La tétracycline, connue sous le nom commercial Sumycin, agit en bloquant la fixation de l’ARNt sur la sous-unité 30S ribosomale, interrompant l’élongation de la chaîne protéique bactérienne. Ce mécanisme confère une activité sur un spectre large, incluant bactéries Gram positives, Gram négatives, rickettsies et spirochètes. Sa biodisponibilité digestive varie selon la prise alimentaire et les interactions avec les ions divalents comme calcium et magnésium. Sa diffusion tissulaire est importante, notamment dans les voies respiratoires et génito-urinaires. L’élimination se fait par voie rénale et biliaire. Les effets indésirables incluent photosensibilisation, troubles digestifs et coloration dentaire en cas d’administration précoce. Les guides thérapeutiques mentionnent sumycin prix, en soulignant la nécessité de restreindre son utilisation afin de limiter les résistances acquises.

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BCBSMN GenRx
Alphabetical Drug List
April 2009
To search for a drug name within this PDF document, use the Control and F keys on your keyboard, or go to Edit in the drop-down menu and
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Category
acarbose (Precose - brand is NF)
acebutolol (Sectral – brand is NF)
acetaminophen/codeine (Tylenol w/Codeine – brand is NF)
acetaminophen/isometheptene/dichloralphenazone (Midrin – brand is NF)
acetazolamide
acetazolamide ext-release (Diamox Sequels – brand is NF)
acetic acid ear soln
acetylcysteine
ACTOS – ST
acyclovir (Zovirax – brand is NF)
ADVAIR DISKUS 250/50 – QL
ADVATE – PA
albuterol sulfate inhal soln
albuterol sulfate syrup, tabs
alclometasone (Aclovate – brand is NF)
alendronate tabs (Fosamax – brand is NF) – QL
allopurinol
ALPHANATE – PA
ALPHANINE SD – PA
alprazolam (Xanax – brand is NF)
aluminum chloride soln (Drysol – brand is NF)
amantadine caps, syrup
amiloride/hydrochlorothiazide
aminocaproic acid inj (Amicar – brand is NF)
aminocaproic acid syrup, tabs (Amicar – brand is NF)
amiodarone
amitriptyline
amlodipine (Norvasc – brand is NF)
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS amlodipine/benazepril (Lotrel – brand is NF)
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS amoxicillin
amoxicillin/potassium clavulanate (Augmentin – brand is NF)
amphetamine/dextroamphetamine mixed salts (Adderall – brand is NF)
ampicillin caps
anagrelide (Agrylin – brand is NF)
GenRx Drug Alphabetical Drug List, April 2009 1
Category
anthralin (Dritho-Creme HP – brand is NF)
ASCENSIA AUTODISC – QL
ASCENSIA BREEZE/BREEZE 2 – QL
ASCENSIA CONTOUR – QL
ASCENSIA ELITE/ELITE XL – QL
ASMANEX – QL
atenolol (Tenormin – brand is NF)
atenolol/chlorthalidone (Tenoretic – brand is NF)
atropine sulfate oint, soln (Isopto Atropine – brand is NF)
azathioprine (Imuran – brand is NF)
azithromycin (Zithromax – brand is NF)
bacitracin oint
bacitracin/polymyxin B oint
baclofen
balsalazide (Colazal - brand is NF)
BEBULIN VH – PA
benazepril (Lotensin – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS benazepril/hydrochlorothiazide (Lotensin HCT – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS BENEFIX – PA
benzocaine/antipyrine
benzonatate (Tessalon – brand is NF)
benztropine
betamethasone dipropionate
betamethasone dipropionate, augmented (Diprolene – brand is NF)
betamethasone valerate
bethanechol (Urecholine – brand is NF)
bisoprolol (Zebeta – brand is NF)
bisoprolol/hydrochlorothiazide (Ziac – brand is NF)
brimonidine soln, 0.2%
bromocriptine (Parlodel – brand is NF)
brompheniramine/pseudoephedrine ext-release caps, 6/60
bumetanide (Bumex – brand is NF)
bupropion (Wellbutrin – brand is NF)
bupropion ext-release – 12 hr (Wellbutrin SR – brand is NF)
bupropion ext-release – 24 hr (Wellbutrin XL – brand is NF)
GenRx Drug Alphabetical Drug List, April 2009 2
Category
bupropion ext-release (Zyban)
buspirone (Buspar – brand is NF)
butalbital/acetaminophen tabs, 50/325 (Phrenilin – brand is NF)
butalbital/acetaminophen tabs, 50/650 (Sedapap – brand is NF)
butalbital/acetaminophen/caffeine caps, 50/325/40 (Esgic – brand is NF)
butalbital/acetaminophen/caffeine tabs, 50/325/40 (Fioricet – brand is NF)
butalbital/acetaminophen/caffeine tabs, 50/500/40 (Esgic Plus – brand is NF)
butalbital/aspirin/caffeine caps, 50/325/40 (Fiorinal – brand is NF)
butalbital/aspirin/caffeine tabs, 50/325/40
butalbital/aspirin/caffeine/codeine caps (Fiorinal w/Codeine – brand is NF)
cabergoline
calcipotriene soln (Dovonex – brand is NF)
calcitonin-salmon nasal – includes Fortical
calcitriol (Rocaltrol – brand is NF)
calcium acetate (Phoslo)
captopril (Capoten – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS captopril/hydrochlorothiazide
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS carbamazepine (Tegretol – brand is NF)
carbidopa/levodopa (Sinemet – brand is NF)
carbidopa/levodopa ext-release (Sinemet CR – brand is NF)
carbidopa/levodopa ODT (Parcopa – brand is NF)
carteolol soln
carvedilol (Coreg – brand is NF)
cefadroxil
cefdinir (Omnicef – brand is NF)
cefpodoxime (Vantin – brand is NF)
cefprozil
ceftriaxone (Rocephin – brand is NF)
cefuroxime (Ceftin – brand is NF)
cephalexin (Keflex – brand is NF)
CHANTIX – QL
chloral hydrate syrup
chlorhexidine oral rinse (Peridex – brand is NF)
chloroquine phosphate (Aralen – brand is NF)
chlorothiazide
chlorpromazine
chlorpropamide
chlorthalidone 25 mg, 50 mg
chlorzoxazone
cholestyramine (Questran, Questran Light – brands are NF)
chorionic gonadotropin
GenRx Drug Alphabetical Drug List, April 2009 3
Category
ciclopirox (Loprox – brand is NF)
cilostazol (Pletal – brand is NF)
cimetidine
ciprofloxacin ext-release (Cipro XR – brand is NF)
ciprofloxacin soln (Ciloxan – brand is NF)
ciprofloxacin tabs (Cipro – brand is NF)
citalopram (Celexa – brand is NF)
clarithromycin (Biaxin – brand is NF)
clarithromycin ext-release (Biaxin XL – brand is NF)
clindamycin (Cleocin – brand is NF)
clindamycin (Cleocin T – brand is NF)
clindamycin crm (Cleocin – brand is NF)
clobetasol (Olux – brand is NF)
clobetasol (Temovate – brand is NF)
clomiphene (Clomid – brand is NF)
clomipramine (Anafranil – brand is NF)
clonazepam (Klonopin – brand is NF)
clonidine (Catapres – brand is NF)
clotrimazole troche (Mycelex – brand is NF)
clotrimazole/betamethasone (Lotrisone – brand is NF)
clozapine 25 mg, 50 mg, 100 mg (Clozaril – brand is NF) – QL
codeine sulfate 30 mg, 60 mg
codeine/guaifenesin soln, 10/100 per 5 mL
colchicine
colestipol tabs (Colestid – brand is NF)
cortisone acetate
COZAAR – ST
CRESTOR 40 mg – ST
cromolyn sodium inhal soln
cromolyn sodium soln (Crolom – brand is NF)
cyanocobalamin inj
cyclobenzaprine (Flexeril – brand is NF)
cyclopentolate soln (Cyclogyl – brand is NF)
cyclosporine (Sandimmune – brand is NF)
cyclosporine modified caps, 25 mg, 100 mg; soln (Neoral – brand is NF)
cyproheptadine
GenRx Drug Alphabetical Drug List, April 2009 4
Category
dantrolene (Dantrium – brand is NF)
demeclocycline (Declomycin – brand is NF)
desipramine (Norpramin – brand is NF)
desmopressin inj (DDAVP – brand is NF)
desmopressin nasal (DDAVP – brand is NF)
desmopressin tabs (DDAVP – brand is NF)
desogestrel/ethinyl estradiol (Cyclessa – brand is NF)
desogestrel/ethinyl estradiol (Mircette – brand is NF)
desogestrel/ethinyl estradiol (Ortho-Cept – brand is NF)
desonide (Desowen – brand is NF)
desoximetasone (Topicort – brand is NF)
DEXAMETHASONE elixir, soln; tabs, 1 mg, 2 mg dexamethasone sodium phosphate soln
EYE, Steroids and Steroid Combination Products dexamethasone tabs, 0.5 mg, 0.75 mg, 1.5 mg, 4 mg, 6 mg
dextroamphetamine ext-release (Dexedrine Spansule – brand is NF)
dextroamphetamine tabs, 5 mg
diazepam tabs (Valium – brand is NF)
diclofenac sodium delayed-release (Voltaren – brand is NF)
diclofenac sodium ext-release (Voltaren XR – brand is NF)
diclofenac soln (Voltaren – brand is NF)
dicloxacillin
dicyclomine (Bentyl – brand is NF)
didanosine delayed-release (Videx EC – brand is NF)
diflorasone
digoxin tabs (Lanoxin – brand is NF)
diltiazem (Cardizem – brand is NF)
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS diltiazem ext-release – 12 hr
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS diltiazem ext-release (Cardizem CD – brand is NF)
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS diltiazem ext-release (Dilacor XR – brand is NF)
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS diltiazem ext-release (Tiazac – brand is NF)
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS diphenoxylate/atropine (Lomotil – brand is NF)
dipivefrin soln (Propine – brand is NF)
disopyramide (Norpace – brand is NF)
disopyramide ext-release 150 mg (Norpace CR – brand is NF)
divalproex delayed-release (Depakote - brand is NF)
divalproex delayed-release (Depakote Sprinkles - brand is NF)
divalproex ext-release (Depakote ER – brand is NF)
dorzolamide (Trusopt – brand is NF)
dorzolamide/timolol maleate (Cosopt – brand is NF)
GenRx Drug Alphabetical Drug List, April 2009 5
Category
doxazosin (Cardura – brand is NF)
doxepin caps, soln
doxepin crm (Zonalon – brand is NF)
doxycycline hyclate
doxycycline monohydrate caps, tabs (Monodox, Adoxa – brands are NF)
dronabinol (Marinol – brand is NF)
drospirenone/ethinyl estradiol (Yasmin – brand is NF)
econazole
ELIDEL – ST
enalapril (Vasotec – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS enalapril/hydrochlorothiazide (Vaseretic – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS ENBREL – ST
epoprostenol (Flolan – brand is NF)
ergocalciferol caps (Drisdol – brand is NF)
ergotamine/caffeine tabs (Cafergot – brand is NF) – QL
erythromycin ethylsuccinate
erythromycin gel
erythromycin oint
erythromycin pads, soln, 2%
erythromycin/benzoyl peroxide (Benzamycin – brand is NF)
erythromycin/sulfisoxazole (Pediazole – brand is NF)
estazolam
estradiol patches (Climara – brand is NF)
estradiol tabs (Estrace – brand is NF)
estradiol/norethindrone acetate 1/0.5 mg (Activella – brand is NF)
estropipate (Ogen – brand is NF)
ethambutol (Myambutol – brand is NF)
ethosuximide (Zarontin – brand is NF)
ethynodiol/ethinyl estradiol (Demulen – brand is NF)
etodolac
etoposide
famciclovir (Famvir – brand is NF)
famotidine (Pepcid – brand is NF)
GenRx Drug Alphabetical Drug List, April 2009 6
Category
FEIBA VH – PA
felodipine ext-release
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS fenofibrate micronized, caps, 67 mg, 134 mg, 200 mg (Lofibra – brand is NF)
fenofibrate tabs, 54 mg, 160 mg (Lofibra – brand is NF)
fentanyl patches (Duragesic – brand is NF)
fexofenadine (Allegra – brand is NF)
finasteride (Proscar – brand is NF)
flecainide (Tambocor – brand is NF)
fluconazole (Diflucan – brand is NF)
fludrocortisone
flunisolide (Nasarel – brand is NF)
flunisolide 25 mcg/spray
fluocinonide
fluorometholone susp (FML – brand is NF)
EYE, Steroids and Steroid Combination Products fluorouracil crm, soln, 5% (Efudex – brand is NF )
fluoxetine (Prozac – brand is NF)
fluphenazine decanoate
fluphenazine hcl tabs
flurbiprofen soln (Ocufen – brand is NF)
flutamide
fluticasone (Flonase – brand is NF)
fluticasone propionate (Cutivate – brand is NF)
folic acid inj
folic acid tabs, 1 mg
FOLLISTIM AQ – PA – Benefit Exclusions May Apply
FORADIL AEROLIZER – QL
fosinopril (Monopril – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS fosinopril/hydrochlorothiazide (Monopril HCT – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS furosemide soln, 10 mg/mL; tabs (Lasix – brand is NF)
gabapentin caps, tabs (Neurontin – brand is NF)
gemfibrozil (Lopid – brand is NF)
gentamicin crm, oint
gentamicin oint, soln
glimepiride (Amaryl – brand is NF)
glipizide (Glucotrol – brand is NF)
glipizide ext-release (Glucotrol XL – brand is NF)
glipizide/metformin (Metaglip – brand is NF)
glyburide (Micronase – brand is NF)
glyburide micronized (Glynase – brand is NF)
glyburide/metformin (Glucovance – brand is NF)
GenRx Drug Alphabetical Drug List, April 2009 7
Category
glycopyrrolate (Robinul – brand is NF)
granisetron tabs (Kytril – brand is NF)
griseofulvin microsize susp (Grifulvin V – brand is NF)
guanfacine (Tenex – brand is NF)
halobetasol (Ultravate – brand is NF)
haloperidol decanoate (Haldol – brand is NF)
haloperidol lactate oral soln
haloperidol tabs
HELIXATE FS – PA
HEMOFIL M – PA
heparin sodium inj
heparin sodium lock flush
homatropine soln (Isopto Homatropine – brand is NF)
HUMATE-P – PA
hydralazine
hydrochlorothiazide caps (Microzide – brand is NF)
hydrochlorothiazide tabs, 25 mg, 50 mg
hydrocodone/acetaminophen caps, 5/500
hydrocodone/acetaminophen soln, 7.5/500 per 15 mL (Lortab – brand is NF)
hydrocodone/acetaminophen tabs, 10/750 (Maxidone – brand is NF)
hydrocodone/acetaminophen tabs, 2.5/500, 5/500, 7.5/500, 10/500
hydrocodone/acetaminophen tabs, 5/325, 7.5/325, 10/325
hydrocodone/acetaminophen tabs, 5/500, 7.5/750, 10/660
(Vicodin, Vicodin ES, Vicodin HP – brands are NF) hydrocodone/acetaminophen tabs, 7.5/650, 10/650
hydrocodone/ibuprofen tabs, 5/200 (Reprexain – brand is NF)
hydrocodone/ibuprofen tabs, 7.5/200 (Vicoprofen – brand is NF)
hydrocodone/ibuprofen tabs, 10/200 (Ibudone – brand is NF)
hydrocortisone (Cortef – brand is NF)
hydrocortisone 2.5%
hydrocortisone acetate supp, 25 mg (Anusol-HC – brand is NF)
hydrocortisone butyrate (Locoid – brand is NF)
hydrocortisone crm, 2.5% (Anusol-HC – brand is NF)
hydrocortisone enema
hydrocortisone valerate (Westcort – brand is NF)
hydrocortisone/acetic acid
hydromorphone tabs (Dilaudid – brand is NF)
hydroxychloroquine (Plaquenil – brand is NF)
hydroxyurea (Hydrea – brand is NF)
hydroxyzine hcl
hydroxyzine pamoate (Vistaril – brand is NF)
GenRx Drug Alphabetical Drug List, April 2009 8
Category
hyoscyamine (Cystospaz – brand is NF)
hyoscyamine (Levsin – brand is NF)
hyoscyamine ext-release tabs (Levbid – brand is NF)
hyoscyamine ODT
HYZAAR – ST
ibuprofen
imipramine hcl (Tofranil – brand is NF)
IMITREX inj – QL
IMITREX nasal – QL
IMITREX tabs – QL
INCRELEX – PA
indapamide
indomethacin
indomethacin ext-release (Indocin SR – brand is NF)
ipratropium inhal soln
ipratropium spray (Atrovent – brand is NF)
ipratropium/albuterol sulfate (Duoneb – brand is NF)
isoniazid tabs
isoniazid/rifampin (Rifamate – brand is NF)
isosorbide dinitrate oral tabs (Isordil – brand is NF)
isosorbide mononitrate (Monoket – brand is NF)
isosorbide mononitrate ext-release
isotretinoin caps (Accutane – brand is NF)
itraconazole caps (Sporanox – brand is NF)
KEPPRA soln; tabs, 1000 mg – ST
ketoconazole crm
ketoconazole shampoo, 2% (Nizoral – brand is NF)
ketoconazole tabs
ketoprofen
ketorolac – QL
KOATE-DVI – PA
KOGENATE FS – PA
labetalol (Trandate – brand is NF)
lactulose
lamotrigine (Lamictal – brand is NF)
GenRx Drug Alphabetical Drug List, April 2009 9
Category
leflunomide (Arava – brand is NF)
leucovorin calcium tabs, 5 mg, 25 mg
leuprolide (Lupron – brand is NF)
CANCER DRUGS, OTHER HORMONES AND RELATED DRUGS levetiracetam (Keppra – brand is NF)
levobunolol soln (Betagan – brand is NF)
levonorgestrel/ethinyl estradiol, 0.1/20
levonorgestrel/ethinyl estradiol (Nordette – brand is NF)
levonorgestrel/ethinyl estradiol (Seasonale – brand is NF)
levonorgestrel/ethinyl estradiol (Triphasil – brand is NF)
levothyroxine – includes Levoxyl (Synthroid – brand is NF)
lidocaine jelly, 2%; oint, 5%; soln, 4% (Xylocaine – brand is NF)
lidocaine viscous
lidocaine/prilocaine crm (Emla – brand is NF)
lindane lotn
lisinopril (Prinivil – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS lisinopril/hydrochlorothiazide (Prinzide – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS lithium carbonate caps
lithium carbonate ext-release 300 mg (Lithobid – brand is NF)
lithium carbonate ext-release 450 mg
lithium citrate
lorazepam (Ativan – brand is NF)
lovastatin (Mevacor – brand is NF)
loxapine
CANCER DRUGS, OTHER HORMONES AND RELATED DRUGS mebendazole
meclizine (Antivert – brand is NF)
meclizine tabs, 32 mg
medroxyprogesterone acetate (Provera – brand is NF)
medroxyprogesterone inj, 150 mg/mL (Depo-Provera – brand is NF)
mefloquine (Lariam – brand is NF)
megestrol (Megace – brand is NF)
meloxicam tabs (Mobic – brand is NF)
mercaptopurine (Purinethol – brand is NF)
GenRx Drug Alphabetical Drug List, April 2009 10
Category
mesalamine enema
metformin (Glucophage – brand is NF)
metformin ext-release (Glucophage XR – brand is NF)
methadone conc, tabs
methazolamide
methenamine hippurate (Hiprex, Urex – brands are NF)
methenamine mandelate/sodium biphosphate
methimazole (Tapazole – brand is NF)
methocarbamol (Robaxin – brand is NF)
methotrexate inj
CANCER DRUGS, RHEUMATOID AND OSTEOARTHRITIS methotrexate tabs 2.5 mg
CANCER DRUGS, RHEUMATOID AND OSTEOARTHRITIS methscopolamine (Pamine – brand is NF)
methyldopa
methylphenidate (Ritalin – brand is NF)
methylphenidate ext-release (Metadate ER – brand is NF)
methylphenidate ext-release (Ritalin SR – brand is NF)
methylprednisolone (Medrol – brand is NF)
metipranolol soln (Optipranolol – brand is NF)
metoclopramide (Reglan – brand is NF)
metolazone (Zaroxolyn – brand is NF)
metoprolol succinate ext-release (Toprol XL – brand is NF)
metoprolol tartrate (Lopressor – brand is NF)
metoprolol tartrate/hydrochlorothiazide 50/25 mg, 100/25 mg
metronidazole (Flagyl – brand is NF)
metronidazole (MetroGel-Vaginal – brand is NF)
metronidazole (Metrolotion – brand is NF)
metronidazole 0.75% (Metrocream – brand is NF)
metronidazole gel, 0.75%
midodrine (Proamatine – brand is NF)
minocycline caps, tabs (Minocin, Dynacin – brands are NF)
minoxidil
mirtazapine (Remeron – brand is NF)
mirtazapine ODT (Remeron Soltab – brand is NF)
misoprostol (Cytotec – brand is NF)
moexipril (Univasc – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS moexipril/hydrochlorothiazide (Uniretic – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS mometasone (Elocon – brand is NF)
MONARC-M – PA
MONOCLATE-P – PA
MONONINE – PA
morphine sulfate conc, soln, tabs
GenRx Drug Alphabetical Drug List, April 2009 11
Category
morphine sulfate ext-release (MS Contin – brand is NF)
morphine sulfate supp, 5 mg, 10 mg, 20 mg
mupirocin oint (Bactroban – brand is NF)
nabumetone
nadolol 20 mg, 40 mg, 80 mg (Corgard – brand is NF)
naltrexone (ReVia – brand is NF)
naproxen (Naprosyn – brand is NF)
naproxen sodium (Anaprox – brand is NF)
neomycin sulfate
neomycin/polymyxin B/bacitracin oint
neomycin/polymyxin B/bacitracin/hydrocortisone oint
EYE, Steroids and Steroid Combination Products neomycin/polymyxin B/dexamethasone oint, susp (Maxitrol – brand is NF)
EYE, Steroids and Steroid Combination Products neomycin/polymyxin B/gramicidin soln (Neosporin – brand is NF)
neomycin/polymyxin B/hydrocortisone soln, susp (Cortisporin – brand is NF)
nicotine gum (Nicorette) – OTC, QL
nicotine lozenges (Commit) – OTC, QL
nicotine patches (Nicoderm CQ) – OTC, QL
NICOTROL INHALER – QL
NICOTROL NS – QL
nifedipine ext-release (Adalat CC – brand is NF)
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS nifedipine ext-release (Procardia XL – brand is NF)
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS nitrofurantoin macrocrystals (Macrodantin – brand is NF)
nitrofurantoin monohydrate/macrocrystals (Macrobid – brand is NF)
nitroglycerin patches (Nitro-Dur – brand is NF)
nitroglycerin sublingual tabs (Nitrostat – brand is NF)
nizatidine (Axid – brand is NF)
norethindrone (Nor-QD – brand is NF)
norethindrone (Ortho Micronor – brand is NF)
norethindrone acetate (Aygestin – brand is NF)
norethindrone acetate/ethinyl estradiol (Loestrin – brand is NF)
norethindrone acetate/ethinyl estradiol/Fe (Loestrin Fe – brand is NF)
norethindrone/ethinyl estradiol (Modicon – brand is NF)
norethindrone/ethinyl estradiol (Ortho-Novum 1/35 – brand is NF)
norethindrone/ethinyl estradiol (Ortho-Novum 7/7/7 – brand is NF)
norethindrone/ethinyl estradiol (Ovcon 35 – brand is NF)
norethindrone/ethinyl estradiol (Tri-Norinyl – brand is NF)
norethindrone/mestranol (Ortho-Novum 1/50 – brand is NF)
norgestimate/ethinyl estradiol (Ortho Tri-Cyclen – brand is NF)
GenRx Drug Alphabetical Drug List, April 2009 12
Category
norgestimate/ethinyl estradiol (Ortho-Cyclen – brand is NF)
norgestrel/ethinyl estradiol (Lo/Ovral – brand is NF)
nortriptyline (Pamelor – brand is NF)
NOVOSEVEN – PA
NOVOSEVEN RT – PA
nystatin (Mycostatin – brand is NF)
nystatin oral powder
nystatin oral tabs
nystatin susp
nystatin/triamcinolone
octreotide (Sandostatin – brand is NF)
ofloxacin (Floxin Otic – brand is NF)
ofloxacin soln (Ocuflox – brand is NF)
ofloxacin tabs
omeprazole delayed-release (Prilosec – brand is NF) – QL
OMNITROPE – PA
ondansetron inj (Zofran – brand is NF)
ondansetron ODT (Zofran ODT – brand is NF)
ondansetron oral soln, tabs (Zofran – brand is NF)
orphenadrine citrate ext-release
orphenadrine/aspirin/caffeine 25/385/30
OVIDREL – PA – Benefit Exclusions May Apply
oxcarbazepine tabs (Trileptal – brand is NF)
oxybutynin – QL
oxybutynin ext-release (Ditropan XL – brand is NF) – QL
oxycodone caps (OxyIR – brand is NF)
oxycodone conc, soln, tabs (Roxicodone – brand is NF)
oxycodone ext-release (OxyContin) – ST, QL
oxycodone/acetaminophen caps, 5/500 (Tylox – brand is NF)
oxycodone/acetaminophen tabs, 5/325, 7.5/325, 7.5/500, 10/325, 10/650
oxycodone/aspirin tabs, 5/325 (Percodan – brand is NF)
OXYCONTIN – QL, ST
pantoprazole delayed-release tabs (Protonix – brand is NF) – QL, ST
paregoric
paromomycin
paroxetine hcl (Paxil – brand is NF)
paroxetine hcl ext-release, 12.5 mg, 25 mg (Paxil CR – brand is NF)
pediatric multivitamins/fluoride
pediatric multivitamins/fluoride/iron
GenRx Drug Alphabetical Drug List, April 2009 13
Category
pediatric vitamins ADC/fluoride
pediatric vitamins ADC/fluoride/iron
PEG-electrolytes for soln (Colyte – brand is NF)
PEG-electrolytes for soln (Nulytely – brand is NF)
penicillin v potassium
pentoxifylline ext-release (Trental – brand is NF)
permethrin crm, 5% (Elimite – brand is NF)
perphenazine
phenazopyridine (Pyridium – brand is NF)
phenobarbital elixer; tabs, 15 mg, 16.2 mg, 30 mg, 32.4 mg, 60 mg, 100 mg
phenytoin sodium extended (Dilantin – brand is NF)
phenytoin susp (Dilantin – brand is NF)
phytonadione inj, 1 mg/0.5 mL
pilocarpine soln (Isopto Carpine – brand is NF)
pilocarpine tabs (Salagen – brand is NF)
piroxicam (Feldene – brand is NF)
podofilox soln (Condylox – brand is NF)
polymyxin B/trimethoprim soln (Polytrim – brand is NF)
potassium bicarbonate/chloride effervescent tabs, 25 mEq
potassium chloride ext-release caps, 10 mEq (Micro-K 10 – brand is NF)
potassium chloride ext-release tabs, 8 mEq
potassium chloride ext-release tabs, 10 mEq (K-Tabs – brand is NF)
potassium chloride ext-release tabs, 10 mEq, 20 mEq
potassium chloride liq 10%, 20%
potassium chloride packets, 20 mEq (K-Lor – brand is NF)
potassium citrate ext-release (Urocit-K – brand is NF)
potassium citrate/citric acid powder, soln (Polycitra-K – brand is NF)
potassium phosphate/sodium phosphates (K-Phos Neutral – brand is NF)
pravastatin (Pravachol – brand is NF)
prazosin (Minipress – brand is NF)
prednisolone acetate susp (Pred Forte – brand is NF)
EYE, Steroids and Steroid Combination Products prednisolone sodium phosphate soln (Orapred, Pediapred – brands are NF)
prednisolone syrup (Prelone – brand is NF)
prednisone
prenatal multivitamins/folic acid 1 mg
primidone (Mysoline – brand is NF)
PROAIR HFA – QL
probenecid
GenRx Drug Alphabetical Drug List, April 2009 14
Category
probenecid/colchicine
prochlorperazine supp
prochlorperazine tabs
PROFILNINE – PA
promethazine supp
promethazine syrup, tabs
propafenone (Rythmol – brand is NF)
propoxyphene hcl/acetaminophen tabs, 65/650
propoxyphene napsylate/acetaminophen tabs, 50/325, 100/650
propranolol ext-release (Inderal LA – brand is NF)
propranolol tabs
propranolol/hydrochlorothiazide 40/25
propylthiouracil
pyrazinamide
pyridostigmine tabs (Mestinon – brand is NF)
quinapril (Accupril – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS quinapril/hydrochlorothiazide (Accuretic – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS quinidine gluconate ext-release
quinidine sulfate
ramipril caps (Altace – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS ranitidine (Zantac – brand is NF)
RECOMBINATE – PA
REFACTO – PA
REVATIO – PA
ribavirin caps (Rebetol – brand is NF)
ribavirin tabs (Copegus – brand is NF)
ribavirin tabs, 400 mg, 600 mg
rifampin (Rifadin – brand is NF)
RISPERDAL M-TAB – QL, ST
RISPERDAL soln – QL, ST
risperidone ODT, 0.5 mg, 2 mg (Risperdal M-Tab) – QL
risperidone soln, tabs (Risperdal - brand is NF) – QL
ropinirole (Requip – brand is NF)
salsalate
scopolamine (Scopace – brand is NF)
selegiline caps (Eldepryl – brand is NF)
GenRx Drug Alphabetical Drug List, April 2009 15
Category
selenium sulfide 2.5% (Selsun – brand is NF)
SEROQUEL – QL, ST
SEROQUEL XR – QL, ST
sertraline (Zoloft – brand is NF)
silver sulfadiazine (Silvadene – brand is NF)
simvastatin (Zocor – brand is NF)
SINGULAIR – ST
sodium citrate/citric acid (Bicitra – brand is NF)
sodium fluoride chew tabs, drops; tabs, 2.2 mg
sodium fluoride crm, gel (Prevident – brand is NF)
SODIUM FLUORIDE soln, 0.55 mg/drop; tabs, 1.1 mg sodium polystyrene sulfonate
sotalol (Betapace – brand is NF)
sotalol (Betapace AF – brand is NF)
SPACER DEVICES, for inhalers – AEROCHAMBER SPIRIVA HANDIHALER – QL
spironolactone (Aldactone – brand is NF)
spironolactone/hydrochlorothiazide tabs, 25/25 (Aldactazide – brand is NF)
stavudine caps (Zerit – brand is NF)
sucralfate tabs (Carafate – brand is NF)
sulfacetamide sodium lotn (Klaron – brand is NF)
sulfacetamide sodium soln (Bleph-10 – brand is NF)
sulfacetamide sodium/prednisolone soln
EYE, Steroids and Steroid Combination Products sulfacetamide sodium/sulfur crm, emulsion (Plexion – brand is NF)
sulfacetamide sodium/sulfur lotn
sulfamethoxazole/trimethoprim (Bactrim, Septra – brands are NF)
sulfasalazine (Azulfidine – brand is NF)
sulindac (Clinoril – brand is NF)
sumatriptan tabs (Imitrex) – QL
sumatriptan vials, 6 mg (Imitrex) – QL
SYMBICORT – QL
SYNAGIS – PA
tamoxifen
GenRx Drug Alphabetical Drug List, April 2009 16
Category
temazepam (Restoril – brand is NF)
terazosin
terbinafine tabs (Lamisil – brand is NF)
terbutaline (Brethine – brand is NF)
terconazole (Terazol – brand is NF)
testosterone cypionate (Depo-Testosterone – brand is NF)
testosterone enanthate (Delatestryl – brand is NF)
tetracycline
theophylline ext-release tabs – 12 hr – Theochron
theophylline ext-release tabs – 24 hr (Uniphyl – brand is NF)
thiothixene (Navane – brand is NF)
THROMBATE III – PA
timolol maleate gel-forming soln (Timoptic-XE – brand is NF)
timolol maleate soln (Timoptic – brand is NF)
tizanidine tabs (Zanaflex – brand is NF)
tobramycin soln (Tobrex – brand is NF)
tobramycin/dexamethasone susp (Tobradex – brand is NF)
TOPAMAX – ST
TOPAMAX SPRINKLES – ST
torsemide (Demadex – brand is NF)
tramadol (Ultram – brand is NF)
tramadol/acetaminophen (Ultracet – brand is NF)
trandolapril (Mavik – brand is NF)
ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS tranylcypromine (Parnate – brand is NF)
trazodone
tretinoin (Retin-A – brand is NF)
tretinoin (Vesanoid – brand is NF)
triamcinolone
triamcinolone paste
triamterene/hydrochlorothiazide caps, 37.5/25 (Dyazide – brand is NF)
triamterene/hydrochlorothiazide caps, 50/25
triamterene/hydrochlorothiazide tabs, 37.5/25 (Maxzide-25 – brand is NF)
triamterene/hydrochlorothiazide tabs, 75/50 (Maxzide – brand is NF)
trifluoperazine
trifluridine soln (Viroptic – brand is NF)
trihexyphenidyl
trimethobenzamide caps (Tigan – brand is NF)
trimethoprim
GenRx Drug Alphabetical Drug List, April 2009 17
Category
ursodiol (Actigall – brand is NF)
valproic acid (Depakene – brand is NF)
venlafaxine (Effexor – brand is NF) – ST
verapamil (Calan – brand is NF)
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS verapamil ext-release (Calan SR – brand is NF)
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS verapamil ext-release (Verelan – brand is NF)
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS verapamil ext-release (Verelan PM – brand is NF)
CALCIUM CHANNEL BLOCKERS AND COMBINATIONS VIAGRA – QL – Benefit Exclusions May Apply
warfarin (Coumadin – brand is NF)
XALATAN – QL
XYNTHA – PA
zaleplon (Sonata – brand is NF)
zidovudine (Retrovir – brand is NF)
zolpidem (Ambien – brand is NF)
ZOMIG nasal – QL
ZOMIG tabs – QL
ZOMIG ZMT – QL
zonisamide (Zonegran – brand is NF)
GenRx Drug Alphabetical Drug List, April 2009 18

Source: http://forums.e-democracy.org/groups/cc/files/f/801-2009-06-10T184646Z/BCBS%20MN%20GenRx%20formulary%202009.pdf