Aetna Preferred Drug Guide

2007

05.05.303.1E (12/06) ©2006 Aetna Inc.

Aetna Preferred Drug Guide3-Tier/Open Formulary Plan

Take this booklet with you when you see your doctor.Do you have a question or need more information?Call the Member Services number on your ID card. Customer Servicerepresentatives are available to take your calls during the following hours:

Weekdays 7 a.m. – 11 p.m. ET

Saturday 8 a.m. – 9:30 p.m. ET

Sunday 8 a.m. – 6 p.m. ET

Visit www.aetna.com for the most up-to-date information

TDD for hearing or speech impaired 1-800-628-3323

Dear Member:

Insurance coverage for prescription drugs continues to be one of the most importantbenefits in a health care plan. To help you determine which medications are coveredby your plan, we are pleased to provide you with a copy of our 2007 Preferred DrugGuide. The drugs that appear on the Preferred Drug List were selected based ontheir effectiveness, quality, safety and value.

This book is designed to provide you with easy to understand and accessibleinformation on the Aetna Preferred Drug List, as well as details on your pharmacybenefit design. We encourage you to take this guide with you when you see yourdoctor, so you can discuss whether any medications recommended by your physician are covered under your pharmacy benefit.

Many commonly prescribed medications, along with their preferred drug status arelisted in this book. Please remember that this is not a complete list of medicationscovered under your plan. Because there are thousands of medications included inyour pharmacy benefit, we only list the most commonly prescribed ones.

In accordance with state law, California HMO members who are receiving coverage for medications thatare added to the Precertification or Step-Therapy lists will continue to have those medications covered, foras long as the treating physician continues prescribing them, provided that the drug is appropriatelyprescribed and is considered safe and effective for treating the enrollee's medical condition. Nothing in thismaterial shall preclude the prescribing provider from prescribing another drug covered by the plan that ismedically appropriate for the enrollee, nor shall anything in this material be construed to prohibit genericdrug substitutions.

For members in Texas, additions to the 2007 Preferred Drug list will be effective no later than January 1, 2007. In accordance with state law, full-risk members in Texas who receive coverage for medications that are removed from the Preferred Drug list during the plan year will continue to havethose medications covered at the same benefit level until their plan renewal date.

Step-therapy, precertification and quantity limits do not apply in all service areas. For example, step-therapydoes not apply to fully insured members in New Jersey and Indiana. Please refer to your plan documentsor call the Member Service number on your ID card for further information.

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Table of Contents

What Pharmacy Benefits Plan Do I Have? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

What is the Preferred Drug List? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Who Reviews Medications for the Preferred Drug List? . . . . . . . . . . . . . . . . . . . . . . 3

How is the Preferred Drug List Developed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

The Preferred Drug List is Subject to Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Why Do Some Medications Require Prior Authorization or Precertification? . . . . . 4

Why Do Some Medications Have Quantity Limits? . . . . . . . . . . . . . . . . . . . . . . . . . . 5

What is Step-Therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

What is Therapeutic Duplication?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

What are Generic Medications? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

How Can I Save Money on Prescriptions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

What is Aetna Rx Home Delivery? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

How Do I Contact Aetna Rx Home Delivery? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

What is Aetna Specialty Pharmacy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Preferred Drug List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Antineoplastic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Blood Products - Modifiers - Volume Expanders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Cardiovascular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Dermatological Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Endocrine System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Gastrointestinal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Genitourinary System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Immunological Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Infections and Infestations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Musculoskeletal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Ophthalmic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Otic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Respiratory Tract Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Precertification List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Quantity Limit List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Step-Therapy List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

2 www.aetna.com/formulary

What Pharmacy BenefitsPlan Do I Have?You are enrolled in a three-tier/openformulary plan.*Open formulary means your pharmacybenefit covers medications that are on thePreferred Drug List (formulary), as well asmany that are not. Your plan may notcover certain medications, even thoughsome are listed in this booklet, such ascontraceptives, infertility medications,erectile dysfunction medications anddiabetic supplies. Please see your plandocuments for a complete description of your pharmacy benefit, or call theMember Services number on your ID card.

Three-tier means there are three copaytiers or levels for covered prescriptionmedications. The three copay tiers are:

Your plan may have a “mandatory genericcost-sharing requirement,” which meansthat if you receive a brand-namemedication when a generic medication isavailable, you will pay the difference incost between the brand-name and genericmedication, in addition to your copay.

For a summary of your pharmacybenefits plan, including copay amounts,please visit Aetna Navigator™ atwww.aetna.com or call the MemberServices number on your ID card.

What is the PreferredDrug List?The Preferred Drug List (also known as aformulary) is a list of medications selectedby Aetna in consultation with a team ofhealth care providers. Aetna will generallycover the drugs listed in our PreferredDrug List as long as the drug is medicallynecessary and plan rules are followed. Formore information on the Preferred DrugList, please review your plan documentsor call the Member Services numberlisted on your ID card.

Drugs that appear on Aetna’s PreferredDrug List have been chosen on the basisof sound medical data, safety and cost.

* Your enrollment in an Aetna three-tier/open formulary plan was based on information available at thetime of this mailing. If your pharmacy benefits plan changes, the copays and coverage of certainmedications detailed in this booklet may no longer apply.

** If your plan has a deductible or copay levels based on a percentage of Aetna’s negotiated charge withthe participating pharmacy, rebates that Aetna receives from drug manufacturers do not reduce theamount you pay to the pharmacy for an individual prescription drug. Also, in some cases, if you need topay a percentage of the cost of a drug or an amount to meet a deductible, your costs may be higher fora preferred drug than they would be for a non-preferred drug.

*** If you are enrolled in a PPO plan, all covered generic medications are available at the lowest copay (tierone), regardless of whether they are on the Preferred Drug List. In most HMO plans, non-preferredgeneric medications are available at the highest copay (tier three).

Copay Tier**

Tier One(Low Copay)

Tier Two(Middle Copay)

Tier Three(High Copay)

Type of DrugCovered genericmedications ***

Covered preferred brand-name medications

Covered non-preferredgeneric or brand-namemedications***


n Both brand-name and genericmedications are on Aetna’s PreferredDrug List.

n All medications on the Preferred Druglist have been approved by the Foodand Drug Administration (FDA) as safe and effective.

n The Preferred Drug List is updated onan ongoing basis and may be subject to change without prior notification.

n Many medications on the PreferredDrug List are subject to manufacturerrebate arrangements between Aetna andthe manufacturer of those medications.

This Preferred Drug Guide is anabbreviated list of some of the mostcommonly prescribed drugs. Yourpharmacy benefit may cover many moremedications that are not listed in thisPreferred Drug Guide. However, certainmedications listed in this booklet, such ascontraceptives, infertility medications,erectile dysfunction medications anddiabetic supplies may not be covered byyour particular plan. Please visit the Aetnawebsite at www.aetna.com/formulary fora more complete listing of medicationsthat may be covered by your plan.

It is important to note that you and yourphysician are responsible for making thefinal decision on your drug therapy. For acomplete description of your pharmacybenefit, see your plan documents or callthe Member Services number on your IDcard for further information.

Who Reviews Medicationsfor the Preferred Drug List?Aetna’s Pharmaceutical and Therapeutics(P&T) Committee reviews availableclinical literature for medications thathave been approved by the FDA.

How is the Preferred DrugList Developed? Our Pharmaceutical and Therapeutics(P&T) Committee is responsible forreviewing drugs for possible inclusion onour Preferred Drug Lists. Although thecommittee includes staff from Aetna, themajority of the members are practicingdoctors and/or pharmacists who arechosen to represent various clinicalspecialties. All committee members mustdisclose any factors that may create a realor apparent conflict of interest or financialstake related to any of the manufacturerswhose products are being reviewed.

The P&T’s clinical determinations arebased on the strength of scientificevidence from literature and databasesearches from a number of sources andincludes, but is not limited to: UnitedStates Pharmacopeia - Drug Information(USP-DI), American Hospital FormularyService Drug Information (AHFS-DI),DrugDex, Medline and other databases,including relevant findings of federalgovernment agencies, the pharmaceuticalmanufacturers, medical professionalassociations, national commissions andpeer-reviewed journals.


The P&T committee meets regularly toevaluate new drug indications and newclinical information on existing preferreddrugs to verify that they continue to meetthe criteria for safety, effectiveness,current use in therapy and overall value.Once the P&T completes its clinicalreview, Aetna conducts additional reviewsof medications based on P&T’s clinicaldeterminations and informationregarding overall value (including costand manufacturer rebate arrangements)and other factors before a decision onPreferred Drug List status is made.

The Preferred Drug List is Subject to ChangeAetna periodically reviews our PreferredDrug List to make sure it meets thecriteria for safety, effectiveness and overallvalue. The list is subject to change.Medications may be covered at a highercopayment and/or removed from thePreferred Drug List at any time.n As brand-name medications lose their

patents and generic versions becomeavailable, the brand-name medicationmay be covered at a higher copayment.Medications likely to become availablegenerically in 2007 are identified in this booklet with a symbol.

n The Preferred Drug List may changebecause the FDA approves many newmedications throughout the year. Open formulary plans generally covernew FDA-approved medications beforethey have completed Aetna’s new drugreview process. Depending on theirplan, some members may pay a higher

copayment, and the medication alsomay be subject to precertification orstep-therapy requirements

n The Preferred Drug List also maychange if a medication is withdrawnfrom the market or becomes availablewithout a prescription. When an over-the-counter (OTC) equivalent becomesavailable, the prescription medicationmay no longer be covered under manyof Aetna’s pharmacy benefits.

Why Do Some MedicationsRequire Prior Authorizationor Precertification?Precertification encourages theappropriate and cost-effective use ofmedications by allowing coverage onlywhen certain conditions are met.Reasons for precertification include age or gender of the member if outsideof recommended dosing guidelines,duplicate therapies, and to help healthcare providers ensure a medication isbeing used based on generally acceptedmedical criteria. The precertificationprogram is based upon current medicalfindings, FDA-approved manufacturerlabeling information, and cost andmanufacturer rebate arrangements.n If your plan includes our

precertification program, your doctormust request authorization for themedication. If the request is approved,your doctor is notified and themedication will then be covered at theapplicable copay under your plan. Youwill also be notified of approvals wherethe state requires notification of


members. If the request is denied, youand your doctor will be notified.

n Certain medications noted in this guide require prior authorization orprecertification before they will becovered under some pharmacy benefitsplans. For information on whetherprecertification applies to your plan,please refer to your plan documents orcall the Member Services number onyour ID card. Refer to pages 33 – 34for further details on whichmedications apply precertification.

n The medications requiringprecertification are subject to change. Refer to our website atwww.aetna.com/formulary or call the Member Services number on your ID card for the most up-to-date information.

Why Do Some MedicationsHave Quantity Limits?Quantity limits are included as part ofour precertification program and aredesigned to help promote appropriateand efficient medication use and enhance patient safety.n Quantity limits are based on generally

accepted pharmaceutical guidelines,efficient dosing regimens and dosingrecommendations. Three types ofquantity limits are in place. They are:— Dose Efficiency Edits – Limits

coverage of prescriptions to one dose per day for drugs that areapproved for once-daily dosing.

— Maximum Daily Dose –Informational message is sent to the pharmacy if prescription liesoutside recommended minimum and maximum doses.

— Quantity limits over time – Limits coverage of prescriptions to a specific number of units per a defined amount of time

Quantity limit medications may becovered for quantities up to thoseindicated. In order to receive coverage for amounts in excess of the quantitylisted, the prescribing physician mustrequest a medical exception. Refer topages 35 – 40 for further details onwhich medications apply quantity limits.

The medications that have quantity limitsare subject to change. Refer to ourwebsite at www.aetna.com/formularyor call the Member Services number onyour ID card for the most up-to-dateinformation.

What is Step-Therapy? Step-therapy means you must first try one or more “pre-requisite” medicationsbefore the step-therapy medication willbe covered. If your plan includes ourstep-therapy program, you need to tryone or more pre-requisite medicationsfirst before the “step-therapy”medication will be covered under your pharmacy benefit. n Pre-requisite medications and their

corresponding step-therapy medicationsare FDA-approved and are used to treatthe same conditions.


n If it is medically necessary, you canobtain coverage for a step-therapymedication without trying a prerequisitemedication first. In this case, yourdoctor must request coverage for a step-therapy medication as a medicalexception. If the request is approved,your doctor will be notified and themedication will then be covered at theapplicable copay under your plan. Youwill also be notified of approvals wherestate requires notification of members. If the request is denied, you and your doctor will be notified.

n Step-therapy is based upon currentmedical findings, FDA-approvedmanufacturer labeling information, and cost and manufacturer rebatearrangements.

n For information on whether step-therapy applies to your plan,please refer to your plan documents or call the Member Services numberon your ID card.

n Refer to page 41 – 42 for furtherdetails on which medications applystep-therapy.

The medications requiring step-therapyare subject to change. Refer to ourwebsite at www.aetna.com/formularyor call the Member Services number onyour ID card for the most up-to-dateinformation.

What is TherapeuticDuplication?Therapeutic Duplication is when twodrugs from the same therapeutic categoryare used at the same time by the sameperson. Rarely are two drugs from thesame category necessary to treat a medicalcondition. Sometimes therapeuticduplication results when two physiciansare prescribing medications for the sameperson or when a physician changes from one medication to another withinthe same therapeutic class, but does not discontinue the first medication. In either situation, the person may endup taking two drugs with similar actionsunnecessarily, potentially leading toserious side effects.

In 2007 Aetna will implement aTherapeutic Duplication program within its fully insured population in an effort to help health care providersavoid these situations. n If a therapeutic duplication is identified

by our claims system, your pharmacistmay ask you and/or your physicianabout the medications you aresupposed to be taking. He can thenhelp determine if both medications arenecessary, or whether one of themedications should be discontinued.

n Medications subject to the therapeuticduplication program in 2007 include:— Selective Serotonin Reuptake

Inhibitors (SSRI) antidepressants— Proton Pump Inhibitors used to

treat ulcers


— “Triptan” drugs used to treatmigraine headaches

— Inhaled steroids for the treatment of asthma

— “Statin” medications used to treathigh cholesterol

What are GenericMedications?Generic drugs are identical to brand-name drugs in dosage, strength, route of administration, performancecharacteristics and intended use. Although generic drugs are chemically the same as their branded counterparts,they are typically sold at substantialdiscounts from the branded price.n Generic medications have been

approved by the FDA as safe andeffective. They contain the same activeingredients in the same amounts as the brand-name products, althoughgenerics may be a different color, shapeor size than brand-name products.

n Your pharmacist generally cansubstitute a generic medication for abrand-name medication when fillingyour prescription when the generic israted by the FDA as equivalent andwhere substitution is permitted by law and by your doctor.

How Can I Save Money on Prescriptions?Ask your doctor to consider prescribingmedications on the Preferred Drug Listwhenever appropriate. Medications on

the Preferred Drug List generally cost youless money with a lower copayment.n In many plans, covered generic

medications on the Preferred Drug Listare available at the lowest copay.

n Ask your doctor or pharmacist whethergeneric medications are appropriate for you.

What is Aetna Rx HomeDelivery?Aetna Rx Home Delivery® is our mail-order prescription service. Aetna RxHome Delivery is an ideal way to obtainyour medications that are taken regularlyto treat a chronic condition such asarthritis, diabetes or heart disease. These medications are delivered right to your door.

How Do I Contact AetnaRx Home Delivery?For a specific question about the status of a prescription requested or filled byAetna Rx Home Delivery:

Call 1-866-612-3862

Weekdays 7 a.m. – 11 p.m. ET

Saturday 8 a.m. – 9:30 p.m. ET

Sunday 8 a.m. – 6 p.m. ET

Or, check the status of your order onlineat www.aetnarxhomedelivery.com.

You may contact Member Services at thetoll-free 800 number listed on the back of your ID card for questions abouteligibility, benefits, copays, forms or other general information.


What is Aetna Specialty Pharmacy? Aetna Specialty Pharmacy® is available to fill your specialty injectablemedication needs. Some injectablemedications, as well as other disease-specific drugs, require special handling,storage or shipping. These drugs areoften referred to as specialty medicationsand are often used to treat certainconditions such as hemophilia, hepatitisand multiple sclerosis.

Aetna Specialty Pharmacy providesconvenient mail-order services forspecialty medications that are not alwaysavailable at retail pharmacies. AetnaSpecialty Pharmacy also offers educationaland clinical support services to helpmembers manage their medications and health condition.

Depending on your benefits plan, youmay have a copay for specialty injectablemedications. Please refer to your plandocuments or contact Member Services at the number on your ID card forfurther information.

For more information on Aetna Specialty Pharmacy, call toll free at 1-866-782-2779 (ASRX) or visitwww.AetnaSpecialtyPharmacy.com.

THERAPEUTIC CLASS LIST KEY

UPPERCASE – Brand-name medication

lower case italics – Generic medication

PR – Precertification required under most plans

ST – Step-therapy applies under most plans

QL – Quantity limit applies under most plans

# – Brand-name medication expected tobecome available generically duringthe year. After the generic medicationbecomes available, the brand-namemedication may be covered at ahigher copayment and/or removedfrom the Preferred Drug List.

MED – Injectable medication that may becovered under the medical benefit

PMED – Preferred injectable medicationthat may be covered under themedical benefit


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Antineoplastic Agents

Adrenal Steroid InhibitorsCYTADREN 3

Alkylating AgentsALKERAN 2CEENU 2cyclophosphamide 1CYTOXAN 3HEXALEN 2LEUKERAN 2MYLERAN 2TEMODAR 2

Antimetabolitesmercaptopurine 1methotrexate 1PURINETHOL 3TABLOID 2TREXALL 3XELODA 2

Antineoplastic - Hormonal AgentsARIMIDEX 2AROMASIN 2CASODEX 2 3

DEPO-PROVERA MEDEMCYT 2EULEXIN 3FARESTON 3FASLODEX MEDFEMARA 2flutamide 1leuprolide MEDLUPRON PMEDLYSODREN 3MEGACE 3MEGACE ES 3megestrol 1NILANDRON 2NOLVADEX 3tamoxifen 1TESLAC 3ZOLADEX MED

Antineoplastic Enzyme InhibitorsGLEEVEC 2IRESSA 3NEXAVAR 2SUTENT 2TARCEVA 2

Antineoplastics Misc.ACTIMMUNE MEDALFERON N MEDHYDREA 3hydroxyurea 1INTRON-A MED 3

MATULANE 2MYLOCEL 3PHOTOFRIN MEDPROLEUKIN MEDROFERON-A MED 3

TARGRETIN 3THERACYS MEDTICE BCG MEDUVADEX MEDVESANOID 2

Chemotherapy Rescue/Antidote Agentsleucovorin calcium 1MESNEX 3

ImmunomodulatorsREVLEMID 3THALOMID 3

Mitotic Inhibitorsetoposide 1VEPESID 3

Blood Products- Modifiers-Volume Expanders

Agents for Gaucher DiseaseCEREDASE MEDCEREZYME MEDZAVESCA 3 3

Agents for Sickle Cell AnemiaDROXIA 3

Coumarin AnticoagulantsCOUMADIN 3warfarin 1

3-Tier Commercial Member Guide


LABEL NAME

Hematopoietic Growth FactorsPROCRIT 2ARANESP 2NEULASTA 2

Hematopoietic MixturesTRINSICON 2

Heparins And Heparinoid-Like AgentsARIXTRA 3FRAGMIN 3heparin sodium MEDINNOHEP 3LOVENOX 3

Platelet Aggregation InhibitorsAGGRENOX 2AGRYLIN 3anagrelide 1cilostazol 1dipyridamole 1PERSANTINE 3PLAVIX # 2PLETAL 3 3

Cardiovascular System

ACE InhibitorsACCUPRIL 3 3 3

ACEON 3 3

ALTACE 2 3

benazepril 1 3

CAPOTEN 3 3

captopril 1 3

enalapril 1 3

fosinopril 1 3

lisinopril 1 3

LOTENSIN 3 3

LYTENSOPRIL 3MAVIK 3 3

MONOPRIL 3 3

PRINIVIL 3 3

quinapril 1 3

UNIVASC 3 3

VASOTEC 3 3

ZESTRIL 3 3


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LABEL NAME

Agents for PheochromocytomaDEMSER 3DIBENZYLINE 2phentolamine MED

Alpha-Beta BlockersCOREG 2labetalol 1TRANDATE 3

Anaphylaxis Therapy AgentsEPIPEN 2TWINJECT 3EPIPEN-JR 2

Angiotensin II Receptor AntagonistATACAND 3 3 3

AVAPRO 3 3 3

BENICAR 3 3

COZAAR 2 3

DIOVAN 2 3

MICARDIS 3 3

TEVETEN 3 3

Antiadrenergic AntihypertensivesCARDURA 3CARDURA XL 3CATAPRES 3CATAPRES-TTS 3clonidine 1doxazosin 1guanabenz 1guanfacine 1HYTRIN 3methyldopa 1MINIPRESS 3prazosin 1reserpine 1TENEX 3terazosin 1

Antianginals- OtherRANEXA 3 3 3

Antiarrhythmics Type I - NonspecificETHMOZINE 2

Antiarrhythmics Type I-Adisopyramide 1NORPACE 3

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LABEL NAME

Antiarrhythmics Type I-A (continued)

procainamide 1procainamide ER 1PROCANBID 3PRONESTYL 3PRONESTYL SR 3quinidine gluconate 1quinidine sulfate 1

Antiarrhythmics Type I-Bmexiletine 1

Antiarrhythmics Type I-Cflecainide 1propafenone 1RYTHMOL 3RYTHMOL SR 3TAMBOCOR 3

Antiarrhythmics Type IIIamiodarone 1CORDARONE 3PACERONE 3TIKOSYN 3

Antihyperlipidemic CombinationsADVICOR 2 3

VYTORIN 10 mg / 10 mg 2 3 3

VYTORIN (all other strengths) 2 3

Antihypertensive CombinationsACCURETIC 3 3

ALDORIL 3ATACAND HCT 3 3 3

atenolol/chlorthalidone 1AVALIDE 3 3 3

benazepril/hydrochlorothiazide 1

BENICAR HCT 3 3

bisoprolol/hydrochlorothiazide 1

CAPOZIDE 3captopril/

hydrochlorothiazide 1CLORPRES 3CORZIDE 3DIOVAN HCT 2 3

enalapril/hydrochlorothiazide 1

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LABEL NAME

Antihypertensive Combinations(continued)

fosinopril/hydrochlorothiazide 1

hydralazine/hydrochlorothiazide 1

HYZAAR 2 3

INDERIDE 3LEXXEL 3lisinopril/

hydrochlorothiazide 1LOPRESS HCT 3LOTENSIN HCT 3LOTREL 2methyldopa/

hydrochlorothiazide 1metoprolol/

hydrochlorothiazide 1MICARDIS HCT 3 3

MINIZIDE 3MONOPRIL HCT 3PRINZIDE 3propranolol/

hydrochlorothiazide 1quinaretic 1rauwolfia/

bendroflumethiazide 1TARKA 3TENORETIC 3TEVETEN HCT 3TIMOLIDE 3UNIRETIC 3UNI-SERP 3VASERETIC 3ZESTORETIC 3ZIAC 3

Beta Blockers Cardio-Selectiveacebutolol 1atenolol 1betaxolol 1bisoprolol fumarate 1KERLONE 3LOPRESSOR 3metoprolol 1SECTRAL 3TENORMIN 3TOPROL XL 3ZEBETA 3

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LABEL NAME

Beta Blockers Non-SelectiveBETAPACE 3BETAPACE AF 3BLOCADREN 3CARTROL 3CORGARD 3INDERAL 3INDERAL LA 3INNOPRAN XL 3LEVATOL 3nadolol 1pindolol 1propranolol 1sorine 1sotalol AF 1sotalol hcl 1timolol maleate 1

Bile Sequestrantscholestyramine 1COLESTID 3colestipol 1prevalite 1QUESTRAN 3WELCHOL 2

Calcium BlockersADALAT CC 3 3 3

afeditab 1 3

CALAN 3 3

CALAN SR 3 3 3

CARDENE 3 3

CARDENE SR 3 3

CARDIZEM 3 3

CARDIZEM CD 3 3 3

CARDIZEM LA 2 3

cartia XT 1 3

COVERA-HS 3 3 3

DILACOR XR 3 3 3

diltia XT 1 3

diltiazem 1diltiazem CD 1 3

diltiazem ER 1 3

diltiazem extended release beads SR 1 3

DYNACIRC 3DYNACIRC CR 3


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Calcium Blockers (continued)

felodipine 1 3

ISOPTIN SR 3 3 3

isradipine 1nicardipine 1nifediac CC 1 3

nifedical 1 3

nifedipine 1nifedipine ER/CR/SR 1 3

NIMOTOP # 2NORVASC 3 3

PLENDIL 3 3

PROCARDIA 3 3

PROCARDIA XL 3 3 3

SULAR 3 3

taztia XT 1 3

TIAZAC 3 3 3

verapamil 1 3

verapamil SR 1 3

VERELAN 3 3 3

VERELAN PM 3 3

Carbonic Anhydrase Inhibitorsacetazolamide 1DIAMOX 3methazolamide 1

Cardiac Glycosidesdigitek 1digoxin 1LANOXICAPS 3LANOXIN 3

Combination DiureticsALDACTAZIDE 3amiloride/

hydrochlorothiazide 1DYAZIDE 3MAXZIDE 3MODURETIC 3spironolactone/

hydrochlorothiazide 1triamterene/

hydrochlorothiazide 1

Fibric Acid DerivativesANTARA 2gemfibrozil 1fenofibrate 1

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Fibric Acid Derivatives (continued)

LOFIBRA 3LOPID 3TRICOR # 2TRIGLIDE 3

HMG CoA Reductase InhibitorsALTOPREV 3 3 3

CRESTOR 5 mg 2 3 3

CRESTOR (all other strengths) 2 3

LESCOL 2 3

LESCOL XL 2 3

LIPITOR 3 3 3

lovastatin 1 3

MEVACOR 3 3 3

PRAVACHOL 3 3 3

pravastatin 1 3

simvastatin 1 3

ZOCOR 3 3 3

Impotence AgentsCAVERJECT 3 3 3

CIALIS 3 3

EDEX 3 3

LEVITRA 3 3

MUSE 3 3

VIAGRA 3 3

Intestinal Cholesterol Absorption InhibitorsZETIA 2 3

Loop Diureticsbumetanide 1BUMEX 3DEMADEX 3EDECRIN 3furosemide 1LASIX 3torsemide 1

Misc. AntihyperlipidemicsLIPEX 3OMACOR 3VANACHOL 3

Misc. Cardiovascular CombinationsBIDIL 3CADUET 3 3 3

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Nicotinic Acid DerivativesNIASPAN 2

Nitratesamyl nitrite 1DILATRATE SR 3IMDUR 3ISMO 3isochron 1ISORDIL 3isosorbide dinitrate 1isosorbide mononitrate 1minitran 1MONOKET 3nitrek 1NITROBID 3NITRO-DUR 3NITROGARD 3nitroglycerin 1nitroglycerin CR 1nitroglycerin SL 1NITROLINGUAL 3nitroquick 1NITROSTAT 2nitrotab 1nitro-time 1nitro-transderm 1

Peripheral Vasodilatorsisoxsuprine 1papaverine ER 1VASODILAN 3

Potassium Sparing DiureticsALDACTONE 3amiloride 1DYRENIUM 3MIDAMOR 3spironolactone 1

Prostaglandin VasodilatorsVENTAVIS 2 3

Pulmonary Hypertension - Endothelin Receptor AntagonistsTRACLEER 2 3

Pulmonary Hypertension- Phosphodiesterase InhibitorsREVATIO 2 3

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Selective Aldosterone Receptor Antagonists (SARAs)INSPRA 3

Thiazides and Thiazide-Like Diureticschlorothiazide 1chlorthalidone 1DIURIL 3hydrochlorothiazide 1indapamide 1LOZOL 3methychlothiazide 1metolazone 1MICROZIDE 3NATURETIN 3THALITONE 3ZAROXOLYN 3

Vasodilatorshydralazine 1minoxidil 1

Central Nervous System

Agents for Chemical DependencyANTABUSE 3CAMPRAL 3naltrexone 1

Alpha-2 Receptor Antagonistsmirtazapine 1mirtazapine ODT 1REMERON 3 3

REMERON SOLUTAB 3 3

ALS AgentsRILUTEK 3

AmphetaminesADDERALL 3 3

ADDERALL XR # 2 3

amphetamine/dextroamphetamine 1 3

DESOXYN 3 3 3

DEXEDRINE 3 3

dextroamphetamine 1 3

dextroamphetamine CR 1 3

DEXTROSTAT 3 3


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Analgesic Combinationsacetaminophen/

salicylamide/phenyltoloxamine 1

butalbital CPD 1butalbital/acetaminophen 1butalbital/acetaminophen/

caffeine 1butalbital/aspirin/caffeine 1

Anti-Cataplectic AgentsXYREM 3 3

Anticonvulsant - Benzodiazepinesclonazepam 1clonazepam orally

disintegrating tab 1DIASTAT 3KLONOPIN 3KLONOPIN WAFER 3

AntidementiaARICEPT 3ARICEPT ODT 3COGNEX 3EXELON 2NAMENDA 2RAZADYNE 3RAZADYNE ER 3

Antiparkinsonian AdjuvantsLODOSYN 3

Antiparkinsonian AnticholinergicAKINETON 3benztropine 1KEMADRIN 3trihexyphenidyl 1

Antiparkinsonian COMT InhibitorsCOMTAN 2TASMAR 3

Antiparkinsonian Dopaminergicamantadine 1atamet 1bromocriptine 1carbidopa/levodopa 1carbidopa/levodopa SR 1MIRAPEX # 2PARCOPA 3

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Antiparkinsonian Dopaminergic(continued)

PARLODEL 3pergolide 1PERMAX 3REQUIP # 2SINEMET 3SINEMET CR 3STALEVO 3SYMMETREL 3

Antiparkinsonian Monoamine Oxidase InhibitorELDEPRYL 3selegiline 1

Barbiturate HypnoticsBUTISOL SODIUM 3MEBARAL 3mephobarbital 1phenobarbital 1SECONAL 3

BenzisoxazolesRISPERDAL # 2 3

RISPERDAL CONSTA MEDRISPERDAL M 2 3

Benzodiazepinesalprazolam 1alprazolam ER 1chlordiazepoxide 1clorazepate 1diazepam 1lorazepam 1NIRAVAM 3oxazepam 1XANAX XR 3

Butyrophenoneshaloperidol 1

CarbamatesFELBATOL 3

Combination Psychotherapeuticschlordiazepoxide/

amitriptyline 1perphenazine/amitriptyline 1SYMBYAX 3 3

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Dibenzapinesclozapine 1 3

CLOZARIL 3 3

FAZACLO 3 3

loxapine 1SEROQUEL 2 3

ZYPREXA 2 3

ZYPREXA ZYDIS 2 3

GABA ModulatorsGABITRIL 3

Hydantoinsphenytoin extended 1phenytoin sodium 1

Lithiumlithium carbonate 1lithium carbonate CR 1lithium citrate 1LITHOBID 3

MAO InhibitorsEMSAM 3MARPLAN 3NARDIL 3PARNATE 3tranylcypromine sulfate 1

Migraine ProductsMIGRANAL 3 3

Misc Psychotherapeutic and Neurological Agentsergoloid mesylate 1ORAP 3

Misc. Antianxiety Agentsbuspirone 1hydroxyzine hcl 1hydroxyzine pamoate 1meprobamate 1

Misc. Anticonvulsantscarbamazepine 1gabapentin 1 3

GABARONE 3 3 3

KEPPRA 2LAMICTAL 2lamotrigine 1LYRICA 3 3 3

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Misc. Anticonvulsants (continued)

NEURONTIN 3 3 3

primidone 1TEGRETOL 3TEGRETOL XR 3TOPAMAX 3TRILEPTAL 2ZONEGRAN 3zonisamide 1

Misc. Antidepressantsbudeprion 1 3

bupropion 1 3

bupropion SR 1 3

maprotiline 1 3

WELLBUTRIN 3 3 3

WELLBUTRIN SR 3 3 3

WELLBUTRIN XL # 2 3 3

Misc. AntipsychoticsEQUETRO 3GEODON 3 3

Modified CyclicsDESYREL 3 3

nefazodone 3 3

TRAZAMINE 3trazodone 1

Multiple Sclerosis AgentsAVONEX 2BETASERON 3COPAXONE 2REBIF 3

Narcotic AgonistsACTIQ 3 3

AVINZA 3codeine phosphate 1codeine sulfate 1DARVON-N 3DEMEROL 3DILAUDID 3DURAGESIC 3 3 3

fentanyl 1 3

hydromorphone 1KADIAN 2levorphanol 1meperidine 1


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Narcotic Agonists (continued)

methadone 1methadose 1morphine sulfate 1morphine sulfate CR 1MS CONTIN 3OPANA 3OPANA ER 3 3

ORAMORPH SR 3oxycodone SR 1 3

OXYCONTIN CR # 3 3 3

oxyfast 1OXYIR 3percolone 1propoxyphene 1tramadol hcl 1ULTRAM 3 3

ULTRAM ER 3 3

Narcotic Combinationsacetaminophen/codeine 1ALCET 3ANEXSIA 3 3

aspirin/codeine 1butalbital/acetaminophen/

caffeine/codeine 1butalbital/aspirin/caffeine/

codeine 1CAPITAL/CODEINE 3 3

COMBUNOX 3 3 3

DARVOCET A500 3 3

DARVOCET-N 3 3

FIORICET/CODEINE 3 3

FIORINAL/CODEINE 3 3

hydrocodone/acetaminophen 1

hydrocodone/ibuprofen 1LORCET 3 3

LORCET PLUS 3 3

LORTAB 3 3

LYNOX 3 3

MAXIDONE 3 3

meperidine/promethazine 1meprozine 1NORCO 3 3

oxycodone/acetaminophen 1oxycodone/aspirin 1

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Narcotic Combinations (continued)

pentazocine/acetaminophen 1

PERCOCET 3 3

PERCODAN 3 3

phrenilin/caffeine/codeine 1propoxyphene/

acetaminophen 1propoxyphene-N/

acetaminophen 1REPREXAIN 3 3

ROXICET 3 3

STAGESIC 3 3

STAFLEX 3SYNALGOS DC 3TALACEN 3 3

tramadol/acetaminophen 1TRYCET 3 3

TYLENOL/CODEINE 3 3

TYLOX 3 3

ULTRACET 3VICODIN 3 3

VICODIN ES 3 3

vicodin HP 1VICOPROFEN 3 3

VOPAC 3 3

XODOL 3 3

ZYDONE 3 3

Narcotic Partial Agonistsbutorphanol 1 3

pentazocine/naloxone 1SUBOXONE 3SUBUTEX 3TALWIN NX 3

Non-Barbiturate HypnoticsAMBIEN 3 3 3

AMBIEN CR 3 3 3

chloral hydrate 1DORAL 3estazolam 1flurazepam 1LUNESTA 3 3 3

midazolam 1SONATA 3 3 3

STRAZEPAM 3

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Non-Barbiturate Hypnotics (continued)

temazepam 1triazolam 1

Phenothiazineschlorpromazine 1compro 1fluphenazine 1perphenazine 1prochlorperazine 1thioridazine 1trifluoperazine 1

Quinolinone DerivativesABILIFY 3 3

ABILIFY DISC 3 3

Selective Melatonin Receptor AgonistsROZEREM 3 3 3

Selective Serotonin Reuptake InhibitorsCELEXA 3 3 3

citalopram 1 3

fluoxetine 1 3

fluvoxamine 1 3

LEXAPRO 3 3 3

paroxetine 1 3

PAXIL 3 3 3

PAXIL CR 3 3

PEXEVA 3 3 3

PROZAC 3 3 3

PROZAC WEEKLY 3 3 3

RAPIFLUX 3 3 3

SARAFEM 3 3

sertraline 1 3

ZOLOFT 3 3 3

Serotonin AgonistsAMERGE 2 3

AXERT 3 3

FROVA 3 3

IMITREX # 2 3

MAXALT 2 3

MAXALT MLT 2 3

RELPAX 3 3

ZOMIG 3 3

ZOMIG ZMT 3 3

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Serotonin-Norepinephrine Reuptake InhibitorsCYMBALTA 2 3 3

EFFEXOR 3 3 3

EFFEXOR XR 2 3 3

venlafaxine 1 3

Stimulants- Misc.CONCERTA 3 3 3

DAYTRANA 2 3

FOCALIN 3 3 3

FOCALIN XR 3 3 3

METADATE CD 2 3

METADATE ER 3 3

methylin 1 3

METHYLIN chew/soln 3 3 3

methylin ER 1 3

methylphenidate 1 3

methylphenidate ER 1 3

methylphenidate SR 1 3

PROVIGIL 3 3 3

RITALIN 3 3 3

RITALIN LA 3 3 3

RITALIN SR 3 3 3

STRATTERA 3 3 3

SuccinimidesCELONTIN 3ethosuximide 1ZARONTIN 3

Thioxanthenesthiothixene 1

Tricyclic Agentsamitriptyline 1amoxapine 1clomipramine 1desipramine 1doxepin hcl 1imipramine hcl 1nortriptyline 1vanatrip 1

Valproic AcidDEPAKOTE # 2DEPAKOTE ER # 2DEPAKOTE SPRINKLE # 2


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Dermatological AgentsAcne ProductsACCUTANE 3 3 3 3

AKNE-MYCIN 3amnesteem 1 3 3

AVAR 3AVAR GREEN 3avar-E green 1AVITA 1 3

AZELEX 3BENZACLIN 3BENZAMYCIN 3BENZIQ 3BENZIQ LS 3BENZIQ wash 3benzoyl peroxide 1benzoyl peroxide/

urea cream 1BINORA 3claravis 1 3 3

clenia 1clindamax 1clindamycin 1DIFFERIN gel/cream 2DUAC 3erythromycin 1erythromycin/benzoyl

peroxide 1ethexderm 1EVOCLIN 3isotretinoin 1 3 3

KLARON 3METROCREAM 3METROGEL 1% only 2METROLOTION 3metronidazole 1NEOBENZ MICRO 3NORITATE 3NUOX 3panoxyl 1panoxyl AQ 1PLEXION cloth 2PLEXION emulsion 3PLEXION SCT 3PLEXION TS 3

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Acne Products (continued)

prascion 1RETIN-A 3 3

RETIN-A MICRO 2 3

ROSAC 3rosaderm 1rosanil 1ROSULA 3ROZEX 3sodium sulfacetamide/

sulfur 1sotret 1 3 3

SULFACET-R 3sulfatol 1SULFOXYL 3suphera 1tretinoin 1 3

TRIAZ 3VANOXIDE-HC 3Z-CLINZ 3ZODERM 3

Antibiotics - TopicalBACTROBAN 3gentamicin 1mupirocin 1

Antifungals - Topicalciclopirox 1clotrimazole/

betamethasone 1econazole 1ERTACZO 3EXELDERM 3hydrocortisone/clioquinol 1hydrocortisone/iodoquinol 1ketoconazole 1LOPROX cream/lotion/

suspension 3LOPROX gel/shampoo # 2LOTRISONE 3NAFTIN 3nystatin 1nystatin/triamcinolone 1OXISTAT 3PENLAC 3 3

VUSION 3

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Antineoplastic or Premalignant Lesions - TopicalCARAC 3EFUDEX 3FLUOROPLEX 3fluorouracil 1LEVULAN KERA 3PANRETIN 2SOLARAZE 3TARGRETIN 2

Antipruriticsprudoxin 1ZONALON 3

Antipsoriatics8-MOP 3AMEVIVE MEDanthralin 1DOVONEX 3DRITHO-SCALP 3OXSORALEN-UL 3PSORIATEC 3RAPTIVA MEDSORIATANE 2TAZORAC 2

Antiseborrheic ProductsCAPITROL 3OVACE 3ROSULA NS 3SEBIZON 3selenium sulfide 1sulfacetamide sodium 1

Antiviral - TopicalDENAVIR 3ZOVIRAX 3

Corticosteroids - Topicalalclometasone 1amcinonide 1augmented betamethasone

dipropionate 1betamethasone valerate 1clobetasol 1clobevate 1CLOBEX lotion/

shampoo/spray 2

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Corticosteroids - Topical (continued)

CLODERM 3CORDRAN 3desonide 1desoximetasone 1diflorasone 1DIPROLENE AF 3ELOCON 3fluocinolone acetonide 1fluocinonide 1fluticasone 1HALOG 3hydrocortisone butyrate 1hydrocortisone 1hydrocortisone valerate 1hydrocortisone/pramoxine 1lacticare/hydrocortisone 1lidocaine/hydrocortisone 1LUXIQ 2mometasone 1NUZON 3OLUX 2TACLONEX 3 3

triamcinolone 1ULTRAVATE 3VANOS 2

Immunomodulating Agents - TopicalALDARA 2ELIDEL 2 3

PROTOPIC 2 3

Keratolytics/Antimitoticspodocon 1podofilox 1

Local Anesthetics - Topicalcocaine hcl 1lidocaine 1lidocaine/prilocaine 1LIDODERM 2SYNERA 3

Rosacea AgentsFINACEA 3ORACEA 3 3 3

Scabicides & PediculicidesEURAX 3


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Scabicides & Pediculicides (continued)

lindane 1permethrin 1sulfurated lime solution 1

Endocrine SystemAlpha-Glucosidase InhibitorsGLYSET 3PRECOSE 3

AndrogensANDRODERM 2ANDROGEL 2danazol 1FIRST-TESTOSTERONE 3STRIANT 3TESTIM 3testosterone MED

Antidiabetic - Amino Acid DerivativesSTARLIX 2

Antidiabetic CombinationsACTOPLUS MET 2AVANDAMET 2AVANDARYL 2GLUCOVANCE 3glipizide/metformin 1glyburide/metformin 1METAGLIP 3

Antithyroid Agentsmethimazole 1propylthiouracil 1TAPAZOLE 3

BiguanidesFORTAMET 3GLUCOPHAGE 3GLUCOPHAGE XR 3metformin 1metformin ER 1RIOMET 3

Combination Contraceptives - TransdermalORTHO EVRA 3

Combination Contraceptives - VaginalNUVARING 3

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Combinations OC’sALESSE 3 3

apri 1 3

aranelle 1 3

aviane 1 3

BREVICON 3 3

cesia 1 3

cryselle 1 3

CYCLESSA 3 3

DEMULEN 1/35 3 3

DEMULEN 1/50 3 3

DESOGEN 3 3

enpresse 1 3

ESTROSTEP FE 3 3

jolessa 1 3

junel 1.5/30 1 3

junel 1/20 1 3

junel FE 1.5/30 1 3

junel FE 1/20 1 3

kariva 1 3

kelnor 1 3

leena 1 3

lessina 1 3

LEVLEN 3 3

LEVLITE 3 3

levora 1 3

LO/OVRAL 3 3

LOESTRIN 1.5/30 3 3

LOESTRIN 1/20 3 3

LOESTRIN FE 3 3

LOESTRIN FE 1.5/30 3 3

LOESTRIN-24 3 3

low-ogestrel 1 3

lutera 1 3

microgestin 1.5/30 1 3

microgestin 1/20 1 3

microgestin FE 1.5/30 1 3

microgestin FE1/20 1 3

MIRCETTE 3 3

MODICON 0.5/35 3 3

mononessa 1 3

necon 0.5/35 1 3

necon 1/35 1 3

necon 1/50 1 3

necon 10/11 1 3

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Combinations OC’s (continued)

necon 7/7/7 1 3

NORDETTE 3 3

NORINYL 1+35 3 3

NORINYL 1+50 3 3

nortrel 0.5/35 1 3

nortrel 1/35 1 3

nortrel 7/7/7 1 3

ogestrel 1 3

ORTHO TRI-CYCLEN 3 3

ORTHO TRI-CYCLEN LO 3 3

ORTHO-CEPT 3 3

ORTHO-CYCLEN 3 3

ORTHO-NOVUM 1/35 3 3



ORTHO-NOVUM 7/7/7 3 3

OVCON 50 3 3

OVCON-35 3 3

portia 1 3

previfem 1 3

quasense 1 3

reclipsen 1 3

SEASONALE 3solia 1 3

sprintex 1 3

sronyx 1 3

TRI-LEVLEN 3 3

trinessa 1 3

TRI-NORINYL 3 3

TRIPHASIL 3 3

tri-previfem 1 3

tri-sprintec 1 3

trivora 1 3

velivet 1 3

YAZ 3 3

YASMIN 3 3

zovia1/35E 1 3

zovia1/50E 1 3

Diabetic OtherGLUCAGON MEDPROGLYCEM 2

Diabetic Suppliesalcohol swabs NCBD insulin syringes 2

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Diabetic Supplies (continued)

FREESTYLE test strips 2gauze pad NCINSULIN SYRINGES

(all syringes other than BD brand) 3

ONE TOUCH BASIC/PROFILE/ONE TOUCH II test strips 2

ONE TOUCH FAST TAKE test strips 2

ONE TOUCH SURE STEP test strips 2

ONE TOUCH ULTRA test strips 2

PRECISION Q-I-D test strips 2

PRECISION SOF-TACT test strips 2

PRECISION XTRA KETONE test strips 2

PRECISION XTRA test strips 2

TEST STRIPS (all other brands) 3

Estrogen CombinationsACTIVELLA 3CLIMARA PRO 3 3

COMBIPATCH 3 3

ESTRATEST 3ESTRATEST HS 3FEMHRT 3FEMHRT LOW DOSE 3FEMTRACE 3PREFEST 3PREMPHASE 3PREMPRO 3syntest D.S. 1syntest H.S. 1

EstrogensALORA 3 3

CENESTIN 2CLIMARA 3 3

ESCLIM 3 3

ESTRACE 3ESTRADERM 3 3

estradiol 1 3


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Estrogens (continued)

ESTRASORB 3ESTROGEL 3estropipate 1gynodiol 1MENEST 2MENOSTAR 3 3

OGEN 3ortho-est 1PREMARIN 3VIVELLE 3 3

VIVELLE DOT 3 3

Fertility RegulatorsGONAL-F PMEDFOLLISTIM PMEDFOLLISTIM AQ PMEDBRAVELLE PMEDREPRONEX PMEDMENOPUR PMED

Glucocorticosteroidsbubbli-pred 1CELESTONE 3cortisone AC 1dexamethasone 1ENTOCORT EC 3hydrocortisone 1methylpred 1ORAPRED 3prednisolone 1prednisone 1

Growth HormoneGENOTROPIN 3 3

HUMATROPE 2 3

NORDITROPIN 3 3

NUTROPIN 2 3

NUTROPIN AQ 2 3

SAIZEN 3 3

SEROSTIM 3 3

TEV-TROPIN 2 3

Growth Hormone Receptor AntagonistSOMAVERT 3 3

Growth Hormone Releasing HormonesGEREF 3 3

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InsulinAPIDRA 3BYETTA 2 3

HUMALOG 2HUMALOG MIX 75/25 2HUMULIN 50/50 2HUMULIN 70/30 2HUMULIN N 2HUMULIN R 2LANTUS 2LEVEMIR 2NOVOLIN 70/30 3 3

NOVOLIN N 3 3

NOVOLIN R 3 3

NOVOLOG 2NOVOLOG MIX 70/30 2RELION 70/30 3 3

RELION N 3 3

RELION R 3 3

SYMLIN 2

Insulin Like Growth FactorsINCRELEX 3 3

Insulin Sensitizing AgentsACTOS 2AVANDIA 2

Meglitinide AnaloguesPRANDIN 2

Metabolic ModifiersCARNITOR 3CYSTADANE 3HECTOROL 3ORFADIN 2 3

SENSIPAR 3ZEMPLAR 2

Mineralocorticoidsfludrocort 1

Posterior PituitaryDDAVP 3 3

desmopressin 1STIMATE 3

Progestin Contraceptives- Injectablesmedroxyprogesterone 1DEPO-PROVERA 3

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Progestin OC’scamila 1 3

errin 1 3

jolivette 1 3

nora-be 1 3

NOR-QD 3 3

ORTHO MICRONOR 3 3

Progestinsmedroxyprogesterone

acetate 1norethindrone acetate 1PROMETRIUM 2

SulfonylureasAMARYL 3chlorpropamide 1glimepiride 1glipizide 1glipizide ER 1glipizide XL 1glyburide 1glyburide micronized 1glycron 1tolazamide 1tolbutamide 1

Thyroid HormonesARMOUR THYROID 3BIO-THROID 3levothroid 3levothyroxine 1levoxyl 1SYNTHROID 3THYROLAR 3UNITHROID 3

Gastrointestinal System5-HT3 Receptor AntagonistsANZEMET 3 3

KYTRIL 3 3

ZOFRAN #(see page 41 for ST note) 2 3 3

ZOFRAN ODT # 2 3

Antiemetics - Anticholinergicmaldemar 1MENI-D 3TRANSDERM

SCOPOLAMINE 3trimethobenzamide 1

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LABEL NAME

Antiemetics Miscellaneoustebamide 1

Antiperistaltic Agentsdiphenoxylate/atropine 1paregoric 1

Antispasmodicsbelladonna alklaloids 1belladonna alkaloids/

opium 1belladonna alkaloids/

phenobarbital 1clidinium/chlordiazepoxide 1hyoscyamine 1hyoscyamine CR 1propanthelin 1SYMAX DUOTAB 3symax SL 3symax SR 3

Digestive Aids - MixturesCREON 2KU-ZYME 3KU-ZYME-HP 3lipram 1lipram CR 1lipram PN 1lipram UL 1PALCAPS 3pancrelipase 1PANOCAPS 3ULTRACAPS 3ULTRASE 2ULTRASE MT 2VIOKASE 2

Digestive EnzymesDIGEX 3pancreatin 1

Gallstone Solubilizing AgentsURSO 250 2URSO FORTE 2ursodiol 1

Gastrointestinal Chloride Channel ActivatorsAMITIZA 3


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LABEL NAME

GI Antiallergy AgentsGASTROCROM 3

GI Stimulantsmetoclopramide hcl 1

H-2 AntagonistsAXID 3cimetidine 1famotidine 1nizatidine 1PEPCID 3PEPCID RPD 3ranitidine 1TAGAMET 3ZANTAC (all other forms) 3ZANTAC syrup 2

Inflammatory Bowel AgentsASACOL 2 3

AZULFIDINE 3 3

AZULFIDINE ENTABS 3 3

CANASA 2 3

COLAZAL 2 3

DIPENTUM 3 3

mesalamine 1PENTASA 3 3 3

REMICADE PMEDROWASA (enema only) # 2sulfasalazine 1 3

sulfasalazine ER 1 3

sulfazine 1 3

sulfazine EC 1 3

Intestinal Acidifierslactulose 1

Intrarectal Steroidscolocort 1CORTIFOAM 3

Irritable Bowel Syndrome (IBS) AgentsLOTRONEX 3 3

ZELNORM 3

Laxative CombinationsCOLYTE 3GOLYTELY 3HALFLYTELY 3NULYTELY 3

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LABEL NAME

Laxative Combinations (continued)

OSMOPREP 3peg 3350 1trilyte 1VISICOL 3

Misc. Anti-Ulcersucralfate 1

Miscellaneous Laxativesglycolax 1KRISTALOSE 3lactulose 1MIRALAX 3polyethylene glycol 1

Proton Pump InhibitorsACIPHEX 3 3 3 3

NEXIUM 2 3 3

omeprazole 1 3 3

PREVACID 2 3 3

PREVACID SOLUTAB 2 3 3

PRILOSEC 3 3 3 3

PROTONIX 3 3 3 3

ZEGERID 3 3 3 3

Rectal Combinationshc pramoxine 1lidazone 1lidocaine/hydrocortisone 1

Rectal Steroidshydrocortisone acetate 1proctocream hc 1proctosert 1proctosol 1proctosol hc 1

Substance P/Neurokinin 1 (NK1) Receptor AntagonistEMEND 2 3

Ulcer Drugs - Prostaglandinsmisoprostol 1

Ulcer Therapy CombinationsHELIDAC 3 3

PREVPAC 2 3

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LABEL NAME

Genitourinary SystemCombination Urinary Anti-infectivesURELLE 3urimar T 1urin D/S 1uriseptic 1uro blue 1urogesic blue 1UTA 3

Cystinosis AgentsCYSTAGON 3

Interstitial Cystitis AgentsDMSO 1ELMIRON 3RIMSO 3

Phosphate BindersFOSRENOL 2PHOSLO 2RENAGEL 2

Prostatic Hypertrophy AgentsAVODART 3 3

finasteride 1 3

FLOMAX 2 3

PROSCAR 3 3

UROXATRAL 2 3

Urinary Analgesicsphenazopyridine hcl 1

Urinary Anti-infectivesMACROBID 3methenamine hippurate 1methenamine mandelate 1MONUROL 3nitrofurantoin 1nitrofurantoin monohydrate

macrocrystal 1UREX 3

Urinary Antispasmodicsbethanechol 1DETROL 3 3

DETROL LA 3 3

DITROPAN 3DITROPAN XL 3 3

ENABLEX 2

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LABEL NAME

Urinary Antispasmodics (continued)

flavoxate 1hyoscyamine 1hyospaz 1oxybutynin 1OXYTROL 2SANCTURA 3 3

URECHOLINE 3URISPAS 3VESICARE 2

Vaginal Anti-infectivesCLEOCIN VAGINAL 3clindamax 1CLINDESSE 3GYNAZOLE-1 3METROGEL VAGINAL 3nystatin vaginal 1TERAZOL 3terconazole 1tioconazole 1vandazole 1ZAZOLE 3

Vaginal EstrogensESTRACE VAGINAL 3ESTRING 3FEMRING 3PREMARIN VAGINAL 3VAGIFEM 3

Vaginal ProgestinsCRINONE 3PROCHIEVE 3PROGESTERONE VAGINAL 3

Immunological AgentsImmunosuppressive AgentsAZASAN 3azathioprine 1CELLCEPT 2cyclosporine 1cyclosporine modified 1gengraf 1IMURAN 3MYFORTIC 3NEORAL 3


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LABEL NAME

Immunosuppressive Agents (continued)

PROGRAF 2RAPAMUNE 3SANDIMMUNE 3

Infections and Infestations

AmebicidesYODOXIN 3

Aminoglycosidesneomycin 1paromomycin 1TOBI 3

Ampicillinsamoxicillin 1AMOXIL 3ampicillin 1DISPERMOX 3principen 1trimox 1

Anthelminticmebendazole 1

Anti TB Combinationsisonarif 1RIFAMATE 3RIFATER 3

AntifungalsANCOBON 3BIO-STATIN 3GRIFULVIN V 3GRIS-PEG 3LAMISIL # 2 3

nystatin 1

AntimalarialARALEN 3 3

chloroquine 1 3

DARAPRIM 3 3

hydroxychloroquine sulfate 1 3

LARIAM 3 3

mefloquine 1 3

primaquine 1quinerva 1quinine sulfate 1

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LABEL NAME

Antimalarial CombinationsFANSIDAR 3 3

MALARONE 3 3

Antimycobacterial Agentsethambutol 1isoniazid 1MYAMBUTOL 2pyrazinamide 1rifampin 1

Antiprotozoal AgentsALINIA 3MEPRON 2

AntiretroviralsAGENERASE 3APTIVUS 3ATRIPLA 3COMBIVIR 2CRIXIVAN 2didanosine delayed relase 1EMTRIVA 2EPIVIR 2EPIVIR HBV 2EPZICOM 3FUZEON 3HIVID 3INVIRASE 2KALETRA 2LEXIVA 2NORVIR 2PREZISTA 3RESCRIPTOR 3RETROVIR 3REYATAZ 2SUSTIVA 2TRIZIVIR 3TRUVADA 2VIDEX 2VIDEX EC 3VIRACEPT 2VIRAMUNE 2VIREAD 2ZERIT 2ZIAGEN # 2zidovudine 1

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LABEL NAME

Azithromycinazithromycin 1ZITHROMAX 3ZMAX 3

Cephalosporins - 1st Generationcefadroxil 1cephalexin 1DURICEF 3PANIXINE 3

Cephalosporins - 2nd Generationcefaclor 1cefaclor ER 1cefprozil 1CEFTIN 3cefuroxime 1CEFZIL 3RANICLOR 3

Cephalosporins - 3rd GenerationCEDAX 3cefpodoxime 1OMNICEF 2SPECTRACEF 3SUPRAX 3VANTIN 3

ClarithromycinBIAXIN 3BIAXIN XL # 2clarithromycin 1

CMV Agentsganciclovir 1VALCYTE 2

DirithromycinDYNABAC 3

Erythromycinse.e.s. 1erythrocin 1erythromycin 1erythromycin delayed

release particles 1erythromycin ethylsuccinate 1PCE 3

Extended Spectrum PenicillinsGEOCILLIN 3

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LABEL NAME

FluoroquinolonesAVELOX 2 3

AVELOX ABC 2 3

CIPRO 3 3

CIPRO XR 3 3

ciprofloxacin 1 3

FACTIVE 3 3

LEVAQUIN 3 3

NOROXIN 3 3

ofloxacin 1 3

PROQUIN XR 3 3

TEQUIN 3 3

Hepatitis AgentsBARACLUDE 3 3

COPEGUS 3HEPSERA 2INFERGEN 3 3

PEGASYS 2 3

PEG-INTRON 2 3

REBETOL 3ribasphere 1ribavirin 1

Herpes Agentsacyclovir 1FAMVIR 3VALTREX 2ZOVIRAX 3

Imidazole-Related AntifungalsDIFLUCAN

(all other strengths) 3 3

DIFLUCAN 150mg 3 3

fluconazole (all other strengths) 1 3

fluconazole 150mg 1 3

itraconazole 1 3

ketoconazole 1SPORANOX 3 3

VFEND 3 3

Influenza AgentsFLUMADINE 3RELENZA 3 3

rimantadine 1TAMIFLU 3 3


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LABEL NAME

KetolidesKETEK 3

Leprostaticsdapsone 1

Lincosamidesclindamycin 1

Misc. Anti-infectivesLORABID 2metronidazole 1metronidazole SR 1NEBUPENT 2TINDAMAX 3trimethoprim 1XIFAXAN 3 3 3

Natural Penicillinspenicillin VK 1veetids 1

OxazolidinonesZYVOX 2 3

Penicillin Combinationsamoxicillin/K clavulanate 1AUGMENTIN 3AUGMENTIN ES 3AUGMENTIN XR 3

Penicillinase-resistantdicloxacillin sodium 1

Respiratory Syncytial Virus (RSV) AgentsVIRAZOLE 3

Sulfonamidessulfadiazine 1sulfisoxazole 1

TetracyclinesADOXA 3 3

DECLOMYCIN 3 3

demeclocycline hcl 1 3

DORYX 3 3

doxy-caps 1 3

doxycycline hyclate 1 3

doxycycline monohydrate 1 3

DYNACIN 3 3

MINOCIN 3 3

minocycline 1 3

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LABEL NAME

Tetracyclines (continued)

MONODOX 3 3

myrac 1 3

PERIOSTAT 3 3

SOLODYN 3 3

SUMYCIN 3 3

tetracycline 1 3

VIBRAMYCIN 3 3

VIBRATAB 3 3

Musculoskeletal System

Antimyasthenic AgentsMESTINON 2pyridostigmine 1

Antirheumatic AntimetaboliteRHEUMATREX 3

Anti-TNF-alpha - Monoclonoal AntibodiesHUMIRA PMED

Calcium RegulatorsACTONEL 2 3

ACTONEL with CALCIUM 2 3

BONIVA 3 3

DIDRONEL 3FORTEO 2fortical 1FOSAMAX 2 3

FOSAMAX PLUS D 2 3

MIACALCIN NASAL 3SKELID 3

Central Muscle Relaxantsbaclofen 1carisoprodol 1chlorzoxazone 1cyclobenzaprine hcl 1methocarbamol 1orphenadrine ER 1PRAZOLAMINE 3SKELAXIN # 2tizanidine 1ZANAFLEX 3

Combination Gout Drugsprobenecid/colchicine 1

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LABEL NAME

Direct Muscle RelaxantsDANTRIUM 3

Gold CompoundsRIDAURA 3

Goutallopurinol 1colchicine 1

Hormone Receptor ModulatorsEVISTA 2

Muscle Relaxant Combinationscarisoprodol/aspirin 1carisoprodol/aspirin/

codeine 1orphenadrine cpd 1orphenadrine/aspirin/

caffeine 1orphengesic 1orphengesic forte 1

NSAID’sARTHROTEC 3CELEBREX 3 3 3

DAYPRO 3diclofenac 1diclofenac potassium 1diclofenac sodium XR 3etodolac 1etodolac ER 3fenoprofen 1flurbiprofen 1ibuprofen 1indomethacin 1indomethacin ER 1ketoprofen 1ketoprofen ER 3ketorolac 1 3

LODINE XL 3meclofenamate sodium 1meloxicam 1MOBIC 3 3

nabumetone 3NAPRELAN 3 3

naproxen 1ORUVAIL ER 3oxaprozin 3

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LABEL NAME

NSAID’s (continued)

piroxicam 1PONSTEL 3PREVACID NAPRAPAC 3 3

RELAFEN 3sulindac 1THERAPROXEN 3TOLECTIN 3tolmetin sodium 3VOLTAREN 3VOLTAREN XR 3

Pyrimidine Synthesis InhibitorsARAVA 3 3

leflunomide 1

Salicylatesamigesic 1aspirin CR 1aspirin CR EC 1choline/magnesium

salicylates 1diflunisal 1mst 600 1salflex 1salsalate 1tricosal 1zero-order 1

Soluble Tumor Necrosis Factor Receptor AgentsENBREL PMED

Ophthalmic AgentsAdrenergic AgentsALPHAGAN P 2brimonidine 1dipivefrin 1IOPIDINE 3PROPINE 3

Beta-blockers - Ophthalmicbetaxolol 1BETIMOL 3BETOPTIC-S 2carteolol 1COSOPT 2ISTALOL 3


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LABEL NAME

Beta-blockers - Ophthalmic (continued)

levobunolol 1metipranolol 3OPTIPRANOLOL 3timolol 1timolol maleate ophth 1

Mioticscarboptic 1ISO CARBACHOL 3ISOPTO CARPINE 3PHOSPHOLINE 3pilocar 1pilocarpine 1PILOPINE HS 3piloptic 1REV-EYES 3

Misc. OphthalmicsACULAR 3ACULAR LS 3ACULAR PF 3akorn balanc 1ALAMAST 3ALOCRIL 3ALOMIDE 2AZOPT 2bal salt 1cromolyn sodium ophth 1ELESTAT 3EMADINE 3flurbiprofen 1ketotifen fumarate 1NEVANAC 3OPTIVAR 2PATANOL 2TRUSOPT 2VOLTAREN 2XIBROM 3ZADITOR # 2

Ophthalmic Anti-infectivesbacitracin 1bacitracin/neomycin/

polymyxin 1bacitracin/polymyxin 1ciprofloxacin 1

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LABEL NAME

Ophthalmic Anti-infectives (continued)

erythromycin 1gentamicin 1neomycin/bacitracin/

polymyxin 1neomycin/polymyxin/

gramicidin 1ofloxacin 1polymyxin B/trimethoprim 1QUIXIN 3sulfacetamide sodium 1tobramycin 1trifluridine 1triple antibiotic 1VIGAMOX 2ZYMAR 2

Ophthalmic ImmunomodulatorsRESTASIS 3

Ophthalmic Steroidsak-pred 1ALREX 2bacitracin/polymyxin/

neomycin/hydrocortisone 1BLEPHAMIDE S.O.P. 3dexacidin 1dexamethasone phosphate 1dexamethasone/

neomycin/polymyxin 1dexasol 1dexasporin 1fluorometholone 1fluor-op 1FML-S 3HMS 3LOTEMAX 2neomycin/polymyxin/

bacitracin/hydrocortisone 1neomycin/polymyxin/

dexamethasone 1neomycin/polymyxin/

hydrocortisone 1poly-dex 1POLY-PRED 3PRED-G 3PRED-G S.O.P 3prednisolone 1

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LABEL NAME

Ophthalmic Steroids (continued)

sulfacetamide sodium/prednisolone 1

TOBRADEX 3VEXOL 3ZYLET 3

Prostaglandins - OphthalmicLUMIGAN 2TRAVATAN 2XALATAN 3

Otic AgentsOtic Anti-infectivesFLOXIN OTIC 2

Otic Combinationsantipyrine/benzocaine 1CIPRO HC 3CIPRODEX 2COLY-MYCIN-S 3cortomycin 1neomycin/polymyxin/

hydrocortisone 1

Respiratory Tract AgentsAntiasthmatic- Monocolonal AntibodiesXOLAIR 3

Antiasthmatics - AnticholinergicsATROVENT 3ATROVENT HFA 3ipratropium 1SPIRIVA 2

Antihistamines - Alkylamineschlorpheniramine ER 1dexchlorpheniramine 1

Antihistamines - Non-SedatingALLEGRA 3 3 3

CLARINEX 3 3 3

CLARINEX REDITAB 3 3 3

fexofenadine 3 3 3

ZYRTEC 3 3 3

Antihistamines - Phenothiazinesphenadoz 1promethazine 1promethegan 1

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LABEL NAME

Antihistamines - Piperidinescyproheptadine 1

Anti-Inflammatory Agentscromolyn sodium nebulizer 1INTAL 3TILADE 3

Cough/Cold/Allergy CombinationsALLEGRA D 3 3 3

CLARINEX D 3 3 3

SEMPREX D 3 3 3

TRINALIN 3TUSSIONEX 2ZYRTEC D 3 3 3

Leukotriene ModulatorsACCOLATE 3 3

SINGULAIR 2 3

ZYFLO 3 3

Mucolyticsacetylcyst 1MUCOMYST 3

Nasal AntiallergyASTELIN NASAL 2

Nasal AnticholinergicsATROVENT NASAL 3ipratropium 1

Nasal Anti-infectivesBACTROBAN NASAL 3

Nasal SteroidsBECONASE AQ 3FLONASE 3flunisolide 1fluticasone propionate

nasal 1NASACORT AQ 3 3

NASAREL 3NASONEX 2RHINOCORT AQ 3 3

Steroid InhalantsAEROBID 3AEROBID-M 3ASMANEX 2AZMACORT 3


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LABEL NAME

Steroid Inhalants (continued)

FLOVENT HFA 2FLOVENT ROTADISC 2PULMICORT RESPULES 2PULMICORT TURBUHALER 3QVAR 3

SympathomimeticsACCUNEB 3ADVAIR DISKUS 2ADVAIR HFA 2airet 1albuterol 1albuterol HFA 1ALUPENT 3COMBIVENT 2DUONEB 2FORADIL 2 3

isoetharine 1MAXAIR AUTOHALER 2metaproterenol nebulizer 3metaproterenol tab/syrup 3micronefrin 1PROVENTIL HFA # 2SEREVENT DISKUS 2 3

terbutaline 1VENTOLIN HFA 3vospire ER 1XOPENEX 3 3

XOPENEX HFA 3

Throat Products- Misc.EVOXAC 2pilocarpine 1SALAGEN 3

Xanthinesaminophylline 1BRONCAP 3SENOPHYLLINE 3THEO-24 3theocap 1theochron 1theophylline ER 1UNIPHYL 3

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PRECERTIFICATION DRUG(S)THERAPEUTIC CLASS


Acne Products ACCUTANE RETIN-A MICRO gel PR > 36 yr oldamnesteem RETIN-A PR > 36 yr oldAVITA PR > 36 yr old sotretclaravis tretinoin PR > 36 yr oldisotretinoin tretinoin-x cream kit PR > 36 yr old

Agents for Gaucher Disease ZAVESCA

Anti-Cataplectic Agents XYREM

Antifungals - Topical PENLAC NAIL LACQUER

Antihistamines - Non-Sedating ALLEGRA CLARINEX REDITAB SEMPREX DALLEGRA D CLARINEX D ZYRTECCLARINEX fexofenadine ZYRTEC D

Antimalarial ARALEN hydroxychloroquine PLAQUENIL(covered for active treatment only – chloroquine LARIAMnot covered for prophylactic treatment) DARAPRIM MALARONE

FANSIDAR mefloquine

Antineoplastics Misc. INTRON-A ROFERON-A

Attention-Deficit/Hyperactivity PROVIGILDisorder Agents

Blood Clotting Factor VIIa NOVOSEVEN

Blood Clotting Factor VIII ADVATE HUMATE-P KOGENATE FSALPHANATE HYATE:C MONARC-MHELIXATE KOATE-HP MONOCLATE-PHELIXATE FS KOATE-DVI RECOMBINATEHEMOFIL M KOGENATE REFACTO

Blood Clotting Factor IX ALPHANINE SD KONYNE 80 PROFILNINE SDBEBULIN VH MONONINE PROPLEX TBENEFIX PROFILNINE

Fluoroquinolones PR < 10 yr old AVELOX FACTIVE ofloxacin CIPRO FLOXIN PROQUIN XR CIPRO XR LEVAQUIN TEQUINciprofloxacin NOROXIN

Growth Hormone GENOTROPIN NUTROPIN SAIZENHUMATROPE NUTROPIN AQ SEROSTIMNORDITROPIN PROTROPIN TEV-TROPIN

Hepatitis Agents INFERGEN PEGASYS PEG-INTRON

Imidazole-Related Antifungals DIFLUCAN itraconazole SPORANOXfluconazole LAMISIL tab VFEND

Immune Globulin IV IMMUNE GLOBULIN (IVIG)

Insulin Like Growth Factors INCRELEX

Irritable Bowel Syndrome (IBS) LOTRONEXAgents

Metabolic Modifiers ORFADIN

Misc. Anti-Infectives XIFAXAN

Precertification List

Precertification List

PRECERTIFICATION DRUG(S)THERAPEUTIC CLASS

Oxazolidinones ZYVOX

Prostatic Hypertrophy Agents AVODART finasteride PROSCAR(PR for females only) CASODEX FLOMAX UROXATRAL

NSAID's CELEBREX PREVACID NAPRAPAC

Pulmonary Hypertension TRACLEER VENTAVISREVATIO

Proton Pump Inhibitors ACIPHEX PREVACID PROTONIXNEXIUM PRILOSEC ZEGERIDomeprazole

Respiratory Syncytial Virus SYNAGIS

Rosacea Agents ORACEA

Tetracyclines PR < 8 yr old ADOXA MINOCIN PERIOSTAT DECLOMYCIN minocycline SOLODYNdemeclocycline MONODOX SUMYCIN DORYX myrac tetracycline doxycycline ORACEA VIBRAMYCIN DYNACIN oxytetracycline VIBRATAB

Typhoid VIVOTIF BERNIA EC


QUANTITY LIMIT DRUGTHERAPEUTIC CLASS QUANTITY LIMIT(S)


5-HT3 Receptor ANZEMET Total quantity any strength = Antagonists 5 tablets/30 day supply

KYTRIL 1 mg = 10 tablets/30 day supplyLiquid = quantity > 5 bottles/

30 day supply

ZOFRAN 4 mg and 8 mg = 12 tablets/ZOFRAN ODT 30 day supply

24 mg = 5 tablets/30 day supplyLiquid = 1 bottle (50 ml)/30 day supply

ACE Inhibitors ACCUPRIL quinapril 5 mg, 10 mg and 20 mg = 2 tablets/day

ACEON 2 mg and 4 mg = 2 tablets/day

ALTACE 1.25 mg, 2.5 mg and 5 mg = 2 capsules/day

CAPOTEN captopril 12.5 mg, 25 mg and 50 mg = 3 tablets/day

LOTENSIN benazepril 5 mg, 10 mg, and 20 mg =2 tablets/day

MAVIK 1 mg and 2 mg = 2 tablets/day

MONOPRIL fosinopril 10 mg and 20 mg = 2 tablets/day

PRINIVIL ZESTRIL 2.5 mg, 5 mg, 10 mg, 20 mg and lisinopril 30 mg = 2 tablets/day

UNIVASC 7.5 mg = 2 tablets/day

VASOTEC enalapril 2.5 mg, 5 mg and 10 mg = 2 tablets/day

Acne Products ACCUTANE isotretinoin all strengths = 30 day supplyamnesteem sotretclaravis

Amphetamines ADDERALL 5 mg, 7.5 mg, 10 mg, 12.5 mg, amphetamine/dextro- 15 mg and 30 mg = 2 tablets/day

amphetamine 20 mg = 3 tablets/day

ADDERALL XR all strengths = 2 capsules/day

DESOXYN all strengths = 4 tablets/day

DEXEDRINE dextrostat all strengths = 4 tablets/daydextroamphetamine

DEXEDRINE CR all strengths = 3 capsules/daydextroamphetamine CR

Antianginals- Other RANEXA 500 mg = 4 tablets/day

Angiotensin II Receptor ATACAND 4 mg, 8 mg and 16 mg = Antagonists 2 tablets/day

ATACAND HCT 16-12.5 mg = 2 tablets/day

AVALIDE 150-12.5 mg = 1 tablet/day

AVAPRO 75 mg and 150 mg = 1 tablet/day

BENICAR 5 mg and 20 mg = 1 tablet/day

BENICAR HCT 20-12.5 mg = 1 tablet/day

COZAAR 25 mg and 50 mg = 2 tablets/day

DIOVAN 40 mg, 80 mg and 160 mg = 2 capsules or tablets/day

Quantity Limit List

Quantity Limit List



Angiotensin II Receptor DIOVAN HCT 80-12.5 mg, 160-12.5 mg, and Antagonists 160-25 mg = 1 tablet/day

(continued) HYZAAR 50-12.5 mg = 1 tablet/day

MICARDIS 20 mg and 40 mg = 1 tablet/day

MICARDIS HCT 40-12.5 mg = 1 tablet/day

TEVETEN 400 mg = 2 tablets/day

Antidiarrheals XIFAXAN 9 capsules = 30 day/supply

Antiemetics- Misc. CESAMET 20 capsules = 30 day/supply

Antihistamines - ALLEGRA 30 mg and 60 mg = 2 tablets/dayNon-Sedating fexofenadine 180 mg = 1 tablet/day

ALLEGRA D 12 hour = 2 tablets/day24 hour = 1 tablet/day

CLARINEX 5 mg = 1 tablet/daySyrup = 10 ml/day

Antihistamines - CLARINEX REDITAB 2.5 mg and 5 mg = 1 tablet/day

Non-Sedating CLARINEX D 12 hour = 2 tablets/day(continued) 24 hour = 1 tablet/day

SEMPREX D 4 capsules/day

ZYRTEC 5 mg and 10 mg = 1 tablet or chewable/day

5 mg/ 5 ml syrup = 10 ml/day

ZYRTEC D 2 tablets/day

Antihyperlipidemic ADVICOR all strengths = 2 tablets/day

Combinations VYTORIN all strengths = 1 tablet/day

Benzisoxazoles RISPERDAL 4 mg = 4 tablets/day RISPERDAL M all other strengths = 2 tablets/day

Calcium Blockers ADALAT CC 30 mg = 1 tablet/day afeditab 60 mg = 2 tablets/daynifediac CCnifedical XLnifedipine CR/ER/SRPROCARDIA XL

CALAN SR VERELAN SR 120 mg = 1 capsule or tablet/dayISOPTIN SR 180 mg = 2 capsules or tablets/dayverapamil ER/SR

CARDIZEM CD taztia XT 120 mg = 1 capsule/dayCARDIZEM LA TIAZAC 180 mg = 3 capsules/daycartia XTDILACOR XRdiltia XTdiltiazem CD/CR/ER/XTdiltiazem extended release

beads SR

COVERA-HS 180 mg = 2 tablets/day

felodipine PLENDIL 2.5 mg and 5 mg = 1 tablet/day

NORVASC 2.5 mg and 5 mg = 1 tablet/day



Calcium Blockers SULAR 10 mg and 20 mg = 1 tablet/day(continued) 30 mg = 2 tablets /day

VERELAN PM 100 mg = 1 capsule/day 200 mg = 2 capsules/day

Calcium Regulators ACTONEL 35 mg = 4 tablets/28 day supply ACTONEL with CALCIUM

BONIVA 2.5 mg = 1 tablet/day150 mg = 3 tablets/ 90 day supply

FOSAMAX 35 mg = 4 tablets/28 day supply70 mg = 4 tablets/28 day supply70 mg/75 ml solution = 4 doses

(75ml each)/28 day supply increments

FOSAMAX PLUS D 4 tablet/28 day supply

Dibenzapines clozapine FAZACLO 12.5 mg = 1 tablet/dayCLOZARIL 25 mg and 50 mg = 3 tablets/day

100 mg = 9 tablets/day

SEROQUEL 25 mg = 6 tablets/day50 mg and 100 mg = 3 tablets/day 200 mg = 4 tablets/day 300 mg and 400 mg = 2 tablets/day

SYMBYAX all strengths = 1 tablet/day

ZYPREXA 2.5mg = 2 tablets/day ZYPREXA ZYDIS all other strengths = 1 tablet/day

Estrogens ALORA ESTRADERM all strengths = 8 patches/28 day supplyCOMBIPATCH VIVELLEESCLIM VIVELLE DOT

CLIMARA MENOSTAR all strengths = 4 patches/28 day supplyCLIMARA PRO WEEKLYestradiol patch

Hepatitis Agents BARACLUDE all strengths = 1 tablet/day, soln = 20ml/day

HMG CoA Reductase ALTOPREV all strengths = 1 tablet/day

Inhibitors CADUET all strengths = 1 tablet/day

CRESTOR all strengths = 1 tablet/day

LESCOL all strengths = 2 tablets/day

LESCOL XL 80 mg = 1 tablet /day

LIPITOR all strengths = 1 tablet/day

MEVACOR lovastatin all strengths = 2 tablets/day

PRAVACHOL pravastatin all strengths = 1 tablet/day

simvastatin ZOCOR all strengths = 1 tablet/day

Imidazole-Related DIFLUCAN fluconazole 150 mg only = 1 dose/30 day supplyAntifungals

Influenza Agents RELENZA 2 treatments (units)/year

TAMIFLU 2 treatments (20 capsules)/year

Insulin BYETTA Limit = 1 pen/30 day supply

Quantity Limit List



Intestinal Cholesterol ZETIA 10 mg = 1 tablet/day Absorption Inhibitors

Inflammatory ASACOL 400 mg = 12 tablets/day

Bowel Agents AZULFIDINE 500 mg = 12 tablets/dayAZULFIDINE ENTABSsulfasalazinesulfazinesulfazine ECsulfasalazine EC

CANASA 500 mg = 3 suppositories/day1000 mg = 2 suppositories/day

COLAZAL 750 mg = 9 capsules/day

DIPENTUM 250 mg = 12 capsules/day

PENTASA 250 mg = 20 capsules/day500 mg = 10 capsules/day

Leukotriene Modulators ACCOLATE 10 mg and 20 mg = 2 tablets/day

SINGULAIR 4 mg granules = 1 granule pack/day10 mg = 1 tablet/day4 mg and 5 mg chewable = 1 tablet/day

ZYFLO Limit = 4 tablets/day

Migraine Products MIGRANAL 2 boxes (12 doses)/30 day supply

Misc. Antidepressants bupropion WELLBUTRIN 75 mg = 6 tablets/daybudeprion 100 mg = 6 tablets/day

bupropion ER/SR 100 mg, 150 mg and 200 mg = budeprion ER/SR 2 tablets/dayWELLBUTRIN SR

maprotiline 25 mg = 1 tablet/day50 mg = 2 tablets/day75 mg = 3 tablets/day

WELLBUTRIN XL All strengths = 1 tablet/day

Misc. Antipsychotics GEODON all strengths = 2 capsules/day

Misc. Anticonvulsants gabapentin NEURONTIN all strengths = 180 tablets/30 day supply gabarone

LYRICA all strengths = 3 capsules/day

Narcotic Agonists ACTIQ all strengths = 6 lollipops/day

butorphanol nasal STADOL NS 2 vials/30 day supply

COMBUNOX Limit = 4 tablets/day

DURAGESIC 20 patches/30 day supply fentanyl patch

ketorolac 20 tablets/30 day supply

OPANA ER Limit = 4 tablets/day

oxycodone SR Quantities up to a total dosage of OXYCONTIN CR mg/day or 120 tablets/30 day supply

Non-Barbiturate AMBIEN 5 mg = 2 tablets/dayHypnotics 10 mg = 1 tablet/day

AMBIEN CR 6.25 mg and 12.5 mg = 1 tablet/day



Non-Barbiturate LUNESTA all strengths = 1 tablet/day

Hypnotics ROZEREM 8 mg = 1 tablet/day

(continued) SONATA 5 mg = 4 tablets/day10 mg = 2 tablets/day

NSAID’s CELEBREX 100 mg = 60 capsules/30 day supply200 mg = 30 capsules/30 day supply 400 mg = 60 capsules/30 day supply

Oral Contraceptives all (except SEASONALE) Limit = 1.4 tablets/day or 28 day supply

Proton Pump Inhibitors ACIPHEX PRILOSEC all strengths = 1 tablet or capsule/dayNEXIUM PROTONIX omeprazole ZEGERIDPREVACIDPREVACID SOLUTAB

ZEGERID packets 20 mg and 40 mg packets = 1 packet/day

Quinolinone Derivatives ABILIFY all strengths = 1 tablet/day Solution = 30 ml/day

Rosacea Agents ORACEA 40 mg = 1 capsule/day

Selective Serotonin CELEXA citalopram 10 mg, 20 mg and 40 mg = 1 tablet/day

Reuptake Inhibitors fluoxetine RAPIFLUX 10 mg = 1 tablet or capsule/dayPROZAC 20 mg = 4 tablets or capsules/day

40 mg = 2 tablets or capsules/dayLiquid 20 mg/5 ml = 10 ml/dayWeekly = 4 tablets/28 day supply

fluvoxamine 25 mg and 50 mg = 1 tablet/day100 mg = 3 tablets/day

LEXAPRO 5 mg, 10 mg and 20 mg = 1 tablet/day5 mg/5 ml solution = 20 ml/day

paroxetine PEXEVA 10 mg and 20 mg = 1 tablet/day

PAXIL 30 mg and 40 mg = 2 tablets/daySuspension 10 mg/5 ml = 30 ml/day

SARAFEM 10 mg = 1 tablet/day20 mg = 4 tablets/day

ZOLOFT 25 mg = 1 tablet/day50 mg = 1 1/2 tablets/day100 mg = 2 tablets/dayLiquid = 10 ml/day

Serotonin-Norepinephrine CYMBALTA 20 mg and 30 mg = 2 capsules/dayReuptake Inhibitors 60 mg = 1 capsule/day

EFFEXOR venlafaxine 25 mg and 100 mg = 3 tablets/day37.5 mg = 4 tablets/day50 mg = 6 tablets/day75 mg = 5 tablets/day

EFFEXOR XR 37.5 mg and 75 mg = 1 capsule/day 150 mg = 2 capsules/day

Serotonin Agonists AMERGE Total quantity any strength = 9 tablets/30 day supply

Quantity Limit List



Serotonin Agonists AXERT all strengths = 6 tablets/30 day supply (continued) FROVA 2.5 mg = 9 tablets/30 day supply

IMITREX Nasal = 6 sprays/30 day supply Injection = 4 kits/30 days or 10 vials/

30 day supply Tablets (all strengths) = 18 tablets/

30 day supply MAXALT All forms and strengths = 12 tablets/ MAXALT MLT 30 day supplyRELPAX 20 mg = 12 tablets/30 day supply

40 mg = 6 tablets/30 day supplyZOMIG 5 mg = 6 tablets/30 day supplyZOMIG ZMT 2.5 mg = 12 tablets/30 day supply

Nasal = 6 sprays/30 day supplyStimulants- Misc. CONCERTA 18 mg = 3 tablets/day;

27 mg, 36 mg and 54 mg = 2 tablets/day

DAYTRANA all strengths = 1 patch/dayFOCALIN 2.5 mg, 5 mg and 10mg =2 tablets/dayFOCALIN XR all strengths = 1 capsule/dayMETADATE CD 10 mg, 40mg, 50 mg and 60 mg =

1 capsule/day 20 mg = 3 capsules/day 30 mg = 2 capsules/day

METADATE ER RITALIN 5 mg, 10mg and 20 mg = 3 tablets/daymethylin RITALIN SRmethylin ERmethylphenidatemethylphenidate CR/ER/SRMETHYLIN chew/soln 2.5 mg, 5 mg and 10 mg = 6 tablets/day

5 mg/ 5 ml solution = 60 ml/day10 mg/ 5 ml solution = 30 ml/day

PROVIGIL 100 mg and 200 mg = 2 tablets/dayRITALIN LA 10 mg, 20 mg, 30 mg and 40 mg =

2 capsules/daySTRATTERA 10 mg, 18 mg, 25 mg, 40 mg, and

60 mg = 2 capsules/day80 mg and 100 mg = 1 capsule/day

Substance P/Neurokinin 1 EMEND 40 mg = 5 tablets/30 day supply(NK1) Receptor 80 mg and 125 mg = 5 tablets/Antagonist 30 day supply

80 mg/125 mg combo pack = 2 packages (6 tablets)/30 day supply

Ulcer Therapy HELIDAC PREVPAC 1 pack/day for 14 daysCombinations

5-HT3 Receptor Antagonists ZOFRAN ondansetron(step-edit will not be implemented until sometime after generic equivalent becomes available)

Acne Products ACCUTANE isotretinoin, claravis, sotretACE Inhibitors ACCUPRIL quinapril

ACCURETIC quinapril/hctzAngiotensin II Receptor ATACAND AVAPRO COZAAR and DIOVAN

Antagonist ATACAND HCT AVALIDE DIOVAN HCT and HYZAARAntianginals- Other RANEXA nitrates and beta blockers

and NORVASCAnticonvulsant LYRICA gabapentin or CYMBALTAAntipsoriatics-Combination TACLONEX TAZORAC and betamethasoneBeta-2 Agonist FORADIL SEREVENT Any one of:

ASMANEX, FLOVENT HFA, PULMICORT

XOPENEX solution/concentrate albuterol nebules or concentrateCalcium Blockers ADALAT PROCARDIA nifedipine

ADALAT CC PROCARDIA XL nifedipine extended releaseCALAN ISOPTIN verapamilCALAN SR ISOPTIN SR verapamil extended releaseCOVERA-HS VERELANCARDENE nicardipineCARDIZEM DILACOR diltiazemCARDIZEM CD DILACOR XR diltiazem extended releaseCARDIZEM SR TIAZAC

HMG CoA Reductase ALTOPREV MEVACOR lovastatinInhibitors CADUET NORVASC and simvastatin or

CRESTOR or VYTORINCRESTOR 5 mg only simvastatinVYTORIN 10 mg/10 mg onlyZOCORLIPITOR pravastatin or simvastatin and

CRESTOR or VYTORIN PRAVACHOL pravastatin

Immunomodulating ELIDEL PROTOPIC Any topical corticosteroidAgents - Topical

Insulin NOVOLIN 70/30 RELION 70/30 HUMULIN 70/30 NOVOLIN N RELION N HUMULIN N NOVOLIN R RELION R HUMULIN R

Misc. Anticonvulsants NEURONTIN gabapentinMisc. Antidepressants/ CELEXA LUVOX Any one of:

Selective Serotonin CYMBALTA PAXIL bupropion, bupropion SR, Reuptake Inhibitors/ DESYREL PAXIL CR citalopram, fluvoxamine, Serotonin-Norepinephrine EFFEXOR PEXEVA fluoxetine, paroxetine, Reuptake Inhibitors EFFEXOR XR PROZAC mirtazapine, sertraline,

LEXAPRO trazodone, venlafaxine

STEP-THERAPY DRUGTHERAPEUTIC CLASSREQUIRED PREREQUISITEDRUG(S)


Step-Therapy List

Step-Therapy List

Misc. Antidepressants/ PROZAC WEEKLY Any one of:Selective Serotonin REMERON bupropion, bupropion SR, Reuptake Inhibitors/ REMERON SOLUTAB citalopram, fluvoxamine, Serotonin-Norepinephrine WELLBUTRIN fluoxetine, paroxetine, Reuptake Inhibitors WELLBUTRIN SR mirtazapine, sertraline, (continued) WELLBUTRIN XL trazodone, venlafaxine

ZOLOFTNarcotic Combinations ANEXSIA NORCO hydrocodone/acetaminophen

LORCET VICODIN LORCET HD VICODIN ESLORCET PLUS vicodin HPLORTAB XODOLLORTAB ELIXIR ZYDONEMAXIDONECOMBUNOX Any oxycodone combinationsCAPITAL/CODEINE codeine/acetaminophenTYLENOL #3VOPACDARVOCET-N TRYCET propoxyphene-N/acetaminophenDURAGESIC fentanyl patchFIORICET/CODEINE butalbital/acetaminophen/caffeine/

codeineFIORINAL/CODEINE butalbital/aspirin/caffeine/codeineOXYCONTIN oxycodone SRLYNOX ROXICET oxycodone/acetaminophenPERCOCET TYLOXPERCODAN oxycodone/aspirinTALACEN pentazocine/acetaminophenULTRAM ULTRAM ER tramadolVICOPROFEN REPREXAIN hydrocodone/ibuprofen

Nasal Steroids NASACORT AQ fluticasone and NASONEXRHINOCORT AQ

Non-Barbiturate Hypnotics AMBIEN ROZEREM zolpidem(step-edit will not be AMBIEN CR SONATAimplemented until sometime LUNESTAafter generic equivalent becomes available)

NSAID's MOBIC NAPRELAN Use of two (2) preferred generic NSAID’s

Posterior Pituitary DDAVP desmopressinProton Pump Inhibitors ACIPHEX PROTONIX NEXIUM and PREVACID

PRILOSEC ZEGERIDStimulants- Misc. CONCERTA RITALIN LA Any one of:

DESOXYN RITALIN SR amphetamine/dextroamphetamine,FOCALIN STRATTERA methylphenidate, FOCALIN XR methylphenidate SR,METHYLIN chew/soln ADDERALL XR, METADATE CD

Urinary Antispasmodics DETROL DITROPAN XL Any one of: DETROL LA SANCTURA ENABLEX, VESICARE, OXYTROL

STEP-THERAPY DRUGTHERAPEUTIC CLASSREQUIRED PREREQUISITEDRUG(S)



#8-MOP . . . . . . . . . . . . . . . . . . 19

AABILIFY . . . . . . . . . . . . . . 17, 39ABILIFY DISC . . . . . . . . . . . . . 17ACCOLATE. . . . . . . . . . . . 32, 38ACCUNEB . . . . . . . . . . . . . . . 32ACCUPRIL . . . . . . . . . 10, 35, 41ACCURETIC . . . . . . . . . . 11, 41ACCUTANE . . . . . 18, 33, 35, 41acebutolol . . . . . . . . . . . . . . . 11ACEON . . . . . . . . . . . . . . 10, 35acetaminophen/codeine . . . . . 16acetaminophen/salicylamide/

phenyltoloxamine . . . . . . . . 14acetazolamide . . . . . . . . . . . . 12acetylcyst . . . . . . . . . . . . . . . . 32ACIPHEX . . . . . . . 25, 34, 39, 42ACTIMMUNE . . . . . . . . . . . . . 9ACTIQ . . . . . . . . . . . . . . . 16, 38ACTIVELLA . . . . . . . . . . . . . . 22ACTONEL. . . . . . . . . . . . . 29, 37ACTONEL with CALCIUM 29, 37ACTOPLUS MET . . . . . . . . . . . 20ACTOS. . . . . . . . . . . . . . . . . . 23ACULAR . . . . . . . . . . . . . . . . 30ACULAR LS . . . . . . . . . . . . . . 30ACULAR PF . . . . . . . . . . . . . . 30acyclovir. . . . . . . . . . . . . . . . . 28ADALAT . . . . . . . . . . . . . . . . . 41ADALAT CC . . . . . . . 12, 36, 41ADDERALL . . . . . . . . . . . . 14, 35ADDERALL XR . . . . . . 14, 35, 42ADOXA . . . . . . . . . . . . . . 28, 34ADVAIR DISKUS . . . . . . . . . . 32ADVAIR HFA . . . . . . . . . . . . . 32ADVATE . . . . . . . . . . . . . . . . . 33ADVICOR. . . . . . . . . . . . . 11, 36AEROBID . . . . . . . . . . . . . . . . 32AEROBID-M . . . . . . . . . . . . . . 32afeditab . . . . . . . . . . . . . . 12, 36AGENERASE . . . . . . . . . . . . . 27AGGRENOX . . . . . . . . . . . . . . 10AGRYLIN . . . . . . . . . . . . . . . . 10airet . . . . . . . . . . . . . . . . . . . . 32AKINETON . . . . . . . . . . . . . . . 14AKNE-MYCIN. . . . . . . . . . . . . 18akorn balanc . . . . . . . . . . . . . 30ak-pred . . . . . . . . . . . . . . . . . 31ALAMAST . . . . . . . . . . . . . . . 30albuterol . . . . . . . . . . . . . . . . 32albuterol HFA. . . . . . . . . . . . . 32albuterol nebules . . . . . . . . . 41ALCET . . . . . . . . . . . . . . . . . . 16alclometasone . . . . . . . . . . . . 19

alcohol swabs . . . . . . . . . . . . 21ALDACTAZIDE . . . . . . . . . . . . 12ALDACTONE . . . . . . . . . . . . . 13ALDARA . . . . . . . . . . . . . . . . 20ALDORIL . . . . . . . . . . . . . . . . 11ALESSE . . . . . . . . . . . . . . . . . 21ALFERON N . . . . . . . . . . . . . . . 9ALINIA . . . . . . . . . . . . . . . . . 27ALKERAN. . . . . . . . . . . . . . . . . 9ALLEGRA . . . . . . . . . . 31, 33, 36ALLEGRA D . . . . . . . . 32, 33, 36allopurinol . . . . . . . . . . . . . . . 29ALOCRIL . . . . . . . . . . . . . . . . 30ALOMIDE . . . . . . . . . . . . . . . . 30ALORA. . . . . . . . . . . . . . . 22, 37ALPHAGAN P. . . . . . . . . . . . . 30ALPHANATE . . . . . . . . . . . . . . 33ALPHANINE SD . . . . . . . . . . . 33alprazolam. . . . . . . . . . . . . . . 15alprazolam ER . . . . . . . . . . . . 15ALREX . . . . . . . . . . . . . . . . . . 31ALTACE . . . . . . . . . . . . . . 10, 35ALTOPREV . . . . . . . . . 13, 37, 41ALUPENT . . . . . . . . . . . . . . . . 32amantadine . . . . . . . . . . . . . . 14AMARYL . . . . . . . . . . . . . . . . 23AMBIEN . . . . . . . . . . . 17, 38, 42AMBIEN CR . . . . . . . . 17, 38, 42amcinonide . . . . . . . . . . . . . . 19AMERGE . . . . . . . . . . . . . 17, 39AMEVIVE . . . . . . . . . . . . . . . . 19amigesic. . . . . . . . . . . . . . . . . 30amiloride . . . . . . . . . . . . . . . . 13amiloride/

hydrochlorothiazide . . . . . . 12aminophylline . . . . . . . . . . . . 32amiodarone . . . . . . . . . . . . . . 11AMITIZA. . . . . . . . . . . . . . . . . 24amitriptyline. . . . . . . . . . . . . . 18amnesteem . . . . . . . . 18, 33, 35amoxapine . . . . . . . . . . . . . . . 18amoxicillin . . . . . . . . . . . . . . . 26amoxicillin/K clavulanate . . . . 28AMOXIL . . . . . . . . . . . . . . . . 26amphetamine/dextro-

amphetamine . . . . . 14, 35, 42ampicillin . . . . . . . . . . . . . . . . 26amyl nitrite . . . . . . . . . . . . . . 13anagrelide . . . . . . . . . . . . . . . 10ANCOBON. . . . . . . . . . . . . . . 26ANDRODERM . . . . . . . . . . . . 20ANDROGEL . . . . . . . . . . . . . . 20ANEXSIA . . . . . . . . . . . . . 16, 42ANTABUSE . . . . . . . . . . . . . . . 14ANTARA . . . . . . . . . . . . . . . . 12anthralin . . . . . . . . . . . . . . . . 19

antipyrine/benzocaine . . . . . . 31ANZEMET . . . . . . . . . . . . 23, 35APIDRA . . . . . . . . . . . . . . . . . 23apri . . . . . . . . . . . . . . . . . . . . 21APTIVUS. . . . . . . . . . . . . . . . . 27ARALEN . . . . . . . . . . . . . . 33, 26aranelle . . . . . . . . . . . . . . . . . 21ARANESP . . . . . . . . . . . . . . . . 10ARAVA. . . . . . . . . . . . . . . . . . 30ARICEPT. . . . . . . . . . . . . . . . . 14ARICEPT ODT. . . . . . . . . . . . . 14ARIMIDEX . . . . . . . . . . . . . . . . 9ARIXTRA . . . . . . . . . . . . . . . . 10ARMOUR THYROID . . . . . . . . 23AROMASIN . . . . . . . . . . . . . . . 9ARTHROTEC. . . . . . . . . . . . . . 29ASACOL . . . . . . . . . . . . . 24, 38ASMANEX . . . . . . . . . . . . 32, 41aspirin CR . . . . . . . . . . . . . . . 30aspirin CR EC . . . . . . . . . . . . . 30aspirin/codeine. . . . . . . . . . . . 16ASTELIN NASAL . . . . . . . . . . . 32ATACAND . . . . . . . . . 10, 35, 41ATACAND HCT . . . . . 11, 35, 41atamet . . . . . . . . . . . . . . . . . . 14atenolol . . . . . . . . . . . . . . . . . 11atenolol/chlorthalidone . . . . . 11ATRIPLA . . . . . . . . . . . . . . . . . 27ATROVENT . . . . . . . . . . . . . . 31ATROVENT HFA . . . . . . . . . . . 31ATROVENT NASAL . . . . . . . . . 32augmented betamethasone

dipropionate. . . . . . . . . . . . 19AUGMENTIN . . . . . . . . . . . . . 28AUGMENTIN ES . . . . . . . . . . . 28AUGMENTIN XR . . . . . . . . . . 28AVALIDE . . . . . . . . . . 11, 35, 41AVANDAMET . . . . . . . . . . . . 20AVANDARYL . . . . . . . . . . . . . 20AVANDIA . . . . . . . . . . . . . . . . 23AVAPRO . . . . . . . . . . 10, 35, 41AVAR . . . . . . . . . . . . . . . . . . . 18AVAR GREEN . . . . . . . . . . . . . 18avar-E green. . . . . . . . . . . . . . 18AVELOX . . . . . . . . . . . . . 28, 33AVELOX ABC . . . . . . . . . . . . . 28aviane . . . . . . . . . . . . . . . . . . 21AVINZA . . . . . . . . . . . . . . . . . 16AVITA. . . . . . . . . . . . . . . . 18, 33AVODART . . . . . . . . . . . . 25, 34AVONEX . . . . . . . . . . . . . . . . 16AXERT . . . . . . . . . . . . . . . 17, 40AXID . . . . . . . . . . . . . . . . . . . 24AZASAN . . . . . . . . . . . . . . . . 26azathioprine. . . . . . . . . . . . . . 26AZELEX . . . . . . . . . . . . . . . . . 18

Index

Index


azithromycin . . . . . . . . . . . . . 27AZMACORT . . . . . . . . . . . . . . 32AZOPT . . . . . . . . . . . . . . . . . . 30AZULFIDINE . . . . . . . . . . . 24, 38AZULFIDINE ENTABS. . . . . 24, 38

Bbacitracin . . . . . . . . . . . . . . . . 30bacitracin/neomycin/

polymyxin . . . . . . . . . . . . . . 30bacitracin/polymyxin. . . . . . . . 30bacitracin/polymyxin/

neomycin/hydrocortisone . . 31baclofen. . . . . . . . . . . . . . . . . 29BACTROBAN . . . . . . . . . . . . . 19BACTROBAN NASAL . . . . . . . 32bal salt . . . . . . . . . . . . . . . . . . 30BARACLUDE . . . . . . . . . . 28, 37BD insulin syringes . . . . . . . . . 21BEBULIN VH . . . . . . . . . . . . . . 33BECONASE AQ . . . . . . . . . . . 32belladonna alkaloids/opium . . 24belladonna alkaloids/

phenobarbital . . . . . . . . . . . 24belladonna alklaloids . . . . . . . 24benazepril . . . . . . . . . . . . 10, 35benazepril/

hydrochlorothiazide . . . . . . 11BENEFIX . . . . . . . . . . . . . . . . . 33BENICAR . . . . . . . . . . . . . 10, 35BENICAR HCT . . . . . . . . . 11, 35BENZACLIN . . . . . . . . . . . . . . 18BENZAMYCIN . . . . . . . . . . . . 18BENZIQ . . . . . . . . . . . . . . . . . 18BENZIQ LS . . . . . . . . . . . . . . . 18BENZIQ wash . . . . . . . . . . . . . 18benzoyl peroxide . . . . . . . . . . 18benzoyl peroxide/urea cream . 18benztropine . . . . . . . . . . . . . . 14betamethasone . . . . . . . . . . . 41betamethasone valerate. . . . . 19BETAPACE . . . . . . . . . . . . . . . 12BETAPACE AF. . . . . . . . . . . . . 12BETASERON . . . . . . . . . . . . . 16betaxolol . . . . . . . . . . . . . 11, 30bethanechol. . . . . . . . . . . . . . 25BETIMOL . . . . . . . . . . . . . . . . 30BETOPTIC-S . . . . . . . . . . . . . . 30BIAXIN . . . . . . . . . . . . . . . . . 27BIAXIN XL . . . . . . . . . . . . . . . 27BIDIL . . . . . . . . . . . . . . . . . . . 13BINORA . . . . . . . . . . . . . . . . . 18BIO-STATIN. . . . . . . . . . . . . . . 26BIO-THROID . . . . . . . . . . . . . . 23bisoprolol fumarate . . . . . . . . 11bisoprolol/

hydrochlorothiazide . . . . . . 11

BLEPHAMIDE S.O.P. . . . . . . . . 31BLOCADREN . . . . . . . . . . . . . 12BONIVA . . . . . . . . . . . . . . 29, 37BRAVELLE. . . . . . . . . . . . . . . . 22BREVICON . . . . . . . . . . . . . . . 21brimonidine . . . . . . . . . . . . . . 30bromocriptine . . . . . . . . . . . . 14BRONCAP . . . . . . . . . . . . . . . 32bubbli-pred . . . . . . . . . . . . . . 22budeprion . . . . . . . . . . . . 16, 38budeprion ER/SR . . . . . . . . . . 38bumetanide . . . . . . . . . . . . . . 13BUMEX . . . . . . . . . . . . . . . . . 13bupropion . . . . . . 16, 38, 41, 42bupropion ER/SR . 16, 38, 41, 42buspirone. . . . . . . . . . . . . . . . 15butalbital CPD . . . . . . . . . . . . 14butalbital/acetaminophen. . . . 14butalbital/acetaminophen/

caffeine . . . . . . . . . . . . . . . 14butalbital/acetaminophen/

caffeine/codeine . . . . . . 16, 42butalbital/aspirin/caffeine . . . . 14butalbital/aspirin/caffeine/

codeine . . . . . . . . . . . . 16, 42BUTISOL SODIUM . . . . . . . . . 15butorphanol. . . . . . . . . . . . . . 17butorphanol nasal . . . . . . . . . 38BYETTA . . . . . . . . . . . . . . 23, 37

CCADUET . . . . . . . . . . 13, 37, 41CALAN . . . . . . . . . . . . . . 12, 41CALAN SR . . . . . . . . . 12, 36, 41camila . . . . . . . . . . . . . . . . . . 23CAMPRAL . . . . . . . . . . . . . . . 14CANASA . . . . . . . . . . . . . 24, 38CAPITAL/CODEINE . . . . . . 16, 42CAPITROL . . . . . . . . . . . . . . . 19CAPOTEN . . . . . . . . . . . . 10, 35CAPOZIDE . . . . . . . . . . . . . . . 11captopril . . . . . . . . . . . . . 10, 35captopril/

hydrochlorothiazide . . . . . . 11CARAC . . . . . . . . . . . . . . . . . 19carbamazepine. . . . . . . . . . . . 15carbidopa/levodopa . . . . . . . . 14carbidopa/levodopa SR. . . . . . 14carboptic . . . . . . . . . . . . . . . . 30CARDENE . . . . . . . . . . . . 12, 41CARDENE SR . . . . . . . . . . . . . 12CARDIZEM. . . . . . . . . . . . 12, 41CARDIZEM CD. . . . . . 12, 36, 41CARDIZEM LA . . . . . . . . . 12, 36CARDIZEM SR . . . . . . . . . . . . 41CARDURA . . . . . . . . . . . . . . . 10CARDURA XL. . . . . . . . . . . . . 10

carisoprodol . . . . . . . . . . . . . . 29carisoprodol/aspirin . . . . . . . . 29carisoprodol/aspirin/codeine . . 29CARNITOR . . . . . . . . . . . . . . . 23carteolol. . . . . . . . . . . . . . . . . 30cartia XT . . . . . . . . . . . . . 12, 36CARTROL . . . . . . . . . . . . . . . . 12CASODEX . . . . . . . . . . . . . 9, 34CATAPRES . . . . . . . . . . . . . . . 10CATAPRES-TTS . . . . . . . . . . . . 10CAVERJECT . . . . . . . . . . . . . . 13CEDAX. . . . . . . . . . . . . . . . . . 27CEENU. . . . . . . . . . . . . . . . . . . 9cefaclor . . . . . . . . . . . . . . . . . 27cefaclor ER. . . . . . . . . . . . . . . 27cefadroxil . . . . . . . . . . . . . . . . 27cefpodoxime . . . . . . . . . . . . . 27cefprozil. . . . . . . . . . . . . . . . . 27CEFTIN . . . . . . . . . . . . . . . . . 27cefuroxime. . . . . . . . . . . . . . . 27CEFZIL . . . . . . . . . . . . . . . . . . 27CELEBREX . . . . . . . . . 29, 34, 39CELESTONE . . . . . . . . . . . . . . 22CELEXA . . . . . . . . . . 17, 39, 41CELLCEPT. . . . . . . . . . . . . . . . 26CELONTIN . . . . . . . . . . . . . . . 18CENESTIN. . . . . . . . . . . . . . . . 22cephalexin . . . . . . . . . . . . . . . 27CEREDASE . . . . . . . . . . . . . . . . 9CEREZYME. . . . . . . . . . . . . . . . 9CESAMET. . . . . . . . . . . . . . . . 36cesia . . . . . . . . . . . . . . . . . . . 21chloral hydrate. . . . . . . . . . . . 17chlordiazepoxide . . . . . . . . . . 15chlordiazepoxide/

amitriptyline . . . . . . . . . . . . 15chloroquine . . . . . . . . . . . 26, 33chlorothiazide . . . . . . . . . . . . 14chlorpheniramine ER . . . . . . . 31chlorpromazine . . . . . . . . . . . 17chlorpropamide . . . . . . . . . . . 23chlorthalidone . . . . . . . . . . . . 14chlorzoxazone . . . . . . . . . . . . 29cholestyramine. . . . . . . . . . . . 12choline/magnesium

salicylates . . . . . . . . . . . . . . 30CIALIS . . . . . . . . . . . . . . . . . . 13ciclopirox . . . . . . . . . . . . . . . . 19cilostazol . . . . . . . . . . . . . . . . 10cimetidine . . . . . . . . . . . . . . . 24CIPRO . . . . . . . . . . . . . . . 28, 33CIPRO HC . . . . . . . . . . . . . . . 31CIPRO XR. . . . . . . . . . . . . 28, 33CIPRODEX . . . . . . . . . . . . . . . 31ciprofloxacin . . . . . . . 28, 30, 33citalopram . . . . . . 17, 39, 41, 42


claravis . . . . . . . . 18, 33, 35, 41CLARINEX . . . . . . . . . 31, 33, 36CLARINEX D . . . . . . . 32, 33, 36CLARINEX REDITAB . . 31, 33, 36clarithromycin . . . . . . . . . . . . 27clenia . . . . . . . . . . . . . . . . . . . 18CLEOCIN VAGINAL . . . . . . . . 26clidinium/chlordiazepoxide . . . 24CLIMARA. . . . . . . . . . . . . 22, 37CLIMARA PRO . . . . . . . . . . . . 22CLIMARA PRO WEEKLY . . . . . 37clindamax . . . . . . . . . . . . 18, 26clindamycin . . . . . . . . . . . 18, 28CLINDESSE . . . . . . . . . . . . . . . 26clobetasol . . . . . . . . . . . . . . . 19clobevate . . . . . . . . . . . . . . . . 19CLOBEX lotion/shampoo/

spray . . . . . . . . . . . . . . . . . 19CLODERM . . . . . . . . . . . . . . . 20clomipramine . . . . . . . . . . . . . 18clonazepam . . . . . . . . . . . . . . 14clonazepam orally

disintegrating tab . . . . . . . . 14clonidine . . . . . . . . . . . . . . . . 10clorazepate . . . . . . . . . . . . . . 15CLORPRES . . . . . . . . . . . . . . . 11clotrimazole/

betamethasone. . . . . . . . . . 19clozapine . . . . . . . . . . . . . 15, 37CLOZARIL . . . . . . . . . . . . 15, 37cocaine hcl. . . . . . . . . . . . . . . 20codeine phosphate . . . . . . . . 16codeine sulfate . . . . . . . . . . . 16codeine/acetaminophen . . . . . 42COGNEX . . . . . . . . . . . . . . . . 14COLAZAL. . . . . . . . . . . . . 24, 38colchicine. . . . . . . . . . . . . . . . 29COLESTID. . . . . . . . . . . . . . . . 12colestipol . . . . . . . . . . . . . . . . 12colocort . . . . . . . . . . . . . . . . . 24COLY-MYCIN-S. . . . . . . . . . . . 31COLYTE . . . . . . . . . . . . . . . . . 25COMBIPATCH . . . . . . . . . 22, 37COMBIVENT . . . . . . . . . . . . . 32COMBIVIR . . . . . . . . . . . . . . . 27COMBUNOX . . . . . . . 16, 38, 42compro . . . . . . . . . . . . . . . . . 17COMTAN . . . . . . . . . . . . . . . 14concentrate . . . . . . . . . . . . . . 41CONCERTA . . . . . . . . 18, 40, 42COPAXONE . . . . . . . . . . . . . . 16COPEGUS . . . . . . . . . . . . . . . 28CORDARONE . . . . . . . . . . . . 11CORDRAN . . . . . . . . . . . . . . . 20COREG . . . . . . . . . . . . . . . . . 10CORGARD . . . . . . . . . . . . . . . 12

corticosteroid . . . . . . . . . . . . . 41CORTIFOAM . . . . . . . . . . . . . 24cortisone AC . . . . . . . . . . . . . 22cortomycin. . . . . . . . . . . . . . . 31CORZIDE . . . . . . . . . . . . . . . . 11COSOPT . . . . . . . . . . . . . . . . 30COUMADIN . . . . . . . . . . . . . . . 9COVERA-HS . . . . . . . 12, 36, 41COZAAR . . . . . . . . . . 10, 35, 41CREON. . . . . . . . . . . . . . . . . . 24CRESTOR . . . . . . . . . . 13, 37, 41CRINONE . . . . . . . . . . . . . . . . 26CRIXIVAN. . . . . . . . . . . . . . . . 27cromolyn sodium nebulizer . . 32cromolyn sodium ophth . . . . . 30cryselle. . . . . . . . . . . . . . . . . . 21CYCLESSA . . . . . . . . . . . . . . 21cyclobenzaprine hcl . . . . . . . . 29cyclophosphamide . . . . . . . . . . 9cyclosporine . . . . . . . . . . . . . . 26cyclosporine modified . . . . . . 26CYMBALTA . . . . . . . . 18, 39, 41cyproheptadine . . . . . . . . . . . 32CYSTADANE . . . . . . . . . . . . . 23CYSTAGON . . . . . . . . . . . . . . 25CYTADREN. . . . . . . . . . . . . . . . 9CYTOXAN . . . . . . . . . . . . . . . . 9

Ddanazol . . . . . . . . . . . . . . . . . 20DANTRIUM . . . . . . . . . . . . . . 29dapsone. . . . . . . . . . . . . . . . . 28DARAPRIM. . . . . . . . . . . . 26, 33DARVOCET A500. . . . . . . . . . 16DARVOCET-N. . . . . . . . . . 16, 42DARVON-N . . . . . . . . . . . . . . 16DAYPRO . . . . . . . . . . . . . . . . 29DAYTRANA . . . . . . . . . . . 18, 40DDAVP. . . . . . . . . . . . . . . . . . 42DDAVP. . . . . . . . . . . . . . . . . . 23DECLOMYCIN . . . . . . . . . 28, 34DEMADEX . . . . . . . . . . . . . . . 13demeclocycline . . . . . . . . . . . 34demeclocycline hcl . . . . . . . . . 28DEMEROL . . . . . . . . . . . . . . . 16DEMSER . . . . . . . . . . . . . . . . 10DEMULEN 1/35 . . . . . . . . . . . 21DEMULEN 1/50 . . . . . . . . . . . 21DENAVIR . . . . . . . . . . . . . . . . 19DEPAKOTE . . . . . . . . . . . . . . 18DEPAKOTE ER . . . . . . . . . . . . 18DEPAKOTE SPRINKLE . . . . . . . 18DEPO-PROVERA . . . . . . . . 9, 23desipramine . . . . . . . . . . . . . . 18desmopressin. . . . . . . . . . 23, 42DESOGEN . . . . . . . . . . . . . . . 21desonide . . . . . . . . . . . . . . . . 20

desoximetasone . . . . . . . . . . . 20DESOXYN . . . . . . . . . 14, 35, 42DESYREL . . . . . . . . . . . . . 16, 41DETROL . . . . . . . . . . . . . 25, 42DETROL LA . . . . . . . . . . . 25, 42dexacidin . . . . . . . . . . . . . . . . 31dexamethasone . . . . . . . . . . 22dexamethasone phosphate . . 31dexamethasone/

neomycin/polymyxin . . . . . . 31dexasol . . . . . . . . . . . . . . . . . 31dexasporin . . . . . . . . . . . . . . . 31dexchlorpheniramine . . . . . . . 31DEXEDRINE . . . . . . . . . . . 14, 35DEXEDRINE CR. . . . . . . . . . . . 35dextroamphetamine. . . . . 14, 35dextroamphetamine CR . . 14, 35DEXTROSTAT . . . . . . . . . . . . . 14dextrostat . . . . . . . . . . . . . . . 35DIAMOX . . . . . . . . . . . . . . . . 12DIASTAT. . . . . . . . . . . . . . . . . 14diazepam. . . . . . . . . . . . . . . . 15DIBENZYLINE . . . . . . . . . . . . . 10diclofenac . . . . . . . . . . . . . . . 29diclofenac potassium . . . . . . . 29diclofenac sodium XR. . . . . . . 29dicloxacillin sodium . . . . . . . . 28didanosine delayed relase . . . 27DIDRONEL . . . . . . . . . . . . . . . 29DIFFERIN gel/cream . . . . . . . . 18diflorasone. . . . . . . . . . . . . . . 20DIFLUCAN . . . . . . . . . 28, 33, 37diflunisal . . . . . . . . . . . . . . . . 30DIGEX . . . . . . . . . . . . . . . . . . 24digitek . . . . . . . . . . . . . . . . . . 12digoxin. . . . . . . . . . . . . . . . . . 12DILACOR . . . . . . . . . . . . . . . . 41DILACOR XR . . . . . . . 12, 36, 41DILATRATE SR . . . . . . . . . . . . 13DILAUDID. . . . . . . . . . . . . . . . 16diltia XT . . . . . . . . . . . . . . 12, 36diltiazem . . . . . . . . . . . . . 12, 41diltiazem CD . . . . . . . . . . . . . 12diltiazem CD/CR/ER/XT . . . . . . 36diltiazem ER . . . . . . . . . . . . . . 12diltiazem extended release . . . 41diltiazem extended

release beads SR. . . . . . 12, 36DIOVAN . . . . . . . . . . 10, 35, 41DIOVAN HCT . . . . . . . 11, 36, 41DIPENTUM . . . . . . . . . . . . 24, 38diphenoxylate/atropine. . . . . . 24dipivefrin . . . . . . . . . . . . . . . . 30DIPROLENE AF . . . . . . . . . . . 20dipyridamole . . . . . . . . . . . . . 10disopyramide . . . . . . . . . . . . . 10

Index


DISPERMOX . . . . . . . . . . . . . 26DITROPAN . . . . . . . . . . . . . . . 25DITROPAN XL. . . . . . . . . . 25, 42DIURIL . . . . . . . . . . . . . . . . . . 14DMSO . . . . . . . . . . . . . . . . . . 25DORAL. . . . . . . . . . . . . . . . . . 17DORYX . . . . . . . . . . . . . . 28, 34DOVONEX . . . . . . . . . . . . . . . 19doxazosin. . . . . . . . . . . . . . . . 10doxepin hcl . . . . . . . . . . . . . . 18doxy-caps. . . . . . . . . . . . . . . . 28doxycycline . . . . . . . . . . . . . . 34doxycycline hyclate . . . . . . . . 28doxycycline monohydrate. . . . 28DRITHO-SCALP . . . . . . . . . . . 19DROXIA . . . . . . . . . . . . . . . . . 9DUAC . . . . . . . . . . . . . . . . . . 18DUONEB . . . . . . . . . . . . . . . . 32DURAGESIC . . . . . . . 16, 38, 42DURICEF . . . . . . . . . . . . . . . . 27DYAZIDE . . . . . . . . . . . . . . . . 12DYNABAC . . . . . . . . . . . . . . . 27DYNACIN. . . . . . . . . . . . . 28, 34DYNACIRC. . . . . . . . . . . . . . . 12DYNACIRC CR . . . . . . . . . . . . 12DYRENIUM. . . . . . . . . . . . . . . 13

Ee.e.s. . . . . . . . . . . . . . . . . . . . 27econazole . . . . . . . . . . . . . . . 19EDECRIN . . . . . . . . . . . . . . . . 13EDEX . . . . . . . . . . . . . . . . . . . 13EFFEXOR . . . . . . . . . . 18, 39, 41EFFEXOR XR. . . . . . . . 18, 39, 41EFUDEX . . . . . . . . . . . . . . . . 19ELDEPRYL. . . . . . . . . . . . . . . . 15ELESTAT . . . . . . . . . . . . . . . . . 30ELIDEL . . . . . . . . . . . . . . . 20, 41ELMIRON . . . . . . . . . . . . . . . . 25ELOCON . . . . . . . . . . . . . . . . 20EMADINE . . . . . . . . . . . . . . . . 30EMCYT . . . . . . . . . . . . . . . . . . 9EMEND . . . . . . . . . . . . . . 25, 40EMSAM . . . . . . . . . . . . . . . . . 15EMTRIVA . . . . . . . . . . . . . . . . 27ENABLEX . . . . . . . . . . . . . 25, 42enalapril. . . . . . . . . . . . . . 10, 35enalapril/

hydrochlorothiazide . . . . . . 11ENBREL . . . . . . . . . . . . . . . . . 30enpresse . . . . . . . . . . . . . . . . 21ENTOCORT EC . . . . . . . . . . . . 22EPIPEN . . . . . . . . . . . . . . . . . 10EPIPEN-JR . . . . . . . . . . . . . . . 10EPIVIR . . . . . . . . . . . . . . . . . . 27EPIVIR HBV. . . . . . . . . . . . . . . 27EPZICOM . . . . . . . . . . . . . . . . 27

EQUETRO. . . . . . . . . . . . . . . . 16ergoloid mesylate. . . . . . . . . . 15errin. . . . . . . . . . . . . . . . . . . . 23ERTACZO . . . . . . . . . . . . . . . . 19erythrocin . . . . . . . . . . . . . . . 27erythromycin . . . . . . . 18, 27, 31erythromycin delayed

release particles . . . . . . . . . 27erythromycin ethylsuccinate . . 27erythromycin/benzoyl

peroxide . . . . . . . . . . . . . . . 18ESCLIM . . . . . . . . . . . . . . 22, 37estazolam . . . . . . . . . . . . . . . 17ESTRACE . . . . . . . . . . . . . . . . 22ESTRACE VAGINAL . . . . . . . . 26ESTRADERM . . . . . . . . . . 22, 37estradiol. . . . . . . . . . . . . . . . . 22estradiol patch . . . . . . . . . . . . 37ESTRASORB . . . . . . . . . . . . . . 22ESTRATEST . . . . . . . . . . . . . . 22ESTRATEST HS . . . . . . . . . . . . 22ESTRING. . . . . . . . . . . . . . . . . 26ESTROGEL . . . . . . . . . . . . . . . 22estropipate. . . . . . . . . . . . . . . 22ESTROSTEP FE . . . . . . . . . . . . 21ethambutol . . . . . . . . . . . . . . 27ethexderm . . . . . . . . . . . . . . . 18ETHMOZINE . . . . . . . . . . . . . 10ethosuximide . . . . . . . . . . . . . 18etodolac. . . . . . . . . . . . . . . . . 29etodolac ER . . . . . . . . . . . . . . 29etoposide. . . . . . . . . . . . . . . . . 9EULEXIN. . . . . . . . . . . . . . . . . . 9EURAX. . . . . . . . . . . . . . . . . . 20EVISTA . . . . . . . . . . . . . . . . . 29EVOCLIN . . . . . . . . . . . . . . . . 18EVOXAC . . . . . . . . . . . . . . . . 32EXELDERM. . . . . . . . . . . . . . . 19EXELON . . . . . . . . . . . . . . . . 14

FFACTIVE. . . . . . . . . . . . . . 28, 33famotidine . . . . . . . . . . . . . . . 24FAMVIR . . . . . . . . . . . . . . . . . 28FANSIDAR . . . . . . . . . . . . 27, 33FARESTON . . . . . . . . . . . . . . . . 9FASLODEX . . . . . . . . . . . . . . . . 9FAZACLO . . . . . . . . . . . . . 15, 37FELBATOL. . . . . . . . . . . . . . . . 15felodipine . . . . . . . . . . . . 12, 36FEMARA . . . . . . . . . . . . . . . . . 9FEMHRT . . . . . . . . . . . . . . . . . 22FEMHRT LOW DOSE. . . . . . . . 22FEMRING . . . . . . . . . . . . . . . . 26FEMTRACE. . . . . . . . . . . . . . . 22fenofibrate. . . . . . . . . . . . . . . 12fenoprofen. . . . . . . . . . . . . . . 29

fentanyl . . . . . . . . . . . . . . . . . 16fentanyl patch . . . . . . . . . 38, 42fexofenadine . . . . . . . 31, 33, 36FINACEA . . . . . . . . . . . . . . . . 20finasteride . . . . . . . . . . . . 25, 34FIORICET/CODEINE . . . . . 16, 42FIORINAL/CODEINE . . . . . 16, 42FIRST-TESTOSTERONE . . . . . . . 20flavoxate . . . . . . . . . . . . . . . . 26flecainide . . . . . . . . . . . . . . . . 11FLOMAX . . . . . . . . . . . . . 25, 34FLONASE . . . . . . . . . . . . . . . . 32FLOVENT HFA . . . . . . . . . 32, 41FLOVENT ROTADISC. . . . . . . . 32FLOXIN. . . . . . . . . . . . . . . . . . 33FLOXIN OTIC . . . . . . . . . . . . . 31fluconazole . . . . . . . . 28, 33, 37fludrocort. . . . . . . . . . . . . . . . 23FLUMADINE . . . . . . . . . . . . . 28flunisolide . . . . . . . . . . . . . . . 32fluocinolone acetonide. . . . . . 20fluocinonide. . . . . . . . . . . . . . 20fluorometholone . . . . . . . . . . 31fluor-op . . . . . . . . . . . . . . . . . 31FLUOROPLEX . . . . . . . . . . . . . 19fluorouracil . . . . . . . . . . . . . . 19fluoxetine . . . . . . 17, 39, 41, 42fluphenazine . . . . . . . . . . . . . 17flurazepam. . . . . . . . . . . . . . . 17flurbiprofen . . . . . . . . . . . 29, 30flutamide . . . . . . . . . . . . . . . . . 9fluticasone . . . . . . . . . . . . 20, 42fluticasone propionate

nasal. . . . . . . . . . . . . . . . . . 32fluvoxamine. . . . . 17, 39, 41, 42FML-S . . . . . . . . . . . . . . . . . . 31FOCALIN . . . . . . . . . . 18, 40, 42FOCALIN XR . . . . . . . 18, 40, 42FOLLISTIM . . . . . . . . . . . . . . . 22FOLLISTIM AQ . . . . . . . . . . . . 22FORADIL . . . . . . . . . . . . . . . . 32FORADIL . . . . . . . . . . . . . . . . 41FORTAMET. . . . . . . . . . . . . . . 20FORTEO . . . . . . . . . . . . . . . . 29fortical . . . . . . . . . . . . . . . . . . 29FOSAMAX . . . . . . . . . . . . 29, 37FOSAMAX PLUS D . . . . . . 29, 37fosinopril . . . . . . . . . . . . . 10, 35fosinopril/

hydrochlorothiazide . . . . . . 11FOSRENOL . . . . . . . . . . . . . . . 25FRAGMIN. . . . . . . . . . . . . . . . 10FREESTYLE test strips . . . . . . . 22FROVA . . . . . . . . . . . . . . . 17, 40furosemide. . . . . . . . . . . . . . . 13FUZEON . . . . . . . . . . . . . . . . 27


Ggabapentin . . . . . . . . 15, 38, 41GABARONE . . . . . . . . . . . . . . 15gabarone . . . . . . . . . . . . . . . . 38GABITRIL . . . . . . . . . . . . . . . . 15ganciclovir . . . . . . . . . . . . . . . 27GASTROCROM . . . . . . . . . . . 24gauze pad . . . . . . . . . . . . . . . 22gemfibrozil. . . . . . . . . . . . . . . 12gengraf . . . . . . . . . . . . . . . . . 26GENOTROPIN. . . . . . . . . . 22, 33gentamicin. . . . . . . . . . . . 19, 31GEOCILLIN . . . . . . . . . . . . . . 27GEODON . . . . . . . . . . . . . 16, 38GEREF . . . . . . . . . . . . . . . . . . 22GLEEVEC . . . . . . . . . . . . . . . . . 9glimepiride. . . . . . . . . . . . . . . 23glipizide . . . . . . . . . . . . . . . . . 23glipizide ER . . . . . . . . . . . . . . 23glipizide XL . . . . . . . . . . . . . . 23glipizide/metformin . . . . . . . . 20GLUCAGON. . . . . . . . . . . . . . 21GLUCOPHAGE . . . . . . . . . . . . 20GLUCOPHAGE XR . . . . . . . . . 20GLUCOVANCE . . . . . . . . . . . . 20glyburide . . . . . . . . . . . . . . . . 23glyburide micronized . . . . . . . 23glyburide/metformin . . . . . . . 20glycolax . . . . . . . . . . . . . . . . . 25glycron. . . . . . . . . . . . . . . . . . 23GLYSET . . . . . . . . . . . . . . . . . 20GOLYTELY . . . . . . . . . . . . . . . 25GONAL-F . . . . . . . . . . . . . . . . 22GRIFULVIN V . . . . . . . . . . . . . 26GRIS-PEG . . . . . . . . . . . . . . . . 26guanabenz. . . . . . . . . . . . . . . 10guanfacine. . . . . . . . . . . . . . . 10GYNAZOLE-1 . . . . . . . . . . . . . 26gynodiol. . . . . . . . . . . . . . . . . 22

HHALFLYTELY . . . . . . . . . . . . . . 25HALOG . . . . . . . . . . . . . . . . . 20haloperidol. . . . . . . . . . . . . . . 15hc pramoxine. . . . . . . . . . . . . 25HECTOROL. . . . . . . . . . . . . . . 23HELIDAC . . . . . . . . . . . . . 25, 40HELIXATE . . . . . . . . . . . . . . . . 33HELIXATE FS. . . . . . . . . . . . . . 33HEMOFIL M . . . . . . . . . . . . . . 33heparin sodium . . . . . . . . . . . 10HEPSERA . . . . . . . . . . . . . . . . 28HEXALEN . . . . . . . . . . . . . . . . . 9HIVID . . . . . . . . . . . . . . . . . . . 27HMS . . . . . . . . . . . . . . . . . . . 31HUMALOG. . . . . . . . . . . . . . . 23

HUMALOG MIX 75/25 . . . . . . 23HUMATE-P . . . . . . . . . . . . . . . 33HUMATROPE . . . . . . . . . 22, 33HUMIRA . . . . . . . . . . . . . . . . 29HUMULIN 50/50 . . . . . . . . . . 23HUMULIN 70/30 . . . . . . . 23, 41HUMULIN N . . . . . . . . . . 23, 41HUMULIN R . . . . . . . . . . 23, 41HYATE:C . . . . . . . . . . . . . . . . 33hydralazine . . . . . . . . . . . . . . 14hydralazine/

hydrochlorothiazide . . . . . . 11HYDREA . . . . . . . . . . . . . . . . . 9hydrochlorothiazide . . . . . . . . 14hydrocodone/

acetaminophen. . . . . . . 16, 42hydrocodone/ibuprofen . . 16, 42hydrocortisone. . . . . . . . . 20, 22hydrocortisone acetate. . . . . . 25hydrocortisone butyrate . . . . . 20hydrocortisone valerate . . . . . 20hydrocortisone/clioquinol . . . . 19hydrocortisone/iodoquinol . . . 19hydrocortisone/pramoxine . . . 20hydromorphone . . . . . . . . . . . 16hydroxychloroquine . . . . . . . . 33hydroxychloroquine sulfate . . 26hydroxyurea . . . . . . . . . . . . . . . 9hydroxyzine hcl . . . . . . . . . . . 15hydroxyzine pamoate. . . . . . . 15hyoscyamine . . . . . . . . . . 24, 26hyoscyamine CR. . . . . . . . . . . 24hyospaz . . . . . . . . . . . . . . . . . 26HYTRIN . . . . . . . . . . . . . . . . . 10HYZAAR . . . . . . . . . . 11, 36, 41

Iibuprofen. . . . . . . . . . . . . . . . 29IMDUR . . . . . . . . . . . . . . . . . . 13imipramine hcl . . . . . . . . . . . . 18IMITREX . . . . . . . . . . . . . . 17, 40IMURAN . . . . . . . . . . . . . . . . 26INCRELEX. . . . . . . . . . . . . 23, 33indapamide . . . . . . . . . . . . . . 14INDERAL . . . . . . . . . . . . . . . . 12INDERAL LA . . . . . . . . . . . . . . 12INDERIDE . . . . . . . . . . . . . . . . 11indomethacin. . . . . . . . . . . . . 29indomethacin ER . . . . . . . . . . 29INFERGEN . . . . . . . . . . . . 33, 28INNOHEP . . . . . . . . . . . . . . . . 10INNOPRAN XL . . . . . . . . . . . . 12INSPRA . . . . . . . . . . . . . . . . . 14INSULIN SYRINGES (all syringes

other than BD brand) . . . . 22INTAL . . . . . . . . . . . . . . . . . . . 32INTRON-A . . . . . . . . . . . . . 9, 33

INVIRASE . . . . . . . . . . . . . . . . 27IOPIDINE . . . . . . . . . . . . . . . . 30ipratropium . . . . . . . . . . . 31, 32IRESSA . . . . . . . . . . . . . . . . . . 9ISMO . . . . . . . . . . . . . . . . . . . 13ISO CARBACHOL . . . . . . . . . 30isochron. . . . . . . . . . . . . . . . . 13isoetharine . . . . . . . . . . . . . . . 32isonarif. . . . . . . . . . . . . . . . . . 26isoniazid. . . . . . . . . . . . . . . . . 27ISOPTIN . . . . . . . . . . . . . . . . . 41ISOPTIN SR. . . . . . . . . 12, 36, 41ISOPTO CARPINE . . . . . . . . . . 30ISORDIL . . . . . . . . . . . . . . . . . 13isosorbide dinitrate . . . . . . . . 13isosorbide mononitrate . . . . . 13isotretinoin . . . . . 18, 33, 35, 41isoxsuprine. . . . . . . . . . . . . . . 13isradipine . . . . . . . . . . . . . . . . 12ISTALOL . . . . . . . . . . . . . . . . . 30itraconazole . . . . . . . . . . . 28, 33IV IMMUNE GLOBULIN

(IVIG) . . . . . . . . . . . . . . . . . 33

Jjolessa . . . . . . . . . . . . . . . . . . 21jolivette . . . . . . . . . . . . . . . . . 23junel 1.5/30 . . . . . . . . . . . . . . 21junel 1/20 . . . . . . . . . . . . . . . 21junel FE 1.5/30. . . . . . . . . . . . 21junel FE 1/20 . . . . . . . . . . . . . 21

KKADIAN . . . . . . . . . . . . . . . . 16KALETRA . . . . . . . . . . . . . . . . 27kariva. . . . . . . . . . . . . . . . . . . 21kelnor . . . . . . . . . . . . . . . . . . 21KEMADRIN. . . . . . . . . . . . . . . 14KEPPRA . . . . . . . . . . . . . . . . . 15KERLONE . . . . . . . . . . . . . . . . 11KETEK . . . . . . . . . . . . . . . . . . 28ketoconazole . . . . . . . . . . 19, 28ketoprofen. . . . . . . . . . . . . . . 29ketoprofen ER . . . . . . . . . . . . 29ketorolac . . . . . . . . . . . . . 29, 38ketotifen fumarate . . . . . . . . . 30KLARON . . . . . . . . . . . . . . . . 18KLONOPIN . . . . . . . . . . . . . . . 14KLONOPIN WAFER . . . . . . . . . 14KOATE-DVI . . . . . . . . . . . . . . 33KOATE-HP . . . . . . . . . . . . . . . 33KOGENATE . . . . . . . . . . . . . . 33KOGENATE FS . . . . . . . . . . . . 33KONYNE 80 . . . . . . . . . . . . . . 33KRISTALOSE . . . . . . . . . . . . . . 25KU-ZYME . . . . . . . . . . . . . . . . 24KU-ZYME-HP . . . . . . . . . . . . . 24

Index


KYTRIL . . . . . . . . . . . . . . 23, 35

Llabetalol. . . . . . . . . . . . . . . . . 10lacticare/hydrocortisone . . . . . 20lactulose . . . . . . . . . . . . . 24, 25LAMICTAL . . . . . . . . . . . . . . . 15LAMISIL . . . . . . . . . . . . . . 26, 33lamotrigine . . . . . . . . . . . . . . 15LANOXICAPS . . . . . . . . . . . . . 12LANOXIN . . . . . . . . . . . . . . . . 12LANTUS . . . . . . . . . . . . . . . . 23LARIAM . . . . . . . . . . . . . 26, 33LASIX . . . . . . . . . . . . . . . . . . . 13leena . . . . . . . . . . . . . . . . . . . 21leflunomide . . . . . . . . . . . . . . 30LESCOL . . . . . . . . . . . . . . 13, 37LESCOL XL . . . . . . . . . . . 13, 37lessina . . . . . . . . . . . . . . . . . . 21leucovorin calcium . . . . . . . . . . 9LEUKERAN . . . . . . . . . . . . . . . . 9leuprolide. . . . . . . . . . . . . . . . . 9LEVAQUIN . . . . . . . . . . . . 28, 33LEVATOL . . . . . . . . . . . . . . . . 12LEVEMIR . . . . . . . . . . . . . . . . 23LEVITRA . . . . . . . . . . . . . . . . . 13LEVLEN . . . . . . . . . . . . . . . . . 21LEVLITE . . . . . . . . . . . . . . . . . 21levobunolol . . . . . . . . . . . . . . 30levora. . . . . . . . . . . . . . . . . . . 21levorphanol . . . . . . . . . . . . . . 16levothroid . . . . . . . . . . . . . . . 23levothyroxine . . . . . . . . . . . . . 23levoxyl . . . . . . . . . . . . . . . . . . 23LEVULAN KERA . . . . . . . . . . . 19LEXAPRO . . . . . . . . . . 17, 39, 41LEXIVA . . . . . . . . . . . . . . . . . 27LEXXEL . . . . . . . . . . . . . . . . . 11lidazone . . . . . . . . . . . . . . . . . 25lidocaine . . . . . . . . . . . . . . . . 20lidocaine/hydrocortisone . 20, 25lidocaine/prilocaine . . . . . . . . 20LIDODERM. . . . . . . . . . . . . . . 20lindane. . . . . . . . . . . . . . . . . . 20LIPEX . . . . . . . . . . . . . . . . . . . 13LIPITOR . . . . . . . . . . . 13, 37, 41lipram . . . . . . . . . . . . . . . . . . 24lipram CR. . . . . . . . . . . . . . . . 24lipram PN. . . . . . . . . . . . . . . . 24lipram UL . . . . . . . . . . . . . . . . 24lisinopril . . . . . . . . . . . . . . 10, 35lisinopril/hydrochlorothiazide . 11lithium carbonate. . . . . . . . . . 15lithium carbonate CR . . . . . . . 15lithium citrate . . . . . . . . . . . . 15LITHOBID . . . . . . . . . . . . . . . . 15LO/OVRAL . . . . . . . . . . . . . . . 21

LODINE XL . . . . . . . . . . . . . . 29LODOSYN . . . . . . . . . . . . . . . 14LOESTRIN 1.5/30 . . . . . . . . . . 21LOESTRIN 1/20. . . . . . . . . . . . 21LOESTRIN FE . . . . . . . . . . . . . 21LOESTRIN FE 1.5/30 . . . . . . . . 21LOESTRIN-24 . . . . . . . . . . . . . 21LOFIBRA. . . . . . . . . . . . . . . . . 13LOPID. . . . . . . . . . . . . . . . . . . 13LOPRESS HCT. . . . . . . . . . . . . 11LOPRESSOR . . . . . . . . . . . . . . 11LOPROX cream/lotion/

suspension . . . . . . . . . . . . . 19LOPROX gel/shampoo . . . . . . 19LORABID . . . . . . . . . . . . . . . . 28lorazepam . . . . . . . . . . . . . . . 15LORCET . . . . . . . . . . . . . 16, 42LORCET HD . . . . . . . . . . . . . . 42LORCET PLUS. . . . . . . . . . 16, 42LORTAB . . . . . . . . . . . . . . 16, 42LORTAB ELIXIR . . . . . . . . . . . . 42LOTEMAX . . . . . . . . . . . . . . . 31LOTENSIN . . . . . . . . . . . . 10, 35LOTENSIN HCT . . . . . . . . . . . 11LOTREL . . . . . . . . . . . . . . . . . 11LOTRISONE . . . . . . . . . . . . . . 19LOTRONEX. . . . . . . . . . . . 24, 33lovastatin . . . . . . . . . . 13, 37, 41LOVENOX . . . . . . . . . . . . . . . 10low-ogestrel. . . . . . . . . . . . . . 21loxapine . . . . . . . . . . . . . . . . . 15LOZOL . . . . . . . . . . . . . . . . . . 14LUMIGAN . . . . . . . . . . . . . . . 31LUNESTA . . . . . . . . . . 17, 39, 42LUPRON . . . . . . . . . . . . . . . . . 9lutera . . . . . . . . . . . . . . . . . . . 21LUVOX. . . . . . . . . . . . . . . . . . 41LUXIQ . . . . . . . . . . . . . . . . . . 20LYNOX . . . . . . . . . . . . . . . 16, 42LYRICA. . . . . . . . . . . . 15, 38, 41LYSODREN . . . . . . . . . . . . . . . . 9LYTENSOPRIL . . . . . . . . . . . . . 10

MMACROBID . . . . . . . . . . . . . . 25MALARONE . . . . . . . . . . . 27, 33maldemar . . . . . . . . . . . . . . . 23maprotiline . . . . . . . . . . . 16, 38MARPLAN . . . . . . . . . . . . . . . 15MATULANE . . . . . . . . . . . . . . . 9MAVIK . . . . . . . . . . . . . . . 10, 35MAXAIR AUTOHALER . . . . . . 32MAXALT . . . . . . . . . . . . . 17, 40MAXALT MLT . . . . . . . . . . 17, 40MAXIDONE . . . . . . . . . . . 16, 42MAXZIDE . . . . . . . . . . . . . . . . 12MEBARAL . . . . . . . . . . . . . . . 15

mebendazole . . . . . . . . . . . . . 26meclofenamate sodium . . . . . 29medroxyprogesterone . . . . . . 23medroxyprogesterone

acetate . . . . . . . . . . . . . . . . 23mefloquine . . . . . . . . . . . 33, 26MEGACE . . . . . . . . . . . . . . . . . 9MEGACE ES. . . . . . . . . . . . . . . 9megestrol . . . . . . . . . . . . . . . . 9meloxicam . . . . . . . . . . . . . . . 29MENEST . . . . . . . . . . . . . . . . 22MENI-D . . . . . . . . . . . . . . . . . 23MENOPUR . . . . . . . . . . . . . . . 22MENOSTAR . . . . . . . . . . . 22, 37meperidine. . . . . . . . . . . . . . . 16meperidine/promethazine . . . 16mephobarbital . . . . . . . . . . . . 15meprobamate . . . . . . . . . . . . 15MEPRON . . . . . . . . . . . . . . . . 27meprozine . . . . . . . . . . . . . . . 16mercaptopurine . . . . . . . . . . . . 9mesalamine . . . . . . . . . . . . . . 24MESNEX . . . . . . . . . . . . . . . . . 9MESTINON. . . . . . . . . . . . . . . 29METADATE CD. . . . . . 18, 40, 42METADATE ER . . . . . . . . . 18, 40METAGLIP . . . . . . . . . . . . . . . 20metaproterenol nebulizer . . . . 32metaproterenol tab/syrup. . . . 32metformin . . . . . . . . . . . . . . . 20metformin ER. . . . . . . . . . . . . 20methadone . . . . . . . . . . . . . . 16methadose. . . . . . . . . . . . . . . 16methazolamide . . . . . . . . . . . 12methenamine hippurate. . . . . 25methenamine mandelate . . . . 25methimazole . . . . . . . . . . . . . 20methocarbamol . . . . . . . . . . . 29methotrexate . . . . . . . . . . . . . . 9methychlothiazide . . . . . . . . . 14methyldopa . . . . . . . . . . . . . . 10methyldopa/

hydrochlorothiazide . . . . . . 11methylin . . . . . . . . . . . . . 18, 40METHYLIN chew/soln. 18, 40, 42methylin ER . . . . . . . . . . . 18, 40methylphenidate . . . . 18, 40, 42methylphenidate

CR/ER/SR . . . . . . . . 18, 40, 42methylpred . . . . . . . . . . . . . . 22metipranolol . . . . . . . . . . . . . 30metoclopramide hcl . . . . . . . . 24metolazone . . . . . . . . . . . . . . 14metoprolol . . . . . . . . . . . . . . . 11metoprolol/

hydrochlorothiazide . . . . . . 11


METROCREAM. . . . . . . . . . . . 18METROGEL . . . . . . . . . . . . . . 18METROGEL VAGINAL . . . . . . . 26METROLOTION. . . . . . . . . . . . 18metronidazole . . . . . . . . . 18, 28metronidazole SR. . . . . . . . . . 28MEVACOR . . . . . . . . . 13, 37, 41mexiletine . . . . . . . . . . . . . . . 11MIACALCIN NASAL . . . . . . . . 29MICARDIS . . . . . . . . . . . . 10, 36MICARDIS HCT . . . . . . . . 11, 36microgestin 1.5/30. . . . . . . . . 21microgestin 1/20 . . . . . . . . . . 21microgestin FE 1.5/30 . . . . . . 21microgestin FE1/20 . . . . . . . . 21micronefrin . . . . . . . . . . . . . . 32MICROZIDE . . . . . . . . . . . . . . 14MIDAMOR . . . . . . . . . . . . . . . 13midazolam. . . . . . . . . . . . . . . 17MIGRANAL . . . . . . . . . . . 15, 38MINIPRESS . . . . . . . . . . . . . . 10minitran . . . . . . . . . . . . . . . . . 13MINIZIDE . . . . . . . . . . . . . . . . 11MINOCIN . . . . . . . . . . . . . 28, 34minocycline . . . . . . . . . . . 28, 34minoxidil . . . . . . . . . . . . . . . . 14MIRALAX . . . . . . . . . . . . . . . . 25MIRAPEX . . . . . . . . . . . . . . . . 14MIRCETTE . . . . . . . . . . . . . . . 21mirtazapine . . . . . . . . 14, 41, 42mirtazapine ODT . . . . . . . . . . 14misoprostol . . . . . . . . . . . . . . 25MOBIC. . . . . . . . . . . . . . . 29, 42MODICON 0.5/35 . . . . . . . . . 21MODURETIC . . . . . . . . . . . . . 12mometasone . . . . . . . . . . . . . 20MONARC-M . . . . . . . . . . . . . 33MONOCLATE-P . . . . . . . . . . . 33MONODOX . . . . . . . . . . . 29, 34MONOKET . . . . . . . . . . . . . . . 13mononessa . . . . . . . . . . . . . . 21MONONINE . . . . . . . . . . . . . . 33MONOPRIL. . . . . . . . . . . . 10, 35MONOPRIL HCT . . . . . . . . . . 11MONUROL . . . . . . . . . . . . . . . 25morphine sulfate . . . . . . . . . . 16morphine sulfate CR . . . . . . . 16MS CONTIN . . . . . . . . . . . . . 16mst 600 . . . . . . . . . . . . . . . . . 30MUCOMYST . . . . . . . . . . . . . 32mupirocin . . . . . . . . . . . . . . . 19MUSE. . . . . . . . . . . . . . . . . . . 13MYAMBUTOL . . . . . . . . . . . . 27MYFORTIC . . . . . . . . . . . . . . . 26MYLERAN . . . . . . . . . . . . . . . . 9MYLOCEL . . . . . . . . . . . . . . . . 9myrac . . . . . . . . . . . . . . . 29, 34

Nnabumetone . . . . . . . . . . . . . 29nadolol . . . . . . . . . . . . . . . . . 12NAFTIN . . . . . . . . . . . . . . . . . 19naltrexone . . . . . . . . . . . . . . . 14NAMENDA. . . . . . . . . . . . . . . 14NAPRELAN. . . . . . . . . . . . 29, 42naproxen . . . . . . . . . . . . . . . . 29NARDIL . . . . . . . . . . . . . . . . . 15NASACORT AQ . . . . . . . . 32, 42NASAREL . . . . . . . . . . . . . . . . 32NASONEX . . . . . . . . . . . . 32, 42NATURETIN . . . . . . . . . . . . . . 14NEBUPENT . . . . . . . . . . . . . . . 28necon 0.5/35 . . . . . . . . . . . . . 21necon 1/35 . . . . . . . . . . . . . . 21necon 1/50 . . . . . . . . . . . . . . 21necon 10/11 . . . . . . . . . . . . . 21necon 7/7/7 . . . . . . . . . . . . . . 21nefazodone . . . . . . . . . . . . . . 16NEOBENZ MICRO. . . . . . . . . . 18neomycin . . . . . . . . . . . . . . . . 26neomycin/bacitracin/

polymyxin . . . . . . . . . . . . . . 31neomycin/polymyxin/

bacitracin/hydrocortisone . . 31neomycin/polymyxin/

dexamethasone . . . . . . . . . 31neomycin/polymyxin/

gramicidin . . . . . . . . . . . . . 31neomycin/polymyxin/

hydrocortisone . . . . . . . . . . 31NEORAL . . . . . . . . . . . . . . . . 26NEULASTA . . . . . . . . . . . . . . . 10NEURONTIN . . . . . . . 16, 38, 41NEVANAC . . . . . . . . . . . . . . . 30NEXAVAR. . . . . . . . . . . . . . . . . 9NEXIUM. . . . . . . . 25, 34, 39, 42NIASPAN . . . . . . . . . . . . . . . . 13nicardipine. . . . . . . . . . . . 12, 41nifediac CC . . . . . . . . . . . 12, 36nifedical . . . . . . . . . . . . . . . . . 12nifedical XL . . . . . . . . . . . . . . 36nifedipine . . . . . . . . . . . . 12, 41nifedipine CR/ER/SR . . . . . 12, 36nifedipine extended release . . 41NILANDRON . . . . . . . . . . . . . . 9NIMOTOP. . . . . . . . . . . . . . . . 12NIRAVAM. . . . . . . . . . . . . . . . 15nitrates . . . . . . . . . . . . . . . . . 41nitrek . . . . . . . . . . . . . . . . . . . 13NITROBID . . . . . . . . . . . . . . . . 13NITRO-DUR . . . . . . . . . . . . . . 13nitrofurantoin . . . . . . . . . . . . 25nitrofurantoin monohydrate

macrocrystal . . . . . . . . . . . . 25

NITROGARD . . . . . . . . . . . . . 13nitroglycerin. . . . . . . . . . . . . . 13nitroglycerin CR . . . . . . . . . . . 13nitroglycerin SL . . . . . . . . . . . 13NITROLINGUAL . . . . . . . . . . . 13nitroquick . . . . . . . . . . . . . . . 13NITROSTAT . . . . . . . . . . . . . . 13nitrotab . . . . . . . . . . . . . . . . . 13nitro-time. . . . . . . . . . . . . . . . 13nitro-transderm . . . . . . . . . . . 13nizatidine . . . . . . . . . . . . . . . . 24NOLVADEX. . . . . . . . . . . . . . . . 9nora-be . . . . . . . . . . . . . . . . . 23NORCO . . . . . . . . . . . . . . 16, 42NORDETTE . . . . . . . . . . . . . . 21NORDITROPIN . . . . . . . . . 22, 33norethindrone acetate . . . . . . 23NORINYL 1+35. . . . . . . . . . . . 21NORINYL 1+50. . . . . . . . . . . . 21NORITATE. . . . . . . . . . . . . . . . 18NOROXIN. . . . . . . . . . . . . 28, 33NORPACE. . . . . . . . . . . . . . . . 10NOR-QD . . . . . . . . . . . . . . . . 23nortrel 0.5/35 . . . . . . . . . . . . 21nortrel 1/35 . . . . . . . . . . . . . . 21nortrel 7/7/7 . . . . . . . . . . . . . 21nortriptyline . . . . . . . . . . . . . . 18NORVASC . . . . . . . . . 12, 36, 41NORVIR . . . . . . . . . . . . . . . . . 27NOVOLIN 70/30 . . . . . . . . 23, 41NOVOLIN N . . . . . . . . . . 23, 41NOVOLIN R . . . . . . . . . . . 23, 41NOVOLOG . . . . . . . . . . . . . . . 23NOVOLOG MIX 70/30 . . . . . . 23NOVOSEVEN . . . . . . . . . . . . . 33NULYTELY. . . . . . . . . . . . . . . . 25NUOX . . . . . . . . . . . . . . . . . . 18NUTROPIN . . . . . . . . . . . . 22, 33NUTROPIN AQ . . . . . . . . . 22, 33NUVARING. . . . . . . . . . . . . . . 20NUZON . . . . . . . . . . . . . . . . . 20nystatin . . . . . . . . . . . . . . 19, 26nystatin vaginal . . . . . . . . . . . 26nystatin/triamcinolone . . . . . . 19

Oofloxacin . . . . . . . . . . 28, 31, 33OGEN . . . . . . . . . . . . . . . . . . 22ogestrel . . . . . . . . . . . . . . . . . 21OLUX . . . . . . . . . . . . . . . . . . . 20OMACOR. . . . . . . . . . . . . . . . 13omeprazole . . . . . . . . 25, 34, 39OMNICEF . . . . . . . . . . . . . . . . 27ondansetron . . . . . . . . . . . . . 41ONE TOUCH BASIC/

PROFILE/ONE TOUCH II test strips . . . . . . . . . . . . . . 22

Index


ONE TOUCH FAST TAKE test strips . . . . . . . . . . . . . . 22

ONE TOUCH SURE STEP test strips . . . . . . . . . . . . . . 22

ONE TOUCH ULTRA test strips . . . . . . . . . . . . . . 22

OPANA . . . . . . . . . . . . . . . . . 16OPANA ER . . . . . . . . . . . . 16, 38OPTIPRANOLOL . . . . . . . . . . . 30OPTIVAR . . . . . . . . . . . . . . . . 30ORACEA . . . . . . . . . . 20, 34, 39ORAMORPH SR . . . . . . . . . . . 16ORAP . . . . . . . . . . . . . . . . . . . 15ORAPRED. . . . . . . . . . . . . . . . 22ORFADIN . . . . . . . . . . . . . 23, 33orphenadrine cpd . . . . . . . . . 29orphenadrine ER . . . . . . . . . . 29orphenadrine/aspirin/

caffeine . . . . . . . . . . . . . . . 29orphengesic . . . . . . . . . . . . . . 29orphengesic forte. . . . . . . . . . 29ORTHO EVRA. . . . . . . . . . . . . 20ORTHO MICRONOR . . . . . . . 23ORTHO TRI-CYCLEN. . . . . . . . 21ORTHO TRI-CYCLEN LO . . . . 21ORTHO-CEPT . . . . . . . . . . . . . 21ORTHO-CYCLEN . . . . . . . . . . 21ortho-est . . . . . . . . . . . . . . . . 22ORTHO-NOVUM 1/35 . . . . . . 21ORTHO-NOVUM 1/50 . . . . . . 21ORTHO-NOVUM 10/11 . . . . . 21ORTHO-NOVUM 7/7/7 . . . . . . 21ORUVAIL ER . . . . . . . . . . . . . . 29OSMOPREP . . . . . . . . . . . . . . 25OVACE. . . . . . . . . . . . . . . . . . 19OVCON 50 . . . . . . . . . . . . . . 21OVCON-35 . . . . . . . . . . . . . . 21oxaprozin. . . . . . . . . . . . . . . . 29oxazepam . . . . . . . . . . . . . . . 15OXISTAT. . . . . . . . . . . . . . . . . 19OXSORALEN-UL . . . . . . . . . . 19oxybutynin . . . . . . . . . . . . . . . 26oxycodone . . . . . . . . . . . . . . . 42oxycodone SR . . . . . . 16, 38, 42oxycodone/

acetaminophen. . . . . . . 16, 42oxycodone/aspirin . . . . . . 16, 42OXYCONTIN . . . . . . . . . . . . . 42OXYCONTIN CR . . . . . . . 16, 38oxyfast . . . . . . . . . . . . . . . . . . 16OXYIR . . . . . . . . . . . . . . . . . . 16oxytetracycline . . . . . . . . . . . . 34OXYTROL. . . . . . . . . . . . . 26, 42

PPACERONE. . . . . . . . . . . . . . . 11PALCAPS . . . . . . . . . . . . . . . . 24

pancreatin . . . . . . . . . . . . . . . 24pancrelipase. . . . . . . . . . . . . . 24PANIXINE . . . . . . . . . . . . . . . . 27PANOCAPS . . . . . . . . . . . . . . 24panoxyl . . . . . . . . . . . . . . . . . 18panoxyl AQ . . . . . . . . . . . . . . 18PANRETIN. . . . . . . . . . . . . . . . 19papaverine ER . . . . . . . . . . . . 13PARCOPA. . . . . . . . . . . . . . . . 14paregoric . . . . . . . . . . . . . . . . 24PARLODEL . . . . . . . . . . . . . . . 15PARNATE . . . . . . . . . . . . . . . . 15paromomycin. . . . . . . . . . . . . 26paroxetine . . . . . . 17, 39, 41, 42PATANOL . . . . . . . . . . . . . . . . 30PAXIL . . . . . . . . . . . . . 17, 39, 41PAXIL CR . . . . . . . . . . . . . 17, 41PCE . . . . . . . . . . . . . . . . . . . . 27peg 3350. . . . . . . . . . . . . . . . 25PEGASYS . . . . . . . . . . . . . 28, 33PEG-INTRON . . . . . . . . . . 28, 33penicillin VK. . . . . . . . . . . . . . 28PENLAC . . . . . . . . . . . . . . . . 19PENLAC NAIL LACQUER. . . . . 33PENTASA . . . . . . . . . . . . . 24, 38pentazocine/

acetaminophen. . . . . . . 17, 42pentazocine/naloxone . . . . . . 17PEPCID . . . . . . . . . . . . . . . . . 24PEPCID RPD . . . . . . . . . . . . . . 24PERCOCET . . . . . . . . . . . . 17, 42PERCODAN . . . . . . . . . . . 17, 42percolone. . . . . . . . . . . . . . . . 16pergolide . . . . . . . . . . . . . . . . 15PERIOSTAT . . . . . . . . . . . . 29, 34PERMAX . . . . . . . . . . . . . . . . 15permethrin. . . . . . . . . . . . . . . 20perphenazine . . . . . . . . . . . . . 17perphenazine/amitriptyline . . . 15PERSANTINE. . . . . . . . . . . . . . 10PEXEVA . . . . . . . . . . 17, 39, 41phenadoz. . . . . . . . . . . . . . . . 31phenazopyridine hcl . . . . . . . . 25phenobarbital . . . . . . . . . . . . 15phentolamine. . . . . . . . . . . . . 10phenytoin extended . . . . . . . . 15phenytoin sodium . . . . . . . . . 15PHOSLO. . . . . . . . . . . . . . . . . 25PHOSPHOLINE . . . . . . . . . . . . 30PHOTOFRIN . . . . . . . . . . . . . . . 9phrenilin/caffeine/codeine . . . 17pilocar . . . . . . . . . . . . . . . . . . 30pilocarpine. . . . . . . . . . . . 30, 32PILOPINE HS. . . . . . . . . . . . . . 30piloptic. . . . . . . . . . . . . . . . . . 30pindolol . . . . . . . . . . . . . . . . . 12

piroxicam. . . . . . . . . . . . . . . . 30PLAQUENIL . . . . . . . . . . . . . . 33PLAVIX . . . . . . . . . . . . . . . . . . 10PLENDIL . . . . . . . . . . . . . . 12, 36PLETAL . . . . . . . . . . . . . . . . . 10PLEXION cloth . . . . . . . . . . . . 18PLEXION emulsion . . . . . . . . . 18PLEXION SCT . . . . . . . . . . . . . 18PLEXION TS . . . . . . . . . . . . . . 18podocon . . . . . . . . . . . . . . . . 20podofilox . . . . . . . . . . . . . . . . 20poly-dex. . . . . . . . . . . . . . . . . 31polyethylene glycol . . . . . . . . 25polymyxin B/trimethoprim . . . 31POLY-PRED . . . . . . . . . . . . . . 31PONSTEL . . . . . . . . . . . . . . . . 30portia. . . . . . . . . . . . . . . . . . . 21PRANDIN . . . . . . . . . . . . . . . . 23prascion . . . . . . . . . . . . . . . . . 19PRAVACHOL . . . . . . . 13, 37, 41pravastatin. . . . . . . . . 13, 37, 41PRAZOLAMINE . . . . . . . . . . . . 29prazosin . . . . . . . . . . . . . . . . . 10PRECISION Q-I-D test strips . . 22PRECISION SOF-TACT

test strips . . . . . . . . . . . . . . 22PRECISION XTRA KETONE

test strips . . . . . . . . . . . . . . 22PRECISION XTRA test strips . . 22PRECOSE . . . . . . . . . . . . . . . . 20PRED-G . . . . . . . . . . . . . . . . . 31PRED-G S.O.P . . . . . . . . . . . . 31prednisolone . . . . . . . . . . 22, 31prednisone. . . . . . . . . . . . . . . 22PREFEST . . . . . . . . . . . . . . . . . 22PREMARIN . . . . . . . . . . . . . . . 22PREMARIN VAGINAL . . . . . . . 26PREMPHASE . . . . . . . . . . . . . 22PREMPRO. . . . . . . . . . . . . . . . 22PREVACID . . . . . . 25, 34, 39, 42PREVACID NAPRAPAC . . . 30, 34PREVACID SOLUTAB. . . . . 25, 39prevalite. . . . . . . . . . . . . . . . . 12previfem . . . . . . . . . . . . . . . . 21PREVPAC . . . . . . . . . . . . . 25, 40PREZISTA . . . . . . . . . . . . . . . . 27PRILOSEC. . . . . . . 25, 34, 39, 42primaquine . . . . . . . . . . . . . . 26primidone . . . . . . . . . . . . . . . 16principen . . . . . . . . . . . . . . . . 26PRINIVIL . . . . . . . . . . . . . . 10, 35PRINZIDE . . . . . . . . . . . . . . . . 11probenecid/colchicine. . . . . . . 29procainamide . . . . . . . . . . . . . 11procainamide ER . . . . . . . . . . 11PROCANBID . . . . . . . . . . . . . 11


PROCARDIA . . . . . . . . . . 12, 41PROCARDIA XL . . . . . 12, 36, 41PROCHIEVE . . . . . . . . . . . . . . 26prochlorperazine . . . . . . . . . . 17PROCRIT . . . . . . . . . . . . . . . . 10proctocream hc . . . . . . . . . . . 25proctosert . . . . . . . . . . . . . . . 25proctosol . . . . . . . . . . . . . . . 25proctosol hc. . . . . . . . . . . . . . 25PROFILNINE . . . . . . . . . . . . . . 33PROFILNINE SD. . . . . . . . . . . . 33PROGESTERONE VAGINAL . . 26PROGLYCEM . . . . . . . . . . . . . 21PROGRAF. . . . . . . . . . . . . . . . 26PROLEUKIN . . . . . . . . . . . . . . . 9promethazine. . . . . . . . . . . . . 31promethegan . . . . . . . . . . . . . 31PROMETRIUM . . . . . . . . . . . . 23PRONESTYL . . . . . . . . . . . . . . 11PRONESTYL SR . . . . . . . . . . . 11propafenone . . . . . . . . . . . . . 11propanthelin . . . . . . . . . . . . . 24PROPINE. . . . . . . . . . . . . . . . . 30PROPLEX T . . . . . . . . . . . . . . . 33propoxyphene . . . . . . . . . . . . 16propoxyphene/

acetaminophen. . . . . . . . . . 17propoxyphene-N/

acetaminophen. . . . . . . 17, 42propranolol . . . . . . . . . . . . . . 12propranolol/

hydrochlorothiazide . . . . . . 11propylthiouracil . . . . . . . . . . . 20PROQUIN XR . . . . . . . . . . 28, 33PROSCAR. . . . . . . . . . . . . 25, 34PROTONIX . . . . . . 25, 34, 39, 42PROTOPIC . . . . . . . . . . . . 20, 41PROTROPIN . . . . . . . . . . . . . . 33PROVENTIL HFA . . . . . . . . . . . 32PROVIGIL . . . . . . . . . . 18, 33, 40PROZAC . . . . . . . . . . 17, 39, 41PROZAC WEEKLY . . . . . . 17, 42prudoxin . . . . . . . . . . . . . . . . 19PSORIATEC . . . . . . . . . . . . . . 19PULMICORT . . . . . . . . . . . . . . 41PULMICORT RESPULES . . . . . . 32PULMICORT TURBUHALER . . . 32PURINETHOL . . . . . . . . . . . . . . 9pyrazinamide . . . . . . . . . . . . . 27pyridostigmine . . . . . . . . . . . . 29

Qquasense . . . . . . . . . . . . . . . . 21QUESTRAN. . . . . . . . . . . . . . . 12quinapril . . . . . . . . . . 10, 35, 41quinapril/hctz . . . . . . . . . . . . . 41quinaretic. . . . . . . . . . . . . . . . 11

quinerva. . . . . . . . . . . . . . . . . 26quinidine gluconate . . . . . . . . 11quinidine sulfate . . . . . . . . . . 11quinine sulfate . . . . . . . . . . . . 26QUIXIN . . . . . . . . . . . . . . . . . 31QVAR. . . . . . . . . . . . . . . . . . . 32

RRANEXA . . . . . . . . . . 10, 35, 41RANICLOR . . . . . . . . . . . . . . . 27ranitidine . . . . . . . . . . . . . . . . 24RAPAMUNE . . . . . . . . . . . . . . 26RAPIFLUX . . . . . . . . . . . . . . . . 17RAPTIVA. . . . . . . . . . . . . . . . . 19rauwolfia/

bendroflumethiazide. . . . . . 11RAZADYNE . . . . . . . . . . . . . . 14RAZADYNE ER . . . . . . . . . . . 14REBETOL . . . . . . . . . . . . . . . . 28REBIF . . . . . . . . . . . . . . . . . . . 16reclipsen . . . . . . . . . . . . . . . . 21RECOMBINATE. . . . . . . . . . . . 33REFACTO . . . . . . . . . . . . . . . . 33RELAFEN . . . . . . . . . . . . . . . . 30RELENZA . . . . . . . . . . . . . 28, 37RELION 70/30 . . . . . . . . . 23, 41RELION N . . . . . . . . . . . . 23, 41RELION R . . . . . . . . . . . . 23, 41RELPAX . . . . . . . . . . . . . . 17, 40REMERON . . . . . . . . . . . . 14, 42REMERON SOLUTAB . . . . 14, 42REMICADE . . . . . . . . . . . . . . . 24RENAGEL . . . . . . . . . . . . . . . . 25REPREXAIN . . . . . . . . . . . 17, 42REPRONEX . . . . . . . . . . . . . . . 22REQUIP . . . . . . . . . . . . . . . . . 15RESCRIPTOR. . . . . . . . . . . . . . 27reserpine . . . . . . . . . . . . . . . . 10RESTASIS . . . . . . . . . . . . . . . . 31RETIN-A . . . . . . . . . . . . . . 19, 33RETIN-A MICRO . . . . . . . . 19, 33RETROVIR. . . . . . . . . . . . . . . . 27REVATIO. . . . . . . . . . . . . . 13, 34REV-EYES . . . . . . . . . . . . . . . . 30REVLEMID . . . . . . . . . . . . . . . . 9REYATAZ . . . . . . . . . . . . . . . . 27RHEUMATREX . . . . . . . . . . . . 29RHINOCORT AQ. . . . . . . . 32, 42ribasphere . . . . . . . . . . . . . . . 28ribavirin . . . . . . . . . . . . . . . . . 28RIDAURA . . . . . . . . . . . . . . . . 29RIFAMATE . . . . . . . . . . . . . . . 26rifampin . . . . . . . . . . . . . . . . . 27RIFATER . . . . . . . . . . . . . . . . . 26RILUTEK . . . . . . . . . . . . . . . . . 14rimantadine . . . . . . . . . . . . . . 28RIMSO . . . . . . . . . . . . . . . . . . 25

RIOMET . . . . . . . . . . . . . . . . . 20RISPERDAL . . . . . . . . . . . . 15, 36RISPERDAL CONSTA. . . . . . . . 15RISPERDAL M. . . . . . . . . . 15, 36RITALIN . . . . . . . . . . . . . . 18, 40RITALIN LA. . . . . . . . . 18, 40, 42RITALIN SR . . . . . . . . . 18, 40, 42ROFERON-A . . . . . . . . . . . 9, 33ROSAC. . . . . . . . . . . . . . . . . . 19rosaderm . . . . . . . . . . . . . . . . 19rosanil . . . . . . . . . . . . . . . . . . 19ROSULA . . . . . . . . . . . . . . . . 19ROSULA NS . . . . . . . . . . . . . . 19ROWASA (enema only) . . . . . 24ROXICET . . . . . . . . . . . . . 17, 42ROZEREM . . . . . . . . . 17, 39, 42ROZEX . . . . . . . . . . . . . . . . . . 19RYTHMOL . . . . . . . . . . . . . . . 11RYTHMOL SR . . . . . . . . . . . . . 11

SSAIZEN . . . . . . . . . . . . . . 22, 33SALAGEN. . . . . . . . . . . . . . . . 32salflex . . . . . . . . . . . . . . . . . . 30salsalate . . . . . . . . . . . . . . . . . 30SANCTURA . . . . . . . . . . . 26, 42SANDIMMUNE . . . . . . . . . . . . 26SARAFEM . . . . . . . . . . . . 17, 39SEASONALE . . . . . . . . . . . . . 21SEBIZON. . . . . . . . . . . . . . . . . 19SECONAL. . . . . . . . . . . . . . . . 15SECTRAL . . . . . . . . . . . . . . . . 11selegiline . . . . . . . . . . . . . . . . 15selenium sulfide . . . . . . . . . . . 19SEMPREX D . . . . . . . . 32, 33, 36SENOPHYLLINE. . . . . . . . . . . . 32SENSIPAR . . . . . . . . . . . . . . . . 23SEREVENT . . . . . . . . . . . . . . . 41SEREVENT DISKUS . . . . . . . . . 32SEROQUEL . . . . . . . . . . . . 15, 37SEROSTIM . . . . . . . . . . . . 22, 33sertraline . . . . . . . . . . 17, 41, 42simvastatin. . . . . . . . . 13, 37, 41SINEMET . . . . . . . . . . . . . . . . 15SINEMET CR. . . . . . . . . . . . . . 15SINGULAIR . . . . . . . . . . . 32, 38SKELAXIN. . . . . . . . . . . . . . . . 29SKELID . . . . . . . . . . . . . . . . . 29sodium sulfacetamide/sulfur. . 19SOLARAZE . . . . . . . . . . . . . . . 19solia . . . . . . . . . . . . . . . . . . . . 21SOLODYN . . . . . . . . . . . . 29, 34SOMAVERT . . . . . . . . . . . . . . 22SONATA. . . . . . . . . . . 17, 39, 42SORIATANE . . . . . . . . . . . . . . 19sorine. . . . . . . . . . . . . . . . . . . 12sotalol AF. . . . . . . . . . . . . . . . 12

Index


sotalol hcl . . . . . . . . . . . . . . . 12sotret. . . . . . . . . . . . . 19, 35, 41SPECTRACEF . . . . . . . . . . . . . 27SPIRIVA . . . . . . . . . . . . . . . . . 31spironolactone . . . . . . . . . . . . 13spironolactone/

hydrochlorothiazide . . . . . . 12SPORANOX . . . . . . . . . . . 28, 33sprintex . . . . . . . . . . . . . . . . . 21sronyx . . . . . . . . . . . . . . . . . . 21STADOL NS . . . . . . . . . . . . . . 38STAFLEX. . . . . . . . . . . . . . . . . 17STAGESIC. . . . . . . . . . . . . . . . 17STALEVO . . . . . . . . . . . . . . . . 15STARLIX . . . . . . . . . . . . . . . . . 20STIMATE . . . . . . . . . . . . . . . . 23STRATTERA . . . . . . . . 18, 40, 42STRAZEPAM . . . . . . . . . . . . . . 17STRIANT. . . . . . . . . . . . . . . . . 20SUBOXONE . . . . . . . . . . . . . . 17SUBUTEX . . . . . . . . . . . . . . . . 17sucralfate . . . . . . . . . . . . . . . . 25SULAR . . . . . . . . . . . . . . . . . . 37SULAR . . . . . . . . . . . . . . . . . . 12sulfacetamide sodium . . . 19, 31sulfacetamide

sodium/prednisolone . . . . . 31SULFACET-R . . . . . . . . . . . . . . 19sulfadiazine . . . . . . . . . . . . . . 28sulfasalazine . . . . . . . . . . 24, 38sulfasalazine EC . . . . . . . . . . . 38sulfasalazine ER . . . . . . . . . . . 24sulfatol. . . . . . . . . . . . . . . . . . 19sulfazine . . . . . . . . . . . . . 24, 38sulfazine EC . . . . . . . . . . . 24, 38sulfisoxazole. . . . . . . . . . . . . . 28SULFOXYL . . . . . . . . . . . . . . . 19sulfurated lime solution . . . . . 20sulindac . . . . . . . . . . . . . . . . . 30SUMYCIN . . . . . . . . . . . . 29, 34suphera . . . . . . . . . . . . . . . . . 19SUPRAX . . . . . . . . . . . . . . . . 27SUSTIVA. . . . . . . . . . . . . . . . . 27SUTENT . . . . . . . . . . . . . . . . . . 9SYMAX DUOTAB . . . . . . . . . . 24symax SL . . . . . . . . . . . . . . . . 24symax SR . . . . . . . . . . . . . . . . 24SYMBYAX . . . . . . . . . . . . 15, 37SYMLIN . . . . . . . . . . . . . . . . . 23SYMMETREL . . . . . . . . . . . . . 15SYNAGIS . . . . . . . . . . . . . . . . 34SYNALGOS DC . . . . . . . . . . . 17SYNERA . . . . . . . . . . . . . . . . . 20syntest D.S. . . . . . . . . . . . . . . 22syntest H.S. . . . . . . . . . . . . . . 22SYNTHROID . . . . . . . . . . . . . 23

TTABLOID . . . . . . . . . . . . . . . . . 9TACLONEX. . . . . . . . . . . . 20, 41TAGAMET . . . . . . . . . . . . . . . 24TALACEN . . . . . . . . . . . . . 17, 42TALWIN NX . . . . . . . . . . . . . . 17TAMBOCOR . . . . . . . . . . . . . . 11TAMIFLU . . . . . . . . . . . . . 28, 37tamoxifen . . . . . . . . . . . . . . . . 9TAPAZOLE . . . . . . . . . . . . . . . 20TARCEVA . . . . . . . . . . . . . . . . . 9TARGRETIN . . . . . . . . . . . . 9, 19TARKA . . . . . . . . . . . . . . . . . . 11TASMAR . . . . . . . . . . . . . . . . 14TAZORAC. . . . . . . . . . . . . 19, 41taztia XT . . . . . . . . . . . . . 12, 36tebamide . . . . . . . . . . . . . . . . 24TEGRETOL . . . . . . . . . . . . . . . 16TEGRETOL XR . . . . . . . . . . . . 16temazepam . . . . . . . . . . . . . . 17TEMODAR . . . . . . . . . . . . . . . . 9TENEX . . . . . . . . . . . . . . . . . . 10TENORETIC . . . . . . . . . . . . . . 11TENORMIN. . . . . . . . . . . . . . . 11TEQUIN . . . . . . . . . . . . . . 28, 33TERAZOL . . . . . . . . . . . . . . . . 26terazosin . . . . . . . . . . . . . . . . 10terbutaline . . . . . . . . . . . . . . . 32terconazole . . . . . . . . . . . . . . 26TESLAC . . . . . . . . . . . . . . . . . . 9TEST STRIPS

(all other brands) . . . . . . . . 22TESTIM . . . . . . . . . . . . . . . . . 20testosterone. . . . . . . . . . . . . . 20tetracycline . . . . . . . . . . . 29, 34TEVETEN . . . . . . . . . . . . . 10, 36TEVETEN HCT . . . . . . . . . . . . 11TEV-TROPIN . . . . . . . . . . . 22, 33THALITONE . . . . . . . . . . . . . . 14THALOMID. . . . . . . . . . . . . . . . 9THEO-24 . . . . . . . . . . . . . . . . 32theocap . . . . . . . . . . . . . . . . . 32theochron . . . . . . . . . . . . . . . 32theophylline ER . . . . . . . . . . . 32THERACYS . . . . . . . . . . . . . . . . 9THERAPROXEN. . . . . . . . . . . . 30thioridazine . . . . . . . . . . . . . . 17thiothixene. . . . . . . . . . . . . . . 18THYROLAR. . . . . . . . . . . . . . . 23TIAZAC . . . . . . . . . . . . . . 12, 41TICE BCG. . . . . . . . . . . . . . . . . 9TIKOSYN . . . . . . . . . . . . . . . . 11TILADE . . . . . . . . . . . . . . . . . 32TIMOLIDE. . . . . . . . . . . . . . . . 11timolol . . . . . . . . . . . . . . . . . . 30timolol maleate . . . . . . . . . . . 12

timolol maleate ophth . . . . . . 30TINDAMAX . . . . . . . . . . . . . . 28tioconazole . . . . . . . . . . . . . . 26tizanidine . . . . . . . . . . . . . . . . 29TOBI. . . . . . . . . . . . . . . . . . . . 26TOBRADEX. . . . . . . . . . . . . . . 31tobramycin. . . . . . . . . . . . . . . 31tolazamide . . . . . . . . . . . . . . . 23tolbutamide . . . . . . . . . . . . . . 23TOLECTIN. . . . . . . . . . . . . . . . 30tolmetin sodium. . . . . . . . . . . 30TOPAMAX . . . . . . . . . . . . . . . 16TOPROL XL . . . . . . . . . . . . . . 11torsemide. . . . . . . . . . . . . . . . 13TRACLEER . . . . . . . . . . . . 13, 34tramadol . . . . . . . . . . . . . . . . 42tramadol hcl . . . . . . . . . . . . . 16tramadol/acetaminophen . . . . 17TRANDATE . . . . . . . . . . . . . . . 10TRANSDERM

SCOPOLAMINE . . . . . . . . . . 23tranylcypromine sulfate . . . . . 15TRAVATAN . . . . . . . . . . . . . . . 31TRAZAMINE . . . . . . . . . . . . . . 16trazodone . . . . . . . . . 16, 41, 42tretinoin. . . . . . . . . . . . . . 19, 33tretinoin-x cream kit. . . . . . . . 33TREXALL . . . . . . . . . . . . . . . . . 9triamcinolone. . . . . . . . . . . . . 20triamterene/

hydrochlorothiazide . . . . . . 12TRIAZ . . . . . . . . . . . . . . . . . . . 19triazolam . . . . . . . . . . . . . . . . 17TRICOR . . . . . . . . . . . . . . . . . 13tricosal . . . . . . . . . . . . . . . . . . 30trifluoperazine . . . . . . . . . . . . 17trifluridine . . . . . . . . . . . . . . . 31TRIGLIDE . . . . . . . . . . . . . . . . 13trihexyphenidyl. . . . . . . . . . . . 14TRILEPTAL . . . . . . . . . . . . . . . 16TRI-LEVLEN. . . . . . . . . . . . . . . 21trilyte . . . . . . . . . . . . . . . . . . . 25trimethobenzamide . . . . . . . . 23trimethoprim . . . . . . . . . . . . . 28trimox . . . . . . . . . . . . . . . . . . 26TRINALIN . . . . . . . . . . . . . . . . 32trinessa . . . . . . . . . . . . . . . . . 21TRI-NORINYL . . . . . . . . . . . . . 21TRINSICON. . . . . . . . . . . . . . . 10TRIPHASIL . . . . . . . . . . . . . . . 21triple antibiotic. . . . . . . . . . . . 31tri-previfem . . . . . . . . . . . . . . 21tri-sprintec . . . . . . . . . . . . . . . 21trivora . . . . . . . . . . . . . . . . . . 21TRIZIVIR . . . . . . . . . . . . . . . . . 27TRUSOPT . . . . . . . . . . . . . . . . 30

TRUVADA . . . . . . . . . . . . . . . 27TRYCET . . . . . . . . . . . . . . 17, 42TUSSIONEX . . . . . . . . . . . . . . 32TWINJECT . . . . . . . . . . . . . . . 10TYLENOL #3. . . . . . . . . . . . . . 42TYLENOL/CODEINE. . . . . . . . . 17TYLOX . . . . . . . . . . . . . . . 17, 42

UULTRACAPS . . . . . . . . . . . . . . 24ULTRACET . . . . . . . . . . . . . . . 17ULTRAM . . . . . . . . . . . . . 16, 42ULTRAM ER . . . . . . . . . . . 16, 42ULTRASE . . . . . . . . . . . . . . . . 24ULTRASE MT . . . . . . . . . . . . . 24ULTRAVATE . . . . . . . . . . . . . . 20UNIPHYL . . . . . . . . . . . . . . . . 32UNIRETIC . . . . . . . . . . . . . . . . 11UNI-SERP . . . . . . . . . . . . . . . . 11UNITHROID . . . . . . . . . . . . . . 23UNIVASC . . . . . . . . . . . . . 10, 35URECHOLINE . . . . . . . . . . . . . 26URELLE . . . . . . . . . . . . . . . . . 25UREX . . . . . . . . . . . . . . . . . . . 25urimar T . . . . . . . . . . . . . . . . . 25urin D/S . . . . . . . . . . . . . . . . . 25uriseptic . . . . . . . . . . . . . . . . . 25URISPAS . . . . . . . . . . . . . . . . . 26uro blue. . . . . . . . . . . . . . . . . 25urogesic blue . . . . . . . . . . . . . 25UROXATRAL . . . . . . . . . . 25, 34URSO 250 . . . . . . . . . . . . . . . 24URSO FORTE . . . . . . . . . . . . . 24ursodiol . . . . . . . . . . . . . . . . . 24UTA . . . . . . . . . . . . . . . . . . . 25UVADEX . . . . . . . . . . . . . . . . . 9

VVAGIFEM . . . . . . . . . . . . . . . . 26VALCYTE . . . . . . . . . . . . . . . . 27VALTREX . . . . . . . . . . . . . . . . 28VANACHOL . . . . . . . . . . . . . . 13vanatrip . . . . . . . . . . . . . . . . . 18vandazole . . . . . . . . . . . . . . . 26VANOS. . . . . . . . . . . . . . . . . . 20VANOXIDE-HC . . . . . . . . . . . . 19VANTIN . . . . . . . . . . . . . . . . . 27VASERETIC . . . . . . . . . . . . . . 11VASODILAN . . . . . . . . . . . . . 13VASOTEC. . . . . . . . . . . . . 10, 35veetids . . . . . . . . . . . . . . . . . . 28velivet . . . . . . . . . . . . . . . . . . 21venlafaxine . . . . . 18, 39, 41, 42VENTAVIS. . . . . . . . . . . . . 13, 34VENTOLIN HFA. . . . . . . . . . . . 32VEPESID . . . . . . . . . . . . . . . . . . 9

verapamil . . . . . . . . . . . . . 12, 41verapamil ER/SR . . . . . . . . 12, 36verapamil extended release . . 41VERELAN . . . . . . . . . . . . . 12, 41VERELAN PM . . . . . . . . . . 12, 37VERELAN SR. . . . . . . . . . . . . . 36VESANOID . . . . . . . . . . . . . . . . 9VESICARE . . . . . . . . . . . . 26, 42VEXOL . . . . . . . . . . . . . . . . . . 31VFEND . . . . . . . . . . . . . . . . . . 33VFEND . . . . . . . . . . . . . . . . . . 28VIAGRA . . . . . . . . . . . . . . . . 13VIBRAMYCIN . . . . . . . . . . 29, 34VIBRATAB. . . . . . . . . . . . . 29, 34VICODIN . . . . . . . . . . . . . 17, 42VICODIN ES . . . . . . . . . . . 17, 42vicodin HP . . . . . . . . . . . . 17, 42VICOPROFEN . . . . . . . . . . 17, 42VIDEX . . . . . . . . . . . . . . . . . . 27VIDEX EC . . . . . . . . . . . . . . . . 27VIGAMOX . . . . . . . . . . . . . . . 31VIOKASE . . . . . . . . . . . . . . . . 24VIRACEPT. . . . . . . . . . . . . . . . 27VIRAMUNE. . . . . . . . . . . . . . . 27VIRAZOLE. . . . . . . . . . . . . . . . 28VIREAD . . . . . . . . . . . . . . . . . 27VISICOL . . . . . . . . . . . . . . . . . 25VIVELLE . . . . . . . . . . . . . . 22, 37VIVELLE-DOT . . . . . . . . . . 22, 37VIVOTIF BERNIA EC . . . . . . . . 34VOLTAREN . . . . . . . . . . . . . . . 30VOLTAREN XR . . . . . . . . . . . . 30VOPAC. . . . . . . . . . . . . . . 17, 42vospire ER . . . . . . . . . . . . . . . 32VUSION . . . . . . . . . . . . . . . . . 19VYTORIN . . . . . . . . . . 11, 36, 41

Wwarfarin . . . . . . . . . . . . . . . . . . 9WELCHOL . . . . . . . . . . . . . . . 12WELLBUTRIN . . . . . . . 16, 38, 42WELLBUTRIN SR. . . . . 16, 38, 42WELLBUTRIN XL. . . . . 16, 38, 42

XXALATAN . . . . . . . . . . . . . . . . 31XANAX XR. . . . . . . . . . . . . . . 15XELODA . . . . . . . . . . . . . . . . . 9XIBROM. . . . . . . . . . . . . . . . . 30XIFAXAN . . . . . . . . . . 28, 33, 36XODOL . . . . . . . . . . . . . . 17, 42XOLAIR . . . . . . . . . . . . . . . . . 31XOPENEX . . . . . . . . . . . . . . . . 32XOPENEX HFA . . . . . . . . . . . . 32XOPENEX

solution/concentrate . . . . . 41XYREM . . . . . . . . . . . . . . 14, 33

YYASMIN . . . . . . . . . . . . . . . . . 21YAZ . . . . . . . . . . . . . . . . . . . . 21YODOXIN. . . . . . . . . . . . . . . . 26

ZZADITOR . . . . . . . . . . . . . . . . 30ZANAFLEX . . . . . . . . . . . . . . . 29ZANTAC (all other forms) . . . 24ZANTAC syrup . . . . . . . . . . . . 24ZARONTIN . . . . . . . . . . . . . . . 18ZAROXOLYN . . . . . . . . . . . . . 14ZAVESCA . . . . . . . . . . . . . 9, 33ZAZOLE . . . . . . . . . . . . . . . . . 26Z-CLINZ . . . . . . . . . . . . . . . . . 19ZEBETA . . . . . . . . . . . . . . . . . 11ZEGERID . . . . . . . 25, 34, 39, 42ZELNORM . . . . . . . . . . . . . . . 24ZEMPLAR . . . . . . . . . . . . . . . . 23ZERIT . . . . . . . . . . . . . . . . . . . 27zero-order . . . . . . . . . . . . . . . 30ZESTORETIC . . . . . . . . . . . . . . 11ZESTRIL . . . . . . . . . . . . . . 10, 35ZETIA . . . . . . . . . . . . . . . . 13, 38ZIAC . . . . . . . . . . . . . . . . . . . 11ZIAGEN . . . . . . . . . . . . . . . . . 27zidovudine . . . . . . . . . . . . . . . 27ZITHROMAX . . . . . . . . . . . . . 27ZMAX . . . . . . . . . . . . . . . . . . 27ZOCOR . . . . . . . . . . . 13, 37, 41ZODERM . . . . . . . . . . . . . . . . 19ZOFRAN. . . . . . . . . . . 23, 35, 41ZOFRAN ODT . . . . . . . . . . 23, 35ZOLADEX . . . . . . . . . . . . . . . . . 9ZOLOFT . . . . . . . . . . . 17, 39, 42zolpidem . . . . . . . . . . . . . . . . 42ZOMIG. . . . . . . . . . . . . . . 17, 40ZOMIG ZMT . . . . . . . . . . 17, 40ZONALON . . . . . . . . . . . . . . . 19ZONEGRAN . . . . . . . . . . . . . . 16zonisamide. . . . . . . . . . . . . . . 16zovia1/35E . . . . . . . . . . . . . . . 21zovia1/50E . . . . . . . . . . . . . . . 21ZOVIRAX . . . . . . . . . . . . . 19, 28ZYDONE . . . . . . . . . . . . . 17, 42ZYFLO . . . . . . . . . . . . . . . 32, 38ZYLET. . . . . . . . . . . . . . . . . . . 31ZYMAR . . . . . . . . . . . . . . . . . 31ZYPREXA . . . . . . . . . . . . . 15, 37ZYPREXA ZYDIS . . . . . . . . 15, 37ZYRTEC . . . . . . . . . . 31, 33, 36ZYRTEC-D . . . . . . . . . 32, 33, 36ZYVOX. . . . . . . . . . . . . . . 28, 34


2007

05.05.303.1E (12/06) ©2006 Aetna Inc.

“Aetna” is the brand name used for products and services providedby one or more of the Aetna group of subsidiary companies. Thosecompanies include: Aetna Health Inc., Aetna Health of California Inc.,Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., AetnaHealth of Washington Inc., Aetna Health Insurance Company of NewYork, Corporate Health Insurance Company and/or Aetna LifeInsurance Company.

This material is for informational purposes only and contains only apartial, general description of plan benefits or programs and does notconstitute a contract. Consult the plan documents (Schedule ofBenefits, Certificate of Coverage, Evidence of Coverage, GroupAgreement, Group Insurance Certificate, Booklet, Booklet Certificate,Group Policy) to determine governing contractual provisions,including procedures, exclusions and limitations relating to the plan.Aetna does not provide health care services and, therefore, cannotguarantee any results or outcomes. The availability of a plan orprogram may vary by geographic service area. Some benefits aresubject to limitations or visit maximums. With the exception of AetnaRx Home Delivery, all participating physicians, hospitals and otherhealth care providers are independent contractors in private practiceand are neither employees nor agents of Aetna. Aetna Rx HomeDelivery and Aetna Specialty Pharmacy refer to Aetna Rx HomeDelivery, LLC, and Aetna Specialty Pharmacy, LLC, respectively. AetnaRx Home Delivery and Aetna Specialty Pharmacy are subsidiaries ofAetna Inc., and are licensed pharmacies that operate through mail-order. The availability of any particular provider cannot beguaranteed, and provider network composition is subject to change.Notice of the change shall be provided in accordance with applicablestate law.

The term precertification means the utilization review process todetermine whether the requested service, procedure, prescriptiondrug or medical device meets the company's clinical criteria forcoverage. It does not mean precertification as defined by Texas law,as a reliable representation of payment of care or services to fullyinsured HMO and PPO members.

Aetna has established a policy to allow exceptions or overrides tocertain refill-too-soon limitations. Requests for such exceptions oroverrides will be evaluated on a case-by-case basis.

While this material is believed to be accurate as of the print date, it issubject to change.

Documents

Aetna Preferred Drug Guide