NMCSD AND NHCP - Lexicomp...Aluminum Hydroxide Outpatient Dosage Forms Suspension, oral: 320 mg/5 mL...

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Alphabetical Listing by Name

This document is current as of July 16, 2020. The availability of formulary items is subject to change.

NMCSD AND NHCP OUTPATIENT FORMULARY

AbacavirOutpatient Dosage FormsSolution, Oral:Ziagen: 20 mg/mL (240 mL) [contains methylparaben, propylene glycol,propylparaben, saccharin sodium; strawberry-banana flavor]

Tablet, Oral:Generic: 300 mg

Abacavir and LamivudineOutpatient Dosage FormsTablet, Oral:Generic: Abacavir 600 mg and lamivudine 300 mg

Abacavir, Dolutegravir, and LamivudineOutpatient Dosage FormsTablet, Oral:Triumeq: Abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg

Abacavir, Lamivudine, and ZidovudineOutpatient Dosage FormsTablet, Oral:Trizivir: Abacavir sulfate 300 mg, lamivudine 150 mg, and zidovudine 300 mg

AcamprosateOutpatient Dosage FormsTablet Delayed Release, Oral, as calcium:Generic: 333 mg

AcetaminophenOutpatient Dosage FormsElixir, Oral:Generic: 160 mg/5 mL (118 mL)

Liquid, Oral:Generic: 160 mg/5 mL (118 mL)

Suppository, Rectal:Generic: 120 mg (12s, 50s); 650 mg (12s, 50s)


Acetaminophen and CodeineOutpatient Dosage FormsSolution, oral [C-V]: Acetaminophen 120 mg and codeine phosphate 12 mg per5 mL (5 mL, 10 mL, 12.5 mL, 15 mL, 118 mL, 473 mL)

Tablet, oral [C-III]: Acetaminophen 300 mg and codeine phosphate30 mg [BCF]

AcetaZOLAMIDEOutpatient Dosage FormsCapsule, sustained release, oral:Diamox® Sequels®: 500 mg

Tablet, oral: 125 mg, 250 mg

Acetic Acid, Propylene Glycol Diacetate, and HydrocortisoneOutpatient Dosage FormsSolution, Otic [drops]:Generic: Acetic acid 2%, propylene glycol diacetate 3%, and hydrocortisone1% (10 mL)

Acetohydroxamic AcidOutpatient Dosage FormsTablet, oral:Lithostat®: 250 mg

AcitretinOutpatient Dosage FormsCapsule, oral:Soriatane®: 10 mg, 25 mg

AclidiniumOutpatient Dosage FormsAerosol Powder Breath Activated, Inhalation, as bromide:Tudorza Pressair: 400 mcg/actuation (1 ea) [contains milk protein]

Acyclovir (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 200 mg [BCF]

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

Tablet, Oral:Generic: 400 mg [BCF], 800 mg [BCF]

Acyclovir (Topical)Outpatient Dosage FormsOintment, topical:Zovirax®: 5% (30 g)

AdalimumabOutpatient Dosage FormsKit, Subcutaneous [preservative free]:Humira: 40 mg/0.8 mL [contains polysorbate 80] [BCF]Humira Pen: 40 mg/0.8 mL [contains polysorbate 80] [BCF]Humira Pen-Crohns Starter: 40 mg/0.8 mL [contains polysorbate 80] [BCF]

AdapaleneOutpatient Dosage FormsCream, External:Generic: 0.1% (45 g)

Gel, External:Generic: 0.1% (45 g)

AdefovirOutpatient Dosage FormsTablet, oral, as dipivoxil:Hepsera: 10 mg

AlbendazoleOutpatient Dosage FormsTablet, Oral:Albenza: 200 mg

AlbuterolOutpatient Dosage FormsAerosol Solution, Inhalation:ProAir HFA: 108 (90 Base) mcg/actuation (8.5 g) [BCF]

Nebulization Solution, Inhalation:Generic: 0.083% [2.5 mg/3 mL] (3 mL) [BCF]

Nebulization Solution, Inhalation [preservative free]:Generic: 1.25 mg/3 mL (3 mL); 0.083% [2.5 mg/3 mL] (3 mL) [BCF]

Syrup, Oral:Generic: 2 mg/5 mL (473 mL)


Alcohol (Isopropyl)Outpatient Dosage FormsPad, External:Pharmacist Choice Alcohol: 70% (100 ea)

AlendronateOutpatient Dosage FormsTablet, oral: 5 mg [BCF], 10 mg [BCF], 35 mg [BCF], 70 mg [BCF]

AlfuzosinOutpatient Dosage FormsTablet, extended release, oral, as hydrochloride: 10 mg [BCF]

AllopurinolOutpatient Dosage FormsTablet, oral: 100 mg [BCF], 300 mg [BCF]

ALPRAZolamOutpatient Dosage FormsTablet, oral: 0.25 mg, 0.5 mg, 1 mg

AlprostadilOutpatient Dosage FormsKit, Intracavernosal:Edex: 10 mcg, 20 mcg, 40 mcg

Pellet, Urethral:Muse: 1000 mcg (6 ea)

Aluminum AcetateOutpatient Dosage FormsPowder, for Solution, External:Domeboro: Aluminum sulfate tetradecahydrate 1347 mg and calcium acetatemonohydrate 952 mg per packet (12s, 100s)

Aluminum Acetate and Acetic AcidOutpatient Dosage Forms Solution, Otic:Generic: Aluminum acetate 10% and

acetic acid 2% (60 mL)

Aluminum Chloride HexahydrateOutpatient Dosage FormsSolution, topical:Drysol: 20% (35 mL, 37.5 mL) [contains ethanol 93%]

Aluminum HydroxideOutpatient Dosage FormsSuspension, oral: 320 mg/5 mL (473 mL)

Aluminum Hydroxide, Magnesium Hydroxide, and SimethiconeOutpatient Dosage FormsLiquid, Oral:Generic: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, andsimethicone 20 mg per 5 mL (360 mL)

ABACAVIR

2

AmantadineOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 100 mg [BCF]

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

Amiloride and HydrochlorothiazideOutpatient Dosage FormsTablet, Oral:5/50: Amiloride hydrochloride 5 mg and hydrochlorothiazide 50 mg

Aminocaproic AcidOutpatient Dosage FormsSolution, Oral:Amicar: 25% (236.5 mL) [contains edetate disodium, methylparaben, propyl-paraben, saccharin sodium]


AmiodaroneOutpatient Dosage FormsTablet, oral, as hydrochloride: 200 mg [BCF]

AmitriptylineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF], 100 mg

AmLODIPineOutpatient Dosage FormsTablet, oral: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF]

Amlodipine and BenazeprilOutpatient Dosage FormsCapsule, 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]5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF]5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF]10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF]10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF]

Amlodipine and ValsartanOutpatient Dosage FormsTablet, Oral:5/160: Amlodipine 5 mg and valsartan 160 mg5/320: Amlodipine 5 mg and valsartan 320 mg10/160: Amlodipine 10 mg and valsartan 160 mg10/320: Amlodipine 10 mg and valsartan 320 mg

Amlodipine, Valsartan, and HydrochlorothiazideOutpatient Dosage FormsTablet, Oral:Amlodipine 5 mg, valsartan 160 mg, and hydrochlorothiazide 12.5 mgAmlodipine 5 mg, valsartan 160 mg, and hydrochlorothiazide 25 mgAmlodipine 10 mg, valsartan 160 mg, and hydrochlorothiazide 12.5 mgAmlodipine 10 mg, valsartan 160 mg, and hydrochlorothiazide 25 mgAmlodipine 10 mg, valsartan 320 mg, and hydrochlorothiazide 25 mg

AmoxicillinOutpatient Dosage FormsCapsule, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

Suspension Reconstituted, Oral:Generic: 125 mg/5 mL (50 mL, 75 mL, 100 mL); 250 mg/5 mL (150 mL) [BCF];400 mg/5 mL (50 mL, 75 mL, 100 mL) [BCF]

Tablet, Chewable, Oral:Generic: 250 mg

Amoxicillin and ClavulanateOutpatient Dosage FormsPowder for Suspension, Oral:Augmentin: 125: Amoxicillin 125 mg and clavulanate potassium 31.25 mg per5 mL (75 mL, 100 mL, 150 mL) [BCF]

Generic:200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (50mL, 75 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 (75mL, 125 mL, 200 mL) [BCF]

Tablet, Oral:Generic:500: Amoxicillin 500 mg and clavulanate potassium 125 mg [BCF]875: Amoxicillin 875 mg and clavulanate potassium 125 mg [BCF]

Tablet, Extended Release, Oral:Generic: Amoxicillin 1000 mg and clavulanate acid 62.5 mg

AnastrozoleOutpatient Dosage FormsTablet, oral: 1 mg

ApixabanOutpatient Dosage FormsTablet, Oral:Eliquis: 2.5 mg [BCF], 5 mg [BCF]Eliquis Starter Pack: 5 mg [BCF]

ApraclonidineOutpatient Dosage FormsSolution, ophthalmic [drops]: 0.5% (5 mL)Iopidine®: 0.5% (5 mL); 1% (0.1 mL) [contains benzalkonium chloride]

ARIPiprazoleOutpatient Dosage FormsSolution, Oral:Generic: 1 mg/mL (150 mL)

Tablet, Oral:Generic: 2 mg [BCF], 5 mg [BCF], 10 mg [BCF], 15 mg [BCF], 20 mg [BCF],30 mg [BCF]

ArmodafinilOutpatient Dosage FormsTablet, Oral:Generic: 50 mg, 150 mg, 250 mg

AspirinOutpatient Dosage FormsTablet, Enteric Coated, Oral:Generic: 81 mg, 325 mg

Aspirin and DipyridamoleOutpatient Dosage FormsCapsule, variable release, oral:Aggrenox®: Aspirin 25 mg [immediate release] and dipyridamole 200 mg[extended release]

AtazanavirOutpatient Dosage FormsCapsule, Oral, as sulfate:Reyataz: 150 mg, 200 mg, 300 mg

Atazanavir and CobicistatOutpatient Dosage FormsTablet, Oral:Evotaz: Atazanavir 300 mg and cobicistat 150 mg

AtenololOutpatient Dosage FormsTablet, oral: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

AtoMOXetineOutpatient Dosage FormsCapsule, oral:Strattera®: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg

AtorvaSTATinOutpatient Dosage FormsTablet, oral: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF]

AtovaquoneOutpatient Dosage FormsSuspension, oral:Mepron®: 750 mg/5 mL (210 mL) [contains benzyl alcohol; citrus flavor]

Atovaquone and ProguanilOutpatient Dosage FormsTablet, Oral:Generic: Atovaquone 250 mg and proguanil hydrochloride 100 mg

Tablet, Oral [pediatric]:Malarone: Atovaquone 62.5 mg and proguanil hydrochloride 25 mg

Atropine (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic, as sulfate:Generic: 1% (3.5 g)

Solution, Ophthalmic, as sulfate [drops]:Generic: 1% (5 mL, 15 mL)

AuranofinOutpatient Dosage FormsCapsule, oral:Ridaura®: 3 mg [gold 29%]

AzaTHIOprineOutpatient Dosage FormsTablet, oral: 50 mg

AZATHIOPRINE

3

Azelastine (Nasal)Outpatient Dosage FormsSolution, intranasal, as hydrochloride [spray]: 0.1% [137 mcg/spray] (30 mL)

Azilsartan and ChlorthalidoneOutpatient Dosage FormsTablet, Oral:Edarbyclor: 40/25: Azilsartan medoxomil 40 mg and chlorthalidone 25 mgEdarbyclor: 40/12.5: Azilsartan medoxomil 40 mg and chlorthalidone 12.5 mg

Azithromycin (Systemic)Outpatient Dosage FormsPowder for suspension, oral, as dihydrate [strength expressed as base]:200 mg/5 mL (15 mL); 1 g/packet (10s) [BCF]

Powder for suspension, oral, as monohydrate [strength expressed as base]:100 mg/5 mL (15 mL) [BCF]

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

Bacitracin and Polymyxin B (Ophthalmic)Outpatient Dosage FormsOintment, ophthalmic: Bacitracin 500 units and polymyxin B 10,000 units per g(3.5 g)

Bacitracin and Polymyxin B (Topical)Outpatient Dosage FormsOintment, topical: Bacitracin 500 units and polymyxin B 10,000 units per g(30 g)

Bacitracin, Neomycin, and Polymyxin B (Topical)Outpatient Dosage FormsOintment, External:Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 5000 units per g(0.9 g, 15 g, 30 g)

Bacitracin (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Generic: 500 units/g (3.5 g)

Bacitracin (Topical)Outpatient Dosage FormsOintment, External, as zinc [strength expressed as base]:Generic: 500 units/g (0.9 g, 15 g, 30 g)

BaclofenOutpatient Dosage FormsTablet, oral: 10 mg, 20 mg

Belladonna and OpiumOutpatient Dosage FormsSuppository, rectal: Belladonna extract 16.2 mg and opium 60 mg (12s)

BenazeprilOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 20 mg

BenzocaineOutpatient Dosage FormsAerosol, spray, topical:Dermoplast Pain Relieving: 20% (60 mL) [contains menthol]

BenzonatateOutpatient Dosage FormsCapsule, softgel, oral: 100 mg

Benzoyl PeroxideOutpatient Dosage FormsGel, External:Generic: 5% (42.5 g); 10% (42.5 g, 60 g)

Liquid, External [wash/water based]:Generic: 5% (237 g)

BenztropineOutpatient Dosage FormsTablet, oral, as mesylate: 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF]

Betamethasone (Topical)Outpatient Dosage FormsCream, External, as dipropionate [strength expressed as base]:Generic: 0.05% (45 g)

Lotion, External, as dipropionate [strength expressed as base]:Generic: 0.05% (60 mL)

Betaxolol (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic:Generic: 0.5% (5 mL, 10 mL, 15 mL)

Suspension, Ophthalmic:Betoptic-S: 0.25% (15 mL)

BethanecholOutpatient Dosage FormsTablet, oral, as chloride: 10 mg, 25 mg

BicalutamideOutpatient Dosage FormsTablet, oral: 50 mg

Bictegravir, Emtricitabine, and Tenofovir AlafenamideOutpatient Dosage FormsTablet, Oral:Biktarvy: Bictegravir 50 mg, emtricitabine 200 mg, and tenofovir alafena-mide 25 mg

BimatoprostOutpatient Dosage FormsSolution, Ophthalmic [drops]:Lumigan: 0.01% (5 mL); 0.03% (5 mL) [contains benzalkonium chloride]

BisacodylOutpatient Dosage FormsSuppository, rectal: 10 mg (500s)Tablet, enteric coated, oral: 5 mg

Bismuth Subcitrate, Metronidazole, and TetracyclineOutpatient Dosage FormsCapsule:Pylera: Bismuth subcitrate potassium 140 mg, metronidazole 125 mg, andtetracycline hydrochloride 125 mg

Bismuth SubsalicylateOutpatient Dosage FormsTablet, chewable, oral, as subsalicylate: 262 mg

Brimonidine and TimololOutpatient Dosage FormsSolution, Ophthalmic [drops]:Combigan: Brimonidine tartrate 0.2% and timolol 0.5% (5 mL,10 mL) [containsbenzalkonium chloride]

Brimonidine (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as tartrate [drops]:Generic: 0.15% (5 mL, 10 mL, 15 mL) [BCF]; 0.2% (15 mL) [BCF]

Budesonide (Oral Inhalation)Outpatient Dosage FormsSuspension, for nebulization: 0.25 mg/2 mL (30s); 0.5 mg/2 mL (30s)

BumetanideOutpatient Dosage FormsTablet, oral: 1 mg

BuPROPionOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 75 mg [BCF], 100 mg [BCF]

Tablet Sustained Release 12 Hour, Oral, as hydrochloride:Generic: 100 mg [BCF] , 150 mg [BCF], 200 mg [BCF]

Tablet Extended Release 24 Hour, Oral, as hydrochloride:Generic: 300 mg [BCF]

BusPIRoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF]

BusulfanOutpatient Dosage FormsTablet, oral:Myleran®: 2 mg [scored]

Butalbital, Acetaminophen, and CaffeineOutpatient Dosage FormsTablet, oral: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg

[BCF]

Butalbital, Aspirin, and CaffeineOutpatient Dosage FormsCapsule, oral: Butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg

ButorphanolOutpatient Dosage FormsSolution, intranasal, as tartrate [spray]: 10 mg/mL (2.5 mL)

CabergolineOutpatient Dosage FormsTablet, oral: 0.5 mg

AZELASTINE (NASAL)

4

CaffeineOutpatient Dosage FormsSolution, Oral, as citrate [preservative free]:Generic: 60 mg/3 mL (3 mL) [equivalent to 10 mg/mL caffeine base]

CalamineOutpatient Dosage FormsSuspension, topical: 8% (118 mL)

CalcipotrieneOutpatient Dosage FormsCream, topical: 0.005% (60 g)Ointment, topical: 0.005% (60 g)Solution, topical: 0.005% (60 mL)

Calcipotriene and BetamethasoneOutpatient Dosage FormsOintment, External:Taclonex: Calcipotriene 0.005% and betamethasone dipropionate0.064% (60 g)

Suspension, External:Taclonex: Calcipotriene 0.005% and betamethasone dipropionate 0.064% (60mL) [contains castor oil]

Calcitriol (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 0.25 mcg, 0.5 mcg

Solution, Oral:Generic: 1 mcg/mL (15 mL)

Calcium AcetateOutpatient Dosage FormsGelcap, oral: 667 mg [equivalent to elemental calcium 169 mg (8.45 mEq)]

Calcium and Vitamin DOutpatient Dosage FormsTablet, oral: Calcium 600 mg and vitamin D 400 units

CandesartanOutpatient Dosage FormsTablet, Oral, as cilexetil:Generic: 16 mg, 32 mg

CapecitabineOutpatient Dosage FormsTablet, oral:Xeloda: 150 mg, 500 mg

CapsaicinOutpatient Dosage FormsCream, External:Generic: 0.025% (60 g)

CaptoprilOutpatient Dosage FormsTablet, Oral:Generic: 12.5 mg [BCF], 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

CarbacholOutpatient Dosage FormsSolution, ophthalmic:Isopto® Carbachol: 3% (15 mL) [contains benzalkonium chloride]

CarBAMazepineOutpatient Dosage FormsSuspension, oral: 100 mg/5 mL (10 mL, 450 mL) [BCF]Tablet, oral: 200 mg [BCF]Tablet, chewable, oral: 100 mg [BCF]Tablet, extended release, oral: 200 mg, 400 mg [BCF]TEGretol®-XR: 100 mg, 400 mg [BCF]

Carbamide PeroxideOutpatient Dosage FormsSolution, otic [drops]: 6.5% (15 mL)

Carbidopa and LevodopaOutpatient Dosage FormsTablet, oral:10/100: Carbidopa 10 mg and levodopa 100 mg [BCF]25/100: Carbidopa 25 mg and levodopa 100 mg [BCF]25/250: Carbidopa 25 mg and levodopa 250 mg [BCF]

Tablet, extended release, oral:25/100: Carbidopa 25 mg and levodopa 100 mg50/200: Carbidopa 50 mg and levodopa 200 mg

CarboxymethylcelluloseOutpatient Dosage FormsSolution, ophthalmic, as sodium [drops, preservative free]:Refresh Celluvisc: 1% (0.4 mL)

CarisoprodolOutpatient Dosage FormsTablet, oral: 350 mg

CarvedilolOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as phosphate:Coreg CR: 10 mg, 20 mg

Tablet, Oral:Generic: 3.125 mg [BCF], 6.25 mg [BCF], 12.5 mg [BCF], 25 mg [BCF]

CefdinirOutpatient Dosage FormsCapsule, Oral:Generic: 300 mg

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

CefiximeOutpatient Dosage FormsCapsule, Oral:Suprax: 400 mg

Powder for suspension, oral, as trihydrate:Suprax: 100 mg/5 mL (50 mL) [contains sodium benzoate; strawberry flavor]

CefpodoximeOutpatient Dosage FormsTablet, Oral:Generic: 200 mg

CefuroximeOutpatient Dosage FormsSuspension Reconstituted, Oral, as axetil [strength expressed as base]:Ceftin: 125 mg/5 mL (100 mL)

Tablet, Oral, as axetil [strength expressed as base]:Generic: 250 mg

CelecoxibOutpatient Dosage FormsCapsule, Oral:CeleBREX: 100 mg, 200 mg, 400 mg

CephalexinOutpatient Dosage FormsCapsule, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

Suspension Reconstituted, Oral:Generic: 125 mg/5 mL (100 mL, 200 mL); 250 mg/5 mL (100 mL, 200mL) [BCF]

Cetirizine (Systemic)Outpatient Dosage FormsSyrup, oral, as hydrochloride: 1 mg/mLTablet, oral, as hydrochloride: 10 mg

Charcoal, ActivatedOutpatient Dosage FormsSuspension, oral:Actidose®-Aqua: 50 g (240 mL)

Suspension, oral [with sorbitol]:Actidose® with Sorbitol: 25 g (120 mL) [contains sorbitol]

ChlorambucilOutpatient Dosage FormsTablet, oral:Leukeran®: 2 mg

ChlordiazePOXIDEOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 10 mg, 25 mg

Chlorhexidine Gluconate (Oral)Outpatient Dosage FormsSolution, Mouth/Throat:Generic: 0.12% (473 mL) [BCF]

Chlorhexidine Gluconate (Topical)Outpatient Dosage FormsLiquid, External:Generic: 4% (118 mL)

ChlorpheniramineOutpatient Dosage FormsTablet, oral, as maleate: 4 mg

ChlorproMAZINEOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 25 mg, 50 mg, 100 mg, 200 mg

CHLORPROMAZINE

5

ChlorthalidoneOutpatient Dosage FormsTablet, Oral:Generic: 25 mg [BCF], 50 mg [BCF]

CholecalciferolOutpatient Dosage FormsLiquid, Oral:Generic: 400 units/mL (50 mL, 52.5 mL)

Cholestyramine ResinOutpatient Dosage FormsPowder, Oral:Questran: 4 g/dose (378 g) [orange flavor]Questran Light: 4 g/dose (210 g) [sugar free; contains aspartame; orangeflavor]

Generic: 4 g/dose (210 g)

CilostazolOutpatient Dosage FormsTablet, oral: 50 mg, 100 mg

CinacalcetOutpatient Dosage FormsTablet, Oral:Sensipar: 30 mg, 60 mg, 90 mg

Ciprofloxacin and DexamethasoneOutpatient Dosage FormsSuspension, otic:Ciprodex®: Ciprofloxacin 0.3% and dexamethasone 0.1% (7.5 mL) [containsbenzalkonium chloride]

Ciprofloxacin (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic, as hydrochloride:Ciloxan: 0.3% (3.5 g)

Solution, Ophthalmic, as hydrochloride:Generic: 0.3% (2.5 mL, 5 mL)

Ciprofloxacin (Systemic)Outpatient Dosage FormsSuspension Reconstituted, Oral:Cipro: 250 mg/5 mL (100 mL) [contains sucrose 1.4 g/5 mL; strawberryflavor] [BCF]

Cipro: 500 mg/5 mL (100 mL) [contains sucrose 1.3 g/5 mL; strawberry flavor]Tablet, Oral, as hydrochloride [strength expressed as base]:Generic: 250 mg [BCF], 500 mg [BCF], 750 mg

CitalopramOutpatient Dosage FormsSolution, Oral:Generic: 10 mg/5 mL (240 mL) [BCF]

Tablet, Oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]

ClarithromycinOutpatient Dosage FormsSuspension Reconstituted, Oral:Generic: 125 mg/5 mL (50 mL, 100 mL)

Tablet, Oral:Generic: 250 mg, 500 mg

Tablet Extended Release 24 Hour, Oral:Generic: 500 mg

Clidinium and ChlordiazepoxideOutpatient Dosage FormsCapsule, Oral:Clidinium bromide 2.5 mg and chlordiazepoxide hydrochloride 5 mg

Clindamycin and Benzoyl PeroxideOutpatient Dosage FormsGel, topical:Duac: Clindamycin phosphate 1.2% and benzoyl peroxide 5% (45 g) [BCF]Clindamycin phosphate 1.2% and benzoyl peroxide 5% (45 g) [BCF]

Clindamycin (Systemic)Outpatient Dosage FormsCapsule, Oral, as hydrochloride [strength expressed as base]:Generic: 150 mg [BCF], 300 mg

Solution Reconstituted, Oral, as palmitate hydrochloride [strength expressed asbase]:Generic: 75 mg/5 mL (100 mL)

Clindamycin (Topical)Outpatient Dosage FormsCream, Vaginal, as phosphate [strength expressed as base]:Generic: 2% (40 g) [BCF]

Gel, External, as phosphate [strength expressed as base]:Generic: 1% (30 g, 60 g)

Lotion, External, as phosphate [strength expressed as base]:Generic: 1% (60 mL)

Solution, External, as phosphate [strength expressed as base]:Generic: 1% (30 mL, 60 mL) [BCF]

Suppository, Vaginal, as phosphate [strength expressed as base]:Cleocin: 100 mg (3 ea)

Clioquinol and HydrocortisoneOutpatient Dosage FormsCream, External:Ala-Quin: Clioquinol 3% and hydrocortisone 0.5% (28.4 g, 80 g)

CloBAZamOutpatient Dosage FormsSuspension, Oral:Generic: 2.5 mg/mL (120 mL)


ClobetasolOutpatient Dosage FormsCream, External, as propionate:Generic: 0.05% (15 g, 30 g, 60 g)

Foam, External, as propionate:Generic: 0.05% (50 g, 100 g)

Gel, External, as propionate:Generic: 0.05% (15 g, 30 g)

Lotion, External, as propionate:Generic: 0.05% (59 mL, 118 mL)

Ointment, External, as propionate:Generic: 0.05% (15 g, 30 g, 45 g, 60 g) [BCF]

Shampoo, External, as propionate:Generic: 0.05% (118 mL)

Solution, External, as propionate [for scalp application]:Generic: 0.05% (25 mL, 50 mL)

ClocortoloneOutpatient Dosage FormsCream, External, as pivalate:Generic: 0.1% (45 g, 75 g, 90 g)

ClomiPHENEOutpatient Dosage FormsTablet, oral, as citrate: 50 mg

ClomiPRAMINEOutpatient Dosage FormsCapsule, oral, as hydrochloride: 25 mg, 50 mg

ClonazePAMOutpatient Dosage FormsTablet, oral: 0.5 mg [BCF], 1 mg, 2 mg

CloNIDineOutpatient Dosage FormsPatch, transdermal: 0.1 mg/24 hours (4s); 0.2 mg/24 hours (4s); 0.3 mg/24hours (4s)

Tablet, oral, as hydrochloride: 0.1 mg [BCF], 0.2 mg [BCF], 0.3 mg [BCF]

ClopidogrelOutpatient Dosage FormsTablet, oral: 75 mg [BCF], 300 [BCF]

ClorazepateOutpatient Dosage FormsTablet, Oral, as dipotassium:Generic: 3.75 mg, 7.5 mg, 15 mg

Clotrimazole (Oral)Outpatient Dosage FormsTroche, oral: 10 mg

Clotrimazole (Topical)Outpatient Dosage FormsCream, External:Generic: 1% (15 g, 30 g)

Cream, Vaginal:Generic: 1% (45 g)

Coal Tar and Salicylic AcidOutpatient Dosage FormsGel, topical [shampoo]:Tarsum: Coal tar solution 10% [equivalent to coal tar 2%] and salicylic acid 5%(120 mL)

CobicistatOutpatient Dosage FormsTablet, Oral:Tybost: 150 mg

CHLORTHALIDONE

6

CodeineOutpatient Dosage FormsTablet, oral, as sulfate: 30 mg

ColchicineOutpatient Dosage FormsTablet, oral: 0.6 mg

ColestipolOutpatient Dosage FormsGranules, Oral, as hydrochloride:Generic: 5 g/5 g scoop (500 g)

Tablet, Oral, as hydrochloride:Generic: 1 g

CortisoneOutpatient Dosage FormsTablet, oral, as acetate: 25 mg

Cromolyn (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as sodium:Generic: 4% (10 mL)

CrotamitonOutpatient Dosage FormsCream, External:Eurax: 10% (60 g)

CyanocobalaminOutpatient Dosage FormsInjection, solution: 1000 mcg/mL (1 mL)

CyclobenzaprineOutpatient Dosage FormsTablet, oral, as hydrochloride: 10 mg [BCF]

CyclopentolateOutpatient Dosage FormsSolution, Ophthalmic, as hydrochloride [drops]:Generic: 1% (15 mL), 2% (2 mL, 5 mL, 15 mL)

Cyclopentolate and PhenylephrineOutpatient Dosage FormsSolution, ophthalmic [drops]:Cyclomydril®: Cyclopentolate hydrochloride 0.2% and phenylephrine hydro-chloride 1% (5 mL) [contains benzalkonium chloride]

CyclophosphamideOutpatient Dosage FormsCapsule, Oral:Generic: 25 mg, 50 mg

CycloSPORINE (Ophthalmic)Outpatient Dosage FormsEmulsion, ophthalmic [drops, preservative free]:Restasis: 0.05% (0.4 mL) [contains castor oil]

CycloSPORINE (Systemic)Outpatient Dosage FormsCapsule, Softgel, Oral [modified]:Generic: 25 mg, 100 mg

Capsule, softgel, oral [non-modified]:SandIMMUNE: 100 mg [contains corn oil, dehydrated ethanol 12.7%]

Solution, Oral:Gengraf: 100 mg/mL (50 mL) [contains propylene glycol]Neoral: 100 mg/mL (50 mL) [contains alcohol, usp]Generic: 100 mg/mL (50 mL)

CyproheptadineOutpatient Dosage FormsSyrup, Oral, as hydrochloride:Generic: 2 mg/5 mL (473 mL) [BCF]

Tablet, Oral, as hydrochloride:Generic: 4 mg [BCF]

Dabigatran EtexilateOutpatient Dosage FormsCapsule, oral:Pradaxa: 75 mg, 150 mg

Dapsone (Systemic)Outpatient Dosage FormsTablet, oral: 25 mg, 100 mg

DarunavirOutpatient Dosage FormsSuspension, Oral:Prezista: 100 mg/mL (200 mL) [contains methylparaben sodium; strawberrycream flavor]

Tablet, Oral:Prezista: 600 mg, 800 mg

Darunavir and CobicistatOutpatient Dosage FormsTablet, Oral:Prezcobix: Darunavir 800 mg and cobicistat 150 mg

DesipramineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 25 mg, 50 mg, 75 mg, 150 mg

DesmopressinOutpatient Dosage FormsSolution, Nasal, as acetate:Stimate: 1.5 mg/mL (2.5 mL) [contains benzalkonium chloride]Generic: 0.1 mg/mL (2.5 mL, 5 mL)

DesonideOutpatient Dosage FormsCream, topical: 0.05% (15 g, 60 g)Ointment, topical: 0.05% (60 g)

DesoximetasoneOutpatient Dosage FormsCream, topical: 0.05% (15 g, 60 g); 0.25% (15 g, 60 g)

DexAMETHasone (Systemic)Outpatient Dosage FormsElixir, oral: 0.5 mg/5 mL (237 mL)Tablet, oral: 0.5 mg, 0.75 mg, 2 mg, 4 mg

DexmethylphenidateOutpatient Dosage FormsCapsule Extended Release 24 Hour, Oral, as hydrochloride:Generic: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg

Tablet, Oral, as hydrochloride:Generic: 2.5 mg, 10 mg

DextroamphetamineOutpatient Dosage FormsCapsule, Extended Release, Oral, as sulfate:Generic: 5 mg, 10 mg, 15 mg

Dextroamphetamine and AmphetamineOutpatient Dosage FormsCapsule, extended release, oral:5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sul-fate 1.25 mg (equivalent to amphetamine base 3.1 mg)] [BCF]

10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate2.5 mg (equivalent to amphetamine base 6.3 mg)] [BCF]

15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccharate3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine sul-fate 3.75 mg (equivalent to amphetamine base 9.4 mg)] [BCF]

20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate5 mg (equivalent to amphetamine base 12.5 mg)] [BCF]

25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine saccharate6.25 mg, amphetamine aspartate monohydrate 6.25 mg, amphetamine sul-fate 6.25 mg (equivalent to amphetamine base 15.6 mg)] [BCF]

30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sulfate7.5 mg (equivalent to amphetamine base 18.8 mg)] [BCF]

Tablet, oral:5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sul-fate 1.25 mg (equivalent to amphetamine base 3.13 mg)]

10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate2.5 mg (equivalent to amphetamine base 6.3 mg)]

15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccharate3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine sul-fate 3.75 mg (equivalent to amphetamine base 9.4 mg)]

20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate5 mg (equivalent to amphetamine base 12.6 mg)]

DextroseOutpatient Dosage FormsGel, Oral:Insta-Glucose: 77.4% (31 g)

Diabetic SuppliesOutpatient Dosage FormsDevice:NovoPen Echo: (1 ea)

DIABETIC SUPPLIES

7

Glucose meter:FreeStyle Lite Glucometer [BCF]Precision Xtra

Lancet:Freestyle 28G (100 ea)

Syringe and needle:BD Syringe 0.3 mL 31 gauge x 5/16" (100 ea)BD Syringe 0.5 mL (30 gauge x 1/2") (100 ea)BD Syringe 0.5 mL (31 gauge x 5/16") (100 ea)BD Syringe 1 mL (30 gauge x 1/2") (100 ea)BD Syringe 1 mL (31 gauge x 5/16") (100 ea) [BCF]BD LUER-LOCK Syringe 3 mL (22 gauge X 1") (IM USE)Monoject TB Syringe: 1 mLSure Comfort Pen Needles (18 gauge - 1")Sure Comfort Pen Needles (30 gauge - 8 mm)Sure Comfort Pen Needles (31 gauge - 5 mm)Sure Comfort Pen Needles (31 gauge - 8 mm)Sure Comfort Pen Needles (32 gauge X 5/32" (4 mm))Sure Comfort Pen Needles (32 gauge - 6 mm)

Test Strips:FreeStyle Lite: 50/box, 100/box [BCF]Precision Xtra Blood Glucose Test Strips [BCF]Precision Xtra Blood Ketone Test Strips: 10/boxPrecision Xtra Urine Ketone Test Strips

DiazePAMOutpatient Dosage FormsSolution, Oral:Generic: 5 mg/5 mL (500 mL)

Tablet, Oral:Generic: 2 mg, 5 mg [BCF], 10 mg

DibucaineOutpatient Dosage FormsOintment, External:Generic: 1% [10 mg/g] (30 g)

Diclofenac (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic, as sodium [drops]: 0.1% (5 mL)

Diclofenac (Systemic)Outpatient Dosage FormsTablet Delayed Release, Oral, as sodium:Generic: 50 mg, 75 mg

Tablet Extended Release 24 Hour, Oral, as sodium:Generic: 100 mg

Diclofenac (Topical)Outpatient Dosage FormsGel, Transdermal, as sodium:Voltaren: 1% (100 g) [contains isopropyl alcohol]

DicloxacillinOutpatient Dosage FormsCapsule, Oral:Generic: 250 mg [BCF], 500 mg [BCF]

DicyclomineOutpatient Dosage FormsCapsule, oral, as hydrochloride: 10 mg [BCF]Tablet, oral, as hydrochloride: 20 mg [BCF]

DiethylpropionOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 25 mg

DigoxinOutpatient Dosage FormsSolution, oral: 50 mcg/mL (60 mL)Tablet, oral: 125 mcg [BCF], 250 mcg [BCF]

DilTIAZemOutpatient Dosage FormsCapsule, Extended Release, Oral, as hydrochloride [once-daily dosing]:Generic: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF], 300 mg [BCF],360 mg [BCF] , 420 mg [BCF]

Ointment, External: 2%, compounded by pharmacyTablet, Oral, as hydrochloride:Generic: 30 mg, 60 mg, 90 mg, 120 mg

DiphenhydrAMINE (Systemic)Outpatient Dosage FormsCapsule, oral, as hydrochloride: 25 mg, 50 mgElixir, oral, as hydrochloride: 12.5 mg/5 mL (120 mL)

Diphenoxylate and AtropineOutpatient Dosage FormsSolution, Oral:Generic: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate 0.025 mgper 5 mL (60 mL)

Tablet, oral:Generic: 2.5/0.025: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate0.025 mg

DipyridamoleOutpatient Dosage FormsTablet, Oral:Generic: 25 mg, 50 mg, 75 mg

DisopyramideOutpatient Dosage FormsCapsule, oral: 100 mg, 150 mgCapsule, controlled release, oral:Norpace® CR: 100 mg, 150 mg

DisulfiramOutpatient Dosage FormsTablet, oral: 250 mg

DocusateOutpatient Dosage FormsCapsule, softgel, oral, as sodium:Generic: 100 mg

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

DolutegravirOutpatient Dosage FormsTablet, Oral:Tivicay: 50 mg

DonepezilOutpatient Dosage FormsTablet, oral, as hydrochloride: 5 mg, 10 mg

DorzolamideOutpatient Dosage FormsSolution, ophthalmic [drops]: 2% (10 mL)

Dorzolamide and TimololOutpatient Dosage FormsSolution, ophthalmic [drops]:Cosopt: Dorzolamide 2% [20 mg/mL] and timolol 0.5% [5 mg/mL] (10 mL)[contains benzalkonium chloride]

Generic: Dorzolamide 2% [20 mg/mL] and timolol 0.5% [5 mg/mL] (10 mL)

DoxazosinOutpatient Dosage FormsTablet, oral: 1 mg, 2 mg, 4 mg, 8 mg

Doxepin (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF], 75 mg [BCF]

Concentrate, Oral:Generic: 10 mg/mL (118 mL) [BCF]

Tablet, Oral:Silenor: 3 mg, 6 mg

DoxycyclineOutpatient Dosage FormsCapsule, Oral, as hyclate [strength expressed as base]:Generic: 100 mg [BCF]

Capsule, Oral, as monohydrate [strength expressed as base]:Generic: 100 mg

Tablet, Oral, as hyclate [strength expressed as base]:Generic: 20 mg, 100 mg [BCF]

DoxylamineOutpatient Dosage FormsTablet, Oral, as succinate:Sleep Aid: 25 mg [scored] [BCF]

DronabinolOutpatient Dosage FormsCapsule, soft gelatin, oral:Generic: 2.5 mg [contains sesame oil], 5 mg [contains sesame oil]

DulaglutideOutpatient Dosage FormsSolution Pen-injector, Subcutaneous [preservative free]:Trulicity: 0.75 mg/0.5 mL (0.5 mL); 1.5 mg/0.5 mL (0.5 mL) [contains poly-sorbate 80]

DIABETIC SUPPLIES

8

DULoxetineOutpatient Dosage FormsCapsule Delayed Release Particles, Oral:Generic: 20 mg, 30 mg, 60 mg

EfavirenzOutpatient Dosage FormsCapsule, Oral:Sustiva: 200 mg

Tablet, Oral:Sustiva: 600 mg

Efavirenz, Emtricitabine, and Tenofovir Disoproxil FumarateOutpatient Dosage FormsTablet, oral:Atripla: Efavirenz 600 mg, emtricitabine 200 mg, and tenofovir disoproxilfumarate 300 mg

EletriptanOutpatient Dosage FormsTablet, Oral:Generic: 20 mg, 40 mg

Elvitegravir, Cobicistat, Emtricitabine, and TenofovirAlafenamide

Outpatient Dosage FormsTablet, Oral:Genvoya: Elvitegravir 150 mg, cobicistat 150 mg, emtricitabine 200 mg, andtenofovir alafenamide 10 mg [Formulary with ID keys only]

Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir DisoproxilFumarate

Outpatient Dosage FormsTablet, oral:Stribild: Elvitegravir 150 mg, cobicistat 150 mg, emtricitabine 200 mg, andtenofovir disoproxil fumarate 300 mg

EmollientsOutpatient Dosage FormsEmulsion, topical: 45 gLotion, topical: 226 mL, 240 mL, 473 mLOintment, topical: 50 g, 114 g, 226 g, 396 g, 454 gPaste: 58.3% (60 g)

EmpagliflozinOutpatient Dosage FormsTablet, Oral:Jardiance: 10 mg, 25 mg

EmtricitabineOutpatient Dosage FormsCapsule, oral:Emtriva: 200 mg

Emtricitabine and Tenofovir AlafenamideOutpatient Dosage FormsTablet, Oral:Descovy: Emtricitabine 200 mg and tenofovir alafenamide 25 mg

Emtricitabine and Tenofovir Disoproxil FumarateOutpatient Dosage FormsTablet, Oral:Truvada: Emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg[gluten free]

Emtricitabine, Rilpivirine, and Tenofovir AlafenamideOutpatient Dosage FormsTablet, Oral:Odefsey: Emtricitabine 200 mg, rilpivirine 25 mg, and tenofovir alafena-mide 25 mg

Emtricitabine, Rilpivirine, and Tenofovir Disoproxil FumarateOutpatient Dosage FormsTablet, oral:Complera: Emtricitabine 200 mg, relpivirine 25 mg, and tenofovir disoproxilfumarate 300 mg

EnalaprilOutpatient Dosage FormsSolution, Oral, as maleate:Epaned: 1 mg/mL (150 mL) [contains sodium benzoate]

Tablet, Oral, as maleate:Generic: 5 mg

EnoxaparinOutpatient Dosage FormsInjection, solution, as sodium [preservative free]:Lovenox®: 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][prefilled syringe]

EntecavirOutpatient Dosage FormsTablet, oral:Baraclude: 1 mg

EnzalutamideOutpatient Dosage FormsCapsule, Oral:Xtandi: 40 mg

EpinastineOutpatient Dosage FormsSolution, Ophthalmic, as hydrochloride:Generic: 0.05% (5 mL)

EPINEPHrine (Systemic)Outpatient Dosage FormsInjection, solution:EpiPen Jr 2-Pak®: 0.15 mg/0.3 mL (2 mL) [contains sodium metabisulfite;1:2000 solution; delivers 0.15 mg per injection]

Twinject®: 0.15 mg/0.15 mL (1.1 mL) [contains chlorobutanol, sodium bisul-fite; 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]

EplerenoneOutpatient Dosage FormsTablet, Oral:Generic: 25 mg, 50 mg

Epoetin AlfaOutpatient Dosage FormsInjection, solution:Epogen®: 10,000 units/mL (2 mL); 20,000 units/mL (1 mL) [contains albumin(human), benzyl alcohol]

Procrit®: 20,000 units/mL (1 mL) [contains albumin (human), benzyl alcohol]Injection, solution [preservative free]:Epogen®: 2000 units/mL (1 mL); 3000 units/mL (1 mL); 4000 units/mL (1 mL);10,000 units/mL (1 mL) [contains albumin (human)]

Procrit®: 2000 units/mL (1 mL); 4000 units/mL (1 mL); 10,000 units/mL (1 mL);40,000 units/mL (1 mL) [contains albumin (human)]

ErenumabOutpatient Dosage FormsSolution Auto-injector, Subcutaneous [preservative free]:Aimovig: 70 mg/mL (1 mL) [contains polysorbate 80]Aimovig 140 Dose: 70 mg/mL (1 mL) [contains polysorbate 80]

ErgocalciferolOutpatient Dosage FormsSolution, Oral [drops]:Drisdol: 8000 units/mL (60 mL) [contains propylene glycol; 200 mcg/mL, OTC]

Ergotamine and CaffeineOutpatient Dosage FormsSuppository, rectal:Migergot®: Ergotamine tartrate 2 mg and caffeine 100 mg (12s)

Tablet, oral: Ergotamine tartrate 1 mg and caffeine 100 mg

Erythromycin (Ophthalmic)Outpatient Dosage FormsOintment, Ophthalmic:Generic: 5 mg/g (1 g, 3.5 g) [BCF]

Erythromycin (Systemic)Outpatient Dosage FormsGranules for suspension, oral, as ethylsuccinate:E.E.S.: Erythromycin activity 200 mg/5 mL (100 mL) [contains sodium 25.9 mg(1.1 mEq)/5 mL; cherry flavor] [BCF]

Suspension Reconstituted, Oral, as ethylsuccinate:EryPed: Erythromycin activity 200 mg/5 mL (100 mL) [contains sodium117.5 mg (5.1 mEq)/5 mL; fruit flavor] [BCF]

Tablet, Oral, as stearate:Erythrocin Stearate: 250 mg [BCF] , 500 mg

Tablet Delayed Release, Oral, as base:Ery-Tab: 250 mg [BCF]

Erythromycin (Topical)Outpatient Dosage FormsPledget, External:Generic: 2% (60s)

Solution, External:Generic: 2% (60 mL) [BCF]

ERYTHROMYCIN (TOPICAL)

9

EscitalopramOutpatient Dosage FormsTablet, Oral:Generic: 5 mg, 10 mg, 20 mg

Estradiol and LevonorgestrelOutpatient Dosage FormsPatch, Transdermal:Climara Pro: Estradiol 0.045 mg and levonorgestrel 0.015 mg per 24 hours(4s) [22 cm2; contains estradiol 4.4 mg and levonorgestrel 1.39 mg]

Estradiol (Systemic)Outpatient Dosage FormsPatch Weekly, Transdermal:Climara: 0.025 mg/24 hours (4s) [6.5 cm2, total estradiol 2.04 mg] [BCF]Climara: 0.0375 mg/24 hours (4s) [9.375 cm2, total estradiol 2.85 mg] [BCF]Climara: 0.05 mg/24 hours (4s) [12.5 cm2, total estradiol 3.8 mg] [BCF]Climara: 0.075 mg/24 hours (4s) [18.75 cm2, total estradiol 5.7 mg] [BCF]Climara: 0.1 mg/24 hours (4s) [25 cm2, total estradiol 7.6 mg] [BCF]Generic: 0.025 mg/24 hr (4 ea) [BCF]; 0.0375 mg/24 hr (4 ea) [BCF];0.05 mg/24 hr (4 ea) [BCF]; 0.075 mg/24 hr (4 ea) [BCF]; 0.1 mg/24 hr (4ea) [BCF]

Patch Twice Weekly, Transdermal:Vivelle-Dot: 0.0375 mg/24 hours (24s) [3.75 cm2, total estradiol 0.585 mg]Vivelle-Dot: 0.05 mg/24 hours (24s) [5 cm2, total estradiol 0.78 mg]Vivelle-Dot: 0.075 mg/24 hours (24s) [7.5 cm2, total estradiol 1.17 mg]Vivelle-Dot: 0.1 mg/24 hours (24s) [10 cm2, total estradiol 1.56 mg]

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

Estradiol (Topical)Outpatient Dosage FormsRing, vaginal, as base:Estring®: 2 mg (1s) [total estradiol 2 mg; releases 7.5 mcg/day over 90 days]

Tablet, vaginal, as base:Vagifem®: 10 mcg

EstramustineOutpatient Dosage FormsCapsule, oral, as phosphate sodium:Emcyt®: 140 mg

Estrogens (Conjugated/Equine) and MedroxyprogesteroneOutpatient Dosage FormsTablet, oral:Prempro®: 0.3/1.5: Conjugated estrogens 0.3 mg and medroxyprogesteroneacetate 1.5 mg [BCF]

Prempro®: 0.45/1.5: Conjugated estrogens 0.45 mg and medroxyprogester-one acetate 1.5 mg [BCF]

Prempro®: 0.625/2.5: Conjugated estrogens 0.625 mg and medroxyproges-terone acetate 2.5 mg [BCF]

Prempro®: 0.625/5: Conjugated estrogens 0.625 mg and medroxyprogester-one acetate 5 mg [BCF]

Tablet, oral [therapy pack contains two separate tablet formulations]:Premphase®: Conjugated estrogens 0.625 mg [14 maroon tablets] and con-jugated estrogen 0.625 mg/medroxyprogesterone acetate 5 mg [14 light bluetablets]

Estrogens (Conjugated/Equine, Systemic)Outpatient Dosage FormsTablet, 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)Outpatient Dosage FormsCream, vaginal:Premarin®: 0.625 mg/g (30 g) [BCF]

EszopicloneOutpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2 mg, 3 mg

EthambutolOutpatient Dosage FormsTablet, oral, as hydrochloride: 100 mg [BCF], 400 mg [BCF]

Ethinyl Estradiol and DesogestrelOutpatient Dosage FormsTablet, oral [low dose formulation]:Azurette:Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 whitetablets]

Day 22-23: 2 inactive green tabletsDay 24-28: Ethinyl estradiol 0.01 mg [5 blue tablets] (28s)

Tablet, Oral [monophasic formulation]:Desogen: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 white tabletsand 7 green inactive tablets] (28s)

Ethinyl Estradiol and DrospirenoneOutpatient Dosage FormsTablet, oral:Yasmin®: Ethinyl estradiol 0.03 mg and drospirenone 3 mg [21 yellow activetablets and 7 white inactive tablets] (28s) [BCF]

Yaz®: Ethinyl estradiol 0.02 mg and drospirenone 3 mg [24 light pink activetablets and 4 white inactive tablets] (28s) [BCF]

Ethinyl Estradiol and Ethynodiol DiacetateOutpatient Dosage FormsTablet, Oral:Zovia 1/35: Ethinyl estradiol 0.035 mg and ethynodiol diacetate 1 mg [21 lightpink tablets and 7 white inactive tablets]

Zovia 1/50: Ethinyl estradiol 0.05 mg and ethynodiol diacetate 1 mg [21 pinktablets and 7 white inactive tablets]

Ethinyl Estradiol and EtonogestrelOutpatient Dosage FormsRing, vaginal:NuvaRing®: Ethinyl estradiol 0.015 mg/day and etonogestrel 0.12 mg/day(3s) [3-week duration]

Ethinyl Estradiol and LevonorgestrelOutpatient Dosage FormsTablet, oral [low-dose formulation]:Generic: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg [21 tablets and 7inactive tablets] (28s) [BCF]

Tablet, oral [extended cycle regimen]:Jolessa: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (91s) [84 pinktablets and 7 white inactive tablets] [BCF]

Tablet, oral [monophasic formulation]:Generic: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [21 tablets and7 inactive tablets] (28s) [BCF]

Tablet, oral [triphasic formulation]:Trivora:Day 1-6: Ethinyl estradiol 0.03 mg and levonorgestrel 0.05 mg [6 bluetablets]

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

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

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

Ethinyl Estradiol and NorelgestrominOutpatient Dosage FormsPatch, transdermal:Ortho Evra®: Ethinyl estradiol 0.75 mg and norelgestromin 6 mg [releasesethinyl estradiol 20 mcg and norelgestromin 150 mcg per day] (3s)

Ethinyl Estradiol and NorethindroneOutpatient Dosage FormsTablet, oral [monophasic formulation]:Blisovi Fe 1/20: Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg [21yellow tablets] and ferrous fumarate 75 mg [7 brown tablets] (28s)

Brevicon: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [21 bluetablets and 7 orange inactive tablets]

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 acetate1.5 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 [21 yellow-green tablets and 7 orange inactive tablets] [BCF]

Ortho-Novum 1/35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21peach tablets and 7 green inactive tablets] (28s) [BCF]

Tablet, oral [triphasic formulation]:Necon 7/7/7:Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [7 whitetablets]

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

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

Day 22-28: 7 green inactive tablets (28s)Ortho-Novum 7/7/7:Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [7 whitetablets]

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

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

Day 22-28: 7 green inactive tablets (28s)Tri-Norinyl:Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [7 bluetablets]

Day 8-16: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [9 yellow-green tablets]

Day 17-21: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [5 bluetablets]

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

ESCITALOPRAM

10

Ethinyl Estradiol and NorgestimateOutpatient Dosage FormsTablet, Oral [monophasic formulation]:Ortho-Cyclen: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 bluetablets and 7 dark green inactive tablets] (28s) [BCF]

Tablet, oral [triphasic formulation]:Ortho Tri-Cyclen [BCF]:Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 whitetablets]

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

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

Day 22-28: 7 dark green inactive tablets (28s)Ortho Tri-Cyclen® Lo [BCF]:Day 1-7: Ethinyl estradiol 0.025 mg and norgestimate 0.18 mg [7 whitetablets]

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

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

Day 22-28: 7 dark green inactive tablets

Ethinyl Estradiol and NorgestrelOutpatient Dosage FormsTablet, Oral [monophasic formulation]:Ogestrel: Ethinyl estradiol 0.05 mg and norgestrel 0.5 mg [21 white tabletsand 7 peach inactive tablets] (28s)

Generic: Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [21 white tablets and7 pink inactive tablets]

EthosuximideOutpatient Dosage FormsCapsule, softgel, oral: 250 mgSolution, oral: 250 mg/5 mL (473 mL)

EtoposideOutpatient Dosage FormsCapsule, softgel, oral: 50 mg

EtravirineOutpatient Dosage FormsTablet, Oral:Intelence: 100 mg, 200 mg

EverolimusOutpatient Dosage FormsTablet, Oral:Afinitor: 2.5 mg, 5 mg, 10 mgZortress: 0.25 mg, 0.5 mg, 0.75 mg

ExemestaneOutpatient Dosage FormsTablet, oral: 25 mg

ExenatideOutpatient Dosage FormsAuto-injector, Subcutaneous:Bydureon BCise: 2 mg/0.85 mL (0.85 mL) [BCF]

Pen-injector, Subcutaneous:Bydureon: 2 mg (1 ea) [BCF]

Suspension Reconstituted ER, Subcutaneous:Bydureon: 2 mg (1 ea) [BCF]

EzetimibeOutpatient Dosage FormsTablet, Oral:Generic: 10 mg

FamotidineOutpatient Dosage FormsSuspension Reconstituted, Oral:Generic: 40 mg/5 mL (50 mL)


FelbamateOutpatient Dosage FormsSuspension, Oral:Generic: 600 mg/5 mL (237 mL, 240 mL, 473 mL)


FelodipineOutpatient Dosage FormsTablet Extended Release 24 Hour, Oral:Generic: 2.5 mg, 5 mg, 10 mg

Fenofibrate and DerivativesOutpatient Dosage FormsTablet, Oral:TriCor: 48 mg [BCF], 145 mg [BCF] [contains soybean lecithin]

FentaNYLOutpatient Dosage FormsPatch, transdermal, as base:Generic: 12 [delivers 12.5 mcg/hr] (5s); 25 [delivers 25 mcg/hr] (5s); 50[delivers 50 mcg/hr] (5s); 75 [delivers 75 mcg/hr] (5s); 100 [delivers 100mcg/hr] (5s)

Ferrous GluconateOutpatient Dosage FormsTablet, oral: 324 mg [elemental iron 38 mg], 325 mg [elemental iron 36 mg]

Ferrous SulfateOutpatient Dosage FormsLiquid, Oral:Generic: 220 (44 Fe) mg/5 mL (473 mL)

Liquid, Oral [drops]:Generic: 75 mg/mL (50 mL) [elemental iron 15 mg/mL]

Tablet, Oral:Generic: 325 mg [elemental iron 65 mg]

FexofenadineOutpatient Dosage FormsTablet, Oral:Generic: 60 mg, 180 mg

FinasterideOutpatient Dosage FormsTablet, oral: 5 mg [BCF]

FlecainideOutpatient Dosage FormsTablet, Oral, as acetate:Generic: 50 mg, 100 mg, 150 mg

FluconazoleOutpatient Dosage FormsTablet, Oral:Generic: 100 mg, 150 mg [BCF], 200 mg

Suspension Reconstituted, Oral:Generic: 10 mg/mL (35 mL); 40 mg/mL (35 mL)

FludrocortisoneOutpatient Dosage FormsTablet, oral, as acetate: 0.1 mg

Flunisolide (Nasal)Outpatient Dosage FormsSolution, Nasal:Generic: 25 mcg/actuation (0.025%) (25 mL)

Fluocinolone (Topical)Outpatient Dosage FormsCream, External, as acetonide:Generic: 0.01% (15 g, 60 g); 0.025% (15 g, 60 g)

Oil, External, as acetonide [scalp oil]:Derma-Smoothe/FS: 0.01% (120 mL) [contains isopropyl alcohol, peanut oil]

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

FluocinonideOutpatient Dosage FormsCream, External:Generic: 0.05% (15 g, 30 g, 60 g, 120 g) [BCF]

Gel, External:Generic: 0.05% (15 g, 60 g)

Ointment, External:Generic: 0.05% (15 g, 30 g, 60 g) [BCF]

Solution, External:Generic: 0.05% (20 mL, 60 mL)

FluorideOutpatient Dosage FormsCream, Oral, as sodium [toothpaste]:PreviDent 5000 Plus: 1.1% (51 g) [contains sodium benzoate; equivalent tofluoride 2.5 mg/dose]

Generic: 1.1% (51 g) [equivalent to fluoride 2.5 mg/dose]Tablet, Chewable, Oral, as sodium:Generic: 0.55 mg [equivalent to fluoride 0.25 mg]

FluorometholoneOutpatient Dosage FormsOintment, Ophthalmic, as base:FML: 0.1% (3.5 g) [contains phenylmercuric acetate]

FLUOROMETHOLONE

11

Fluorouracil (Topical)Outpatient Dosage FormsSolution, topical: 2% (10 mL); 5% (10 mL)

FLUoxetineOutpatient Dosage FormsCapsule, oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF]

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

Flurbiprofen (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic, as sodium [drops]: 0.03% (2.5 mL)

FlutamideOutpatient Dosage FormsCapsule, oral: 125 mg

Fluticasone and SalmeterolOutpatient Dosage FormsAerosol, for oral inhalation:Advair HFA: 45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg perinhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]

Advair HFA: 115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcgper inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]

Advair HFA: 230/21: Fluticasone propionate 230 mcg and salmeterol 21 mcgper inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF]

Powder, for oral inhalation:Advair Diskus®: 100/50: Fluticasone propionate 100 mcg and salmeterol 50mcg (14s, 60s) [contains lactose] [BCF]

Advair Diskus®: 250/50: Fluticasone propionate 250 mcg and salmeterol 50mcg (14s, 60s) [contains lactose] [BCF]

Advair Diskus®: 500/50: Fluticasone propionate 500 mcg and salmeterol 50mcg (14s, 60s) [contains lactose] [BCF]

Fluticasone (Nasal)Outpatient Dosage FormsSuspension, Nasal, as propionate:Generic: 50 mcg/inhalation (16 g) [BCF]

Fluticasone (Oral Inhalation)Outpatient Dosage FormsAerosol, for oral inhalation, as propionate:Flovent HFA: 44 mcg/inhalation (10.6 g) [chlorofluorocarbon free; 120 meteredactuations] [BCF]

Flovent HFA: 110 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 meteredactuations] [BCF]

Flovent HFA: 220 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 meteredactuations] [BCF]

Powder, for oral inhalation, as propionate:Flovent Diskus: 50 mcg (60s) [contains lactose] [BCF]Flovent Diskus: 100 mcg (60s) [contains lactose] [BCF]

Fluticasone (Topical)Outpatient Dosage FormsCream, External, as propionate:Generic: 0.05% (15 g, 30 g, 60 g)

Fluticasone, Umeclidinium, and VilanterolOutpatient Dosage FormsAerosol Powder Breath Activated, Inhalation:Trelegy Ellipta: Fluticasone furoate 100 mcg, umeclidinium 62.5 mcg, andvilanterol 25 mcg (28 ea, 60 ea) [contains lactose monohydrate]

FluvoxaMINEOutpatient Dosage FormsTablet, Oral, as maleate:Generic: 50 mg, 100 mg

Folic AcidOutpatient Dosage FormsTablet, oral: 1 mg [BCF]

FosamprenavirOutpatient Dosage FormsTablet, oral, as calcium:Lexiva: 700 mg [equivalent to amprenavir ~600 mg]

FosinoprilOutpatient Dosage FormsTablet, oral, as sodium: 10 mg, 20 mg, 40 mg

FurosemideOutpatient Dosage FormsSolution, Oral:Generic: 10 mg/mL (60 mL, 120 mL) [BCF]

Tablet, Oral:Generic: 20 mg [BCF], 40 mg [BCF] , 80 mg [BCF]

GabapentinOutpatient Dosage FormsCapsule, oral: 100 mg [BCF], 300 mg [BCF], 400 mg [BCF]Tablet, oral: 600 mg [BCF], 800 mg [BCF]

GatifloxacinOutpatient Dosage FormsSolution, ophthalmic [drops]:Zymaxid: 0.5% (2.5 mL) [contains benzalkonium chloride]

GemfibrozilOutpatient Dosage FormsTablet, oral: 600 mg [BCF]

Gentamicin (Ophthalmic)Outpatient Dosage FormsOintment, ophthalmic:Gentak: 0.3% (3.5 g) [BCF]

Solution, ophthalmic [drops]:Generic: 0.3% (5 mL, 15 mL) [BCF]

GlimepirideOutpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2 mg, 4 mg

GlipiZIDEOutpatient Dosage FormsTablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF]

Tablet, Extended Release, Oral:Generic: 2.5 mg, 5 mg, 10 mg

GlucagonOutpatient Dosage FormsInjection, powder for reconstitution:Glucagon Emergency Kit: 1 mg [contains glycerin (in diluent), lactose 49 mg;equivalent to 1 unit]

GlyBURIDEOutpatient Dosage FormsTablet, Oral:Generic: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF]

Tablet, Oral [micronized]:Generic: 3 mg [BCF]

Glyburide and MetforminOutpatient Dosage FormsTablet, oral: 1.25/250: Glyburide 1.25 mg and metformin hydrochloride 250 mg,2.5/500: Glyburide 2.5 and metformin hydrochloride 500 mg, 5/500: Glyburide5 mg and metformin hydrochloride 500 mg

GlycerinOutpatient Dosage FormsSuppository, rectal [pediatric]: 82.5% (25s)

Glycopyrrolate (Systemic)Outpatient Dosage FormsSolution, Oral:Cuvposa: 1 mg/5 mL (473 mL)

Tablet, oral:Generic: 1 mg

GoserelinOutpatient Dosage FormsImplant, subcutaneous:Zoladex®: 3.6 mg (1s) [1 month implant] [BCF]Zoladex®: 10.8 mg (1s) [3 month implant] [BCF]

GranisetronOutpatient Dosage FormsTablet, oral: 1 mg

GriseofulvinOutpatient Dosage FormsSuspension, Oral [microsize]:Generic: 125 mg/5 mL (120 mL) [BCF]

Tablet, Oral [Ultramicrosize]:Gris-PEG: 125 mg [BCF], 250 mg [BCF] [scored]

GuaiFENesinOutpatient Dosage FormsSolution, Oral:Generic: 100 mg/5 mL (5 mL, 10 mL, 15 mL)

Guaifenesin and DextromethorphanOutpatient Dosage FormsSyrup, oral: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mgper 5 mL (5 mL)

FLUOROURACIL (TOPICAL)

12

Guaifenesin and PseudoephedrineOutpatient Dosage FormsTablet, Extended Release, Oral:Generic: Guaifenesin 600 mg and pseudoephedrine hydrochloride 60 mg

GuanFACINEOutpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2 mg

Halobetasol and TazaroteneOutpatient Dosage FormsLotion, External:Duobrii: Halobetasol propionate 0.01% and tazarotene 0.045% (100 g)

HaloperidolOutpatient Dosage FormsTablet, Oral:Generic: 0.5 mg, 1 mg, 2 mg, 5 mg

HomatropineOutpatient Dosage FormsSolution, ophthalmic, as hydrobromide [drops]:Isopto Homatropine: 5% (5 mL) [contains benzalkonium chloride]Generic: 5% (5 mL)

HydrALAZINEOutpatient Dosage FormsTablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

HydroCHLOROthiazideOutpatient Dosage FormsCapsule, Oral:Generic: 12.5 mg [BCF]

Tablet, Oral:Generic: 25 mg [BCF], 50 mg [BCF]

Hydrochlorothiazide and SpironolactoneOutpatient Dosage FormsTablet, Oral:Aldactazide: 50/50: Hydrochlorothiazide 50 mg and spironolactone 50 mg

Hydrochlorothiazide and TriamtereneOutpatient Dosage FormsTablet, Oral:Hydrochlorothiazide 25 mg and triamterene 37.5 mg [BCF]Hydrochlorothiazide 50 mg and triamterene 75 mg [BCF]

Hydrocodone and AcetaminophenOutpatient Dosage FormsSolution, Oral:Hydrocodone bitartrate 7.5 mg and acetaminophen 325 mg per 15 mL

Tablet, Oral:Hydrocodone bitartrate 5 mg and acetaminophen 325 mgHydrocodone bitartrate 7.5 mg and acetaminophen 325 mgHydrocodone bitartrate 10 mg and acetaminophen 325 mg

Hydrocodone and ChlorpheniramineOutpatient Dosage FormsSuspension, Extended Release, Oral:Hydrocodone polistirex [equivalent to hydrocodone bitartrate 10 mg] andchlorpheniramine polistirex [equivalent to chlorpheniramine maleate 8 mg]per 5 mL (115 mL, 473 mL)

Hydrocortisone (Systemic)Outpatient Dosage FormsTablet, oral, as base: 5 mg, 10 mg, 20 mg

Hydrocortisone (Topical)Outpatient Dosage FormsCream, External, as base:Generic: 1% (28.4 g, 30 g, 454 g); 2.5% (30 g) [BCF]

Cream, External, as valerate:Generic: 0.2% (15 g, 45 g, 60 g)

Cream, Rectal, as base:Proctozone-HC 2.5%: 2.5% (30 g) [BCF]

Foam, Rectal, as acetate:Cortifoam: 10% (15 g) [90 mg/applicator]

Lotion, External, as base:Generic: 1% (114 g)

Ointment, External, as base:Generic: 2.5% (20 g, 30 g)

Ointment, External, as valerate:Generic: 0.2% (15 g, 45 g, 60 g)

Suppository, Rectal, as acetate:Generic: 25 mg (12 ea, 24 ea) [BCF]

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

HYDROmorphoneOutpatient Dosage FormsTablet, oral, as hydrochloride: 2 mg, 4 mg

HydroxychloroquineOutpatient Dosage FormsTablet, oral, as sulfate: 200 mg [equivalent to 155 mg base]

HYDROXYprogesterone CaproateOutpatient Dosage FormsSolution Auto-injector, Subcutaneous [preservative free]:Makena: 275 mg/1.1 mL (1.1 mL) [contains benzyl benzoate, castor oil(ricine oil)]

HydroxyureaOutpatient Dosage FormsCapsule, oral:Droxia: 200 mg, 300 mgHydrea: 500 mg

HydrOXYzineOutpatient Dosage FormsCapsule, Oral, as pamoate:Generic: 50 mg

Syrup, Oral, as hydrochloride:Generic: 10 mg/5 mL (118 mL, 473 mL) [BCF]

Tablet, Oral, as hydrochloride:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

HyoscyamineOutpatient Dosage FormsTablet, Sublingual, as sulfate: 0.125 mgTablet, Extended Release, Oral, as sulfate: 0.375 mg

Hyoscyamine, Atropine, Scopolamine, and PhenobarbitalOutpatient Dosage FormsTablet, Oral:Donnatal: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, sco-polamine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg

IbandronateOutpatient Dosage FormsTablet, oral: 150 mg

IbuprofenOutpatient Dosage FormsSuspension, oral: 100 mg/5 mL (5 mL, 120 mL)Tablet, oral: 400 mg [BCF], 600 mg [BCF], 800 mg [BCF]

ImipramineOutpatient Dosage FormsTablet, oral, as hydrochloride: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

ImiquimodOutpatient Dosage FormsCream, topical: 5% (12s, 24s) [0.25 g/packet]

IndapamideOutpatient Dosage FormsTablet, oral: 2.5 mg

IndomethacinOutpatient Dosage FormsCapsule, Oral:Generic: 25 mg [BCF], 50 mg [BCF]

Ingenol MebutateOutpatient Dosage FormsGel, External:Picato: 0.015% (3 ea) [contains benzyl alcohol, isopropyl alcohol]

Insulin AspartOutpatient Dosage FormsInjection, 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 AspartOutpatient Dosage FormsSuspension, Subcutaneous:NovoLOG Mix 70/30 FlexPen: Insulin aspart protamine suspension 70%[intermediate acting] and insulin aspart solution 30% [rapid-acting]: 100units/mL (3 mL) [contains metacresol, phenol] [BCF]

Insulin DetemirOutpatient Dosage FormsSolution, subcutaneous:Levemir: 100 units/mL (10 mL) [contains metacresol, phenol]

INSULIN DETEMIR

13

Insulin GlargineOutpatient Dosage FormsSolution, Subcutaneous:Lantus: 100 units/mL (10 mL) [contains metacresol] [BCF]

Solution Pen-injector, Subcutaneous:Lantus Solostar: 100 units/mL (3 mL) [BCF]

Insulin LisproOutpatient Dosage FormsSolution, Subcutaneous:HumaLOG: 100 units/mL (3 mL, 10 mL) [contains metacresol, phenol]

Solution Pen-injector, Subcutaneous:HumaLOG KwikPen: 100 units/mL (3 mL) [contains metacresol, phenol]

Insulin Lispro Protamine and Insulin LisproOutpatient Dosage FormsSuspension Pen-injector, Subcutaneous:HumaLOG Mix 75/25 KwikPen: Insulin lispro protamine suspension 75%[intermediate acting] and insulin lispro solution 25% [rapid acting]: 100units/mL (3 mL)

Insulin NPHOutpatient Dosage FormsSuspension, Subcutaneous:HumuLIN N: 100 units/mL (3 mL, 10 mL) [contains metacresol, phenol]NovoLIN N: 100 units/mL (10 mL) [vial] [BCF]

Suspension Pen-injector, Subcutaneous:HumuLIN N KwikPen: 100 units/mL (3 mL) [contains metacresol, phenol]

Insulin NPH and Insulin RegularOutpatient Dosage FormsInjection, suspension:NovoLIN® 70/30: Insulin NPH suspension 70% [intermediate acting] andinsulin regular solution 30% [short acting]: 100 units/mL (10 mL) [vial] [BCF]

Insulin RegularOutpatient Dosage FormsSolution, Injection:NovoLIN R: 100 units/mL (10 mL) [contains metacresol] [BCF]

Interferon Beta-1aOutpatient Dosage FormsInjection, Solution:Avonex: 30 mcg/0.5 mL [albumin free; prefilled syringe]Avonex Pen: 30 mcg/0.5 mL (0.5 mL) [albumin free; contains mouse (murine)and/or hamster protein]

Injection, Solution [preservative free]:Rebif: 22 mcg/0.5 mL, 44 mcg/0.5 mL [contains albumin (human)]Rebif Rebidose: 44 mcg/0.5 mL (0.5 mL) [contains albumin (human), mouse(murine) and/or hamster protein; autoinjector]

Injection, Solution [combination package, preservative free]:Rebif Titration Pack: 8.8 mcg/0.2 mL (6s) and 22 mcg/0.5 mL (6s) [containsalbumin (human)]

Interferon Beta-1bOutpatient Dosage FormsKit, Subcutaneous:Betaseron: 0.3 mg [contains albumin human] [BCF]

Ipratropium and AlbuterolOutpatient Dosage FormsSolution for nebulization: Ipratropium bromide 0.5 mg and albuterol (base)2.5 mg per 3 mL (60s) [BCF]

Solution for oral inhalation [spray]:Combivent® Respimat®: Ipratropium bromide 20 mcg and albuterol (base)100 mcg per inhalation (4 g) [contains benzalkonium chloride; 120 meteredactuations]

Ipratropium (Nasal)Outpatient Dosage FormsSolution, Nasal, as bromide:Generic: 0.03% (30 mL); 0.06% (15 mL)

Ipratropium (Oral Inhalation)Outpatient Dosage FormsAerosol, for oral inhalation, as bromide:Atrovent® HFA: 17 mcg/actuation (12.9 g) [chlorofluorocarbon free; 200metered actuations] [BCF]

Solution, for nebulization, as bromide: 0.02% [500 mcg/2.5 mL] (25s, 30s, 60s)

IrbesartanOutpatient Dosage FormsTablet, Oral:Generic: 150 mg, 300 mg

IsoniazidOutpatient Dosage FormsSolution, oral: 50 mg/5 mL (473 mL)Tablet, oral: 100 mg [BCF], 300 mg [BCF]

Isosorbide DinitrateOutpatient Dosage FormsCapsule, Sustained Release, Oral:Dilatrate-SR: 40 mg

Tablet, Oral:Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg [BCF]

Isosorbide Dinitrate and HydralazineOutpatient Dosage FormsTablet, Oral:BiDil: Isosorbide dinitrate 20 mg and hydralazine hydrochloride 37.5 mg

Isosorbide MononitrateOutpatient Dosage FormsTablet, Extended Release, Oral:Generic: 30 mg [BCF] , 60 mg [BCF] , 120 mg [BCF]

ISOtretinoin (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 10 mg, 20 mg, 40 mg

Ivermectin (Systemic)Outpatient Dosage FormsTablet, Oral:Generic: 3 mg

Ketoconazole (Systemic)Outpatient Dosage FormsTablet, oral: 200 mg

Ketoconazole (Topical)Outpatient Dosage FormsCream, topical: 2% (15 g, 30 g, 60 g)Shampoo, topical: 2% (120 mL)

Ketorolac (Ophthalmic)Outpatient Dosage FormsSolution, Ophthalmic, as tromethamine:Generic: 0.4% (5 mL); 0.5% (5 mL)

Ketorolac (Systemic)Outpatient Dosage FormsTablet, oral, as tromethamine:Generic: 10 mg

LabetalolOutpatient Dosage FormsTablet, oral, as hydrochloride: 100 mg, 200 mg, 300 mg

LacosamideOutpatient Dosage FormsSolution, Oral:Vimpat: 10 mg/mL (200 mL, 465 mL)

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

Lactic Acid and Ammonium HydroxideOutpatient Dosage FormsCream, topical: Lactic acid 12% with ammonium hydroxide (140 g)

LactuloseOutpatient Dosage FormsSolution, oral: 10 g/15 mL (30 mL, 473 mL) [BCF]

LamiVUDineOutpatient Dosage FormsSolution, Oral:Generic: 10 mg/mL (240 mL)

Tablet, Oral:Generic: 100 mg, 150 mg, 300 mg

Lamivudine and ZidovudineOutpatient Dosage FormsTablet, Oral:Lamivudine 150 mg and zidovudine 300 mg

LamoTRIgineOutpatient Dosage FormsKit, Oral:Generic: 25 mg (14s) & 50 mg (14s) & 100 mg (7s)

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

Tablet, Chewable/Dispersible, Oral:Generic: 5 mg, 25 mg

Tablet Extended Release 24 Hour, Oral:Generic: 25 mg, 50 mg, 100 mg, 200 mg, 300 mg

INSULIN GLARGINE

14

LanolinOutpatient Dosage FormsOintment, hydrous: 28 g

LatanoprostOutpatient Dosage FormsSolution, ophthalmic [drops]: 0.005% (2.5 mL) [BCF]

LetrozoleOutpatient Dosage FormsTablet, oral: 2.5 mg

Leucovorin CalciumOutpatient Dosage FormsTablet, oral [strength expressed as base]: 5 mg, 25 mg

LeuprolideOutpatient Dosage FormsInjection, powder for reconstitution, as acetate [depot formulation, preservativefree]:Lupron Depot-Ped®: 7.5 mg (monthly), 11.25 mg (monthly), 15 mg (monthly)[contains polylactide-co-glycolide, polysorbate 80]

Lupron Depot®: 3.75 mg (monthly), 7.5 mg (monthly), 11.25 mg (3 month),22.5 mg (3 month), 30 mg (4 month) [contains polylactide-co-glycolide,polysorbate 80]

Injection, solution, as acetate: 5 mg/mL (2.8 mL)

LevETIRAcetamOutpatient Dosage FormsSolution, Oral:Generic: 100 mg/mL (500 mL)

Tablet, Oral:Generic: 250 mg, 500 mg, 750 mg, 1000 mg

Tablet Extended Release 24 Hour, Oral:Generic: 500 mg, 750 mg

LevobunololOutpatient Dosage FormsSolution, ophthalmic, as hydrochloride [drops]: 0.25% (5 mL); 0.5% (5 mL)

Levodopa, Carbidopa, and EntacaponeOutpatient Dosage FormsTablet, Oral:Stalevo 50: Levodopa 50 mg, carbidopa 12.5 mg, and entacapone 200 mgStalevo 100: Levodopa 100 mg, carbidopa 25 mg, and entacapone 200 mgStalevo 200: Levodopa 200 mg, carbidopa 50 mg, and entacapone 200 mg

LevoFLOXacin (Systemic)Outpatient Dosage FormsSolution, Oral:Generic: 25 mg/mL (480 mL) [BCF]

Tablet, Oral:Generic: 250 mg [BCF], 500 mg [BCF], 750 mg [BCF]

Levonorgestrel (Systemic)Outpatient Dosage FormsTablet, Oral:Plan B: 1.5 mgGeneric: 1.5 mg

LevothyroxineOutpatient Dosage FormsTablet, 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], 150mcg [BCF], 175 mcg [BCF], 200 mcg [BCF], 300 mcg [BCF]

Lidocaine and PrilocaineOutpatient Dosage FormsCream, topical: Lidocaine 2.5% and prilocaine 2.5% (5 g, 30 g)

Lidocaine (Topical)Outpatient Dosage FormsCream, topical:L-M-X 4: 4% (5 g, 30 g) [contains benzyl alcohol]

Jelly, topical, as hydrochloride:Generic: 2% (5 mL, 30 mL)

Ointment, topical:Generic: 5% (35.4 g, 50 g)

Patch, topical:Lidoderm: 5% (30s)

Solution, viscous, oral topical, as hydrochloride: 2% (100 mL); 2% [20 mg/mL](100 mL)

LifitegrastOutpatient Dosage FormsSolution, Ophthalmic:Xiidra: 5% (5 ea)

LiothyronineOutpatient Dosage FormsTablet, Oral:Generic: 5 mcg, 25 mcg, 50 mcg

LisinoprilOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg

[BCF], 40 mg [BCF]

Lisinopril and HydrochlorothiazideOutpatient Dosage FormsTablet, 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]

LithiumOutpatient Dosage FormsCapsule, Oral, as carbonate:Generic: 150 mg [BCF], 300 mg [BCF]

Solution, Oral, as citrate:Generic: 8 mEq/5 mL (500 mL) [BCF]

Tablet, Extended Release, Oral, as carbonate:Generic: 300 mg, 450 mg

LomustineOutpatient Dosage FormsCapsule, oral:CeeNU®: 100 mg

LoperamideOutpatient Dosage FormsCapsule, oral, as hydrochloride: 2 mg [BCF]Solution, oral, as hydrochloride: 1 mg/5 mL (120 mL)

Lopinavir and RitonavirOutpatient Dosage FormsTablet, oral:Kaletra: Lopinavir 200 mg and ritonavir 50 mg

LoratadineOutpatient Dosage FormsSyrup, oral: 5 mg/5 mL (120 mL)Tablet, oral: 10 mg

Loratadine and PseudoephedrineOutpatient Dosage FormsTablet, Extended Release, oral:Claritin-D 24 Hour Allergy & Congestion: Loratadine 10 mg and pseudoephe-drine sulfate 240 mg [contains calcium 25 mg/tablet]

LORazepamOutpatient Dosage FormsConcentrate, Oral:Generic: 2 mg/mL (30 mL)

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

LosartanOutpatient Dosage FormsTablet, oral, as potassium: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]

Losartan and HydrochlorothiazideOutpatient Dosage FormsTablet, oral:50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg [BCF]100/12.5: Losartan potassium 100 mg and hydrochlorothiazide12.5 mg [BCF]

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

LoteprednolOutpatient Dosage FormsGel, Ophthalmic, as etabonate:Lotemax: 0.5% (5 g) [contains benzalkonium chloride, edetate disodiumdihydrate, propylene glycol]

Ointment, Ophthalmic, as etabonate:Lotemax: 0.5% (3.5 g)

Suspension, Ophthalmic, as etabonate:Alrex: 0.2% (5 mL) [Restricted to Ophthalmology and Optometry only]

Loteprednol and TobramycinOutpatient Dosage FormsSuspension, ophthalmic [drops]:Zylet: Loteprednol etabonate 0.5% and tobramycin 0.3% (2.5 mL, 5 mL, 10mL) [contains benzalkonium chloride]

LOTEPREDNOL AND TOBRAMYCIN

15

LubiprostoneOutpatient Dosage FormsCapsule, Oral:Amitiza: 8 mcg, 24 mcg

LurasidoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Latuda: 20 mg, 40 mg, 60 mg, 80 mg, 120 mg

Magnesium CitrateOutpatient Dosage FormsSolution, oral: 290 mg/5 mL (296 mL)

Magnesium HydroxideOutpatient Dosage FormsSuspension, oral:Milk of Magnesia: 400 mg/5 mL (480 mL)

Magnesium OxideOutpatient Dosage FormsTablet, Oral:Generic: 400 mg [equivalent to elemental magnesium 240 mg]

MalathionOutpatient Dosage FormsLotion, topical: 0.5% (59 mL)

MaravirocOutpatient Dosage FormsTablet, oral:Selzentry®: 150 mg, 300 mg

MeclizineOutpatient Dosage FormsTablet Chewable, Oral, as hydrochloride:Generic: 25 mg

Medical Devices and SuppliesOutpatient Dosage FormsSyringe:VanishPoint: 3 ML-23G X 1VanishPoint: 1CC 25G X 5/8

Syringe, IM:VanishPoint: 1CC 25G X 1VanishPoint: 3CC 25G X 1

Syring, SubQVanishPoint: 3CC 25G X 5/8

MedroxyPROGESTERoneOutpatient Dosage FormsSuspension, Intramuscular, as acetate:Generic: 150 mg/mL (1 mL)

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

MegestrolOutpatient Dosage FormsSuspension, oral, as acetate:Generic: 40 mg/mL (240 mL); 625 mg/5 mL (150 mL)

Tablet, oral, as acetate:Generic: 20 mg, 40 mg

MeloxicamOutpatient Dosage FormsTablet, oral: 7.5 mg [BCF], 15 mg [BCF]

MelphalanOutpatient Dosage FormsTablet, oral:Alkeran®: 2 mg

MemantineOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 5 mg, 10 mgGeneric Titration Pak: 5 mg (28s) and 10 mg (21s)

MercaptopurineOutpatient Dosage FormsTablet, oral: 50 mg

MesalamineOutpatient Dosage FormsSuppository, Rectal:Canasa: 1000 mg (30 ea) [contains saturated vegetable fatty esters]

Suspension, Rectal: 4 g/60 mL (7 ea)Tablet, delayed release, enteric coated, oral:Lialda: 1.2 g [BCF]

MetaproterenolOutpatient Dosage FormsSyrup, oral, as sulfate: 10 mg/5 mL (473 mL)

MetFORMINOutpatient Dosage FormsTablet, oral, as hydrochloride: 500 mg [BCF], 850 mg [BCF], 1000 mg [BCF]Tablet, extended release, oral, as hydrochloride: 500 mg [BCF], 750 mg [BCF]

MethadoneOutpatient Dosage FormsSolution, oral, as hydrochloride: 5 mg/5 mL (500 mL)Tablet, oral, as hydrochloride: 5 mg, 10 mg

MethazolAMIDEOutpatient Dosage FormsTablet, oral: 25 mg, 50 mg

MethIMAzoleOutpatient Dosage FormsTablet, oral: 5 mg, 10 mg

MethocarbamolOutpatient Dosage FormsTablet, oral: 500 mg [BCF]

MethotrexateOutpatient Dosage FormsSolution, Injection: 25 mg/mL (2 mL)Solution, Injection [preservative free]: 25 mg/mL (2 mL)Tablet, Oral: 2.5 mg [BCF]

Methoxsalen (Systemic)Outpatient Dosage FormsCapsule, oral:Oxsoralen-Ultra®: 10 mg [soft-gelatin capsule]

MethyldopaOutpatient Dosage FormsTablet, oral: 250 mg, 500 mg

MethylergonovineOutpatient Dosage FormsTablet, Oral, as maleate:Generic: 0.2 mg

MethylphenidateOutpatient Dosage FormsCapsule Extended Release, Oral, as hydrochloride:Generic: 10 mg, 20 mg, 30 mg

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

Suspension Reconstituted, Oral, as hydrochloride:Quillivant XR: 25 mg/5 mL

Tablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg, 20 mg

Tablet Extended Release, Oral, as hydrochloride:Generic: 18 mg [BCF], 27 mg [BCF], 36 mg [BCF], 54 mg [BCF]

MethylPREDNISoloneOutpatient Dosage FormsTablet, oral: 4 mg, 16 mgMedrol®: 2 mg [scored]

Tablet, oral [dose-pack]: 4 mg [21s]

Methyl Salicylate and MentholOutpatient Dosage FormsBalm, topical: 28 g

MetoclopramideOutpatient Dosage FormsSolution, oral: 5 mg/5 mL (10 mL, 473 mL) [BCF]Tablet, oral: 10 mg [BCF]

MetOLazoneOutpatient Dosage FormsTablet, oral: 2.5 mg, 5 mg

MetoprololOutpatient Dosage FormsTablet, oral, as tartrate: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF]Tablet, extended release, oral, as succinate [expressed as mg equivalent totartrate]: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF]

MetroNIDAZOLE (Systemic)Outpatient Dosage FormsTablet, oral: 250 mg [BCF], 500 mg [BCF]

LUBIPROSTONE

16

MetroNIDAZOLE (Topical)Outpatient Dosage FormsCream, topical:Generic: 0.75% (45 g)

Gel, topical:MetroGel: 1% (60 g)

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

Miconazole (Topical)Outpatient Dosage FormsCream, Vaginal, as nitrate:Generic: 2% (45 g)

Suppository, Vaginal, as nitrate:Generic: 100 mg (7 ea)

Minocycline (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 50 mg, 100 mg

Minoxidil (Systemic)Outpatient Dosage FormsTablet, oral: 2.5 mg, 10 mg

MirtazapineOutpatient Dosage FormsTablet, Oral:Generic: 7.5 mg, 15 mg, 30 mg, 45 mg

Tablet Disintegrating, Oral:Generic: 15 mg

MiSOPROStolOutpatient Dosage FormsTablet, oral: 100 mcg, 200 mcg

ModafinilOutpatient Dosage FormsTablet, Oral:Generic: 100 mg, 200 mg

Mometasone (Topical)Outpatient Dosage FormsCream, topical, as furoate:Generic: 0.1% (45 g)

Lotion, topical, as furoate:Generic: 0.1% (30 mL)

Ointment, topical, as furoate:Generic: 0.1% (45 g)

MontelukastOutpatient Dosage FormsGranules, oral:Singulair: 4 mg/packet (30s) [BCF]

Tablet, oral:Singulair: 10 mg [contains lactose 89.3 mg/tablet] [BCF]

Tablet, chewable, oral:Singulair: 4 mg [contains phenylalanine 0.67 mg/tablet; cherry flavor] [BCF]Singulair: 5 mg [contains phenylalanine 0.84 mg/tablet; cherry flavor] [BCF]

Morphine (Systemic)Outpatient Dosage FormsTablet, Oral, as sulfate:Generic: 15 mg, 30 mg

Tablet, Controlled Release, Oral, as sulfate:MS Contin: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF]

Moxifloxacin (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic [drops]:Vigamox®: 0.5% (3 mL)

Moxifloxacin (Systemic)Outpatient Dosage FormsTablet, oral:Avelox®: 400 mg

MupirocinOutpatient Dosage FormsOintment, External:Generic: 2% (22 g) [BCF]

Ointment, Nasal, as calcium [strength expressed as base]:Bactroban Nasal: 2% (1 g)

MycophenolateOutpatient Dosage FormsCapsule, Oral, as mofetil:Generic: 250 mg

Suspension Reconstituted, Oral, as mofetil:Generic: 200 mg/mL (160 mL)

Tablet, Oral, as mofetil:Generic: 500 mg

Tablet Delayed Release, Oral, as mycophenolic acid:Generic: 180 mg, 360 mg

NabumetoneOutpatient Dosage FormsTablet, oral: 500 mg

NadololOutpatient Dosage FormsTablet, Oral:Generic: 20 mg, 40 mg, 80 mg

NaloxoneOutpatient Dosage FormsLiquid, Nasal [spray]:Narcan: 4 mg/0.1 mL (1 ea) [contains benzalkonium chloride, edetate diso-dium] [BCF]

NaltrexoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic; 50 mg

Naphazoline and PheniramineOutpatient Dosage FormsSolution, ophthalmic:Naphcon-A: Naphazoline hydrochloride 0.025% and pheniramine maleate0.3% (5 mL) [contains benzalkonium chloride; 2 bottles/box], (15 mL)[contains benzalkonium chloride]

Naphazoline (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic, as hydrochloride [drops]:AK-Con™: 0.1% (15 mL) [contains benzalkonium chloride]

NaproxenOutpatient Dosage FormsSuspension, Oral:Generic: 125 mg/5 mL (500 mL) [BCF]

Tablet, Oral:Generic: 250 mg [BCF] , 375 mg, 500 mg [BCF]

Tablet, Oral, as sodium:Generic: 275 mg [equivalent to naproxen base 250 mg]

NaratriptanOutpatient Dosage FormsTablet, Oral:Generic: 1 mg, 2.5 mg

NatamycinOutpatient Dosage FormsSuspension, ophthalmic [drops]:Natacyn: 5% (15 mL) [contains benzalkonium chloride]

NefazodoneOutpatient Dosage FormsTablet, Oral, as hydrochloride:Generic: 100 mg, 150 mg, 200 mg, 250 mg

NelfinavirOutpatient Dosage FormsTablet, Oral:Viracept: 250 mg, 625 mg

NeomycinOutpatient Dosage FormsTablet, Oral, as sulfate:Generic: 500 mg

Neomycin and Polymyxin BOutpatient Dosage FormsSolution, irrigation: Neomycin 40 mg and polymyxin B sulfate 200,000 units per1 mL (1 mL, 20 mL)

Neomycin, Polymyxin B, and DexamethasoneOutpatient Dosage FormsOintment, Ophthalmic:Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame-thasone 0.1% per g (3.5 g)

Suspension, Ophthalmic [drops]:Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame-thasone 0.1% per 1 mL (5 mL)

Neomycin, Polymyxin B, and GramicidinOutpatient Dosage FormsSolution, Ophthalmic [drops]:Generic: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin0.025 mg per 1 mL (10 mL) [BCF]

NEOMYCIN, POLYMYXIN B, AND GRAMICIDIN

17

Neomycin, Polymyxin B, and Hydrocortisone (Otic)Outpatient Dosage FormsSolution, otic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone10 mg per 1 mL (10 mL)

Suspension, otic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydro-cortisone 10 mg per 1 mL (10 mL) [BCF]

NeostigmineOutpatient Dosage FormsTablet, oral, as bromide:Prostigmin®: 15 mg [scored]

NetarsudilOutpatient Dosage FormsSolution, Ophthalmic:Rhopressa: 0.02% (2.5 mL) [contains benzalkonium chloride]

NevirapineOutpatient Dosage FormsSuspension, Oral:Generic: 50 mg/5 mL (240 mL)


NiacinOutpatient Dosage FormsTablet, Oral:Generic: 500 mg

Tablet, Extended Release, Oral:Niaspan: 500 mg [BCF], 750 mg [BCF], 1000 mg [BCF]

NicotineOutpatient Dosage FormsGum, Chewing, Oral, as polacrilex:Generic: 2 mg (110s) [BCF] ; 4 mg (110s) [BCF]

Lozenge, Mouth/Throat, as polacrilex:Generic: 2 mg, 4 mg

Patch, Transdermal:Generic: 7 mg/24 hours (7s, 14s) [BCF] ; 14 mg/24 hours (7s, 14s) [BCF] ;21 mg/24 hours (7s, 14s) [BCF]

NIFEdipineOutpatient Dosage FormsCapsule, Oral:Generic: 10 mg

Tablet, Extended Release, Oral:Generic: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF]

NitrofurantoinOutpatient Dosage FormsCapsule, oral [macrocrystal]: 50 mg [BCF], 100 mgMacrodantin: 25 mg

Capsule, oral [macrocrystal/monohydrate]: 100 mg [BCF]Suspension, oral: 25 mg/5 mL (230 mL)

NitroglycerinOutpatient Dosage FormsCapsule, Extended Release, Oral:Generic: 6.5 mg

Ointment, Rectal:Rectiv: 0.4% (30 g) [contains propylene glycol]

Patch, Transdermal:Nitro-Dur: 0.3 mg/hour (30s) [BCF] ; 0.8 mg/hr (30s) [BCF]Generic: 0.1 mg/hour (30s) [BCF] ; 0.2 mg/hour (30s) [BCF] ; 0.4 mg/hour(30s) [BCF] ; 0.6 mg/hour (30s) [BCF]

Solution, translingual [spray]:Generic: 0.4 mg/spray (4.9 g, 12 g) [BCF]

Tablet, sublingual:Nitrostat®: 0.4 mg [BCF]

NorethindroneOutpatient Dosage FormsTablet, oral: 0.35 mg [BCF]Tablet, oral, as acetate: 5 mg

Norethindrone and MestranolOutpatient Dosage FormsTablet, Monophasic formulations:Necon 1/50: Norethindrone 1 mg and mestranol 0.05 mg [21 light blue tabletsand 7 white inactive tablets] (28s)

NortriptylineOutpatient Dosage FormsCapsule, Oral:Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF]

Nystatin and TriamcinoloneOutpatient Dosage FormsCream, topical: Nystatin 100,000 units and triamcinolone acetonide 0.1% (15 g,30 g, 60 g)

Nystatin (OralOutpatient Dosage FormsSuspension, oral: 100,000 units/mL (60 mL) [BCF]Tablet, oral: 500,000 units

Nystatin (Topical)Outpatient Dosage FormsCream, topical: 100,000 units/g (15 g, 30 g) [BCF]Ointment, topical: 100,000 units/g (15 g, 30 g) [BCF]Powder, topical: 100,000 units/g (15 g)

Ofloxacin (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic [drops]: 0.3% (5 mL)

OLANZapineOutpatient Dosage FormsTablet, Oral:Generic: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg

Tablet Disintegrating, Oral:Generic: 5 mg, 10 mg, 15 mg

Olopatadine (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic [drops]:Patanol: 0.1% (5 mL) [contains benzalkonium chloride] [BCF]

OmeprazoleOutpatient Dosage FormsCapsule, delayed release, oral:Generic: 10 mg [BCF], 20 mg [BCF], 40 mg

Powder for suspension, oral [compounding kit]:First-Omeprazole: 2 mg/mL (90 mL, 150 mL, 300 mL) [contains benzylalcohol] [Restricted]

OndansetronOutpatient Dosage FormsSolution, Oral:Generic: 4 mg/5 mL (50 mL)


Tablet, Orally Disintegrating, Oral:Generic: 4 mg, 8 mg

OseltamivirOutpatient Dosage FormsCapsule, oral, as phosphate:Tamiflu: 75 mg

Powder for suspension, oral:Tamiflu: 6 mg/mL (60 mL) [contains sodium benzoate; tutti frutti flavor]

OXcarbazepineOutpatient Dosage FormsSuspension, Oral:Generic: 300 mg/5 mL (250 mL)

Tablet, Oral:Generic: 150 mg, 300 mg, 600 mg

OxybutyninOutpatient Dosage FormsSyrup, Oral, as chloride:Generic: 5 mg/5 mL (473 mL)

Tablet, Oral, as chloride:Generic: 5 mg

Tablet, Extended Release, Oral, as chloride:Generic: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF]

OxyCODONEOutpatient Dosage FormsSolution, Oral, as hydrochloride:Generic: 5 mg/5 mL (500 mL)

Tablet, Oral, as hydrochloride:Generic: 5 mg, 10 mg, 15 mg, 30 mg

Tablet, Extended Release, 12 hour abuse-deterrent, oral, as hydrochloride:OxyCONTIN: 10 mg, 15 mg, 20 mg, 40 mg, 60 mg

Oxycodone and AcetaminophenOutpatient Dosage FormsTablet, Oral:5/325: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg [BCF]10/325: Oxycodone hydrochloride 10 mg and acetaminophen 325 mg

Oxymetazoline (Nasal)Outpatient Dosage FormsSolution, intranasal, as hydrochloride [spray]: 0.05% (15 mL, 30 mL)

PaliperidoneOutpatient Dosage FormsTablet Extended Release 24 Hour, Oral:Generic: 1.5 mg, 3 mg, 6 mg, 9 mg

NEOMYCIN, POLYMYXIN B, AND HYDROCORTISONE (OTIC)

18

PalonosetronOutpatient Dosage FormsInjection, solution:Aloxi®: 0.05 mg/mL (5 mL) [contains edetate disodium]

PancrelipaseOutpatient Dosage FormsCapsule, delayed release, enteric coated beads, oral [porcine derived]:Zenpep: Lipase 3,000 units, protease 10,000 units, and amylase 16,000 unitsZenpep: Lipase 5000 units, protease 17,000 units, and amylase 27,000 unitsZenpep: Lipase 10,000 units, protease 34,000 units, and amylase 55,000 unitsZenpep: Lipase 15,000 units, protease 51,000 units, and amylase 82,000 unitsZenpep: Lipase 20,000 USP units, protease 63,000 USP units, and amylase84,000 USP units

Capsule, delayed release, enteric coated microsphere, oral [new formulation/porcine derived]:Creon: Lipase 3000 units, protease 9500 units, and amylase 15,000units [BCF]

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

Creon: Lipase 12,000 units, protease 38,000 units, and amylase 60,000units [BCF]

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

Creon: Lipase 36,000 USP units, protease 114,000 USP units, and amylase180,000 USP units [BCF]

PantoprazoleOutpatient Dosage FormsTablet, delayed release, oral:Generic: 20 mg, 40 mg

PARoxetineOutpatient Dosage FormsSuspension, Oral, as hydrochloride [strength expressed as base]:Paxil: 10 mg/5 mL (250 mL) [contains propylene glycol; orange flavor]

Tablet, Oral, as hydrochloride [strength expressed as base]:Generic: 7.5 mg, 10 mg, 20 mg, 30 mg, 40 mg

Tablet Extended Release 24 Hour, Oral, as hydrochloride [strength expressedas base]:Generic: 12.5 mg, 25 mg, 37.5 mg

PatiromerOutpatient Dosage FormsPacket, Oral:Veltassa: 8.4 g (1 ea, 4 ea, 30 ea); 16.8 g (1 ea, 30 ea); 25.2 g (1 ea, 30 ea)

PenicillAMINEOutpatient Dosage FormsCapsule, oral:Cuprimine®: 250 mg

Penicillin V PotassiumOutpatient Dosage FormsPowder for solution, oral: 250 mg/5 mL (100 mL, 200 mL) [BCF]Tablet, oral: 250 mg [BCF], 500 mg [BCF]

Pentosan Polysulfate SodiumOutpatient Dosage FormsCapsule, oral:Elmiron: 100 mg

PentoxifyllineOutpatient Dosage FormsTablet, extended release, oral: 400 mg

PermethrinOutpatient Dosage FormsCream, topical: 5% (60 g) [BCF]Liquid, External: 1%Lotion, topical: 1% (60 mL)

PhenazopyridineOutpatient Dosage FormsTablet, oral, as hydrochloride: 100 mg [BCF], 200 mg [BCF]

PhenelzineOutpatient Dosage FormsTablet, oral:Nardil: 15 mg [ECF]

PHENobarbitalOutpatient Dosage FormsTablet, Oral:Generic: 15 mg [BCF], 16.2 mg, 30 mg [BCF], 32.4 mg

PhentermineOutpatient Dosage FormsCapsule, Oral, as hydrochloride:Generic: 15 mg, 30 mg, 37.5 mg

Phenylephrine (Nasal)Outpatient Dosage FormsSolution, intranasal, as hydrochloride [drops]:Little Noses Decongestant: 0.125% (15 mL) [ethanol free; contains benzalko-nium chloride]

Rhinall: 0.25% (30 mL) [contains benzalkonium chloride, sodium bisulfite]

Phenylephrine (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic, as hydrochloride [drops]: 2.5% (15 mL)

Phenylephrine (Topical)Outpatient Dosage FormsSuppository, Rectal, as hydrochloride:Generic: 0.25% (12s)

PhenytoinOutpatient Dosage FormsCapsule, Extended Release, Oral, as sodium:Dilantin: 30 mg, 100 mg [BCF]Generic: 100 mg [BCF]

Suspension, Oral:Generic: 125 mg/5 mL (237 mL, 240 mL) [BCF]Dilantin-125: 125 mg/5 mL (240 mL) [contains ethanol ≤0.6%, sodium ben-zoate; orange-vanilla flavor] [BCF]

Tablet, Chewable, oral:Dilantin: 50 mg [scored] [BCF]

PhytonadioneOutpatient Dosage FormsTablet, oral:Mephyton®: 5 mg [scored]

Pilocarpine (Ophthalmic)Outpatient Dosage FormsSolution, ophthalmic, as hydrochloride [drops]: 1% (15 mL) [BCF]; 2% (15 mL)

[BCF]; 4% (15 mL) [BCF]

Pilocarpine (Systemic)Outpatient Dosage FormsTablet, oral, as hydrochloride: 5 mg

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

PimozideOutpatient Dosage FormsTablet, Oral:Generic: 2 mg

PindololOutpatient Dosage FormsTablet, Oral:Generic: 10 mg

PioglitazoneOutpatient Dosage FormsTablet, oral: 15 mg, 30 mg, 45 mg

Pioglitazone and MetforminOutpatient Dosage FormsTablet, oral: 15/500: Pioglitazone 15 mg and metformin hydrochloride 500 mg;15/850: Pioglitazone 15 mg and metformin hydrochloride 850 mg

Piroxicam (Systemic)Outpatient Dosage FormsCapsule, Oral:Generic: 10 mg, 20 mg

PodofiloxOutpatient Dosage FormsGel, External:Condylox: 0.5% (3.5 g)

Solution, External:Generic: 0.5% (3.5 mL)

Polyethylene Glycol 3350Outpatient Dosage FormsPowder for solution, oral: 17 g/dose (255 g)

Polyethylene Glycol-Electrolyte SolutionOutpatient Dosage FormsPowder for solution, oral:GoLYTELY®: PEG 3350 236 g, sodium sulfate 22.74 g, sodium bicarbonate6.74 g, sodium chloride 5.86 g, and potassium chloride 2.97 g (4000 mL)[original flavor]

POLYETHYLENE GLYCOL-ELECTROLYTE SOLUTION

19

Potassium ChlorideOutpatient Dosage FormsSolution, Oral:Generic: 20 mEq/15 mL (15 mL, 480 mL) [BCF]

Packet, Oral:Generic: 20 mEq (30 ea, 100 ea) [BCF]

Tablet, extended release, wax matrix, oral:Generic: 8 mEq, 10 mEq [BCF], 20 mEq [BCF]

Potassium CitrateOutpatient Dosage FormsTablet Extended Release, Oral:Generic: 5 mEq (540 mg), 10 mEq (1080 mg)

Potassium IodideOutpatient Dosage FormsSolution, oral:SSK

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