Download - TRIPLER ARMY MEDICALCENTER OUTPATIENT FORMULARY ...online.lexi.com/lco/splashes/files/pdf/Tripler-Army.pdf1 Alphabetical Listing by Name This document is current as of The availability

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Alphabetical Listing by Name

This document is current as of The availability of formulary items is subject to change.

OUTPATIENT FORMULARYTRIPLER ARMY MEDICALCENTER

January 22, 2020.

Tripler Army Outpatient Formulary

Alphabetical Drug Listing Available Dosage Forms

Abacavir Tablet, Oral: 300 mg

Abacavir and Lamivudine Tablet:

Epzicom®: Abacavir 600 mg and lamivudine 300 mg

Abacavir, Lamivudine, and

Zidovudine

Tablet, oral:

Trizivir®: Abacavir sulfate 300 mg, lamivudine 150 mg, and zidovudine 300 mg

Acamprosate Tablet Delayed Release, Oral, as calcium:

Campral: 333 mg

Acarbose Tablet, Oral: 50 mg, 100 mg

Acetaminophen Liquid, oral: 160 mg/5 mL (120 mL)

Tablet, oral: 325 mg

Acetaminophen and Codeine Solution, oral [C-V]: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 mL (12.5

mL) [BCF]

Tablet, oral [C-III]: Acetaminophen 300 mg and codeine phosphate 30 mg [BCF]

AcetaZOLAMIDE Capsule Extended Release 12 Hour, Oral: 500 mg

Tablet, Oral: 125 mg, 250 mg

Acetic Acid (Otic) Solution, Otic:

Generic: 2% (15 mL)

Acetylcysteine Solution, for inhalation/oral: 10% [100 mg/mL] (30 mL); 20% [200 mg/mL] (30 mL)

Solution, for inhalation/oral [preservative free]: 10% [100 mg/mL] (4 mL); 20% [200 mg/mL] (4

mL, 30 mL)

Acitretin Capsule, Oral:

Soriatane: 10 mg, 25 mg [contains edetate calcium disodium]

Acyclovir (Systemic) Capsule, oral: 200 mg [BCF]

Suspension, oral: 200 mg/5 mL (473 mL) [BCF]

Tablet, oral: 400 mg [BCF], 800 mg [BCF]

Adalimumab Kit, Subcutaneous [preservative free]:

Humira: 20 mg/0.4 mL, 40 mg/0.8 mL [contains polysorbate 80] [ECF]

Humira® Pen: 40 mg/0.8 mL (0.8 mL) [contains natural rubber/natural latex in packaging,

polysorbate 80] [ECF]

Adapalene Cream, External:

Generic: 0.1% (45 g)

Gel, External:

Differin: 0.3% (45 g) [contains edetate disodium, methylparaben, propylene glycol]

Aflibercept (Ophthalmic) Solution, Intraocular [preservative free]:

Eylea: 2 mg/0.05 mL (0.05 mL) [contains mouse protein (murine) (hamster)]

Albendazole Tablet, Oral:

Albenza: 200 mg [contains saccharin sodium]

Albuterol Aerosol, for oral inhalation:

Proventil® HFA: 90 mcg/inhalation (6.7 g) [chlorofluorocarbon free; 200 metered actuations]

[BCF]

Solution, for nebulization: 0.5% (20 mL); 0.083% [2.5 mg/3 mL] (30s) [BCF]

Alendronate Tablet, oral: 5 mg [BCF], 10 mg [BCF], 35 mg [BCF], 70 mg [BCF]

Alfuzosin Tablet, extended release, oral, as hydrochloride: 10 mg [BCF]

Allopurinol Solution Reconstituted, Intravenous, as sodium [preservative free]: 500 mg (1 ea)


ALPRAZolam Tablet, Oral: 0.25 mg

Alprostadil Kit, Intracavernosal:

Caverject Impulse: 10 mcg [contains benzyl alcohol]

Caverject Impulse: 20 mcg

Edex: 10 mcg, 20 mcg, 40 mcg

Pellet, Urethral:

Muse: 500 mcg; 1000 mcg

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Aluminum Acetate Packet, External:

Domeboro: Aluminum sulfate tetradecahydrate 1347 mg and calcium acetate monohydrate

952 mg per packet (12s, 100s)

Generic: Aluminum sulfate 1191 mg and calcium acetate 839 mg per packet (12s)

Aluminum Chloride Liquid, oral topical: 20% (37.5 mL)

Aluminum Hydroxide,

Magnesium Hydroxide, and

Simethicone

Liquid, oral: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20

mg per 5 mL (360 mL); aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and

simethicone 40 mg per 5 mL (360 mL)

Suspension, oral: Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and

simethicone 25 mg per 5 mL (360 mL)

Amantadine Capsule, oral, as hydrochloride: 100 mg [BCF]

Syrup, oral, as hydrochloride: 50 mg/5 mL (10 mL, 473 mL) [BCF]

Aminocaproic Acid Tablet, Oral: 500 mg

Aminolevulinic Acid (Topical) Solution Reconstituted, External, as hydrochloride:

Levulan Kerastick: 20% (1 ea) [contains alcohol, usp, isopropyl alcohol, laureth, polyethylene

glycol]

Amiodarone Tablet, oral, as hydrochloride: 200 mg [BCF]

Amitriptyline Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF], 100 mg

AmLODIPine Tablet, oral: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

Amlodipine and Benazepril Capsule, oral:

2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF]

5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF]





Amoxicillin Capsule, oral: 250 mg [BCF], 500 mg [BCF]

Powder for suspension, oral: 250 mg/5 mL [BCF]; 400 mg/5 mL [BCF]

Amoxicillin and Clavulanate Powder for Suspension, Oral:

250: Amoxicillin 250 mg and clavulanate potassium 62.5 mg per 5 mL (100 mL) [BCF]

400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (50 mL, 75 mL, 100 mL)

[BCF]

600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (75 mL, 125 mL, 200

mL) [BCF]

Tablet, oral:

500: Amoxicillin 500 mg and clavulanate potassium 125 mg [BCF]

875: Amoxicillin 875 mg and clavulanate potassium 125 mg [BCF]

Anagrelide Capsule, Oral: 0.5 mg

Anastrozole Tablet, Oral: 1 mg

Apixaban Tablet, Oral:

Eliquis: 2.5 mg, 5 mg

Aprepitant Capsule, Oral:

Emend: 80 mg, 125 mg; 80 mg & 125 mg [dose pack]

ARIPiprazole Prefilled Syringe, Intramuscular:

Abilify Maintena: 300 mg (1 ea); 400 mg (1 ea)

Solution, Oral:

Abilify: 1 mg/mL (150 mL) [contains methylparaben, propylene glycol, propylparaben; orange

cream flavor]

Tablet, Oral:

Abilify: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg

Artemether and Lumefantrine Tablet:

Coartem: Artemether 20 mg and lumefantrine 120 mg

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Artificial Tears Solution, ophthalmic:

LiquiTears®: 1.4% (15 mL)

Systane®: Polyethylene glycol 400 0.4% and propylene glycol 0.3% (15 mL)

Tears Renewed®: (15 mL)

Ascorbic Acid Syrup, Oral: 500 mg/5 mL (118 mL, 473 mL)

Aspirin Tablet, chewable, oral: 81 mg

Tablet, enteric coated, oral: 81 mg, 325 mg

Aspirin and Dipyridamole Capsule, variable release:

Aggrenox®: Aspirin 25 mg [immediate release] and dipyridamole 200 mg [extended release]

[contains lactose, sucrose]

Atazanavir Capsule, Oral, as sulfate:

Reyataz: 300 mg

Atenolol Tablet, oral: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

AtoMOXetine Capsule, Oral:

Strattera: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg

Strattera: 80 mg, 100 mg [contains fd&c blue #2 (indigotine)]

AtorvaSTATin Tablet, oral: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]

Atovaquone and Proguanil Tablet, oral: Atovaquone 250 mg and proguanil hydrochloride 100 mg

Malarone®: Atovaquone 250 mg and proguanil hydrochloride 100 mg

Tablet, oral [pediatric]:

Malarone®: Atovaquone 62.5 mg and proguanil hydrochloride 25 mg

Atropine (Ophthalmic) Ointment, Ophthalmic, as sulfate: 1% (3.5 g)

Solution, Ophthalmic, as sulfate: 1% (15 mL)

AzaTHIOprine Tablet, Oral: 50 mg

Azelaic Acid Cream, External:

Azelex: 20% (30 g)

Gel, External:

Finacea: 15% (50 g) [contains benzoic acid, disodium edta, polysorbate 80, propylene glycol]

Azelastine (Nasal) Solution, Nasal, as hydrochloride: 137 mcg/spray (30 mL)

Azithromycin (Systemic) Powder for suspension, oral, as dihydrate [strength expressed as base]: 200 mg/5 mL (15 mL;

1 g/packet (3s) [BCF]

Tablet, oral, as dihydrate [strength expressed as base]: 250 mg [BCF], 600 mg

Zithromax® Z-PAK®: 250 mg [contains sodium 0.9 mg/tablet] [BCF]

Bacitracin, Neomycin, and

Polymyxin B (Ophthalmic)

Ointment, ophthalmic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units

per g (3.5 g) [BCF]

Bacitracin (Ophthalmic) Ointment, Ophthalmic:

Generic: 500 units/g (3.5 g)

Bacitracin (Topical) Ointment, External, as zinc [strength expressed as base]:

Generic: 500 units/g (28.35 g)

Baclofen Tablet, Oral:

Generic: 10 mg

Suspension, Oral:

First-Baclofen 5: 5 mg/mL (120 mL) [contains saccharin sodium, sodium benzoate]

Balanced Salt Solution Solution, ophthalmic [irrigation; preservative free]:

BSS®: Sodium chloride 0.64%, potassium chloride 0.075%, calcium chloride 0.048%,

magnesium chloride 0.03%, sodium acetate 0.39%, sodium citrate 0.17% (15 mL)

Balsalazide Capsule, Oral, as disodium: 750 mg

Barium Enema, Rectal, as sulfate: 50% (500 mL)

Belladonna and Opium Suppository: Belladonna extract 16.2 mg and opium 30 mg; belladonna extract 16.2 mg and

opium 60 mg

Benadryl, Maalox, and Lidocaine

Benzocaine Aerosol, External:

Dermoplast: Benzocaine 20% and menthol 0.5% (56 g) [contains methylparaben]

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Benzoin Tincture, topical: Benzoin Compound USP: Benzoin 10% (60 mL)

Benzonatate Capsule, Oral: 100 mg

Benzoyl Peroxide Gel, External: 10% (45 g)

Liquid, External wash: 5% (120 mL)

Benztropine Tablet, oral, as mesylate: 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF]

Betamethasone (Topical) Cream, External, as valerate [strength expressed as base]: 0.1% (15 g, 45 g)

Betaxolol (Ophthalmic) Suspension, Ophthalmic:

Betoptic-S: 0.25% (10 mL)

Bicalutamide Tablet, Oral: 50 mg

Bictegravir, Emtricitabine, and

Tenofovir Alafenamide

Tablet, Oral:

Biktarvy: Bictegravir 50 mg, emtricitabine 200 mg, and tenofovir alafenamide 25 mg

Bisacodyl Suppository, Rectal: 10 mg

Tablet Delayed Release, Oral:

Dulcolax: 5 mg

Bismuth Subsalicylate Tablet Chewable, Oral, as subsalicylate: 262 mg

Brimonidine and Timolol Solution, ophthalmic [drops]:

Combigan®: Brimonidine tartrate 0.2% and timolol 0.5% (10 mL) [contains benzalkonium

chloride]

Brimonidine (Ophthalmic) Solution, ophthalmic, as tartrate [drops]: 0.2% (5 mL) [BCF]

Alphagan® P: 0.15% (10 mL) [contains Purite®] [BCF]

Bromocriptine Capsule, Oral: 5 mg

Tablet, Oral: 2.5 mg

Brompheniramine,

Pseudoephedrine, and

Dextromethorphan

Elixir, oral:

Bromaline® DM: Brompheniramine maleate 1 mg, pseudoephedrine hydrochloride 15 mg, and

dextromethorphan hydrobromide 5 mg per 5 mL (480 mL) [ethanol free; contains sodium

benzoate; grape flavor]

Budesonide (Oral Inhalation) Suspension, Inhalation: 0.25 mg/2 mL (2 mL); 0.5 mg/2 mL (2 mL)

Budesonide (Systemic) Capsule Extended Release 24 Hour, Oral: 3 mg

Bumetanide Tablet, Oral: 1 mg

BuPROPion Tablet, oral, as hydrochloride: 75 mg [generic for Wellbutrin®] [BCF], 100 mg [generic for

Wellbutrin®] [BCF]

Tablet, extended release, oral, as hydrochloride: 100 mg [generic for Wellbutrin SR®] [BCF],

150 mg [generic for Wellbutrin XL®] [BCF], 300 mg [generic for Wellbutrin XL®] [BCF]

Wellbutrin XL®: 150 mg [BCF], 300 mg [BCF]

Tablet, sustained release, oral, as hydrochloride:

Wellbutrin SR®: 100 mg [BCF]

BusPIRone Tablet, oral, as hydrochloride: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF]

Butalbital, Acetaminophen, and

Caffeine

Tablet, oral: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg [BCF]

Cabergoline Tablet, Oral: 0.5 mg

Caffeine Solution, oral, as citrate [preservative free]: 20 mg/mL (3 mL) [equivalent to 10 mg/mL caffeine

base]

Calcipotriene Cream, External: 0.005% (60 g)

Solution, External: 0.005% (60 mL)

Calcitriol (Systemic) Capsule, Oral:

Generic: 0.25 mcg

Calcitriol (Topical) Ointment, External:

Generic: 3 mcg/g (100 g)

Calcium Acetate Capsule, Oral: 667 mg

Calcium and Vitamin D Tablet, oral: Calcium 500 mg and vitamin D 200 units

Calcium Glubionate Syrup, Oral:

Calcionate: 1.8 g/5 mL (473 mL) [fruit flavor]

Camphor and Menthol Lotion, topical:

Sarna®: Camphor 0.5% and menthol 0.5% (222 mL)

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Candesartan Tablet, Oral, as cilexetil:

Atacand: 4 mg, 8 mg, 16 mg, 32 mg [scored]

Capecitabine Tablet, Oral:

Xeloda: 150 mg, 500 mg

Captopril Tablet, oral: 12.5 mg [BCF], 25 mg [BCF], 50 mg [BCF]

CarBAMazepine Suspension, Oral:

Generic: 100 mg/5 mL (10 mL, 450 mL) [BCF]

Tablet, Oral:

Generic: 200 mg [BCF]

Tablet, Chewable, Oral:


Tablet Extended Release 12 Hour, Oral:


Carbamide Peroxide Solution, Otic: 6.5% (15 mL)

Carbidopa and Levodopa Tablet, oral:

25/100: Carbidopa 25 mg and levodopa 100 mg [BCF]

25/250: Carbidopa 25 mg and levodopa 250 mg [BCF]

Tablet, sustained release:

25/100: Carbidopa 25 mg and levodopa 100 mg

50/200: Carbidopa 50 mg and levodopa 200 mg

Carboxymethylcellulose Solution, Ophthalmic, as sodium [preservative free]:

Refresh Plus: 0.5% (30 ea)

Carvedilol Tablet, oral: 3.125 mg [BCF], 6.25 mg [BCF], 12.5 mg [BCF], 25 mg [BCF]

Cefdinir Suspension Reconstituted, Oral:

Generic: 125 mg/5 mL (100 mL)

Cefixime Tablet, Oral, as trihydrate:

Suprax: 400 mg [scored]

Cefpodoxime Tablet, Oral: 100 mg, 200 mg

Celecoxib Capsule, Oral:

Generic: 100 mg, 200 mg

Cephalexin Capsule, oral: 250 mg [BCF], 500 mg [BCF]

Powder for suspension, oral: 250 mg/5 mL (100 mL, 200 mL) [BCF]

Cetirizine (Systemic) Syrup, Oral, as hydrochloride: 1 mg/mL (120 mL, 480 mL)

Tablet, Oral, as hydrochloride: 10 mg

Charcoal, Activated Liquid, Oral:

Actidose-Aqua: 25 g/120 mL (120 mL) [sweet flavor]

Actidose/Sorbitol: 25 g/120 mL (120 mL); 50 g/240 mL (240 mL) [sweet flavor]

Chlorhexidine Gluconate (Oral) Solution, Mouth/Throat:

Generic: 0.12% (473 mL) [BCF]

Chlorhexidine Gluconate

(Topical)

Liquid, External:

Generic: 4% (946 mL)

Chloroquine Tablet, Oral, as phosphate: 500 mg [equivalent to chloroquine base 300 mg]

Chlorothiazide Suspension, Oral:

Diuril: 250 mg/5 mL (237 mL) [contains alcohol, usp, benzoic acid, fd&c yellow #10 (quinoline

yellow), methylparaben, propylparaben, saccharin sodium]

Chlorpheniramine Syrup, Oral, as maleate:

Aller-Chlor: 2 mg/5 mL (118 mL) [fruit flavor]

Chlor-Trimeton: 2 mg/5 mL (120 mL) [contains alcohol, usp]

Ed Chlorped Jr: 2 mg/5 mL (118 mL, 473 mL) [alcohol free, sugar free; contains fd&c red #40,

methylparaben, propylene glycol, propylparaben; cherry flavor]

Tablet, Oral, as maleate: 4 mg

Chlorpheniramine and

Phenylephrine

Liquid, oral [drops]: Chlorpheniramine maleate 1 mg and phenylephrine hydrochloride 3.5 mg

per 1 mL (30 mL)

Chlorthalidone Tablet, oral: 25 mg [BCF], 50 mg [BCF]

5


Cholecalciferol Liquid, Oral:

Generic: 400 units/mL (50 mL)

Cilostazol Tablet, Oral: 50 mg, 100 mg

Ciprofloxacin and

Dexamethasone

Suspension, otic:

Ciprodex®: Ciprofloxacin 0.3% and dexamethasone 0.1% (7.5 mL) [contains benzalkonium

chloride]

Ciprofloxacin (Ophthalmic) Solution, Ophthalmic, as hydrochloride:

Generic: 0.3% (5 mL)

Ciprofloxacin (Systemic) Suspension Reconstituted, Oral:

Cipro: 500 mg/5 mL (100 mL) [strawberry flavor]

Tablet, oral, as hydrochloride [strength expressed as base]: 250 mg [BCF], 500 mg [BCF], 750

mg

Citalopram Solution, oral: 10 mg/5 mL (240 mL) [BCF]

Tablet, oral: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]

Clarithromycin Suspension Reconstituted, Oral: 125 mg/5 mL (50 mL, 100 mL); 250 mg/5 mL (50 mL, 100

mL)

Tablet, Oral: 500 mg

Clindamycin and Benzoyl

Peroxide

Gel, topical: Clindamycin phosphate 1% and benzoyl peroxide 5% (50 g)

Duac®: Clindamycin phosphate 1.2% and benzoyl peroxide 5% (45 g)

Clindamycin (Systemic) Capsule, oral, as hydrochloride [strength expressed as base]: 150 mg [BCF], 300 mg

Solution Reconstituted, Oral, as palmitate hydrochloride [strength expressed as base]: 75

mg/5 mL (100 mL)

Clindamycin (Topical) Cream, Vaginal, as phosphate [strength expressed as base]:

Generic: 2% (40 g) [BCF]

Gel, External, as phosphate [strength expressed as base]:

Generic: 1% (30 g) [BCF]

Lotion, External, as phosphate [strength expressed as base]:

Generic: 1% (60 mL) [BCF]

Solution, External, as phosphate [strength expressed as base]:


Clobetasol Cream, External, as propionate: 0.05% (30 g)

Foam, External, as propionate: 0.05% (100 g)

Ointment, External, as propionate: 0.05% (30 g)

Solution, External, as propionate: 0.05% (25 mL, 50 mL)

ClomiPHENE Tablet, Oral, as citrate: 50 mg

ClonazePAM Tablet, oral: 0.5 mg [BCF], 1 mg

CloNIDine Patch Weekly, Transdermal: 0.1 mg/24 hr (4 ea); 0.2 mg/24 hr (4 ea); 0.3 mg/24 hr (4 ea)

Tablet, oral, as hydrochloride: 0.1 mg [BCF], 0.2 mg [BCF]

Clopidogrel Tablet, oral: 75 mg [BCF]

Clotrimazole (Oral) Troche, Mouth/Throat: 10 mg

Clotrimazole (Topical) Cream, External:

Generic: 1% (30 g)

Cream, Vaginal:

Gyne-Lotrimin: 1% (45 g) [contains benzyl alcohol]

Codeine Tablet, Oral, as sulfate: 30 mg

Colchicine Tablet, Oral:

Colcrys: 0.6 mg [scored; contains fd&c blue #2 (indigotine), fd&c red #40]

Colestipol Tablet, Oral, as hydrochloride: 1 g

Collagenase (Topical) Ointment, External:

Santyl: 250 units/g (30 g)

Cromolyn (Nasal) Aerosol Solution, Nasal, as sodium: 5.2 mg/actuation (26 mL)

Cromolyn (Ophthalmic) Solution, Ophthalmic, as sodium: 4% (10 mL)

Cromolyn (Oral Inhalation) Nebulization Solution, Inhalation, as sodium:

Generic: 20 mg/2 mL (2 mL)

6


Cyanocobalamin Solution, Injection: 1000 mcg/mL (1 mL)

Tablet, Oral: 500 mcg

Cyclobenzaprine Tablet, oral, as hydrochloride: 5 mg, 10 mg [BCF]

Cyclopentolate Solution, Ophthalmic, as hydrochloride: 1% (15 mL); 2% (5 mL)

CycloSPORINE (Ophthalmic) Emulsion, Ophthalmic [preservative free]:

Restasis: 0.05% (1 ea) [contains polysorbate 80]

CycloSPORINE (Systemic) Capsule, Oral: 25 mg, 50 mg

Gengraf: 25 mg [contains alcohol, usp]

Solution, Oral: 100 mg/mL (50 mL)

Gengraf: 100 mg/mL (50 mL) [contains alcohol, usp]

Cyproheptadine Syrup, oral, as hydrochloride: 2 mg/5 mL (473 mL, 480 mL) [BCF]

Tablet, oral, as hydrochloride: 4 mg [BCF]

Danazol Capsule, Oral: 100 mg, 200 mg

Dantrolene Capsule, Oral, as sodium: 25 mg

Dapsone (Systemic) Tablet, Oral: 25 mg, 100 mg

Darunavir Tablet, Oral:

Prezista: 400 mg, 600 mg [contains fd&c yellow #6 (sunset yellow)]

Darunavir and Cobicistat Tablet, Oral:

Prezcobix: Darunavir 800 mg and cobicistat 150 mg

Dasatinib Tablet, Oral:

Sprycel: 20 mg, 50 mg, 70 mg, 80 mg, 100 mg, 140 mg

Desipramine Tablet, Oral, as hydrochloride: 25 mg

Desmopressin Solution, Nasal, as acetate: 0.01% (2.5 mL, 5 mL)

DDAVP: 0.01% (5 mL)

DDAVP Rhinal Tube: 0.01% (2.5 mL)

Tablet, Oral, as acetate: 0.1 mg, 0.2 mg

Desonide Cream, External: 0.05% (15 g, 60 g)

Ointment, External: 0.05% (15 g, 60 g)

Desoximetasone Cream, External: 0.25% (15 g)

DexAMETHasone (Systemic) Concentrate, Oral:

Dexamethasone Intensol: 1 mg/mL (30 mL) [contains alcohol, usp; unflavored flavor]

Elixir, Oral: 0.5 mg/5 mL (237 mL)

Tablet, Oral: 0.5 mg, 4 mg

Dextroamphetamine Capsule Extended Release 24 Hour, Oral, as sulfate: 10 mg

Tablet, Oral, as sulfate: 5 mg

7


Dextroamphetamine and

Amphetamine

Capsule, extended release, oral:

5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate 1.25 mg,

amphetamine aspartate monohydrate 1.25 mg, amphetamine sulfate 1.25 mg (equivalent to

amphetamine base 3.1 mg)] [BCF]







20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate 5 mg, amphetamine

aspartate monohydrate 5 mg, amphetamine sulfate 5 mg (equivalent to amphetamine base

12.5 mg)] [BCF]







Tablet, oral:



amphetamine base 3.13 mg)]




20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate 5 mg, amphetamine

aspartate monohydrate 5 mg, amphetamine sulfate 5 mg (equivalent to amphetamine base

12.6 mg)]




Dextrose Gel, Oral:

Glutose 15: 40% (37.5 g)

Diabetic Supplies Glucose meter:

Freestyle Freedom Lite

Lancet:

Accu-Chek FastClix: (102/box)

FreeStyle Lancets: (100/box)

Lancing device:

Easy Touch Lancing Device: (100/box)

Lancet kit:

Accu-Chek FastClix Lancet Kit

Syringe and needle:

0.3 mL [30 G x 1/2"]

0.5 mL [30 G x 1/2"]

1 mL [30 G x 1/2"]

0.3 mL [31 G x 5/16"]

NovoFine-30 Pen Needle:100/box

NovoFine-32 Pen Needle:100/box

Test Strips/Kit:

Ketostix Strips 100/box

Precision Xtra Blood Ketone Test Strips (10/box)

Precision Xtra test strips: (50/box), (100/box) [BCF]

Urine ketone strips: (20/box) [individually wrapped]

8


DiazePAM Gel, Rectal: 2.5 mg (1 ea); 10 mg (1 ea); 20 mg (1 ea)

Solution, Oral: 1 mg/mL (5 mL)

Tablet, oral: 5 mg [BCF]

Diclofenac (Ophthalmic) Solution, Ophthalmic, as sodium: 0.1% (2.5 mL, 5 mL)

Diclofenac (Topical) Gel, Transdermal, as sodium:

Generic: 1% (100 g)

Dicloxacillin Capsule, oral: 250 mg [BCF], 500 mg [BCF]

Dicyclomine Capsule, oral, as hydrochloride: 10 mg [BCF]


Digoxin Solution, Oral: 0.05 mg/mL (60 mL)

Tablet, oral: 125 mcg [BCF], 250 mcg [BCF]

DilTIAZem Capsule, extended release, oral, as hydrochloride [once-daily dosing]: 120 mg [BCF], 180 mg

[BCF], 240 mg [BCF], 300 mg [BCF], 360 mg [BCF]


DiphenhydrAMINE (Systemic) Capsule, Oral, as hydrochloride: 25 mg, 50 mg

Elixir, Oral, as hydrochloride: 12.5 mg/5 mL (5 mL, 10 mL)

Dipyridamole Tablet, Oral: 25 mg

Disulfiram Tablet, Oral: 250 mg

Docusate Capsule, Oral, as sodium: 100 mg

Liquid, Oral, as sodium: 50 mg/5 mL (10 mL)

Dolutegravir Tablet, Oral:

Tivicay: 10 mg, 25 mg, 50 mg

Donepezil Tablet, oral, as hydrochloride: 5 mg, 10 mg

Aricept®: 5 mg

Dornase Alfa Solution, Inhalation:

Pulmozyme: 1 mg/mL (2.5 mL)

Dorzolamide Solution, Ophthalmic: 2% (10 mL)

Dorzolamide and Timolol Solution, ophthalmic [drops]: Dorzolamide 2% and timolol 0.5% (10 mL)

Doxepin (Systemic) Capsule, oral: 10 mg [BCF], 25 mg [BCF], 100 mg

Solution, oral [concentrate]: 10 mg/mL (120 mL) [BCF]

Doxycycline Capsule, oral, as hyclate [strength expressed as base]: 100 mg [BCF]

Tablet, oral, as hyclate [strength expressed as base]: 100 mg [BCF]

DULoxetine Capsule Delayed Release Particles, Oral: 20 mg, 30 mg, 60 mg

Efavirenz, Emtricitabine, and

Tenofovir Disoproxil Fumarate

Tablet:

Atripla®: Efavirenz 600 mg, emtricitabine 200 mg, and tenofovir disoproxil fumarate 300 mg

Elvitegravir, Cobicistat,

Emtricitabine, and Tenofovir

Alafenamide

Tablet, Oral:

Genvoya: Elvitegravir 150 mg, cobicistat 150 mg, emtricitabine 200 mg, and tenofovir

alafenamide 10 mg [contains fd&c blue #2 aluminum lake]

Emollients Cream, topical:

Atopiclair®: (100 g) [dye free; contains shea nut derivatives]

Vanicream™: (453 g)

Ointment, topical:

Aquaphor®: (453 g)

Empagliflozin Tablet, Oral:

Jardiance: 10 mg, 25 mg

Emtricitabine and Tenofovir

Alafenamide

Tablet, Oral:

Descovy: Emtricitabine 200 mg and tenofovir alafenamide 25 mg [contains fd&c blue #2

aluminum lake]

Emtricitabine and Tenofovir

Disoproxil Fumarate

Tablet:

Truvada®: Emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg

Emtricitabine, Rilpivirine, and

Tenofovir Alafenamide

Tablet, Oral:

Odefsey: Emtricitabine 200 mg, rilpivirine 25 mg, and tenofovir alafenamide 25 mg

9


Enoxaparin Injection, solution, as sodium [preservative free]: 30 mg/0.3 mL (0.3 mL) [BCF]; 40 mg/0.4 mL

(0.4 mL) [BCF]; 60 mg/0.6 mL (0.6 mL) [BCF]; 80 mg/0.8 mL (0.8 mL) [BCF]; 100 mg/mL (1

mL) [BCF]; 120 mg/0.8 mL (0.8 mL) [BCF]; 150 mg/mL (1 mL) [BCF]

Entecavir Tablet, Oral:

Baraclude: 0.5 mg, 1 mg

EPINEPHrine (Systemic) Device, solution:

EpiPen 2-Pak: 0.3 mg/0.3 mL (2 ea) [latex free; contains sodium metabisulfite]

EpiPen Jr 2-Pak: 0.15 mg/0.3 mL (2 ea) [contains sodium metabisulfite]

Twinject: 0.15 mg/0.15 mL (1.1 mL) [contains chlorobutanol, sodium bisulfite; 1:1000 solution;

delivers 0.15 mg per injection]

Twinject: 0.3 mg/0.3 mL (1.1 mL) [contains chlorobutanol, sodium bisulfite; 1:1000 solution;

delivers 0.3 mg per injection]

Ergocalciferol Capsule, Oral: 50,000 units

Solution, Oral: 8000 units/mL (60 mL)

Erlotinib Tablet, Oral:

Tarceva: 25 mg,100 mg, 150 mg

Erythromycin and Benzoyl

Peroxide

Gel, topical: Erythromycin 30 mg and benzoyl peroxide 50 mg per g (60 pk/box)

Erythromycin (Ophthalmic) Ointment, Ophthalmic:

Generic: 5 mg/g (1 g, 3.5 g) [BCF]

Erythromycin (Systemic) Suspension Reconstituted, Oral, as ethylsuccinate:

EryPed: 200 mg/5 mL (100 mL) [fruit flavor] [BCF]

Tablet, delayed release, enteric coated, oral, as base:

Ery-Tab®: 250 mg [contains sodium 8.3 mg (0.4 mEq)/tablet] [BCF]

Erythromycin (Topical) Solution, topical: 2% (60 mL) [BCF]

Escitalopram Solution, Oral: 5 mg/5 mL (240 mL)

Tablet, Oral: 5 mg, 10 mg, 20 mg

Estradiol (Systemic) Patch, transdermal [once-weekly patch]:

0.025 mg/24 hours (4s) [BCF]

0.0375 mg/24 hours (4s) [BCF]

0.05 mg/24 hours (4s) [BCF]

0.1 mg/24 hours (4s) [BCF]

Tablet, Oral: 1 mg

Estradiol (Topical) Cream, Vaginal:

Generic: 0.1 mg/g (42.5 g)

Estrogens (Conjugated/Equine)

and Medroxyprogesterone

Tablet, oral:

Premphase® [therapy pack contains 2 separate tablet formulations]: Conjugated estrogens

0.625 mg [14 maroon tablets] and conjugated estrogen 0.625 mg/medroxyprogesterone

acetate 5 mg [14 light blue tablets] (28s)

Prempro®: 0.3/1.5: Conjugated estrogens 0.3 mg and medroxyprogesterone acetate 1.5 mg

[BCF]

Prempro®: 0.45/1.5: Conjugated estrogens 0.45 mg and medroxyprogesterone acetate 1.5 mg

[BCF]

Prempro®: 0.625/2.5: Conjugated estrogens 0.625 mg and medroxyprogesterone acetate 2.5

mg [BCF]

Prempro®: 0.625/5: Conjugated estrogens 0.625 mg and medroxyprogesterone acetate 5 mg

[BCF]

Estrogens (Conjugated/Equine,

Systemic)

Tablet, oral:

Premarin®: 0.3 mg [BCF], 0.45 mg [BCF], 0.625 mg [BCF], 0.9 mg, 1.25 mg [BCF]

Estrogens (Conjugated/Equine,

Topical)

Cream, vaginal:

Premarin®: 0.625 mg/g (30 g) [BCF]

Estropipate Tablet, Oral: 0.75 mg, 1.5 mg

Eszopiclone Tablet, Oral:

Lunesta: 1 mg, 2 mg, 3 mg

10


Ethambutol Tablet, oral, as hydrochloride: 100 mg [BCF], 400 mg [BCF]

Ethinyl Estradiol and

Desogestrel

Tablet, oral [low dose formulation]:

Azurette™:

Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 white tablets]

Day 22-23: 2 inactive green tablets

Day 24-28: Ethinyl estradiol 0.01 mg [5 blue tablets] (28s)

Tablet, oral [monophasic formulation]:

Reclipsen®: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 white tablets and 7 green

inactive tablets] (28s)


Drospirenone

Tablet, oral:

Yasmin®: Ethinyl estradiol 0.03 mg and drospirenone 3 mg [21 yellow active tablets and 7

white inactive tablets] (28s) [BCF]

Yaz®: Ethinyl estradiol 0.02 mg and drospirenone 3 mg [24 light pink active tablets and 4 white

inactive tablets] (28s) [BCF]

Ethinyl Estradiol and Ethynodiol

Diacetate


Zovia® 1/35-28: Ethinyl estradiol 0.035 mg and ethynodiol diacetate 1 mg [21 light pink tablets

and 7 white inactive tablets] (28s)

Zovia® 1/50-28: Ethinyl estradiol 0.05 mg and ethynodiol diacetate 1 mg [21 pink tablets and 7

white inactive tablets] (28s)


Etonogestrel

Ring, vaginal:

NuvaRing®: Ethinyl estradiol 0.015 mg/day and etonogestrel 0.12 mg/day (3s) [3-week

duration]


Levonorgestrel

Tablet, oral [extended cycle regimen]:

Jolessa™: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (91s) [84 pink tablets and 7

white inactive tablets] [BCF]

Tablet, oral [low dose formulation]:

Sronyx®: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg (28s) [21 white tablets and 7

peach inactive tablets] [BCF]


Levora®: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (28s) [21 white tablets and 7

peach inactive tablets] [BCF]

Tablet, oral [triphasic formulation]:

Trivora®:

Day 1-6: Ethinyl estradiol 0.03 mg and levonorgestrel 0.05 mg [6 blue tablets]

Day 7-11: Ethinyl estradiol 0.04 mg and levonorgestrel 0.075 mg [5 white tablets]

Day 12-21: Ethinyl estradiol 0.03 mg and levonorgestrel 0.125 mg [10 pink tablets]

Day 22-28: 7 peach inactive tablets (28s)


Norelgestromin

Patch, transdermal:

Ortho Evra®: Ethinyl estradiol 0.75 mg and norelgestromin 6 mg [releases ethinyl estradiol 20

mcg and norelgestromin 150 mcg per day] (1s, 3s)


Norethindrone


Loestrin® Fe 1/20: Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg [21 light yellow

tablets] and ferrous fumarate 75 mg [7 brown tablets] (28s)

Loestrin® Fe 1.5/30: Ethinyl estradiol 0.03 mg and norethindrone acetate 1.5 mg [21 pink

tablets] and ferrous fumarate 75 mg [7 brown tablets] (28s)

Norinyl® 1+35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg (28s) [21 yellow-green

tablets and 7 orange inactive tablets] [BCF]


Necon® 7/7/7:

Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [7 white tablets]

Day 8-14: Ethinyl estradiol 0.035 mg and norethindrone 0.75 mg [7 light peach tablets]

Day 15-21: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [7 peach tablets]

Day 22-28: 7 green inactive tablets (28s)

11



Norgestimate


MonoNessa®: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 blue tablets and 7

green inactive tablets] [BCF]


Ortho Tri-Cyclen® Lo [BCF]:

Day 1-7: Ethinyl estradiol 0.025 mg and norgestimate 0.18 mg [7 white tablets]

Day 8-14: Ethinyl estradiol 0.025 mg and norgestimate 0.215 mg [7 light blue tablets]

Day 15-21: Ethinyl estradiol 0.025 mg and norgestimate 0.25 mg [7 dark blue tablets]

Day 22-28: 7 dark green inactive tablets

TriNessa® [BCF]:

Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 white tablets]

Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light blue tablets]

Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 blue tablets]

Day 22-28: 7 green inactive tablets

Ethinyl Estradiol and Norgestrel Tablet, oral [monophasic formulation]: Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [21

tablets and 7 inactive tablets] (28s)

Lo/Ovral®-28: Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [21 white tablets and 7 pink

inactive tablets] (28s)

Ethosuximide Capsule, Oral: 250 mg

Solution, Oral: 250 mg/5 mL (473 mL)

Everolimus Tablet, Oral:

Afinitor: 2.5 mg, 5 mg, 7.5 mg, 10 mg

Exenatide Suspension Reconstituted, Subcutaneous:

Bydureon: 2 mg (1 ea)

Ezetimibe Tablet, Oral:

Generic: 10 mg

Famciclovir Tablet, Oral: 500 mg

Felodipine Tablet Extended Release 24 Hour, Oral: 2.5 mg, 5 mg, 10 mg

Fenofibrate and Derivatives Tablet, oral: 54 mg, 160 mg

TriCor®: 48 mg [BCF], 145 mg [BCF] [contains soybean lecithin]

FentaNYL Patch, transdermal, as base:

12 [delivers 12.5 mcg/hr] (5s)

25 [delivers 25 mcg/hr] (5s)




Ferric Hexacyanoferrate Capsule, oral:

Radiogardase®: 0.5 g

Ferrous Sulfate Solution, Oral: 75 (15 Fe) mg/mL (50 mL)

Tablet, Oral: 325 (65 Fe) mg

Fexofenadine Tablet, Oral, as hydrochloride: 60 mg, 180 mg

Finasteride Tablet, oral: 5 mg [BCF]

Flecainide Tablet, Oral, as acetate: 100 mg

Fluconazole Suspension Reconstituted, Oral: 10 mg/mL (35 mL)

Tablet, oral: 100 mg, 150 mg [BCF], 200 mg

Fludrocortisone Tablet, Oral, as acetate: 0.1 mg

Fluocinolone (Ophthalmic) Implant, Intravitreal, as acetonide:

Iluvien: 0.19 mg (1 ea)

Fluocinolone (Topical) Oil, External, as acetonide:

Derma-Smoothe/FS Body: 0.01% (118.28 mL) [contains isopropyl alcohol, peanut oil]

Solution, External, as acetonide: 0.01% (60 mL)

12


Fluocinonide Cream, External:

Generic: 0.05% (15 g, 60 g) [BCF]

Gel, External:

Generic: 0.05% (15 g, 60 g)

Ointment, External:

Generic: 0.05% (15 g, 60 g)

Solution, External:


Fluoride Cream, oral, as sodium [toothpaste]: 1.1% (51 g) [equivalent to fluoride 2.5 mg/dose]

Gel, topical, as sodium: 1.1% (56 g) [equivalent to fluoride 2 mg/dose]

Solution, oral, as sodium [drops]: 1.1 mg/mL (50 mL) [equivalent to fluoride 0.5 mg/mL]

Tablet, chewable, oral, as sodium: 2.2 mg [equivalent to fluoride 1 mg]

Fluorometholone Suspension, Ophthalmic, as base: 0.1% (10 mL)

Fluorouracil (Topical) Cream, External: 5% (40 g)

FLUoxetine Capsule, oral: 10 mg [BCF], 20 mg [BCF]

Solution, oral: 20 mg/5 mL (5 mL, 120 mL) [BCF]

FluPHENAZine Tablet, Oral, as hydrochloride: 1 mg, 2.5 mg, 5 mg

Flurandrenolide Tape, External:

Cordran: 4 mcg/cm2 (1 ea)

Flutamide Capsule, Oral: 125 mg

Fluticasone and Salmeterol Aerosol, for oral inhalation:

Advair® HFA: 45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg per inhalation (8

g) [chlorofluorocarbon free; 60 metered actuations] [BCF]

Advair® HFA: 45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg per inhalation (12

g) [chlorofluorocarbon free; 120 metered actuations] [BCF]

Advair® HFA: 115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcg per inhalation

(8 g) [chlorofluorocarbon free; 60 metered actuations] [BCF]







Powder, for oral inhalation:

Advair Diskus®: 100/50: Fluticasone propionate 100 mcg and salmeterol 50 mcg (14s, 60s)

[contains lactose] [BCF]





Fluticasone (Nasal) Suspension, intranasal, as propionate [spray]: 50 mcg/inhalation (16 g) [BCF]

Fluticasone (Oral Inhalation) Aerosol, for oral inhalation, as propionate:

Flovent® HFA: 44 mcg/inhalation (10.6 g) [chlorofluorocarbon free; 120 metered actuations]

[BCF]

Flovent® HFA: 110 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations]

[BCF]

Flovent® HFA: 220 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations]

[BCF]

Powder, for oral inhalation, as propionate:

Flovent® Diskus®: 50 mcg (60s) [contains lactose] [BCF]



Folic Acid Tablet, oral: 1 mg [BCF]

Fosfomycin Packet, Oral:

Monurol: 3 g (3 ea) [orange flavor]

13


Furosemide Solution, oral: 10 mg/mL (60 mL, 120 mL) [BCF]


Gabapentin Capsule, oral: 100 mg [BCF], 300 mg [BCF], 400 mg [BCF]

Solution, Oral: 250 mg/5 mL (5 mL, 6 mL, 470 mL, 473 mL)


Ganciclovir (Ophthalmic) Gel, Ophthalmic:

Zirgan: 0.15% (5 g) [contains benzalkonium chloride]

Gemfibrozil Tablet, oral: 600 mg [BCF]

Gentamicin (Ophthalmic) Ointment, ophthalmic:

Gentak®: 0.3% (3.5 g) [BCF]

Ointment, ophthalmic [preservative free]:

Garamycin™: 0.3% (3.5 g) [BCF]

Solution, ophthalmic [drops]: 0.3% (5 mL) [BCF]

Gentamicin (Topical) Ointment, External: 0.1% (15 g)

Glimepiride Tablet, Oral: 1 mg, 2 mg, 4 mg

GlipiZIDE Tablet, oral: 5 mg [BCF], 10 mg [BCF]

Tablet Extended Release 24 Hour, Oral: 2.5 mg, 5 mg, 10 mg

Glucagon Kit, Injection:

Glucagon Emergency: 1 mg

Solution Reconstituted, Injection, as hydrochloride:

GlucaGen: 1 mg (1 ea)

GlyBURIDE Tablet, oral: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF]

Tablet, oral [micronized]: 1.5 mg [BCF], 3 mg [BCF], 6 mg [BCF]

Glyburide and Metformin Tablet:

1.25 mg/250 mg: Glyburide 1.25 mg and metformin hydrochloride 250 mg

2.5 mg/500 mg: Glyburide 2.5 mg and metformin hydrochloride 500 mg

5 mg/500 mg: Glyburide 5 mg and metformin hydrochloride 500 mg

Goserelin This medication is nonformulary. For formulary alternatives, refer to Therapeutic Category.

Granisetron Tablet, Oral: 1 mg

Griseofulvin Suspension, oral [microsize]: 125 mg/5 mL (120 mL) [BCF]

Tablet, oral [ultramicrosize]: 125 mg [BCF]

GuaiFENesin Tablet Extended Release 12 Hour, Oral:

Generic: 600 mg

Guaifenesin and Codeine Syrup, oral: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (473 mL)

Guaifenesin and

Dextromethorphan

Syrup, oral: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (480

mL)

Guaifenesin and

Pseudoephedrine

Tablet, extended release, oral:

Mucinex® D: Guaifenesin 600 mg and pseudoephedrine hydrochloride 60 mg

GuanFACINE Tablet, Oral:

Generic: 1 mg [BCF]

Tablet Extended Release 24 Hour, Oral:

Generic: 1 mg, 2 mg, 3 mg, 4 mg

Haloperidol Concentrate, Oral, as lactate [strength expressed as base]: 2 mg/mL (5 mL, 15 mL, 120 mL)

Tablet, Oral: 0.5 mg, 1 mg, 2 mg, 5 mg

Hepatitis B Vaccine

(Recombinant [Adjuvanted])

Solution Prefilled Syringe, Intramuscular [preservative free]:

Heplisav-B: 20 mcg/0.5 mL (0.5 mL) [contains polysorbate 80]

HydrALAZINE Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 100 mg

HydroCHLOROthiazide Capsule, oral: 12.5 mg [BCF]


Hydrochlorothiazide and

Triamterene

Tablet, oral: Hydrochlorothiazide 50 mg and triamterene 75 mg [BCF]

Hydrocodone and

Acetaminophen

Tablet, Oral:

Hydrocodone bitartrate 5 mg and acetaminophen 325 mg

14


Hydrocortisone (Systemic) Tablet, Oral, as base: 5 mg, 10 mg, 20 mg

Hydrocortisone (Topical) Cream, topical, as base: 1% (30 g)

Anusol-HC®: 2.5% (30 g) [contains benzyl alcohol] [BCF]

Cream, topical, as valerate: 0.2% (15 g, 45 g)

Enema, Rectal, as base: 100 mg/60 mL (60 mL)

Foam, Rectal, as acetate:

Cortifoam: 90 mg (15 g) [contains cetyl alcohol, methylparaben, propylene glycol,

propylparaben, trolamine (triethanolamine)]

Ointment, External, as valerate: 0.2% (15 g, 45 g)

Suppository, rectal, as acetate: 25 mg (12s) [BCF]

HYDROmorphone Tablet, Oral, as hydrochloride: 2 mg

Hydroxychloroquine Tablet, Oral, as sulfate: 200 mg

Hydroxypropyl Methylcellulose Solution, Ophthalmic [preservative free]: 0.3% (15 mL)

Hydroxyurea Capsule, Oral: 500 mg

HydrOXYzine Capsule, Oral, as pamoate: 50 mg

Solution, oral, as hydrochloride: 10 mg/5 mL (473 mL) [BCF]

Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF]

Hyoscyamine Tablet, Oral, as sulfate: 0.125 mg

Ibandronate Tablet, oral: 150 mg

Ibuprofen Suspension, Oral:

Generic: 100 mg/5 mL (118 mL, 120 mL, 473 mL)

Tablet, oral:

Generic: 400 mg [BCF], 600 mg [BCF], 800 mg [BCF]

Imatinib Tablet, Oral:

Gleevec: 100 mg, 400 mg [scored]

Imipramine Tablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

Imiquimod Cream, External: 5% (25 g)

Indomethacin Capsule, oral: 25 mg [BCF]

Suppository, Rectal:

Indocin: 50 mg (30 ea)

Suspension, Oral:

Indocin: 25 mg/5 mL (237 mL) [contains alcohol, usp; pineapple-coconut-mint flavor]

Inhalation Devices Holding chamber with mask:

AeroChamber® Max: Small, medium, large

Insulin Aspart Injection, solution:

NovoLOG®: 100 units/mL (10 mL) [vial] [BCF]

NovoLOG® FlexPen®: 100 units/mL (3 mL) [BCF]

NovoLOG® Penfill®: 100 units/mL (3 mL) [cartridge] [BCF]

Insulin Aspart Protamine and

Insulin Aspart

Injection, suspension:

NovoLOG® Mix 70/30 FlexPen®: 100 units/mL: Insulin aspart protamine suspension 70%

[intermediate acting] and insulin aspart solution 30% [rapid-acting] (3 mL) [BCF]

Insulin Glargine Injection, solution:

Lantus®: 100 units/mL (10 mL) [vial] [BCF]

Lantus® Solostar®: 100 units/mL (3 mL) [prefilled pen] [BCF]

Insulin NPH Injection, suspension:

NovoLIN® N: 100 units/mL (10 mL) [vial] [BCF]

Insulin NPH and Insulin Regular Injection, suspension:

NovoLIN® 70/30: Insulin NPH suspension 70% [intermediate acting] and insulin regular

solution 30% [short acting]: 100 units/mL (10 mL) [vial] [BCF]

Insulin Regular Injection, solution:

NovoLIN® R: 100 units/mL (10 mL) [BCF]

15


Interferon Beta-1a Injection, powder for reconstitution [preservative free]:

Avonex®: 33 mcg [contains albumin (human); provides 30 mcg/mL following reconstitution;

derived from or manufactured using Chinese hamster ovary cells; supplied with diluent]

Injection, solution:

Avonex®: 30 mcg/0.5 mL (0.5 mL) [albumin free]

Interferon Beta-1b Kit, Subcutaneous:

Betaseron: 0.3 mg [contains albumin human] [BCF]

Iodine This medication is nonformulary. For formulary alternatives, refer to Therapeutic Category.

Iopanoic Acid

Ipratropium and Albuterol Aerosol, for oral inhalation:

Combivent®: Ipratropium bromide 18 mcg and albuterol (base) 90 mcg per inhalation (14.7 g)

[contains chlorofluorocarbon, soya lecithin; 200 metered actuations] [BCF]

Solution, for nebulization: Ipratropium bromide 0.5 mg and albuterol (base) 2.5 mg per 3 mL

(30s)

Ipratropium (Nasal) Solution, Nasal, as bromide: 0.03% (30 mL)

Ipratropium (Oral Inhalation) Aerosol, for oral inhalation, as bromide:

Atrovent® HFA: 17 mcg/actuation (12.9 g) [chlorofluorocarbon free; 200 metered actuations]

[BCF]

Solution, for nebulization, as bromide: 0.02% [500 mcg/2.5 mL] (60s)

Irbesartan Tablet, Oral: 75 mg, 150 mg, 300 mg

Irbesartan and

Hydrochlorothiazide

Tablet, Oral:

Generic 150/12.5: Irbesartan 150 mg and hydrochlorothiazide 12.5 mg

Generic 300/12.5: Irbesartan 300 mg and hydrochlorothiazide 12.5 mg

Isoniazid Syrup, Oral: 50 mg/5 mL (473 mL)


Isosorbide Dinitrate Tablet, oral: 10 mg [BCF]

Isosorbide Dinitrate and

Hydralazine

Tablet, oral:

BiDil: Isosorbide dinitrate 20 mg and hydralazine hydrochloride 37.5 mg

Isosorbide Mononitrate Tablet, Oral: 20 mg

Tablet, extended release, oral: 30 mg [BCF], 60 mg [BCF], 120 mg [BCF]

ISOtretinoin (Systemic) Capsule, Oral:

Myorisan: 30 mg


Itraconazole Capsule, Oral: 100 mg

Solution, Oral:

Sporanox: 10 mg/mL (150 mL)

Ivermectin (Systemic) Tablet, Oral:

Stromectol: 3 mg

Ketoconazole (Topical) Cream, External: 2% (30 g)

Shampoo, External: 2% (120 mL)

Ketorolac (Ophthalmic) Solution, Ophthalmic, as tromethamine: 0.5% (5 mL, 10 mL)

Ketotifen (Systemic) Solution, ophthalmic: 0.025% (5 mL)

Labetalol Tablet, Oral, as hydrochloride: 100 mg, 200 mg

Lacosamide Solution, Oral:

Vimpat: 10 mg/mL (465 mL) [contains aspartame, methylparaben, polyethylene glycol,

propylene glycol; strawberry flavor]

Tablet, Oral:

Vimpat: 50 mg, 100 mg, 150 mg, 200 mg

Lactic Acid and Ammonium

Hydroxide

Lotion, topical: Lactic acid 12% with ammonium hydroxide (225 g)

Lactulose Solution, oral: 10 g/15 mL (473 mL) [BCF]

16


LamiVUDine Tablet, Oral: 150 mg

Epivir: 150 mg

Epivir HBV: 100 mg

Lamivudine and Zidovudine Tablet, oral: Lamivudine 150 mg and zidovudine 300 mg

LamoTRIgine Tablet, Oral: 25 mg, 100 mg, 150 mg, 200 mg

Tablet Chewable, Oral: 5 mg, 25 mg

Lansoprazole Suspension, Oral:

First-Lansoprazole: 3 mg/mL (300 mL) [contains benzyl alcohol, fd&c red #40, saccharin

sodium; strawberry flavor]

Latanoprost Solution, ophthalmic [drops]: 0.005% (2.5 mL) [BCF]

Ledipasvir and Sofosbuvir Tablet, Oral:

Harvoni: Ledipasvir 90 mg and sofosbuvir 400 mg

Leflunomide Tablet, Oral:


Letrozole Tablet, Oral: 2.5 mg

Leucovorin Calcium Tablet, Oral [strength expressed as base]: 5 mg, 15 mg

LevETIRAcetam Solution, Oral: 100 mg/mL (5 mL, 473 mL, 500 mL)


Levobunolol Solution, Ophthalmic, as hydrochloride: 0.5% (5 mL)

LevOCARNitine Tablet, Oral: 330 mg

LevoFLOXacin (Ophthalmic) Solution, Ophthalmic: 0.5% (5 mL)

LevoFLOXacin (Systemic) Tablet, oral: 250 mg [BCF], 500 mg [BCF], 750 mg [BCF]

Levonorgestrel (IUD) Intrauterine Device:

Skyla: 13.5 mg

Levonorgestrel (Systemic) Tablet, Oral:

Plan B: 0.75 mg [BCF]

Plan B One-Step: 1.5 mg

Levothyroxine Tablet, oral, as sodium: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg [BCF], 100 mcg

[BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150 mcg [BCF], 175 mcg [BCF], 200

mcg [BCF]

Lidocaine and Tetracaine Patch, transdermal:

Synera®: Lidocaine 70 mg and tetracaine 70 mg (10s) [contains heating component, metal;

each patch is ~50 cm2]

Lidocaine (Topical) Cream, External: 4% (30 g) [contains benzyl alcohol]

Gel, External, as hydrochloride: 2% (30 mL)

Ointment, External: 5% (30 g)

Patch, External:

Lidoderm: 5% (30 ea) [contains disodium edta, methylparaben, propylene glycol,

propylparaben]

Solution, Mouth/Throat, as hydrochloride: 2% (15 mL, 100 mL)

Liothyronine Tablet, Oral: 5 mcg, 25 mcg

Lisinopril Tablet, oral: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg [BCF], 40 mg [BCF]

Lisinopril and

Hydrochlorothiazide

Tablet, oral:

10/12.5: Lisinopril 10 mg and hydrochlorothiazide 12.5 mg [BCF]

20/12.5: Lisinopril 20 mg and hydrochlorothiazide 12.5 mg [BCF]

20/25: Lisinopril 20 mg and hydrochlorothiazide 25 mg [BCF]

Lithium Capsule, oral, as carbonate: 150 mg [BCF], 300 mg [BCF]

Solution, oral, as citrate: 300 mg/5 mL (5 mL, 500 mL) [equivalent to amount of lithium in

lithium carbonate] [BCF]

Tablet Extended Release, Oral, as carbonate: 300 mg

Loperamide Capsule, oral, as hydrochloride: 2 mg [BCF]

17


Lopinavir and Ritonavir Tablet:

Kaletra®:

Lopinavir 100 mg and ritonavir 25 mg

Lopinavir 200 mg and ritonavir 50 mg

Loratadine Syrup, Oral:

Claritin: 5 mg/5 mL (60 mL, 120 mL) [alcohol free, color free, dye free, sugar free; contains

edetate disodium, propylene glycol, sodium benzoate; grape flavor]

Tablet, Oral: 10 mg

LORazepam Concentrate, Oral: 2 mg/mL (30 mL)

Tablet, Oral: 0.5 mg, 1 mg

Losartan Tablet, oral, as potassium: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Losartan and

Hydrochlorothiazide

Tablet, oral:

50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg [BCF]

100/12.5: Losartan potassium 100 mg and hydrochlorothiazide 12.5 mg [BCF]

100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg [BCF]

Loteprednol Ointment, Ophthalmic, as etabonate:

Lotemax: 0.5% (3.5 g)

Suspension, Ophthalmic, as etabonate:

Lotemax: 0.5% (10 mL)

Lurasidone Tablet, Oral, as hydrochloride:

Latuda: 20 mg, 40 mg, 60 mg

Latuda: 80 mg [contains fd&c blue #2 aluminum lake]

Latuda: 120 mg

Magnesium Citrate Solution, Oral: 1.745 g/30 mL (296 mL)

Magnesium Oxide Tablet, Oral: 400 mg

Meclizine Tablet, Oral, as hydrochloride: 25 mg

Medium Chain Triglycerides Oil, oral:

MCT Oil®: 14 g/15 mL (960 mL) [gluten free; contains coconut oil; 115 cal/15 mL]

MedroxyPROGESTERone Tablet, oral, as acetate: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

Mefloquine Tablet, Oral, as hydrochloride: 250 mg

Megestrol Suspension, Oral, as acetate: 40 mg/mL (10 mL, 240 mL, 480 mL)

Tablet, Oral, as acetate: 40 mg

Meloxicam Tablet, oral: 7.5 mg [BCF], 15 mg [BCF]

Memantine Tablet, Oral, as hydrochloride:

Namenda: 5 mg, 10 mg

Namenda Titration Pak: 5 mg (28), 10 mg (21)

Meningococcal Group B

Vaccine

Suspension Prefilled Syringe, Intramuscular:

Bexsero: (0.5 mL)

Meningococcal Polysaccharide

(Groups C and Y) and

Haemophilus b Tetanus Toxoid

Conjugate Vaccine

Solution Reconstituted, Intramuscular [preservative free]:

Menhibrix: 5 mcg each of polysaccharide antigen groups C and Y, and 2.5 mcg Haemophilus b

capsular polysaccharide per 0.5 mL dose (1 ea) [contains tetanus toxoid]

Menthol and Zinc Oxide

(Topical)

Ointment, topical:

Calmoseptine®: Menthol 0.44% and zinc oxide 20.625% (3.5 g/packet)

Meperidine Solution, Injection, as hydrochloride: 25 mg/mL (1 mL)

Mercaptopurine Tablet, Oral: 50 mg

Mesalamine Enema, Rectal: 4 g (60 mL)

Suppository, Rectal:

Canasa: 1000 mg (30 ea, 42 ea)

Tablet Delayed Release, Oral:

Asacol: 400 mg [DSC]

MetFORMIN Tablet, oral, as hydrochloride: 500 mg [BCF], 850 mg [BCF], 1000 mg [BCF]

Tablet, extended release, oral, as hydrochloride: 500 mg [BCF], 750 mg [BCF]

Methadone Tablet, Oral, as hydrochloride: 10 mg

18


MethIMAzole Tablet, Oral: 5 mg, 10 mg

Tapazole: 10 mg [scored]

Methocarbamol Tablet, oral: 500 mg [BCF]

Methotrexate Tablet, oral: 2.5 mg [BCF]

Methyldopa Tablet, Oral: 250 mg

Methylergonovine Tablet, Oral, as maleate: 0.2 mg

Methylphenidate Capsule, extended release, oral, as hydrochloride [bi-modal release]: 20 mg [generic for Ritalin

LA®] [BCF], 30 mg [generic for Ritalin LA®] [BCF], 40 mg [generic for Ritalin LA®] [BCF]

Ritalin LA®: 10 mg [5 mg immediate release, 5 mg extended release] [BCF]




Tablet, oral, as hydrochloride: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF]

Tablet, extended release, oral, as hydrochloride [bi-modal release]: 18 mg [BCF], 27 mg

[BCF], 36 mg [BCF], 54 mg [BCF]

MethylPREDNISolone Tablet, Oral: 4 mg

Medrol (Pak): 4 mg [scored]

Metoclopramide Solution, oral: 5 mg/5 mL (10 mL, 473 mL) [BCF]


MetOLazone Tablet, Oral: 2.5 mg, 5 mg

Metoprolol Tablet, oral, as tartrate: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Tablet, extended release, oral, as succinate [expressed as mg equivalent to tartrate]: 25 mg

[BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF]

MetroNIDAZOLE (Systemic) Solution, Intravenous:

Generic: 500 mg (100 mL)

Tablet, Oral:

Generic: 250 mg [BCF], 500 mg [BCF]

MetroNIDAZOLE (Topical) Cream, External: 0.75% (45 g)

Gel, External:

Metrogel: 1% (60 g) [contains methylparaben, propylparaben]

Gel, vaginal: 0.75% (70 g) [BCF]

Midazolam Syrup, Oral: 2 mg/mL (118 mL)

Minocycline (Systemic) Tablet, Oral: 50 mg, 100 mg

Minoxidil (Systemic) Tablet, Oral: 2.5 mg, 10 mg

Mirtazapine Tablet, Oral: 15 mg, 30 mg, 45 mg

MiSOPROStol Tablet, Oral: 200 mcg

Mometasone (Topical) Cream, External, as furoate: 0.1% (15 g, 45 g)

Ointment, External, as furoate: 0.1% (15 g, 45 g)

Montelukast Granules, oral:

Singulair®: 4 mg/packet (30s) [BCF]


Tablet, chewable, oral: 4 mg [BCF], 5 mg [BCF]

Morphine (Systemic) Solution, Oral, as sulfate: 10 mg/5 mL (5 mL, 100 mL, 500 mL); 20 mg/mL (15 mL, 30 mL, 120

mL, 240 mL)

Tablet, Oral, as sulfate: 15 mg, 30 mg

Tablet, extended release, oral, as sulfate: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg

[BCF]

Moxifloxacin (Ophthalmic) Solution, Ophthalmic:

Vigamox: 0.5% (3 mL)

Mupirocin Cream, External, as calcium [strength expressed as base]: 2% (15 g, 30 g)

Ointment, topical: 2% (22 g) [BCF]

19


Mycophenolate Capsule, Oral, as mofetil: 250 mg

Tablet, Oral, as mofetil: 500 mg

Tablet, Oral, as mycophenolic acid: 500 mg

Tablet Delayed Release, Oral, as mycophenolic acid:

Myfortic: 180 mg

Myfortic: 360 mg

Naftifine Cream, External, as hydrochloride:

Naftin: 1% (60 g) [contains benzyl alcohol, cetyl alcohol]

Naloxone Liquid, Nasal:

Narcan: 4 mg/0.1 mL (1 ea) [contains benzalkonium chloride, edetate disodium] [BCF]

Naltrexone Tablet, Oral, as hydrochloride: 50 mg

Naphazoline and Pheniramine Solution, ophthalmic:

Naphcon-A®: Naphazoline hydrochloride 0.025% and pheniramine maleate 0.3% (15 mL)

[contains benzalkonium chloride]

Opcon-A®: Naphazoline hydrochloride 0.027% and pheniramine maleate 0.3% (15 mL)


Visine-A®: Naphazoline hydrochloride 0.025% and pheniramine maleate 0.3% (15 mL)


Naproxen Suspension, oral: 125 mg/5 mL (500 mL) [BCF]


Natamycin Suspension, Ophthalmic:

Natacyn: 5% (15 mL)

Nateglinide Tablet, Oral: 60 mg, 120 mg

Neomycin Tablet, Oral, as sulfate: 500 mg

Neomycin and Polymyxin B Solution, irrigation: Neomycin 40 mg and polymyxin B sulfate 200,000 units per 1 mL (1 mL)

Neomycin, Polymyxin B, and

Dexamethasone

Ointment, ophthalmic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and

dexamethasone 0.1% per g (3.5 g)

Suspension, ophthalmic [drops]: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and

dexamethasone 0.1% per 1 mL (5 mL)


Gramicidin

Solution, ophthalmic [drops]: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin

0.025 mg per 1 mL (10 mL) [BCF]


Hydrocortisone (Otic)

Suspension, otic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone 10 mg per

1 mL (10 mL) [BCF]

Nepafenac Suspension, Ophthalmic:

Nevanac: 0.1% (3 mL) [contains edentate disodium benzalkonium chloride]

Netarsudil Solution, Ophthalmic:

Rhopressa: 0.02% (2.5 mL) [contains benzalkonium chloride]

Netarsudil and Latanoprost Solution, Ophthalmic:

Rocklatan: Netarsudil dimesylate 0.02% and latanoprost 0.005% (2.5 mL) [contains

benzalkonium chloride]

Niacin Tablet, Oral: 50 mg, 100 mg, 500 mg


Niaspan®: 500 mg [BCF], 750 mg [BCF], 1000 mg [BCF]

Nicotine Gum, Mouth/Throat, as polacrilex: 2 mg [BCF], 4 mg [BCF]

Patch 24 Hour, Transdermal: 7 mg/24 hr (7 ea, 14 ea) [BCF]; 14 mg/24 hr (7 ea, 14 ea) [BCF];

21 mg/24 hr (7 ea, 14 ea, 28 ea) [BCF]

NIFEdipine Capsule, Oral: 10 mg


Nitazoxanide Suspension Reconstituted, Oral:

Alinia: 100 mg/5 mL (60 mL) [contains sodium benzoate; strawberry flavor]

Nitrofurantoin Capsule, oral: 50 mg [BCF], 100 mg

Suspension, Oral: 25 mg/5 mL (230 mL)

20


Nitroglycerin Patch, transdermal: 0.1 mg/hour (30s) [BCF]; 0.2 mg/hour (30s) [BCF]; 0.4 mg/hour (30s)

[BCF]

Solution, translingual [spray]: 0.4 mg/spray (12 g) [BCF]

Tablet, sublingual:

Nitrostat®: 0.4 mg [BCF]

Norethindrone Tablet, oral: 0.35 mg [BCF]

Nora-BE®: 0.35 mg [BCF]

Tablet, Oral, as acetate: 5 mg

Nortriptyline Capsule, oral: 10 mg [BCF], 25 mg [BCF]

Nystatin and Triamcinolone Cream: Nystatin 100,000 units and triamcinolone acetonide 0.1% (15 g)

Nystatin (Oral) Suspension, oral: 100,000 units/mL (5 mL, 60 mL, 473 mL) [BCF]

Tablet, Oral: 500,000 units

Nystatin (Topical) Cream, topical: 100,000 units/g (30 g) [BCF]

Ointment, topical: 100,000 units/g (30 g) [BCF]

Powder, External: 100,000 units/g (15 g)

Tablet, Vaginal: 100,000 units

Octreotide Solution, Injection: 50 mcg/mL (1 mL); 100 mcg/mL (1 mL); 1000 mcg/mL (5 mL)

Ofloxacin (Otic) Solution, Otic: 0.3% (5 mL, 10 mL)

OLANZapine Solution Reconstituted, Intramuscular: 10 mg (1 ea)

Tablet, Oral: 2.5 mg, 5 mg, 7.5 mg, 10 mg

Olopatadine (Ophthalmic) Solution, Ophthalmic [drops]:

Patanol: 0.1% (5 mL) [contains benzalkonium chloride] [BCF]

Pazeo: 0.7% (2.5 mL) [contains benzalkonium chloride]

Omeprazole Capsule, Delayed Release, Oral:

Generic: 20 mg [BCF], 40 mg

Suspension, Oral:

First-Omeprazole: 2 mg/mL (90 mL) [contains benzyl alcohol, fd&c red #40, saccharin sodium;

strawberry flavor]

Ondansetron Solution, Oral: 4 mg/5 mL (50 mL)

Tablet, Oral: 4 mg, 8 mg

Oseltamivir Capsule, Oral, as phosphate:

Tamiflu: 30 mg, 45 mg, 75 mg

Suspension Reconstituted, Oral, as base:

Tamiflu: 6 mg/mL (60 mL) [contains saccharin sodium, sodium benzoate; tutti-frutti flavor]

Oxazepam Capsule, Oral: 15 mg

OXcarbazepine Suspension, Oral: 300 mg/5 mL (250 mL)


Oxybutynin Syrup, Oral, as chloride: 5 mg/5 mL (473 mL)

Tablet, Oral, as chloride: 5 mg

Tablet, extended release, oral, as chloride: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF]

OxyCODONE Solution, Oral, as hydrochloride: 5 mg/5 mL (5 mL, 500 mL)


Tablet Extended Release 12 Hour, Oral, as hydrochloride: 10 mg, 20 mg, 40 mg, 80 mg

Oxycodone and Acetaminophen Tablet, oral: 5/325: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg [BCF]

Oxymetazoline (Nasal) Solution, Nasal, as hydrochloride:

Afrin Nasal Spray: 0.05% (15 mL)

Pancrelipase Capsule, Delayed Release, Enteric Coated Microspheres, Oral [porcine derived]:

Creon: Lipase 3000 units, protease 9500 units, and amylase 15,000 units [BCF]

Creon: Lipase 6000 units, protease 19,000 units, and amylase 30,000 units [BCF]

Creon: Lipase 12000 units, protease 38,000 units, and amylase 60,000 units [BCF]

Creon: Lipase 24,000 units, protease 76,000 units, and amylase 120,000 units [BCF]

21


Papillomavirus (9-Valent)

Vaccine (Human, Recombinant)

Suspension Prefilled Syringe, Intramuscular [preservative free]:

Gardasil 9: (0.5 mL) [contains polysorbate 80, yeast extract]

Paromomycin Capsule, Oral: 250 mg

PARoxetine Tablet, Oral, as hydrochloride [strength expressed as base]: 10 mg, 20 mg, 30 mg, 40 mg

Pegfilgrastim Solution, Subcutaneous [preservative free]:

Neulasta: 6 mg/0.6 mL (0.6 mL)

Peginterferon Alfa-2a Kit, Subcutaneous [preservative free]:

Pegasys: 180 mcg/0.5 mL [contains benzyl alcohol]

Penicillin V Potassium Powder for solution, oral: 250 mg/5 mL (100 mL, 200 mL) [BCF]


Pentosan Polysulfate Sodium Capsule, Oral: 100 mg

Pentoxifylline Tablet Extended Release, Oral: 400 mg

Perflutren Protein Type A Injection, suspension [preservative free]:

Optison™: Perflutren 0.11-0.33 mg and protein-type A microspheres 5-8 x 108 per mL (3 mL)

[contains human albumin 10 mg/mL]

Permethrin Cream, topical: 5% (60 g) [BCF]

Lotion, External: 1% (59 mL)

Phenazopyridine Tablet, oral, as hydrochloride: 200 mg [BCF]

PHENobarbital Elixir, oral: 20 mg/5 mL (5 mL, 7.5 mL, 15 mL, 473 mL) [BCF]

Tablet, oral: 32.4 mg, 64.8 mg

Phenylephrine (Ophthalmic) Solution, Ophthalmic, as hydrochloride: 2.5% (15 mL)

Phenytoin Capsule, extended release, oral, as sodium: 100 mg [BCF]

Dilantin®: 30 mg

Suspension, oral: 125 mg/5 mL (237 mL, 240 mL) [BCF]

Tablet, chewable, oral: 50 mg [BCF]

Phytonadione Tablet, oral:

Mephyton®: 5 mg [scored]

Pilocarpine (Ophthalmic) Solution, ophthalmic, as hydrochloride [drops]: 1% (15 mL) [BCF]; 2% (15 mL) [BCF]; 4% (15

mL) [BCF]

Pilocarpine (Systemic) Tablet, Oral, as hydrochloride: 5 mg

Pimecrolimus Cream, topical:

Elidel®: 1% (30 g, 100 g) [BCF] [contains benzyl alcohol]

Pioglitazone Tablet, Oral: 15 mg, 30 mg, 45 mg

Piroxicam (Systemic) Capsule, Oral: 20 mg

Podofilox Solution, External: 0.5% (3.5 mL)

Polyethylene Glycol 3350 Powder, Oral: 255 g

Polyethylene Glycol-Electrolyte

Solution

Powder, for solution, oral:

MoviPrep: Pouch A: PEG 3350 100g, sodium sulfate 7.5 g, sodium chloride 2.69 g, potassium

chloride 1.02 g; Pouch B: Ascorbic acid 4.7 g, sodium ascorbate 5.9 g (1000 mL) [contains

phenylalanine 131 mg/treatment; lemon flavor; packaged with 2 of Pouch A and 2 of Pouch B

in carton and a disposable reconstitution container]

PEG 3350 240 g, sodium sulfate 22.72 g, sodium bicarbonate 6.72 g, sodium chloride 5.84 g,

and potassium chloride 2.98 g (4000 mL)

PEG 3350 236 g, sodium sulfate 22.74 g, sodium bicarbonate 6.74 g, sodium chloride 5.86 g,

and potassium chloride 2.97 g (4000 mL)

PEG 3350 240 g, sodium bicarbonate 5.72 g, sodium chloride 11.2 g, and potassium chloride

1.48 g (4000 mL)

Polysaccharide-Iron Complex Capsule, Oral:

Ferrex 150: 150 mg

Potassium Chloride Solution, oral: 20 mEq/15 mL (15 mL, 30 mL, 473 mL) [BCF]

Tablet, extended release, oral: 8 mEq, 20 mEq

Potassium Citrate Tablet Extended Release, Oral: 10 mEq (1080 mg)

22


Potassium Iodide Solution, Oral:

SSKI: 1 g/mL (30 mL, 237 mL)

Potassium Phosphate and

Sodium Phosphate

Powder for solution, oral:

Phos-NaK: Dibasic potassium phosphate, monobasic potassium phosphate, dibasic sodium

phosphate, and monobasic sodium phosphate per packet (100s) [sugar free; equivalent to

elemental phosphorus 250 mg (8 mmol), sodium 160 mg (6.9 mEq), and potassium 280 mg

(7.1 mEq) per packet; fruit flavor]

Povidone-Iodine (Ophthalmic) Solution, Ophthalmic:

Betadine Ophthalmic Prep: 5% (30 mL)

Pramipexole Tablet, Oral, as dihydrochloride monohydrate: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 1.5 mg

Pramoxine and Hydrocortisone Aerosol, foam, topical:

Epifoam®: Pramoxine hydrochloride 1% and hydrocortisone acetate 1% (10 g)

Cream, topical: Pramoxine hydrochloride 1% and hydrocortisone acetate 1% (30 g);

pramoxine hydrochloride 1% and hydrocortisone acetate 2.5% (30 g)

Pravastatin Tablet, oral, as sodium: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]

Praziquantel Tablet, Oral:

Biltricide: 600 mg [scored]

Prazosin Capsule, Oral: 1 mg, 2 mg, 5 mg

PrednisoLONE (Ophthalmic) Suspension, ophthalmic, as acetate [drops]: 1% (5 mL) [BCF]

Pred Forte®: 1% (5 mL) [contains benzalkonium chloride, sodium bisulfite] [BCF]

Pred Mild®: 0.12% (5 mL) [contains benzalkonium chloride, sodium bisulfite] [BCF]

PrednisoLONE (Systemic) Solution, oral, as sodium phosphate [strength expressed as base]:

Orapred®: 15 mg/5 mL (20 mL, 237 mL) [dye free; contains ethanol 2%, sodium benzoate;

grape flavor] [BCF]

PredniSONE Tablet, oral: 1 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 50 mg

Primaquine Tablet, Oral, as phosphate: 26.3 mg

Primidone Tablet, Oral: 50 mg, 250 mg

Probenecid Tablet, Oral:


Prochlorperazine Suppository, Rectal: 25 mg

Tablet, Oral, as maleate [strength expressed as base]: 5 mg, 10 mg

Progesterone Gel, Vaginal:

Crinone: 8% (1.45 g)

Suppository, Vaginal:

First-Progesterone VGS 100: 100 mg (30 ea)

Promethazine Suppository, rectal, as hydrochloride: 25 mg (12s) [BCF]


Propafenone Tablet, Oral, as hydrochloride: 150 mg

Propantheline Tablet, Oral, as bromide: 15 mg

Propranolol Capsule Extended Release 24 Hour, Oral, as hydrochloride: 80 mg

Solution, Oral, as hydrochloride: 20 mg/5 mL (500 mL)

Tablet, Oral, as hydrochloride: 10 mg, 20 mg, 40 mg

Propylthiouracil Tablet, oral: 50 mg [BCF]

Pseudoephedrine Syrup, Oral, as hydrochloride: 30 mg/5 mL


Pyrazinamide Tablet, oral: 500 mg [BCF]

Pyrethrins and Piperonyl

Butoxide

Shampoo:

RID: Pyrethrins 0.33% and piperonyl butoxide 4% (60 mL)

Pyridostigmine Tablet, Oral, as bromide: 60 mg

Pyridoxine Solution, Injection, as hydrochloride: 100 mg/mL (1 mL)


Pyrimethamine Tablet, Oral:

Daraprim: 25 mg [scored]

23


QUEtiapine Tablet, oral: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF], 300 mg [BCF], 400 mg

[BCF]


SEROquel XR®: 50 mg [BCF], 200 mg [BCF], 300 mg [BCF], 400 mg [BCF]

QuiNIDine Tablet Extended Release, Oral, as gluconate: 324 mg

Raloxifene Tablet, oral, as hydrochloride:

Evista®: 60 mg [BCF]

Raltegravir Tablet, Oral:

Isentress: 400 mg [contains polyethylene glycol]

Ramipril Capsule, oral: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

RaNITIdine Syrup, oral: 15 mg/mL (5 mL, 10 mL, 473 mL, 474 mL, 480 mL) [BCF]


Ranolazine Tablet Extended Release 12 Hour, Oral:


Regadenoson Solution, Intravenous:

Lexiscan: 0.4 mg/5 mL (5 mL) [contains edetate disodium dihydrate, propylene glycol]

Ribavirin (Systemic) Capsule, Oral:

Generic: 200 mg [ECF]

Rifabutin Capsule, Oral:

Mycobutin: 150 mg

RifAMPin Capsule, oral: 300 mg [BCF]

RisperiDONE Solution, Oral:

RisperDAL: 1 mg/mL (30 mL) [contains benzoic acid] [BCF]

Generic: 1 mg/mL (30 mL) [BCF]

Tablet, Oral:

Generic: 0.25 mg [BCF], 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF], 3 mg [BCF], 4 mg [BCF]

Tablet Dispersible, Oral:

Generic: 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF]

Ritonavir Tablet, Oral:

Norvir: 100 mg

Rivaroxaban Tablet, Oral:

Xarelto: 2.5 mg

Rizatriptan Tablet, oral: 10 mg [BCF]

Tablet, orally disintegrating: 5 mg [BCF], 10 mg [BCF]

ROPINIRole Tablet, Oral: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg

Rosuvastatin Tablet, Oral:

Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]

Sacubitril and Valsartan Tablet, Oral:

Entresto: Sacubitril 24 mg and valsartan 26 mg, Sacubitril 49 mg and valsartan 51 mg,

Sacubitril 97 mg and valsartan 103 mg

Salicylic Acid Liquid, External:

Generic: 17% 9.3 mL)

Pad, External:

Mediplast: 40% (1 ea, 25 ea)

Saliva Substitute Solution, oral [spray]: 240 mL

Salmeterol Powder, for oral inhalation:

Serevent® Diskus®: 50 mcg (28s, 60s) [contains lactose] [BCF]

Salsalate Tablet, oral: 500 mg [BCF], 750 mg [BCF]

Saquinavir Tablet, Oral:

Invirase: 500 mg

Scopolamine (Ophthalmic) Solution, Ophthalmic, as hydrobromide:

Isopto Hyoscine: 0.25% (5 mL)

Scopolamine (Systemic) Patch 72 Hour, Transdermal:

Transderm-Scop: 1.5 mg (1 ea, 4 ea, 10 ea, 24 ea)

24


Selegiline Tablet, Oral, as hydrochloride: 5 mg

Selenium Sulfide Lotion, topical: 2.5% (120 mL) [BCF]

Senna Syrup, Oral: 8.8 mg/5 mL (236 mL, 237 mL)

Tablet, Oral: 8.6 mg

Sertraline Tablet, oral: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Sevelamer Tablet, Oral, as carbonate:

Renvela: 800 mg

Sildenafil Tablet, oral:

Viagra®: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Silver Sulfadiazine Cream, topical: 1% (50 g) [BCF]

Simeprevir Capsule, Oral:

Olysio: 150 mg

Simethicone Suspension, Oral: 40 mg/0.6 mL (30 mL)

Simvastatin Tablet, oral: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg

Sinus Rinse

SITagliptin Tablet, oral:

Januvia®: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Sitagliptin and Metformin Tablet, oral:

Janumet® 50/500: Sitagliptin 50 mg and metformin hydrochloride 500 mg [BCF]

Janumet® 50/1000: Sitagliptin 50 mg and metformin hydrochloride 1000 mg [BCF]


Janumet® XR: 50/500: Sitagliptin 50 mg and metformin hydrochloride 500 mg [BCF]



Sitagliptin and Simvastatin Tablet, oral:

Juvisync™ 100/10: Sitagliptin 100 mg and simvastatin 10 mg



Sodium Bicarbonate Tablet, Oral: 650 mg

Sodium Chloride Nebulization Solution, Inhalation [preservative free]:

HyperSal: 7% (4 mL)

Generic: 0.9% (100 vial/box); 3% (4 mL, 15 mL); 7% (4 mL); 10% (15 mL)

Ointment, Ophthalmic:

Generic: 5% (3.5 g)

Solution, Nasal:


Solution, Ophthalmic:

Generic: 5% (15 mL)

Sodium Citrate and Citric Acid Solution, oral: Sodium citrate 500 mg and citric acid 334 mg per 5 mL (480 mL)

Sodium Hypochlorite Solution, External: 0.125% (473 mL); 0.25% (473 mL)

Sodium Phosphates Injection, solution [concentrate; preservative free]: Phosphorus 3 mmol and sodium 4 mEq per

1 mL (15 mL, 50 mL) [equivalent to phosphorus 93 mg and sodium 92 mg per 1 mL; source of

electrolytes: monobasic and dibasic sodium phosphate]

Solution, rectal [enema]: Monobasic sodium phosphate monohydrate 19 g and dibasic sodium

phosphate heptahydrate 7 g per 118 mL delivered dose (133 mL)

Sodium Polystyrene Sulfonate Suspension, Oral: 15 g/60 mL (60 mL, 480 mL)

Somatropin Solution, Subcutaneous:

Norditropin FlexPro: 5 mg/1.5 mL (1.5 mL); 10 mg/1.5 mL (1.5 mL); 15 mg/1.5 mL (1.5 mL)

[contains phenol]

Nutropin AQ Pen: 10 mg/2 mL (2 mL)

Nutropin AQ Pen: 20 mg/2 mL (2 mL) [contains phenol]

Sorbitol Solution, Oral: 70% (30 mL, 473 mL, 474 mL, 480 mL, 3840 mL)

Spironolactone Tablet, oral: 25 mg [BCF], 100 mg

25


Sucralfate Suspension, Oral:

Carafate: 1 g/10 mL (420 mL)

Tablet, Oral: 1 g

Sulfacetamide (Ophthalmic) Solution, ophthalmic, as sodium [drops]: 10% (15 mL) [BCF]

Sulfacetamide (Topical) Suspension, External, as sodium:


SulfADIAZINE Tablet, Oral: 500 mg

Sulfamethoxazole and

Trimethoprim

Suspension, oral: Sulfamethoxazole 200 mg and trimethoprim 40 mg per 5 mL (20 mL, 473

mL) [BCF]

Tablet, double strength, oral: Sulamethoxazole 800 mg and trimethoprim 160 mg [BCF]

SulfaSALAzine Tablet, oral: 500 mg [BCF]

Tablet, delayed release, enteric coated, oral: 500 mg [BCF]

Sulindac Tablet, Oral: 150 mg

SUMAtriptan Injection, solution, as succinate [strength expressed as base]: 6 mg/0.5 mL (0.5 mL) [BCF]

Solution, Nasal: 5 mg/actuation (1 ea); 20 mg/actuation (1 ea)

Solution, Subcutaneous, as succinate [strength expressed as base]:

Imitrex STATdose Refill: 6 mg/0.5 mL (0.5 mL)

Imitrex STATdose System: 6 mg/0.5 mL (0.5 mL)

Tablet, oral, as succinate [strength expressed as base]: 25 mg [BCF], 50 mg [BCF], 100 mg

[BCF]

SUNItinib Capsule, Oral:

Sutent: 12.5 mg, 25 mg, 50 mg

Tacrolimus (Systemic) Capsule, Oral: 0.5 mg, 1 mg, 5 mg

Tacrolimus (Topical) Ointment, External:

Protopic: 0.03% (30 g); 0.1% (30 g)

Tamoxifen Tablet, oral: 10 mg [BCF], 20 mg [BCF]

Tamsulosin Capsule, oral, as hydrochloride: 0.4 mg [BCF]

Tazarotene Gel, External:

Tazorac: 0.1% (30 g) [contains benzyl alcohol]

Telaprevir Tablet, Oral:

Incivek: 375 mg

Temazepam Capsule, oral: 15 mg [BCF], 30 mg [BCF]

Tenofovir Alafenamide Tablet, Oral:

Vemlidy: 25 mg

Tenofovir Disoproxil Fumarate Tablet, Oral, as disoproxil fumarate:

Viread: 300 mg

Terazosin Capsule, oral: 1 mg [BCF], 2 mg [BCF], 5 mg [BCF], 10 mg [BCF]

Terbinafine (Systemic) Tablet, Oral: 250 mg

Terbutaline Tablet, Oral, as sulfate: 2.5 mg, 5 mg

Testosterone Gel, Transdermal:

Fortesta: 10 mg/actuation (2%) (60 g) [odorless; contains propylene glycol, trolamine

(triethanolamine)] [BCF]

Patch 24 Hour, Transdermal:

Androderm: 2 mg/24 hr (60 ea); 4 mg/24 hr (1 ea, 30 ea)

Pellet, Implant:

Testopel: 75 mg (10 ea)

Theophylline Solution, oral:

Elixophyllin® Elixir: 80 mg/15 mL (473 mL) [contains ethanol 20%; mixed fruit flavor] [BCF]


Thiamine Tablet, Oral, as hydrochloride: 50 mg

Ticagrelor Tablet, Oral:

Brilinta: 90 mg

26


Timolol (Ophthalmic) Gel forming solution, ophthalmic, as maleate [strength expressed as base, drops]: 0.25% (5

mL) [BCF]; 0.5% (5 mL) [BCF]

Solution, ophthalmic, as maleate [strength expressed as base, drops]: 0.25% (5 mL) [BCF];

0.5% (15 mL) [BCF]

Tinidazole Tablet, Oral: 500 mg

Tiotropium Aerosol Solution, Inhalation:

Spiriva Respimat: 2.5 mcg/actuation (4 g) [BCF] [contains benzalkonium chloride, disodium

edta]

Capsule, Inhalation:

Spiriva HandiHaler: 18 mcg [contains milk protein] [BCF]

Tiotropium and Olodaterol Aerosol Solution, Inhalation:

Stiolto Respimat: Tiotropium 2.5 mcg and olodaterol 2.5 mcg per actuation (4 g) [contains

benzalkonium chloride, edetate disodium]

Tobramycin (Ophthalmic) Ointment, Ophthalmic:

Tobrex: 0.3% (3.5 g)

Solution, Ophthalmic: 0.3% (5 mL)

Tobramycin (Oral Inhalation) Nebulization Solution, Inhalation [preservative free]:

Tobi: 300 mg/5 mL (5 mL) [contains sodium chloride, sodium hydroxide, sulfuric acid]

Tolterodine Capsule, extended release, oral, as tartrate:

Detrol® LA: 2 mg [BCF], 4 mg [BCF]

Topiramate Capsule Sprinkle, Oral: 15 mg, 25 mg

Tablet, Oral: 25 mg, 50 mg, 100 mg, 200 mg

Torsemide Tablet, Oral:

Generic: 20 mg

TraMADol Tablet, oral, as hydrochloride: 50 mg [BCF]

Tranexamic Acid Tablet, Oral:

Generic: 650 mg

TraZODone Tablet, oral, as hydrochloride: 50 mg [BCF]

Tretinoin (Topical) Cream, topical: 0.025% (20 g, 45 g) [BCF]; 0.05% (20 g); 0.1% (20 g) [BCF]

Gel, External: 0.01% (15 g); 0.1% (20 g)

Retin-A Micro Pump: 0.04% (50 g) [contains benzyl alcohol, disodium edta, propylene glycol,

trolamine (triethanolamine)]

Triamcinolone (Topical) Aerosol Solution, External, as acetonide:

Kenalog: (63 g)

Cream, topical, as acetonide: 0.025% (15 g, 80 g); 0.1% (15 g, 80 g) [BCF]

Lotion, External, as acetonide:


Ointment, External, as acetonide: 0.1% (15 g, 80 g)

Paste, Mouth/Throat, as acetonide: 0.1% (5 g)

Triazolam Tablet, Oral: 0.25 mg

Trihexyphenidyl Tablet, oral, as hydrochloride: 2 mg [BCF], 5 mg

Trimethoprim Tablet, Oral: 100 mg

Trimethoprim and Polymyxin B Solution, Ophthalmic:

Polytrim: Trimethoprim 1 mg and polymyxin B sulfate 10,000 units per 1 mL (10 mL) [contains

benzalkonium chloride] [BCF]

Generic: Trimethoprim 1 mg and polymyxin B sulfate 10,000 units per 1 mL (10 mL) [BCF]

Triprolidine and

Pseudoephedrine

Tablet, oral:

Aprodine: Triprolidine hydrochloride 2.5 mg and pseudoephedrine hydrochloride 60 mg

Tropicamide Solution, Ophthalmic: 0.5% (15 mL); 1% (15 mL)

Typhoid Vaccine Capsule, enteric coated [live]:

Vivotif®: Viable S. typhi Ty21a 2-6.8 x 109 colony-forming units and nonviable S. typhi Ty21a 5-

50 x 109 bacterial cells [contains lactose 100-180 mg/capsule and sucrose 26-130 mg/capsule]

27


Ulipristal Tablet, Oral, as acetate:

Ella: 30 mg

Urea (Topical) Cream, External: 40% (30 g, 90 g)

Ursodiol Capsule, Oral: 30 mg

ValACYclovir Tablet, Oral: 500 mg, 1 g

ValGANciclovir Tablet, Oral: 450 mg

Valproic Acid and Derivatives Capsule, sprinkle, oral [strength expressed as valproic acid]: 125 mg [BCF]

Syrup, oral, as valproate sodium: 250 mg/5 mL (5 mL, 10 mL, 473 mL, 480 mL) [strength

expressed as valproic acid]

Tablet, delayed release, oral [strength expressed as valproic acid]: 125 mg [BCF], 250 mg

[BCF], 500 mg [BCF]

Tablet, extended release, oral [strength expressed as valproic acid]: 250 mg [BCF], 500 mg

[BCF]

Valsartan Tablet, oral:

Diovan®: 40 mg [scored] [BCF], 80 mg [BCF], 160 mg [BCF], 320 mg [BCF]

Valsartan and

Hydrochlorothiazide

Tablet, oral:

80 mg/12.5 mg: Valsartan 80 mg and hydrochlorothiazide 12.5 mg [BCF]


160 mg/25 mg: Valsartan 160 mg and hydrochlorothiazide 25 mg [BCF]


320 mg/25 mg: Valsartan 320 mg and hydrochlorothiazide 25 mg [BCF]

Vancomycin Capsule, Oral:


Venlafaxine Capsule, extended release, oral: 37.5 mg [BCF], 75 mg [BCF], 150 mg [BCF]

Verapamil Tablet, Oral, as hydrochloride: 80 mg, 120 mg

Tablet, extended release, oral, as hydrochloride: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF]

Vitamin A Capsule, Oral: 10,000 units

Vitamin B Complex, Ascorbic

Acid, and Folic Acid

Content may vary slightly depending on product used.

Nephro-Vite

Vitamins (Multiple/Oral) Content varies depending on product used.

Source CF

Vitamins (Multiple/Pediatric) Content varies depending on product used.

Capsule, oral:

AquADEKs (60 ea)

Liquid, oral:

AquADEKs: 60 mL

Tablet, chewable:

AquADEKs (60 ea)

Vitamins (Multiple/Prenatal) Content varies depending on product used.

Warfarin Tablet, oral, as sodium: 1 mg [BCF], 2 mg [BCF], 2.5 mg [BCF], 3 mg [BCF], 4 mg [BCF], 5

mg [BCF], 6 mg [BCF]

Coumadin®: 1 mg [BCF], 2 mg [BCF], 2.5 mg [BCF], 3 mg [BCF], 4 mg [BCF], 5 mg [BCF], 6

mg [BCF]

Witch Hazel Pad, External: 40/box [contains glycerin]

Zinc Oxide Ointment, topical: 20% (30 g)

Zinc Sulfate Capsule, Oral: 220 mg

Ziprasidone Capsule, Oral, as hydrochloride: 20 mg, 40 mg, 60 mg, 80 mg

ZOLMitriptan Tablet, Oral:

Zomig: 2.5 mg, 5 mg

Tablet Dispersible, Oral:

Generic: 2.5 mg [BCF], 5 mg [BCF]

Zolpidem Tablet, oral, as tartrate: 5 mg [BCF], 10 mg [BCF]

Tablet Extended Release, Oral, as tartrate: 6.25 mg, 12.5 mg

28


Zoster Vaccine (Recombinant) Suspension Reconstituted, Intramuscular:

Shingrix: 50 mcg [contains polysorbate 80]

29