: 0.75% (45 g) [contains benzyl alcohol] Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 500 mg [BCF], 850 mg [BCF], 1000 mg [BCF]
Tablet, extended release, oral, as hydrochloride: 500 mg [BCF], 750 mg [BCF]
Gel, vaginal: 0.75% (70 g) [BCF]
Methadone
Outpatient Formulary Brands Available Dolophine®
Miconazole (Topical)
Outpatient Dosage Forms
Outpatient Dosage Forms
Methimazole
Midodrine
Outpatient Formulary Brands Available
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 5 mg, 10 mg Mifepristone
Outpatient Formulary Brands Available Mifeprex®
Methocarbamol
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral: 500 mg [BCF]
Methotrexate
Mineral Oil
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral: 2.5 mg [BCF]
Methyldopa
Minocycline
Outpatient Dosage Forms
Outpatient Formulary Brands Available Minocin®
Outpatient Dosage Forms
Methylergonovine
Outpatient Formulary Brands Available Methergine®
Outpatient Dosage Forms
Minoxidil (Systemic)
Outpatient Dosage Forms
Methylphenidate
Mirtazapine
Outpatient Formulary Brands Available Concerta®; Metadate® ER; Ritalin
Outpatient Formulary Brands Available Remeron®
Outpatient Dosage Forms
Outpatient Dosage Forms
Capsule, extended release, oral, as hydrochloride [bi-modal release]: Ritalin LA®: 10 mg [5 mg immediate release, 5 mg extended release] [BCF]
Ritalin LA®: 20 mg [10 mg immediate release, 10 mg extended release] [BCF]
Misoprostol
Ritalin LA®: 30 mg [15 mg immediate release, 15 mg extended release] [BCF]
Outpatient Formulary Brands Available Cytotec®
Ritalin LA®: 40 mg [20 mg immediate release, 20 mg extended release] [BCF]
Outpatient Dosage Forms
Methylin®: 5 mg [BCF], 10 mg [BCF]
Ritalin®: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF]
MODAFINIL
Modafinil
Nabumetone
Outpatient Formulary Brands Available Provigil®
Outpatient Dosage Forms
Outpatient Dosage Forms
Naftifine
Outpatient Formulary Brands Available Naftin®
Outpatient Dosage Forms
Mometasone and Formoterol
Outpatient Formulary Brands Available Dulera®
Naftin®: 1% (15 g [DSC], 30 g) [contains benzyl alcohol] Outpatient Dosage Forms
Naphazoline and Pheniramine
Dulera®: Mometasone furoate 100 mcg and formoterol fumarate dihydrate 5 Outpatient Formulary Brands Available Naphcon® A [OTC]
mcg per inhalation (13 g) [120 metered actuations] Outpatient Dosage Forms
Dulera®: Mometasone furoate 200 mcg and formoterol fumarate dihydrate 5 mcg per inhalation (13 g) [120 metered actuations] Naphcon® A: Naphazoline hydrochloride 0.025% and pheniramine maleate 0.3% (15 mL) [contains benzalkonium chloride] Mometasone (Nasal)
Outpatient Formulary Brands Available Nasonex®
Naproxen
Outpatient Dosage Forms
Outpatient Dosage Forms
Suspension, intranasal, as furoate [spray]: Suspension, oral: 125 mg/5 mL (500 mL) [BCF]
Nasonex®: 50 mcg/spray (17 g) [contains benzalkonium chloride; delivers 120 Tablet, oral: 250 mg [BCF], 500 mg [BCF]
Tablet, oral, as sodium: 275 mg [equivalent to naproxen base 250 mg] [BCF],
550 mg [equivalent to naproxen base 500 mg] [BCF]
Mometasone (Oral Inhalation)
Outpatient Formulary Brands Available
Neomycin
Outpatient Dosage Forms
Outpatient Dosage Forms
Neomycin and Polymyxin B
110 mcg (30 units) [contains lactose; delivers 100 mcg/actuation] [BCF]
Outpatient Formulary Brands Available Neosporin® G.U.
220 mcg (14 units, 30 units, 60 units, 120 units) [contains lactose; delivers Outpatient Dosage Forms
200 mcg/actuation] [BCF]
Mometasone (Topical)
Neosporin® G.U.: Neomycin 40 mg and polymyxin B sulfate 200,000 units per Outpatient Formulary Brands Available Elocon®
Outpatient Dosage Forms
Neomycin, Polymyxin B, and Dexamethasone
Outpatient Formulary Brands Available Maxitrol®
Outpatient Dosage Forms
Montelukast
Outpatient Formulary Brands Available Singulair®
Maxitrol®: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame- Outpatient Dosage Forms
Maxitrol®: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame- Singulair®: 4 mg/packet (30s) [BCF]
thasone 0.1% per 1 mL (5 mL) [contains benzalkonium chloride] Singulair®: 10 mg [BCF]
Neomycin, Polymyxin B, and Gramicidin
Outpatient Formulary Brands Available Neosporin® Ophthalmic Solution
Outpatient Dosage Forms
4 mg [contains phenylalanine 0.674 mg/tablet; cherry flavor] [BCF]
Solution, ophthalmic [drops]: Neomycin 1.75 mg, polymyxin B 10,000 units, and 5 mg [contains phenylalanine 0.842 mg/tablet; cherry flavor] [BCF]
gramicidin 0.025 mg per 1 mL (10 mL) [BCF]
Morphine (Systemic)
Neosporin® Ophthalmic Solution: Neomycin 1.75 mg, polymyxin B 10,000 Outpatient Formulary Brands Available
units, and gramicidin 0.025 mg per 1 mL (10 mL) Outpatient Dosage Forms
Neomycin, Polymyxin B, and Hydrocortisone
Solution, oral, as sulfate: 10 mg/5 mL (100 mL) Outpatient Dosage Forms
Suspension, otic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydro- Tablet, controlled release, oral, as sulfate: cortisone 10 mg per mL (10 mL) [BCF]
MS Contin®: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF],
200 mg [BCF]
Tablet, extended release, oral, as sulfate: 15 mg [BCF], 30 mg [BCF], 60 mg
Outpatient Formulary Brands Available Niaspan®
[BCF], 100 mg [BCF], 200 mg [BCF]
Outpatient Dosage Forms
Tablet, sustained release, oral, as sulfate: Oramorph® SR: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF]
Niaspan®: 500 mg [BCF], 750 mg [BCF], 1000 mg [BCF]
Moxifloxacin (Ophthalmic)
Nicotine
Outpatient Formulary Brands Available Vigamox®
Outpatient Dosage Forms
Outpatient Dosage Forms
Patch, transdermal: 14 mg/24 hours (7s) [BCF]; 21 mg/24 hours (7s) [BCF]
NIFEdipine
Outpatient Formulary Brands Available Adalat® CC; Procardia®
Moxifloxacin (Systemic)
Outpatient Dosage Forms
Outpatient Formulary Brands Available Avelox®; Avelox® ABC Pack
Outpatient Dosage Forms
Tablet, extended release, oral: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF]
Nitrofurantoin
Mupirocin
Outpatient Formulary Brands Available Furadantin®; Macrodantin®
Outpatient Dosage Forms
Outpatient Dosage Forms
Ointment, topical: 2% (22 g) [BCF]
Capsule, oral [macrocrystal]: 50 mg [BCF]
Mycophenolate
Capsule, oral [macrocrystal/monohydrate]: 100 mg [BCF]
Outpatient Formulary Brands Available CellCept®
Outpatient Dosage Forms
Nitroglycerin
Outpatient Formulary Brands Available Nitro-Dur®; Nitrolingual®; Nitro-
CellCept®: 500 mg [contains ethanol (may have trace amounts)] PERMETHRIN
Outpatient Dosage Forms
Outpatient Dosage Forms
0.1 mg/hour (30s) [BCF]
0.2 mg/hour (30s) [BCF]
0.4 mg/hour (30s) [BCF]
Tablet, orally disintegrating, oral: 4 mg, 8 mg 0.6 mg/hour (30s) [BCF]
Zofran® ODT: 4 mg, 8 mg [contains phenylalanine <0.03 mg/tablet; strawberry 0.3 mg/hour (30s) [BCF]
0.8 mg/hour (30s) [BCF]
Oxazepam
Outpatient Dosage Forms
0.4 mg/spray (12 g) [contains ethanol 20%; 200 metered sprays] [BCF]
OXcarbazepine
0.4 mg/spray (4.9 g) [contains ethanol 20%; 60 metered sprays] [BCF]
Outpatient Formulary Brands Available Trileptal®
Nitrostat®: 0.4 mg [BCF]
Outpatient Dosage Forms
Norethindrone
Trileptal®: 300 mg/5 mL (250 mL) [contains ethanol, propylene glycol] Outpatient Formulary Brands Available Aygestin®; Camila®; Errin®; Joliv-
ette®; Nor-QD®; Nora-BE®; Ortho Micronor® Trileptal®: 150 mg, 300 mg, 600 mg [scored] Outpatient Dosage Forms
Oxybutynin
Outpatient Formulary Brands Available Ditropan XL®
Camila®: 0.35 mg [BCF]
Errin®: 0.35 mg [BCF]
Outpatient Dosage Forms
Jolivette®: 0.35 mg [BCF]
Nor-QD®: 0.35 mg [BCF]
Tablet, extended release, oral, as chloride: 5 mg [BCF], 10 mg [BCF],
15 mg [BCF]
Nora-BE®: 0.35 mg [BCF]
Ortho Micronor®: 0.35 mg [BCF]
OxyCODONE
Outpatient Formulary Brands Available OxyCONTIN®
Nortriptyline
Outpatient Dosage Forms
Outpatient Dosage Forms
Tablet, oral, as hydrochloride: 5 mgTablet, controlled release, oral, as hydrochloride: Capsule, oral: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]
OxyCONTIN®: 10 mg, 20 mg, 30 mg, 40 mg, 80 mg Solution, oral: 10 mg/5 mL (473 mL, 480 mL) Nystatin (Oral)
Oxycodone and Acetaminophen
Outpatient Dosage Forms
Outpatient Formulary Brands Available Roxicet™; Tylox®
Outpatient Dosage Forms
Suspension, oral: 100,000 units/mL (5 mL, 60 mL, 473 mL, 480 mL) [BCF]
Tablet, oral: 500,000 units
Tylox®: 5/500: Oxycodone hydrochloride 5 mg and acetaminophen 500 mg Nystatin (Topical)
[contains sodium benzoate, sodium metabisulfite] Outpatient Formulary Brands Available Nystop®
Outpatient Dosage Forms
Roxicet™: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg per 5 Cream, topical: 100,000 units/g (15 g, 30 g) [BCF]
mL (500 mL) [contains ethanol <0.5%; mint flavor] Ointment, topical: 100,000 units/g (15 g, 30 g) [BCF]
Tablet, oral: 5/325: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg [BCF]
Nystop®: 100,000 units/g (15 g) [contains talc] Oxymetazoline (Nasal)
Octreotide
Outpatient Dosage Forms
Outpatient Formulary Brands Available SandoSTATIN LAR®; SandoSTA-
Solution, intranasal, as hydrochloride [spray]: 0.05% (15 mL) Pancrelipase
Outpatient Dosage Forms
Outpatient Formulary Brands Available Creon®; Pancreaze™
Injection, microspheres for suspension, as acetate [depot formulation]: Outpatient Dosage Forms
SandoSTATIN LAR®: 10 mg, 20 mg, 30 mg [contains polylactide-co-glycolide] Capsule, delayed release, enteric coated microspheres [new formulation; por- Injection, solution, as acetate [preservative free]: Creon®: Lipase 12000 units, protease 38,000 units, and amylase 60,000 units Ofloxacin (Ophthalmic)
Capsule, delayed release, enteric coated microtablets [porcine derived]: Pancreaze™: Lipase 16,800 units, protease 40,000 units, and amylase 70,000 Outpatient Formulary Brands Available Ocuflox®
Outpatient Dosage Forms
Pantoprazole
Ocuflox®: 0.3% (5 mL) [contains benzalkonium chloride] Outpatient Dosage Forms
Ofloxacin (Otic)
Outpatient Formulary Brands Available Floxin® [DSC]
Paricalcitol
Outpatient Dosage Forms
Outpatient Formulary Brands Available Zemplar®
Outpatient Dosage Forms
Floxin®: 0.3% (5 mL [DSC]) [contains benzalkonium chloride] Olopatadine (Ophthalmic)
Zemplar®: 1 mcg [contains coconut oil (may have trace amounts), ethanol, palm kernel oil (may have trace amounts)] Outpatient Formulary Brands Available Pataday™; Patanol®
Outpatient Dosage Forms
PARoxetine
Outpatient Formulary Brands Available Paxil®
Pataday™: 0.2% (2.5 mL) [contains benzalkonium chloride, edetate disodium] Outpatient Dosage Forms
Patanol®: 0.1% (5 mL) [contains benzalkonium chloride] [BCF]
Tablet, oral, as hydrochloride [strength expressed as base]: 20 mg, 30 mg Omega-3-Acid Ethyl Esters
Outpatient Formulary Brands Available Lovaza®
Penicillin V Potassium
Outpatient Dosage Forms
Outpatient Dosage Forms
Powder for solution, oral: 125 mg/5 mL (100 mL, 200 mL) [BCF]; 250 mg/5 mL
Lovaza®: 1 g [contains DHA ~375 mg/capsule, EPA ~465 mg/capsule, soy- (100 mL, 200 mL) [BCF]
Tablet, oral: 250 mg [BCF], 500 mg [BCF]
Omeprazole
Pentoxifylline
Outpatient Dosage Forms
Outpatient Dosage Forms
Capsule, delayed release, oral: 10 mg [BCF], 20 mg [BCF]
Ondansetron
Permethrin
Outpatient Formulary Brands Available Zofran®; Zofran® ODT
Outpatient Formulary Brands Available Elimite®; Nix® Creme Rinse [OTC]
PERMETHRIN
Outpatient Dosage Forms
Outpatient Dosage Forms
Cream, topical: 5% (60 g) [BCF]
Elimite®: 5% (60 g) [contains coconut oil] MiraLAX®: PEG 3350 255 g (14 oz [DSC]); PEG 3350 17 g/packet Liquid, topical [creme rinse formulation]: Nix® Creme Rinse: 1% (60 mL) [contains isopropyl alcohol 20%] Potassium Chloride
Phenazopyridine
Outpatient Formulary Brands Available Klor-Con® 8
Outpatient Formulary Brands Available Pyridium®
Outpatient Dosage Forms
Outpatient Dosage Forms
Capsule, extended release, microencapsulated, oral: 10 mEq [BCF]
Tablet, oral, as hydrochloride: 100 mg [BCF], 200 mg [BCF]
Powder for solution, oral: 20 mEq/packet [BCF]
Solution, oral: 20 mEq/15 mL (15 mL, 30 mL, 480 mL) [BCF]
PHENobarbital
Tablet, extended release, microencapsulated, oral: 10 mEq [BCF], 20
Outpatient Dosage Forms
mEq [BCF]
Elixir, oral: 20 mg/5 mL (5 mL, 7.5 mL, 15 mL) [BCF]
Tablet, extended release, wax matrix, oral: Tablet, oral: 60 mg [BCF], 100 mg [BCF]
Tablet, oral [new reformulated strengths]: 16.2 mg, 32.4 mg Potassium Citrate
Phenylephrine (Nasal)
Outpatient Formulary Brands Available Urocit®-K
Outpatient Formulary Brands Available Neo-Synephrine® Mild Formula
Outpatient Dosage Forms
Outpatient Dosage Forms
Solution, intranasal, as hydrochloride [spray]: Neo-Synephrine® Mild Formula: 0.25% (15 mL) [contains benzalkonium Pramipexole
Phenylephrine (Ophthalmic)
Outpatient Formulary Brands Available Mirapex®
Outpatient Formulary Brands Available AK-Dilate™; Neo-Synephrine®
Outpatient Dosage Forms
Tablet, oral, as dihydrochloride monohydrate: 0.25 mg, 0.5 mg, 1.5 mg Outpatient Dosage Forms
Mirapex®: 0.25 mg, 0.5 mg, 1.5 mg [scored] Solution, ophthalmic, as hydrochloride [drops]: Prasugrel
AK-Dilate™: 10% (5 mL) [contains benzalkonium chloride] Outpatient Formulary Brands Available Effient®
Neo-Synephrine®: 2.5% (15 mL [DSC]) [contains benzalkonium chloride] Outpatient Dosage Forms
Phenytoin
Outpatient Formulary Brands Available Dilantin-125®; Dilantin®
Outpatient Dosage Forms
Pravastatin
Capsule, extended release, oral, as sodium: 100 mg [BCF]
Outpatient Formulary Brands Available Pravachol®
Suspension, oral: 125 mg/5 mL (4 mL, 120 mL, 237 mL, 240 mL) [BCF]
Outpatient Dosage Forms
Dilantin-125®: 125 mg/5 mL (240 mL) [contains ethanol ≤0.6%, sodium Tablet, oral, as sodium: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]
Prazosin
Dilantin®: 50 mg [scored] [BCF]
Outpatient Formulary Brands Available Minipress®
Phytonadione
Outpatient Dosage Forms
Outpatient Formulary Brands Available Mephyton®
Capsule, oral, as hydrochloride: 1 mg, 2 mg, 5 mg Outpatient Dosage Forms
PrednisoLONE (Ophthalmic)
Outpatient Formulary Brands Available Pred Forte®; Pred Mild®
Pilocarpine (Ophthalmic)
Outpatient Dosage Forms
Outpatient Formulary Brands Available Pilopine HS®
Suspension, ophthalmic, as acetate [drops]: 1% (5 mL, 10 mL, 15 mL) [BCF]
Outpatient Dosage Forms
Pred Mild®: 0.12% (5 mL, 10 mL) [contains benzalkonium chloride, sodium Pilopine HS®: 4% (4 g) [contains benzalkonium chloride] [BCF]
bisulfite] [BCF]
Solution, ophthalmic, as hydrochloride [drops]: 1% (2 mL, 15 mL) [BCF]; 2% (2
PrednisoLONE (Systemic)
mL, 15 mL) [BCF]; 4% (2 mL, 15 mL) [BCF] [may contain benzalkonium
chloride]
Outpatient Formulary Brands Available Orapred®
Outpatient Dosage Forms
Pilocarpine (Systemic)
Solution, oral, as sodium phosphate [strength expressed as base]: 15 mg/5 mL Outpatient Formulary Brands Available Salagen®
(237 mL, 473 mL) [BCF]
Outpatient Dosage Forms
Orapred®: 15 mg/5 mL (237 mL) [dye free; contains ethanol 2%, sodium PredniSONE
Pimecrolimus
Outpatient Dosage Forms
Outpatient Formulary Brands Available Elidel®
Tablet, oral: 1 mg [BCF], 2.5 mg, 5 mg [BCF], 10 mg [BCF], 20 mg [BCF],
Outpatient Dosage Forms
Elidel®: 1% (30 g, 60 g, 100 g) [BCF]
Primaquine
Outpatient Dosage Forms
Pioglitazone
Tablet, oral, as phosphate: 26.3 mg [15 mg base] Outpatient Formulary Brands Available Actos®
Outpatient Dosage Forms
Primidone
Outpatient Formulary Brands Available Mysoline®
Outpatient Dosage Forms
Piroxicam
Outpatient Dosage Forms
Probenecid
Outpatient Dosage Forms
Podofilox
Outpatient Formulary Brands Available Condylox®
Outpatient Dosage Forms
Prochlorperazine
Outpatient Dosage Forms
Condylox®: 0.5% (3.5 mL) [contains ethanol 95%] Tablet, oral, as maleate [strength expressed as base]: 5 mg, 10 mg Polyethylene Glycol 3350
Progesterone
Outpatient Formulary Brands Available MiraLAX® [OTC]
Outpatient Formulary Brands Available Prometrium®
SEVELAMER
Outpatient Dosage Forms
Outpatient Dosage Forms
Capsule, oral: 300 mg [BCF]
Prometrium®: 100 mg [contains peanut oil] Promethazine
Rifapentine
Outpatient Dosage Forms
Outpatient Dosage Forms
Suppository, rectal, as hydrochloride: 12.5 mg (12s) [BCF]; 25 mg (12s) [BCF]
Syrup, oral, as hydrochloride: 6.25 mg/5 mL (118 mL, 473 mL) [BCF]
Tablet, oral, as hydrochloride: 25 mg [BCF]
RisperiDONE
Propranolol
Outpatient Formulary Brands Available RisperDAL®
Outpatient Formulary Brands Available Inderal® LA
Outpatient Dosage Forms
Outpatient Dosage Forms
Solution, oral: 1 mg/mL (30 mL) [BCF]
Capsule, sustained release, oral, as hydrochloride: RisperDAL®: 1 mg/mL (30 mL) [contains benzoic acid] Tablet, oral: 0.25 mg [BCF], 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF], 3 mg
Tablet, oral, as hydrochloride: 10 mg, 40 mg, 80 mg [BCF], 4 mg [BCF]
RisperDAL®: 0.25 mg, 0.5 mg
Propylthiouracil
Outpatient Dosage Forms
Tablet, oral: 50 mg [BCF]
Ritonavir
Pseudoephedrine
Outpatient Formulary Brands Available Norvir®
Outpatient Dosage Forms
Outpatient Dosage Forms
Liquid, oral, as hydrochloride: 15 mg/5 mL (118 mL)

Source: https://online.lexi.com/lco/splashes/files/pdf/Keesler-AFB.pdf