List of Covered Drugs (Formulary)

Transcrição

H9576_PHMDRUGLISTFinalPr CMS Aprovado 6/17/16
Neighborhood INTEGRITY (Plano Medicare-Medicaid)
Formulário 2016
Lista de medicamentos abrangidos
POR FAVOR, LEIA ESTE DOCUMENTO CONTÉM INFORMAÇÃO
SOBRE MEDICAMENTOS ABRANGIDOS NESTE PLANO
Identificação do ficheiro do formulário de submissão aprovado pelo HPMS: H9576, versão 1
Não foram efetuadas alterações neste formulário desde 01/01/2016.
Se tiver dúvidas, por favor contacte a Neighborhood INTEGRITY através do 1-844-812-6896, das
8h00 às 20h00, de Segunda a Sexta; das 8h00 às 12h00 ao Sábado. Aos Sábados à tarde, Domingos
e feriados nacionais, poderá ter de deixar uma mensagem. A sua chamada será devolvida dentro de
um dia útil. A chamada é gratuita. TTY/TDD: 711. Para mais informações, visite
www.nhpri.org/INTEGRITY.
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Neighborhood INTEGRITY | Lista de medicamentos abrangidos 2016
(Formulário)
Esta é uma lista de medicamentos que os Membros recebem na Neighborhood INTEGRITY.
 Neighborhood INTEGRITY (Plano Medicare-Medicaid) é um plano de saúde desenvolvido em
parceria com a Medicare e a Rhode Island Medicaid para proporcionar benefícios de ambos os
programas aos inscritos.
 Os benefícios, a Lista de medicamentos abrangidos, e/ou a rede de farmácias ou fornecedores
podem sofrer alterações durante o ano. Ser-lhe-á comunicada qualquer alteração que o afete.
 A qualquer momento, poderá consultar a Lista atualizada de medicamentos abrangidos da
Neighborhood INTEGRITY online emwww.nhpri.org/INTEGRITY.
 Poderão aplicar-se limitações e restrições. Para mais informações, contacte os Serviços para
membros da Neighborhood INTEGRITY ou leia o Manual para membros da Neighborhood
INTEGRITY.
 Poderá solicitar esta informação noutros formatos, tais como, em letras grandes, braille ou áudio.
Contacte os Serviços para membros através do 1-844-812-6896 das 8h00 às 20h00, de Segunda a
Sexta; das 8h00 às 12h00 aos Sábados. Os utilizadores de TTY devem ligar para o 711. A
chamada é gratuita.
 Esta informação encontra-se disponível gratuitamente noutros idiomas. Por favor, contacte os
nossos Serviços para membros através do 1-844-812-6896 (TTY 711), das 8h00 às 20h00, de
Segunda a Sexta; das 8h00 às 12h00 aos Sábados. Aos Sábados à tarde, Domingos e feriados
nacionais, poderá ter de deixar uma mensagem. A sua chamada será devolvida dentro de um dia
útil. A chamada é gratuita.
 Esta información está disponible de forma gratuita en otros idiomas. Por favor llame a nuestro
Departamento de Servicios para Miembros al 1-844-812-6896 (TTY 711) de 8 am a 8 pm, lunesviernes; sábados de 8 am a 12 pm. Los sábados por la tarde, domingos y días festivos federales,
se le pedirá que deje un mensaje. Su llamada será devuelta dentro del siguiente día laborable. La
llamada es gratuita.
 Estas informações estão disponíveis gratuitamente noutros idiomas. Por favor, ligue para os
Serviços para membros através do 1-844-812-6896 (TTY 711), das 8h00 às 20h00, de Segunda a
Sexta; e das 8h00 às 12h00 aos Sábados. Aos Sábados à tarde, Domingos e feriados nacionais,
poderá ter de deixar uma mensagem. A sua chamada será respondida no próximo dia útil. Esta
chamada é gratuita.
 ព័ត៌មានននេះមានផ្ដ ល់ជូនឥតគិតថ្លៃ ជាភាសានផ្េងន ៀត។ សូ ម ូ រស័ពទមកកាន់ផ្ផ្ែ កនសវាកមម
សមាជិកតាមរយៈនលខ 1-844-812-6896 (TTY 711) ចាប់ពីនមា៉ោង 8 ព្ពឹកដល់ 8 យប់ ពីថ្លៃចនទ –
សុព្ក និងចាប់ពីនមា៉ោង 8 ព្ពឹកដល់ 12 ថ្លៃព្តង់នៅថ្លៃនៅរ៍។ នរៀងរាល់រនសៀលថ្លៃនៅរ៍ ថ្លៃអា ិតយ
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និងថ្លៃឈប់សព្មាករបស់សហព័នធ នោកអ្ែ កនឹងព្តូវបាននសែ ើសឲ្
ុុំ យនផ្ញើសារ ុក។
នគនឹងនៅព្តលប់នៅនោកអ្ែ កកនុងរវាងថ្លៃន្វ កា
ើ របន្ទទប់ ។ ការនៅ ូ រស័ពទគឺឥតគិតថ្លៃ។
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Perguntas frequentes (FAQ)
Encontre aqui as respostas para as suas questões sobre a Lista de medicamentos abrangidos. Poderá
ler todas as FAQ para saber mais, ou procurar uma pergunta e resposta.
1.
Que medicamentos sujeitos a receita médica se encontram na Lista de
medicamentos abrangidos?
(Chamamos à Lista de medicamentos abrangidos “Lista de
medicamentos” para abreviar)
Os medicamentos na Lista de medicamentos abrangidos que inicia na página 12, são medicamentos
abrangidos pela Neighborhood INTEGRITY. Estes medicamentos estão disponíveis em farmácias
dentro da nossa rede. Uma farmácia encontra-se na nossa rede ser tivermos um acordo com esta para
trabalhar connosco e prestar os seus serviços. Referimos-nos as estas farmácias como “farmácias da
rede”.
 A Neighborhood INTEGRITY irá abranger todos os medicamentos clinicamente necessários na
Lista de medicamentos, se:
 o seu médico ou outro médico prescritor afirmar que necessita desses medicamentos para
melhorar ou manter-se saudável, e
 apresentar a receita numa farmácia da rede Neighborhood INTEGRITY.
 A Neighborhood INTEGRITY poderá ter passos adicionais para aceder a determinados
medicamentos (consulte a pergunta #5 abaixo).
Poderá também consultar uma lista atualizada dos medicamentos que abrangemos no nosso website
www.nhpri.org/INTEGRITY ou ligue para os Serviços para membros através do 1-844-812-6896 (TTY
711).
2.
A Lista de medicamentos sofre alterações?
Sim. A Neighborhood INTEGRITY pode acrescentar ou remover medicamentos da Lista de
medicamentos ao longo do ano. Geralmente, a Lista de medicamentos apenas será alterada, se:

surgir um medicamento mais económico que produza os mesmos resultados do que o
atualmente existente na Lista de medicamentos, ou

tomarmos conhecimento de que o medicamento não é seguro.
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Podemos também alterar as nossas regras sobre os medicamentos. Por exemplo, podemos:
 Decidir pedir ou não pedir aprovação prévia para um medicamento. (A aprovação prévia consiste
na autorização por parte da Neighborhood INTEGRITY antes de obter um medicamento.)
 Acrescentar ou alterar a quantidade permitida para obter um medicamento (designado “limites de
quantidade”).
 Acrescentar ou alterar as restrições da terapia escalonada num medicamento. (A terapia
escalonada significa que tem de testar um medicamento antes de cobrirmos outro
medicamento.)
(Para mais informações sobre estas regras de medicamentos, consulte a página 5.)
Informá-lo-emos quando um medicamento que esteja a tomar seja removido da Lista de
medicamentos. Informá-lo-emos também quando alterarmos as nossas regras para a cobertura de um
medicamento. As perguntas 3, 4 e 7 abaixo possuem mais informação sobre o que acontece quando a
Lista de medicamentos é alterada.
 A qualquer momento, pode consultar a Lista atualizada de medicamentos Neighborhood
INTEGRITY online em www.nhpri.org/INTEGRITY. Pode também contactar os Serviços para
membros para verificar a Lista atual de medicamentos em 1-844-812-6896 (TTY 711).
3.
O que acontece se surgir um medicamento mais económico que
produza os mesmos resultados do que o atualmente existente na Lista
de medicamentos?
Informá-lo-emos caso se encontre a tomar um medicamento que venha a ser removido por surgir um
medicamento mais económico, que produz os mesmos resultados. Informá-lo-emos, no mínimo, com
60 dias de antecedência antes de o medicamento ser removido da Lista de medicamentos ou quando
precisar de reabastecer. Poderá receber 60 dias de abastecimento do medicamento antes de ser
efetuada a alteração na Lista de medicamentos. O plano enviar-lhe-á uma carta a informá-lo desta
alteração.
4.
O que acontece quando descobrimos que um medicamento não é
seguro?
Se a FDA (Administração de Alimentos e Medicamentos dos EUA) comunicar que um medicamento
que está a tomar não é seguro, este será imediatamente removido da Lista de medicamentos. Ser-lhe-
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á também enviada uma carta a informá-lo. A carta indicar-lhe-á como proceder com o seu fornecedor e
farmacêutico.
5.
Existem algumas restrições ou limites sobre a cobertura dos
medicamentos? Ou são necessárias algumas ações para obter
determinados medicamentos?
Sim, alguns medicamentos possuem regras de cobertura ou têm limites na quantidade que pode obter.
Em alguns casos, o utente, o seu médico ou outro médico prescritor têm de realizar algo antes de
obter o medicamento. Por exemplo:
 Aprovação prévia (ou autorização prévia): Para alguns medicamentos, o utente, o seu médico
ou outro médico prescritor têm de receber aprovação da Neighborhood INTEGRITY antes de
apresentar a sua receita. Caso não obtenha aprovação, a Neighborhood INTEGRITY poderá não
cobrir o medicamento.
 Limites de quantidade: Por vezes, a Neighborhood INTEGRITY limita a quantidade de um
medicamento que pode obter.
 Terapia escalonada: Por vezes, a Neighborhood INTEGRITY exige-lhe terapia escalonada. Isto
significa que tem de testar medicamentos por uma determinada ordem para a sua condição
médica. Poderá ter de testar um medicamento antes de cobrirmos outro medicamento. Se o seu
fornecedor achar que o primeiro medicamento não produz resultados consigo, então cobriremos o
segundo.
Observe as tabelas da página 12 para saber se o seu medicamento dispõe de algum requisito ou limite
adicional. Pode também obter mais informação ao visitar o nosso website em
www.nhpri.org/INTEGRITY. Publicamos online um documento que explica a nossa autorização prévia
e as restrições da terapia escalonada. Pode também pedir que lhe seja enviada uma cópia.
Pode pedir uma “exceção” destes limites. Por favor, consulte a pergunta 11 para mais informação
sobre exceções.
 Caso se encontre numa casa de repouso ou noutras instalações de cuidados de longa duração e
necessite de um medicamento que não se encontra na Lista de medicamentos, ou caso não
consiga obter facilmente o medicamento de que necessita, nós podemos ajudar. Nós garantimos
um fornecimento de emergência por 31 dias do medicamento de que necessita (exceto se tiver
uma receita para menos dias), mesmo não sendo um novo Membro da Neighborhood INTEGRITY.
Isto permitir-lhe-á ter tempo para contactar o seu médico ou outro médico prescritor. O seu médico
poderá ajudá-lo a decidir se existe um medicamento similar na Lista de medicamentos que pode
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tomar ou se deve pedir uma exceção. Por favor, consulte a questão 11 para mais informações
sobre exceções.
6.
Como poderá saber se o medicamento que pretende possui limitações
ou se são necessárias ações para obter o medicamento?
A Lista de medicamentos abrangidos na página 12 possui uma coluna designada “Ações necessárias,
restrições ou limites de utilização.”
7.
O que acontece se mudarmos as nossas regras sobre como cobrir
alguns medicamentos? Por exemplo, se acrescentarmos autorização
(aprovação) prévia, limites de quantidade e/ou restrições de terapia
escalonada a um medicamento.
Avisá-lo-emos, se acrescentarmos autorização (aprovação) prévia, limites de quantidade e/ou
restrições de terapia escalonada a um medicamento.
Informá-lo-emos, no mínimo, com 60 dias de antecedência antes de uma restrição ser acrescentada
ou quando precisar de reabastecer. Poderá receber 60 dias de abastecimento do medicamento antes
de ser efetuada a alteração na Lista de medicamentos. Isto permitir-lhe-á ter tempo para contactar o
seu fornecedor ou outro médico prescritor para saber o que fazer de seguida.
8.
Como pode encontrar um medicamento na Lista de medicamentos?
Existem duas formas de encontrar um medicamento:
 Pode procurar por ordem alfabética (se souber escrever o nome do medicamento), ou
 Pode procurar por condição médica.
Para procurar por ordem alfabética, vá à secção de Listagem alfabética. Poderá encontrá-la no Índice
- secção de Listagem alfabética que começa na página 146.
Para procurar por condição médica, encontre a secção designada “Lista de medicamentos por
condição médica”, na página 11. Os medicamentos nesta acção estão agrupados por categorias
dependendo do tipo de condições médicas que habitualmente tratam. Por exemplo, se tiver um
problema cardíaco, deve procurar na categoria “Agentes cardiovasculares”. Aí encontrará
medicamentos que tratam os problemas cardíacos.
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9.
E se o medicamento que procura não se encontrar na Lista de
medicamentos?
Se não encontrar o medicamento na Lista de medicamentos, contacte o Serviço para membros
através do 1-844-812-6896 (TTY 711) e coloque a sua questão. Se tomar conhecimento de que a
Neighborhood INTEGRITY não irá cobrir o medicamento, pode proceder da seguinte forma:
 Pedir aos Serviços para membros uma lista dos medicamentos como o que pretende tomar. De
seguida, mostrar a lista ao seu médico ou outro médico prescritor. O médico pode prescrever um
medicamento da Lista de medicamentos igual ao que pretende tomar. Ou
 Pode pedir ao plano de saúde que abra uma exceção para cobrir o seu medicamento. Por favor,
consulte a questão 11 para mais informações sobre exceções.
10. E se for um novo Membro da Neighborhood INTEGRITY e não
conseguir encontrar o seu medicamento na Lista de medicamentos ou
tiver um problema em obter o seu medicamento?
Nós podemos ajudar. Podemos garantir o fornecimento temporário por 30 dias do seu medicamento
Part D ou o fornecimento por 90 dias do seu medicamento abrangido pela Medicaid durante os
primeiros 90 dias em que é Membro da Neighborhood INTEGRITY. Isto permitir-lhe-á ter tempo para
contactar o seu médico ou outro médico prescritor. O seu médico poderá ajudá-lo a decidir se existe
um medicamento similar na Lista de medicamentos que pode tomar ou se deve pedir uma exceção.
Garantiremos um fornecimento por 30 dias do seu medicamento Part D ou um fornecimento por 90
dias do seu medicamento abrangido pela Medicaid, se:
 estiver a tomar um medicamento que não conste na Lista de medicamentos, ou
 as regras do plano de saúde não lhe permitem obter a quantidade pedida pelo seu médico, ou
 o medicamento requer aprovação prévia da Neighborhood INTEGRITY, ou
 está a tomar um medicamento que faz parte de uma restrição da terapia escalonada.
Se está a viver numa casa de repouso ou noutras instalações de cuidados de longa duração, pode
apresentar a sua receita por até 91 dias. Pode reabastecer o medicamento diversas vezes durante os
seus primeiros 90 dias no plano. Isto proporciona tempo ao médico prescritor para alterar os seus
medicamentos para medicamentos que constem na Lista de medicamentos ou pedir uma exceção.
Se é um membro atual e está a mudar o nível de cuidado de um tipo de tratamento para outro, poderá
ter direito ao reabastecimento de um medicamento que não conste na Lista de medicamentos para
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proporcionar tempo ao seu médico ou outro médico prescritor para localizar um medicamento na lista
ou pedir uma exceção.
Alguns exemplos de transições de níveis de cuidado são:

entrar numa instalação de cuidados de longa duração (LTC) de um hospital ou outro tipo

deixar uma instalação de LTC e voltar à comunidade

ter alta de um hospital para uma residência, ou

ter alta de um hospital psiquiátrico com regimes de medicação
11. Pode pedir uma exceção para cobrir o seu medicamento?
Sim. Pode pedir à Neighborhood INTEGRITY para abrir uma exceção para cobrir um medicamento
que não conste na Lista de medicamentos.
Pode também pedir-nos para mudar as regras sobre o seu medicamento.
 Por exemplo, a Neighborhood INTEGRITY pode limitar a quantidade de um medicamento que
cobrimos. Se o seu medicamento possui um limite, pode pedir-nos para alterar o limite e cobrir
mais.
 Outros exemplos: Pode pedir-nos para abandonar as restrições da terapia escalonada ou
requisitos de aprovação prévia.
12. Quanto tempo demora a obter uma exceção?
Primeiro temos de receber uma declaração do seu médico prescritor que corrobore o seu pedido por
uma exceção. Após recebermos a declaração, apresentar-lhe-emos uma decisão sobre o seu pedido
de exceção dentro de 72 horas.
Se você e o seu médico prescritor considerarem que a sua saúde poderá ser prejudicada se tiver de
aguardar 72 horas por uma decisão, poderá pedir uma exceção célere. Trata-se de uma decisão mais
rápida. Se o seu médico prescritor corroborar o seu pedido, podemos apresentar-lhe uma decisão
dentro de 24 horas, após receber a declaração de corroboração do médico prescritor.
13. Como pode pedir uma exceção?
Para pedir uma exceção, contacte os Serviços para membros ou o seu Gestor de cuidados. O
representante do seu Gestor de cuidados ou Serviços para membros trabalhará consigo e o seu
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fornecedor para o ajudar a pedir uma exceção.
14. O que são medicamentos genéricos?
Os medicamentos genéricos são feitos a partir dos mesmos agentes ativos que os medicamentos com
nomes de marcas. Geralmente, são mais económicos do que os medicamentos com nomes de marcas
e e não têm nomes conhecidos. Os medicamentos genéricos são aprovados pela FDA (Administração
de Alimentos e Medicamentos dos EUA).
A Neighborhood INTEGRITY cobre medicamentos com nomes de marcas e medicamentos genéricos.
15. O que são medicamentos MVL?
MVL significa “medicamentos de venda livre”. A Neighborhood INTEGRITY cobre alguns
medicamentos de venda livre quando são escritos em receitas pelo seu médico prescritor.
Pode ler a Lista de medicamentos da Neighborhood INTEGRITY para consultar os medicamentos de
venda livre que estão abrangidos.
16. A Neighborhood INTEGRITY cobre produtos de venda livre que não
sejam medicamentos?
A Neighborhood INTEGRITY cobre alguns produtos de venda livre que não são medicamentos se
forem escritos na receita pelo seu médico prescritor.
Pode ser a Lista de medicamentos da Neighborhood INTEGRITY para consultar os produtos de venda
livre que não são medicamentos que estão abrangidos.
17. Qual é o seu copagamento?
Enquanto membro da Neighborhood INTEGRITY, não possui copagamentos para receitas e
medicamentos de venda livre desde que siga as regras da Neighborhood INTEGRITY.
18. O que é a categorização de medicamentos?
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As categorizações são grupos de medicamentos na nossa Lista de medicamentos. Nenhuma
categorização tem copagamentos.
 Os medicamentos de categorização 1 são medicamentos genéricos.
 Os medicamentos de categorização 2 são medicamentos de nome de marca.
 Os medicamentos de categorização 3 abrangidos pela sua cobertura Medicaid
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Lista de medicamentos abrangidos
A lista de medicamentos abrangidos abaixo disponibiliza informação sobre os medicamentos
abrangidos pela Neighborhood INTEGRITY. Se tiver dificuldades em encontrar o seu medicamento na
lista, consulte o Índice que começa na página 146.
A primeira coluna do gráfico lista o nome do medicamento. Os medicamentos com nome de marca
(ex.: EXEMPLO DO NOME DA MARCA) e os medicamentos genéricos são apresentados em letras
minúsculas em itálico (ex.: exemplo de genérico).
A informação na coluna das ações necessárias, restrições ou limites de utilização indica se a
Neighborhood INTEGRITY possui alguma regra para abranger o seu medicamento.
Nota: O DP a seguir a um medicamento dignifica que o medicamento não é um “Medicamento Part D”.
Estes medicamentos possuem diferentes regras para recursos. Um recurso (appeal) é uma maneira
formal de nos pedir uma revisão de uma decisão de cobertura e de a alterar caso considere que
cometemos um erro. Por exemplo, podemos decidir que um medicamento que pretende não está
abrangido ou deixou de ser abrangido pela Medicare ou Medicaid. Se você ou o seu fornecedor não
concordar com a nossa decisão, poderá apresentar um recurso. Para pedir instruções sobre como
apresentar um recurso, contacte os Serviços para membros através do 1-844-812-6896 (TTY 711).
Pode também ler o Manual do membro para saber como recorrer de uma decisão.
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Lista de medicamentos por condição médica
Os medicamentos nesta acção estão agrupados por categorias dependendo do tipo de condições
médicas que habitualmente tratam. Por exemplo, se tiver um problema cardíaco, deve procurar na
categoria “Agentes cardiovasculares”. Aí encontrará medicamentos que tratam os problemas
cardíacos.
Imunossupressores
Quanto lhe irá custar o
medicamento (nível de
Ações necessárias, restrições
Nome de medicamentos
classificação)
ou limites de utilização.
AZASAN
$0–$3 (Classificação 3)
PA
Aqui ficam os significados dos códigos usados na coluna “Ações necessárias, restrições ou limites de
utilização”:
B/D: Este medicamento sujeito a receita médica possui um requisito de autorização administrativa
prévia da Part B versus D Este medicamento pode ser abrangido pela Part B ou D da Medicare
dependendo das circunstâncias. Poderá ser necessário submeter informação que descreva a
utilização e a tipologia do medicamento para proceder à determinação.
QL: Limites de quantidade. Para determinados medicamentos, a Neighborhood INTEGRITY limita a
quantidade de medicamentos que a Neighborhood INTEGRITY irá abranger. Por exemplo, a
Neighborhood INTEGRITY proporciona doze tabelas por prescrição para Succinato de Sumatriptana.
Isto poderá ter um fornecimento padrão mensal ou trimestral.
ST: Terapia escalonada. Nestes casos, a Neighborhood INTEGRITY requer que experimento primeiro
determinados medicamentos para tratar a sua condição médica antes de abranger outro medicamento
para essa condição. Por exemplo, se o Medicamento A e o Medicamento B ambos tratarem a sua
condição, a Neighborhood INTEGRITY pode não abranger o Medicamento B, exceto se testar o
Medicamento A primeiro. Se o Medicamento A não resultar consigo, a Neighborhood INTEGRITY irá
então abranger o Medicamento B.
PA: Autorização prévia. A Neighborhood INTEGRITY requer que você ou o seu médico obtenham uma
autorização prévia para determinados medicamentos. Isto significa que irá necessitar da aprovação da
Neighborhood INTEGRITY antes de apresentar as suas receitas. Caso não obtenha aprovação, a
Neighborhood INTEGRITY poderá não cobrir o medicamento.
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ATUAL A PARTIR DE 01/01/2016
Nome do medicamento
Classificação do
medicamento
Ações necessárias, restrições ou
limites de utilização.
Analgesics
Analgesics
ACEPHEN RECTAL SUPPOSITORY 325 MG
3
DP; QL (370 EA per 30 days)
ACEPHEN RECTAL SUPPOSITORY 650 MG
3
acetaminophen (bulk) powder 100 %
3
PA; DP
acetaminophen-codeine oral solution 300 mg-30
mg /12.5 ml
1
acetaminophen-codeine oral tablet 300-15 mg,
300-30 mg, 300-60 mg
1
ARTHRITIS PAIN RELIEF(CAPSAIC)
TOPICAL CREAM 0.1 %
3
DP
ascomp with codeine oral capsule 30-50-325-40
mg
1
PA
aspirin oral tablet 325 mg
3
DP
aspirin oral tablet,delayed release (dr/ec) 500 mg
3
DP
aspirin rectal suppository 600 mg
3
DP
BUFFERIN ORAL TABLET 325 MG
3
DP
butalbital-acetaminop-caf-cod oral capsule 50325-40-30 mg
1
PA
capsaicin powder
3
PA; DP
capsaicin topical cream 0.025 %
3
DP
carisoprodol-asa-codeine oral tablet 200-325-16
mg
1
PA
carisoprodol-aspirin oral tablet 200-325 mg
1
PA
CHILDREN'S FEVER REDUCING RECTAL
SUPPOSITORY 120 MG
3
CHILDREN'S PAIN RELIEF ORAL
SUSPENSION 160 MG/5 ML
3
DP; QL (3750 ML per 30 days)
14
Nome do medicamento
Classificação do
medicamento
endocet oral tablet 10-325 mg, 5-325 mg, 7.5-325
mg
1
endodan oral tablet 4.8355-325 mg
1
hydrocodone-acetaminophen oral tablet 10-325
mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg
1
hydrocodone-ibuprofen oral tablet 7.5-200 mg
1
INFANT'S NON-ASPIRIN ORAL DROPS 100
MG/ML
3
INFANTS' TRIAMINIC FEVER ORAL LIQUID
160 MG/5 ML
3
lorcet plus oral tablet 7.5-325 mg
1
MAPAP (ACETAMINOPHEN) ORAL
CAPSULE 500 MG
3
MAPAP (ACETAMINOPHEN) ORAL ELIXIR
160 MG/5 ML
3
NON-ASPIRIN ORAL TABLET,CHEWABLE 80
MG
3
oxycodone-acetaminophen oral tablet 10-325 mg,
2.5-325 mg, 5-325 mg, 7.5-325 mg
1
oxycodone-aspirin oral tablet 4.8355-325 mg
1
PAIN RELIEF ORAL TABLET 500 MG
3
PAIN RELIEVER ORAL TABLET 325 MG
3
pentazocine-naloxone oral tablet 50-0.5 mg
1
PA
Q-PAP ORAL DROPS 80 MG/0.8 ML
3
tramadol-acetaminophen oral tablet 37.5-325 mg
1
TYLENOL ARTHRITIS PAIN ORAL TABLET
EXTENDED RELEASE 650 MG
3
Nonsteroidal Anti-Inflammatory Drugs
celecoxib oral capsule 100 mg, 200 mg, 400 mg,
50 mg
1
CHILDREN'S ADVIL ORAL SUSPENSION 100
MG/5 ML
3
DP
15
Nome do medicamento
Classificação do
medicamento
diclofenac potassium oral tablet 50 mg
1
diclofenac sodium oral tablet extended release 24
hr 100 mg
1
diclofenac sodium oral tablet,delayed release
(dr/ec) 25 mg, 50 mg, 75 mg
1
diclofenac sodium topical gel 3 %
1
diflunisal oral tablet 500 mg
1
etodolac oral capsule 200 mg, 300 mg
1
etodolac oral tablet 400 mg, 500 mg
1
etodolac oral tablet extended release 24 hr 400
mg, 500 mg, 600 mg
1
fenoprofen oral tablet 600 mg
1
flurbiprofen oral tablet 100 mg, 50 mg
1
IBUPROFEN JR STRENGTH ORAL
TABLET,CHEWABLE 100 MG
3
ibuprofen oral suspension 100 mg/5 ml
1
ibuprofen oral tablet 400 mg, 600 mg, 800 mg
1
ibuprofen-oxycodone oral tablet 400-5 mg
1
indomethacin oral capsule 25 mg, 50 mg
1
PA
indomethacin oral capsule, extended release 75
mg
1
PA
INFANT'S IBUPROFEN ORAL
DROPS,SUSPENSION 50 MG/1.25 ML
3
DP
ketoprofen oral capsule 50 mg, 75 mg
1
ketoprofen oral capsule,ext rel. pellets 24 hr 200
mg
1
ketorolac injection solution 15 mg/ml, 30 mg/ml (1
ml)
1
PA
ketorolac oral tablet 10 mg
1
PA
meclofenamate oral capsule 100 mg, 50 mg
1
meloxicam oral suspension 7.5 mg/5 ml
1
meloxicam oral tablet 15 mg, 7.5 mg
1
DP
16
Nome do medicamento
Classificação do
medicamento
MOTRIN JUNIOR STRENGTH ORAL TABLET
100 MG
3
DP
nabumetone oral tablet 500 mg, 750 mg
1
naproxen oral suspension 125 mg/5 ml
1
naproxen oral tablet 250 mg, 375 mg, 500 mg
1
naproxen oral tablet,delayed release (dr/ec) 375
mg, 500 mg
1
naproxen sodium oral tablet 275 mg, 550 mg
1
oxaprozin oral tablet 600 mg
1
piroxicam oral capsule 10 mg, 20 mg
1
sulindac oral tablet 150 mg, 200 mg
1
tolmetin oral capsule 400 mg
1
tolmetin oral tablet 600 mg
1
VOLTAREN TOPICAL GEL 1 %
2
ZORVOLEX ORAL CAPSULE 18 MG, 35 MG
2
ST
duramorph (pf) injection solution 0.5 mg/ml, 1
mg/ml
1
B/D
fentanyl citrate buccal lozenge on a handle 1,200
mcg, 1,600 mcg, 200 mcg, 400 mcg, 600 mcg, 800
mcg
1
PA; QL (120 EA per 30 days)
fentanyl transdermal patch 72 hour 100 mcg/hr,
12 mcg/hr, 25 mcg/hr, 37.5 mcg/hour, 50 mcg/hr,
62.5 mcg/hour, 75 mcg/hr, 87.5 mcg/hour
1
QL (10 EA per 30 days)
levorphanol tartrate oral tablet 2 mg
1
methadone oral solution 10 mg/5 ml, 5 mg/5 ml
1
methadone oral tablet 10 mg, 5 mg
1
morphine oral capsule,extend.release pellets 10
mg, 100 mg, 20 mg, 30 mg, 50 mg, 60 mg, 80 mg
1
morphine oral tablet 15 mg, 30 mg
1
morphine oral tablet extended release 100 mg, 15
mg, 200 mg, 30 mg, 60 mg
1
Opioid Analgesics, Long-Acting
17
Nome do medicamento
Classificação do
medicamento
oxycodone oral tablet,oral only,ext.rel.12 hr 10
mg, 20 mg, 40 mg, 80 mg
1
OXYCONTIN ORAL TABLET,ORAL
ONLY,EXT.REL.12 HR 15 MG, 30 MG, 60 MG
2
butorphanol tartrate injection solution 1 mg/ml, 2
mg/ml
1
B/D
butorphanol tartrate nasal spray,non-aerosol 10
mg/ml
1
DILAUDID (PF) INJECTION SOLUTION 1
MG/ML, 2 MG/ML, 4 MG/ML
2
hydromorphone (pf) injection solution 10 mg/ml
1
hydromorphone oral tablet 2 mg, 4 mg, 8 mg
1
LAZANDA NASAL SPRAY,NON-AEROSOL
100 MCG/SPRAY
2
LAZANDA NASAL SPRAY,NON-AEROSOL
400 MCG/SPRAY
2
meperidine oral solution 50 mg/5 ml
1
PA; QL (3600 ML per 30 days)
meperidine oral tablet 50 mg
1
meperitab oral tablet 100 mg
1
nalbuphine injection solution 10 mg/ml, 20 mg/ml
1
B/D
oxycodone oral solution 5 mg/5 ml
1
QL (5400 ML per 30 days)
oxycodone oral tablet 10 mg, 15 mg, 20 mg, 30
mg, 5 mg
1
tramadol oral tablet 50 mg
1
Opioid Analgesics, Short-Acting
B/D
Anesthetics
Local Anesthetics
lidocaine (pf) injection solution 10 mg/ml (1 %), 5
mg/ml (0.5 %)
1
lidocaine hcl mucous membrane gel 2 %
1
lidocaine hcl mucous membrane solution 4 % (40
mg/ml)
1
18
Nome do medicamento
Classificação do
medicamento
lidocaine hcl urethral gel 2 %
1
lidocaine topical adhesive patch,medicated 5
%(700 mg/patch)
1
lidocaine topical ointment 5 %
1
lidocaine-prilocaine topical cream 2.5-2.5 %
1
SYNERA TOPICAL PATCH, MEDICATED
SELF-HEATING 70-70 MG
2
Anti-Addiction/ Substance Abuse Treatment Agents
Alcohol Deterrents/ Anti-Craving
acamprosate oral tablet,delayed release (dr/ec)
333 mg
1
disulfiram oral tablet 250 mg, 500 mg
1
naltrexone oral tablet 50 mg
1
PA
Opioid Dependence Treatments
buprenorphine hcl sublingual tablet 2 mg, 8 mg
1
buprenorphine-naloxone sublingual tablet 2-0.5
mg, 8-2 mg
1
SUBOXONE SUBLINGUAL FILM 12-3 MG, 20.5 MG, 4-1 MG, 8-2 MG
2
ZUBSOLV SUBLINGUAL TABLET 1.4-0.36
MG, 5.7-1.4 MG, 8.6-2.1 MG
2
Opioid Reversal Agents
naloxone injection syringe 1 mg/ml
1
Smoking Cessation Agents
CHANTIX CONTINUING MONTH BOX ORAL
TABLET 1 MG
2
CHANTIX ORAL TABLET 0.5 MG, 1 MG
2
CHANTIX STARTING MONTH BOX ORAL
TABLETS,DOSE PACK 0.5 MG (11)- 1 MG (42)
2
nicotine (polacrilex) buccal lozenge 2 mg, 4 mg
3
DP
19
Nome do medicamento
Classificação do
medicamento
nicotine transdermal patch 24 hour 14 mg/24 hr,
21 mg/24 hr, 7 mg/24 hr
3
DP
nicotine transdermal patch, td daily, sequential
21-14-7 mg/24 hr
3
DP
NICOTROL INHALATION CARTRIDGE 10
MG
2
NICOTROL NS NASAL SPRAY,NONAEROSOL 10 MG/ML
2
THRIVE NICOTINE BUCCAL GUM 2 MG, 4
MG
3
DP
Antibacterials
Aminoglycosides
amikacin injection solution 500 mg/2 ml
1
gentak ophthalmic ointment 0.3 % (3 mg/gram)
1
gentamicin ophthalmic drops 0.3 %
1
gentamicin ophthalmic ointment 0.3 % (3
mg/gram)
1
gentamicin sulfate (pf) intravenous solution 80
mg/8 ml
1
gentamicin topical cream 0.1 %
1
gentamicin topical ointment 0.1 %
1
neomycin oral tablet 500 mg
1
neomycin-polymyxin b gu irrigation solution 40
mg-200,000 unit/ml
1
paromomycin oral capsule 250 mg
1
streptomycin intramuscular recon soln 1 gram
1
TOBRADEX OPHTHALMIC OINTMENT 0.30.1 %
2
tobramycin in 0.225 % nacl inhalation solution for
nebulization 300 mg/5 ml
1
tobramycin ophthalmic drops 0.3 %
1
PA
20
Nome do medicamento
Classificação do
medicamento
tobramycin sulfate injection solution 10 mg/ml, 40
mg/ml
1
ZANOSAR INTRAVENOUS RECON SOLN 1
GRAM
2
PA
Antibacterials
colistin (colistimethate na) injection recon soln
150 mg
1
SYNERCID INTRAVENOUS RECON SOLN
500 MG
2
PA
acetic acid (bulk) liquid 3 %
3
PA; DP
acetic acid otic solution 2 %
1
alcohol pads topical pads, medicated
1
bacitracin ophthalmic ointment 500 unit/gram
1
bacitracin topical ointment 500 unit/gram
3
DP
bacitracin topical packet 500 unit/gram
3
DP
bacitracin zinc topical ointment 500 unit/gram
3
DP
bacitracin zinc topical packet 500 unit/gram
3
DP
bacitracin-polymyxin b topical packet 500-10,000
unit/gram
3
DP
BACTROBAN NASAL NASAL OINTMENT 2
%
2
QL (3 GM per 30 days)
benzoin (bulk) topical tincture
3
PA; DP
chloramphenicol sod succinate intravenous recon
soln 1 gram
1
CLEOCIN INJECTION SOLUTION 150 MG/ML
2
clindamycin hcl oral capsule 150 mg, 300 mg, 75
mg
1
clindamycin pediatric oral recon soln 75 mg/5 ml
1
clindamycin phosphate topical gel 1 %
1
clindamycin phosphate topical lotion 1 %
1
Antibacterials, Other
PA
21
Nome do medicamento
Classificação do
medicamento
clindamycin phosphate topical solution 1 %
1
clindamycin phosphate topical swab 1 %
1
clindamycin phosphate vaginal cream 2 %
1
CUBICIN INTRAVENOUS RECON SOLN 500
MG
2
LINCOCIN INJECTION SOLUTION 300
MG/ML
2
linezolid intravenous parenteral solution 600
mg/300 ml
1
PA
linezolid oral tablet 600 mg
1
PA
methenamine hippurate oral tablet 1 gram
1
metronidazole in nacl (iso-os) intravenous
piggyback 500 mg/100 ml
1
metronidazole oral capsule 375 mg
1
metronidazole oral tablet 250 mg, 500 mg
1
metronidazole topical cream 0.75 %
1
metronidazole topical gel 0.75 %, 1 %
1
metronidazole topical lotion 0.75 %
1
metronidazole vaginal gel 0.75 %
1
mupirocin topical ointment 2 %
1
nitrofurantoin macrocrystal oral capsule 100 mg,
50 mg
1
nitrofurantoin monohyd/m-cryst oral capsule 100
mg
1
tea tree oil (bulk) oil
3
PA; DP
trimethoprim oral tablet 100 mg
1
TRIPLE ANTIBIOTIC PLUS TOPICAL
OINTMENT 3.5-500-10,000 MG-UNIT-UNIT/G
3
DP
TRIPLE ANTIBIOTIC TOPICAL OINTMENT
3.5MG-400 UNIT- 5,000 UNIT/GRAM
3
DP
TRIPLE ANTIBIOTIC TOPICAL OINTMENT
IN PACKET 3.5-400-5,000 MG-UNIT-UNIT
3
DP
PA
22
Nome do medicamento
Classificação do
medicamento
vancomycin intravenous recon soln 1,000 mg, 10
gram, 500 mg
1
B/D
vancomycin oral capsule 125 mg, 250 mg
1
PA
vandazole vaginal gel 0.75 %
1
ZYVOX ORAL SUSPENSION FOR
RECONSTITUTION 100 MG/5 ML
2
PA
Beta-Lactam, Cephalosporins
cefaclor oral capsule 250 mg, 500 mg
1
cefaclor oral tablet extended release 12 hr 500 mg
1
cefadroxil oral capsule 500 mg
1
cefadroxil oral suspension for reconstitution 250
mg/5 ml, 500 mg/5 ml
1
cefadroxil oral tablet 1 gram
1
cefazolin injection recon soln 1 gram
1
cefdinir oral capsule 300 mg
1
cefdinir oral suspension for reconstitution 125
1
cefepime in dextrose 5 % intravenous piggyback 1
gram/50 ml, 2 gram/50 ml
1
cefepime in dextrose,iso-osm intravenous
piggyback 1 gram/50 ml, 2 gram/100 ml
1
cefepime injection recon soln 1 gram, 2 gram
1
cefotaxime injection recon soln 1 gram, 2 gram,
500 mg
1
cefoxitin in dextrose, iso-osm intravenous
piggyback 1 gram/50 ml, 2 gram/50 ml
1
cefoxitin intravenous recon soln 1 gram, 10 gram,
2 gram
1
cefpodoxime oral suspension for reconstitution
100 mg/5 ml, 50 mg/5 ml
1
cefpodoxime oral tablet 100 mg, 200 mg
1
23
Nome do medicamento
Classificação do
medicamento
cefprozil oral suspension for reconstitution 125
1
cefprozil oral tablet 250 mg, 500 mg
1
ceftriaxone injection recon soln 500 mg
1
cefuroxime axetil oral tablet 250 mg, 500 mg
1
cefuroxime sodium injection recon soln 1.5 gram
1
cephalexin oral capsule 250 mg, 500 mg
1
cephalexin oral suspension for reconstitution 125
1
cephalexin oral tablet 250 mg, 500 mg
1
TEFLARO INTRAVENOUS RECON SOLN 400
MG, 600 MG
2
PA
Beta-Lactam, Other
aztreonam injection recon soln 1 gram
1
DORIBAX INTRAVENOUS RECON SOLN 500
MG
2
PA
imipenem-cilastatin intravenous recon soln 250
mg, 500 mg
1
PA
INVANZ INJECTION RECON SOLN 1 GRAM
2
PA
meropenem intravenous recon soln 500 mg
1
Beta-Lactam, Penicillins
amoxicillin oral capsule 250 mg, 500 mg
1
amoxicillin oral suspension for reconstitution 125
mg/5 ml, 200 mg/5 ml, 250 mg/5 ml, 400 mg/5 ml
1
amoxicillin oral tablet 500 mg, 875 mg
1
amoxicillin oral tablet,chewable 125 mg, 250 mg
1
amoxicillin-pot clavulanate oral suspension for
reconstitution 200-28.5 mg/5 ml, 250-62.5 mg/5
ml, 400-57 mg/5 ml, 600-42.9 mg/5 ml
1
amoxicillin-pot clavulanate oral tablet 250-125
mg, 500-125 mg, 875-125 mg
1
24
Nome do medicamento
Classificação do
medicamento
amoxicillin-pot clavulanate oral tablet extended
release 12 hr 1,000-62.5 mg
1
amoxicillin-pot clavulanate oral tablet,chewable
200-28.5 mg, 400-57 mg
1
ampicillin oral capsule 250 mg, 500 mg
1
ampicillin oral suspension for reconstitution 125
1
ampicillin sodium injection recon soln 1 gram, 10
gram, 125 mg
1
ampicillin-sulbactam injection recon soln 15
gram, 3 gram
1
ampicillin-sulbactam intravenous recon soln 1.5
gram, 3 gram
1
BICILLIN L-A INTRAMUSCULAR SYRINGE
1,200,000 UNIT/2 ML, 2,400,000 UNIT/4 ML,
600,000 UNIT/ML
2
dicloxacillin oral capsule 250 mg, 500 mg
1
nafcillin injection recon soln 1 gram
1
penicillin g procaine intramuscular syringe 1.2
million unit/2 ml
1
penicillin g sodium injection recon soln 5 million
unit
1
penicillin v potassium oral recon soln 125 mg/5
ml, 250 mg/5 ml
1
penicillin v potassium oral tablet 250 mg, 500 mg
1
piperacillin-tazobactam intravenous recon soln
3.375 gram, 4.5 gram
1
Macrolides
azithromycin intravenous recon soln 500 mg, 500
mg (2 mg/ml)
1
azithromycin oral packet 1 gram
1
azithromycin oral suspension for reconstitution
100 mg/5 ml, 200 mg/5 ml
1
25
Nome do medicamento
Classificação do
medicamento
azithromycin oral tablet 250 mg, 500 mg, 600 mg
1
clarithromycin oral suspension for reconstitution
125 mg/5 ml, 250 mg/5 ml
1
clarithromycin oral tablet 250 mg, 500 mg
1
clarithromycin oral tablet extended release 24 hr
500 mg
1
e.e.s. 400 oral tablet 400 mg
1
E.E.S. GRANULES ORAL SUSPENSION FOR
2
ery pads topical swab 2 %
1
ERYPED 200 ORAL SUSPENSION FOR
2
erythrocin (as stearate) oral tablet 250 mg
1
ERYTHROCIN INTRAVENOUS RECON SOLN
500 MG
2
erythromycin ethylsuccinate oral tablet 400 mg
1
erythromycin ophthalmic ointment 5 mg/gram (0.5
%)
1
erythromycin oral tablet 250 mg, 500 mg
1
erythromycin with ethanol topical gel 2 %
1
erythromycin with ethanol topical solution 2 %
1
KETEK ORAL TABLET 300 MG, 400 MG
2
Quinolones
AVELOX IN NACL (ISO-OSMOTIC)
INTRAVENOUS PIGGYBACK 400 MG/250 ML
2
ciprofloxacin (mixture) oral tablet, er multiphase
24 hr 1,000 mg, 500 mg
1
ciprofloxacin hcl ophthalmic drops 0.3 %
1
ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500
mg, 750 mg
1
ciprofloxacin lactate intravenous solution 400
mg/40 ml
1
26
Nome do medicamento
Classificação do
medicamento
levofloxacin oral solution 250 mg/10 ml
1
levofloxacin oral tablet 250 mg, 500 mg, 750 mg
1
MOXEZA OPHTHALMIC DROPS, VISCOUS
0.5 %
2
moxifloxacin oral tablet 400 mg
1
ofloxacin ophthalmic drops 0.3 %
1
ofloxacin oral tablet 200 mg, 300 mg, 400 mg
1
ofloxacin otic drops 0.3 %
1
VIGAMOX OPHTHALMIC DROPS 0.5 %
2
Sulfonamides
silver sulfadiazine topical cream 1 %
1
ssd topical cream 1 %
1
sulfacetamide sodium (acne) topical suspension 10
%
1
sulfacetamide sodium ophthalmic drops 10 %
1
sulfacetamide sodium ophthalmic ointment 10 %
1
sulfadiazine oral tablet 500 mg
1
sulfamethoxazole-trimethoprim intravenous
solution 400-80 mg/5 ml
1
sulfamethoxazole-trimethoprim oral suspension
200-40 mg/5 ml
1
sulfamethoxazole-trimethoprim oral tablet 400-80
mg, 800-160 mg
1
Tetracyclines
demeclocycline oral tablet 150 mg, 300 mg
1
doxy-100 intravenous recon soln 100 mg
1
doxycycline hyclate intravenous recon soln 100 mg
1
doxycycline hyclate oral capsule 100 mg, 50 mg
1
doxycycline hyclate oral tablet 100 mg, 20 mg, 50
mg
1
27
Nome do medicamento
Classificação do
medicamento
doxycycline monohydrate oral capsule 100 mg, 50
mg
1
doxycycline monohydrate oral tablet 100 mg, 150
mg, 50 mg, 75 mg
1
minocycline oral capsule 100 mg, 50 mg, 75 mg
1
minocycline oral tablet 100 mg, 50 mg, 75 mg
1
Anticonvulsants
Anticonvulsants, Other
diazepam rectal kit 12.5-15-17.5-20 mg
1
diazepam rectal kit 2.5 mg
1
diazepam rectal kit 5-7.5-10 mg
1
levetiracetam in nacl (iso-os) intravenous
piggyback 1,000 mg/100 ml, 1,500 mg/100 ml, 500
mg/100 ml
1
levetiracetam intravenous solution 500 mg/5 ml
1
levetiracetam oral solution 100 mg/ml
1
levetiracetam oral tablet 1,000 mg, 250 mg, 500
mg, 750 mg
1
levetiracetam oral tablet extended release 24 hr
500 mg, 750 mg
1
POTIGA ORAL TABLET 200 MG, 300 MG, 400
MG, 50 MG
2
Calcium Channel Modifying Agents
CELONTIN ORAL CAPSULE 300 MG
2
ethosuximide oral capsule 250 mg
1
ethosuximide oral solution 250 mg/5 ml
1
LYRICA ORAL CAPSULE 100 MG, 150 MG,
200 MG, 225 MG, 25 MG, 300 MG, 50 MG, 75
MG
2
LYRICA ORAL SOLUTION 20 MG/ML
2
zonisamide oral capsule 100 mg, 25 mg, 50 mg
1
28
Nome do medicamento
Classificação do
medicamento
Gamma-Aminobutyric Acid (GABA) Augmenting Agents
clonazepam oral tablet 0.5 mg, 1 mg
1
clonazepam oral tablet 2 mg
1
clonazepam oral tablet,disintegrating 0.125 mg,
0.25 mg, 0.5 mg, 1 mg
1
clonazepam oral tablet,disintegrating 2 mg
1
clorazepate dipotassium oral tablet 15 mg
1
clorazepate dipotassium oral tablet 3.75 mg, 7.5
mg
1
diazepam intensol oral concentrate 5 mg/ml
1
diazepam oral solution 5 mg/5 ml
1
diazepam oral tablet 10 mg, 2 mg, 5 mg
1
divalproex oral capsule, sprinkle 125 mg
1
divalproex oral tablet extended release 24 hr 250
mg, 500 mg
1
divalproex oral tablet,delayed release (dr/ec) 125
mg, 250 mg, 500 mg
1
gabapentin oral capsule 100 mg, 300 mg, 400 mg
1
gabapentin oral solution 250 mg/5 ml
1
gabapentin oral tablet 600 mg, 800 mg
1
GABITRIL ORAL TABLET 12 MG, 16 MG
2
HORIZANT ORAL TABLET EXTENDED
RELEASE 300 MG
2
lamotrigine oral tablet,disintegrating 100 mg, 200
mg, 25 mg, 50 mg
1
lorazepam intensol oral concentrate 2 mg/ml
1
lorazepam oral tablet 0.5 mg, 1 mg
1
lorazepam oral tablet 2 mg
1
ONFI ORAL SUSPENSION 2.5 MG/ML
2
ONFI ORAL TABLET 10 MG, 20 MG
2
phenobarbital oral elixir 20 mg/5 ml
1
PA
29
Nome do medicamento
Classificação do
medicamento
phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg,
30 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg
1
primidone oral tablet 250 mg, 50 mg
1
SABRIL ORAL POWDER IN PACKET 500 MG
2
SABRIL ORAL TABLET 500 MG
2
tiagabine oral tablet 2 mg, 4 mg
1
valproate sodium intravenous solution 500 mg/5
ml (100 mg/ml)
1
valproic acid (as sodium salt) oral solution 250
mg/5 ml
1
valproic acid oral capsule 250 mg
1
PA
Glutamate Reducing Agents
felbamate oral suspension 600 mg/5 ml
1
felbamate oral tablet 400 mg, 600 mg
1
FYCOMPA ORAL TABLET 10 MG, 12 MG, 2
MG, 4 MG, 6 MG, 8 MG
2
LAMICTAL STARTER (BLUE) KIT ORAL
TABLETS,DOSE PACK 25 MG (35)
2
LAMICTAL STARTER (GREEN) KIT ORAL
TABLETS,DOSE PACK 25 MG (84) -100 MG
(14)
2
LAMICTAL STARTER (ORANGE) KIT ORAL
TABLETS,DOSE PACK 25 MG (42) -100 MG
(7)
2
LAMICTAL XR STARTER (BLUE) ORAL
TABLET EXTENDED REL,DOSE PACK 25 MG
(21) -50 MG (7)
2
LAMICTAL XR STARTER (GREEN) ORAL
TABLET EXTENDED REL,DOSE PACK 50
MG(14)-100MG (14)-200 MG (7)
2
LAMICTAL XR STARTER (ORANGE) ORAL
TABLET EXTENDED REL,DOSE PACK 25MG
(14)-50 MG (14)-100MG (7)
2
30
Nome do medicamento
Classificação do
medicamento
lamotrigine oral tablet 100 mg, 150 mg, 200 mg,
25 mg
1
lamotrigine oral tablet extended release 24hr 100
mg, 200 mg, 25 mg, 250 mg, 300 mg, 50 mg
1
lamotrigine oral tablet, chewable dispersible 25
mg, 5 mg
1
topiramate oral capsule, sprinkle 15 mg, 25 mg
1
topiramate oral tablet 100 mg, 200 mg, 25 mg, 50
mg
1
TROKENDI XR ORAL CAPSULE,EXTENDED
RELEASE 24HR 100 MG, 200 MG, 25 MG, 50
MG
2
Sodium Channel Agents
APTIOM ORAL TABLET 200 MG, 400 MG, 600
MG, 800 MG
2
BANZEL ORAL SUSPENSION 40 MG/ML
2
BANZEL ORAL TABLET 200 MG, 400 MG
2
carbamazepine oral suspension 100 mg/5 ml
1
carbamazepine oral tablet 200 mg
1
carbamazepine oral tablet extended release 12 hr
200 mg, 400 mg
1
carbamazepine oral tablet,chewable 100 mg
1
DILANTIN ORAL CAPSULE 30 MG
2
epitol oral tablet 200 mg
1
EQUETRO ORAL CAPSULE, ER
MULTIPHASE 12 HR 100 MG, 200 MG, 300
MG
2
fosphenytoin injection solution 100 mg pe/2 ml
1
oxcarbazepine oral suspension 300 mg/5 ml
1
oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg
1
OXTELLAR XR ORAL TABLET EXTENDED
RELEASE 24 HR 150 MG, 300 MG, 600 MG
2
31
Nome do medicamento
Classificação do
medicamento
PEGANONE ORAL TABLET 250 MG
2
phenytoin oral suspension 125 mg/5 ml
1
phenytoin oral tablet,chewable 50 mg
1
phenytoin sodium extended oral capsule 100 mg,
200 mg, 300 mg
1
phenytoin sodium intravenous solution 50 mg/ml
1
TEGRETOL XR ORAL TABLET EXTENDED
RELEASE 12 HR 100 MG
2
VIMPAT INTRAVENOUS SOLUTION 200
MG/20 ML
2
VIMPAT ORAL SOLUTION 10 MG/ML
2
VIMPAT ORAL TABLET 100 MG, 150 MG, 200
MG, 50 MG
2
Antidementia Agents
Antidementia Agents, Other
ergoloid oral tablet 1 mg
1
PA
Cholinesterase Inhibitors
donepezil oral tablet 10 mg, 23 mg, 5 mg
1
donepezil oral tablet,disintegrating 10 mg, 5 mg
1
EXELON TRANSDERMAL PATCH 24 HOUR
13.3 MG/24 HOUR, 4.6 MG/24 HR, 9.5 MG/24
HR
2
rivastigmine tartrate oral capsule 1.5 mg, 3 mg,
4.5 mg, 6 mg
1
N-Methyl-D-Aspartate (NMDA) Receptor Antagonist
NAMENDA XR ORAL CAP,SPRINKLE,ER
24HR DOSE PACK 7-14-21-28 MG
2
NAMENDA XR ORAL
CAPSULE,SPRINKLE,ER 24HR 14 MG, 21 MG,
28 MG, 7 MG
2
Antidepressants
Antidepressants
32
Nome do medicamento
Classificação do
medicamento
amitriptyline-chlordiazepoxide oral tablet 12.5-5
mg, 25-10 mg
1
PA
fluoxetine oral tablet 60 mg
1
olanzapine-fluoxetine oral capsule 12-25 mg, 1250 mg, 3-25 mg, 6-25 mg, 6-50 mg
1
perphenazine-amitriptyline oral tablet 2-10 mg, 225 mg, 4-10 mg, 4-25 mg, 4-50 mg
1
PA
ABILIFY DISCMELT ORAL
TABLET,DISINTEGRATING 10 MG
2
ABILIFY MAINTENA INTRAMUSCULAR
SUSPENSION,EXTENDED REL RECON 300
MG
2
ABILIFY MAINTENA INTRAMUSCULAR
SUSPENSION,EXTENDED REL SYRING 300
MG, 400 MG
2
APLENZIN ORAL TABLET EXTENDED
2
aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20
mg, 30 mg, 5 mg
1
buproban oral tablet extended release 150 mg
1
bupropion hcl oral tablet 100 mg, 75 mg
1
bupropion hcl oral tablet extended release 100 mg,
150 mg, 200 mg
1
bupropion hcl oral tablet extended release 24 hr
150 mg, 300 mg
1
FORFIVO XL ORAL TABLET EXTENDED
2
maprotiline oral tablet 25 mg, 50 mg, 75 mg
1
mirtazapine oral tablet 15 mg, 30 mg, 45 mg, 7.5
mg
1
mirtazapine oral tablet,disintegrating 15 mg, 30
mg, 45 mg
1
Antidepressants, Other
33
Nome do medicamento
Classificação do
medicamento
nefazodone oral tablet 100 mg, 150 mg, 200 mg,
250 mg, 50 mg
1
SEROQUEL XR ORAL TABLET EXTENDED
RELEASE 24 HR 150 MG, 200 MG
2
SEROQUEL XR ORAL TABLET EXTENDED
2
trazodone oral tablet 100 mg, 150 mg, 300 mg, 50
mg
1
VIIBRYD ORAL TABLETS,DOSE PACK 10
MG (7)-20 MG (7)-40 MG (16)
2
Monoamine Oxidase Inhibitors
EMSAM TRANSDERMAL PATCH 24 HOUR
12 MG/24 HR, 6 MG/24 HR, 9 MG/24 HR
2
MARPLAN ORAL TABLET 10 MG
2
phenelzine oral tablet 15 mg
1
tranylcypromine oral tablet 10 mg
1
SSRIs/ SNRIs
BRINTELLIX ORAL TABLET 10 MG, 20 MG, 5
MG
2
citalopram oral solution 10 mg/5 ml
1
citalopram oral tablet 10 mg, 20 mg, 40 mg
1
desvenlafaxine oral tablet extended release 24 hr
100 mg, 50 mg
1
duloxetine oral capsule,delayed release(dr/ec) 20
mg, 30 mg, 60 mg
1
escitalopram oxalate oral solution 5 mg/5 ml
1
escitalopram oxalate oral tablet 10 mg, 20 mg, 5
mg
1
FETZIMA ORAL CAPSULE,EXT REL 24HR
DOSE PACK 20 MG (2)- 40 MG (26)
2
FETZIMA ORAL CAPSULE,EXTENDED
RELEASE 24 HR 120 MG, 20 MG, 40 MG, 80
MG
2
34
Nome do medicamento
Classificação do
medicamento
fluoxetine oral capsule 10 mg, 20 mg, 40 mg
1
fluoxetine oral capsule,delayed release(dr/ec) 90
mg
1
fluoxetine oral solution 20 mg/5 ml
1
fluoxetine oral tablet 10 mg, 20 mg
1
fluvoxamine oral tablet 100 mg, 25 mg, 50 mg
1
paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40
mg
1
paroxetine hcl oral tablet extended release 24 hr
12.5 mg, 25 mg
1
PAXIL ORAL SUSPENSION 10 MG/5 ML
2
PRISTIQ ORAL TABLET EXTENDED
2
sertraline oral concentrate 20 mg/ml
1
sertraline oral tablet 100 mg, 25 mg, 50 mg
1
venlafaxine oral capsule,extended release 24hr
150 mg, 37.5 mg, 75 mg
1
venlafaxine oral tablet 100 mg, 25 mg, 37.5 mg, 50
mg, 75 mg
1
venlafaxine oral tablet extended release 24hr 150
mg, 225 mg, 37.5 mg, 75 mg
1
VIIBRYD ORAL TABLET 10 MG, 20 MG, 40
MG
2
Tricyclics
amitriptyline oral tablet 10 mg, 100 mg, 150 mg,
25 mg, 50 mg, 75 mg
1
amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50
mg
1
clomipramine oral capsule 25 mg, 50 mg, 75 mg
1
desipramine oral tablet 10 mg, 100 mg, 150 mg,
25 mg, 50 mg, 75 mg
1
doxepin oral capsule 10 mg, 100 mg, 150 mg, 25
mg, 50 mg, 75 mg
1
PA
PA
PA
35
Nome do medicamento
Classificação do
medicamento
doxepin oral concentrate 10 mg/ml
1
PA
imipramine hcl oral tablet 10 mg, 25 mg, 50 mg
1
PA
imipramine pamoate oral capsule 100 mg, 125 mg,
150 mg, 75 mg
1
PA
nortriptyline oral capsule 10 mg, 25 mg, 50 mg, 75
mg
1
nortriptyline oral solution 10 mg/5 ml
1
protriptyline oral tablet 10 mg, 5 mg
1
PRUDOXIN TOPICAL CREAM 5 %
2
PA
SURMONTIL ORAL CAPSULE 100 MG, 25
MG, 50 MG
2
PA
Antiemetics
Antiemetics, Other
chlorpromazine injection solution 25 mg/ml
1
chlorpromazine oral tablet 10 mg, 100 mg, 200
mg, 25 mg, 50 mg
1
compro rectal suppository 25 mg
1
diphenhydramine hcl injection solution 50 mg/ml
1
PA
hydroxyzine hcl oral solution 10 mg/5 ml
1
PA
hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg
1
PA
hydroxyzine pamoate oral capsule 100 mg, 25 mg,
50 mg
1
PA
meclizine oral tablet 12.5 mg, 25 mg
1
metoclopramide hcl injection solution 5 mg/ml
1
metoclopramide hcl oral solution 5 mg/5 ml
1
metoclopramide hcl oral tablet 10 mg, 5 mg
1
perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg
1
phenadoz rectal suppository 12.5 mg, 25 mg
1
prochlorperazine edisylate injection solution 10
mg/2 ml (5 mg/ml)
1
prochlorperazine maleate oral tablet 10 mg, 5 mg
1
PA
36
Nome do medicamento
Classificação do
medicamento
prochlorperazine rectal suppository 25 mg
1
promethazine oral syrup 6.25 mg/5 ml
1
PA
promethazine oral tablet 12.5 mg, 25 mg, 50 mg
1
PA
promethazine rectal suppository 12.5 mg, 25 mg
1
PA
promethegan rectal suppository 25 mg, 50 mg
1
PA
TRANSDERM-SCOP TRANSDERMAL PATCH
3 DAY 1.5 MG (1 MG OVER 3 DAYS)
2
trimethobenzamide oral capsule 300 mg
1
PA
CELLCEPT INTRAVENOUS INTRAVENOUS
RECON SOLN 500 MG
2
PA
dronabinol oral capsule 10 mg, 2.5 mg, 5 mg
1
B/D
EMEND ORAL CAPSULE 125 MG, 40 MG, 80
MG
2
B/D
EMEND ORAL CAPSULE,DOSE PACK 125
MG (1)- 80 MG (2)
2
B/D
granisetron (pf) intravenous solution 100 mcg/ml
1
PA
granisetron hcl intravenous solution 1 mg/ml (1
ml)
1
PA
granisetron hcl oral tablet 1 mg
1
PA
granisol oral solution 1 mg/5 ml
1
PA
ondansetron hcl (pf) injection solution 4 mg/2 ml
1
ondansetron hcl (pf) injection syringe 4 mg/2 ml
1
ondansetron hcl intravenous syringe 4 mg/2 ml
1
ondansetron hcl oral solution 4 mg/5 ml
1
B/D
ondansetron hcl oral tablet 24 mg
1
B/D; QL (15 EA per 30 days)
ondansetron hcl oral tablet 4 mg, 8 mg
1
B/D
ondansetron oral tablet,disintegrating 4 mg, 8 mg
1
B/D
Emetogenic Therapy Adjuncts
Antifungals
Antifungals
37
Nome do medicamento
Classificação do
medicamento
abelcet intravenous suspension 5 mg/ml
1
B/D
AMBISOME INTRAVENOUS SUSPENSION
FOR RECONSTITUTION 50 MG
2
B/D
amphotericin b injection recon soln 50 mg
1
B/D
CANCIDAS INTRAVENOUS RECON SOLN 50
MG, 70 MG
2
PA
ciclopirox topical cream 0.77 %
1
ciclopirox topical solution 8 %
1
ciclopirox topical suspension 0.77 %
1
clotrimazole mucous membrane troche 10 mg
1
clotrimazole topical cream 1 %
1
clotrimazole topical solution 1 %
1
DESENEX (CLOTRIMAZOLE) TOPICAL
CREAM 1 %
3
econazole topical cream 1 %
1
ERAXIS(WATER DILUENT) INTRAVENOUS
RECON SOLN 100 MG
2
fluconazole in dextrose(iso-o) intravenous
piggyback 400 mg/200 ml
1
fluconazole oral suspension for reconstitution 10
mg/ml, 40 mg/ml
1
fluconazole oral tablet 100 mg, 150 mg, 200 mg,
50 mg
1
flucytosine oral capsule 250 mg, 500 mg
1
griseofulvin microsize oral suspension 125 mg/5
ml
1
GYNE-LOTRIMIN VAGINAL CREAM 1 %, 2
%
3
itraconazole oral capsule 100 mg
1
JOCK ITCH TOPICAL AEROSOL POWDER 1
%
3
ketoconazole oral tablet 200 mg
1
DP
PA
DP
DP
38
Nome do medicamento
Classificação do
medicamento
ketoconazole topical cream 2 %
1
ketoconazole topical shampoo 2 %
1
LAMISIL AT TOPICAL CREAM 1 %
3
DP
LAMISIL ORAL GRANULES IN PACKET 125
MG, 187.5 MG
2
PA
MENTAX TOPICAL CREAM 1 %
2
MICONAZOLE 7 VAGINAL CREAM 2 %
3
DP
MICONAZOLE 7 VAGINAL SUPPOSITORY
100 MG
3
DP
miconazole nitrate topical cream 2 %
3
DP
MYCAMINE INTRAVENOUS RECON SOLN
100 MG, 50 MG
2
PA
NOXAFIL ORAL SUSPENSION 200 MG/5 ML
(40 MG/ML)
2
NOXAFIL ORAL TABLET,DELAYED
RELEASE (DR/EC) 100 MG
2
nyamyc topical powder 100,000 unit/gram
1
nystatin oral suspension 100,000 unit/ml
1
nystatin oral tablet 500,000 unit
1
nystatin topical cream 100,000 unit/gram
1
nystatin topical ointment 100,000 unit/gram
1
nystatin topical powder 100,000 unit/gram
1
nystop topical powder 100,000 unit/gram
1
pedi-dri topical powder 100,000 unit/gram
1
terbinafine hcl oral tablet 250 mg
1
terconazole vaginal cream 0.4 %, 0.8 %
1
terconazole vaginal suppository 80 mg
1
tolnaftate topical cream 1 %
3
DP
tolnaftate topical solution 1 %
3
DP
undecylenic acid (bulk) liquid 100 %
3
PA; DP
39
Nome do medicamento
Classificação do
medicamento
VAGISTAT-3 VAGINAL KIT 200 MG- 2 % (9
GRAM)
3
voriconazole intravenous solution 200 mg
1
voriconazole oral suspension for reconstitution
200 mg/5 ml (40 mg/ml)
1
voriconazole oral tablet 200 mg, 50 mg
1
ZOLINZA ORAL CAPSULE 100 MG
2
DP
PA
Antigout Agents
Antigout Agents
allopurinol oral tablet 100 mg, 300 mg
1
colchicine oral tablet 0.6 mg
1
colchicine-probenecid oral tablet 0.5-500 mg
1
probenecid oral tablet 500 mg
1
ULORIC ORAL TABLET 40 MG, 80 MG
2
Anti-Inflammatory Agents
Glucocorticoids
a-hydrocort injection recon soln 100 mg
1
betamethasone dipropionate topical cream 0.05 %
1
betamethasone dipropionate topical lotion 0.05 %
1
betamethasone dipropionate topical ointment 0.05
%
1
betamethasone valerate topical cream 0.1 %
1
betamethasone valerate topical lotion 0.1 %
1
betamethasone valerate topical ointment 0.1 %
1
betamethasone, augmented topical cream 0.05 %
1
betamethasone, augmented topical gel 0.05 %
1
betamethasone, augmented topical lotion 0.05 %
1
betamethasone, augmented topical ointment 0.05
%
1
cortisone oral tablet 25 mg
1
40
Nome do medicamento
Classificação do
medicamento
dexamethasone intensol oral drops 1 mg/ml
1
dexamethasone oral elixir 0.5 mg/5 ml
1
dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg,
1.5 mg, 2 mg, 4 mg, 6 mg
1
dexamethasone sodium phosphate injection
solution 10 mg/ml, 4 mg/ml
1
hydrocortisone oral tablet 20 mg, 5 mg
1
methylprednisolone acetate injection suspension
40 mg/ml, 80 mg/ml
1
methylprednisolone oral tablet 16 mg, 32 mg, 4
mg, 8 mg
1
methylprednisolone sodium succ injection recon
soln 125 mg, 40 mg
1
prednisolone acetate ophthalmic drops,suspension
1%
1
prednisolone sodium phosphate ophthalmic drops
1%
1
prednisolone sodium phosphate oral solution 15
mg/5 ml, 25 mg/5 ml (5 mg/ml), 5 mg base/5 ml
(6.7 mg/5 ml)
1
prednisone oral solution 5 mg/5 ml
1
prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20
mg, 5 mg, 50 mg
1
RAYOS ORAL TABLET,DELAYED RELEASE
(DR/EC) 1 MG, 2 MG, 5 MG
2
sulfacetamide-prednisolone ophthalmic drops 10
%-0.23 % (0.25 %)
1
Antimigraine Agents
Antimigraine Agents
TREXIMET ORAL TABLET 85-500 MG
2
Ergot Alkaloids
dihydroergotamine injection solution 1 mg/ml
1
PA
41
Nome do medicamento
Classificação do
medicamento
dihydroergotamine nasal spray,non-aerosol 0.5
mg/pump act. (4 mg/ml)
1
ERGOMAR SUBLINGUAL TABLET 2 MG
2
Prophylactic
timolol maleate oral tablet 10 mg, 20 mg, 5 mg
1
Serotonin (5-HT) 1B/1D Receptor Agonists
IMITREX STATDOSE KIT REFILL
SUBCUTANEOUS CARTRIDGE 4 MG/0.5 ML,
6 MG/0.5 ML
2
naratriptan oral tablet 1 mg, 2.5 mg
1
sumatriptan nasal spray,non-aerosol 20
mg/actuation, 5 mg/actuation
1
sumatriptan succinate oral tablet 100 mg, 25 mg,
50 mg
1
sumatriptan succinate subcutaneous pen injector 6
mg/0.5 ml
1
sumatriptan succinate subcutaneous solution 6
mg/0.5 ml
1
Antimyasthenic Agents
Parasympathomimetics
guanidine oral tablet 125 mg
1
pyridostigmine bromide oral tablet 60 mg
1
Antimycobacterials
Antimycobacterials, Other
dapsone oral tablet 100 mg, 25 mg
1
PRIFTIN ORAL TABLET 150 MG
2
rifabutin oral capsule 150 mg
1
Antituberculars
CAPASTAT INJECTION RECON SOLN 1
GRAM
2
ethambutol oral tablet 100 mg, 400 mg
1
42
Nome do medicamento
Classificação do
medicamento
isoniazid injection solution 100 mg/ml
1
isoniazid oral tablet 100 mg, 300 mg
1
PASER ORAL GRANULES DR FOR SUSP IN
PACKET 4 GRAM
2
pyrazinamide oral tablet 500 mg
1
rifampin intravenous recon soln 600 mg
1
rifampin oral capsule 150 mg, 300 mg
1
RIFATER ORAL TABLET 50-120-300 MG
2
SIRTURO ORAL TABLET 100 MG
2
TRECATOR ORAL TABLET 250 MG
2
PA
Antineoplastics
Alkylating Agents
BUSULFEX INTRAVENOUS SOLUTION 60
MG/10 ML
2
PA
cyclophosphamide oral capsule 25 mg, 50 mg
1
B/D
cyclophosphamide oral tablet 25 mg, 50 mg
1
B/D
HEXALEN ORAL CAPSULE 50 MG
2
PA
LEUKERAN ORAL TABLET 2 MG
2
lomustine oral capsule 10 mg, 100 mg, 40 mg
1
MATULANE ORAL CAPSULE 50 MG
2
melphalan hcl intravenous recon soln 50 mg
1
PA
TREANDA INTRAVENOUS SOLUTION 45
MG/0.5 ML
2
PA
VALCHLOR TOPICAL GEL 0.016 %
2
Antiandrogens
bicalutamide oral tablet 50 mg
1
flutamide oral capsule 125 mg
1
NILANDRON ORAL TABLET 150 MG
2
XTANDI ORAL CAPSULE 40 MG
2
PA
ZYTIGA ORAL TABLET 250 MG
2
PA
43
Nome do medicamento
Classificação do
medicamento
Antiangiogenic Agents
POMALYST ORAL CAPSULE 1 MG, 2 MG, 3
MG, 4 MG
2
PA
REVLIMID ORAL CAPSULE 10 MG, 15 MG,
25 MG, 5 MG
2
PA; LA
THALOMID ORAL CAPSULE 100 MG, 150
MG, 200 MG, 50 MG
2
Antiestrogens/Modifiers
EMCYT ORAL CAPSULE 140 MG
2
PA
FARESTON ORAL TABLET 60 MG
2
PA
SOLTAMOX ORAL SOLUTION 10 MG/5 ML
2
tamoxifen oral tablet 10 mg, 20 mg
1
Antimetabolites
adrucil intravenous solution 2.5 gram/50 ml, 5
gram/100 ml
1
B/D
DROXIA ORAL CAPSULE 200 MG, 300 MG,
400 MG
2
gemcitabine intravenous recon soln 1 gram
1
hydroxyurea oral capsule 500 mg
1
PURIXAN ORAL SUSPENSION 20 MG/ML
2
TABLOID ORAL TABLET 40 MG
2
PA
adrucil intravenous solution 500 mg/10 ml
1
B/D
ALIMTA INTRAVENOUS RECON SOLN 500
MG
2
PA
ARRANON INTRAVENOUS SOLUTION 250
MG/50 ML
2
PA
AVASTIN INTRAVENOUS SOLUTION 25
MG/ML
2
PA
azacitidine injection recon soln 100 mg
1
PA
PA
Antineoplastics
44
Nome do medicamento
Classificação do
medicamento
BELEODAQ INTRAVENOUS RECON SOLN
500 MG
2
PA
BICNU INTRAVENOUS RECON SOLN 100
MG
2
PA
bleomycin injection recon soln 30 unit
1
B/D
carboplatin intravenous solution 10 mg/ml
1
B/D
cisplatin intravenous solution 1 mg/ml
1
B/D
cladribine intravenous solution 10 mg/10 ml
1
PA
CLOLAR INTRAVENOUS SOLUTION 20
MG/20 ML
2
PA
COSMEGEN INTRAVENOUS RECON SOLN
0.5 MG
2
PA
cytarabine (pf) injection solution 2 gram/20 ml
(100 mg/ml)
1
B/D
cytarabine injection solution 20 mg/ml
1
B/D
dacarbazine intravenous recon soln 200 mg
1
B/D
daunorubicin intravenous solution 5 mg/ml
1
B/D
DAUNOXOME INTRAVENOUS SOLUTION 2
MG/ML
2
B/D
decitabine intravenous recon soln 50 mg
1
B/D
DEXRAZOXANE HCL INTRAVENOUS
RECON SOLN 250 MG
2
B/D
DOCEFREZ INTRAVENOUS RECON SOLN 20
MG
2
PA
DOCETAXEL INTRAVENOUS SOLUTION 80
MG/4 ML (20 MG/ML), 80 MG/8 ML (10
MG/ML)
2
PA
DOXIL INTRAVENOUS SUSPENSION 2
MG/ML
2
PA
doxorubicin intravenous solution 50 mg/25 ml
1
B/D
ELITEK INTRAVENOUS RECON SOLN 1.5
MG
2
PA
45
Nome do medicamento
Classificação do
medicamento
ELLENCE INTRAVENOUS SOLUTION 200
MG/100 ML
2
PA
EPIRUBICIN INTRAVENOUS SOLUTION 50
MG/25 ML
2
PA
ERBITUX INTRAVENOUS SOLUTION 100
MG/50 ML
2
PA
ERWINAZE INTRAMUSCULAR RECON
SOLN 10,000 UNIT
2
PA
FASLODEX INTRAMUSCULAR SYRINGE 250
MG/5 ML
2
PA
GLEOSTINE ORAL CAPSULE 10 MG, 100 MG,
40 MG
2
PA
HALAVEN INTRAVENOUS SOLUTION 1
MG/2 ML (0.5 MG/ML)
2
PA
HERCEPTIN INTRAVENOUS RECON SOLN
440 MG
2
PA
idarubicin intravenous solution 1 mg/ml
1
PA
IFOSFAMIDE INTRAVENOUS RECON SOLN
1 GRAM
2
PA
IRINOTECAN INTRAVENOUS SOLUTION 100
MG/5 ML
2
PA
ISTODAX INTRAVENOUS RECON SOLN 10
MG/2 ML
2
PA
IXEMPRA INTRAVENOUS RECON SOLN 45
MG
2
PA
JEVTANA INTRAVENOUS SOLUTION 10
MG/ML (FIRST DILUTION)
2
PA
KADCYLA INTRAVENOUS RECON SOLN 100
MG
2
PA
levoleucovorin calcium intravenous solution 10
mg/ml
1
B/D
LYNPARZA ORAL CAPSULE 50 MG
2
PA
mesna intravenous solution 100 mg/ml
1
B/D
MESNEX ORAL TABLET 400 MG
2
46
Nome do medicamento
Classificação do
medicamento
mitomycin intravenous recon soln 20 mg
1
B/D
MUSTARGEN INJECTION RECON SOLN 10
MG
2
PA
oxaliplatin intravenous solution 100 mg/20 ml
1
PA
PACLITAXEL INTRAVENOUS
CONCENTRATE 6 MG/ML
2
PA
PERJETA INTRAVENOUS SOLUTION 420
MG/14 ML (30 MG/ML)
2
PA
PROLEUKIN INTRAVENOUS RECON SOLN
22 MILLION UNIT
2
PA
TREANDA INTRAVENOUS RECON SOLN 100
MG
2
PA
TRISENOX INTRAVENOUS SOLUTION 10
MG/10 ML
2
PA
VECTIBIX INTRAVENOUS SOLUTION 100
MG/5 ML (20 MG/ML)
2
PA
VELCADE INJECTION RECON SOLN 3.5 MG
2
PA
VINBLASTINE INTRAVENOUS SOLUTION 1
MG/ML
2
PA
vincasar pfs intravenous solution 1 mg/ml
1
B/D
vincristine intravenous solution 1 mg/ml
1
B/D
vinorelbine intravenous solution 50 mg/5 ml
1
B/D
ABRAXANE INTRAVENOUS SUSPENSION
FOR RECONSTITUTION 100 MG
2
PA
amifostine crystalline intravenous recon soln 500
mg
1
PA
DOCEFREZ INTRAVENOUS RECON SOLN 80
MG
2
PA
FLUDARABINE INTRAVENOUS RECON
SOLN 50 MG
2
PA
FUSILEV INTRAVENOUS RECON SOLN 50
MG
2
PA
Antineoplastics, Other
47
Nome do medicamento
Classificação do
medicamento
leucovorin calcium injection recon soln 100 mg
1
B/D
leucovorin calcium oral tablet 10 mg, 15 mg, 25
mg, 5 mg
1
mitoxantrone intravenous concentrate 2 mg/ml
1
ONCASPAR INJECTION SOLUTION 750
UNIT/ML
2
PA
REVLIMID ORAL CAPSULE 2.5 MG, 20 MG
2
PA; LA
SYNRIBO SUBCUTANEOUS RECON SOLN
3.5 MG
2
PA
YERVOY INTRAVENOUS SOLUTION 50
MG/10 ML (5 MG/ML)
2
PA
ZALTRAP INTRAVENOUS SOLUTION 100
MG/4 ML (25 MG/ML)
2
PA
Aromatase Inhibitors, 3rd Generation
anastrozole oral tablet 1 mg
1
exemestane oral tablet 25 mg
1
letrozole oral tablet 2.5 mg
1
Enzyme Inhibitors
ETOPOPHOS INTRAVENOUS RECON SOLN
100 MG
2
PA
etoposide intravenous solution 20 mg/ml
1
B/D
FARYDAK ORAL CAPSULE 10 MG, 15 MG, 20
MG
2
PA
IBRANCE ORAL CAPSULE 100 MG, 125 MG,
75 MG
2
PA
toposar intravenous solution 20 mg/ml
1
B/D
topotecan intravenous recon soln 4 mg
1
PA
ZYDELIG ORAL TABLET 100 MG, 150 MG
2
PA
AFINITOR ORAL TABLET 10 MG, 2.5 MG, 5
MG, 7.5 MG
2
PA
BOSULIF ORAL TABLET 100 MG, 500 MG
2
PA
Molecular Target Inhibitors
48
Nome do medicamento
Classificação do
medicamento
CAPRELSA ORAL TABLET 100 MG, 300 MG
2
PA
COMETRIQ ORAL CAPSULE 100 MG/DAY(80
MG[1]-20 MG[1]), 140 MG/DAY(80 MG[1]-20
MG[3]), 60 MG/DAY (20 MG [3]/DAY)
2
PA
ERIVEDGE ORAL CAPSULE 150 MG
2
PA
GILOTRIF ORAL TABLET 20 MG, 30 MG, 40
MG
2
PA
GLEEVEC ORAL TABLET 100 MG, 400 MG
2
PA
ICLUSIG ORAL TABLET 15 MG, 45 MG
2
PA
IMBRUVICA ORAL CAPSULE 140 MG
2
PA
INLYTA ORAL TABLET 1 MG, 5 MG
2
PA
JAKAFI ORAL TABLET 10 MG, 15 MG, 20
MG, 25 MG, 5 MG
2
PA
LENVIMA ORAL CAPSULE 10 MG/DAY (10
MG [1]/DAY), 14 MG (10 MG[1] -4
MG[1])/DAY, 20 MG/DAY (10 MG [2]/DAY), 24
MG (10 MG[2] -4 MG[1])/DAY
2
PA
MEKINIST ORAL TABLET 0.5 MG, 2 MG
2
PA
NEXAVAR ORAL TABLET 200 MG
2
PA
OFEV ORAL CAPSULE 100 MG, 150 MG
2
PA
SPRYCEL ORAL TABLET 100 MG, 140 MG, 20
MG, 50 MG, 70 MG, 80 MG
2
PA
STIVARGA ORAL TABLET 40 MG
2
PA
SUTENT ORAL CAPSULE 12.5 MG, 25 MG,
37.5 MG, 50 MG
2
PA
TAFINLAR ORAL CAPSULE 50 MG, 75 MG
2
PA
TARCEVA ORAL TABLET 100 MG, 150 MG,
25 MG
2
PA
TASIGNA ORAL CAPSULE 150 MG, 200 MG
2
PA
TYKERB ORAL TABLET 250 MG
2
PA
VOTRIENT ORAL TABLET 200 MG
2
PA
XALKORI ORAL CAPSULE 200 MG, 250 MG
2
PA
49
Nome do medicamento
Classificação do
medicamento
ZELBORAF ORAL TABLET 240 MG
2
PA
ZYKADIA ORAL CAPSULE 150 MG
2
PA
ARZERRA INTRAVENOUS SOLUTION 100
MG/5 ML
2
PA
KEYTRUDA INTRAVENOUS RECON SOLN
50 MG
2
PA
OPDIVO INTRAVENOUS SOLUTION 40 MG/4
ML
2
PA
RITUXAN INTRAVENOUS CONCENTRATE
10 MG/ML
2
PA
PANRETIN TOPICAL GEL 0.1 %
2
PA
TARGRETIN ORAL CAPSULE 75 MG
2
TARGRETIN TOPICAL GEL 1 %
2
tretinoin (chemotherapy) oral capsule 10 mg
1
tretinoin topical cream 0.025 %, 0.05 %, 0.1 %
1
tretinoin topical gel 0.01 %, 0.025 %
1
Monoclonal Antibodies
Retinoids
PA
Antiparasitics
Anthelmintics
ALBENZA ORAL TABLET 200 MG
2
BILTRICIDE ORAL TABLET 600 MG
2
REESE'S PINWORM MEDICINE ORAL
SUSPENSION 50 MG/ML
3
Antiprotozoals
ALINIA ORAL SUSPENSION FOR
2
ALINIA ORAL TABLET 500 MG
2
atovaquone oral suspension 750 mg/5 ml
1
atovaquone-proguanil oral tablet 62.5-25 mg
1
50
Nome do medicamento
Classificação do
medicamento
chloroquine phosphate oral tablet 250 mg, 500 mg
1
COARTEM ORAL TABLET 20-120 MG
2
DARAPRIM ORAL TABLET 25 MG
2
hydroxychloroquine oral tablet 200 mg
1
MALARONE ORAL TABLET 250-100 MG
2
mefloquine oral tablet 250 mg
1
NEBUPENT INHALATION RECON SOLN 300
MG
2
B/D
PENTAM INJECTION RECON SOLN 300 MG
2
PA
PRIMAQUINE ORAL TABLET 26.3 MG
2
quinine sulfate oral capsule 324 mg
1
Pediculicides/ Scabicides
lindane topical lotion 1 %
1
lindane topical shampoo 1 %
1
malathion topical lotion 0.5 %
1
permethrin topical cream 5 %
1
Pediculicides/Scabicides
benzyl benzoate (bulk) liquid
3
PA; DP
COMPLETE LICE TREATMENT TOPICAL KIT
4-0.33-0.5 %
3
DP
HOUSEHOLD LICE CONTROL
AEROSOL,SPRAY
3
DP
LICE KILLING TOPICAL SHAMPOO 0.33-4 %
3
DP
LICE TREATMENT TOPICAL LIQUID 0.33-4
%, 1 %
3
DP
LICIDE SPRAY AEROSOL,SPRAY 0.2-1 %
3
DP
benztropine oral tablet 0.5 mg, 1 mg, 2 mg
1
PA
trihexyphenidyl oral elixir 0.4 mg/ml
1
PA
Antiparkinson Agents
Anticholinergics
51
Nome do medicamento
trihexyphenidyl oral tablet 2 mg, 5 mg
Classificação do
medicamento
1
PA
Antiparkinson Agents, Other
amantadine hcl oral capsule 100 mg
1
amantadine hcl oral solution 50 mg/5 ml
1
amantadine hcl oral tablet 100 mg
1
entacapone oral tablet 200 mg
1
tolcapone oral tablet 100 mg
1
Dopamine Agonists
APOKYN SUBCUTANEOUS CARTRIDGE 10
MG/ML
2
bromocriptine oral capsule 5 mg
1
bromocriptine oral tablet 2.5 mg
1
NEUPRO TRANSDERMAL PATCH 24 HOUR 1
MG/24 HOUR, 2 MG/24 HOUR, 3 MG/24
HOUR, 4 MG/24 HOUR, 6 MG/24 HOUR, 8
MG/24 HOUR
2
pramipexole oral tablet 0.125 mg, 0.25 mg, 0.5
mg, 0.75 mg, 1 mg, 1.5 mg
1
ropinirole oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg,
3 mg, 4 mg, 5 mg
1
PA
PA
Dopamine Precursors/ L-Amino Acid Decarboxylase Inhibitors
carbidopa-levodopa oral tablet 10-100 mg, 25-100
mg, 25-250 mg
1
carbidopa-levodopa oral tablet extended release
25-100 mg, 50-200 mg
1
Monoamine Oxidase B (MAO-B) Inhibitors
AZILECT ORAL TABLET 0.5 MG, 1 MG
2
selegiline hcl oral capsule 5 mg
1
selegiline hcl oral tablet 5 mg
1
ST
Antipsychotics
1st Generation/ Typical
52
Nome do medicamento
Classificação do
medicamento
fluphenazine decanoate injection solution 25
mg/ml
1
fluphenazine hcl injection solution 2.5 mg/ml
1
fluphenazine hcl oral concentrate 5 mg/ml
1
fluphenazine hcl oral elixir 2.5 mg/5 ml
1
fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5
mg
1
haloperidol decanoate intramuscular solution 100
mg/ml, 50 mg/ml
1
haloperidol lactate injection solution 5 mg/ml
1
haloperidol lactate oral concentrate 2 mg/ml
1
haloperidol oral tablet 0.5 mg, 2 mg, 5 mg
1
haloperidol oral tablet 1 mg
1
haloperidol oral tablet 10 mg, 20 mg
1
loxapine succinate oral capsule 10 mg
1
loxapine succinate oral capsule 25 mg, 5 mg
1
loxapine succinate oral capsule 50 mg
1
ORAP ORAL TABLET 1 MG, 2 MG
2
thioridazine oral tablet 10 mg, 100 mg, 25 mg, 50
mg
1
thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg
1
trifluoperazine oral tablet 1 mg, 10 mg, 2 mg, 5
mg
1
PA
2nd Generation/ Atypical
ABILIFY DISCMELT ORAL
2
ABILIFY INTRAMUSCULAR SOLUTION 9.75
MG/1.3 ML
2
ABILIFY ORAL SOLUTION 1 MG/ML
2
FANAPT ORAL TABLET 1 MG, 10 MG, 12
MG, 2 MG, 4 MG, 6 MG, 8 MG
2
53
Nome do medicamento
Classificação do
medicamento
FANAPT ORAL TABLETS,DOSE PACK
1MG(2)-2MG(2)- 4MG(2)-6MG(2)
2
GEODON INTRAMUSCULAR RECON SOLN
20 MG/ML (FINAL CONC.)
2
INVEGA ORAL TABLET EXTENDED
RELEASE 24HR 1.5 MG, 3 MG, 9 MG
2
INVEGA ORAL TABLET EXTENDED
RELEASE 24HR 6 MG
2
INVEGA SUSTENNA INTRAMUSCULAR
SYRINGE 117 MG/0.75 ML
2
PA; QL (0.75 ML per 28 days)
SYRINGE 156 MG/ML
2
2
2
2
LATUDA ORAL TABLET 120 MG, 20 MG, 40
MG, 60 MG, 80 MG
2
olanzapine intramuscular recon soln 10 mg
1
olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20
mg, 5 mg, 7.5 mg
1
olanzapine oral tablet,disintegrating 10 mg, 15
mg, 20 mg, 5 mg
1
quetiapine oral tablet 100 mg, 200 mg, 300 mg,
400 mg
1
quetiapine oral tablet 25 mg, 50 mg
1
RISPERDAL CONSTA INTRAMUSCULAR
SYRINGE 12.5 MG/2 ML, 25 MG/2 ML, 37.5
MG/2 ML, 50 MG/2 ML
2
risperidone oral solution 1 mg/ml
1
risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2
mg, 3 mg, 4 mg
1
54
Nome do medicamento
Classificação do
medicamento
risperidone oral tablet,disintegrating 0.25 mg, 0.5
mg, 1 mg, 2 mg, 3 mg, 4 mg
1
SAPHRIS (BLACK CHERRY) SUBLINGUAL
TABLET 10 MG, 2.5 MG, 5 MG
2
ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg,
80 mg
1
ZYPREXA RELPREVV INTRAMUSCULAR
SUSPENSION FOR RECONSTITUTION 210
MG
2
PA
clozapine oral tablet 100 mg
1
clozapine oral tablet 200 mg
1
clozapine oral tablet 25 mg, 50 mg
1
clozapine oral tablet,disintegrating 100 mg, 12.5
mg, 25 mg
1
clozapine oral tablet,disintegrating 150 mg
1
clozapine oral tablet,disintegrating 200 mg
1
VERSACLOZ ORAL SUSPENSION 50 MG/ML
2
Treatment-Resistant
Antispasticity Agents
Antispasticity Agents
baclofen oral tablet 10 mg, 20 mg
1
dantrolene oral capsule 100 mg, 25 mg, 50 mg
1
tizanidine oral tablet 2 mg, 4 mg
1
Antivirals
Anti-Cytomegalovirus (CMV) Agents
cidofovir intravenous solution 75 mg/ml
1
ganciclovir sodium intravenous recon soln 500 mg
1
VALCYTE ORAL RECON SOLN 50 MG/ML
2
valganciclovir oral tablet 450 mg
1
ZIRGAN OPHTHALMIC GEL 0.15 %
2
55
Nome do medicamento
Classificação do
medicamento
Anti-Hepatitis B (HBV) Agents
ADEFOVIR ORAL TABLET 10 MG
2
PA
BARACLUDE ORAL SOLUTION 0.05 MG/ML
2
entecavir oral tablet 0.5 mg, 1 mg
1
EPIVIR HBV ORAL SOLUTION 25 MG/5 ML
(5 MG/ML)
2
INTRON A INJECTION RECON SOLN 10
MILLION UNIT (1 ML)
2
PA
INTRON A INJECTION SOLUTION 6
MILLION UNIT/ML
2
PA
lamivudine oral solution 10 mg/ml
1
lamivudine oral tablet 100 mg, 150 mg, 300 mg
1
REBETOL ORAL SOLUTION 40 MG/ML
2
PA
RIBASPHERE ORAL CAPSULE 200 MG
2
PA
RIBASPHERE ORAL TABLET 200 MG, 400
MG, 600 MG
2
PA
RIBAVIRIN ORAL CAPSULE 200 MG
2
PA
RIBAVIRIN ORAL TABLET 200 MG
2
PA
TYZEKA ORAL TABLET 600 MG
2
VIRAZOLE INHALATION RECON SOLN 6
GRAM
2
VIREAD ORAL POWDER 40 MG/SCOOP (40
MG/GRAM)
2
VIREAD ORAL TABLET 150 MG, 200 MG, 250
MG, 300 MG
2
PA
Anti-Hepatitis C (HCV) Agents
HARVONI ORAL TABLET 90-400 MG
2
PA
INTRON A INJECTION RECON SOLN 18
MILLION UNIT (1 ML), 50 MILLION UNIT (1
ML)
2
PA
56
Nome do medicamento
Classificação do
medicamento
MODERIBA DOSE PACK ORAL
TABLETS,DOSE PACK 400 MG (7)- 400 MG
(7), 600 MG (7)- 600 MG (7)
2
PA
MODERIBA ORAL TABLET 200 MG
2
PA
OLYSIO ORAL CAPSULE 150 MG
2
PA
PEGASYS PROCLICK SUBCUTANEOUS PEN
INJECTOR 135 MCG/0.5 ML, 180 MCG/0.5 ML
2
PA
PEGASYS SUBCUTANEOUS SOLUTION 180
MCG/ML
2
PA
PEGASYS SUBCUTANEOUS SYRINGE 180
MCG/0.5 ML
2
PA
PEGINTRON REDIPEN SUBCUTANEOUS
PEN INJECTOR KIT 120 MCG/0.5 ML, 150
MCG/0.5 ML, 50 MCG/0.5 ML, 80 MCG/0.5 ML
2
PA
PEGINTRON SUBCUTANEOUS KIT 120
MCG/0.5 ML, 150 MCG/0.5 ML, 50 MCG/0.5
ML, 80 MCG/0.5 ML
2
PA
RIBASPHERE RIBAPAK ORAL
TABLETS,DOSE PACK 400-400 MG (28)-MG
(28), 600-400 MG (28)-MG (28), 600-600 MG
(28)-MG (28)
2
PA
SOVALDI ORAL TABLET 400 MG
2
PA
SYLATRON SUBCUTANEOUS KIT 200 MCG,
300 MCG, 600 MCG
2
PA
VIEKIRA PAK ORAL TABLETS,DOSE PACK
12.5 MG-75 MG -50 MG/250 MG
2
PA
Antiherpetic Agents
acyclovir oral capsule 200 mg
1
acyclovir oral suspension 200 mg/5 ml
1
acyclovir oral tablet 400 mg, 800 mg
1
acyclovir sodium intravenous solution 50 mg/ml
1
acyclovir topical ointment 5 %
1
DENAVIR TOPICAL CREAM 1 %
2
B/D
57
Nome do medicamento
Classificação do
medicamento
famciclovir oral tablet 125 mg, 250 mg, 500 mg
1
trifluridine ophthalmic drops 1 %
1
valacyclovir oral tablet 1 gram, 500 mg
1
Anti-HIV Agents, Integrase Inhibitors (INSTI)
ISENTRESS ORAL POWDER IN PACKET 100
MG
2
ISENTRESS ORAL TABLET 400 MG
2
ISENTRESS ORAL TABLET,CHEWABLE 100
MG, 25 MG
2
STRIBILD ORAL TABLET 150-150-200-300
MG
2
TIVICAY ORAL TABLET 50 MG
2
VITEKTA ORAL TABLET 150 MG, 85 MG
2
Anti-HIV Agents, Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)
COMPLERA ORAL TABLET 200-25-300 MG
2
EDURANT ORAL TABLET 25 MG
2
INTELENCE ORAL TABLET 100 MG, 200 MG,
25 MG
2
nevirapine oral suspension 50 mg/5 ml
1
nevirapine oral tablet 200 mg
1
nevirapine oral tablet extended release 24 hr 400
mg
1
RESCRIPTOR ORAL TABLET 200 MG
2
RESCRIPTOR ORAL TABLET, DISPERSIBLE
100 MG
2
SUSTIVA ORAL CAPSULE 200 MG, 50 MG
2
SUSTIVA ORAL TABLET 600 MG
2
VIRAMUNE XR ORAL TABLET EXTENDED
2
Anti-HIV Agents, Nucleoside And Nucleotide Reverse Transcriptase Inhibitors (NRTI)
abacavir oral tablet 300 mg
1
58
Nome do medicamento
Classificação do
medicamento
abacavir-lamivudine-zidovudine oral tablet 300150-300 mg
1
ATRIPLA ORAL TABLET 600-200-300 MG
2
didanosine oral capsule,delayed release(dr/ec)
125 mg, 200 mg, 250 mg, 400 mg
1
EMTRIVA ORAL CAPSULE 200 MG
2
EMTRIVA ORAL SOLUTION 10 MG/ML
2
EPZICOM ORAL TABLET 600-300 MG
2
lamivudine-zidovudine oral tablet 150-300 mg
1
RETROVIR INTRAVENOUS SOLUTION 10
MG/ML
2
stavudine oral capsule 15 mg, 20 mg, 30 mg, 40
mg
1
stavudine oral recon soln 1 mg/ml
1
TRUVADA ORAL TABLET 200-300 MG
2
VIDEX 2 GRAM PEDIATRIC ORAL RECON
SOLN 10 MG/ML (FINAL)
2
ZIAGEN ORAL SOLUTION 20 MG/ML
2
zidovudine oral capsule 100 mg
1
zidovudine oral syrup 10 mg/ml
1
zidovudine oral tablet 300 mg
1
Anti-HIV Agents, Other
FUZEON SUBCUTANEOUS RECON SOLN 90
MG
2
SELZENTRY ORAL TABLET 150 MG, 300 MG
2
TRIUMEQ ORAL TABLET 600-50-300 MG
2
TYBOST ORAL TABLET 150 MG
2
Anti-HIV Agents, Protease Inhibitors
APTIVUS ORAL CAPSULE 250 MG
2
APTIVUS ORAL SOLUTION 100 MG/ML
2
CRIXIVAN ORAL CAPSULE 200 MG, 400 MG
2
59
Nome do medicamento
Classificação do
medicamento
EVOTAZ ORAL TABLET 300-150 MG
2
INVIRASE ORAL CAPSULE 200 MG
2
INVIRASE ORAL TABLET 500 MG
2
KALETRA ORAL SOLUTION 400-100 MG/5
ML
2
KALETRA ORAL TABLET 100-25 MG, 200-50
MG
2
LEXIVA ORAL SUSPENSION 50 MG/ML
2
LEXIVA ORAL TABLET 700 MG
2
NORVIR ORAL CAPSULE 100 MG
2
NORVIR ORAL SOLUTION 80 MG/ML
2
NORVIR ORAL TABLET 100 MG
2
PREZCOBIX ORAL TABLET 800-150 MG-MG
2
PREZISTA ORAL SUSPENSION 100 MG/ML
2
PREZISTA ORAL TABLET 150 MG, 600 MG,
75 MG, 800 MG
2
REYATAZ ORAL CAPSULE 150 MG, 200 MG,
300 MG
2
REYATAZ ORAL POWDER IN PACKET 50
MG
2
VIRACEPT ORAL TABLET 250 MG, 625 MG
2
Anti-Influenza Agents
RELENZA DISKHALER INHALATION
BLISTER WITH DEVICE 5 MG/ACTUATION
2
rimantadine oral tablet 100 mg
1
TAMIFLU ORAL CAPSULE 30 MG
2
2
2
TAMIFLU ORAL SUSPENSION FOR
RECONSTITUTION 6 MG/ML
2
Anxiolytics
60
Nome do medicamento
Classificação do
medicamento
Anxiolytics, Other
buspirone oral tablet 10 mg, 15 mg, 30 mg, 5 mg,
7.5 mg
1
meprobamate oral tablet 200 mg, 400 mg
1
PA
alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg
1
alprazolam oral tablet 2 mg
1
Benzodiazepines
Bipolar Agents
Mood Stabilizers
carbamazepine oral capsule, er multiphase 12 hr
100 mg, 200 mg, 300 mg
1
lithium carbonate oral capsule 150 mg, 300 mg,
600 mg
1
lithium carbonate oral tablet 300 mg
1
lithium carbonate oral tablet extended release 300
mg, 450 mg
1
lithium citrate oral solution 8 meq/5 ml
1
Blood Glucose Regulators
Antidiabetic Agents
acarbose oral tablet 100 mg, 25 mg, 50 mg
1
ST
AVANDAMET ORAL TABLET 4-500 MG
2
ST; QL (60 EA per 30 days)
AVANDARYL ORAL TABLET 4-1 MG, 4-2
MG
2
AVANDARYL ORAL TABLET 4-4 MG, 8-2
MG, 8-4 MG
2
AVANDIA ORAL TABLET 2 MG
2
2
2
BYDUREON SUBCUTANEOUS PEN
INJECTOR 2 MG/0.65 ML
2
PA
61
Nome do medicamento
Classificação do
medicamento
BYDUREON SUBCUTANEOUS
SUSPENSION,EXTENDED REL RECON 2 MG
2
PA
BYETTA SUBCUTANEOUS PEN INJECTOR
10 MCG/DOSE(250 MCG/ML) 2.4 ML, 5
MCG/DOSE (250 MCG/ML) 1.2 ML
2
PA
DIABETISWEET ORAL POWDER
3
PA; DP
glimepiride oral tablet 1 mg
1
1
1
glipizide oral tablet 10 mg
1
glipizide oral tablet 5 mg
1
glipizide oral tablet extended release 24hr 10 mg
1
glipizide oral tablet extended release 24hr 2.5 mg
1
glipizide oral tablet extended release 24hr 5 mg
1
glyburide micronized oral tablet 1.5 mg
1
glyburide micronized oral tablet 3 mg
1
glyburide micronized oral tablet 6 mg
1
glyburide oral tablet 1.25 mg
1
glyburide oral tablet 2.5 mg
1
glyburide oral tablet 5 mg
1
INVOKAMET ORAL TABLET 150-1,000 MG,
150-500 MG, 50-1,000 MG
2
INVOKAMET ORAL TABLET 50-500 MG
2
INVOKANA ORAL TABLET 100 MG
2
INVOKANA ORAL TABLET 300 MG
2
JANUVIA ORAL TABLET 100 MG
2
2
2
JENTADUETO ORAL TABLET 2.5-1,000 MG,
2.5-500 MG, 2.5-850 MG
2
metformin oral tablet 1,000 mg
1
62
Nome do medicamento
Classificação do
medicamento
metformin oral tablet 500 mg
1
metformin oral tablet 850 mg
1
metformin oral tablet extended release 24 hr 500
mg
1
metformin oral tablet extended release 24 hr 750
mg
1
nateglinide oral tablet 120 mg, 60 mg
1
ST
ONGLYZA ORAL TABLET 2.5 MG
2
ONGLYZA ORAL TABLET 5 MG
2
pioglitazone oral tablet 15 mg
1
1
1
repaglinide oral tablet 0.5 mg, 1 mg, 2 mg
1
ST
SYMLINPEN 120 SUBCUTANEOUS PEN
INJECTOR 2,700 MCG/2.7 ML
2
PA
SYMLINPEN 60 SUBCUTANEOUS PEN
INJECTOR 1,500 MCG/1.5 ML
2
PA
tolazamide oral tablet 250 mg
1
tolazamide oral tablet 500 mg
1
tolbutamide oral tablet 500 mg
1
TRADJENTA ORAL TABLET 5 MG
2
VICTOZA 3-PAK SUBCUTANEOUS PEN
INJECTOR 0.6 MG/0.1 ML (18 MG/3 ML)
2
WELCHOL ORAL POWDER IN PACKET 3.75
GRAM
2
WELCHOL ORAL TABLET 625 MG
2
Blood Glucose Regulators
ACTOPLUS MET XR ORAL TABLET, ER
MULTIPHASE 24 HR 15-1,000 MG
2
ACTOPLUS MET XR ORAL TABLET, ER
2
63
Nome do medicamento
Classificação do
medicamento
AVANDAMET ORAL TABLET 2-1,000 MG
2
CLINITEST REAGENT TABLET
3
DP
DIASTIX STRIP
3
DP
glipizide-metformin oral tablet 2.5-250 mg
1
glipizide-metformin oral tablet 2.5-500 mg, 5-500
mg
1
glyburide-metformin oral tablet 1.25-250 mg
1
glyburide-metformin oral tablet 2.5-500 mg, 5-500
mg
1
JANUMET ORAL TABLET 50-1,000 MG, 50500 MG
2
JANUMET XR ORAL TABLET, ER
2
JANUMET XR ORAL TABLET, ER
MULTIPHASE 24 HR 50-1,000 MG, 50-500 MG
2
KETO-DIASTIX STRIP
3
DP
KOMBIGLYZE XR ORAL TABLET, ER
MULTIPHASE 24 HR 2.5-1,000 MG
2
KOMBIGLYZE XR ORAL TABLET, ER
MULTIPHASE 24 HR 5-1,000 MG, 5-500 MG
2
pioglitazone-glimepiride oral tablet 30-2 mg, 30-4
mg
1
pioglitazone-metformin oral tablet 15-500 mg, 15850 mg
1
GLUCAGEN HYPOKIT INJECTION RECON
SOLN 1 MG
2
GLUCAGON EMERGENCY KIT (HUMAN)
INJECTION KIT 1 MG
2
KORLYM ORAL TABLET 300 MG
2
PA
PROGLYCEM ORAL SUSPENSION 50 MG/ML
2
Glycemic Agents
Insulins
64
Nome do medicamento
Classificação do
medicamento
APIDRA SOLOSTAR SUBCUTANEOUS
INSULIN PEN 100 UNIT/ML
2
APIDRA SUBCUTANEOUS SOLUTION 100
UNIT/ML
2
assure id insulin safety syringe 1 ml 29 x 1/2"
1
gauze pad topical bandage 2 x 2 "
1
HUMALOG KWIKPEN SUBCUTANEOUS
INSULIN PEN 100 UNIT/ML, 200 UNIT/ML (3
ML)
2
HUMALOG MIX 50-50 KWIKPEN
SUBCUTANEOUS INSULIN PEN 100
UNIT/ML (50-50)
2
HUMALOG MIX 50-50 SUBCUTANEOUS
SUSPENSION 100 UNIT/ML (50-50)
2
HUMALOG MIX 75-25 KWIKPEN
UNIT/ML (75-25)
2
HUMALOG MIX 75-25 SUBCUTANEOUS
2
HUMALOG SUBCUTANEOUS CARTRIDGE
100 UNIT/ML
2
HUMALOG SUBCUTANEOUS SOLUTION 100
UNIT/ML, 100 UNIT/ML (PREFILLED
SYRINGE)
2
HUMULIN 70/30 KWIKPEN SUBCUTANEOUS
INSULIN PEN 100 UNIT/ML (70-30)
2
HUMULIN 70/30 SUBCUTANEOUS
2
HUMULIN N KWIKPEN SUBCUTANEOUS
INSULIN PEN 100 UNIT/ML (3 ML)
2
HUMULIN N SUBCUTANEOUS SUSPENSION
100 UNIT/ML
2
HUMULIN R INJECTION SOLUTION 100
UNIT/ML
2
65
Nome do medicamento
Classificação do
medicamento
HUMULIN R U-500 "CONCENTRATED"
SUBCUTANEOUS SOLUTION 500 UNIT/ML
2
insulin syringe-needle u-100 syringe 0.3 ml 29, 1
ml 29 x 1/2", 1/2 ml 28
1
LANTUS SOLOSTAR SUBCUTANEOUS
2
LANTUS SUBCUTANEOUS SOLUTION 100
UNIT/ML
2
LEVEMIR FLEXTOUCH SUBCUTANEOUS
2
LEVEMIR SUBCUTANEOUS SOLUTION 100
UNIT/ML
2
NOVOLIN 70/30 SUBCUTANEOUS
2
NOVOLIN N SUBCUTANEOUS SUSPENSION
100 UNIT/ML
2
NOVOLIN R INJECTION SOLUTION 100
UNIT/ML
2
NOVOLOG FLEXPEN SUBCUTANEOUS
INSULIN PEN 100 UNIT/ML
2
NOVOLOG MIX 70-30 FLEXPEN
UNIT/ML (70-30)
2
NOVOLOG MIX 70-30 SUBCUTANEOUS
SOLUTION 100 UNIT/ML (70-30)
2
NOVOLOG PENFILL SUBCUTANEOUS
CARTRIDGE 100 UNIT/ML
2
NOVOLOG SUBCUTANEOUS SOLUTION 100
UNIT/ML
2
Blood Products/ Modifiers/ Volume Expanders
Anticoagulants
argatroban in 0.9 % sod chlor intravenous
solution 125 mg/125 ml (1 mg/ml)
1
B/D
argatroban intravenous solution 100 mg/ml
1
B/D
66
Nome do medicamento
Classificação do
medicamento
COUMADIN INTRAVENOUS RECON SOLN 5
MG
2
COUMADIN ORAL TABLET 1 MG, 10 MG, 2
MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 MG
2
ELIQUIS ORAL TABLET 2.5 MG, 5 MG
2
enoxaparin subcutaneous solution 300 mg/3 ml
1
enoxaparin subcutaneous syringe 100 mg/ml, 120
mg/0.8 ml, 150 mg/ml, 30 mg/0.3 ml, 40 mg/0.4 ml,
60 mg/0.6 ml, 80 mg/0.8 ml
1
fondaparinux subcutaneous syringe 10 mg/0.8 ml,
2.5 mg/0.5 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml
1
heparin (porcine) in 5 % dex intravenous
parenteral solution 20,000 unit/500 ml (40
unit/ml)
1
heparin (porcine) in nacl (pf) intravenous
parenteral solution 1,000 unit/500 ml
1
heparin (porcine) injection solution 1,000 unit/ml,
10,000 unit/ml, 5,000 unit/ml
1
jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3
mg, 4 mg, 5 mg, 6 mg, 7.5 mg
1
PRADAXA ORAL CAPSULE 150 MG, 75 MG
2
warfarin oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3
mg, 4 mg, 5 mg, 6 mg, 7.5 mg
1
XARELTO ORAL TABLET 10 MG, 15 MG, 20
MG
2
XARELTO ORAL TABLETS,DOSE PACK 15
MG (42)- 20 MG (9)
2
Blood Formation Modifiers
anagrelide oral capsule 0.5 mg, 1 mg
1
ARANESP (IN POLYSORBATE) INJECTION
SOLUTION 100 MCG/ML, 200 MCG/ML, 25
MCG/ML, 300 MCG/ML, 40 MCG/ML, 60
MCG/ML
2
PA
67
Nome do medicamento
Classificação do
medicamento
ARANESP (IN POLYSORBATE) INJECTION
SYRINGE 10 MCG/0.4 ML, 100 MCG/0.5 ML,
150 MCG/0.3 ML, 200 MCG/0.4 ML, 25
MCG/0.42 ML, 300 MCG/0.6 ML, 40 MCG/0.4
ML, 500 MCG/ML, 60 MCG/0.3 ML
2
PA
EPOGEN INJECTION SOLUTION 2,000
UNIT/ML, 20,000 UNIT/2 ML, 20,000 UNIT/ML,
3,000 UNIT/ML, 4,000 UNIT/ML
2
PA
GRANIX SUBCUTANEOUS SYRINGE 300
MCG/0.5 ML, 480 MCG/0.8 ML
2
PA
LEUKINE INJECTION RECON SOLN 250 MCG
2
PA
MOZOBIL SUBCUTANEOUS SOLUTION 24
MG/1.2 ML (20 MG/ML)
2
PA
NEULASTA SUBCUTANEOUS SYRINGE 6
MG/0.6ML
2
PA
NEUMEGA SUBCUTANEOUS RECON SOLN
5 MG
2
PA
NEUPOGEN INJECTION SOLUTION 300
MCG/ML, 480 MCG/1.6 ML
2
PA
NEUPOGEN INJECTION SYRINGE 300
MCG/0.5 ML, 480 MCG/0.8 ML
2
PA
PROCRIT INJECTION SOLUTION 10,000
UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/ML,
3,000 UNIT/ML, 4,000 UNIT/ML, 40,000
UNIT/ML
2
PA
PROMACTA ORAL TABLET 12.5 MG, 25 MG,
50 MG, 75 MG
2
Coagulants
MEPHYTON ORAL TABLET 5 MG
3
tranexamic acid intravenous solution 1,000 mg/10
ml (100 mg/ml)
1
tranexamic acid oral tablet 650 mg
1
VITAMIN K INJECTION SOLUTION 1 MG/0.5
ML
3
DP
DP
68
Nome do medicamento
VITAMIN K1 INJECTION SOLUTION 10
MG/ML
Classificação do
medicamento
3
DP
Platelet Modifying Agents
AGGRENOX ORAL CAPSULE, ER
MULTIPHASE 12 HR 25-200 MG
2
aspirin oral tablet,chewable 81 mg
3
DP
aspirin oral tablet,delayed release (dr/ec) 81 mg
3
DP
BRILINTA ORAL TABLET 90 MG
2
cilostazol oral tablet 100 mg, 50 mg
1
clopidogrel oral tablet 300 mg, 75 mg
1
dipyridamole oral tablet 25 mg, 50 mg, 75 mg
1
EFFIENT ORAL TABLET 10 MG, 5 MG
2
ticlopidine oral tablet 250 mg
1
PA
PA
Cardiovascular Agents
Alpha-Adrenergic Agonists
clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg
1
clonidine transdermal patch weekly 0.1 mg/24 hr,
0.2 mg/24 hr, 0.3 mg/24 hr
1
guanfacine oral tablet 1 mg, 2 mg
1
PA
methyldopa oral tablet 250 mg, 500 mg
1
PA
methyldopate intravenous solution 250 mg/5 ml
1
PA
midodrine oral tablet 10 mg, 2.5 mg, 5 mg
1
NORTHERA ORAL CAPSULE 100 MG, 200
MG, 300 MG
2
Alpha-Adrenergic Blocking Agents
doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg
1
prazosin oral capsule 1 mg, 2 mg, 5 mg
1
terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg
1
Angiotensin II Receptor Antagonists
69
Nome do medicamento
Classificação do
medicamento
BENICAR ORAL TABLET 20 MG, 40 MG, 5
MG
2
irbesartan oral tablet 150 mg, 300 mg, 75 mg
1
losartan oral tablet 100 mg, 25 mg, 50 mg
1
valsartan oral tablet 160 mg, 320 mg, 40 mg, 80
mg
1
ST
ST
Angiotensin-Converting Enzyme (ACE) Inhibitors
benazepril oral tablet 10 mg, 20 mg, 40 mg, 5 mg
1
captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50
mg
1
enalapril maleate oral tablet 10 mg, 2.5 mg, 20
mg, 5 mg
1
fosinopril oral tablet 10 mg, 20 mg, 40 mg
1
lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg,
40 mg, 5 mg
1
moexipril oral tablet 15 mg, 7.5 mg
1
quinapril oral tablet 10 mg, 20 mg, 40 mg, 5 mg
1
ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5
mg
1
trandolapril oral tablet 1 mg, 2 mg, 4 mg
1
Antiarrhythmics
amiodarone oral tablet 200 mg, 400 mg
1
disopyramide phosphate oral capsule 100 mg, 150
mg
1
flecainide oral tablet 100 mg, 150 mg, 50 mg
1
mexiletine oral capsule 150 mg, 200 mg, 250 mg
1
MULTAQ ORAL TABLET 400 MG
2
NORPACE CR ORAL CAPSULE, EXTENDED
RELEASE 100 MG, 150 MG
2
PACERONE ORAL TABLET 100 MG, 200 MG
2
propafenone oral tablet 150 mg, 225 mg, 300 mg
1
PA
PA
70
Nome do medicamento
Classificação do
medicamento
quinidine gluconate oral tablet extended release
324 mg
1
quinidine sulfate oral tablet 200 mg, 300 mg
1
quinidine sulfate oral tablet extended release 300
mg
1
sorine oral tablet 120 mg, 160 mg, 240 mg, 80 mg
1
sotalol af oral tablet 120 mg
1
sotalol oral tablet 160 mg, 240 mg, 80 mg
1
TIKOSYN ORAL CAPSULE 125 MCG, 250
MCG, 500 MCG
2
Beta-Adrenergic Blocking Agents
acebutolol oral capsule 200 mg, 400 mg
1
atenolol oral tablet 100 mg, 25 mg, 50 mg
1
betaxolol oral tablet 10 mg, 20 mg
1
bisoprolol fumarate oral tablet 10 mg, 5 mg
1
carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg,
6.25 mg
1
COREG CR ORAL CAPSULE, ER
MULTIPHASE 24 HR 10 MG, 20 MG, 40 MG,
80 MG
2
labetalol oral tablet 100 mg, 200 mg, 300 mg
1
metoprolol succinate oral tablet extended release
24 hr 100 mg, 200 mg, 25 mg, 50 mg
1
metoprolol tartrate oral tablet 100 mg, 25 mg, 50
mg
1
nadolol oral tablet 20 mg, 40 mg, 80 mg
1
pindolol oral tablet 10 mg, 5 mg
1
propranolol oral capsule,extended release 24 hr
120 mg, 160 mg, 60 mg, 80 mg
1
propranolol oral solution 20 mg/5 ml, 40 mg/5 ml
1
propranolol oral tablet 10 mg, 20 mg, 40 mg, 60
mg, 80 mg
1
71
Nome do medicamento
Classificação do
medicamento
Calcium Channel Blocking Agents
afeditab cr oral tablet extended release 30 mg, 60
mg
1
ST
amlodipine oral tablet 10 mg, 2.5 mg, 5 mg
1
cartia xt oral capsule,extended release 24hr 120
mg, 180 mg, 240 mg, 300 mg
1
diltiazem hcl intravenous recon soln 100 mg
1
diltiazem hcl intravenous solution 5 mg/ml
1
diltiazem hcl oral capsule, extended release 180
mg, 360 mg, 420 mg
1
diltiazem hcl oral capsule,extended release 12 hr
120 mg, 60 mg, 90 mg
1
diltiazem hcl oral capsule,extended release 24hr
120 mg, 240 mg, 300 mg
1
diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90
mg
1
dilt-xr oral capsule,ext release degradable 120
mg, 180 mg, 240 mg
1
felodipine oral tablet extended release 24 hr 10
mg, 2.5 mg, 5 mg
1
isradipine oral capsule 2.5 mg, 5 mg
1
nicardipine oral capsule 20 mg, 30 mg
1
nifedical xl oral tablet extended release 24hr 30
mg, 60 mg
1
ST
nifedipine oral capsule 10 mg, 20 mg
1
PA
nifedipine oral tablet extended release 24hr 30 mg,
60 mg, 90 mg
1
ST
nimodipine oral capsule 30 mg
1
taztia xt oral capsule, extended release 120 mg,
180 mg, 240 mg, 300 mg, 360 mg
1
verapamil oral capsule, 24 hr er pellet ct 100 mg,
200 mg, 300 mg
1
ST
72
Nome do medicamento
Classificação do
medicamento
verapamil oral capsule,ext rel. pellets 24 hr 120
mg, 180 mg, 240 mg, 360 mg
1
verapamil oral tablet 120 mg, 40 mg, 80 mg
1
verapamil oral tablet extended release 120 mg,
180 mg, 240 mg
1
Cardiovascular Agents
ALDACTAZIDE ORAL TABLET 50-50 MG
2
amiloride-hydrochlorothiazide oral tablet 5-50 mg
1
amlodipine-atorvastatin oral tablet 10-10 mg, 1020 mg, 10-40 mg, 10-80 mg, 2.5-10 mg, 2.5-20 mg,
2.5-40 mg, 5-10 mg, 5-20 mg, 5-40 mg, 5-80 mg
1
amlodipine-benazepril oral capsule 10-20 mg, 1040 mg, 2.5-10 mg, 5-10 mg, 5-20 mg, 5-40 mg
1
amlodipine-valsartan oral tablet 10-160 mg, 10320 mg, 5-160 mg, 5-320 mg
1
amlodipine-valsartan-hcthiazid oral tablet 10-16012.5 mg, 10-160-25 mg, 10-320-25 mg, 5-160-12.5
mg, 5-160-25 mg
1
atenolol-chlorthalidone oral tablet 100-25 mg, 5025 mg
1
AZOR ORAL TABLET 10-20 MG, 10-40 MG, 520 MG, 5-40 MG
2
benazepril-hydrochlorothiazide oral tablet 10-12.5
mg, 20-12.5 mg, 20-25 mg, 5-6.25 mg
1
BENICAR HCT ORAL TABLET 20-12.5 MG,
40-12.5 MG, 40-25 MG
2
bisoprolol-hydrochlorothiazide oral tablet 10-6.25
mg, 2.5-6.25 mg, 5-6.25 mg
1
captopril-hydrochlorothiazide oral tablet 25-15
mg, 25-25 mg, 50-15 mg, 50-25 mg
1
DEMSER ORAL CAPSULE 250 MG
2
enalapril-hydrochlorothiazide oral tablet 10-25
mg, 5-12.5 mg
1
ST
PA
73
Nome do medicamento
Classificação do
medicamento
fosinopril-hydrochlorothiazide oral tablet 10-12.5
mg, 20-12.5 mg
1
irbesartan-hydrochlorothiazide oral tablet 15012.5 mg, 300-12.5 mg
1
lisinopril-hydrochlorothiazide oral tablet 10-12.5
mg, 20-12.5 mg, 20-25 mg
1
losartan-hydrochlorothiazide oral tablet 100-12.5
mg, 100-25 mg, 50-12.5 mg
1
methyldopa-hydrochlorothiazide oral tablet 25015 mg, 250-25 mg
1
metoprolol ta-hydrochlorothiaz oral tablet 100-25
mg, 100-50 mg, 50-25 mg
1
moexipril-hydrochlorothiazide oral tablet 15-12.5
mg, 15-25 mg, 7.5-12.5 mg
1
nadolol-bendroflumethiazide oral tablet 40-5 mg,
80-5 mg
1
propranolol-hydrochlorothiazid oral tablet 40-25
mg, 80-25 mg
1
quinapril-hydrochlorothiazide oral tablet 10-12.5
mg, 20-12.5 mg, 20-25 mg
1
reserpine oral tablet 0.1 mg, 0.25 mg
1
SIMCOR ORAL TABLET, ER MULTIPHASE
24 HR 500-20 MG, 750-20 MG
2
spironolacton-hydrochlorothiaz oral tablet 25-25
mg
1
TEKTURNA HCT ORAL TABLET 150-12.5
MG, 150-25 MG, 300-12.5 MG, 300-25 MG
2
triamterene-hydrochlorothiazid oral capsule 37.525 mg, 50-25 mg
1
triamterene-hydrochlorothiazid oral tablet 37.5-25
mg, 75-50 mg
1
TRIBENZOR ORAL TABLET 20-5-12.5 MG,
40-10-12.5 MG, 40-10-25 MG, 40-5-12.5 MG, 405-25 MG
2
PA
PA
74
Nome do medicamento
Classificação do
medicamento
valsartan-hydrochlorothiazide oral tablet 160-12.5
mg, 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5
mg
1
VYTORIN 10-10 ORAL TABLET 10-10 MG
2
2
2
2
ST
Cardiovascular Agents, Other
digitek oral tablet 125 mcg
1
digitek oral tablet 250 mcg
1
PA
digoxin oral solution 50 mcg/ml
1
PA
digoxin oral tablet 125 mcg
1
digoxin oral tablet 250 mcg
1
PA
pentoxifylline oral tablet extended release 400 mg
1
RANEXA ORAL TABLET EXTENDED
RELEASE 12 HR 1,000 MG, 500 MG
2
TEKTURNA ORAL TABLET 150 MG, 300 MG
2
PA
Diuretics, Carbonic Anhydrase Inhibitors
acetazolamide oral capsule, extended release 500
mg
1
acetazolamide oral tablet 125 mg, 250 mg
1
methazolamide oral tablet 25 mg, 50 mg
1
Diuretics, Loop
bumetanide oral tablet 0.5 mg, 1 mg, 2 mg
1
furosemide injection solution 10 mg/ml
1
furosemide injection syringe 10 mg/ml
1
furosemide oral solution 10 mg/ml, 40 mg/5 ml
1
furosemide oral tablet 20 mg, 40 mg, 80 mg
1
torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg
1
Diuretics, Potassium-Sparing
75
Nome do medicamento
Classificação do
medicamento
amiloride oral tablet 5 mg
1
eplerenone oral tablet 25 mg, 50 mg
1
spironolactone oral tablet 100 mg, 25 mg, 50 mg
1
ST
Diuretics, Thiazide
chlorothiazide oral tablet 250 mg, 500 mg
1
chlorthalidone oral tablet 25 mg, 50 mg
1
hydrochlorothiazide oral capsule 12.5 mg
1
hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50
mg
1
indapamide oral tablet 1.25 mg, 2.5 mg
1
methyclothiazide oral tablet 5 mg
1
metolazone oral tablet 10 mg, 2.5 mg, 5 mg
1
Dyslipidemics, Fibric Acid Derivatives
fenofibrate micronized oral capsule 134 mg, 200
mg, 67 mg
1
fenofibrate oral tablet 160 mg, 54 mg
1
fenofibric acid (choline) oral capsule,delayed
release(dr/ec) 135 mg, 45 mg
1
gemfibrozil oral tablet 600 mg
1
Dyslipidemics, HMG COA Reductase Inhibitors
atorvastatin oral tablet 10 mg, 20 mg, 40 mg, 80
mg
1
CRESTOR ORAL TABLET 10 MG, 20 MG, 5
MG
2
CRESTOR ORAL TABLET 40 MG
2
LIVALO ORAL TABLET 1 MG, 2 MG, 4 MG
2
lovastatin oral tablet 10 mg, 20 mg, 40 mg
1
pravastatin oral tablet 10 mg, 20 mg, 40 mg, 80
mg
1
simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg,
80 mg
1
ST
76
Nome do medicamento
Classificação do
medicamento
Dyslipidemics, Other
cholestyramine light oral powder in packet 4 gram
1
cod liver oil oral capsule
3
DP
cod liver oil oral oil
3
DP
colestipol oral granules 5 gram
1
colestipol oral tablet 1 gram
1
JUXTAPID ORAL CAPSULE 10 MG, 20 MG, 30
MG, 40 MG, 5 MG, 60 MG
2
PA
KYNAMRO SUBCUTANEOUS SYRINGE 200
MG/ML
2
PA
niacin (bulk) powder
3
PA; DP
NIACIN FLUSH FREE ORAL CAPSULE 400
MG NIACIN (500 MG)
3
DP
niacin oral capsule, extended release 250 mg, 500
mg
3
DP
niacin oral tablet 100 mg, 50 mg, 500 mg
3
DP
niacin oral tablet extended release 1,000 mg, 250
mg, 750 mg
3
DP
niacin oral tablet extended release 24 hr 1,000 mg,
500 mg, 750 mg
1
omega-3 acid ethyl esters oral capsule 1 gram
1
prevalite oral powder 4 gram
1
QUESTRAN ORAL POWDER IN PACKET 4
GRAM
2
SIMCOR ORAL TABLET, ER MULTIPHASE
24 HR 1,000-20 MG, 1,000-40 MG, 500-40 MG
2
SLO-NIACIN ORAL TABLET EXTENDED
RELEASE 500 MG
3
ZETIA ORAL TABLET 10 MG
2
PA
DP
Vasodilators, Direct-Acting Arterial
hydralazine oral tablet 10 mg, 100 mg, 25 mg, 50
mg
1
77
Nome do medicamento
minoxidil oral tablet 10 mg, 2.5 mg
Classificação do
medicamento
1
Vasodilators, Direct-Acting Arterial/ Venous
isosorbide dinitrate oral tablet 10 mg, 20 mg, 30
mg, 5 mg
1
isosorbide dinitrate oral tablet extended release 40
mg
1
isosorbide mononitrate oral tablet 10 mg, 20 mg
1
isosorbide mononitrate oral tablet extended
release 24 hr 120 mg, 30 mg, 60 mg
1
minitran transdermal patch 24 hour 0.1 mg/hr, 0.2
mg/hr, 0.4 mg/hr, 0.6 mg/hr
1
NITRO-BID TRANSDERMAL OINTMENT 2 %
2
NITRO-DUR TRANSDERMAL PATCH 24
HOUR 0.3 MG/HR, 0.8 MG/HR
2
nitroglycerin transdermal patch 24 hour 0.1
mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr
1
nitroglycerin translingual spray,non-aerosol 400
mcg/spray
1
NITROSTAT SUBLINGUAL TABLET 0.3 MG,
0.4 MG, 0.6 MG
2
RECTIV RECTAL OINTMENT 0.4 % (W/W)
2
Central Nervous System Agents
Attention Deficit Hyperactivity Disorder Agents, Amphetamines
amphetamine salt combo oral tablet 10 mg, 20 mg,
30 mg, 5 mg, 7.5 mg
1
amphetamine salt combo oral tablet 12.5 mg
1
amphetamine salt combo oral tablet 15 mg
1
dextroamphetamine oral capsule, extended release
10 mg
1
15 mg
1
5 mg
1
78
Nome do medicamento
Classificação do
medicamento
dextroamphetamine oral tablet 10 mg
1
dextroamphetamine oral tablet 5 mg
1
dextroamphetamine-amphetamine oral
capsule,extended release 24hr 10 mg, 15 mg, 20
mg, 25 mg, 30 mg, 5 mg
1
Attention Deficit Hyperactivity Disorder Agents, Non-Amphetamines
clonidine hcl oral tablet extended release 12 hr 0.1
mg
1
dexmethylphenidate oral capsule,er biphasic 5050 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 5 mg
1
PA
dexmethylphenidate oral tablet 10 mg, 2.5 mg, 5
mg
1
PA
FOCALIN XR ORAL CAPSULE,ER BIPHASIC
50-50 25 MG, 35 MG
2
PA
metadate er oral tablet extended release 20 mg
1
PA
methylphenidate oral tablet 10 mg, 20 mg, 5 mg
1
PA
methylphenidate oral tablet extended release 20
mg
1
PA
methylphenidate oral tablet extended release 24hr
18 mg, 27 mg, 36 mg, 54 mg
1
PA
STRATTERA ORAL CAPSULE 10 MG, 100
MG, 18 MG, 25 MG, 40 MG, 60 MG, 80 MG
2
Central Nervous System, Other
benzphetamine oral tablet 50 mg
3
PA; DP
diethylpropion oral tablet 25 mg
3
PA; DP
diethylpropion oral tablet extended release 75 mg
3
PA; DP
HORIZANT ORAL TABLET EXTENDED
RELEASE 600 MG
2
NUEDEXTA ORAL CAPSULE 20-10 MG
2
phendimetrazine tartrate oral capsule, extended
release 105 mg
3
PA; DP
phendimetrazine tartrate oral tablet 35 mg
3
PA; DP
79
Nome do medicamento
Classificação do
medicamento
phentermine oral capsule 15 mg, 30 mg, 37.5 mg
3
PA; DP
phentermine oral tablet 37.5 mg
3
PA; DP
QSYMIA ORAL CAPSULE, ER MULTIPHASE
24 HR 11.25-69 MG, 15-92 MG, 3.75-23 MG,
7.5-46 MG
3
PA; DP
riluzole oral tablet 50 mg
1
SUPRENZA ORAL
TABLET,DISINTEGRATING 15 MG, 30 MG,
37.5 MG
3
XENAZINE ORAL TABLET 12.5 MG, 25 MG
2
XENICAL ORAL CAPSULE 120 MG
3
PA
AMPYRA ORAL TABLET EXTENDED
RELEASE 12 HR 10 MG
2
PA
AUBAGIO ORAL TABLET 14 MG, 7 MG
2
PA
AVONEX (WITH ALBUMIN)
INTRAMUSCULAR KIT 30 MCG
2
PA
AVONEX INTRAMUSCULAR PEN INJECTOR
KIT 30 MCG/0.5 ML
2
PA
AVONEX INTRAMUSCULAR SYRINGE KIT
30 MCG/0.5 ML
2
PA
BETASERON SUBCUTANEOUS KIT 0.3 MG
2
PA
COPAXONE SUBCUTANEOUS SYRINGE 20
MG/ML, 40 MG/ML
2
PA
EXTAVIA SUBCUTANEOUS KIT 0.3 MG
2
PA
GILENYA ORAL CAPSULE 0.5 MG
2
PA
REBIF (WITH ALBUMIN) SUBCUTANEOUS
SYRINGE 22 MCG/0.5 ML, 44 MCG/0.5 ML
2
PA
REBIF REBIDOSE SUBCUTANEOUS PEN
INJECTOR 22 MCG/0.5 ML, 44 MCG/0.5 ML,
8.8MCG/0.2ML-22 MCG/0.5ML (6)
2
PA
REBIF TITRATION PACK SUBCUTANEOUS
SYRINGE 8.8MCG/0.2ML-22 MCG/0.5ML (6)
2
PA
PA; DP
Multiple Sclerosis Agents
80
Nome do medicamento
Classificação do
medicamento
TECFIDERA ORAL CAPSULE,DELAYED
RELEASE(DR/EC) 120 MG, 120 MG (14)- 240
MG (46), 240 MG
2
PA
TYSABRI INTRAVENOUS SOLUTION 300
MG/15 ML
2
PA; LA
Dental And Oral Agents
Dental And Oral Agents
cevimeline oral capsule 30 mg
1
chlorhexidine gluconate mucous membrane
mouthwash 0.12 %
1
CUVPOSA ORAL SOLUTION 1 MG/5 ML (0.2
MG/ML)
2
DENTAL BASE GEL
3
periogard mucous membrane mouthwash 0.12 %
1
pilocarpine hcl oral tablet 5 mg, 7.5 mg
1
triamcinolone acetonide dental paste 0.1 %
1
PA; DP
Dermatological Agents
Dermatological Agents
8-MOP ORAL CAPSULE 10 MG
2
PA
acitretin oral capsule 10 mg, 17.5 mg, 25 mg
1
PA
AMLACTIN TOPICAL LOTION 12 %
3
DP
ammonium lactate topical cream 12 %
1
ammonium lactate topical lotion 12 %
1
amnesteem oral capsule 10 mg, 20 mg, 40 mg
1
AQUA GLYCOLIC FACE TOPICAL CREAM
3
PA; DP
ARBEM H-COSMETIC CREAM
3
PA; DP
ARBEM LIPOPEN CREAM
3
PA; DP
AZ TOPICAL CREAM
3
PA; DP
BASE 7542 TRANSDERMAL CREAM
3
PA; DP
calamine phenolated topical lotion
3
DP
81
Nome do medicamento
Classificação do
medicamento
calamine topical lotion
3
DP
calamine-zinc oxide topical lotion
3
DP
calcipotriene topical cream 0.005 %
1
calcipotriene topical ointment 0.005 %
1
calcipotriene topical solution 0.005 %
1
CAPZASIN TOPICAL LIQUID 0.15 %
3
CARAC TOPICAL CREAM 0.5 %
2
claravis oral capsule 10 mg, 20 mg, 30 mg, 40 mg
1
clotrimazole-betamethasone topical cream 1-0.05
%
1
clotrimazole-betamethasone topical lotion 1-0.05
%
1
cocoa butter (bulk) stick
3
PA; DP
cocoa butter (bulk) topical bar
3
PA; DP
cocoa butter (bulk) topical ointment 100 %
3
PA; DP
cormax topical solution 0.05 %
1
ELIDEL TOPICAL CREAM 1 %
2
erythromycin-benzoyl peroxide topical gel 3-5 %
1
fluocinonide topical cream 0.1 %
1
PA
fluorouracil intravenous solution 2.5 gram/50 ml
1
B/D
fluorouracil topical cream 0.5 %, 5 %
1
fluorouracil topical solution 2 %, 5 %
1
fluticasone topical cream 0.05 %
1
fluticasone topical lotion 0.05 %
1
fluticasone topical ointment 0.005 %
1
FREE & CLEAR TOPICAL SHAMPOO
3
PA; DP
HRT BASE (JOJOBA) TRANSDERMAL
CREAM
3
PA; DP
HYDROPHILIC OINTMENT BASE(FAG)
TOPICAL OINTMENT
3
PA; DP
DP
ST
82
Nome do medicamento
Classificação do
medicamento
imiquimod topical cream in packet 5 %
1
JELENE GEL
3
PA; DP
LIPOBASE BASE (GEL MATRIX) TOPICAL
CREAM
3
PA; DP
LIPOVAN CREAM BASE TOPICAL CREAM
3
PA; DP
methoxsalen rapid oral capsule 10 mg
1
PA
MICROSOME BASE CREAM CREAM
3
PA; DP
myorisan oral capsule 10 mg, 20 mg, 40 mg
1
nystatin-triamcinolone topical cream 100,000-0.1
unit/g-%
1
nystatin-triamcinolone topical ointment 100,0000.1 unit/gram-%
1
PEG OINTMENT BASE (BULK) OINTMENT
40-60 %
3
PA; DP
PEGBLEND WAX 59-39-2 %
3
PA; DP
PENTRAVAN PLUS TOPICAL CREAM
3
PA; DP
PENTRAVAN TRANSDERMAL CREAM
3
PA; DP
PHARMABASE COSMETIC TOPICAL CREAM
3
PA; DP
PHARMABASE LIGHT TOPICAL CREAM
3
PA; DP
PHARMABASE NATURAL TOPICAL CREAM
3
PA; DP
PHARMABASE TOPICAL CREAM
3
PA; DP
PHARMABASE VAGINAL CREAM
3
PA; DP
PHYTOBASE CREAM
3
PA; DP
PLO GEL PREMIUM LECITHIN BASE
TRANSDERMAL GEL
3
PA; DP
PLO ULTRAMAX GEL PREM LECITHIN
TRANSDERMAL GEL
3
PA; DP
podofilox topical solution 0.5 %
1
prednicarbate topical cream 0.1 %
1
REGRANEX TOPICAL GEL 0.01 %
2
PA; QL (15 GM per 30 days)
83
Nome do medicamento
Classificação do
medicamento
SANTYL TOPICAL OINTMENT 250
UNIT/GRAM
2
selenium sulfide topical suspension 2.5 %
1
SQUARIC ACID IN BUTANOL LIQUID 150
MG
3
PA; DP
STELARA SUBCUTANEOUS SYRINGE 45
MG/0.5 ML, 90 MG/ML
2
PA
tacrolimus topical ointment 0.03 %, 0.1 %
1
ST
TAZORAC TOPICAL CREAM 0.05 %, 0.1 %
2
TAZORAC TOPICAL GEL 0.05 %, 0.1 %
2
TRANS D HORMONE BASE TOPICAL
CREAM
3
PA; DP
TRANS-PEN TRANSDERMAL
TRANSDERMAL CREAM
3
PA; DP
TRIXAICIN HP TOPICAL CREAM 0.075 %
3
DP
U-BASE TOPICAL CREAM
3
PA; DP
UNIBASE TOPICAL CREAM
3
PA; DP
UVADEX INJECTION SOLUTION 20 MCG/ML
2
B/D
VANIBASE TRADITIONAL FORMULA
TOPICAL CREAM
3
PA; DP
VERSATILE TOPICAL CREAM
3
PA; DP
VERSIGEL CREAM
3
PA; DP
zenatane oral capsule 30 mg
1
ZONALON TOPICAL CREAM 5 %
2
PA
ZYCLARA TOPICAL CREAM IN METEREDDOSE PUMP 2.5 %
2
PA
ZYCLARA TOPICAL CREAM IN PACKET 3.75
%
2
PA
2
PA
Enzyme Replacement/ Modifiers
Enzyme Replacement/ Modifiers
ADAGEN INTRAMUSCULAR SOLUTION 250
UNIT/ML
84
Nome do medicamento
Classificação do
medicamento
ALDURAZYME INTRAVENOUS SOLUTION
2.9 MG/5 ML
2
PA
CEREZYME INTRAVENOUS RECON SOLN
400 UNIT
2
PA
CO Q-10 ORAL CAPSULE 150 MG, 75 MG
3
DP
coenzyme q10 (bulk) powder 100 %
3
PA; DP
coenzyme q10 oral capsule 10 mg, 100 mg, 30 mg,
50 mg, 60 mg
3
DP
CREON ORAL CAPSULE,DELAYED
RELEASE(DR/EC) 12,000-38,000 -60,000 UNIT,
24,000-76,000 -120,000 UNIT, 3,000-9,50015,000 UNIT, 36,000-114,000- 180,000 UNIT,
6,000-19,000 -30,000 UNIT
2
CYSTADANE ORAL POWDER 1 GRAM/1.7
ML
2
CYSTAGON ORAL CAPSULE 150 MG, 50 MG
2
PA
ELAPRASE INTRAVENOUS SOLUTION 6
MG/3 ML
2
PA
ELELYSO INTRAVENOUS RECON SOLN 200
UNIT
2
PA
FABRAZYME INTRAVENOUS RECON SOLN
35 MG
2
PA
KUVAN ORAL POWDER IN PACKET 500 MG
2
PA
KUVAN ORAL TABLET,SOLUBLE 100 MG
2
PA
NAGLAZYME INTRAVENOUS SOLUTION 5
MG/5 ML
2
PA
ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5
MG
2
PA
RAVICTI ORAL LIQUID 1.1 GRAM/ML
2
PA
SUCRAID ORAL SOLUTION 8,500 UNIT/ML
2
PA
VPRIV INTRAVENOUS RECON SOLN 400
UNIT
2
B/D
ZAVESCA ORAL CAPSULE 100 MG
2
PA
85
Nome do medicamento
ZENPEP ORAL CAPSULE,DELAYED
RELEASE(DR/EC) 10,000-34,000 -55,000 UNIT,
15,000-51,000 -82,000 UNIT, 20,000-68,000 109,000 UNIT, 25,000-85,000- 136,000 UNIT,
3,000-10,000- 16,000 UNIT, 40,000-136,000218,000 UNIT, 5,000-17,000 -27,000 UNIT
Classificação do
medicamento
2
Gastrointestinal Agents
Antispasmodics, Gastrointestinal
dicyclomine oral capsule 10 mg
1
dicyclomine oral solution 10 mg/5 ml
1
dicyclomine oral tablet 20 mg
1
glycopyrrolate oral tablet 1 mg, 2 mg
1
KAOPECTATE (BISMUTH SUBSALICY)
ORAL SUSPENSION 262 MG/15 ML
3
methscopolamine oral tablet 2.5 mg, 5 mg
1
DP
Gastrointestinal Agents, Other
aluminum hydroxide gel (bulk) powder
3
PA; DP
aluminum hydroxide gel oral suspension 320 mg/5
ml
3
DP
ANTACID PLUS ANTI-GAS ORAL
SUSPENSION 200-200-20 MG/5 ML
3
DP
ANTI-DIARRHEAL (LOPERAMIDE) ORAL
CAPSULE 2 MG
3
DP
LIQUID 1 MG/5 ML
3
DP
TABLET 2 MG
3
DP
calcium carbonate oral suspension 500 mg/5 ml
(1,250 mg/5 ml)
3
DP
diphenoxylate-atropine oral liquid 2.5-0.025 mg/5
ml
1
diphenoxylate-atropine oral tablet 2.5-0.025 mg
1
EPSOM SALT CRYSTALS 100 %
3
PA; DP
86
Nome do medicamento
Classificação do
medicamento
FULYZAQ ORAL TABLET,DELAYED
2
GATTEX ONE-VIAL SUBCUTANEOUS KIT 5
MG
2
PA
L-GLUTAMINE POWDER
3
PA; DP
loperamide oral capsule 2 mg
1
MAALOX MAXIMUM STRENGTH ORAL
SUSPENSION 400-400-40 MG/5 ML
3
DP
MAGNEBIND 300 ORAL TABLET 250-300 MG
3
DP
magnesium citrate powder
3
PA; DP
MINTOX PLUS ORAL TABLET,CHEWABLE
200-200-25 MG
3
DP
proctozone-hc rectal cream 2.5 %
1
RELISTOR SUBCUTANEOUS SOLUTION 12
MG/0.6 ML
2
PA
RELISTOR SUBCUTANEOUS SYRINGE 12
MG/0.6 ML, 8 MG/0.4 ML
2
PA
simethicone liquid
3
PA; DP
SOOTHE (BISMUTH SUBSALICYLATE)
ORAL TABLET 262 MG
3
DP
SOOTHE (BISMUTH SUBSALICYLATE)
ORAL TABLET,CHEWABLE 262 MG
3
DP
ursodiol oral capsule 300 mg
1
ursodiol oral tablet 250 mg, 500 mg
1
Histamine2 (H2) Receptor Antagonists
cimetidine hcl oral solution 300 mg/5 ml
1
cimetidine oral tablet 200 mg, 300 mg, 400 mg,
800 mg
1
famotidine (pf) intravenous solution 20 mg/2 ml
1
famotidine oral tablet 20 mg, 40 mg
1
nizatidine oral capsule 150 mg, 300 mg
1
ranitidine hcl oral syrup 15 mg/ml
1
87
Nome do medicamento
ranitidine hcl oral tablet 150 mg, 300 mg
Classificação do
medicamento
1
Irritable Bowel Syndrome Agents
alosetron oral tablet 0.5 mg, 1 mg
1
AMITIZA ORAL CAPSULE 24 MCG, 8 MCG
2
BUDESONIDE ORAL
CAPSULE,DELAYED,EXTEND.RELEASE 3
MG
2
DELZICOL ORAL CAPSULE,DELAYED
RELEASE(DR/EC) 400 MG
2
LINZESS ORAL CAPSULE 145 MCG, 290 MCG
2
Laxatives
bismuth subcarbonate (bulk) powder
3
PA; DP
bismuth subnitrate (bulk) powder 100 %
3
PA; DP
constulose oral solution 10 gram/15 ml
1
docusate calcium oral capsule 240 mg
3
DP
docusate sodium oral capsule 250 mg
3
DP
docusate sodium oral liquid 50 mg/5 ml
3
DP
docusate sodium oral syrup 60 mg/15 ml
3
DP
DOCUSOL RECTAL ENEMA 283 MG
3
DP
ENEMEEZ PLUS RECTAL ENEMA 283-20
MG/5 ML
3
DP
ENEMEEZ RECTAL ENEMA 283 MG/5 ML
3
DP
enulose oral solution 10 gram/15 ml
1
FLEET GLYCERIN (CHILD) RECTAL
SUPPOSITORY
3
DP
FLEET LAXATIVE ORAL TABLET,DELAYED
3
DP
gavilyte-c oral recon soln 240-22.72-6.72 -5.84
gram
1
gavilyte-g oral recon soln 236-22.74-6.74 -5.86
gram
1
88
Nome do medicamento
Classificação do
medicamento
gavilyte-n oral recon soln 420 gram
1
generlac oral solution 10 gram/15 ml
1
GENTLE LAXATIVE RECTAL SUPPOSITORY
10 MG
3
DP
glycerin (bulk) liquid 100 %
3
PA; DP
KONSYL (SUGAR) ORAL POWDER 3.4
GRAM/11 GRAM
3
DP
KONSYL FORMULA-D ORAL POWDER 3.4
GRAM/ 6.5 GRAM
3
DP
KONSYL SUGAR-FREE (ASPARTAME) ORAL
POWDER 3.5 GRAM/5.8 GRAM
3
DP
KONSYL SUGAR-FREE ORAL POWDER 6
GRAM/6 GRAM
3
DP
KRISTALOSE ORAL PACKET 10 GRAM, 20
GRAM
2
PA
lactulose oral solution 10 gram/15 ml
1
LAXATIVE PEG 3350 ORAL POWDER 17
GRAM/DOSE
3
DP
LAXATIVE PEG 3350 ORAL POWDER IN
PACKET 17 GRAM
3
DP
methylcellulose (bulk) gel 1 %, 2 %, 3 %
3
PA; DP
PEDIA-LAX STOOL SOFTENER ORAL
SYRUP 50 MG/15 ML
3
DP
polyethylene glycol 1000 powder
3
PA; DP
3
PA; DP
polyethylene glycol 300 liquid
3
PA; DP
polyethylene glycol 3350 oral powder 17
gram/dose
1
3
PA; DP
polyethylene glycol 400 (bulk) liquid
3
PA; DP
polyethylene glycol 8000(bulk) powder
3
PA; DP
SENEXON ORAL SYRUP 8.8 MG/5 ML
3
DP
89
Nome do medicamento
Classificação do
medicamento
SENEXON ORAL TABLET 8.6 MG
3
DP
sodium phosphate monobasic powder
3
PA; DP
STOOL SOFTENER ORAL CAPSULE 100 MG
3
DP
STOOL SOFTENER-LAXATIVE ORAL
TABLET 8.6-50 MG
3
DP
trilyte with flavor packets oral recon soln 420
gram
1
Protectants
misoprostol oral tablet 100 mcg, 200 mcg
1
sucralfate oral tablet 1 gram
1
Proton Pump Inhibitors
DEXILANT ORAL CAPSULE,BIPHASE
DELAYED RELEAS 30 MG, 60 MG
2
ST
lansoprazole oral capsule,delayed release(dr/ec)
15 mg, 30 mg
1
ST
omeprazole oral capsule,delayed release(dr/ec) 10
mg, 20 mg, 40 mg
1
pantoprazole intravenous recon soln 40 mg
1
pantoprazole oral tablet,delayed release (dr/ec) 20
mg, 40 mg
1
PROTONIX INTRAVENOUS RECON SOLN 40
MG
2
Genitourinary Agents
Antispasmodics, Urinary
ENABLEX ORAL TABLET EXTENDED
RELEASE 24 HR 15 MG, 7.5 MG
2
flavoxate oral tablet 100 mg
1
MYRBETRIQ ORAL TABLET EXTENDED
2
oxybutynin chloride oral syrup 5 mg/5 ml
1
oxybutynin chloride oral tablet 5 mg
1
90
Nome do medicamento
Classificação do
medicamento
oxybutynin chloride oral tablet extended release
24hr 10 mg, 15 mg, 5 mg
1
tolterodine oral capsule,extended release 24hr 2
mg, 4 mg
1
ST
tolterodine oral tablet 1 mg, 2 mg
1
ST
TOVIAZ ORAL TABLET EXTENDED
2
VESICARE ORAL TABLET 10 MG, 5 MG
2
Benign Prostatic Hypertrophy Agents
alfuzosin oral tablet extended release 24 hr 10 mg
1
AVODART ORAL CAPSULE 0.5 MG
2
finasteride oral tablet 5 mg
1
JALYN ORAL CAPSULE, ER MULTIPHASE 24
HR 0.5-0.4 MG
2
tamsulosin oral capsule,extended release 24hr 0.4
mg
1
Genitourinary Agents, Other
bethanechol chloride oral tablet 10 mg, 25 mg, 5
mg, 50 mg
1
DEPEN TITRATABS ORAL TABLET 250 MG
2
ELMIRON ORAL CAPSULE 100 MG
2
potassium citrate oral tablet extended release 10
meq (1,080 mg), 15 meq, 5 meq (540 mg)
1
sodium phenylbutyrate oral powder 0.94
gram/gram
1
PA
PA
Phosphate Binders
calcium acetate oral capsule 667 mg
1
FOSRENOL ORAL POWDER IN PACKET
1,000 MG, 750 MG
2
FOSRENOL ORAL TABLET,CHEWABLE
1,000 MG, 500 MG, 750 MG
2
RENAGEL ORAL TABLET 400 MG, 800 MG
2
91
Nome do medicamento
Classificação do
medicamento
RENVELA ORAL POWDER IN PACKET 0.8
GRAM, 2.4 GRAM
2
RENVELA ORAL TABLET 800 MG
2
Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal)
Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal)
ala-cort topical cream 1 %
1
alclometasone topical cream 0.05 %
1
alclometasone topical ointment 0.05 %
1
amcinonide topical cream 0.1 %
1
amcinonide topical lotion 0.1 %
1
amcinonide topical ointment 0.1 %
1
clobetasol topical gel 0.05 %
1
clobetasol topical ointment 0.05 %
1
clobetasol topical solution 0.05 %
1
clobetasol-emollient topical cream 0.05 %
1
desonide topical cream 0.05 %
1
desonide topical lotion 0.05 %
1
desonide topical ointment 0.05 %
1
desoximetasone topical cream 0.05 %, 0.25 %
1
desoximetasone topical gel 0.05 %
1
desoximetasone topical ointment 0.05 %, 0.25 %
1
diflorasone topical cream 0.05 %
1
diflorasone topical ointment 0.05 %
1
fludrocortisone oral tablet 0.1 mg
1
fluocinolone topical cream 0.01 %, 0.025 %
1
fluocinolone topical ointment 0.025 %
1
fluocinolone topical solution 0.01 %
1
fluocinonide topical gel 0.05 %
1
fluocinonide topical ointment 0.05 %
1
92
Nome do medicamento
Classificação do
medicamento
fluocinonide topical solution 0.05 %
1
fluocinonide-e topical cream 0.05 %
1
halobetasol propionate topical cream 0.05 %
1
halobetasol propionate topical ointment 0.05 %
1
hydrocortisone butyrate topical ointment 0.1 %
1
hydrocortisone butyrate topical solution 0.1 %
1
hydrocortisone butyr-emollient topical cream 0.1
%
1
hydrocortisone oral tablet 10 mg
1
hydrocortisone topical cream 1 %, 2.5 %
1
hydrocortisone topical lotion 2.5 %
1
hydrocortisone topical ointment 1 %, 2.5 %
1
hydrocortisone valerate topical cream 0.2 %
1
hydrocortisone valerate topical ointment 0.2 %
1
lokara topical lotion 0.05 %
1
methylprednisolone oral tablets,dose pack 4 mg
1
mometasone topical cream 0.1 %
1
mometasone topical ointment 0.1 %
1
mometasone topical solution 0.1 %
1
prednicarbate topical ointment 0.1 %
1
procto-pak rectal cream 1 %
1
TEMOVATE TOPICAL CREAM 0.05 %
2
triamcinolone acetonide topical cream 0.025 %,
0.1 %, 0.5 %
1
triamcinolone acetonide topical lotion 0.025 %,
0.1 %
1
triamcinolone acetonide topical ointment 0.025 %,
0.1 %, 0.5 %
1
triderm topical cream 0.1 %
1
PA
Hormonal Agents, Stimulant/ Replacement/ Modifying (Pituitary)
93
Nome do medicamento
Classificação do
medicamento
Hormonal Agents, Stimulant/ Replacement/ Modifying (Pituitary)
chorionic gonadotropin, human intramuscular
recon soln 10,000 unit
1
desmopressin injection solution 4 mcg/ml
1
desmopressin nasal solution 0.1 mg/ml
(refrigerate)
1
desmopressin nasal spray,non-aerosol 10
mcg/spray (0.1 ml)
1
desmopressin oral tablet 0.1 mg, 0.2 mg
1
EGRIFTA SUBCUTANEOUS RECON SOLN 1
MG
2
PA
GENOTROPIN MINIQUICK SUBCUTANEOUS
SYRINGE 0.2 MG/0.25 ML, 0.4 MG/0.25 ML,
0.6 MG/0.25 ML, 0.8 MG/0.25 ML, 1 MG/0.25
ML, 1.2 MG/0.25 ML, 1.4 MG/0.25 ML, 1.6
MG/0.25 ML, 1.8 MG/0.25 ML, 2 MG/0.25 ML
2
PA
GENOTROPIN SUBCUTANEOUS
CARTRIDGE 12 MG/ML (36 UNIT/ML), 5
MG/ML (15 UNIT/ML)
2
PA
HUMATROPE INJECTION CARTRIDGE 12
MG (36 UNIT), 24 MG (72 UNIT), 6 MG (18
UNIT)
2
PA
HUMATROPE INJECTION RECON SOLN 5 (15
UNIT) MG
2
PA
INCRELEX SUBCUTANEOUS SOLUTION 10
MG/ML
2
PA
NORDITROPIN FLEXPRO SUBCUTANEOUS
PEN INJECTOR 10 MG/1.5 ML (6.7 MG/ML),
15 MG/1.5 ML (10 MG/ML), 5 MG/1.5 ML (3.3
MG/ML)
2
PA
NORDITROPIN NORDIFLEX
SUBCUTANEOUS PEN INJECTOR 30 MG/3
ML (10 MG/ML)
2
PA
NUTROPIN AQ NUSPIN SUBCUTANEOUS
CARTRIDGE 5 MG/2 ML (2.5 MG/ML)
2
PA
94
Nome do medicamento
Classificação do
medicamento
NUTROPIN AQ SUBCUTANEOUS
CARTRIDGE 20 MG/2 ML (10 MG/ML)
2
PA
OMNITROPE SUBCUTANEOUS CARTRIDGE
10 MG/1.5 ML (6.7 MG/ML), 5 MG/1.5 ML (3.3
MG/ML)
2
PA
OMNITROPE SUBCUTANEOUS RECON
SOLN 5.8 MG
2
PA
SEROSTIM SUBCUTANEOUS RECON SOLN 4
MG, 5 MG, 6 MG
2
PA
Hormonal Agents, Stimulant/ Replacement/ Modifying (Sex Hormones/ Modifiers)
Anabolic Steroids
ANADROL-50 ORAL TABLET 50 MG
2
oxandrolone oral tablet 10 mg, 2.5 mg
1
PA
Androgens
ANDROGEL TRANSDERMAL GEL IN
METERED-DOSE PUMP 1.25 GRAM/
ACTUATION (1 %), 20.25 MG/1.25 GRAM
(1.62 %)
2
ST
ANDROGEL TRANSDERMAL GEL IN
PACKET 1 % (25 MG/2.5GRAM), 1 % (50 MG/5
GRAM), 1.62 % (20.25 MG/1.25 GRAM), 1.62 %
(40.5 MG/2.5 GRAM)
2
ST
DANAZOL ORAL CAPSULE 100 MG, 200 MG,
50 MG
2
TESTIM TRANSDERMAL GEL 50 MG/5
GRAM (1 %)
2
testosterone cypionate intramuscular oil 100
mg/ml, 200 mg/ml
1
testosterone transdermal gel in metered-dose
pump 1.25 gram/ actuation (1 %)
1
testosterone transdermal gel in packet 1 % (25
mg/2.5gram), 1 % (50 mg/5 gram)
1
ST
Estrogens
95
Nome do medicamento
Classificação do
medicamento
ESTRACE VAGINAL CREAM 0.01 % (0.1
MG/GRAM)
2
estradiol oral tablet 0.5 mg, 1 mg, 2 mg
1
estradiol transdermal patch weekly 0.025 mg/24
hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.06 mg/24
hr, 0.075 mg/24 hr, 0.1 mg/24 hr
1
estradiol valerate intramuscular oil 20 mg/ml
1
ESTRING VAGINAL RING 2 MG
2
estropipate oral tablet 0.75 mg, 1.5 mg, 3 mg
1
marlissa oral tablet 0.15-0.03 mg
1
MENEST ORAL TABLET 0.3 MG, 0.625 MG,
1.25 MG, 2.5 MG
2
PREMARIN INJECTION RECON SOLN 25 MG
2
PREMARIN ORAL TABLET 0.3 MG, 0.45 MG,
0.625 MG, 0.9 MG, 1.25 MG
2
PREMARIN VAGINAL CREAM 0.625
MG/GRAM
2
VAGIFEM VAGINAL TABLET 10 MCG
2
PA
PA
Hormonal Agents, Stimulant/ Replacement/ Modifying (Sex Hormones/ Modifiers)
apri oral tablet 0.15-0.03 mg
1
aranelle (28) oral tablet 0.5/1/0.5-35 mg-mcg
1
aubra oral tablet 0.1-20 mg-mcg
1
aviane oral tablet 0.1-20 mg-mcg
1
balziva (28) oral tablet 0.4-35 mg-mcg
1
briellyn oral tablet 0.4-35 mg-mcg
1
CLIMARA PRO TRANSDERMAL PATCH
WEEKLY 0.045-0.015 MG/24 HR
2
COMBIPATCH TRANSDERMAL PATCH
SEMIWEEKLY 0.05-0.14 MG/24 HR, 0.05-0.25
MG/24 HR
2
cryselle (28) oral tablet 0.3-30 mg-mcg
1
cyclafem 1/35 (28) oral tablet 1-35 mg-mcg
1
96
Nome do medicamento
Classificação do
medicamento
cyclafem 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35
mcg
1
deblitane oral tablet 0.35 mg
1
delyla (28) oral tablet 0.1-20 mg-mcg
1
desog-e.estradiol/e.estradiol oral tablet 0.15-0.02
mgx21 /0.01 mg x 5
1
drospirenone-ethinyl estradiol oral tablet 3-0.03
mg
1
emoquette oral tablet 0.15-0.03 mg
1
enpresse oral tablet 50-30 (6)/75-40 (5)/12530(10)
1
estradiol valerate intramuscular oil 40 mg/ml
1
estradiol-norethindrone acet oral tablet 1-0.5 mg
1
falmina (28) oral tablet 0.1-20 mg-mcg
1
gildagia oral tablet 0.4-35 mg-mcg
1
gildess oral tablet 1.5-30 mg-mcg
1
introvale oral tablets,dose pack,3 month 0.15-30
mg-mcg
1
jinteli oral tablet 1-5 mg-mcg
1
junel 1.5/30 (21) oral tablet 1.5-30 mg-mcg
1
junel 1/20 (21) oral tablet 1-20 mg-mcg
1
junel fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg
(21)/75 mg (7)
1
junel fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75
mg (7)
1
kariva (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x
5
1
kelnor 1/35 (28) oral tablet 1-35 mg-mcg
1
larin 1.5/30 (21) oral tablet 1.5-30 mg-mcg
1
larin 1/20 (21) oral tablet 1-20 mg-mcg
1
larin fe oral tablet 1 mg-20 mcg (21)/75 mg (7),
1.5 mg-30 mcg (21)/75 mg (7)
1
97
Nome do medicamento
Classificação do
medicamento
leena 28 oral tablet 0.5/1/0.5-35 mg-mcg
1
lessina oral tablet 0.1-20 mg-mcg
1
levonest (28) oral tablet 50-30 (6)/75-40 (5)/12530(10)
1
levonorgestrel-ethinyl estrad oral tablet 0.1-20
mg-mcg
1
levonorgestrel-ethinyl estrad oral tablets,dose
pack,3 month 0.15-30 mg-mcg
1
levora-28 oral tablet 0.15-0.03 mg
1
lopreeza oral tablet 0.5-0.1 mg, 1-0.5 mg
1
lutera (28) oral tablet 0.1-20 mg-mcg
1
microgestin 1.5/30 (21) oral tablet 1.5-30 mg-mcg
1
microgestin 1/20 (21) oral tablet 1-20 mg-mcg
1
microgestin fe 1.5/30 (28) oral tablet 1.5 mg-30
mcg (21)/75 mg (7)
1
microgestin fe 1/20 (28) oral tablet 1 mg-20 mcg
(21)/75 mg (7)
1
mimvey lo oral tablet 0.5-0.1 mg
1
mononessa (28) oral tablet 0.25-35 mg-mcg
1
necon 0.5/35 (28) oral tablet 0.5-35 mg-mcg
1
necon 1/35 (28) oral tablet 1-35 mg-mcg
1
necon 10/11 (28) oral tablet 0.5-35/1-35 mgmcg/mg-mcg
1
necon 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg
1
nora-be oral tablet 0.35 mg
1
norethindrone ac-eth estradiol oral tablet 1-5 mgmcg
1
norlyroc oral tablet 0.35 mg
1
nortrel 0.5/35 (28) oral tablet 0.5-35 mg-mcg
1
nortrel 1/35 (21) oral tablet 1-35 mg-mcg
1
nortrel 1/35 (28) oral tablet 1-35 mg-mcg
1
98
Nome do medicamento
Classificação do
medicamento
nortrel 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35
mcg
1
ocella oral tablet 3-0.03 mg
1
orsythia oral tablet 0.1-20 mg-mcg
1
pimtrea (28) oral tablet 0.15-0.02 mgx21 /0.01 mg
x5
1
pirmella oral tablet 1-35 mg-mcg
1
portia oral tablet 0.15-0.03 mg
1
PREMPHASE ORAL TABLET 0.625 MG (14)/
0.625MG-5MG(14)
2
PREMPRO ORAL TABLET 0.3-1.5 MG, 0.451.5 MG, 0.625-2.5 MG, 0.625-5 MG
2
previfem oral tablet 0.25-35 mg-mcg
1
quasense oral tablets,dose pack,3 month 0.15-30
mg-mcg
1
reclipsen (28) oral tablet 0.15-0.03 mg
1
sharobel oral tablet 0.35 mg
1
sprintec (28) oral tablet 0.25-35 mg-mcg
1
sronyx oral tablet 0.1-20 mg-mcg
1
tarina fe oral tablet 1 mg-20 mcg (21)/75 mg (7)
1
tri-legest fe oral tablet 1-20(5)/1-30(7) /1mg35mcg (9)
1
trinessa (28) oral tablet 0.18/0.215/0.25 mg-35
mcg (28)
1
tri-previfem (28) oral tablet 0.18/0.215/0.25 mg-35
mcg (28)
1
tri-sprintec (28) oral tablet 0.18/0.215/0.25 mg-35
mcg (28)
1
trivora (28) oral tablet 50-30 (6)/75-40 (5)/12530(10)
1
velivet triphasic regimen (28) oral tablet
0.1/.125/.15-25 mg-mcg
1
vyfemla (28) oral tablet 0.4-35 mg-mcg
1
99
Nome do medicamento
Classificação do
medicamento
xulane transdermal patch weekly 150-35 mcg/24
hr
1
zenchent (28) oral tablet 0.4-35 mg-mcg
1
zovia 1/35e (28) oral tablet 1-35 mg-mcg
1
zovia 1/50e (28) oral tablet 1-50 mg-mcg
1
Progestins
camila oral tablet 0.35 mg
1
DEPO-PROVERA INTRAMUSCULAR
SOLUTION 400 MG/ML
2
PA
DEPO-SUBQ PROVERA 104
SUBCUTANEOUS SYRINGE 104 MG/0.65 ML
2
PA
errin oral tablet 0.35 mg
1
jolivette oral tablet 0.35 mg
1
lyza oral tablet 0.35 mg
1
medroxyprogesterone intramuscular suspension
150 mg/ml
1
medroxyprogesterone oral tablet 10 mg, 2.5 mg, 5
mg
1
MEGACE ES ORAL SUSPENSION 625 MG/5
ML
2
PA
megestrol oral suspension 400 mg/10 ml (40
mg/ml)
1
PA
megestrol oral tablet 20 mg, 40 mg
1
PA
norethindrone (contraceptive) oral tablet 0.35 mg
1
norethindrone acetate oral tablet 5 mg
1
progesterone micronized oral capsule 100 mg, 200
mg
1
Selective Estrogen Receptor Modifying Agents
raloxifene oral tablet 60 mg
1
Hormonal Agents, Stimulant/ Replacement/ Modifying (Thyroid)
Hormonal Agents, Stimulant/ Replacement/ Modifying (Thyroid)
100
Nome do medicamento
Classificação do
medicamento
levothyroxine intravenous recon soln 100 mcg
1
levothyroxine oral tablet 100 mcg, 112 mcg, 125
mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25
mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg
1
levoxyl oral tablet 100 mcg, 112 mcg, 125 mcg,
137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50
mcg, 75 mcg, 88 mcg
1
liothyronine intravenous solution 10 mcg/ml
1
liothyronine oral tablet 25 mcg, 5 mcg, 50 mcg
1
SYNTHROID ORAL TABLET 100 MCG, 112
MCG, 125 MCG, 137 MCG, 150 MCG, 175
MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG,
75 MCG, 88 MCG
2
unithroid oral tablet 100 mcg, 112 mcg, 125 mcg,
150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50
mcg, 75 mcg, 88 mcg
1
Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers)
Androgens
ANDROXY ORAL TABLET 10 MG
2
Estrogens
CENESTIN ORAL TABLET 0.3 MG, 0.45 MG,
0.625 MG, 0.9 MG
2
low-ogestrel (28) oral tablet 0.3-30 mg-mcg
1
PA
Progesterone Agonists/Antagonists
ELLA ORAL TABLET 30 MG
2
Hormonal Agents, Suppressant (Adrenal)
Hormonal Agents, Suppressant (Adrenal)
LYSODREN ORAL TABLET 500 MG
2
Hormonal Agents, Suppressant (Parathyroid)
Hormonal Agents, Suppressant (Parathyroid)
SENSIPAR ORAL TABLET 30 MG, 60 MG, 90
MG
2
PA
101
Nome do medicamento
Classificação do
medicamento
Hormonal Agents, Suppressant (Pituitary)
Hormonal Agents, Suppressant (Pituitary)
cabergoline oral tablet 0.5 mg
1
ELIGARD SUBCUTANEOUS SYRINGE 22.5
MG (3 MONTH), 30 MG (4 MONTH), 45 MG (6
MONTH), 7.5 MG (1 MONTH)
2
PA
FIRMAGON KIT W DILUENT SYRINGE
SUBCUTANEOUS RECON SOLN 120 MG, 80
MG
2
PA
leuprolide subcutaneous kit 1 mg/0.2 ml
1
LUPRON DEPOT (3 MONTH)
INTRAMUSCULAR SYRINGE KIT 11.25 MG,
22.5 MG
2
PA
INTRAMUSCULAR SYRINGE KIT 30 MG
2
PA
INTRAMUSCULAR SYRINGE KIT 45 MG
2
PA
LUPRON DEPOT INTRAMUSCULAR
SYRINGE KIT 3.75 MG, 7.5 MG
2
PA
LUPRON DEPOT-PED INTRAMUSCULAR KIT
11.25 MG, 15 MG
2
PA
octreotide acetate injection solution 1,000 mcg/ml,
500 mcg/ml
1
PA
OCTREOTIDE ACETATE INJECTION
SOLUTION 100 MCG/ML, 200 MCG/ML, 50
MCG/ML
2
PA
SANDOSTATIN LAR DEPOT
INTRAMUSCULAR KIT 10 MG, 20 MG, 30 MG
2
PA
SIGNIFOR SUBCUTANEOUS SOLUTION 0.3
MG/ML (1 ML), 0.6 MG/ML (1 ML), 0.9 MG/ML
(1 ML)
2
PA
SOMATULINE DEPOT SUBCUTANEOUS
SYRINGE 120 MG/0.5 ML, 60 MG/0.2 ML, 90
MG/0.3 ML
2
PA
102
Nome do medicamento
Classificação do
medicamento
SOMAVERT SUBCUTANEOUS RECON SOLN
10 MG, 15 MG, 20 MG, 25 MG, 30 MG
2
PA
SYNAREL NASAL SPRAY,NON-AEROSOL 2
MG/ML
2
PA
TRELSTAR INTRAMUSCULAR SUSPENSION
FOR RECONSTITUTION 22.5 MG
2
PA
TRELSTAR INTRAMUSCULAR SYRINGE
11.25 MG/2 ML, 3.75 MG/2 ML
2
PA
Hormonal Agents, Suppressant (Thyroid)
Antithyroid Agents
methimazole oral tablet 10 mg, 5 mg
1
potassium iodide (bulk) crystals 100 %
3
propylthiouracil oral tablet 50 mg
1
PA; DP
Immunological Agents
Angioedema (HAE) Agents
CINRYZE INTRAVENOUS RECON SOLN 500
UNIT (5 ML)
2
PA
FIRAZYR SUBCUTANEOUS SYRINGE 30
MG/3 ML
2
PA
ACTEMRA SUBCUTANEOUS SYRINGE 162
MG/0.9 ML
2
PA
AFINITOR DISPERZ ORAL TABLET FOR
SUSPENSION 2 MG, 3 MG, 5 MG
2
PA
ASTAGRAF XL ORAL CAPSULE,EXTENDED
RELEASE 24HR 0.5 MG, 1 MG, 5 MG
2
B/D
ATGAM INTRAVENOUS INJECTABLE 50
MG/ML
2
B/D
AZASAN ORAL TABLET 100 MG, 75 MG
2
PA
azathioprine oral tablet 50 mg
1
B/D
BENLYSTA INTRAVENOUS RECON SOLN
120 MG
2
PA
Immune Suppressants
103
Nome do medicamento
Classificação do
medicamento
CIMZIA POWDER FOR RECONST
SUBCUTANEOUS KIT 400 MG (200 MG X 2
VIALS)
2
PA
CIMZIA SUBCUTANEOUS SYRINGE KIT 400
MG/2 ML (200 MG/ML X 2)
2
PA
cyclosporine intravenous solution 250 mg/5 ml
1
B/D
cyclosporine modified oral capsule 100 mg, 25
mg, 50 mg
1
B/D
cyclosporine modified oral solution 100 mg/ml
1
B/D
cyclosporine oral capsule 100 mg, 25 mg
1
B/D
ENBREL SUBCUTANEOUS RECON SOLN 25
MG (1 ML)
2
PA
ENBREL SUBCUTANEOUS SYRINGE 25
MG/0.5ML (0.51), 50 MG/ML (0.98 ML)
2
PA
ENBREL SURECLICK SUBCUTANEOUS PEN
INJECTOR 50 MG/ML (0.98 ML)
2
PA
gengraf oral capsule 100 mg, 25 mg
1
B/D
gengraf oral solution 100 mg/ml
1
B/D
HUMIRA CROHN'S DIS START PCK
SUBCUTANEOUS PEN INJECTOR KIT 40
MG/0.8 ML
2
PA
HUMIRA SUBCUTANEOUS SYRINGE KIT 10
MG/0.2 ML, 20 MG/0.4 ML, 40 MG/0.8 ML
2
PA
KINERET SUBCUTANEOUS SYRINGE 100
MG/0.67 ML
2
PA
mercaptopurine oral tablet 50 mg
1
methotrexate sodium (pf) injection recon soln 1
gram
1
methotrexate sodium (pf) injection solution 25
mg/ml
1
methotrexate sodium oral tablet 2.5 mg
1
mycophenolate mofetil oral capsule 250 mg
1
B/D
mycophenolate mofetil oral suspension for
reconstitution 200 mg/ml
1
B/D
104
Nome do medicamento
Classificação do
medicamento
mycophenolate mofetil oral tablet 500 mg
1
B/D
mycophenolate sodium oral tablet,delayed release
(dr/ec) 180 mg, 360 mg
1
B/D
NULOJIX INTRAVENOUS RECON SOLN 250
MG
2
B/D
ORENCIA (WITH MALTOSE) INTRAVENOUS
RECON SOLN 250 MG
2
PA
ORENCIA SUBCUTANEOUS SYRINGE 125
MG/ML
2
PA
OTEZLA ORAL TABLET 30 MG
2
PA
OTEZLA STARTER ORAL TABLETS,DOSE
PACK 10 MG (4)-20 MG (4)-30 MG (47), 10 MG
(4)-20 MG (4)-30 MG(19)
2
PA
PROGRAF INTRAVENOUS SOLUTION 5
MG/ML
2
PA
RAPAMUNE ORAL SOLUTION 1 MG/ML
2
PA
REMICADE INTRAVENOUS RECON SOLN
100 MG
2
PA
RHEUMATREX ORAL TABLETS,DOSE PACK
2.5 MG, 2.5 MG (DOSE PACK 12), 2.5 MG
(DOSE PACK 16), 2.5 MG (DOSE PACK 20),
2.5 MG (DOSE PACK 8)
2
PA
SANDIMMUNE ORAL SOLUTION 100 MG/ML
2
B/D
SIMPONI ARIA INTRAVENOUS SOLUTION
12.5 MG/ML
2
PA
SIMPONI SUBCUTANEOUS PEN INJECTOR
100 MG/ML, 50 MG/0.5 ML
2
PA
SIMPONI SUBCUTANEOUS SYRINGE 50
MG/0.5 ML
2
PA
SIMULECT INTRAVENOUS RECON SOLN 20
MG
2
PA
sirolimus oral tablet 0.5 mg, 1 mg, 2 mg
1
PA
tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg
1
B/D
105
Nome do medicamento
Classificação do
medicamento
TORISEL INTRAVENOUS RECON SOLN 30
MG/3 ML (10 MG/ML) (FIRST)
2
PA
TREXALL ORAL TABLET 10 MG, 15 MG, 5
MG, 7.5 MG
2
PA
ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG,
0.75 MG
2
B/D
BIVIGAM INTRAVENOUS SOLUTION 10 %
2
B/D
CARIMUNE NF NANOFILTERED
INTRAVENOUS RECON SOLN 6 GRAM
2
B/D
FLEBOGAMMA DIF INTRAVENOUS
SOLUTION 10 %
2
B/D
GAMASTAN S/D INTRAMUSCULAR
SOLUTION 15-18 % RANGE
2
B/D
GAMMAGARD LIQUID INJECTION
SOLUTION 10 %
2
B/D
GAMMAKED INJECTION SOLUTION 1
GRAM/10 ML (10 %), 10 GRAM/100 ML (10
%), 2.5 GRAM/25 ML (10 %), 20 GRAM/200 ML
(10 %), 5 GRAM/50 ML (10 %)
2
B/D
GAMMAPLEX INTRAVENOUS SOLUTION 5
%
2
B/D
GAMUNEX-C INJECTION SOLUTION 1
GRAM/10 ML (10 %)
2
B/D
HYPERRAB S/D (PF) INTRAMUSCULAR
SOLUTION 150 UNIT/ML, 150 UNIT/ML (10
ML)
2
PRIVIGEN INTRAVENOUS SOLUTION 10 %
2
B/D
SYNAGIS INTRAMUSCULAR SOLUTION 50
MG/0.5 ML
2
PA
THYMOGLOBULIN INTRAVENOUS RECON
SOLN 25 MG
2
B/D
Immunizing Agents, Passive
Immunomodulators
106
Nome do medicamento
Classificação do
medicamento
ACTEMRA INTRAVENOUS SOLUTION 200
MG/10 ML (20 MG/ML)
2
PA
ACTIMMUNE SUBCUTANEOUS SOLUTION
100 MCG/0.5 ML
2
PA
ARCALYST SUBCUTANEOUS RECON SOLN
220 MG
2
PA
ILARIS (PF) SUBCUTANEOUS RECON SOLN
180 MG/1.2 ML (150 MG/ML)
2
PA
leflunomide oral tablet 10 mg, 20 mg
1
SIMPONI SUBCUTANEOUS SYRINGE 100
MG/ML
2
PA
Vaccines
ACTHIB (PF) INTRAMUSCULAR RECON
SOLN 10 MCG/0.5 ML
2
ADACEL(TDAP ADOLESN/ADULT)(PF)
INTRAMUSCULAR SUSPENSION 2 LF-(2.5-53-5 MCG)-5LF/0.5 ML
2
BCG VACCINE, LIVE (PF) PERCUTANEOUS
SUSPENSION FOR RECONSTITUTION 50 MG
2
BEXSERO (PF) INTRAMUSCULAR SYRINGE
50-50-50-25 MCG/0.5 ML
2
BOOSTRIX TDAP INTRAMUSCULAR
SUSPENSION 2.5-8-5 LF-MCG-LF/0.5ML
2
BOOSTRIX TDAP INTRAMUSCULAR
SYRINGE 2.5-8-5 LF-MCG-LF/0.5ML
2
CERVARIX VACCINE (PF)
INTRAMUSCULAR SYRINGE 20-20 MCG/0.5
ML
2
COMVAX (PF) INTRAMUSCULAR
SUSPENSION 5-7.5-125 MCG/0.5 ML
2
DAPTACEL (DTAP PEDIATRIC) (PF)
INTRAMUSCULAR SUSPENSION 15-10-5 LFMCG-LF/0.5ML
2
ENGERIX-B (PF) INTRAMUSCULAR
SYRINGE 20 MCG/ML
2
B/D
107
Nome do medicamento
Classificação do
medicamento
ENGERIX-B PEDIATRIC (PF)
INTRAMUSCULAR SUSPENSION 10 MCG/0.5
ML
2
B/D
INTRAMUSCULAR SYRINGE 10 MCG/0.5 ML
2
B/D
GARDASIL (PF) INTRAMUSCULAR
SUSPENSION 20-40-40-20 MCG/0.5 ML
2
GARDASIL (PF) INTRAMUSCULAR
SYRINGE 20-40-40-20 MCG/0.5 ML
2
GARDASIL 9 (PF) INTRAMUSCULAR
SUSPENSION 0.5 ML
2
GARDASIL 9 (PF) INTRAMUSCULAR
SYRINGE 0.5 ML
2
HAVRIX (PF) INTRAMUSCULAR
SUSPENSION 1,440 ELISA UNIT/ML
2
HAVRIX (PF) INTRAMUSCULAR SYRINGE
720 ELISA UNIT/0.5 ML
2
IMOVAX RABIES VACCINE (PF)
INTRAMUSCULAR RECON SOLN 2.5 UNIT
2
INFANRIX (DTAP) (PF) INTRAMUSCULAR
SUSPENSION 25-58-10 LF-MCG-LF/0.5ML
2
IPOL INJECTION SUSPENSION 40-8-32
UNIT/0.5 ML
2
IPOL INJECTION SYRINGE 40-8-32 UNIT/0.5
ML
2
IXIARO (PF) INTRAMUSCULAR SYRINGE 6
MCG/0.5 ML
2
MENACTRA (PF) INTRAMUSCULAR
SOLUTION 4 MCG/0.5 ML
2
MENOMUNE - A/C/Y/W-135 (PF)
SUBCUTANEOUS RECON SOLN 50 MCG
2
MENVEO A-C-Y-W-135-DIP (PF)
INTRAMUSCULAR KIT 10-5 MCG/0.5 ML
2
M-M-R II (PF) SUBCUTANEOUS RECON
SOLN 1,000-12,500 TCID50/0.5 ML
2
108
Nome do medicamento
Classificação do
medicamento
PEDVAX HIB (PF) INTRAMUSCULAR
SOLUTION 7.5 MCG/0.5 ML
2
PROQUAD (PF) SUBCUTANEOUS
SUSPENSION FOR RECONSTITUTION
10EXP3-4.3-3- 3.99 TCID50/0.5
2
QUADRACEL (PF) INTRAMUSCULAR
SUSPENSION 15 LF-48 MCG- 5 LF
UNIT/0.5ML
2
RABAVERT (PF) INTRAMUSCULAR
SUSPENSION FOR RECONSTITUTION 2.5
UNIT
2
RECOMBIVAX HB (PF) INTRAMUSCULAR
SUSPENSION 10 MCG/ML, 40 MCG/ML
2
B/D
RECOMBIVAX HB (PF) INTRAMUSCULAR
SYRINGE 10 MCG/ML, 5 MCG/0.5 ML
2
B/D
ROTARIX ORAL SUSPENSION FOR
RECONSTITUTION 10EXP6 CCID50/ML
2
ROTATEQ VACCINE ORAL SUSPENSION 2
ML
2
TENIVAC (PF) INTRAMUSCULAR SYRINGE
5-2 LF UNIT/0.5 ML
2
tetanus toxoid,adsorbed (pf) intramuscular
suspension 5 lf unit/0.5 ml
1
tetanus,diphtheria tox ped(pf) intramuscular
suspension 5-25 lf unit/0.5 ml
1
tetanus-diphtheria toxoids-td intramuscular
suspension 2-2 lf unit/0.5 ml
1
TRUMENBA INTRAMUSCULAR SYRINGE
120 MCG/0.5 ML
2
TWINRIX (PF) INTRAMUSCULAR
SUSPENSION 720 ELISA UNIT -20 MCG/ML
2
TYPHIM VI INTRAMUSCULAR SOLUTION 25
MCG/0.5 ML
2
TYPHIM VI INTRAMUSCULAR SYRINGE 25
MCG/0.5 ML
2
B/D
109
Nome do medicamento
Classificação do
medicamento
VAQTA (PF) INTRAMUSCULAR
SUSPENSION 25 UNIT/0.5 ML, 50 UNIT/ML
2
VAQTA (PF) INTRAMUSCULAR SYRINGE 25
UNIT/0.5 ML, 50 UNIT/ML
2
VARIVAX (PF) SUBCUTANEOUS
SUSPENSION FOR RECONSTITUTION 1,350
UNIT/0.5 ML
2
VARIZIG INTRAMUSCULAR SOLUTION 125
UNIT/1.2 ML
2
YF-VAX (PF) SUBCUTANEOUS SUSPENSION
FOR RECONSTITUTION 10 EXP4.74 UNIT/0.5
ML
2
ZOSTAVAX (PF) SUBCUTANEOUS
SUSPENSION FOR RECONSTITUTION 19,400
UNIT/0.65 ML
2
Inflammatory Bowel Disease Agents
Aminosalicylates
balsalazide oral capsule 750 mg
1
CANASA RECTAL SUPPOSITORY 1,000 MG
2
DIPENTUM ORAL CAPSULE 250 MG
2
LIALDA ORAL TABLET,DELAYED RELEASE
(DR/EC) 1.2 GRAM
2
mesalamine with cleansing wipe rectal enema kit 4
gram/60 ml
1
PENTASA ORAL CAPSULE, EXTENDED
RELEASE 250 MG, 500 MG
2
SFROWASA RECTAL ENEMA 4 GRAM/60 ML
2
PA
Glucocorticoids
colocort rectal enema 100 mg/60 ml
1
hydrocortisone rectal enema 100 mg/60 ml
1
prednisone intensol oral concentrate 5 mg/ml
1
proctosol hc rectal cream 2.5 %
1
110
Nome do medicamento
Classificação do
medicamento
Sulfonamides
sulfasalazine oral tablet 500 mg
1
sulfazine ec oral tablet,delayed release (dr/ec) 500
mg
1
Metabolic Bone Disease Agents
Metabolic Bone Disease Agents
alendronate oral tablet 10 mg, 35 mg, 40 mg, 5
mg, 70 mg
1
calcitonin (salmon) nasal spray,non-aerosol 200
unit/actuation
1
calcitriol oral capsule 0.25 mcg, 0.5 mcg
1
calcitriol oral solution 1 mcg/ml
1
doxercalciferol intravenous solution 4 mcg/2 ml
1
doxercalciferol oral capsule 0.5 mcg, 1 mcg, 2.5
mcg
1
etidronate disodium oral tablet 200 mg, 400 mg
1
FORTEO SUBCUTANEOUS PEN INJECTOR
20 MCG/DOSE - 600 MCG/2.4 ML
2
fortical nasal spray,non-aerosol 200
unit/actuation
1
ibandronate intravenous solution 3 mg/3 ml
1
PA
ibandronate intravenous syringe 3 mg/3 ml
1
PA
MIACALCIN INJECTION SOLUTION 200
UNIT/ML
2
B/D
NATPARA SUBCUTANEOUS CARTRIDGE
100 MCG/DOSE, 25 MCG/DOSE, 50
MCG/DOSE, 75 MCG/DOSE
2
PA
pamidronate intravenous solution 30 mg/10 ml (3
mg/ml), 60 mg/10 ml (6 mg/ml), 90 mg/10 ml (9
mg/ml)
1
paricalcitol oral capsule 1 mcg, 2 mcg, 4 mcg
1
PROLIA SUBCUTANEOUS SYRINGE 60
MG/ML
2
PA
PA
111
Nome do medicamento
Classificação do
medicamento
risedronate oral tablet 150 mg, 30 mg, 35 mg, 35
mg (12 pack), 5 mg
1
XGEVA SUBCUTANEOUS SOLUTION 120
MG/1.7 ML (70 MG/ML)
2
PA
zoledronic acid intravenous solution 4 mg/5 ml
1
PA
zoledronic acid-mannitol-water intravenous
solution 5 mg/100 ml
1
PA
ZOMETA INTRAVENOUS SOLUTION 4
MG/100 ML
2
PA
7-oxo-dhea, micronized (bulk) powder 100 %
3
PA; DP
acacia powder
3
PA; DP
acesulfame potassium (bulk) powder 100 %
3
PA; DP
acetylcarnitine (bulk) powder 100 %
3
PA; DP
allantoin powder
3
PA; DP
almond oil, sweet (bulk) oil
3
PA; DP
aloe vera leaf gel xtr (bulk) powder 200:1
3
PA; DP
alpha lipoic acid (bulk) powder
3
PA; DP
ammonium chloride (bulk) granules
3
PA; DP
apple flavor (bulk) liquid
3
PA; DP
apple flavor (bulk) powder
3
PA; DP
arginine (l-arginine) (bulk) powder 100 %
3
PA; DP
arginine hcl(l-arginine)(bulk) powder 100 %
3
PA; DP
ascorbic acid (bulk) granules 100 %
3
PA; DP
ascorbic acid (bulk) powder 100 %
3
PA; DP
ascorbic acid oral tablet extended release 500 mg
3
DP
ascorbyl palmitate (bulk) powder 100 %
3
PA; DP
aspartame powder
3
PA; DP
aspirin (bulk) powder 100 %
3
PA; DP
Miscellaneous
Miscellaneous
112
Nome do medicamento
Classificação do
medicamento
balsam peru (bulk) liquid
3
PA; DP
BANANA CONCENTRATE LIQUID
3
PA; DP
BANANA CREAM FLAVOR LIQUID
3
PA; DP
benzyl alcohol liquid
3
PA; DP
betaine (bulk) powder 100 %
3
PA; DP
bioflavonoid, lemon (bulk) powder
3
PA; DP
bismuth subgallate powder
3
PA; DP
black food color (bulk) powder
3
PA; DP
blue food color (bulk) powder
3
PA; DP
blueberry flavor (bulk) liquid
3
PA; DP
boric acid (bulk) powder
3
PA; DP
boric acid granules
3
PA; DP
bubblegum flavor (bulk) liquid
3
PA; DP
BUFFER CREAM POWDER
3
PA; DP
butylparaben (bulk) powder 100 %
3
PA; DP
calamine powder
3
PA; DP
calcium carbonate (bulk) powder
3
PA; DP
calcium hydroxide powder
3
PA; DP
CALCIUM SACCHARATE POWDER 100 %
3
PA; DP
camphor crystals
3
PA; DP
caramel flavor (bulk) liquid
3
PA; DP
carbamide peroxide (bulk) powder 100 %
3
PA; DP
CARBOHOL GEL
3
PA; DP
carbomer homopolymer c (bulk) powder 56 % to
68 %
3
PA; DP
carboxymethylcellulose sodium granules
3
PA; DP
cetyl alcohol flakes
3
PA; DP
CHARCOAL POWDER
3
PA; DP
cheesecake flavor (bulk) liquid
3
PA; DP
113
Nome do medicamento
Classificação do
medicamento
cherry flavor oral syrup
3
PA; DP
CHERRY FLAVOR POWDER
3
PA; DP
chloroform liquid
3
PA; DP
chocolate flavor (bulk) liquid
3
PA; DP
cholesterol (bulk) powder 100 %
3
PA; DP
citric acid anhydrous (bulk) granules 100 %
3
PA; DP
citric acid monohydrate (bulk) granules 100 %
3
PA; DP
citrulline powder
3
PA; DP
clove oil oil
3
PA; DP
coal tar (bulk) topical solution 20 %
3
PA; DP
coconut oil (bulk) oil
3
PA; DP
collodion (bulk) liquid
3
PA; DP
corn starch (bulk) powder
3
PA; DP
cotton candy flavor (bulk) liquid
3
PA; DP
cottonseed oil (bulk) oil
3
PA; DP
creatine monohydrate (bulk) powder 100 %
3
PA; DP
CREME DE MENTHE FLAVORING LIQUID
3
PA; DP
croton oil (bulk) oil 100 %
3
PA; DP
cysteine hcl(l-cysteine)(bulk) powder
3
PA; DP
dextromethorphan hbr (bulk) crystals
3
PA; DP
DPI WOW GEL TOPICAL GEL
3
PA; DP
d-xylose powder
3
PA; DP
ETHOXY ETHOXY ETHANOL REAGENT
LIQUID
3
PA; DP
ethyl alcohol (bulk) liquid
3
PA; DP
ethyl oleate (bulk) liquid 100 %
3
PA; DP
eugenol liquid
3
PA; DP
FATTYBLEND WAX
3
PA; DP
fd&c 6 (sunset yel fcf) (bulk) powder
3
PA; DP
114
Nome do medicamento
Classificação do
medicamento
fd&c blue no.1 (bulk) powder
3
PA; DP
fd&c blue no.2 (bulk) powder
3
PA; DP
fd&c no.3 (green) (bulk) powder
3
PA; DP
fd&c no.5 (tartrazine) (bulk) powder
3
PA; DP
FD&C RED 40 (ALLURA RED)(BULK)
POWDER
3
PA; DP
FD&C RED NO.3 POWDER 100 %
3
PA; DP
flexible collodion (bulk) liquid
3
PA; DP
FOOD COLOR BROWN POWDER 100 %
3
PA; DP
formaldehyde (bulk) solution 37 %
3
PA; DP
fructose granules
3
PA; DP
fullers earth powder
3
PA; DP
GERI-HYDROLAC TOPICAL CREAM 12 %
3
DP
glucosamine (bulk) powder
3
PA; DP
glucosamine su 2kcl (bulk) powder 100 %
3
PA; DP
glutathione (bulk) powder 100 %
3
PA; DP
glycine powder
3
PA; DP
glycolic acid (bulk) crystals
3
PA; DP
glycolic acid solution 70 %
3
PA; DP
grape flavor (bulk) liquid
3
PA; DP
grape seed oil (bulk) oil 100 %
3
PA; DP
green food color (bulk) powder
3
PA; DP
green tea extract (bulk) powder 100 %
3
PA; DP
guava flavor (bulk) liquid
3
PA; DP
honey flavor (bulk) liquid
3
PA; DP
hydrochloric acid (bulk) liquid 37 %
3
PA; DP
HYDROUS EMULSIFIED BASE CREAM
3
PA; DP
ichthammol (bulk) powder
3
PA; DP
iodine (bulk) crystals
3
PA; DP
115
Nome do medicamento
Classificação do
medicamento
iodoform (bulk) powder 100 %
3
PA; DP
isoleucine powder
3
PA; DP
isopropyl palmitate (bulk) liquid 90 %
3
PA; DP
kaolin powder
3
PA; DP
karaya gum (bulk) powder
3
PA; DP
kojic acid powder
3
PA; DP
KPN ORAL TABLET
3
DP
lactic acid (bulk) liquid 88 % to 92 % (usp)
3
PA; DP
lecithin granules
3
PA; DP
lime green food color (bulk) powder 100 %
3
PA; DP
LIP BALM BASE (BULK) TOPICAL
OINTMENT 1.3 GM/3 ML
3
PA; DP
LIP BALM NATURAL TOPICAL OINTMENT
3
PA; DP
LIPOIL LIQUID
3
PA; DP
LOLLIBASE POWDER
3
PA; DP
LOZIBASE GEL
3
PA; DP
malic acid (bulk) powder
3
PA; DP
mannitol (bulk) powder
3
PA; DP
marshmallow flavor (bulk) liquid
3
PA; DP
methionine powder
3
PA; DP
methylcellulose 1500cps (bulk) powder 27.5 % to
31.5 % (usp)
3
PA; DP
methylcellulose 4000cps (bulk) powder 30 %
3
PA; DP
methylparaben (bulk) powder
3
PA; DP
methylsulfonylmethane (bulk) crystals 100 %
3
PA; DP
mineral oil oil
3
PA; DP
NATURAL BITTERNESS MASKING POWDER
3
PA; DP
niacinamide (bulk) crystals
3
PA; DP
niacinamide oral tablet 100 mg, 500 mg
3
DP
ORA-BLEND ORAL SUSPENSION
3
PA; DP
116
Nome do medicamento
Classificação do
medicamento
ORA-BLEND SF ORAL SUSPENSION
3
PA; DP
ORA-HESIVE BASE OINTMENT
3
PA; DP
orange flavor (bulk) liquid
3
PA; DP
orange food color (bulk) powder
3
PA; DP
ORA-PLUS ORAL SUSPENSION
3
PA; DP
ORA-SWEET ORAL LIQUID
3
PA; DP
ORA-SWEET SF ORAL LIQUID
3
PA; DP
ornithine powder
3
PA; DP
oxalic acid crystals
3
PA; DP
PCCA MBK BASE WAX
3
PA; DP
peach flavor (bulk) liquid
3
PA; DP
pectin powder
3
PA; DP
phenol (bulk) liquid 89 %
3
PA; DP
phenylalanine,dl- (bulk) crystals 100 %
3
PA; DP
phosphatidyl serine (bulk) powder 20 %
3
PA; DP
pina colada flavor (bulk) liquid
3
PA; DP
pineapple flavor (bulk) liquid
3
PA; DP
PLO20 FLOWABLE TOPICAL GEL 20 %
3
PA; DP
POLOX GEL 20 %
3
PA; DP
POLOXAMER 407 POWDER
3
PA; DP
polysorbate 20 (bulk) solution
3
PA; DP
potassium bromide (bulk) crystals
3
PA; DP
potassium citrate m-hyd(bulk) granules
3
PA; DP
potassium hydroxide (bulk) pellet
3
PA; DP
potassium hydroxide (bulk) solution 10 %, 20 %
3
PA; DP
potassium sorbate crystals
3
PA; DP
propylene glycol (bulk) liquid 99.5 % (not less
than, usp)
3
PA; DP
propylparaben (bulk) crystals
3
PA; DP
117
Nome do medicamento
Classificação do
medicamento
psyllium husk (bulk) powder 100 %
3
PA; DP
pyruvic acid (bulk) liquid 98 %
3
PA; DP
RAPID DISSOLVE TABLET POWDER
3
PA; DP
raspberry flavor (bulk) liquid
3
PA; DP
red food color (bulk) powder
3
PA; DP
red yeast rice extract (bulk) powder
3
PA; DP
resorcinol powder
3
PA; DP
root beer flavor (bulk) liquid
3
PA; DP
saccharin powder
3
DP
safflower oil oil
3
PA; DP
salicylic acid powder
3
PA; DP
SALTSTABLE LO CREAM
3
PA; DP
simple syrup oral syrup
3
DP
sodium benzoate (bulk) powder
3
PA; DP
sodium bicarbonate (bulk) powder
3
PA; DP
sodium borate powder
3
PA; DP
sodium bromide granules
3
PA; DP
sodium citrate dihydrate granules
3
PA; DP
sodium fluoride (bulk) powder
3
PA; DP
sodium hydroxide granules
3
PA; DP
sodium lauryl sulfate (bulk) powder 100 %
3
PA; DP
sodium metabisulfite (bulk) granules 100 %
3
PA; DP
sodium phosphate,dibasic(bulk) granules 100 %
3
PA; DP
sodium propionate powder
3
PA; DP
sodium saccharin (bulk) oral granules 100 %
3
PA; DP
sodium saccharin (bulk) oral powder 100 %
3
PA; DP
sodium sulfite (bulk) powder 100 %
3
PA; DP
sorbic acid powder
3
PA; DP
sorbitol solution 70 %
3
DP
118
Nome do medicamento
Classificação do
medicamento
soybean oil (bulk) oil
3
PA; DP
SPERMACETI FLAKES 100 %
3
PA; DP
squalane (bulk) oil 100 %
3
PA; DP
squaric acid dibutylester powder
3
PA; DP
STEVIA POWDER 90 %
3
PA; DP
strawberry flavor (bulk) liquid
3
PA; DP
sulfur (bulk) powder 100 %
3
PA; DP
SYRSPEND SF LIQUID ORAL SUSPENSION
3
DP
talc (bulk) powder 100 %
3
PA; DP
tangerine oil (bulk) oil
3
PA; DP
tannic acid powder
3
PA; DP
tartaric acid (bulk) granules
3
PA; DP
thiamine hcl (bulk) powder
3
PA; DP
thiamine hcl injection solution 100 mg/ml
3
DP
threonine powder
3
PA; DP
thymol iodide powder
3
PA; DP
TROCHIBASE S CLASSIC FLAKES
3
PA; DP
tropical punch flavor (bulk) liquid
3
PA; DP
turpentine liquid
3
PA; DP
tutti-frutti flavor (bulk) liquid
3
PA; DP
urea (bulk) beads 100 %
3
PA; DP
valine powder
3
PA; DP
VANIBASE TOPICAL CREAM
3
PA; DP
vanilla butternut flavor(bulk) liquid
3
PA; DP
vanillin (bulk) powder
3
PA; DP
watermelon flavor (bulk) liquid
3
PA; DP
white petrolatum (bulk) gel 100 %
3
PA; DP
WINTERGREEN FLAVORING OIL
3
PA; DP
WITEPSOL H-15 PELLET 100 %
3
PA; DP
119
Nome do medicamento
Classificação do
medicamento
xanthan gum powder
3
PA; DP
xylitol (bulk) powder
3
PA; DP
zinc oxide (bulk) powder
3
PA; DP
Ophthalmic Agents
Ophthalmic Agents
bacitracin-polymyxin b ophthalmic ointment 50010,000 unit/gram
1
garamycin ophthalmic drops 0.3 %
1
neomycin-bacitracin-poly-hc ophthalmic ointment
3.5-400-10,000 mg-unit/g-1%
1
neomycin-bacitracin-polymyxin ophthalmic
ointment 3.5-400-10,000 mg-unit-unit/g
1
neomycin-polymyxin b-dexameth ophthalmic
drops,suspension 3.5mg/ml-10,000 unit/ml-0.1 %
1
neomycin-polymyxin b-dexameth ophthalmic
ointment 3.5 mg/g-10,000 unit/g-0.1 %
1
neomycin-polymyxin-gramicidin ophthalmic drops
1.75 mg-10,000 unit-0.025mg/ml
1
neomycin-polymyxin-hc ophthalmic
drops,suspension 3.5-10,000-10 mg-unit-mg/ml
1
polymyxin b sulf-trimethoprim ophthalmic drops
10,000 unit- 1 mg/ml
1
tobramycin-dexamethasone ophthalmic
drops,suspension 0.3-0.1 %
1
Ophthalmic Agents, Other
naphazoline ophthalmic drops 0.1 %
1
OPCON-A OPHTHALMIC DROPS 0.026750.315 %
3
proparacaine ophthalmic drops 0.5 %
1
RESTASIS OPHTHALMIC DROPPERETTE
0.05 %
2
SYSTANE CONTACTS OPHTHALMIC DROPS
3
PA; DP
DP
120
Nome do medicamento
Classificação do
medicamento
Ophthalmic Anti-Allergy Agents
azelastine ophthalmic drops 0.05 %
1
cromolyn ophthalmic drops 4 %
1
epinastine ophthalmic drops 0.05 %
1
PATADAY OPHTHALMIC DROPS 0.2 %
2
ST
PATANOL OPHTHALMIC DROPS 0.1 %
2
ST
Ophthalmic Antiglaucoma Agents
ALPHAGAN P OPHTHALMIC DROPS 0.1 %
2
AZOPT OPHTHALMIC DROPS,SUSPENSION
1%
2
brimonidine ophthalmic drops 0.15 %, 0.2 %
1
carteolol ophthalmic drops 1 %
1
COMBIGAN OPHTHALMIC DROPS 0.2-0.5 %
2
dorzolamide ophthalmic drops 2 %
1
dorzolamide-timolol ophthalmic drops 22.3-6.8
mg/ml
1
levobunolol ophthalmic drops 0.5 %
1
metipranolol ophthalmic drops 0.3 %
1
PHOSPHOLINE IODIDE OPHTHALMIC
DROPS 0.125 %
2
SIMBRINZA OPHTHALMIC
DROPS,SUSPENSION 1-0.2 %
2
timolol maleate ophthalmic drops 0.25 %, 0.5 %
1
timolol maleate ophthalmic gel forming solution
0.25 %, 0.5 %
1
Ophthalmic Anti-Inflammatories
dexamethasone sodium phosphate ophthalmic
drops 0.1 %
1
diclofenac sodium ophthalmic drops 0.1 %
1
DUREZOL OPHTHALMIC DROPS 0.05 %
2
121
Nome do medicamento
Classificação do
medicamento
fluorometholone ophthalmic drops,suspension 0.1
%
1
flurbiprofen sodium ophthalmic drops 0.03 %
1
FML FORTE OPHTHALMIC
DROPS,SUSPENSION 0.25 %
2
ketorolac ophthalmic drops 0.4 %, 0.5 %
1
Ophthalmic Prostaglandin And Prostamide Analogs
latanoprost ophthalmic drops 0.005 %
1
LUMIGAN OPHTHALMIC DROPS 0.01 %
2
TRAVATAN Z OPHTHALMIC DROPS 0.004 %
2
Ophthlalmic Anti-Allergy Agents
VISINE-A OPHTHALMIC DROPS 0.025-0.3 %
3
DP
Otic Agents
Otic Agents
CIPRODEX OTIC DROPS,SUSPENSION 0.3-0.1
%
2
hydrocortisone-acetic acid otic drops 1-2 %
1
neomycin-polymyxin-hc otic drops,suspension 3.510,000-1 mg/ml-unit/ml-%
1
neomycin-polymyxin-hc otic solution 3.5-10,000-1
mg/ml-unit/ml-%
1
Respiratory Tract/ Pulmonary Agents
Antihistamines
ALER-DRYL ORAL TABLET 50 MG
3
DP
ALL DAY ALLERGY-D ORAL TABLET
EXTENDED RELEASE 12 HR 5-120 MG
3
DP
ALLER-EASE ORAL TABLET 60 MG
3
DP
ALLERGY RELIEF(DIPHENHYDRAMIN)
ORAL CAPSULE 25 MG
3
DP
ALLER-TEC ORAL TABLET 10 MG
3
DP
ALTARYL ORAL ELIXIR 12.5 MG/5 ML
3
DP
122
Nome do medicamento
Classificação do
medicamento
azelastine nasal aerosol,spray 137 mcg (0.1 %)
1
azelastine nasal spray,non-aerosol 0.15 % (205.5
mcg)
1
BENADRYL ALLERGY ORAL TABLET 25
MG
3
DP
cetirizine oral tablet 5 mg
3
DP
cetirizine oral tablet,chewable 10 mg
3
DP
CHILDREN'S WAL-DRYL ALLERGY ORAL
LIQUID 12.5 MG/5 ML
3
DP
CHILDREN'S WAL-ZYR ORAL SOLUTION 1
MG/ML
3
DP
CHILDREN'S WAL-ZYR ORAL TABLET,
CHEWABLE 5 MG
3
DP
clemastine oral syrup 0.67 mg/5 ml
1
PA
clemastine oral tablet 2.68 mg
1
PA
cyproheptadine oral syrup 2 mg/5 ml
1
PA
cyproheptadine oral tablet 4 mg
1
PA
DAYHIST ORAL TABLET 1.34 MG
3
DP
diphenhydramine hcl oral capsule 50 mg
3
DP
ED CHLORPED JR ORAL SYRUP 2 MG/5 ML
3
DP
fexofenadine oral tablet 180 mg
3
DP
levocetirizine oral solution 2.5 mg/5 ml
1
levocetirizine oral tablet 5 mg
1
loratadine oral tablet 10 mg
3
DP
PHENYLHISTINE DH ORAL LIQUID 2-30-10
MG/5 ML
3
DP
promethazine-codeine oral syrup 6.25-10 mg/5 ml
3
DP
WAL-FEX D 24 HOUR ORAL TABLET
EXTENDED RELEASE 24 HR 180-240 MG
3
DP
WAL-FINATE ORAL TABLET 4 MG
3
DP
WAL-ITIN ALLER-MELTS ORAL
3
DP
123
Nome do medicamento
Classificação do
medicamento
WAL-ITIN D ORAL TABLET EXTENDED
RELEASE 24 HR 10-240 MG
3
DP
WAL-ITIN ORAL SOLUTION 5 MG/5 ML
3
DP
Anti-Inflammatories, Inhaled Corticosteroids
ADVAIR DISKUS INHALATION BLISTER
WITH DEVICE 100-50 MCG/DOSE, 250-50
MCG/DOSE, 500-50 MCG/DOSE
2
ADVAIR HFA INHALATION HFA AEROSOL
INHALER 115-21 MCG/ACTUATION, 230-21
MCG/ACTUATION, 45-21 MCG/ACTUATION
2
ASMANEX HFA INHALATION HFA
AEROSOL INHALER 100 MCG/ACTUATION,
200 MCG/ACTUATION
2
ASMANEX TWISTHALER INHALATION
AEROSOL POWDR BREATH ACTIVATED 110
MCG (30 DOSES), 220 MCG (120 DOSES), 220
MCG (30 DOSES), 220 MCG (60 DOSES)
2
budesonide inhalation suspension for nebulization
0.25 mg/2 ml, 0.5 mg/2 ml
1
FLOVENT DISKUS INHALATION BLISTER
WITH DEVICE 100 MCG/ACTUATION, 250
MCG/ACTUATION, 50 MCG/ACTUATION
2
FLOVENT HFA INHALATION HFA AEROSOL
INHALER 110 MCG/ACTUATION, 220
2
flunisolide nasal spray,non-aerosol 25 mcg (0.025
%)
1
fluticasone nasal spray,suspension 50
mcg/actuation
1
NASONEX NASAL SPRAY,NON-AEROSOL 50
MCG/ACTUATION
2
PULMICORT INHALATION SUSPENSION
FOR NEBULIZATION 1 MG/2 ML
2
QVAR INHALATION AEROSOL 40
2
B/D
124
Nome do medicamento
triamcinolone acetonide nasal aerosol,spray 55
mcg
Classificação do
medicamento
1
Antileukotrienes
montelukast oral granules in packet 4 mg
1
montelukast oral tablet 10 mg
1
montelukast oral tablet,chewable 4 mg, 5 mg
1
zafirlukast oral tablet 10 mg, 20 mg
1
PA
ZYFLO CR ORAL TABLET, ER MULTIPHASE
12 HR 600 MG
2
PA
ZYFLO ORAL TABLET 600 MG
2
PA
Bronchodilators, Anticholinergic
ATROVENT HFA INHALATION HFA
AEROSOL INHALER 17 MCG/ACTUATION
2
ipratropium bromide inhalation solution 0.02 %
1
ipratropium bromide nasal spray,non-aerosol 0.03
%, 0.06 %
1
SPIRIVA RESPIMAT INHALATION MIST 2.5
MCG/ACTUATION
2
SPIRIVA WITH HANDIHALER INHALATION
CAPSULE, W/INHALATION DEVICE 18 MCG
2
TUDORZA PRESSAIR INHALATION
AEROSOL POWDR BREATH ACTIVATED 400
(30 ACTUAT)
2
B/D
Bronchodilators, Sympathomimetic
albuterol sulfate inhalation solution for
nebulization 0.63 mg/3 ml, 1.25 mg/3 ml, 2.5 mg /3
ml (0.083 %), 5 mg/ml
1
albuterol sulfate oral syrup 2 mg/5 ml
1
albuterol sulfate oral tablet 2 mg, 4 mg
1
albuterol sulfate oral tablet extended release 12 hr
4 mg, 8 mg
1
B/D
125
Nome do medicamento
Classificação do
medicamento
DULERA INHALATION HFA AEROSOL
INHALER 100-5 MCG/ACTUATION, 200-5
MCG/ACTUATION
2
EPIPEN 2-PAK INJECTION AUTO-INJECTOR
0.3 MG/0.3 ML (1:1,000)
2
EPIPEN JR 2-PAK INJECTION AUTOINJECTOR 0.15 MG/0.3 ML (1:2,000)
2
FORADIL AEROLIZER INHALATION
CAPSULE, W/INHALATION DEVICE 12 MCG
2
metaproterenol oral syrup 10 mg/5 ml
1
metaproterenol oral tablet 10 mg, 20 mg
1
PROVENTIL HFA INHALATION HFA
2
SEREVENT DISKUS INHALATION BLISTER
WITH DEVICE 50 MCG/DOSE
2
terbutaline oral tablet 2.5 mg, 5 mg
1
terbutaline subcutaneous solution 1 mg/ml
1
VENTOLIN HFA INHALATION HFA
2
Cystic Fibrosis Agents
KALYDECO ORAL GRANULES IN PACKET
50 MG, 75 MG
2
PA
KALYDECO ORAL TABLET 150 MG
2
PA
PULMOZYME INHALATION SOLUTION 1
MG/ML
2
PA
cromolyn inhalation solution for nebulization 20
mg/2 ml
1
B/D
cromolyn nasal spray,non-aerosol 5.2 mg/spray (4
%)
3
DP
Mast Cell Stabilizers
Phosphodiesterase Inhibitors, Airways Disease
aminophylline intravenous solution 250 mg/10 ml
1
DALIRESP ORAL TABLET 500 MCG
2
126
Nome do medicamento
Classificação do
medicamento
ELIXOPHYLLIN ORAL ELIXIR 80 MG/15 ML
2
LUFYLLIN ORAL TABLET 200 MG, 400 MG
2
theophylline oral tablet extended release 12 hr 100
mg, 200 mg, 300 mg, 450 mg
1
theophylline oral tablet extended release 400 mg,
600 mg
1
Pulmonary Antihypertensives
ADEMPAS ORAL TABLET 0.5 MG, 1 MG, 1.5
MG, 2 MG, 2.5 MG
2
PA
LETAIRIS ORAL TABLET 10 MG, 5 MG
2
PA
REMODULIN INJECTION SOLUTION 1
MG/ML, 10 MG/ML, 2.5 MG/ML, 5 MG/ML
2
PA
REVATIO ORAL SUSPENSION FOR
RECONSTITUTION 10 MG/ML
2
PA
sildenafil intravenous solution 10 mg/12.5 ml
1
PA
sildenafil oral tablet 20 mg
1
PA
TRACLEER ORAL TABLET 125 MG, 62.5 MG
2
PA; LA
VENTAVIS INHALATION SOLUTION FOR
NEBULIZATION 10 MCG/ML, 20 MCG/ML
2
PA
12 HOUR DECONGESTANT ORAL TABLET
3
DP
acetylcysteine solution 100 mg/ml (10 %), 200
mg/ml (20 %)
1
B/D
ADT ROBITUSSIN PEAK CLD DM MAX
ORAL LIQUID 10-200 MG/5 ML
3
DP
ADULT ROBITUSSIN PEAK COLD DM ORAL
LIQUID 10-100 MG/5 ML
3
DP
ADULT ROBITUSSIN PEAK COLD M-S ORAL
LIQUID 5-10-100 MG/5 ML
3
DP
ALTARUSSIN ORAL LIQUID 100 MG/5 ML
3
DP
ARALAST NP INTRAVENOUS RECON SOLN
500 MG
2
PA
Respiratory Tract Agents, Other
127
Nome do medicamento
Classificação do
medicamento
BALAMINE DM (CHLOR-PE) ORAL LIQUID
2-5-10 MG/5 ML
3
DP
benzonatate oral capsule 100 mg, 200 mg
3
DP
brompheniramine-pseudoeph-dm oral syrup 2-3010 mg/5 ml
3
DP
brompheniramin-phenylephrin-dm oral liquid 2-510 mg/5 ml
3
DP
BUCKLEY'S CHEST CONGESTION MIX
ORAL LIQUID 100 MG/5 ML
3
DP
CAPCOF ORAL LIQUID 2-5-10 MG/5 ML
3
DP
CHERATUSSIN DAC ORAL SYRUP 30-10-100
MG/5 ML
3
DP
CHEST CONGESTION-COUGH RELIEF ORAL
TABLET 20-400 MG
3
codeine-guaifenesin oral liquid 10-100 mg/5 ml
3
DP
COUGH DM ER ORAL
SUSPENSION,EXTENDED REL 12 HR 30
MG/5 ML
3
DP
ENDACOF-C ORAL LIQUID 2-10 MG/5 ML
3
DP
GLASSIA INTRAVENOUS SOLUTION 1
GRAM/50 ML (2 %)
2
PA
hydrocodone-chlorpheniramine oral
suspension,extended rel 12 hr 10-8 mg/5 ml
3
DP
hydrocodone-homatropine oral syrup 5-1.5 mg/5
ml (5 ml)
3
DP
hydrocodone-homatropine oral tablet 5-1.5 mg
3
DP
HYDROMET ORAL SYRUP 5-1.5 MG/5 ML
3
DP
LUMIZYME INTRAVENOUS RECON SOLN 50
MG
2
PA
MAR-COF BP ORAL LIQUID 2-30-7.5 MG/5
ML
3
DP
M-CLEAR WC ORAL LIQUID 6.3-100 MG/5
ML
3
DP
128
Nome do medicamento
Classificação do
medicamento
M-END MAX D ORAL LIQUID 0.667-20-6
MG/5 ML
3
DP
M-END WC ORAL LIQUID 1.3-10-6.3 MG/5
ML
3
DP
menthol crystals
3
PA; DP
NASAL DECONGESTANT (PE) ORAL
TABLET 10 MG
3
DP
NASAL DECONGESTANT (PSEUDOEPH)
ORAL TABLET 30 MG
3
DP
POLOX GEL 30 %
3
PA; DP
POLY-TUSSIN D ORAL LIQUID 9.375-30-10
MG/5 ML
3
DP
POLY-TUSSIN ORAL LIQUID 9.375-10 MG/5
ML
3
DP
PRO-CLEAR AC ORAL LIQUID 9-8.33 MG/5
ML
3
DP
PROLASTIN-C INTRAVENOUS RECON SOLN
1,000 MG
2
PA
PROMETHAZINE VC-CODEINE ORAL
SYRUP 6.25-5-10 MG/5 ML
3
DP
promethazine-dm oral syrup 6.25-15 mg/5 ml
3
DP
PRO-RED AC (W/ DEXCHLORPHENIR) ORAL
LIQUID 1-5-9 MG/5 ML
3
DP
pseudoephedrine hcl oral tablet 60 mg
3
DP
REZIRA ORAL SOLUTION 60-5 MG/5 ML
3
DP
STATUSS GREEN (CODEINE) ORAL LIQUID
12.5-30-9 MG/5 ML
3
DP
SUPHEDRIN ORAL LIQUID 15 MG/5 ML
3
DP
TRYMINE CG ORAL LIQUID 7.5-225 MG/5
ML
3
DP
TUSSICAPS ORAL CAPSULE,EXTENDED
RELEASE 12 HR 10-8 MG, 5-4 MG
3
DP
TUSSIN DM ORAL SYRUP 10-100 MG/5 ML
3
DP
129
Nome do medicamento
Classificação do
medicamento
VITUZ ORAL SOLUTION 5-4 MG/5 ML
3
DP
WAL-TAP COLD & ALLERGY ORAL LIQUID
1-15 MG/5 ML
3
DP
ZEMAIRA INTRAVENOUS RECON SOLN
1,000 MG
2
PA
ZONATUSS ORAL CAPSULE 150 MG
3
DP
Respiratory Tract/ Pulmonary Agents
COMBIVENT RESPIMAT INHALATION MIST
20-100 MCG/ACTUATION
2
ESBRIET ORAL CAPSULE 267 MG
2
PA
ipratropium-albuterol inhalation solution for
nebulization 0.5 mg-3 mg(2.5 mg base)/3 ml
1
B/D
promethazine vc oral syrup 6.25-5 mg/5 ml
1
PA
SYMBICORT INHALATION HFA AEROSOL
INHALER 160-4.5 MCG/ACTUATION, 80-4.5
MCG/ACTUATION
2
XOLAIR SUBCUTANEOUS RECON SOLN 150
MG
2
PA
carisoprodol oral tablet 350 mg
1
PA
chlorzoxazone oral tablet 500 mg
1
PA
cyclobenzaprine oral tablet 10 mg, 5 mg
1
PA
methocarbamol oral tablet 500 mg, 750 mg
1
PA
orphenadrine citrate oral tablet extended release
100 mg
1
PA
zaleplon oral capsule 10 mg, 5 mg
1
zolpidem oral tablet 10 mg, 5 mg
1
Skeletal Muscle Relaxants
Skeletal Muscle Relaxants
Sleep Disorder Agents
Gaba Receptor Modulators
Sleep Disorders, Other
130
Nome do medicamento
Classificação do
medicamento
HETLIOZ ORAL CAPSULE 20 MG
2
PA
MODAFINIL ORAL TABLET 100 MG, 200 MG
2
PA
ROZEREM ORAL TABLET 8 MG
2
XYREM ORAL SOLUTION 500 MG/ML
2
LA
AMINOSYN 7 % WITH ELECTROLYTES
INTRAVENOUS PARENTERAL SOLUTION 7
%
2
B/D
AMINOSYN-RF 5.2 % INTRAVENOUS
PARENTERAL SOLUTION 5.2 %
2
B/D
EXJADE ORAL TABLET, DISPERSIBLE 125
MG, 250 MG, 500 MG
2
PA
FERRIPROX ORAL TABLET 500 MG
2
PA
kionex oral powder
1
SAMSCA ORAL TABLET 15 MG, 30 MG
2
sodium polystyrene (sorb free) oral suspension 15
gram/60 ml
1
SYPRINE ORAL CAPSULE 250 MG
2
PA
alum, ammonium (bulk) powder
3
PA; DP
aluminum acetate topical solution
3
DP
aluminum chloride powder
3
PA; DP
ammonium chloride intravenous solution 5 meq/ml
1
BEELITH ORAL TABLET 362-20 MG
3
DP
CALCARB 600 ORAL TABLET 600 MG (1,500
MG)
3
DP
CALCET CREAMY BITES ORAL
TABLET,CHEWABLE 500 MG CALCIUM -400
UNIT
3
DP
CALCET PETITES ORAL TABLET 200 MG
CALCIUM -250 UNIT
3
DP
Therapeutic Nutrients/ Minerals/ Electrolytes
Electrolyte/ Mineral Modifiers
Electrolyte/ Mineral Replacement
131
Nome do medicamento
Classificação do
medicamento
CALCI-CHEW ORAL TABLET,CHEWABLE
500 MG CALCIUM (1,250 MG)
3
DP
CALCI-MIX ORAL CAPSULE 500 MG
CALCIUM (1,250 MG)
3
DP
CALCIONATE ORAL SYRUP 115 MG/5 ML
(1.8 GRAM/5 ML)
3
DP
calcium carbonate oral tablet 260 mg calcium
(648 mg), 500 mg calcium (1,250 mg)
3
DP
calcium gluconate oral tablet 45 mg (500 mg)
3
DP
calcium gluconate powder
3
PA; DP
calcium lactate (bulk) powder 100 %
3
PA; DP
calcium lactate oral tablet 84 mg (648 mg)
3
DP
calcium phos, tribasic (bulk) powder 100 %
3
PA; DP
calcium phosphate (bulk) powder
3
PA; DP
calcium-magnesium-zinc oral tablet , 333-133-5
mg, 333-133-8.3 mg
3
DP
CARBAGLU ORAL TABLET, DISPERSIBLE
200 MG
2
PA
CENTAVITE A-Z COMPLETE-MINERAL
ORAL TABLET 27-0.4 MG
3
DP
CHELATED ZINC ORAL TABLET 50 MG
3
DP
chromium chloride intravenous solution 4 mcg/ml
3
DP
chrysin powder
3
PA; DP
citric acid powder
3
DP
coenzyme q10 oral liquid 30 mg/5 ml
3
DP
COMTREX DEEP CHEST COLD ORAL
TABLET 325-200 MG
3
DP
COPPER CHLORIDE INTRAVENOUS
SOLUTION 0.4 MG/ML
3
DP
COPPER SULFATE CRYSTALS
3
PA; DP
DEXFERRUM INTRAVENOUS SOLUTION
100 MG/2 ML (50 MG/ML), 50 MG/ML (1 ML)
3
DP
132
Nome do medicamento
Classificação do
medicamento
dextrose (bulk) granules
3
PA; DP
DHEA ORAL TABLET 25 MG
3
PA; DP
DIALYVITE 800 ORAL TABLET 0.8 MG
3
DP
DUOFER ORAL TABLET 28 MG
3
DP
EZFE 200 ORAL CAPSULE 200 MG IRON
3
DP
EZFE FORTE ORAL CAPSULE 155-1,000 MG
IRON-MCG
3
DP
FERAHEME INTRAVENOUS SOLUTION 510
MG/17 ML (30 MG/ML)
3
DP
FERGON ORAL TABLET 240 MG (27 MG
IRON)
3
DP
FER-IRON ORAL DROPS 15 MG IRON (75
MG)/ML
3
DP
FERRETTS IPS ORAL LIQUID 40 MG/15 ML
3
DP
FERRETTS ORAL TABLET 325 MG (106 MG
IRON)
3
DP
FERREX 150 ORAL CAPSULE 150 MG IRON
3
DP
ferric subsulfate (bulk) powder
3
PA; DP
ferric subsulfate (bulk) solution 20 to 22 gram/100
ml
3
PA; DP
FERRIMIN 150 ORAL TABLET 456 MG (150
MG IRON)
3
DP
ferrous gluconate oral tablet 236 mg (27 mg iron),
324 mg (37.5 mg iron), 324 mg (38 mg iron)
3
DP
ferrous sulfate oral liquid 300 mg (60 mg iron)/5
ml
3
DP
ferrous sulfate oral tablet 325 mg (65 mg iron)
3
DP
ferrous sulfate oral tablet extended release 140 mg
(45 mg iron)
3
DP
ferrous sulfate oral tablet,delayed release (dr/ec)
324 mg (65 mg iron), 325 mg (65 mg iron)
3
DP
ferrous sulfate, dried (bulk) powder 100 %
3
PA; DP
133
Nome do medicamento
Classificação do
medicamento
FOLITAB ORAL TABLET EXTENDED
RELEASE 105 MG IRON- 500 MG-800 MCG
3
DP
HEMOCYTE ORAL TABLET 324 MG (106 MG
IRON)
3
DP
HIGH POTENCY IRON ORAL TABLET 134
MG (27 MG IRON)
3
DP
ICAPS ORAL TABLET EXTENDED RELEASE
3,300-5-200-75 UNIT-MG-MG-UNIT
3
DP
indole-3-carbinol (bulk) powder
3
PA; DP
INFED INJECTION SOLUTION 100 MG/2 ML
(50 MG/ML)
3
DP
INTEGRA ORAL CAPSULE 125-40-3 MG
3
DP
IRON (DRIED) ORAL TABLET EXTENDED
RELEASE 160 MG (50 MG IRON)
3
DP
IRON CHEWS ORAL TABLET,CHEWABLE 15
MG
3
DP
klor-con 10 oral tablet extended release 10 meq
1
klor-con 8 oral tablet extended release 8 meq
1
KLOR-CON M15 ORAL TABLET,ER
PARTICLES/CRYSTALS 15 MEQ
2
klor-con m20 oral tablet,er particles/crystals 20
meq
1
lactose (bulk) powder
3
PA; DP
M.V.I.-12 (WITHOUT VITAMIN K)
INTRAVENOUS SOLUTION 3,300 UNIT-200
UNIT/10 ML
3
DP
MAG-DELAY ORAL TABLET EXTENDED
RELEASE 64 MG
3
DP
magnesium amino acid chelate oral tablet 27 mg
3
DP
magnesium carbonate powder
3
PA; DP
magnesium chloride crystals
3
PA; DP
magnesium oral tablet 200 mg, 250 mg
3
DP
magnesium oxide (bulk) powder 100 %
3
PA; DP
134
Nome do medicamento
Classificação do
medicamento
magnesium oxide oral tablet 400 mg, 420 mg, 500
mg
3
DP
magnesium sulfate injection solution 4 meq/ml (50
%)
1
MAGONATE (MAGNESIUM CARB) ORAL
LIQUID 54 MG/5 ML
3
DP
MAGTAB ORAL TABLET EXTENDED
RELEASE 84 MG
3
DP
manganese chloride intravenous solution 0.1
mg/ml
3
DP
MYKIDZ IRON ORAL SUSPENSION 10-1,500400 MG -UNIT-UNIT/2 ML, 15 MG /1.5 ML
IRON
3
DP
NATURAL B-100 COMPLEX ORAL TABLET
100 MG
3
DP
normosol-r ph 7.4 intravenous parenteral solution
1
NOVAFERRUM 125 ORAL LIQUID 125 MG
IRON- 100 UNIT/5 ML
3
DP
NOVAFERRUM 50 ORAL CAPSULE 50 MG
IRON
3
DP
NOVAFERRUM ORAL DROPS 15 MG/ML
IRON
3
DP
OPTIMAL D3 ORAL CAPSULE 50,000 UNIT
3
DP
ORALYTE ORAL SOLUTION
3
DP
OYST-CAL D ORAL TABLET 250-125 MGUNIT
3
DP
PHOS-NAK ORAL POWDER IN PACKET 280160-250 MG
3
DP
potassium chloride intravenous piggyback 40
meq/100 ml
1
potassium chloride oral capsule, extended release
10 meq, 8 meq
1
potassium chloride oral tablet extended release 8
meq
1
135
Nome do medicamento
Classificação do
medicamento
potassium chloride oral tablet,er particles/crystals
10 meq, 20 meq
1
potassium gluconate (bulk) powder
3
PA; DP
potassium nitrate (bulk) granules
3
PA; DP
prasterone (dhea) oral capsule 25 mg
3
PA; DP
PRESERVISION LUTEIN ORAL CAPSULE
226-200-5-0.8 MG-UNIT-MG-MG
3
DP
PRO FE ORAL CAPSULE 180 MG IRON
3
DP
SLOW RELEASE IRON ORAL TABLET
EXTENDED RELEASE 143 MG (45 MG IRON),
159 MG (45 MG IRON), 160 MG (50 MG IRON)
3
DP
sodium chloride (bulk) granules
3
PA; DP
sodium chloride 0.9 % intravenous parenteral
solution 0.9 %
1
sodium chloride 3 % intravenous parenteral
solution 3 %
1
sodium chloride intravenous parenteral solution
2.5 meq/ml
1
sodium chloride irrigation solution 0.9 %
1
sodium chloride tablet,soluble 1,000 mg
3
SODIUM FLUORIDE ORAL TABLET 1 MG
FLUORIDE (2.2 MG)
2
SYRSPEND SF ALKA ORAL SUSPENSION
FOR RECONSTITUTION
3
DP
TANDEM DUAL ACTION ORAL CAPSULE
162-115.2 (106) MG
3
DP
THERAPEUTIC-M ORAL TABLET 27-0.4 MG
3
DP
THEREMS-H ORAL TABLET 27-0.33 MG
3
DP
THEREMS-M ORAL TABLET 27-0.4 MG
3
DP
thymol crystals
3
PA; DP
VENOFER INTRAVENOUS SOLUTION 200
MG/10 ML IRON
3
DP
B/D
DP
136
Nome do medicamento
Classificação do
medicamento
WEE CARE ORAL SUSPENSION 15 MG/1.25
ML
3
DP
zinc chloride intravenous solution 1 mg/ml
3
DP
zinc gluconate oral tablet 50 mg
3
DP
zinc sulfate (bulk) powder 100 %
3
PA; DP
zinc sulfate oral capsule 220 (50) mg
3
DP
zinc sulfate oral tablet 220 mg
3
DP
aminosyn 8.5 %-electrolytes intravenous
parenteral solution 8.5 %
1
B/D
AMINOSYN II 10 % INTRAVENOUS
PARENTERAL SOLUTION 10 %
2
B/D
2
B/D
2
B/D
AMINOSYN II 8.5 % INTRAVENOUS
2
B/D
aminosyn ii 8.5 %-electrolytes intravenous
1
B/D
AMINOSYN M 3.5 % INTRAVENOUS
2
B/D
AMINOSYN-HBC 7% INTRAVENOUS
2
B/D
AMINOSYN-PF 10 % INTRAVENOUS
2
B/D
AMINOSYN-PF 7 % (SULFITE-FREE)
INTRAVENOUS PARENTERAL SOLUTION 7
%
2
B/D
clinimix 4.25%/d10w sulf free intravenous
1
B/D
clinimix 4.25%-d20w sulf-free intravenous
1
B/D
Therapeutic Nutrients/ Minerals/ Electrolytes
137
Nome do medicamento
Classificação do
medicamento
clinimix 4.25%-d25w sulf-free intravenous
1
B/D
clinisol sf 15 % intravenous parenteral solution 15
%
1
B/D
d10 % & 0.45 % sodium chloride intravenous
parenteral solution
1
d2.5 %-0.45 % sodium chloride intravenous
parenteral solution
1
d5 % and 0.9 % sodium chloride intravenous
parenteral solution
1
d5 %-0.45 % sodium chloride intravenous
parenteral solution
1
dextrose 10 % and 0.2 % nacl intravenous
parenteral solution
1
dextrose 10 % in water (d10w) intravenous
parenteral solution 10 %
1
dextrose 5 % in water (d5w) intravenous
parenteral solution
1
dextrose 5 %-lactated ringers intravenous
parenteral solution
1
dextrose 5%-0.2 % sod chloride intravenous
parenteral solution
1
dextrose 5%-0.3 % sod.chloride intravenous
parenteral solution
1
intralipid intravenous emulsion 20 %
1
lactated ringers intravenous parenteral solution
1
levocarnitine (with sugar) oral solution 100 mg/ml
1
levocarnitine oral tablet 330 mg
1
potassium chlorid-d5-0.45%nacl intravenous
parenteral solution 20 meq/l
1
PRENATAL VITAMINS LOW IRON ORAL
TABLET 27 MG IRON- 1 MG
2
water for irrigation, sterile irrigation solution
1
B/D
PA
138
Nome do medicamento
Classificação do
medicamento
Vitamins
A THRU Z SELECT ORAL TABLET 500-300250 MCG
3
DP
ANTIOXIDANT VITAMINS ORAL TABLET
1,000 UNIT-200 MG-60 UNIT-2 MG
3
DP
APATATE ORAL LIQUID
3
DP
AQUADEKS ORAL CAPSULE 100-10 MCGMG
3
DP
AQUADEKS ORAL TABLET,CHEWABLE 1005 MCG-MG
3
DP
AQUADEKS PEDIATRIC ORAL DROPS 400
MCG/ML
3
DP
AQUASOL A INTRAMUSCULAR SOLUTION
50,000 UNIT/ML
3
DP
B COMPLEX PLUS VITAMIN C ORAL
CAPSULE 15-10-50-5-300 MG
3
DP
BALANCED B-100 COMPLEX ORAL TABLET
3
DP
BALANCED B-100 ORAL TABLET 100 MG
3
DP
BALANCED B-50 ORAL TABLET
3
DP
biotin (bulk) powder 100 %
3
PA; DP
biotin oral capsule 5 mg
3
DP
biotin oral tablet 300 mcg
3
DP
CAL MAG ZINC + D3 ORAL TABLET 333 MG133 UNIT -133 MG-5 MG
3
DP
CALCIFEROL ORAL DROPS 8,000 UNIT/ML
3
DP
CALCITRATE ORAL TABLET 200 MG (950
MG)
3
DP
CALCIUM 500 WITH D ORAL TABLET 500
MG(1,250MG) -400 UNIT
3
DP
CALCIUM 600 + D(3) ORAL TABLET 600
MG(1,500MG) -200 UNIT
3
DP
calcium carbonate (bulk) powder 100 %
3
PA; DP
139
Nome do medicamento
Classificação do
medicamento
calcium carbonate-vit d3-min oral tablet 600 mg
calcium- 400 unit
3
DP
calcium carbonate-vit d3-min oral tablet,chewable
600 mg (1,500 mg)-400 unit
3
DP
calcium carbonate-vitamin d3 oral tablet 600
mg(1,500mg) -400 unit
3
DP
calcium carbonate-vitamin d3 oral
tablet,chewable 500 mg(1,250mg) -400 unit, 500100 mg-unit
3
DP
calcium citrate (bulk) powder 100 %
3
PA; DP
CALCIUM CITRATE + D ORAL TABLET 315200 MG-UNIT
3
DP
calcium-vitamin d3-vitamin k oral tablet,chewable
500-200-40 mg-unit-mcg
3
DP
CALVITE P&D ORAL TABLET 105-120 MGUNIT
3
DP
CARBOGEL GEL
3
PA; DP
CENTRAL-VITE ORAL TABLET 18-500-300250 MG-MCG-MCG-MCG
3
DP
CENTRUM CARDIO ORAL TABLET 3-200-400
MG-MCG-MG
3
DP
CENTRUM COMPLETE ORAL TABLET 18400 MG-MCG
3
DP
CENTRUM ORAL LIQUID 9 MG IRON/15 ML
3
DP
CENTRUM PERFORMANCE ORAL TABLET ,
18 MG IRON-400 MCG-50 MG
3
DP
CENTRUM SILVER ORAL TABLET , 0.4-300250 MG-MCG-MCG
3
DP
CENTRUM SILVER ULTRA WOMEN'S ORAL
TABLET
3
DP
CENTRUM SPECIALIST ENERGY ORAL
TABLET 18 MG IRON-400 MCG-25 MCG75MG
3
DP
140
Nome do medicamento
Classificação do
medicamento
CENTRUM ULTRA MEN'S ORAL TABLET 8
MG IRON- 200 MCG-600 MCG
3
DP
CEROVITE JR ORAL TABLET,CHEWABLE
3
DP
CHEWABLE-VITE ORAL
TABLET,CHEWABLE
3
DP
CHILDREN'S CHEWABLE COMPLETE ORAL
TABLET,CHEWABLE 9-200 MG IRON-MCG
3
DP
CHILDREN'S COMPLETE VITAMIN ORAL
TABLET,CHEWABLE 18 MG IRON
3
DP
CHILDS CHEW VITE ORAL
TABLET,CHEWABLE
3
DP
CHILDS/IRON ORAL TABLET,CHEWABLE
3
DP
cholecalciferol (vitamin d3) oral capsule 10,000
unit, 5,000 unit
3
DP
cholecalciferol (vitamin d3) oral tablet 1,000 unit,
2,000 unit, 5,000 unit
3
DP
CITRUS CALCIUM ORAL TABLET 200 MG
CALCIUM -250 UNIT, 315-250 MG-UNIT
3
DP
CORAL CALCIUM ORAL TABLET 390 MG
(1,000 MG)
3
DP
cyanocobalamin (vitamin b-12) injection solution
1,000 mcg/ml
3
DP
cyanocobalamin (vitamin b-12) oral tablet
extended release 1,000 mcg
3
DP
cyanocobalamin (vitamin b-12) sublingual tablet
1,000 mcg
3
DP
DIALYVITE 800 WITH ZINC 15 ORAL
TABLET 0.8-15 MG
3
DP
DIALYVITE 800 WITH ZINC 50 ORAL
TABLET 0.8-50 MG
3
DP
DIALYVITE 800-ULTRA D ORAL TABLET
0.8-2,000 MG-UNIT
3
DP
DIALYVITE VITAMIN D3 MAX ORAL
TABLET 50,000 UNIT
3
DP
141
Nome do medicamento
Classificação do
medicamento
D-VI-SOL ORAL DROPS 400 UNIT/ML
3
DP
ECEE PLUS ORAL TABLET 200-100-10-18
UNIT-MG-MG-MG
3
DP
ELDERTONIC ORAL ELIXIR 0.5-0.6-7-0.7 MG
3
DP
FATIGUE RELIEF COMPLEX ORAL TABLET
150-125-75 MG
3
DP
ferrous sulfate oral solution 220 mg (44 mg
iron)/5 ml
3
DP
FLINTSTONES MULTIVITAMIN ORAL
TABLET,CHEWABLE 300 MCG
3
DP
FLINTSTONES WITH IRON ORAL
TABLET,CHEWABLE 18 MG IRON
3
DP
FOLGARD ORAL TABLET 2,000-800-0.32
UNIT-MCG-MG
3
DP
folic acid (bulk) powder 100 %
3
PA; DP
folic acid injection solution 5 mg/ml
3
DP
folic acid oral tablet 1 mg, 400 mcg, 800 mcg
3
DP
FOLTABS 800 ORAL TABLET 0.8-10-115 MGMG-MCG
3
DP
FOSFREE ORAL TABLET 175.5-14.5 MG
3
DP
GERAVIM ORAL LIQUID
3
DP
hydroxocobalamin intramuscular solution 1,000
mcg/ml
3
DP
ICAPS AREDS ORAL CAPSULE 14,320-226200 UNIT-MG-UNIT
3
DP
ICAPS AREDS ORAL TABLET,DELAYED
RELEASE (DR/EC) 7,160-113-100 UNIT-MGUNIT
3
DP
ICAPS MV ORAL TABLET,DELAYED
RELEASE (DR/EC) 100-1.66-0.83 MCG-MGMG
3
DP
I-CAPS ORAL CAPSULE 280-10-2 MG
3
DP
ICAPS PLUS ORAL TABLET
3
DP
142
Nome do medicamento
Classificação do
medicamento
INFUVITE ADULT INTRAVENOUS
SOLUTION 3,300 UNIT- 150 MCG/10 ML
3
DP
INFUVITE PEDIATRIC INTRAVENOUS
SOLUTION 80 MG-400 UNIT- 200 MCG/5 ML
3
DP
IRON 100 PLUS ORAL TABLET 100-250-25-1
MG-MG-MCG-MG
3
DP
iron-vitamin c oral tablet 100-250 mg
3
DP
I-VITE PROTECT ORAL TABLET 7,160-113100 UNIT-MG-UNIT
3
DP
M.V.I. ADULT INTRAVENOUS SOLUTION
3,300 UNIT- 150 MCG/10 ML
3
DP
M.V.I. PEDIATRIC INTRAVENOUS RECON
SOLN 80-400-200 MG-UNIT-MCG
3
DP
magnesium gluconate oral tablet 27 mg (500 mg)
3
DP
MEGA MULTIVITAMIN FOR MEN ORAL
TABLET 200-175-250 MCG
3
DP
MEGA MULTIVITAMIN WITH MINERAL
ORAL TABLET 13.5-200-250 MG-MCG-MCG
3
DP
MULTI-DELYN ORAL LIQUID
3
DP
MULTI-DELYN WITH IRON ORAL LIQUID 10
MG IRON/5 ML
3
DP
MULTILEX-T&M ORAL TABLET
3
DP
MULTIPLE VITAMIN ORAL TABLET
3
DP
MULTIPLE VITAMIN, WOMENS ORAL
TABLET
3
MULTI-VITAMIN HP/MINERALS ORAL
CAPSULE
3
DP
NEPHRONEX ORAL LIQUID 900 MCG/5 ML
3
DP
OCUVITE ORAL CAPSULE 150-30-5-150 MGUNIT-MG-MG
3
DP
ONCOVITE ORAL TABLET
3
DP
ONE DAILY FOR MEN 50+ ADVANCED
ORAL TABLET 400-600-120 MCG-MCG-MG
3
DP
143
Nome do medicamento
Classificação do
medicamento
ONE DAILY FOR MEN ORAL TABLET 0.4-600
MG-MCG
3
DP
ONE DAILY MAXIMUM ORAL TABLET 180.4 MG
3
DP
ONE DAILY MULTIVITAMIN ORAL TABLET
400 MCG
3
DP
ONE DAILY PRENATAL ORAL COMBO
PACK 28-800-440 MG-MCG-MG
3
DP
ONE DAILY WOMEN'S ORAL TABLET 18 MG
IRON-400 MCG-450 MG CA
3
DP
OYSCO 500/D ORAL TABLET 500
MG(1,250MG) -200 UNIT
3
DP
POLY-VITAMIN ORAL DROPS 1,500-35-400
UNIT-MG-UNIT/ML
3
DP
POLY-VITAMIN WITH IRON ORAL DROPS
1,500 UNIT-400 UNIT-10 MG/ML
3
DP
PRENATAL MULTIVITAMINS ORAL
TABLET 28 MG IRON- 800 MCG
3
DP
prenatal vit#96-ferrous fum-fa oral tablet 27 mg
iron- 800 mcg
3
DP
PRENATAL VITAMIN ORAL TABLET 27-0.8
MG
3
DP
PRENATAL VITAMIN WITH MINERALS
ORAL TABLET 28-0.8 MG
3
DP
PROSIGHT ORAL TABLET 5,000-60-30 UNITMG-UNIT
3
DP
pyridoxine injection solution 100 mg/ml
3
DP
STRESS 500 PLUS ZINC ORAL TABLET
3
DP
STRESS FORMULA ORAL TABLET
3
DP
STRESS FORMULA WITH IRON ORAL
TABLET 500 MG-400 MCG- 18 MG IRON
3
DP
TAB A VITE ORAL TABLET 18-0.4 MG
3
DP
THERA VITAL M ORAL TABLET
3
DP
THERAPEUTIC LIQUID ORAL LIQUID
3
DP
144
Nome do medicamento
Classificação do
medicamento
THERAPEUTIC-M ORAL TABLET 9-0.4 MG
3
DP
TOTAL B/C ORAL TABLET
3
DP
TRI-VITAMIN ORAL DROPS 1,500-35-400
UNIT-MG-UNIT/ML
3
DP
tyrosine (bulk) powder
3
PA; DP
ULTIMATE MEN'S COMPLETE 50+ ORAL
TABLET 300-600-300 MCG
3
DP
ULTIMATE WOMEN'S COMPLETE 50+ ORAL
TABLET 8 MG IRON-400 MCG-300 MCG
3
DP
vit a & d3 in cod liver oil oral capsule 1,250-135
unit
3
DP
vit e acid succinate (bulk) powder 100 %
3
PA; DP
VITABASIC SENIOR ORAL TABLET
3
DP
vitamin a oral capsule 10,000 unit, 8,000 unit
3
DP
VITAMIN B-1 (MONONITRATE) ORAL
TABLET 100 MG
3
DP
VITAMIN B-12 ORAL TABLET 1,000 MCG,
100 MCG, 250 MCG, 500 MCG
3
DP
VITAMIN B-12 ORAL TABLET EXTENDED
RELEASE 2,000 MCG
3
DP
VITAMIN B-6 ORAL TABLET 100 MG, 50 MG
3
DP
VITAMIN C DROPS ORAL LOZENGE 60 MG
3
DP
VITAMIN C ORAL CAPSULE, EXTENDED
RELEASE 500 MG
3
DP
VITAMIN C ORAL SYRUP 500 MG/5 ML
3
DP
VITAMIN C ORAL TABLET 1,000 MG, 250
MG, 500 MG
3
DP
VITAMIN C ORAL TABLET,CHEWABLE 250
MG, 500 MG
3
DP
VITAMIN D2 ORAL CAPSULE 50,000 UNIT
3
DP
VITAMIN D3 ORAL CAPSULE 1,000 UNIT,
2,000 UNIT, 400 UNIT
3
DP
VITAMIN D3 ORAL TABLET 400 UNIT
3
DP
145
Nome do medicamento
Classificação do
medicamento
VITAMIN D3 ORAL TABLET,CHEWABLE
1,000 UNIT
3
DP
vitamin e (dl, acetate) oral capsule 1,000 unit, 200
unit, 400 unit
3
DP
vitamin e acetate oral capsule 200 unit
3
DP
vitamin e mixed oral capsule 400 unit
3
DP
vitamin e oral capsule 1,000 unit, 100 unit, 200
unit, 400 unit
3
DP
vitamin e oral drops 50 unit/ml
3
DP
VITAMINS & MINERALS ORAL TABLET
3
DP
VITAMINS B COMPLEX ORAL CAPSULE
3
DP
WOMEN'S 50+ DAILY FORM (GKB) ORAL
TABLET 400-120 MCG-MG
3
DP
WOMEN'S DAILY FORMULA ORAL TABLET
27-0.4 MG
3
DP
yeast oral tablet 500 mg (7.5 gr)
3
DP
zinc sulfate-vitamin c oral lozenge 15-30 mg
3
DP
ZOO FRIENDS COMPLETE ORAL
TABLET,CHEWABLE 9-200 MG-MCG
3
DP
ZOO FRIENDS ORAL TABLET,CHEWABLE ,
15 MG, 300 MCG
3
DP
Therapeutic Nutrients/Minerals/Electrolytes
DAILY MULTIPLE VITAMINS/IRON ORAL
TABLET
3
pyridoxine oral tablet 25 mg
3
thiamine hcl oral tablet 100 mg, 50 mg
3
146
OTC Drugs
Name of Drug
Drug Tier
ALAWAY OPHTHALMIC DROPS 0.025 %
(0.035 %)
1
ketotifen fumarate ophthalmic drops 0.025 %
(0.035 %)
1
ZADITOR OPHTHALMIC DROPS 0.025 %
(0.035 %)
1
Necessary actions, restrictions, or
limits on use
147
Index – Alphabetical Listing
1
12 HOUR DECONGESTANT
......................................... 125
7
7-oxo-dhea, micronized (bulk)
......................................... 110
8
8-MOP ................................... 79
A
A THRU Z SELECT ........... 137
abacavir ................................. 56
abacavir-lamivudine-zidovudine
........................................... 57
abelcet ................................... 36
ABILIFY ............................... 51
ABILIFY DISCMELT .... 31, 51
ABILIFY MAINTENA ......... 31
ABRAXANE ......................... 45
acacia .................................. 110
acamprosate .......................... 17
acarbose ................................ 59
acebutolol .............................. 69
ACEPHEN............................. 12
acesulfame potassium (bulk) 110
acetaminophen (bulk) ............ 12
acetaminophen-codeine ......... 12
acetazolamide ........................ 73
acetic acid.............................. 19
acetic acid (bulk) ................... 19
acetylcarnitine (bulk)........... 110
acetylcysteine....................... 125
acitretin ................................. 79
ACTEMRA ................. 101, 105
ACTHIB (PF) ...................... 105
ACTIMMUNE .................... 105
ACTOPLUS MET XR .......... 61
acyclovir ................................ 55
acyclovir sodium.................... 55
ADACEL(TDAP
ADOLESN/ADULT)(PF) 105
ADAGEN .............................. 82
ADEFOVIR ........................... 54
ADEMPAS .......................... 125
adrucil ................................... 42
ADT ROBITUSSIN PEAK
CLD DM MAX ............... 125
ADULT ROBITUSSIN PEAK
COLD DM ...................... 125
ADULT ROBITUSSIN PEAK
COLD M-S ...................... 125
ADVAIR DISKUS .............. 122
ADVAIR HFA .................... 122
afeditab cr ............................. 70
AFINITOR ............................ 46
AFINITOR DISPERZ ......... 101
AGGRENOX ........................ 67
a-hydrocort ............................ 38
ala-cort .................................. 90
ALAWAY ........................... 145
ALBENZA ............................ 48
albuterol sulfate................... 123
alclometasone ........................ 90
alcohol pads .......................... 19
ALDACTAZIDE ................... 71
ALDURAZYME ................... 83
alendronate ......................... 109
ALER-DRYL ...................... 120
alfuzosin ................................ 89
ALIMTA ............................... 42
ALINIA ................................. 48
ALL DAY ALLERGY-D.... 120
allantoin .............................. 110
ALLER-EASE..................... 120
ALLERGY
RELIEF(DIPHENHYDRAM
IN) ................................... 120
ALLER-TEC ....................... 120
allopurinol ............................. 38
almond oil, sweet (bulk) ...... 110
aloe vera leaf gel xtr (bulk) . 110
alosetron ................................ 86
alpha lipoic acid (bulk) ....... 110
ALPHAGAN P .................... 119
alprazolam............................. 59
ALTARUSSIN .................... 125
ALTARYL .......................... 120
alum, ammonium (bulk) ...... 129
aluminum acetate ................ 129
aluminum chloride .............. 129
aluminum hydroxide gel ........ 84
aluminum hydroxide gel (bulk)
........................................... 84
amantadine hcl ...................... 50
AMBISOME ......................... 36
amcinonide ............................ 90
amifostine crystalline ............ 45
amikacin ................................ 18
amiloride ............................... 74
amiloride-hydrochlorothiazide
........................................... 71
aminophylline ...................... 124
AMINOSYN 7 % WITH
ELECTROLYTES .......... 129
aminosyn 8.5 %-electrolytes 135
AMINOSYN II 10 % .......... 135
AMINOSYN II 15 % .......... 135
AMINOSYN II 7 % ............ 135
AMINOSYN II 8.5 % ......... 135
aminosyn ii 8.5 %-electrolytes
......................................... 135
AMINOSYN M 3.5 % ........ 135
AMINOSYN-HBC 7% ....... 135
AMINOSYN-PF 10 % ........ 135
AMINOSYN-PF 7 %
(SULFITE-FREE) ........... 135
AMINOSYN-RF 5.2 %....... 129
amiodarone ........................... 68
AMITIZA .............................. 86
amitriptyline .......................... 33
amitriptyline-chlordiazepoxide
........................................... 31
AMLACTIN ......................... 79
amlodipine............................. 70
amlodipine-atorvastatin ........ 71
amlodipine-benazepril .......... 71
amlodipine-valsartan ............ 71
148
amlodipine-valsartan-hcthiazid
........................................... 71
ammonium chloride ............. 129
ammonium chloride (bulk) .. 110
ammonium lactate ................. 79
amnesteem ............................. 79
amoxapine ............................. 33
amoxicillin ............................. 22
amoxicillin-pot clavulanate .. 22,
23
amphetamine salt combo ....... 76
amphotericin b ....................... 36
ampicillin ............................... 23
ampicillin sodium .................. 23
ampicillin-sulbactam ............. 23
AMPYRA .............................. 78
ANADROL-50 ...................... 93
anagrelide .............................. 65
anastrozole ............................ 46
ANDROGEL ......................... 93
ANDROXY ........................... 99
ANTACID PLUS ANTI-GAS
........................................... 84
ANTI-DIARRHEAL
(LOPERAMIDE) ............... 84
ANTIOXIDANT VITAMINS
......................................... 137
APATATE ........................... 137
APIDRA ................................ 63
APIDRA SOLOSTAR........... 63
APLENZIN ........................... 31
APOKYN .............................. 50
apple flavor (bulk) ............... 110
apri ........................................ 94
APTIOM ................................ 29
APTIVUS .............................. 57
AQUA GLYCOLIC FACE ... 79
AQUADEKS ....................... 137
AQUADEKS PEDIATRIC . 137
AQUASOL A ...................... 137
ARALAST NP .................... 125
aranelle (28) .......................... 94
ARANESP (IN
POLYSORBATE) ....... 65, 66
ARBEM H-COSMETIC ....... 79
ARBEM LIPOPEN ............... 79
ARCALYST ........................ 105
argatroban............................. 64
argatroban in 0.9 % sod chlor
........................................... 64
arginine (l-arginine) (bulk) . 110
arginine hcl(l-arginine)(bulk)
......................................... 110
aripiprazole ........................... 31
ARRANON ........................... 42
ARTHRITIS PAIN
RELIEF(CAPSAIC) .......... 12
ARZERRA ............................ 48
ascomp with codeine ............. 12
ascorbic acid ....................... 110
ascorbic acid (bulk)............. 110
ascorbyl palmitate (bulk) .... 110
ASMANEX HFA ................ 122
ASMANEX TWISTHALER
......................................... 122
aspartame ............................ 110
aspirin ............................. 12, 67
aspirin (bulk) ....................... 110
assure id insulin safety .......... 63
ASTAGRAF XL ................. 101
atenolol .................................. 69
atenolol-chlorthalidone ......... 71
ATGAM .............................. 101
atorvastatin ........................... 74
atovaquone ............................ 48
atovaquone-proguanil ........... 48
ATRIPLA .............................. 57
ATROVENT HFA .............. 123
AUBAGIO ............................ 78
aubra ..................................... 94
AVANDAMET ............... 59, 62
AVANDARYL ..................... 59
AVANDIA ............................ 59
AVASTIN ............................. 42
AVELOX IN NACL (ISOOSMOTIC) ....................... 24
aviane .................................... 94
AVODART ........................... 89
AVONEX .............................. 78
AVONEX (WITH ALBUMIN)
........................................... 78
AZ ......................................... 79
azacitidine ............................. 42
AZASAN ............................ 101
azathioprine ........................ 101
azelastine......................119, 121
AZILECT .............................. 50
azithromycin .....................23, 24
AZOPT ................................ 119
AZOR .................................... 71
aztreonam .............................. 22
B
B COMPLEX PLUS VITAMIN
C ...................................... 137
bacitracin .............................. 19
bacitracin zinc ....................... 19
bacitracin-polymyxin b ..19, 118
baclofen ................................. 53
BACTROBAN NASAL ........ 19
BALAMINE DM (CHLOR-PE)
......................................... 126
BALANCED B-100 ............ 137
BALANCED B-100
COMPLEX ..................... 137
BALANCED B-50 .............. 137
balsalazide .......................... 108
balsam peru (bulk) .............. 111
balziva (28) ........................... 94
BANANA CONCENTRATE
......................................... 111
BANANA CREAM FLAVOR
......................................... 111
BANZEL ............................... 29
BARACLUDE ...................... 54
BASE 7542 ........................... 79
BCG VACCINE, LIVE (PF)105
BEELITH ............................ 129
BELEODAQ ......................... 43
BENADRYL ALLERGY ... 121
benazepril .............................. 68
benazepril-hydrochlorothiazide
........................................... 71
BENICAR ............................. 68
149
BENICAR HCT .................... 71
BENLYSTA ........................ 101
benzoin (bulk) ........................ 19
benzonatate .......................... 126
benzphetamine ....................... 77
benztropine ............................ 49
benzyl alcohol ...................... 111
benzyl benzoate (bulk) ........... 49
betaine (bulk) ....................... 111
betamethasone dipropionate . 38
betamethasone valerate ......... 38
betamethasone, augmented.... 38
BETASERON ....................... 78
betaxolol ................................ 69
bethanechol chloride ............. 89
BEXSERO (PF) ................... 105
bicalutamide .......................... 41
BICILLIN L-A ...................... 23
BICNU................................... 43
BILTRICIDE ......................... 48
bioflavonoid, lemon (bulk)... 111
biotin.................................... 137
biotin (bulk) ......................... 137
bismuth subcarbonate (bulk) . 86
bismuth subgallate ............... 111
bismuth subnitrate (bulk) ....... 86
bisoprolol fumarate ............... 69
bisoprolol-hydrochlorothiazide
........................................... 71
BIVIGAM ........................... 104
black food color (bulk) ........ 111
bleomycin............................... 43
blue food color (bulk) .......... 111
blueberry flavor (bulk) ........ 111
BOOSTRIX TDAP.............. 105
boric acid ............................. 111
boric acid (bulk) .................. 111
BOSULIF .............................. 46
briellyn................................... 94
BRILINTA ............................ 67
brimonidine ......................... 119
BRINTELLIX ....................... 32
bromocriptine ........................ 50
brompheniramine-pseudoephdm .................................... 126
brompheniramin-phenylephrindm .................................... 126
bubblegum flavor (bulk) ...... 111
BUCKLEY'S CHEST
CONGESTION MIX....... 126
budesonide........................... 122
BUDESONIDE ..................... 86
BUFFER CREAM............... 111
BUFFERIN ........................... 12
bumetanide ............................ 73
buprenorphine hcl ................. 17
buprenorphine-naloxone ....... 17
buproban ............................... 31
bupropion hcl ........................ 31
buspirone ............................... 59
BUSULFEX .......................... 41
butalbital-acetaminop-caf-cod
........................................... 12
butorphanol tartrate .............. 16
butylparaben (bulk) ............. 111
BYDUREON................... 59, 60
BYETTA ............................... 60
C
cabergoline .......................... 100
CAL MAG ZINC + D3 ....... 137
calamine ........................ 80, 111
calamine phenolated ............. 79
calamine-zinc oxide ............... 80
CALCARB 600 ................... 129
CALCET CREAMY BITES 129
CALCET PETITES ............. 129
CALCI-CHEW .................... 130
CALCIFEROL .................... 137
CALCI-MIX ........................ 130
CALCIONATE ................... 130
calcipotriene .......................... 80
calcitonin (salmon).............. 109
CALCITRATE .................... 137
calcitriol .............................. 109
CALCIUM 500 WITH D .... 137
CALCIUM 600 + D(3)........ 137
calcium acetate...................... 89
calcium carbonate ..........84, 130
calcium carbonate (bulk) ... 111,
137
calcium carbonate-vit d3-min
......................................... 138
calcium carbonate-vitamin d3
......................................... 138
calcium citrate (bulk) .......... 138
CALCIUM CITRATE + D . 138
calcium gluconate ............... 130
calcium hydroxide ............... 111
calcium lactate .................... 130
calcium lactate (bulk).......... 130
calcium phos, tribasic (bulk) 130
calcium phosphate (bulk) .... 130
CALCIUM SACCHARATE111
calcium-magnesium-zinc..... 130
calcium-vitamin d3-vitamin k
......................................... 138
CALVITE P&D .................. 138
camila.................................... 98
camphor .............................. 111
CANASA ............................ 108
CANCIDAS .......................... 36
CAPASTAT .......................... 40
CAPCOF ............................. 126
CAPRELSA .......................... 47
capsaicin ............................... 12
captopril ................................ 68
captopril-hydrochlorothiazide
........................................... 71
CAPZASIN ........................... 80
CARAC ................................. 80
caramel flavor (bulk) .......... 111
CARBAGLU....................... 130
carbamazepine .................29, 59
carbamide peroxide (bulk) .. 111
carbidopa-levodopa .............. 50
CARBOGEL ....................... 138
CARBOHOL ....................... 111
carbomer homopolymer c (bulk)
......................................... 111
carboplatin ............................ 43
carboxymethylcellulose sodium
......................................... 111
150
CARIMUNE NF
NANOFILTERED........... 104
carisoprodol ........................ 128
carisoprodol-asa-codeine ...... 12
carisoprodol-aspirin .............. 12
carteolol............................... 119
cartia xt.................................. 70
carvedilol ............................... 69
cefaclor .................................. 21
cefadroxil ............................... 21
cefazolin................................. 21
cefdinir................................... 21
cefepime ................................. 21
cefepime in dextrose 5 % ....... 21
cefepime in dextrose,iso-osm . 21
cefotaxime .............................. 21
cefoxitin ................................. 21
cefoxitin in dextrose, iso-osm 21
cefpodoxime ........................... 21
cefprozil ................................. 22
ceftriaxone ............................. 22
cefuroxime axetil ................... 22
cefuroxime sodium ................. 22
celecoxib ................................ 13
CELLCEPT INTRAVENOUS
........................................... 35
CELONTIN ........................... 26
CENESTIN ............................ 99
CENTAVITE A-Z
COMPLETE-MINERAL 130
CENTRAL-VITE ................ 138
CENTRUM ......................... 138
CENTRUM CARDIO ......... 138
CENTRUM COMPLETE ... 138
CENTRUM PERFORMANCE
......................................... 138
CENTRUM SILVER........... 138
CENTRUM SILVER ULTRA
WOMEN'S....................... 138
CENTRUM SPECIALIST
ENERGY ......................... 138
CENTRUM ULTRA MEN'S
......................................... 139
cephalexin .............................. 22
CEREZYME ......................... 83
CEROVITE JR .................... 139
CERVARIX VACCINE (PF)
......................................... 105
cetirizine .............................. 121
cetyl alcohol ........................ 111
cevimeline .............................. 79
CHANTIX ............................. 17
CHANTIX CONTINUING
MONTH BOX ................... 17
CHANTIX STARTING
MONTH BOX ................... 17
CHARCOAL ....................... 111
cheesecake flavor (bulk) ...... 111
CHELATED ZINC ............. 130
CHERATUSSIN DAC ........ 126
cherry flavor ........................ 112
CHERRY FLAVOR ............ 112
CHEST CONGESTIONCOUGH RELIEF ............ 126
CHEWABLE-VITE ............ 139
CHILDREN'S ADVIL .......... 13
CHILDREN'S CHEWABLE
COMPLETE .................... 139
CHILDREN'S COMPLETE
VITAMIN ....................... 139
CHILDREN'S FEVER
REDUCING ...................... 12
CHILDREN'S PAIN RELIEF12
CHILDREN'S WAL-DRYL
ALLERGY ...................... 121
CHILDREN'S WAL-ZYR .. 121
CHILDS CHEW VITE........ 139
CHILDS/IRON ................... 139
chloramphenicol sod succinate
........................................... 19
chlorhexidine gluconate ........ 79
chloroform ........................... 112
chloroquine phosphate .......... 49
chlorothiazide ........................ 74
chlorpromazine ..................... 34
chlorthalidone ....................... 74
chlorzoxazone ...................... 128
chocolate flavor (bulk) ........ 112
cholecalciferol (vitamin d3) 139
cholesterol (bulk)................. 112
cholestyramine light .............. 75
chorionic gonadotropin, human
........................................... 92
chromium chloride .............. 130
chrysin ................................. 130
ciclopirox .............................. 36
cidofovir ................................ 53
cilostazol ............................... 67
cimetidine .............................. 85
cimetidine hcl ........................ 85
CIMZIA .............................. 102
CIMZIA POWDER FOR
RECONST ...................... 102
CINRYZE ........................... 101
CIPRODEX ......................... 120
ciprofloxacin (mixture) ......... 24
ciprofloxacin hcl ................... 24
ciprofloxacin lactate ............. 24
cisplatin ................................. 43
citalopram ............................. 32
citric acid ............................ 130
citric acid anhydrous (bulk) 112
citric acid monohydrate (bulk)
......................................... 112
citrulline .............................. 112
CITRUS CALCIUM ........... 139
cladribine .............................. 43
claravis .................................. 80
clarithromycin ....................... 24
clemastine ........................... 121
CLEOCIN ............................. 19
CLIMARA PRO ................... 94
clindamycin hcl ..................... 19
clindamycin pediatric ............ 19
clindamycin phosphate.....19, 20
clinimix 4.25%/d10w sulf free
......................................... 135
clinimix 4.25%-d20w sulf-free
......................................... 135
clinimix 4.25%-d25w sulf-free
......................................... 136
clinisol sf 15 % .................... 136
CLINITEST REAGENT ....... 62
clobetasol .............................. 90
clobetasol-emollient .............. 90
151
CLOLAR ............................... 43
clomipramine ......................... 33
clonazepam ............................ 27
clonidine ................................ 67
clonidine hcl .................... 67, 77
clopidogrel............................. 67
clorazepate dipotassium ........ 27
clotrimazole ........................... 36
clotrimazole-betamethasone .. 80
clove oil ............................... 112
clozapine ................................ 53
CO Q-10 ................................ 83
coal tar (bulk) ...................... 112
COARTEM ........................... 49
cocoa butter (bulk) ................ 80
coconut oil (bulk)................. 112
cod liver oil ............................ 75
codeine-guaifenesin ............. 126
coenzyme q10 ................ 83, 130
coenzyme q10 (bulk) .............. 83
colchicine............................... 38
colchicine-probenecid ........... 38
colestipol ............................... 75
colistin (colistimethate na) .... 19
collodion (bulk) ................... 112
colocort ................................ 108
COMBIGAN ....................... 119
COMBIPATCH ..................... 94
COMBIVENT RESPIMAT. 128
COMETRIQ .......................... 47
COMPLERA ......................... 56
COMPLETE LICE
TREATMENT ................... 49
compro ................................... 34
COMTREX DEEP CHEST
COLD .............................. 130
COMVAX (PF) ................... 105
constulose .............................. 86
COPAXONE ......................... 78
COPPER CHLORIDE ......... 130
COPPER SULFATE ........... 130
CORAL CALCIUM ............ 139
COREG CR ........................... 69
cormax ................................... 80
corn starch (bulk) ................ 112
cortisone ................................ 38
COSMEGEN ......................... 43
cotton candy flavor (bulk) ... 112
cottonseed oil (bulk) ............ 112
COUGH DM ER ................. 126
COUMADIN ......................... 65
creatine monohydrate (bulk) 112
CREME DE MENTHE
FLAVORING .................. 112
CREON ................................. 83
CRESTOR ............................. 74
CRIXIVAN ........................... 57
cromolyn ...................... 119, 124
croton oil (bulk)................... 112
cryselle (28) ........................... 94
CUBICIN .............................. 20
CUVPOSA ............................ 79
cyanocobalamin (vitamin b-12)
......................................... 139
cyclafem 1/35 (28) ................. 94
cyclafem 7/7/7 (28) ................ 95
cyclobenzaprine................... 128
cyclophosphamide ................. 41
cyclosporine ........................ 102
cyclosporine modified ......... 102
cyproheptadine .................... 121
CYSTADANE....................... 83
CYSTAGON ......................... 83
cysteine hcl(l-cysteine)(bulk)
......................................... 112
cytarabine .............................. 43
cytarabine (pf) ....................... 43
D
d10 % & 0.45 % sodium
chloride ........................... 136
d2.5 %-0.45 % sodium chloride
......................................... 136
d5 % and 0.9 % sodium
chloride ........................... 136
d5 %-0.45 % sodium chloride
......................................... 136
dacarbazine ........................... 43
DAILY MULTIPLE
VITAMINS/IRON .......... 144
DALIRESP ......................... 124
DANAZOL ........................... 93
dantrolene ............................. 53
dapsone ................................. 40
DAPTACEL (DTAP
PEDIATRIC) (PF) .......... 105
DARAPRIM ......................... 49
daunorubicin ......................... 43
DAUNOXOME .................... 43
DAYHIST ........................... 121
deblitane ................................ 95
decitabine .............................. 43
delyla (28) ............................. 95
DELZICOL ........................... 86
demeclocycline ...................... 25
DEMSER .............................. 71
DENAVIR ............................. 55
DENTAL BASE ................... 79
DEPEN TITRATABS ........... 89
DEPO-PROVERA ................ 98
DEPO-SUBQ PROVERA 104
........................................... 98
DESENEX
(CLOTRIMAZOLE) ......... 36
desipramine ........................... 33
desmopressin ......................... 92
desog-e.estradiol/e.estradiol . 95
desonide ................................ 90
desoximetasone ..................... 90
desvenlafaxine ....................... 32
dexamethasone ...................... 39
dexamethasone intensol ........ 39
dexamethasone sodium
phosphate ...................39, 119
DEXFERRUM .................... 130
DEXILANT .......................... 88
dexmethylphenidate............... 77
DEXRAZOXANE HCL ....... 43
dextroamphetamine ..........76, 77
dextroamphetamineamphetamine ..................... 77
dextromethorphan hbr (bulk)
......................................... 112
dextrose (bulk)..................... 131
152
dextrose 10 % and 0.2 % nacl
......................................... 136
dextrose 10 % in water (d10w)
......................................... 136
dextrose 5 % in water (d5w) 136
dextrose 5 %-lactated ringers
......................................... 136
dextrose 5%-0.2 % sod chloride
......................................... 136
dextrose 5%-0.3 % sod.chloride
......................................... 136
DHEA .................................. 131
DIABETISWEET .................. 60
DIALYVITE 800................. 131
DIALYVITE 800 WITH ZINC
15 ..................................... 139
DIALYVITE 800 WITH ZINC
50 ..................................... 139
DIALYVITE 800-ULTRA D
......................................... 139
DIALYVITE VITAMIN D3
MAX................................ 139
DIASTIX ............................... 62
diazepam .......................... 26, 27
diazepam intensol .................. 27
diclofenac potassium ............. 13
diclofenac sodium .......... 14, 119
dicloxacillin ........................... 23
dicyclomine ............................ 84
didanosine ............................. 57
diethylpropion ....................... 77
diflorasone ............................. 90
diflunisal ................................ 14
digitek .................................... 73
digoxin ................................... 73
dihydroergotamine .......... 39, 40
DILANTIN ............................ 29
DILAUDID (PF) ................... 16
diltiazem hcl .......................... 70
dilt-xr ..................................... 70
DIPENTUM ........................ 108
diphenhydramine hcl ..... 34, 121
diphenoxylate-atropine .......... 84
dipyridamole .......................... 67
disopyramide phosphate ........ 68
disulfiram .............................. 17
divalproex .............................. 27
DOCEFREZ .................... 43, 45
DOCETAXEL ....................... 43
docusate calcium ................... 86
docusate sodium .................... 86
DOCUSOL ............................ 86
donepezil ............................... 30
DORIBAX ............................. 22
dorzolamide ......................... 119
dorzolamide-timolol ............ 119
doxazosin ............................... 67
doxepin ............................ 33, 34
doxercalciferol .................... 109
DOXIL .................................. 43
doxorubicin ........................... 43
doxy-100 ................................ 25
doxycycline hyclate ............... 25
doxycycline monohydrate ...... 26
DPI WOW GEL .................. 112
dronabinol ............................. 35
drospirenone-ethinyl estradiol
........................................... 95
DROXIA ............................... 42
DULERA............................. 124
duloxetine .............................. 32
DUOFER ............................. 131
duramorph (pf) ...................... 15
DUREZOL .......................... 119
D-VI-SOL ........................... 140
d-xylose ............................... 112
E
e.e.s. 400 ................................ 24
E.E.S. GRANULES .............. 24
ECEE PLUS ........................ 140
econazole ............................... 36
ED CHLORPED JR ............ 121
EDURANT ............................ 56
EFFIENT ............................... 67
EGRIFTA .............................. 92
ELAPRASE........................... 83
ELDERTONIC .................... 140
ELELYSO ............................. 83
ELIDEL ................................. 80
ELIGARD ........................... 100
ELIQUIS ............................... 65
ELITEK................................. 43
ELIXOPHYLLIN................ 125
ELLA .................................... 99
ELLENCE ............................. 44
ELMIRON ............................ 89
EMCYT................................. 42
EMEND ................................ 35
emoquette .............................. 95
EMSAM ................................ 32
EMTRIVA ............................ 57
ENABLEX ............................ 88
enalapril maleate .................. 68
enalapril-hydrochlorothiazide
........................................... 71
ENBREL ............................. 102
ENBREL SURECLICK ...... 102
ENDACOF-C ...................... 126
endocet .................................. 12
endodan ................................. 13
ENEMEEZ ............................ 86
ENEMEEZ PLUS ................. 86
ENGERIX-B (PF) ............... 105
......................................... 106
enoxaparin ............................ 65
enpresse................................. 95
entacapone ............................ 50
entecavir ................................ 54
enulose .................................. 86
epinastine ............................ 119
EPIPEN 2-PAK ................... 124
EPIPEN JR 2-PAK.............. 124
EPIRUBICIN ........................ 44
epitol ..................................... 29
EPIVIR HBV ........................ 54
eplerenone ............................. 74
EPOGEN ............................... 66
EPSOM SALT ...................... 84
EPZICOM ............................. 57
EQUETRO ............................ 29
ERAXIS(WATER DILUENT)
........................................... 36
153
ERBITUX .............................. 44
ergoloid ................................. 30
ERGOMAR ........................... 40
ERIVEDGE ........................... 47
errin ....................................... 98
ERWINAZE .......................... 44
ery pads ................................. 24
ERYPED 200 ........................ 24
ERYTHROCIN ..................... 24
erythrocin (as stearate) ......... 24
erythromycin .......................... 24
erythromycin ethylsuccinate .. 24
erythromycin with ethanol ..... 24
erythromycin-benzoyl peroxide
........................................... 80
ESBRIET ............................. 128
escitalopram oxalate ............. 32
ESTRACE ............................. 94
estradiol ................................. 94
estradiol valerate ............. 94, 95
estradiol-norethindrone acet . 95
ESTRING .............................. 94
estropipate ............................. 94
ethambutol ............................. 40
ethosuximide .......................... 26
ETHOXY ETHOXY
ETHANOL REAGENT... 112
ethyl alcohol (bulk) .............. 112
ethyl oleate (bulk) ................ 112
etidronate disodium ............. 109
etodolac ................................. 14
ETOPOPHOS ........................ 46
etoposide ................................ 46
eugenol ................................ 112
EVOTAZ ............................... 58
EXELON ............................... 30
exemestane............................. 46
EXJADE .............................. 129
EXTAVIA ............................. 78
EZFE 200 ............................ 131
EZFE FORTE ...................... 131
F
FABRAZYME ...................... 83
falmina (28) ........................... 95
famciclovir............................. 56
famotidine .............................. 85
famotidine (pf) ....................... 85
FANAPT ......................... 51, 52
FARESTON .......................... 42
FARYDAK ........................... 46
FASLODEX .......................... 44
FATIGUE RELIEF COMPLEX
......................................... 140
FATTYBLEND................... 112
fd&c 6 (sunset yel fcf) (bulk) 112
fd&c blue no.1 (bulk) .......... 113
fd&c blue no.2 (bulk) .......... 113
fd&c no.3 (green) (bulk)...... 113
fd&c no.5 (tartrazine) (bulk)113
FD&C RED 40 (ALLURA
RED)(BULK) .................. 113
FD&C RED NO.3 ............... 113
felbamate ............................... 28
felodipine ............................... 70
fenofibrate ............................. 74
fenofibrate micronized........... 74
fenofibric acid (choline) ........ 74
fenoprofen ............................. 14
fentanyl .................................. 15
fentanyl citrate ...................... 15
FERAHEME ....................... 131
FERGON ............................. 131
FER-IRON .......................... 131
FERRETTS ......................... 131
FERRETTS IPS .................. 131
FERREX 150 ...................... 131
ferric subsulfate (bulk) ........ 131
FERRIMIN 150 ................... 131
FERRIPROX ....................... 129
ferrous gluconate................. 131
ferrous sulfate.............. 131, 140
ferrous sulfate, dried (bulk) . 131
FETZIMA ............................. 32
fexofenadine ........................ 121
finasteride .............................. 89
FIRAZYR ............................ 101
FIRMAGON KIT W DILUENT
SYRINGE ....................... 100
flavoxate ................................ 88
FLEBOGAMMA DIF ......... 104
flecainide ............................... 68
FLEET GLYCERIN (CHILD)
........................................... 86
FLEET LAXATIVE ............. 86
flexible collodion (bulk) ...... 113
FLINTSTONES
MULTIVITAMIN ........... 140
FLINTSTONES WITH IRON
......................................... 140
FLOVENT DISKUS ........... 122
FLOVENT HFA ................. 122
fluconazole ............................ 36
fluconazole in dextrose(iso-o) 36
flucytosine ............................. 36
FLUDARABINE .................. 45
fludrocortisone ...................... 90
flunisolide ............................ 122
fluocinolone........................... 90
fluocinonide................80, 90, 91
fluocinonide-e........................ 91
fluorometholone .................. 120
fluorouracil ........................... 80
fluoxetine ..........................31, 33
fluphenazine decanoate ......... 51
fluphenazine hcl .................... 51
flurbiprofen ........................... 14
flurbiprofen sodium ............. 120
flutamide ............................... 41
fluticasone ......................80, 122
fluvoxamine ........................... 33
FML FORTE ....................... 120
FOCALIN XR ....................... 77
FOLGARD .......................... 140
folic acid.............................. 140
folic acid (bulk) ................... 140
FOLITAB ............................ 132
FOLTABS 800 .................... 140
fondaparinux ......................... 65
FOOD COLOR BROWN ... 113
FORADIL AEROLIZER .... 124
FORFIVO XL ....................... 31
formaldehyde (bulk) ............ 113
154
FORTEO ............................. 109
fortical ................................. 109
FOSFREE ............................ 140
fosinopril ............................... 68
fosinopril-hydrochlorothiazide
........................................... 72
fosphenytoin........................... 29
FOSRENOL .......................... 89
FREE & CLEAR ................... 80
fructose ................................ 113
fullers earth ......................... 113
FULYZAQ ............................ 85
furosemide ............................. 73
FUSILEV............................... 45
FUZEON ............................... 57
FYCOMPA ............................ 28
G
gabapentin ............................. 27
GABITRIL ............................ 27
GAMASTAN S/D ............... 104
GAMMAGARD LIQUID ... 104
GAMMAKED ..................... 104
GAMMAPLEX ................... 104
GAMUNEX-C..................... 104
ganciclovir sodium ................ 53
garamycin ............................ 118
GARDASIL (PF) ................. 106
GARDASIL 9 (PF) .............. 106
GATTEX ONE-VIAL ........... 85
gauze pad ............................... 63
gavilyte-c ............................... 86
gavilyte-g ............................... 86
gavilyte-n ............................... 87
gemcitabine ........................... 42
gemfibrozil ............................. 74
generlac ................................. 87
gengraf................................. 102
GENOTROPIN ..................... 92
GENOTROPIN MINIQUICK
........................................... 92
gentak .................................... 18
gentamicin ............................. 18
gentamicin sulfate (pf) ........... 18
GENTLE LAXATIVE .......... 87
GEODON .............................. 52
GERAVIM .......................... 140
GERI-HYDROLAC ............ 113
gildagia ................................. 95
gildess.................................... 95
GILENYA ............................. 78
GILOTRIF............................. 47
GLASSIA ............................ 126
GLEEVEC............................. 47
GLEOSTINE ......................... 44
glimepiride ............................ 60
glipizide ................................. 60
glipizide-metformin ............... 62
GLUCAGEN HYPOKIT ...... 62
GLUCAGON EMERGENCY
KIT (HUMAN) ................. 62
glucosamine (bulk) .............. 113
glucosamine su 2kcl (bulk) .. 113
glutathione (bulk) ................ 113
glyburide ............................... 60
glyburide micronized ............. 60
glyburide-metformin .............. 62
glycerin (bulk) ....................... 87
glycine ................................. 113
glycolic acid ........................ 113
glycolic acid (bulk) .............. 113
glycopyrrolate ....................... 84
granisetron (pf) ..................... 35
granisetron hcl ...................... 35
granisol ................................. 35
GRANIX ............................... 66
grape flavor (bulk) .............. 113
grape seed oil (bulk)............ 113
green food color (bulk) ........ 113
green tea extract (bulk) ....... 113
griseofulvin microsize ........... 36
guanfacine ............................. 67
guanidine ............................... 40
guava flavor (bulk) .............. 113
GYNE-LOTRIMIN ............... 36
H
HALAVEN ........................... 44
halobetasol propionate.......... 91
haloperidol ............................ 51
haloperidol decanoate........... 51
haloperidol lactate ................ 51
HARVONI ............................ 54
HAVRIX (PF) ..................... 106
HEMOCYTE ...................... 132
heparin (porcine) .................. 65
heparin (porcine) in 5 % dex 65
heparin (porcine) in nacl (pf) 65
HERCEPTIN ......................... 44
HETLIOZ ............................ 129
HEXALEN ............................ 41
HIGH POTENCY IRON .... 132
honey flavor (bulk) .............. 113
HORIZANT .....................27, 77
HOUSEHOLD LICE
CONTROL ........................ 49
HRT BASE (JOJOBA) ......... 80
HUMALOG .......................... 63
HUMALOG KWIKPEN ....... 63
HUMALOG MIX 50-50 ....... 63
HUMALOG MIX 50-50
KWIKPEN ........................ 63
HUMALOG MIX 75-25 ....... 63
HUMALOG MIX 75-25
KWIKPEN ........................ 63
HUMATROPE ...................... 92
HUMIRA ............................ 102
HUMIRA CROHN'S DIS
START PCK ................... 102
HUMULIN 70/30.................. 63
HUMULIN 70/30 KWIKPEN
........................................... 63
HUMULIN N ........................ 63
HUMULIN N KWIKPEN .... 63
HUMULIN R ........................ 63
HUMULIN R U-500 ............. 64
hydralazine ............................ 75
hydrochloric acid (bulk)...... 113
hydrochlorothiazide .............. 74
hydrocodone-acetaminophen 13
hydrocodone-chlorpheniramine
......................................... 126
hydrocodone-homatropine .. 126
hydrocodone-ibuprofen ......... 13
hydrocortisone .........39, 91, 108
155
hydrocortisone butyrate......... 91
hydrocortisone butyr-emollient
........................................... 91
hydrocortisone valerate ......... 91
hydrocortisone-acetic acid .. 120
HYDROMET ...................... 126
hydromorphone ..................... 16
hydromorphone (pf) ............... 16
HYDROPHILIC OINTMENT
BASE(FAG) ...................... 80
HYDROUS EMULSIFIED
BASE ............................... 113
hydroxocobalamin ............... 140
hydroxychloroquine ............... 49
hydroxyurea ........................... 42
hydroxyzine hcl ...................... 34
hydroxyzine pamoate ............. 34
HYPERRAB S/D (PF) ........ 104
I
ibandronate ......................... 109
IBRANCE ............................. 46
ibuprofen ............................... 14
IBUPROFEN JR STRENGTH
........................................... 14
ibuprofen-oxycodone ............. 14
ICAPS .................................. 132
I-CAPS ................................ 140
ICAPS AREDS .................... 140
ICAPS MV .......................... 140
ICAPS PLUS ....................... 140
ichthammol (bulk)................ 113
ICLUSIG ............................... 47
idarubicin .............................. 44
IFOSFAMIDE ....................... 44
ILARIS (PF) ........................ 105
IMBRUVICA ........................ 47
imipenem-cilastatin ............... 22
imipramine hcl ....................... 34
imipramine pamoate .............. 34
imiquimod .............................. 81
IMITREX STATDOSE KIT
REFILL ............................. 40
IMOVAX RABIES VACCINE
(PF) .................................. 106
INCRELEX ........................... 92
indapamide ............................ 74
indole-3-carbinol (bulk) ...... 132
indomethacin ......................... 14
INFANRIX (DTAP) (PF).... 106
INFANT'S IBUPROFEN ...... 14
INFANT'S NON-ASPIRIN ... 13
INFANTS' TRIAMINIC
FEVER .............................. 13
INFED ................................. 132
INFUVITE ADULT ............ 141
INFUVITE PEDIATRIC..... 141
INLYTA ................................ 47
insulin syringe-needle u-100 . 64
INTEGRA ........................... 132
INTELENCE ......................... 56
intralipid .............................. 136
INTRON A ............................ 54
introvale ................................ 95
INVANZ ............................... 22
INVEGA ............................... 52
INVEGA SUSTENNA .......... 52
INVIRASE ............................ 58
INVOKAMET....................... 60
INVOKANA ......................... 60
iodine (bulk) ........................ 113
iodoform (bulk).................... 114
IPOL .................................... 106
ipratropium bromide ........... 123
ipratropium-albuterol.......... 128
irbesartan .............................. 68
irbesartan-hydrochlorothiazide
........................................... 72
IRINOTECAN ...................... 44
IRON (DRIED) ................... 132
IRON 100 PLUS ................. 141
IRON CHEWS .................... 132
iron-vitamin c ...................... 141
ISENTRESS .......................... 56
isoleucine............................. 114
isoniazid ................................ 41
isopropyl palmitate (bulk) ... 114
isosorbide dinitrate ............... 76
isosorbide mononitrate.......... 76
isradipine .............................. 70
ISTODAX ............................. 44
itraconazole........................... 36
I-VITE PROTECT .............. 141
IXEMPRA............................. 44
IXIARO (PF) ...................... 106
J
JAKAFI ................................. 47
JALYN .................................. 89
jantoven ................................. 65
JANUMET ............................ 62
JANUMET XR ..................... 62
JANUVIA ............................. 60
JELENE ................................ 81
JENTADUETO ..................... 60
JEVTANA............................. 44
jinteli ..................................... 95
JOCK ITCH .......................... 36
jolivette .................................. 98
junel 1.5/30 (21) .................... 95
junel 1/20 (21) ....................... 95
junel fe 1.5/30 (28) ................ 95
junel fe 1/20 (28) ................... 95
JUXTAPID ........................... 75
K
KADCYLA ........................... 44
KALETRA ............................ 58
KALYDECO....................... 124
kaolin................................... 114
KAOPECTATE (BISMUTH
SUBSALICY) ................... 84
karaya gum (bulk) ............... 114
kariva (28) ............................. 95
kelnor 1/35 (28)..................... 95
KETEK ................................. 24
ketoconazole .....................36, 37
KETO-DIASTIX ................... 62
ketoprofen ............................. 14
ketorolac ........................14, 120
ketotifen fumarate ............... 145
KEYTRUDA......................... 48
KINERET ........................... 102
kionex .................................. 129
klor-con 10 .......................... 132
156
klor-con 8 ............................ 132
KLOR-CON M15 ................ 132
klor-con m20........................ 132
kojic acid ............................. 114
KOMBIGLYZE XR .............. 62
KONSYL (SUGAR) .............. 87
KONSYL FORMULA-D ...... 87
KONSYL SUGAR-FREE ..... 87
KONSYL SUGAR-FREE
(ASPARTAME) ................ 87
KORLYM .............................. 62
KPN ..................................... 114
KRISTALOSE....................... 87
KUVAN................................. 83
KYNAMRO .......................... 75
L
labetalol ................................. 69
lactated ringers.................... 136
lactic acid (bulk) .................. 114
lactose (bulk) ....................... 132
lactulose................................. 87
LAMICTAL STARTER
(BLUE) KIT ...................... 28
LAMICTAL STARTER
(GREEN) KIT ................... 28
LAMICTAL STARTER
(ORANGE) KIT ................ 28
LAMICTAL XR STARTER
(BLUE) .............................. 28
LAMICTAL XR STARTER
(GREEN) ........................... 28
LAMICTAL XR STARTER
(ORANGE) ........................ 28
LAMISIL ............................... 37
LAMISIL AT ........................ 37
lamivudine ............................. 54
lamivudine-zidovudine........... 57
lamotrigine ...................... 27, 29
lansoprazole .......................... 88
LANTUS ............................... 64
LANTUS SOLOSTAR.......... 64
larin 1.5/30 (21) .................... 95
larin 1/20 (21) ....................... 95
larin fe ................................... 95
latanoprost........................... 120
LATUDA .............................. 52
LAXATIVE PEG 3350 ......... 87
LAZANDA ........................... 16
lecithin ................................. 114
leena 28 ................................. 96
leflunomide .......................... 105
LENVIMA ............................ 47
lessina.................................... 96
LETAIRIS ........................... 125
letrozole ................................. 46
leucovorin calcium ................ 46
LEUKERAN ......................... 41
LEUKINE ............................. 66
leuprolide ............................ 100
LEVEMIR ............................. 64
LEVEMIR FLEXTOUCH .... 64
levetiracetam ......................... 26
levetiracetam in nacl (iso-os) 26
levobunolol .......................... 119
levocarnitine ........................ 136
levocarnitine (with sugar) ... 136
levocetirizine ....................... 121
levofloxacin ........................... 25
levoleucovorin calcium ......... 44
levonest (28) .......................... 96
levonorgestrel-ethinyl estrad. 96
levora-28 ............................... 96
levorphanol tartrate .............. 15
levothyroxine ......................... 99
levoxyl ................................... 99
LEXIVA ................................ 58
L-GLUTAMINE ................... 85
LIALDA .............................. 108
LICE KILLING ..................... 49
LICE TREATMENT ............. 49
LICIDE SPRAY .................... 49
lidocaine ................................ 17
lidocaine (pf) ......................... 16
lidocaine hcl .................... 16, 17
lidocaine-prilocaine .............. 17
lime green food color (bulk) 114
LINCOCIN ............................ 20
lindane ................................... 49
linezolid ................................. 20
LINZESS............................... 86
liothyronine ........................... 99
LIP BALM BASE (BULK) 114
LIP BALM NATURAL ...... 114
LIPOBASE BASE (GEL
MATRIX) ......................... 81
LIPOIL ................................ 114
LIPOVAN CREAM BASE ... 81
lisinopril ................................ 68
lisinopril-hydrochlorothiazide
........................................... 72
lithium carbonate .................. 59
lithium citrate ........................ 59
LIVALO ................................ 74
lokara .................................... 91
LOLLIBASE ....................... 114
lomustine ............................... 41
loperamide ............................ 85
lopreeza ................................. 96
loratadine ............................ 121
lorazepam .............................. 27
lorazepam intensol ................ 27
lorcet plus.............................. 13
losartan ................................. 68
losartan-hydrochlorothiazide 72
lovastatin ............................... 74
low-ogestrel (28) ................... 99
loxapine succinate ................. 51
LOZIBASE ......................... 114
LUFYLLIN ......................... 125
LUMIGAN .......................... 120
LUMIZYME ....................... 126
LUPRON DEPOT ............... 100
......................................... 100
......................................... 100
......................................... 100
LUPRON DEPOT-PED ...... 100
lutera (28) ............................. 96
LYNPARZA ......................... 44
LYRICA ................................ 26
LYSODREN ......................... 99
157
lyza......................................... 98
M
M.V.I. ADULT .................... 141
M.V.I. PEDIATRIC ............ 141
M.V.I.-12 (WITHOUT
VITAMIN K) .................. 132
MAALOX MAXIMUM
STRENGTH ...................... 85
MAG-DELAY ..................... 132
MAGNEBIND 300 ................ 85
magnesium ........................... 132
magnesium amino acid chelate
......................................... 132
magnesium carbonate.......... 132
magnesium chloride............. 132
magnesium citrate ................. 85
magnesium gluconate .......... 141
magnesium oxide ................. 133
magnesium oxide (bulk) ....... 132
magnesium sulfate ............... 133
MAGONATE (MAGNESIUM
CARB) ............................. 133
MAGTAB ............................ 133
MALARONE ........................ 49
malathion ............................... 49
malic acid (bulk) .................. 114
manganese chloride ............. 133
mannitol (bulk) .................... 114
MAPAP (ACETAMINOPHEN)
........................................... 13
maprotiline ............................ 31
MAR-COF BP ..................... 126
marlissa ................................. 94
MARPLAN ........................... 32
marshmallow flavor (bulk) .. 114
MATULANE......................... 41
M-CLEAR WC.................... 126
meclizine ................................ 34
meclofenamate ....................... 14
medroxyprogesterone ............ 98
mefloquine ............................. 49
MEGA MULTIVITAMIN FOR
MEN ................................ 141
MEGA MULTIVITAMIN
WITH MINERAL ........... 141
MEGACE ES ........................ 98
megestrol ............................... 98
MEKINIST ............................ 47
meloxicam ............................. 14
melphalan hcl ........................ 41
MENACTRA (PF) .............. 106
M-END MAX D.................. 127
M-END WC ........................ 127
MENEST ............................... 94
MENOMUNE - A/C/Y/W-135
(PF).................................. 106
MENTAX .............................. 37
menthol ................................ 127
MENVEO A-C-Y-W-135-DIP
(PF).................................. 106
meperidine ............................. 16
meperitab............................... 16
MEPHYTON......................... 66
meprobamate ......................... 59
mercaptopurine ................... 102
meropenem ............................ 22
mesalamine with cleansing wipe
......................................... 108
mesna..................................... 44
MESNEX .............................. 44
metadate er ............................ 77
metaproterenol .................... 124
metformin ........................ 60, 61
methadone ............................. 15
methazolamide....................... 73
methenamine hippurate ......... 20
methimazole......................... 101
methionine ........................... 114
methocarbamol .................... 128
methotrexate sodium ........... 102
methotrexate sodium (pf) ..... 102
methoxsalen rapid ................. 81
methscopolamine ................... 84
methyclothiazide .................... 74
methylcellulose (bulk) ........... 87
methylcellulose 1500cps (bulk)
......................................... 114
methylcellulose 4000cps (bulk)
......................................... 114
methyldopa ............................ 67
methyldopahydrochlorothiazide .......... 72
methyldopate ......................... 67
methylparaben (bulk) .......... 114
methylphenidate .................... 77
methylprednisolone ..........39, 91
methylprednisolone acetate... 39
methylprednisolone sodium succ
........................................... 39
methylsulfonylmethane (bulk)
......................................... 114
metipranolol ........................ 119
metoclopramide hcl ............... 34
metolazone ............................ 74
metoprolol succinate ............. 69
metoprolol ta-hydrochlorothiaz
........................................... 72
metoprolol tartrate ................ 69
metronidazole ........................ 20
metronidazole in nacl (iso-os)20
mexiletine .............................. 68
MIACALCIN ...................... 109
MICONAZOLE 7 ................. 37
miconazole nitrate ................. 37
microgestin 1.5/30 (21) ......... 96
microgestin 1/20 (21) ............ 96
microgestin fe 1.5/30 (28) ..... 96
microgestin fe 1/20 (28) ........ 96
MICROSOME BASE CREAM
........................................... 81
midodrine .............................. 67
mimvey lo .............................. 96
mineral oil ........................... 114
minitran ................................. 76
minocycline ........................... 26
minoxidil ............................... 76
MINTOX PLUS .................... 85
mirtazapine ........................... 31
misoprostol ............................ 88
mitomycin .............................. 45
mitoxantrone ......................... 46
M-M-R II (PF) .................... 106
MODAFINIL ...................... 129
158
MODERIBA .......................... 55
MODERIBA DOSE PACK ... 55
moexipril ................................ 68
moexipril-hydrochlorothiazide
........................................... 72
mometasone ........................... 91
mononessa (28)...................... 96
montelukast .......................... 123
morphine ................................ 15
MOTRIN JUNIOR
STRENGTH ...................... 15
MOXEZA .............................. 25
moxifloxacin .......................... 25
MOZOBIL ............................. 66
MULTAQ .............................. 68
MULTI-DELYN.................. 141
MULTI-DELYN WITH IRON
......................................... 141
MULTILEX-T&M .............. 141
MULTIPLE VITAMIN ....... 141
MULTIPLE VITAMIN,
WOMENS ....................... 141
MULTI-VITAMIN
HP/MINERALS .............. 141
mupirocin............................... 20
MUSTARGEN ...................... 45
MYCAMINE ......................... 37
mycophenolate mofetil . 102, 103
mycophenolate sodium ........ 103
MYKIDZ IRON .................. 133
myorisan ................................ 81
MYRBETRIQ ....................... 88
N
nabumetone ........................... 15
nadolol ................................... 69
nadolol-bendroflumethiazide . 72
nafcillin.................................. 23
NAGLAZYME ...................... 83
nalbuphine ............................. 16
naloxone ................................ 17
naltrexone .............................. 17
NAMENDA XR .................... 30
naphazoline ......................... 118
naproxen ................................ 15
naproxen sodium ................... 15
naratriptan ............................ 40
NASAL DECONGESTANT
(PE) ................................. 127
NASAL DECONGESTANT
(PSEUDOEPH) ............... 127
NASONEX .......................... 122
nateglinide ............................. 61
NATPARA .......................... 109
NATURAL B-100 COMPLEX
......................................... 133
NATURAL BITTERNESS
MASKING ...................... 114
NEBUPENT .......................... 49
necon 0.5/35 (28)................... 96
necon 1/35 (28)...................... 96
necon 10/11 (28).................... 96
necon 7/7/7 (28) .................... 96
nefazodone............................. 32
neomycin ............................... 18
neomycin-bacitracin-poly-hc
......................................... 118
neomycin-bacitracin-polymyxin
......................................... 118
neomycin-polymyxin b gu ...... 18
neomycin-polymyxin bdexameth ......................... 118
neomycin-polymyxin-gramicidin
......................................... 118
neomycin-polymyxin-hc118, 120
NEPHRONEX..................... 141
NEULASTA .......................... 66
NEUMEGA ........................... 66
NEUPOGEN ......................... 66
NEUPRO ............................... 50
nevirapine .............................. 56
NEXAVAR ........................... 47
niacin ..................................... 75
niacin (bulk) .......................... 75
NIACIN FLUSH FREE ........ 75
niacinamide ......................... 114
niacinamide (bulk)............... 114
nicardipine ............................ 70
nicotine .................................. 18
nicotine (polacrilex) .............. 17
NICOTROL .......................... 18
NICOTROL NS .................... 18
nifedical xl ............................. 70
nifedipine............................... 70
NILANDRON ....................... 41
nimodipine............................. 70
NITRO-BID .......................... 76
NITRO-DUR......................... 76
nitrofurantoin macrocrystal .. 20
nitrofurantoin monohyd/m-cryst
........................................... 20
nitroglycerin .......................... 76
NITROSTAT ........................ 76
nizatidine ............................... 85
NON-ASPIRIN ..................... 13
nora-be .................................. 96
NORDITROPIN FLEXPRO . 92
NORDITROPIN NORDIFLEX
........................................... 92
norethindrone (contraceptive)
........................................... 98
norethindrone acetate ........... 98
norethindrone ac-eth estradiol
........................................... 96
norlyroc ................................. 96
normosol-r ph 7.4................ 133
NORPACE CR ...................... 68
NORTHERA ......................... 67
nortrel 0.5/35 (28) ................. 96
nortrel 1/35 (21) .................... 96
nortrel 1/35 (28) .................... 96
nortrel 7/7/7 (28)................... 97
nortriptyline .......................... 34
NORVIR ............................... 58
NOVAFERRUM................. 133
NOVAFERRUM 125.......... 133
NOVAFERRUM 50............ 133
NOVOLIN 70/30 .................. 64
NOVOLIN N ........................ 64
NOVOLIN R ......................... 64
NOVOLOG ........................... 64
NOVOLOG FLEXPEN ........ 64
NOVOLOG MIX 70-30 ........ 64
159
NOVOLOG MIX 70-30
FLEXPEN ......................... 64
NOVOLOG PENFILL .......... 64
NOXAFIL ............................. 37
NUEDEXTA ......................... 77
NULOJIX ............................ 103
NUTROPIN AQ .................... 93
NUTROPIN AQ NUSPIN ..... 92
nyamyc ................................... 37
nystatin .................................. 37
nystatin-triamcinolone........... 81
nystop..................................... 37
O
ocella ..................................... 97
octreotide acetate ................ 100
OCTREOTIDE ACETATE . 100
OCUVITE ........................... 141
OFEV..................................... 47
ofloxacin ................................ 25
olanzapine ............................. 52
olanzapine-fluoxetine ............ 31
OLYSIO ................................ 55
omega-3 acid ethyl esters ...... 75
omeprazole ............................ 88
OMNITROPE ........................ 93
ONCASPAR .......................... 46
ONCOVITE......................... 141
ondansetron ........................... 35
ondansetron hcl ..................... 35
ondansetron hcl (pf) .............. 35
ONE DAILY FOR MEN ..... 142
ONE DAILY FOR MEN 50+
ADVANCED................... 141
ONE DAILY MAXIMUM .. 142
ONE DAILY
MULTIVITAMIN ........... 142
ONE DAILY PRENATAL.. 142
ONE DAILY WOMEN'S .... 142
ONFI...................................... 27
ONGLYZA ............................ 61
OPCON-A ........................... 118
OPDIVO ................................ 48
OPTIMAL D3 ..................... 133
ORA-BLEND ...................... 114
ORA-BLEND SF ................ 115
ORA-HESIVE BASE .......... 115
ORALYTE .......................... 133
orange flavor (bulk) ............ 115
orange food color (bulk) ..... 115
ORAP .................................... 51
ORA-PLUS ......................... 115
ORA-SWEET ...................... 115
ORA-SWEET SF ................ 115
ORENCIA ........................... 103
ORENCIA (WITH MALTOSE)
......................................... 103
ORFADIN ............................. 83
ornithine .............................. 115
orphenadrine citrate............ 128
orsythia .................................. 97
OTEZLA ............................. 103
OTEZLA STARTER........... 103
oxalic acid ........................... 115
oxaliplatin ............................. 45
oxandrolone........................... 93
oxaprozin ............................... 15
oxcarbazepine ....................... 29
OXTELLAR XR ................... 29
oxybutynin chloride ......... 88, 89
oxycodone .............................. 16
oxycodone-acetaminophen .... 13
oxycodone-aspirin ................. 13
OXYCONTIN ....................... 16
OYSCO 500/D .................... 142
OYST-CAL D ..................... 133
P
PACERONE .......................... 68
PACLITAXEL ...................... 45
PAIN RELIEF ....................... 13
PAIN RELIEVER ................. 13
pamidronate ........................ 109
PANRETIN ........................... 48
pantoprazole .......................... 88
paricalcitol .......................... 109
paromomycin ......................... 18
paroxetine hcl ........................ 33
PASER .................................. 41
PATADAY .......................... 119
PATANOL .......................... 119
PAXIL ................................... 33
PCCA MBK BASE ............. 115
peach flavor (bulk) .............. 115
pectin ................................... 115
PEDIA-LAX STOOL
SOFTENER ...................... 87
pedi-dri .................................. 37
PEDVAX HIB (PF) ............ 107
PEG OINTMENT BASE
(BULK) ............................. 81
PEGANONE ......................... 30
PEGASYS ............................. 55
PEGASYS PROCLICK ........ 55
PEGBLEND .......................... 81
PEGINTRON ........................ 55
PEGINTRON REDIPEN ...... 55
penicillin g procaine ............. 23
penicillin g sodium ................ 23
penicillin v potassium............ 23
PENTAM .............................. 49
PENTASA........................... 108
pentazocine-naloxone............ 13
pentoxifylline ......................... 73
PENTRAVAN ...................... 81
PENTRAVAN PLUS............ 81
periogard............................... 79
PERJETA .............................. 45
permethrin ............................. 49
perphenazine ......................... 34
perphenazine-amitriptyline ... 31
PHARMABASE ................... 81
PHARMABASE COSMETIC
........................................... 81
PHARMABASE LIGHT ...... 81
PHARMABASE NATURAL 81
PHARMABASE VAGINAL 81
phenadoz ............................... 34
phendimetrazine tartrate ....... 77
phenelzine ............................. 32
phenobarbital ...................27, 28
phenol (bulk) ....................... 115
phentermine........................... 78
phenylalanine,dl- (bulk) ...... 115
160
PHENYLHISTINE DH ....... 121
phenytoin ............................... 30
phenytoin sodium ................... 30
phenytoin sodium extended.... 30
PHOS-NAK ......................... 133
phosphatidyl serine (bulk) ... 115
PHOSPHOLINE IODIDE ... 119
PHYTOBASE ....................... 81
pilocarpine hcl ....................... 79
pimtrea (28) ........................... 97
pina colada flavor (bulk) ..... 115
pindolol.................................. 69
pineapple flavor (bulk) ........ 115
pioglitazone ........................... 61
pioglitazone-glimepiride........ 62
pioglitazone-metformin.......... 62
piperacillin-tazobactam......... 23
pirmella ................................. 97
piroxicam ............................... 15
PLO GEL PREMIUM
LECITHIN BASE ............. 81
PLO ULTRAMAX GEL PREM
LECITHIN......................... 81
PLO20 FLOWABLE ........... 115
podofilox ................................ 81
POLOX ........................ 115, 127
POLOXAMER 407 ............. 115
polyethylene glycol 1000 ....... 87
polyethylene glycol 300 ......... 87
polyethylene glycol 400 (bulk)
........................................... 87
polyethylene glycol 8000(bulk)
........................................... 87
polymyxin b sulf-trimethoprim
......................................... 118
polysorbate 20 (bulk)........... 115
POLY-TUSSIN ................... 127
POLY-TUSSIN D ............... 127
POLY-VITAMIN ................ 142
POLY-VITAMIN WITH IRON
......................................... 142
POMALYST ......................... 42
portia ..................................... 97
potassium bromide (bulk) .... 115
potassium chlorid-d50.45%nacl........................ 136
potassium chloride ...... 133, 134
potassium citrate ................... 89
potassium citrate m-hyd(bulk)
......................................... 115
potassium gluconate (bulk) . 134
potassium hydroxide (bulk) . 115
potassium iodide (bulk) ....... 101
potassium nitrate (bulk) ...... 134
potassium sorbate................ 115
POTIGA ................................ 26
PRADAXA ........................... 65
pramipexole ........................... 50
prasterone (dhea) ................ 134
pravastatin............................. 74
prazosin ................................. 67
prednicarbate .................. 81, 91
prednisolone acetate ............. 39
prednisolone sodium phosphate
........................................... 39
prednisone ............................. 39
prednisone intensol ............. 108
PREMARIN .......................... 94
PREMPHASE ....................... 97
PREMPRO ............................ 97
PRENATAL
MULTIVITAMINS ......... 142
prenatal vit#96-ferrous fum-fa
......................................... 142
PRENATAL VITAMIN ...... 142
PRENATAL VITAMIN WITH
MINERALS .................... 142
PRENATAL VITAMINS LOW
IRON ............................... 136
PRESERVISION LUTEIN . 134
prevalite................................. 75
previfem ................................. 97
PREZCOBIX ......................... 58
PREZISTA ............................ 58
PRIFTIN ................................ 40
PRIMAQUINE ...................... 49
primidone .............................. 28
PRISTIQ ................................ 33
PRIVIGEN .......................... 104
PRO FE ............................... 134
probenecid............................. 38
prochlorperazine ................... 35
prochlorperazine edisylate .... 34
prochlorperazine maleate ..... 34
PRO-CLEAR AC ................ 127
PROCRIT .............................. 66
procto-pak ............................. 91
proctosol hc ......................... 108
proctozone-hc ........................ 85
progesterone micronized ....... 98
PROGLYCEM ...................... 62
PROGRAF .......................... 103
PROLASTIN-C................... 127
PROLEUKIN ........................ 45
PROLIA .............................. 109
PROMACTA ........................ 66
promethazine ......................... 35
promethazine vc .................. 128
PROMETHAZINE VCCODEINE ....................... 127
promethazine-codeine ......... 121
promethazine-dm................. 127
promethegan ......................... 35
propafenone .......................... 68
proparacaine ....................... 118
propranolol ........................... 69
propranolol-hydrochlorothiazid
........................................... 72
propylene glycol (bulk) ....... 115
propylparaben (bulk) .......... 115
propylthiouracil .................. 101
PROQUAD (PF) ................. 107
PRO-RED AC (W/
DEXCHLORPHENIR) ... 127
PROSIGHT ......................... 142
PROTONIX .......................... 88
protriptyline .......................... 34
PROVENTIL HFA ............. 124
PRUDOXIN .......................... 34
pseudoephedrine hcl ........... 127
psyllium husk (bulk) ............ 116
PULMICORT ..................... 122
161
PULMOZYME .................... 124
PURIXAN ............................. 42
pyrazinamide ......................... 41
pyridostigmine bromide ......... 40
pyridoxine .................... 142, 144
pyruvic acid (bulk)............... 116
Q
Q-PAP ................................... 13
QSYMIA ............................... 78
QUADRACEL (PF) ............ 107
quasense ................................ 97
QUESTRAN .......................... 75
quetiapine .............................. 52
quinapril ................................ 68
quinapril-hydrochlorothiazide
........................................... 72
quinidine gluconate ............... 69
quinidine sulfate .................... 69
quinine sulfate ....................... 49
QVAR .................................. 122
R
RABAVERT (PF) ............... 107
raloxifene ............................... 98
ramipril.................................. 68
RANEXA .............................. 73
ranitidine hcl ................... 85, 86
RAPAMUNE....................... 103
RAPID DISSOLVE TABLET
......................................... 116
raspberry flavor (bulk) ........ 116
RAVICTI ............................... 83
RAYOS ................................. 39
REBETOL ............................. 54
REBIF (WITH ALBUMIN) .. 78
REBIF REBIDOSE ............... 78
REBIF TITRATION PACK .. 78
reclipsen (28) ......................... 97
RECOMBIVAX HB (PF).... 107
RECTIV................................. 76
red food color (bulk)............ 116
red yeast rice extract (bulk) . 116
REESE'S PINWORM
MEDICINE ....................... 48
REGRANEX ......................... 81
RELENZA DISKHALER ..... 58
RELISTOR ............................ 85
REMICADE ........................ 103
REMODULIN ..................... 125
RENAGEL ............................ 89
RENVELA ............................ 90
repaglinide ............................ 61
RESCRIPTOR....................... 56
reserpine ................................ 72
resorcinol ............................ 116
RESTASIS .......................... 118
RETROVIR ........................... 57
REVATIO ........................... 125
REVLIMID ..................... 42, 46
REYATAZ ............................ 58
REZIRA .............................. 127
RHEUMATREX ................. 103
RIBASPHERE ...................... 54
RIBASPHERE RIBAPAK .... 55
RIBAVIRIN .......................... 54
rifabutin ................................. 40
rifampin ................................. 41
RIFATER .............................. 41
riluzole................................... 78
rimantadine ........................... 58
risedronate .......................... 110
RISPERDAL CONSTA ........ 52
risperidone ...................... 52, 53
RITUXAN ............................. 48
rivastigmine tartrate.............. 30
root beer flavor (bulk) ......... 116
ropinirole............................... 50
ROTARIX ........................... 107
ROTATEQ VACCINE ....... 107
ROZEREM .......................... 129
S
SABRIL................................. 28
saccharin ............................. 116
safflower oil ......................... 116
salicylic acid........................ 116
SALTSTABLE LO ............. 116
SAMSCA ............................ 129
SANDIMMUNE ................. 103
SANDOSTATIN LAR DEPOT
......................................... 100
SANTYL ............................... 82
SAPHRIS (BLACK CHERRY)
........................................... 53
selegiline hcl ......................... 50
selenium sulfide ..................... 82
SELZENTRY ........................ 57
SENEXON .......................87, 88
SENSIPAR ............................ 99
SEREVENT DISKUS ......... 124
SEROQUEL XR ................... 32
SEROSTIM ........................... 93
sertraline ............................... 33
SFROWASA ....................... 108
sharobel................................. 97
SIGNIFOR .......................... 100
sildenafil .............................. 125
silver sulfadiazine ................. 25
SIMBRINZA ....................... 119
SIMCOR ..........................72, 75
simethicone ........................... 85
simple syrup ........................ 116
SIMPONI .....................103, 105
SIMPONI ARIA ................. 103
SIMULECT......................... 103
simvastatin ............................ 74
sirolimus .............................. 103
SIRTURO ............................. 41
SLO-NIACIN ........................ 75
SLOW RELEASE IRON .... 134
sodium benzoate (bulk) ....... 116
sodium bicarbonate (bulk) .. 116
sodium borate...................... 116
sodium bromide ................... 116
sodium chloride ................... 134
sodium chloride (bulk) ........ 134
sodium chloride 0.9 % ........ 134
sodium chloride 3 % ........... 134
sodium citrate dihydrate ..... 116
SODIUM FLUORIDE ........ 134
sodium fluoride (bulk) ......... 116
sodium hydroxide ................ 116
sodium lauryl sulfate (bulk) 116
162
sodium metabisulfite (bulk) . 116
sodium phenylbutyrate........... 89
sodium phosphate monobasic 88
sodium phosphate,dibasic(bulk)
......................................... 116
sodium polystyrene (sorb free)
......................................... 129
sodium propionate ............... 116
sodium saccharin (bulk) ...... 116
sodium sulfite (bulk) ............ 116
SOLTAMOX ......................... 42
SOMATULINE DEPOT ..... 100
SOMAVERT ....................... 101
SOOTHE (BISMUTH
SUBSALICYLATE) ......... 85
sorbic acid ........................... 116
sorbitol................................. 116
sorine ..................................... 69
sotalol .................................... 69
sotalol af ................................ 69
SOVALDI ............................. 55
soybean oil (bulk) ................ 117
SPERMACETI .................... 117
SPIRIVA RESPIMAT ......... 123
SPIRIVA WITH
HANDIHALER ............... 123
spironolactone ....................... 74
spironolacton-hydrochlorothiaz
........................................... 72
sprintec (28) .......................... 97
SPRYCEL ............................. 47
squalane (bulk) .................... 117
squaric acid dibutylester ..... 117
SQUARIC ACID IN
BUTANOL ........................ 82
sronyx .................................... 97
ssd .......................................... 25
STATUSS GREEN
(CODEINE) ..................... 127
stavudine ................................ 57
STELARA ............................. 82
STEVIA ............................... 117
STIVARGA ........................... 47
STOOL SOFTENER ............. 88
STOOL SOFTENERLAXATIVE....................... 88
STRATTERA ........................ 77
strawberry flavor (bulk) ...... 117
streptomycin .......................... 18
STRESS 500 PLUS ZINC... 142
STRESS FORMULA .......... 142
STRESS FORMULA WITH
IRON ............................... 142
STRIBILD ............................. 56
SUBOXONE ......................... 17
SUCRAID ............................. 83
sucralfate ............................... 88
sulfacetamide sodium ............ 25
sulfacetamide sodium (acne) . 25
sulfacetamide-prednisolone .. 39
sulfadiazine ........................... 25
sulfamethoxazole-trimethoprim
........................................... 25
sulfasalazine ........................ 109
sulfazine ec .......................... 109
sulfur (bulk) ......................... 117
sulindac ................................. 15
sumatriptan ........................... 40
sumatriptan succinate ........... 40
SUPHEDRIN ...................... 127
SUPRENZA .......................... 78
SURMONTIL ....................... 34
SUSTIVA .............................. 56
SUTENT ............................... 47
SYLATRON ......................... 55
SYMBICORT ..................... 128
SYMLINPEN 120 ................. 61
SYMLINPEN 60 ................... 61
SYNAGIS ........................... 104
SYNAREL .......................... 101
SYNERA ............................... 17
SYNERCID ........................... 19
SYNRIBO ............................. 46
SYNTHROID ........................ 99
SYPRINE ............................ 129
SYRSPEND SF ALKA ....... 134
SYRSPEND SF LIQUID .... 117
SYSTANE CONTACTS ..... 118
T
TAB A VITE....................... 142
TABLOID ............................. 42
tacrolimus ......................82, 103
TAFINLAR ........................... 47
talc (bulk) ............................ 117
TAMIFLU ............................. 58
tamoxifen ............................... 42
tamsulosin ............................. 89
TANDEM DUAL ACTION 134
tangerine oil (bulk).............. 117
tannic acid ........................... 117
TARCEVA ............................ 47
TARGRETIN ........................ 48
tarina fe ................................. 97
tartaric acid (bulk) .............. 117
TASIGNA ............................. 47
TAZORAC ............................ 82
taztia xt .................................. 70
tea tree oil (bulk) ................... 20
TECFIDERA ......................... 79
TEFLARO............................. 22
TEGRETOL XR ................... 30
TEKTURNA ......................... 73
TEKTURNA HCT ................ 72
TEMOVATE......................... 91
TENIVAC (PF) ................... 107
terazosin ................................ 67
terbinafine hcl ....................... 37
terbutaline ........................... 124
terconazole ............................ 37
TESTIM ................................ 93
testosterone ........................... 93
testosterone cypionate ........... 93
tetanus toxoid,adsorbed (pf) 107
tetanus,diphtheria tox ped(pf)
......................................... 107
tetanus-diphtheria toxoids-td
......................................... 107
THALOMID ......................... 42
theophylline ......................... 125
THERA VITAL M .............. 142
THERAPEUTIC LIQUID... 142
THERAPEUTIC-M .....134, 143
163
THEREMS-H ...................... 134
THEREMS-M ..................... 134
thiamine hcl ................. 117, 144
thiamine hcl (bulk)............... 117
thioridazine ............................ 51
thiothixene ............................. 51
threonine .............................. 117
THRIVE NICOTINE............. 18
THYMOGLOBULIN .......... 104
thymol .................................. 134
thymol iodide ....................... 117
tiagabine ................................ 28
ticlopidine .............................. 67
TIKOSYN ............................. 69
timolol maleate .............. 40, 119
TIVICAY............................... 56
tizanidine ............................... 53
TOBRADEX ......................... 18
tobramycin ............................. 18
tobramycin in 0.225 % nacl... 18
tobramycin sulfate ................. 19
tobramycin-dexamethasone . 118
tolazamide ............................. 61
tolbutamide ............................ 61
tolcapone ............................... 50
tolmetin .................................. 15
tolnaftate ................................ 37
tolterodine ............................. 89
topiramate ............................. 29
toposar ................................... 46
topotecan ............................... 46
TORISEL............................. 104
torsemide ............................... 73
TOTAL B/C ........................ 143
TOVIAZ ................................ 89
TRACLEER ........................ 125
TRADJENTA ........................ 61
tramadol ................................ 16
tramadol-acetaminophen....... 13
trandolapril ........................... 68
tranexamic acid ..................... 66
TRANS D HORMONE BASE
........................................... 82
TRANSDERM-SCOP ........... 35
TRANS-PEN
TRANSDERMAL ............. 82
tranylcypromine .................... 32
TRAVATAN Z ................... 120
trazodone ............................... 32
TREANDA ...................... 41, 45
TRECATOR .......................... 41
TRELSTAR......................... 101
tretinoin ................................. 48
tretinoin (chemotherapy) ....... 48
TREXALL........................... 104
TREXIMET........................... 39
triamcinolone acetonide . 79, 91,
123
triamterene-hydrochlorothiazid
........................................... 72
TRIBENZOR ........................ 72
triderm ................................... 91
trifluoperazine ....................... 51
trifluridine ............................. 56
trihexyphenidyl ................ 49, 50
tri-legest fe ............................ 97
trilyte with flavor packets ...... 88
trimethobenzamide ................ 35
trimethoprim .......................... 20
trinessa (28) .......................... 97
TRIPLE ANTIBIOTIC ......... 20
TRIPLE ANTIBIOTIC PLUS20
tri-previfem (28) .................... 97
TRISENOX ........................... 45
tri-sprintec (28) ..................... 97
TRIUMEQ............................. 57
TRI-VITAMIN .................... 143
trivora (28) ............................ 97
TRIXAICIN HP .................... 82
TROCHIBASE S CLASSIC 117
TROKENDI XR .................... 29
tropical punch flavor (bulk) 117
TRUMENBA ...................... 107
TRUVADA ........................... 57
TRYMINE CG .................... 127
TUDORZA PRESSAIR ...... 123
turpentine ............................ 117
TUSSICAPS ........................ 127
TUSSIN DM ....................... 127
tutti-frutti flavor (bulk) ........ 117
TWINRIX (PF) ................... 107
TYBOST ............................... 57
TYKERB............................... 47
TYLENOL ARTHRITIS PAIN
........................................... 13
TYPHIM VI ........................ 107
tyrosine (bulk) ..................... 143
TYSABRI ............................. 79
TYZEKA............................... 54
U
U-BASE ................................ 82
ULORIC ................................ 38
ULTIMATE MEN'S
COMPLETE 50+ ............ 143
ULTIMATE WOMEN'S
COMPLETE 50+ ............ 143
undecylenic acid (bulk) ......... 37
UNIBASE ............................. 82
unithroid ................................ 99
urea (bulk) ........................... 117
ursodiol ................................. 85
UVADEX .............................. 82
V
VAGIFEM ............................ 94
VAGISTAT-3 ....................... 38
valacyclovir ........................... 56
VALCHLOR ......................... 41
VALCYTE ............................ 53
valganciclovir........................ 53
valine ................................... 117
valproate sodium ................... 28
valproic acid ......................... 28
valproic acid (as sodium salt) 28
valsartan ............................... 68
valsartan-hydrochlorothiazide
........................................... 73
vancomycin ........................... 21
vandazole .............................. 21
VANIBASE ........................ 117
VANIBASE TRADITIONAL
FORMULA ....................... 82
164
vanilla butternut flavor(bulk)
......................................... 117
vanillin (bulk) ...................... 117
VAQTA (PF) ....................... 108
VARIVAX (PF) .................. 108
VARIZIG............................. 108
VECTIBIX ............................ 45
VELCADE ............................ 45
velivet triphasic regimen (28) 97
venlafaxine............................. 33
VENOFER........................... 134
VENTAVIS ......................... 125
VENTOLIN HFA ................ 124
verapamil ......................... 70, 71
VERSACLOZ ....................... 53
VERSATILE ......................... 82
VERSIGEL ............................ 82
VESICARE ........................... 89
VICTOZA 3-PAK ................. 61
VIDEX 2 GRAM PEDIATRIC
........................................... 57
VIEKIRA PAK ...................... 55
VIGAMOX ............................ 25
VIIBRYD ........................ 32, 33
VIMPAT ................................ 30
VINBLASTINE ..................... 45
vincasar pfs............................ 45
vincristine .............................. 45
vinorelbine ............................. 45
VIRACEPT ........................... 58
VIRAMUNE XR ................... 56
VIRAZOLE ........................... 54
VIREAD ................................ 54
VISINE-A ............................ 120
vit a & d3 in cod liver oil..... 143
vit e acid succinate (bulk) .... 143
VITABASIC SENIOR ........ 143
vitamin a .............................. 143
VITAMIN B-1
(MONONITRATE) ......... 143
VITAMIN B-12 ................... 143
VITAMIN B-6 ..................... 143
VITAMIN C ........................ 143
VITAMIN C DROPS .......... 143
VITAMIN D2 ...................... 143
VITAMIN D3 .............. 143, 144
vitamin e .............................. 144
vitamin e (dl, acetate) .......... 144
vitamin e acetate.................. 144
vitamin e mixed.................... 144
VITAMIN K .......................... 66
VITAMIN K1........................ 67
VITAMINS & MINERALS 144
VITAMINS B COMPLEX.. 144
VITEKTA ............................. 56
VITUZ ................................. 128
VOLTAREN ......................... 15
voriconazole .......................... 38
VOTRIENT ........................... 47
VPRIV ................................... 83
vyfemla (28) ........................... 97
VYTORIN 10-10................... 73
VYTORIN 10-20................... 73
VYTORIN 10-40................... 73
VYTORIN 10-80................... 73
W
WAL-FEX D 24 HOUR ...... 121
WAL-FINATE .................... 121
WAL-ITIN .......................... 122
WAL-ITIN ALLER-MELTS
......................................... 121
WAL-ITIN D ...................... 122
WAL-TAP COLD &
ALLERGY ...................... 128
warfarin ................................. 65
water for irrigation, sterile.. 136
watermelon flavor (bulk) ..... 117
WEE CARE ........................ 135
WELCHOL ........................... 61
white petrolatum (bulk) ....... 117
WINTERGREEN
FLAVORING .................. 117
WITEPSOL H-15 ................ 117
WOMEN'S 50+ DAILY FORM
(GKB).............................. 144
WOMEN'S DAILY
FORMULA ..................... 144
X
XALKORI............................. 47
xanthan gum ........................ 118
XARELTO ............................ 65
XENAZINE .......................... 78
XENICAL ............................. 78
XGEVA............................... 110
XOLAIR ............................. 128
XTANDI ............................... 41
xulane .................................... 98
xylitol (bulk) ........................ 118
XYREM .............................. 129
Y
yeast .................................... 144
YERVOY .............................. 46
YF-VAX (PF) ..................... 108
Z
ZADITOR ........................... 145
zafirlukast ............................ 123
zaleplon ............................... 128
ZALTRAP............................. 46
ZANOSAR ............................ 19
ZAVESCA ............................ 83
ZELBORAF .......................... 48
ZEMAIRA .......................... 128
zenatane ................................ 82
zenchent (28) ......................... 98
ZENPEP ................................ 84
ZETIA ................................... 75
ZIAGEN ................................ 57
zidovudine ............................. 57
zinc chloride ........................ 135
zinc gluconate ..................... 135
zinc oxide (bulk) .................. 118
zinc sulfate .......................... 135
zinc sulfate (bulk) ................ 135
zinc sulfate-vitamin c .......... 144
ziprasidone hcl ...................... 53
ZIRGAN ............................... 53
zoledronic acid .................... 110
zoledronic acid-mannitol-water
......................................... 110
ZOLINZA ............................. 38
zolpidem .............................. 128
165
ZOMETA ............................ 110
ZONALON ............................ 82
ZONATUSS ........................ 128
zonisamide ............................. 26
ZOO FRIENDS ................... 144
ZOO FRIENDS COMPLETE
......................................... 144
ZORTRESS ......................... 104
ZORVOLEX ......................... 15
ZOSTAVAX (PF) ............... 108
zovia 1/35e (28) ..................... 98
zovia 1/50e (28) ..................... 98
ZUBSOLV ............................ 17
ZYCLARA ............................ 82
ZYDELIG ............................. 46
ZYFLO ................................ 123
ZYFLO CR ......................... 123
ZYKADIA ............................ 48
ZYPREXA RELPREVV....... 53
ZYTIGA ................................ 41
ZYVOX................................. 21
166
Neighborhood INTEGRITY (Medicare-Medicaid Plan)
2016 Formulary
List of Covered Drugs
PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION
ABOUT THE DRUGS WE COVER IN THIS PLAN
HPMS Approved Formulary File Submission ID: H9576, Version 1
We have made no changes to this formulary since 01/01/2016.
167

List of Covered Drugs (Formulary)

Transcrição

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