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User formulary combined 011811 - formatted.xls

Drug Formulary, January 18, 2011
Medications listed on this formulary will be issued as a generic drug if a generic version exists, regardless of whether it is listed here as a brand or generic. Brand-name drugs are displayed in italicized text.
90-day items are highlighted as bold, underlined. These formulations and dosages may vary
and are at the discretion of the pharmacy.
Cancer Treatment
Dermatologicals
AKNE-MYCIN BENZACLIN GEL BENZOYL PEROXIDE GEL BENZOYL PEROXIDE LIQ VANOXIDE-HC LOTbenzoyl per gel or lot with erythro or clinda Topical Anesthetics
EMLA CRE
ETHYL CHLOR AER
LIDOCAINE GEL, CREAM, OINT, VISC
Lidocaine 2% viscous sol100ml
LIDODERM
XYLO/EPI INJ
XYLOCAINE INJ
Lidocaine 2% viscous sol100ml
Topical Antibacterials
AKNE-MYCIN BACTROBAN CRE/OINTCAPITROL CLINDAMYCIN GEL KLARON LOT 10%METRONIDAZOLE GELNORITATE Page 1 of 24
Drug Formulary, January 18, 2011
PHISOHEX LIQ 3%
SILVER SULFADIAZINE CREAM
SULFACET-R LOT TINT-FRE
Silver Sulfadiazine 1% cream 50gm tube
Topical Antifungals
EXELDERM CRE/SOL
LOPROX CRE/GEL/LOT
OXISTAT CRE/LOT
KETOCONAZOLE CRE 2%
NYSTATIN CRE 100000U
NYSTATIN OIN 100000U
Terbinafine 250mg tab
Psoriasis and Seborrhea
CAPEX SHA 0.01%
CARAC CRE 0.5%
DOVONEX CRE/OINT/SOL
NIZORAL SHA 2%
OXSORALEN-UL CAP
SELENIUM SULFIDE SHAMPOO
Selenium Sulfide 2.5% lotion(120ml bottle)
Scabies/Lice
EURAX CRE/LOTLINDANE LOTIONELIMITE Steroids
BETAMETHASONE oin,cre,gel
ACLOVATE CRE/oint 0.05%
CARMOL 40 CRE 40%
CELESTONE INJ/TAB
CLOBETASOL CREAM
CORTISPORIN CRE/OIN/SUS
CUTIVATE CRE
CYCLOCORT CRE/LOT
DESONIDE
DESOXIMETASONE
Page 2 of 24
Drug Formulary, January 18, 2011
DIFLORASONE
ELOCON CRE/LOT
EMBELINE E
FLUOCINALONE ACETAMIDE
HALOG SOL 0.1%
HC VALERATE
HYDROCORTISONE CRE
Hydrocortisone AC 25mg supp.
HYDROCORTISONE VALERATE CRE 0.2%
HYDROCORTISONE/ IODOQUIN CREAM
LIDA MANTLE CRE
LIDEX CR, OINT, LIQ
LOCOID CRE/OIN/SOL
MOMETASONE OINT
NUTRACORT LOTION
PRAMOSONE CRE/LOT/OINT
PROTOPIC OINT
PSORCON E CRE/OINT
TRIAMCIN/ORA PST 0.1%
TRIAMCINOLON CREAM
ULTRAVATE CRE/ OIN
BETAMETHASONE DIPROP 0.05%, CR, OIN
BETAMETHASONE VAL 0.1%, CR, OIN
Fluocinonide .05% cr tube 15g, 30g
Hydrocortisone 1, 2.5% cream
Triamcinolone .025, 0.1, 0.5% cr, oint

Miscellaneous
ACCUZYME ALDARA APHTHASOL PST 5%CONDYLOX GEL 0.5%CORTROSYN DOVONEX CRE/OINT/SOLEFUDEX CRE ELIDEL CRE EPIPEN /JRFLUOROPLEX CRE/SOLHYDROQUINONE CREAM Page 3 of 24
Drug Formulary, January 18, 2011
HYDROXYCHLOROQUINE
LACTINOL LOT 10%
LOTRISONE LOT
MELPAQUE HP CREAM
MELQUIN 3
NUQUIN HP CREAM
POTABA POW
PSORIATEC CRE
REGRANEX GEL
SANTYL
Selenium Sulfide 2.5% lotion(120ml bottle)
Gynecology
Contraceptives
DEMULEN TAB 1/35-28DEPO-PROVERA INJ ESTROSTEP FE TABLEVLEN-28 TABLO/OVRAL TAB -28LOESTRIN FE TAB 1.5/30LOESTRIN FE TAB 1/20LOW-OGESTREL TABMICROGESTIN TAB FE 1/20MICRONORMIRCETTE TAB 28NORDETTE-28 TABNOR-QD TAB 0.35MGNUVARINGORTHO EVRA PATCHORTHO MICRON TAB DIALPAKORTHO TRI-CYCLENORTHO TRI-CYCLEN LOORTHO-CEPT TAB 28ORTHO-CYCLEN TAB 0.25/35ORTHO-NOVUM TAB 1/35-21ORTHO-NOVUM TAB 1/35-28ORTHO-NOVUM TAB 7/7/7-21ORTHO-NOVUM TAB 7/7/7-28ORTHO-PREFES TAB Page 4 of 24
Drug Formulary, January 18, 2011
OVCON-35 28 TABTRI-LEVLEN TAB 28TRI-NORINYL TAB 28TRIPHASIL 28 TABYASMIN 28 TAB 3-0.03MG Estrogen & Progesterone Replacement
COMBIPATCH DIS .05/.14
CRINONE GEL 8% VAG
DESOGEN-28 TAB
ESTRACE VAG CRE
ESTRADERM DIS 0.05/0.1MG
ESTRADIOL TAB
ESTRATEST HS TAB
FEMHRT 1/5 TAB
LEUPROLIDE INJ
MEDROXYPROGESTERONE
MEGESTROL AC
NECON TAB 1/35-28
NORETHIN ACE TAB 5MG
NOVAREL INJ 10000U
OGEN TAB 0.625
PREGNYL INJ 10000U
PREMARIN TAB/VAG CREAM
PREMPHASE TAB
PREMPRO TAB
PROFASI INJ 10000U
PROGESTERONE INJ 50MG/ML
VAGIFEM
CLIMARA

Vaginal Anti-Infectives
ACI-JEL VAG GEL W/APPLOPROX CRE/GEL/LOTTERAZOL 3 / 7METROGEL VAG Miscellaneous
Clomiphene 50mg tab
Page 5 of 24
Drug Formulary, January 18, 2011
EST Estrogen/Methyl Testost DS tab
Estropipate 0.75, 1.5mg tab
FOLLISTIM INJ 75IU
OVIDREL INJ 250MCG
PERGONAL INJ 75IU
REPRONEX INJ 75IU
TAMOXIFEN
Page 6 of 24
Drug Formulary, January 18, 2011
Blood Clotting
COUMADIN
DIPYRIDAMOLE
HEPARIN SOD INJ 10000/ML
PLAVIX
TICLOPIDINE
WARFARIN (Coumadin)
Blood Pressure
ACEBUTOLOL
Amlodipine 2.5, 5, 10mg tab
ATENOLOL
Atenolol 25, 50, 100mg tab
ATENOLOL/CHLORTHALIDONE
Benazepril tab
BISOPROLOL/HCTZ
BISOPROLOL/HCTZ
Bumetanide 0.5, 1mg tab
CAPTOPR/HCTZ
CAPTOPRIL
CATAPRES-TTS DIS 0.1/24HR
Chlorthalidone
CLONIDINE
COREG
COZAAR / losartan
DIBENZYLINE
Digoxin 0.125, 0.25mg tab
DILTIAZEM
DILTIAZEM XT
DOXAZOSIN
ENALAPRIL
ENALAPRIL/HCTZ
Furosemide 20, 40,80mg tab
GUANFACINE
HYDRALAZINE
Hydrochlorothiazide(HCTZ) cap
HYZAAR / losartan- hctz
Indapamide 1.25, 2.5mg tab

Page 7 of 24
Drug Formulary, January 18, 2011
LABETOLOL
LISINOPRIL
LISINOPRIL-HCTZ
LOPRESS HCT
METAPROTERANOL SYRUP 10MG/5ML
METHYLDOPA
METOPROLOL
METOPROLOL/HCTZ
MINOXIDIL
NADOLOL 20,40
NIFEDIPINE
NORVASC
Pindolol tab 5, 10mg
PRAZOSIN HCL
PROPANOLOL LA
Propranolol 10, 40, 80mg tab
Sotalol HCL 80mg tab
Spironolactone 25mg tab
TERAZOSIN
TIAZAC CAP 360MG/24
TOPROL XL
VERAPAMIL ER
verapamil 80, 120
Cholesterol/Triglyceride Lowering
CHOLESTYRAMINE POWDER
CHOLESTYRAMINE POWDER LITE
COLESTID POW 5GM
GEMFIBROZIL
LOVASTATIN
PRAVACHOL /pravastatin
VYTORIN
SIMVASTATIN [ZOCOR]
ZETIA
Page 8 of 24
Drug Formulary, January 18, 2011
Heart Failure, Angina and Irregular Beats
AMIODARONE
COZAAR /losartan
DILATRATE SR
DISOPYRAMIDE
FLECAINIDE
ISOSORB MONONITRATE ER
ISOSORBIDE DINITRATE
LANOXIN / DIGOXIN
MEXILETINE
MINITRAN
NITROGLYCERINE OINT
NITROLINGUAL AER
NITROLINGUAL SPR PUMPSPRA
NITROQUICK SUBLINGUAL
NITROTAB SUBLINGUAL
NITRO-TRANSDERM
PROCANBID
QUINIDINE SULFATE ER
SOTALOL HCL
TAMBOCOR
Potassium Supplements
K-VESCENT EF
KLOR-CON 10 ER
KLOR-CON M10 ER
POTASSIUM CHLORIDE ER
POTASSIUM CHLORIDE 10% LIQ
“Water Pills” (Diuretics)
AMILOR/HCTZ
AMILORIDE
BUMETANIDE
DEMADEX
FUROSEMIDE
HCTZ
INDAPAMIDE
SPIRONO/HCTZ
SPIRONOLACT
Page 9 of 24
Drug Formulary, January 18, 2011
Triamterene-HCTZ
TORSEMIDE
ZAROXOLYN
Miscellaneous
Ear, Nose and Throat
ACE ACD/ALUM SOL OTIC
ACETASOL SOL OTIC
ACETIC ACID SOL /HC OTIC
ANTIBIOT EAR SOL OTIC
CIPRO HC OTIC
FLOXIN OTIC SOL
NEO/POLY/HC SOL OTIC
Nasal Steroids
Endocrine
Diabetes
AMARYL /GLIMEPRIMIDE
CHLORPROPRAMIDE
Glimepiride tab
GLIPIZIDE
GLIPIZIDE XL
GLUCAGON KIT
GLUCOTROL XL
GLYBURIDE TAB
GLYBURIDE MCR
JANUMET
JANUVIA
METFORMIN
PRANDIN
PRECOSE
NOVOLIN R
NOVOLIN N

Page 10 of 24
Drug Formulary, January 18, 2011
Male Hormones
Osteoporosis
ALENDRONATE
Steroids
CORTEF
DEPO-MEDROL
DERMATOP CRE/OINT
DEXAMETHASONE
FLUDROCORT
HYDROCORTONE
MEDROL
METHYLPRED PAK
Methylpred 4mg tab
ORAPRED SOL 15MG/5ML
PEDIAPRED LIQ 6.7/5ML
PREDNISOLONE SYP 15MG/5ML
PREDNISONE
Prednisone 5mg,10mg dose pak 21
Prednisone 5mg, 10mg dose pak 48
SOLU-CORTEF
SOLU-MEDROL

CYTOMEL
LEVOXYL
METHIMAZOLE
PROPYLTHIOURACIL
SYNTHROID
Miscellaneous
Page 11 of 24
Drug Formulary, January 18, 2011
BROMOCRIPTINECLIMARA DIS DANAZOLDDAVP SOL /TABDESMOPRESSIN SPRAY DOSTINEX MEGACE ORAL SUS MIACALCIN SPR 200IU/AC Infections
Antibacterial and Antiviral
ACYCLOVIR
AMANTADINE
AMOX/K CLAV CHW
AMOXICILLIN
AMOXIL DRO/SUS
AMPICILLIN
AUGMENTIN CHW SUS TAB
BIAXIN SUS /TAB
BICILLIN L-A INJ
CEFACLOR
CEFADROXIL
CEFTIN SUSP
CEFUROXIME
CEFUROXIME
CEPHALEXIN
CEPHRADINE
Chlorhexidine Gluconate 0.12% soln (473ml bottle)
CIPRO
CLEOCIN SUP;SUSP;CR
CLINDAMYCIN
CYTOVENE
DICLOXACILLIN
DOXYCYC MONO CAP
DOXYCYCLINE CAP
DURICEF SUS 125/250/500/5ML
EES/SULFISOX SUS 200-600
ERYPED DROPS 100/2.5
ERYTHROM EST SUS

Page 12 of 24
Drug Formulary, January 18, 2011
ERYTHROMYCIN EC
ERYZOLE SUSP
FAMVIR
FLAGYL ER
MACROBID
METROCREAM
METROGEL
METRONIDAZOLE
MINOCYCLINE
NEOMYCIN
NITROFURONTOIN
PENICILLN VK
PERIOSTAT
POLYMYXIN B/ SOL TRIMETHP
PREVPAC MIS
SMZ-TMP
TAMIFLU
TETRACYCLINE
TOBI NEB
TRIMOX
VALCYTE
VALTREX
VANCOMYCIN INJ
VANTIN SUS/TAB
ZPAK
ROCEPHIN INJ
ZITHROMAX POW/SUS/TAB

Antifungal
AVC CREAMCLOTRIM/BETA CRE DIPROPDIFLUCANECONAZOLE FULVICIN U/F TAB MICR GRIFULVIN V SUS /TABGRISACTIN TAB MICR GRISEOFULVIN TAB ULTR 125GRIS-PEG TAB KETOCONAZOLE CRE 2% Page 13 of 24
Drug Formulary, January 18, 2011
KETOCONAZOLE TABMENTAX MYCELEX NAFTIN CRE/GELNYSTATIN cre/oin/sus/pow Parasites
CHLOROQUINE CHLOROQUINE HYDROXYCHLOROQUINEMEBENDAZOLE CHW MEFLOQUINE MEPRON SUS Tuberculosis
ETHAMBUTOL
ISONIAZID
MYAMBUTOL
MYCOBUTIN
PYRAZINAMIDE
RIFADIN
RIFAMATE
RIFAMPIN
Antiallergy
Anti-Infective and Antiviral

AK-SPORE HC OIN OP
ALREX SUS 0.2%
BACITRACIN OPH OINT
BAC/POLY/NEO OIN /HC OP
BLEPHAMIDE OIN/SUS
CILOXAN OIN 0.3% OP
CORTOMYCIN OIN OP
Erthromycin op. oint 3.5mg
GENTAK 3% OPH oint
Gentamicin oph sol, cr, oint
Page 14 of 24
Drug Formulary, January 18, 2011
LIVOSTIN SUS 0.05% OP
NEO/POLY/GRA SOL OP
Neomycin/P/D .1% op. oint./sol
OCUFLOX SOL 0.3% OP
PEDIOTIC SUS 1% OTIC
QUIXIN SOL 0.5%
SOD SUL/SULF LOT 10%-5%
Sulfacet Sodium 10% op. soln
TOBRADEX OIN/SUS OP
TOBRAMYCIN oph sol
TOBREX oph oint
TRIFLURIDINE SOL OPH
TRIMETHOPRIM SOL POLYMYXN
VIROPTIC SOL OPH
Anti-Inflammatory
ACULAR SOL OPHALAMAST ALOCRIL EFLONE SUS OPHOPTIVAR PRED MILD SUSP OPH Decongestants
Glaucoma
ACETAZOLAMID TAB 125MG
ALPHAGAN/P SOL OPH
AZOPT SUS 1% OP
BETIMOL SOL 0.5%
BETOPTIC-S SUS OPH
CARTEOLOL SOL OPH
COSOPT SOL
DIPIVEFRIN SOL OPH
IOPIDINE SOL OPH
LEVOBUNOLOL SOL OPH
LUMIGAN SOL
METHAZOLAMIDE
Page 15 of 24
Drug Formulary, January 18, 2011
OPTIPRANOLOL SOL OPH
PILOPINE HS GEL OPH
TIMOLOL OPH SOL
TRAVATAN
TRAVATAN Z
TRUSOPT SOL
XALATAN SOL

Steroids
LOTEMAX SUSPPREDNISOLONE SUSP OPHVEXOL SUSP OPH Steroid-Antibiotic Combinations
AK-PENTOLATE SOL OPH
ATROPINE SUL OPH sol
CYCLOGYL SOL OPH
CYCLOPENTOL SOL OPH
FLUOROMETHOL SUS OPH
HMS LIQUIFLM SUS OPH
HOMATROPINE SOL OPH
ISO CARBACHO SOL OPH
ISO HOMATROP SOL OPH
ISOHYOSCINE SOL OPH
PILOCARPINE SOL OPH
PILOPTIC-1 SOL OPH
Mental Health
ALPRAZOLAM
BUPROPION
BUPROPRION ER 12 HR
BUSPIRONE
CLONAZEPAM
CLORAZ DIPOT
LORAZEPAM
Page 16 of 24
Drug Formulary, January 18, 2011
Depression
AMITRIPTYLINE
BUPROPION
CITALOPRAM/CELEXA
CLOMIPRAMINE
DESIPRAMINE
DOXEPIN HCL
FLUOXETINE
FLUVOXAMINE
IMIPRAMAMINE
NORTRIPTYLINE
PAXIL /PAROXETENE
PERPHEN/AMITRYP
PERPHENAZINE
SURMONTIL
TRAZODONE
WELLBUTRIN SR
ZOLOFT / sertraline
Psychosis
CHLORPROMAZINE
FLUPHENAZINE
HALOPERIDOL
LOXAPINE
SEROQUEL
SEROQUEL XR
thioridazine
THIOTHIXENE
TRIFLUOPERAZINE
AMBIEN DIASTAT PED MIS GELFLURAZEPAM TRIAZOLAM Page 17 of 24
Drug Formulary, January 18, 2011
Miscellaneous
BENZTROPINE/ COGENTIN
CHANTIX
NICOTINE PATCHES
ESKALITH CR TAB 450MG
LITHIUM CARBONATE
LITHOBID SR
METADATE ER
METHYLIN
METHYLPHENIDATE
NALTREXONE
SERZONE
TRIHEXYPHENIDYL/ARTANE
Miscellaneous
ACETAZOLAMIDE
CHEMET
FOLIC ACID
CHLORHEXIDENE /PERIDEX
MAGNESIUM OXIDE
METHAZOLAMIDE
PRENATAL PLUS
Sodium Fluoride .25mg chew
THEROBEC PLUS

Muscle Relaxants
CARISOPRODOL/ASA
CARISOPRODOL
CYCLOBENZAPRINE
METHOCARBAM OL
ORPHEN CPD TAB DS
ORPHENADRINE CR
Neurology
Parkinson’s Disease
CARB/LEVO TAB 25-250MGCOMTAN MIRAPEX REQUIP Page 18 of 24
Drug Formulary, January 18, 2011
Seizures
CARBAMAZEPINE CHW
DEPAKOTE
DILANTIN TAB/SUS/CHW
LAMICTAL
PHENOBARBITAL
PHENYTOIN
PRIMIDONE
TEGRETOL/CARBAMAZAPINE
TOPAMAX
VALPROIC ACID
ZARONTIN
ZONEGRAN

Migraine Headaches
MAXALT NARATRIPTAN [old "amerge"]SUMATRIPTAN [old "imitrex"] Miscellaneous
AMPHETAMINE ARICEPTBENZTROPINE BETASERON MESTINON NEURONTIN Pain Management
Arthritis and Inflammation
ARTHROTEC
BACLOFEN
CELEBREX
CHO MAG TRIS
DICLOFEN POT
DIFLUNISAL
ETODOLAC
Page 19 of 24
Drug Formulary, January 18, 2011
FLURBIPROFEN
IBUPROFEN
Ibuprofen 100mg/5ml susp
INDOMETHACIN
KETOPROFEN
KETOROLAC
LIDO/EPI INJ 1%
MECLOFEN
MELOXICAM / MOBIC
NABUMETONE
NAPROSYN SUS 125/5ML
NAPROXEN
NAPROXEN DR
OXAPROZIN
PIROXICAM
SALSALATE
SULINDAC
ALLOPURINOL
PROBEN/COLCH
PROBENECID
Narcotics/Non-narcotics
APAP/CODEINE
BUT/APAP/CAF
DURAGESIC
ENDOCET
HYDROCO/APAP
HYDROMORPHONE
MORPHINE SUL
OXYBUTYNIN
OXYCOD/APAP
OXYCODONE
OXYCONTIN TAB /CR
PERCOCET
ROXICET
TRAMADOL
Respiratory
Page 20 of 24
Drug Formulary, January 18, 2011
Antihistamine and Antiallergy
CYPROHEPTADINE
DIPHENHYDRAMINE
HYDROXYZINE
PROCHLORPERAZINE/compazine
Cough and Cold
ANDEHIST DM DRO NR
BELIX ELX
BENZONATATE
CARBOFED DM DRO
GANI-TUSS NR LIQ
GFN600/PSE60 TAB /DM30 SA
HYDROMET SYP
PROMETH/COD SYP
PROMETHAZINE SYP DM
PROMETHAZINE TAB, SYR
PROMETHEGAN SUP
QUAD-TUSS SUS TANN/PED
TANNATE 12 S SUS
TRI TANNATE SUS PED
TUSSIGON
Inhalants
ADVAIR DISKU MIS 100/250/500/50
AEROBID AER
ALBUTEROL NEB
ALUPENT INH AER .65/ACT
ASMANEX
ATROVENT INH AER
AZMACORT
COMBIVENT
CROMOLYN SOD NEB 20MG/2ML
DULERA
FLOVENT
INTAL INH
IPRATROPIUM SOL INHAL
MAXAIR
PROVENTIL HFA

Page 21 of 24
Drug Formulary, January 18, 2011
PULMICORT INHPULMICORT SUSSPIRIVAVANCERIL Oral Asthma
ACCOLATE
ALBUTEROL SYP
Albuterol 2mg/5ml syrup
ALBUTEROL TAB
SINGULAIR CHW/TAB
THEO-24 CR
THEOPHYLLINE ER
Miscellaneous
AEROCHAMBER/ MIS MASKPULMOZYME SOL 1MG/ML Stomach and Intestinal
Intestinal Spasms
HYOSCYAMINE ERHYOSOL/SL SUB HYOSPAZ TAB 0.15MGHYOSYNE ELIX SPASTRIN TRANSDERM-SC DIS HYDROXYZINE/Vistaril
PROCHLORPERAZINE
PROMETHAZINE
TRIMETHOBENZAMIDE
Ulcer and Reflux
CARAFATE SUSP
cimetidine
CYTOTEC
famotidine
Page 22 of 24
Drug Formulary, January 18, 2011
SUCRALFATE
ranitidine
Miscellaneous
ASACOL EC
CANASA SUP
COLAZAL
CONSTULOSE SYR
CORTIFOAM
Cytra-2 Solution
DICYCLOMINE
DUPHALAC SYR
GOLYTELY SOL
KRISTALOSE PAK
LACTULOSE SYR
METOCLOPRAMIDE SYR, TAB
NULYTELY SOL CHERRY
PANCREASE EC
PANCRELIPASE CAP
PANCRON EC
PENTASA CR
PROCTOCORT CRE/SUPP
ROWASA ENEMA
SALAGEN
SULFASALAZINE
SULFAZINE EC
URSODIOL
VIOKASE 8
DETROL LA
DIAMOX CR
FLOMAX
OXYBUTYNIN
PHENAZOPYRIDINE
PHOSLO
PROSCAR
PYRIDIUM PLUS
RENAGEL
Page 23 of 24
Drug Formulary, January 18, 2011
Page 24 of 24

Source: http://www.itpclass.org/SPDs/Formulary/NYHTC_and_HANYC_Health_Center_Inc_Drug_Formulary_01-2011_by_Therapeutic_Class.pdf

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