DISTRICT OF COLUMBIA
HEALTH CARE ALLIANCE
Drug
Formulary
2010 - 2011
TABLE OF CONTENTS
USE OF THE FORMULARY…………………………………………………………….
PHARMACY BENEFIT………………………………………………………………...
PHARMACY, AND THERAPEUTICS COMMITTEE………………………………....
Formulary Additions and Deletions………………………………………………..
Generic Substitutions………………………………………………………………
Formulary Status………………………………………………………….………..
PHARMACY LOCATIONS……..……………………………………………………….
THERAPEUTIC CATEGORY LISTING OF DRUGS……………………………….….
ALPHABETICAL LISTING OF DRUGS BY GENERIC NAME………………………
ALPHABETICAL LISTING OF DRUGS BY BRAND NAME…………………………
APPENDIX………………………………………………………………………………..
AIDS DRUG ASSISTANCE PROGRAM FORMULARY……………………….
POUND-KILOGRAM CONVERSIONS………………………………………….
PHARMACOKINETIC FORMULAS…………………………………………….
A. Ideal Body Weight…………………………………………………...
B. Creatinine Clearance (CrCl)………………………………………….
C. Creatinine Clearance Values In Renal Dysfunction………………….
D. Body Surface Area…………………………………………………...
TEMPERATURE CONVERSION………………………………………………...
GLUCOCORTICOID EQUIVALENCIES, POTENCIES, & HALF-LIFE ……
APPROXIMATE DOSAGE EQUIVALENTS OF THYROID PRODUCTS…….
NARCOTIC AGONISTS (COMPARATIVE PHARMACOKINETICS) ……...
GUIDELINE FOR DRUG LEVELS COMMONLY MONITORED……………..
ADJUSTMENT OF SERUM CONC. WITH LOW SERUM ALBUMIN………..
STANDARD LABORATORY VALUES
DRUGS WHICH MAY CAUSE DISCOLORATION OF THE FECES………….
DRUGS WHICH MAY CAUSE DISCOLORATION OF URINE……………….
DRUGS WHICH AFFECT LABORATORY VALUES…………………………..
REQUEST FOR FORMULARY CHANGE ……………………………………
2
3
4
4
4
4
5
6
29
39
49
50/51
52
53
53
53
54
54
54
54
55
55
56
57
57/58
59
60
61/63
64
USE OF FORMULARY
The District of Columbia Health Care Alliance formulary is divided into five sections.
The first section is a compilation of selected policies, guidelines, medical and pharmaceutical
information designed to assist the practitioner in the care of patients.
The second section is a drug listing within therapeutic category and subcategory as classified by
American Hospital Formulary Service. Medications are listed by generic name with a crossreference to its common trade name. The inclusion of a trade name is for information and crossreferencing only and does not necessarily coincide with the product currently stocked.
The third section is a listing of all medication alphabetized generically with cross-referencing to
brand names.
The fourth section is a listing of all medication alphabetized by brand name with crossreferencing to generic names.
The fifth section, the Appendix, is a compilation of tables, guidelines, and information, which
can be very useful in consideration of patient care. (Contains ADAP Formulary)
PRESCRIPTION PLAN SUMMARY
Description of
Benefits
Deductible
Co-Pay
Generic Mandate
Quantity Limits
Refill Limits
Coverage
None
None
Generic equivalents may be substituted for products
considered identical with respect to active components,
therapeutic effectiveness, and bioavailability.
Maximum thirty day supply
No sooner than the date when at least 75% of your
prescription should have been used (If a 30 day supply was
issued, a prescription may be refilled after day 23).
Prescriptions are valid for a maximum of 12 months.
Alliance Pharmacies will only stock formulary medication
The Alliance Formulary may not totally eliminate the need to participate in compassionate use
programs or other public or privately funded medication access programs.
The program does not cover Antiretrovirals. Alliance patients are eligible to participate in the
AIDS Drug Assistance Program (ADAP). ADAP currently carries every commercially available
antiretroviral. (The ADAP Formulary is included for reference in the Appendix – Fifth Section).
Non-formulary psychotropic drugs should be available through the Department of Mental
Health.
For information and assistance on how to obtain non-formulary medication please call the
Patient Health Plan:



Chartered Health Plan (202) 408-4720 or 1-800-408-7511 and ask for the Medical
Management Department
Health Right, Inc. (202) 218-0373
Unison Health Plan, Inc. 1-800-701-7192 TTY Line 1-888-616-0021
Should you have a need to refer Alliance patients to the AIDS Drug Assistance Program
(ADAP), please call (202) 671-4900.
PHARMACY AND THERAPEUTICS COMMITTEE
The primary purpose of the committee is to develop a system whereby medications are
evaluated, appraised and selected such that drugs considered most useful for patient care are on
the Alliance Drug Formulary. It reviews request for formulary change and prevents unnecessary
duplication of the same basic drug or its combination. Evaluates the formulary and provides for
its constant revision to accommodate changing needs and advances in therapeutics. Studies
problems involved in the prescribing, distribution, administration, monitoring and labeling of
medication. Assesses the Health Care Alliance’s entire medication use system for the purpose
of assuring rational prescribing, appropriate use, safety, and cost effectiveness.
FORMULARY ADDITIONS AND DELETIONS
The Pharmacy and Therapeutics Committee (P&T) makes recommendations for formulary
changes. Final approval authority rests with the Department of Health. The P&T Committee
utilizes a class review process to evaluate the formulary. Formulary reviews take into
consideration the following criteria: the client population served, effectiveness, risk and cost.
In addition to the class review process any Alliance physician may petition the committee in
writing to review a drug for formulary inclusion. The request should address the advantages of
the new agent or the unmet need. Individual request should be made utilizing the Request for
Formulary Change Form; a copy of the form is located in the appendix section of this manual. It
may be photo copied and utilized as an official request form.
In addition to the above processes, formulary deletion request will be initiated by the
pharmaceutical service department based on trends in product use.
GENERIC SUBSTITUTIONS
The Pharmacy and Therapeutics Committee has approved the dispensing of generic equivalents.
Generic equivalents are drug products considered identical with respect to active component,
therapeutic effectiveness, and bioavailability.
FORMULARY STATUS
Formulary Drug: A drug approved by the committee for inclusion on the Alliance formulary.
Formulary drugs are generally available for routine use.
Restricted Drug: A drug approved by the committee for inclusion on the Alliance formulary,
however, prescribing of this drug will be limited in scope (i.e., to a particular physician, medical
service or protocol).
Nonformulary Drug: Any drug that has not been reviewed by the committee or has been
reviewed and denied inclusion on the formulary. Non-formulary drugs are not stocked in
Alliance Pharmacies and are not available for routine use.
PHARMACEUTICAL SERVICES
The primary responsibilities of the District of Columbia Health Care Alliance Pharmacies are to
provide efficient, effective, control and distribution of pharmaceuticals to alliance patients and to
provide drug information, pharmaceutical care, and comprehensive clinical pharmacy services to
alliance patients, physicians, and staff.
LOCATIONS:
ANACOSTIA CLINIC
1328 W. St., S.E.
Washington, D.C. 20020
Phone (202) 610-7188
Fax (202) 610-0832
DC GENERAL PHARMACY
19th St & Mass Ave S.E.
Washington, D.C. 20003
Phone (202) 548-6565
Fax (202) 548-6570
SOUTHWEST CLINIC
850 Delaware Ave., S.W.
Washington D.C. 20024
Phone (202) 548-4548
Fax (202) 554-0459
CONGRESS HEIGHT CLINIC
3720 MLK JR, Ave., SE
Washington, D.C. 20032
Phone (202) 279-1825
Fax (202) 562-7240
HUNT PLACE CLINIC
4130 Hunt Place, N.E.
Washington, D.C. 20019
Phone (202) 388-8385
Fax (202) 396-4941
UPPER CARDOZO CLINIC
3020 14TH St., N.W.
Washington, D.C. 20009
Phone (202) 518-6417
Fax (202) 745-0194
WALKER JONES CLINIC
40 Patterson Street N.E.
Washington, D.C. 20009
Phone (202) 478-4227
Fax (202) 478-0605
THERAPEUTIC CATEGORY INDEX
I.
ANTIHISTAMINE ……………………………………………….………………...
10
II.
ANTI-INFECTIVE AGENTS…………………………………………….…………
10
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
ANTIFUNGAL ANTIBIOTICS ……. ………………………….…………. 10
ANTIHELMINTICS
…………………………………………....
10
ANTIMALARIAL AGENTS………………………………………….…… 11
ANTITUBERCULOSIS AGENTS………………………………………… 11
ANTIVIRALS………………………………………………………………
11
CEPHALOSPORINS……………………………………………………….
10
MACROLIDE ANTIBIOTICS………………………………………….….
10
MISC ANTIBIOTICS………………………………………….…………...
11
MISC ANTI-INFECTIVES………………………………………….……..
12
PENICILLINS………………………………………….…………………... 10/11
QUINOLONES………………………………………….………………….
12
SULFONAMIDES………………………………………….………………
12
SULFONES………………………………………….……………………..
12
TETRACYCLINES………………………………………….……………... 11
URINARY ANTI-INFECTIVES………………..…………………………... 12
III.
ANTINEOPLASTIC AGENTS…………………………………………….……….
12
IV.
AUTONOMIC DRUGS…………………………………………….……………….
13
A.
B.
C.
D.
E.
F.
13
13
13
13
13
13
V.
VI.
VII.
ANTIMUSCARINICS/ANTISPASMODICS………………………………...
ANTIPARKINSONIAN AGENTS…………………………………………….
PARASYMPATHOMIMETIC (CHOLINERGIC AGENTS)………………...
SKELETAL MUSCLE RELAXANTS………………………………………...
SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS……………..
SYMPATHOMIMETIC (ADRENERGIC) AGENTS…..………………….....
BLOOD FORMATION AND COAGULATION……………………………….
14
A.
B.
C.
ANTICOAGULANTS……………………………………………….…….…..
HEMORHEOLOGIC AGENTS……………………………………………….
IRON PREPARATION…………………………………………….………….
14
14
14
CARDIOVASCULAR DRUGS …………………………………...………….….…
14
A.
B.
C.
D.
E.
15
16
14/15
15
16
ANTILIPEMIC AGENTS……………………………………………….…….
BETA ADRENERGIC BLOCKING AGENTS………….……………...
CARDIAC DRUGS…………………………………………….……………...
HYPOTENSIVE AGENTS……………………………………………….……
VASODILATING AGENTS……………………………………..…….……
CENTRAL NERVOUS SYSTEM DRUGS……………………………..………..…
16
A.
18
ANTIDEPRESSANTS…………………………………………….………..…
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
ANTIMANIC AGENTS…………………………..………………….…….….
ANTIPSYCHOTIC AGENTS……………………………..…………….….…
BARBITURATES…………………………………………..….……….……...
BENZODIAZEPINES………………………………………..…….…….……
HYDANTOINS…………………………………………….…..……….……...
MISC ANALGESICS AND ANTIPYRETICS…………………..…….……...
MISC ANTICONVULSANTS…………………………………..…….………
MISC ANXIOLYTICS, SEDATINES AND HYPNOTICS……..…….……...
MISC CENTRAL NERVOUS SYSTEM AGENTS……………..…….……..
NONSTEROIDAL ANTI -INFLAMMATORY AGENTS………..….………
OPIATE AGONISTS…………………………………………….…………….
RESPIRATORY AND CEREBRAL STIMULANTS ………………..………
SALICYLATES
19
18
17/18
17/19
16
17
17
19
19
16
16/17
18
16
VIII.
CONTRACEPTIVES (e.g. FOAMS, DEVICES)…………………...………………. 19
IX.
DIAGNOSTIC AGENTS……………………………………...……….……………. 19
A.
ROENTGENOGRAPHY…………………………………...………….………
19
ELECTROLYTIC CALORIC AND WATER BALANCE…………………..……..
20
A.
B.
C.
D.
E.
F.
G.
ALKALINIZING AGENTS……………………………………..……….……
AMMONIA DETOXICANTS ……………………………………..….………
DIURETICS…………………………………………….…………...…….…...
POTASSIUM -REMOVING RESINS…………………………..…..…………
POTASSIUM – SPARING DIURETICS……………………………………...
REPLACEMENT SOLUTIONS………………………………...…..…………
URICOSURIC AGENTS………………………………………...…….………
20
20
20
20
20
20
21
XI.
ENZYMES…………………………………………….……………….……...……..
21
XII.
ANTITUSSIVES, EXPECTORANTS AND MUCYOLYTIC………...……………
21
X.
A.
B.
XIII.
ANTITUSSIVES…………………………………………….…...……………. 21
EXPECTORANTS…………………………………………….……...……….. 21
EYE, EAR, NOSE AND THROAT (EENT) PREPARATIONS………….…...……
21
A.
B
C
D.
E.
F.
G.
21
22
21
22
22
23
23
23
ANTIBIOTICS …………………………………….………...………....
ANTI-INFLAMMATORY AGENTS………………………………………….
ANTIVIRALS…………………………………………….…………...…….…
CARBONIC ANHYDRASE INHIBITORS…………………………...………
LOCAL ANESTHETICS……………………………………………....………
MISC EENT DRUG …………………………………….……...………
VASOCONSTRICTORS…………………………………………………..
G.
H.
I.
J.
K.
L.
XIV.
MISC ANTI -INFECTIVES…………………………………………...….…...
MIOTICS…………………………………………….………………...………
MOUTHWASHES AND GARGLES…………………………………...……..
MYDRIATICS…………………………………………….………….…..…....
SULFONAMIDES…………………………………………….………...……..
VASOCONSTRICTORS………………………………………………………
22
22
22
22
21
23
GASTROINTESTINAL DRUGS……………………………………………………
23
A.
B.
C.
D.
E.
F.
23
23
23/24
23
23
24
ANTACIDS AND ADSORBENTS……………………………………...…….
ANTIDIARRHEAL AGENTS……………………………..……………….…
ANTIEMETICS…………………………………………….…………...……..
CATHARTICS AND LAXATIVES………………………………...…………
DIGESTANTS…………………………………………….…………...……....
MISC GI DRUGS……………………………………………....……………...
XV.
GOLD COMPOUNDS……………………………………………….……………… 24
XVI.
HEAVY METAL ANTAGONISTS…………………………...………………….…
24
XVII.
HORMONES AND SYNTHETIC SUBSTITUTES………………...………………
24
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
24
26
25
24/25
25
25
25
25
25
26
ADRENALS…………………………………………….………………….…..
ANTITHYROID AGENTS……………………………………………….……
BIGUANIDES
CONTRACEPTIVES……………………………………………….………….
ESTROGENS…………………………………………….………………….…
INSULINS…………………………………………….………………….…….
PROGESTINS…………………………………………….……………………
SULFONYL UREAS…………………………………………….…………….
THIAZOLINEDIONES ……………………………………………………..
THYROID AGENTS
XVIII.
OXYTOCICS…………………………………………….……………...….………..
XIX.
SKIN AND MUCCOUS MEMBRANE AGENTS………………………………….. 26
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
ANTIBIOTICS.……………………………………………….………………..
ANTIFUNGALS……………………………………………….………………
ANTI-INFLAMMATORY AGENTS………………………………………….
ANTI -PRURITICS AND LOCAL ANESTHETICS …………………………
ANTIVIRALS.…………………………………………….…………………...
KERATOLYTIC AGENTS………………………………………...……….…
KERATOPLASTIC AGENTS…………………………………………………
MISC LOCAL ANTI –INFECTIVES………………………………...……….
MISC SKIN AND MUCOUS MEMBRANE AGENTS.……………...………
SCABICIDES AND PEDICULICIDES………………………………...……..
26
26
26
27
27
26
27
27
27
27
26
XX.
SMOOTH MUSCLE RELAXANTS…………………………...……………………
A.
B.
XXI
27
GENITOURINARY SMOOTH MUSCLE RELAXANTS……...……………. 27
RESPIRATORY SMOOTH MUSCLE RELAXANTS……………………….. 28
VITAMINS…………………………………………………….…...………………... 28
A.
B.
C.
D.
MULTIVITAMIN PREPARATIONS.………………………...………………
VITAMIN B COMPLEX……………………………………………….……...
VITAMIN D……………………………………………….…………………...
VITAMIN K ACTIVITY…………………………………………….….……..
28
28
28
28
XXII.
MISCELLANEOUS THERAPEUTIC AGENTS …………………………………
28
XXIII.
DEVICES………….…………………………………………….…………………...
28
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Category:
Trade Name
ANTIHISTAMINE DRUGS
LORATADINE 10MG TAB
LORATADINE 5MG/5ML SYRUP
DIPHENHYDRAMINE 12.5MG/5ML ELX
DIPHENHYDRAMINE 25MG CAPS
PROMETHAZINE HCL 25MG SUPP
PROMETHAZINE HCL 50MG SUPP
CLARITIN 10MG TAB
CLARITIN 5MG/5ML SYRUP
BENADRYL 12.5MG/5ML ELXIR
BENADRYL 25MG CAP
PHENERGAN 25MG SUPP
PHENERGAN 50MG SUPP
Category: ANTI-INFECTIVE AGENTS
Subcategory: Anthelmintics
MEBENDAZOLE 100MG CHEWABLE TAB
VERMOX 100MG CHEWABLE TAB
Subcategory: Antibiotics
Subcategory: Antifungal Antibiotics
FLUCONAZOLE 150MG TAB
GRISEOFULVIN 125MG/5ML SUSP
GRISEOFULVIN 250MG TAB
NYSTATIN 100000U/ML SUSP
DIFLUCAN 150MG TAB
GRIFULVIN V 125MG/5ML SUSP
GRIFULVIN V 250MG TAB
NILSTAT 100000U/ML SUSP
Subcategory: Cephalosporins
CEPHALEXIN 125MG/5ML ORAL SUSP
CEPHALEXIN 250MG CAP
CEPHALEXIN 500MG CAP
KEFLEX 125MG/5ML ORAL SUSP
KEFLEX 250MG CAP
KEFLEX 500MG CAP
Subcategory: Macrolide Antibiotics
AZITHROMYCIN 250MG CAP (Z-PAK)
AZITHROMYCIN 600MG/15ML SUSP
AZITHROMYCIN 900MG/22.5ML SUSP
CLARITHROMYCIN 250MG TAB
CLARITHROMYCIN 500MG TAB
ERYTHROMYCIN 200MG/5ML SUSP
ERYTHROMYCIN 250MG FILMTAB
ZITHROMAX 250MG CAP (Z-PAK)
ZITHROMAX 600MG/15ML ORAL SUSP
ZITHROMAX 900MG/22.5ML SUSP
BIAXIN 250MG TAB
BIAXIN 500MG TAB
E.E.S. 200MG/5ML SUSP
E.E.S 250MG FILMTAB
Subcategory: Penicillins
AMOXICILLIN 125/CLAV 31.25/5ML
AMOXICILLIN 125MG/5ML SUSP
AUGMENTIN 125 SUSP
TRIMOX 125/5ML SUSP
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
AMOXICILLIN 250/CLAV 125 TAB
AMOXICILLIN 250/CLAV 62.5/5ML
AMOXICILLIN 250MG CAP
AMOXICILLIN 250MG/5ML SUSP
AMOXICILLIN 500/CLAV 125 TAB
AMOXICILLIN 500MG CAP
AMOXICILLIN 875/CLAV 125 TAB
DICLOXACILLIN 250MG CAP
PENICILLIN VK 250MG TAB
PENICILLIN VK 250MG/5ML SUSP
AUGMENTIN 250MG TAB
AUGMENTIN 250 SUSP
AMOXICILLIN 250MG CAP
TRIMOX 250MG/5ML SUSP
AUGMENTIN 500MG TAB
AMOXICILLIN 500MG CAP
AUGMENTIN 875MG TAB
PATHOCIL 250MG CAP
PENICILLIN VK 250MG TAB
LEDERCILLIN VK 250MG/5ML SUSP
Subcategory: Tetracyclines
DOXYCYCLINE 100MG CAP
TETRACYCLINE 250MG CAP
VIBRAMYCIN 100MG CAP
SUMYCIN 250MG CAP
Subcategory: Misc Antibiotics
CLINDAMYCIN 150MG CAP
CLEOCIN 150MG CAP
Subcategory: Antituberculosis Agents
ETHAMBUTOL 100MG TAB
ETHAMBUTOL 400MG TAB
ISONIAZID 100MG TAB
ISONIAZID 300MG TAB
ISONIAZID 50MG/5ML SYRUP
PYRAZINAMIDE 500MG TAB
RIFAMPIN 300MG CAP
MYAMBUTOL 100MG TAB
MYAMBUTOL 400MG TAB
ISONIAZID 100MG TAB
ISONIAZID 300MG TAB
ISONIAZID 50MG/5ML SYRUP
PYRAZINAMIDE 500MG TAB
RIMACTANE 300MG CAP
Subcategory: Antivirals
ACYCLOVIR 200MG CAP
ZOVIRAX 200MG CAP
Subcategory: Antimalarial Agents
HYDROXYCHLOROQUINE 200MG TAB
PRIMAQUINE 26.3MG TAB
PYRIMETHAMINE 25MG TAB
PLAQUENIL 200MG TAB
PRIMAQUINE 26.3MG TAB
DARAPRIM 25MG TAB
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
Subcategory: Quinolones
CIPROFLOXACIN HCL 250MG TAB
CIPROFLOXACIN HCL 500MG TAB
CIPROFLOXACIN HCL 750MG TAB
LEVOFLOXACIN 250MG TAB
LEVOFLOXACIN 500MG TAB
LEVOFLOXACIN 750MG TAB
CIPRO 250MG TAB
CIPRO 500MG TAB
CIPRO 750MG TAB
LEVAQUIN 250MG TAB
LEVAQUIN 500MG TAB
LEVAQUIN 750MG TAB
Subcategory: Sulfonamides
ERYTHROMYCIN/SULFISOX ORL SUSP
SULFADIAZINE 500MG TAB
SULFASALAZINE 500MG TAB
PEDIAZOLE ORAL SUSP
SULFADIAZINE 500MG TAB
AZULFIDINE 500MG TAB
Subcategory: Sulfones
DAPSONE 100MG TAB
DAPSONE 25MG TAB
DAPSONE 100MG TAB
DAPSONE 25MG TAB
Subcategory: Urinary Anti-Infectives
NITROFURANTOIN 100MG CAP
NITROFURANTOIN 50MG CAP
TRIMETHOPRIM 100MG TAB
MACRODANTIN 100MG CAP
MACRODANTIN 50MG CAP
TRIMPEX 100MG TAB
Subcategory: Misc Anti-Infectives
METRONIDAZOLE 250MG TAB
SULFAMETH 200/TRIMETH 40MG/5ML
SULFAMETH 800/TRIMET l60MG TAB
FLAGYL 250MG TAB
BACTRIM PEDIATRIC ORAL SUSP
BACTRIM DS TAB
Category: ANTINEOPLASTIC AGENTS
BUSULFAN 2MG TAB
CHLORAMBUCIL 2MG TAB
HYDROXYUREA 500MG CAP
MEGESTROL 40MG TAB
MEGESTROL 40MG/ML ORAL SUSP
MELPHALAN 2MG TAB
METHOTREXATE 2.5MG TAB
TAMOXIFEN 10MG TAB
MYLERAN 2MG TAB
LEUKERAN 2MG TAB
HYDREA 500MG CAP
MEGACE 40MG TAB
MEGACE 40MG/ML ORAL SUSP
ALKERAN 2MG TAB
METHOTREXATE 2.5MG TAB
NOLVADEX 10MG TAB
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
Category: AUTONOMIC DRUGS
Subcategory: Parasympathomimetic (Cholinergic Agents)
BETHANECHOL 25MG TAB
BETHANECHOL 5MG TAB
BETHANECOL 10MG TAB
PYRIDOSTIGMINE 60MG TAB
URECHOLINE 25MG TAB
URECHOLINE 5MG TAB
URECHOLINE 10MG TAB
MESTINON 60MG TAB
Subcategory: Anticholinergic Agents
Subcategory: Antiparkinsonian Agents
BENZTROPINE 1MG TAB
BENZTROPINE 2MG TAB
COGENTIN 1MG TAB
COGENTIN 2MG TAB
Subcategory: Antimuscarinics/Antispasmodics
DICYCLOMINE 10MG CAP
IPRATROPIUM BR INHALER
PROPANTHELINE 15MG TAB
BENTYL 10MG CAP
ATROVENT INHALER
PROBANTHINE 15MG TAB
Subcategory: Sympathomimetic (Adrenergic) Agents
ALBUTEROL 2MG TAB
ALBUTEROL 2MG/5ML SYRUP
ALBUTEROL 4MG REPETAB
ALBUTEROL 4MG TAB
ALBUTEROL METERED INHALER
ALBUTEROL 0.083% NEB UD SOL
ALBUTEROL/IPRATROPIUM INHALER
METAPROTERENOL 10MG TAB
METAPROTERENOL 5% INH SOLUTION
METAPROTERENOL METERED INHALER
SALMETRL-FLUTICASON 100/50 DISK
SALMETRL-FLUTICASON 250/50 DISK
SALMETRL-FLUTICASON 500/50 DISK
SALMETEROL XINAFOATE DISKUS INH
TERBUTALINE 2.5MG TAB
TERBUTALINE 5MG TAB
PROVENTIL 2MG TAB
PROVENTIL 2MG/5ML SYRUP
PROVENTIL 4MG REPETAB
PROVENTIL 4MG TAB
PROVENTIL METERED INHALER
PROVENTIL 0.083% NEB UD SOL
COMBIVENT INHALER
ALUPENT 10MG TAB
ALUPENT 5% INH SOLUTION
ALUPENT METERED INHALER
ADVAIR 100/50MCG DISK INH
ADVAIR 250/50MCG DISKUS INH
ADVAIR 500/50MCG DISKUS INH
SEREVENT DISKUS 50MCG INH
BRETHINE 2.5MG TAB
BRETHINE 5MG TAB
Subcategory: Sympatholytic (Adrenergic Blocking) Agents
ERGOTAMINE 1MG/CAFF 100MG TAB
CAFERGOT TABLET
Subcategory: Skeletal Muscle Relaxants
BACLOFEN 10MG TAB
CYCLOBENZAPRINE 10MG TAB
LIORESAL 10MG TAB
FLEXERIL 10MG TAB
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
Category: BLOOD FORMATION AND COAGULATION
Subcategory: Antianemia Drugs
Subcategory: Iron Preparations
FERROUS SULF 325MG TAB UD
FERROUS SULF 220MG/5ML ELIXIR
FERROUS SULF 325MG TAB UD
FERROUS SULF 220/5ML ELIXIR
Subcategory: Coagulants and Anticoagulants
Subcategory: Anticoagulants
ENOXAPARIN 30MG INJ
ENOXAPARIN 40MG INJ
ENOXAPARIN 60MG INJ
ENOXAPARIN 80MG INJ
ENOXAPARIN 100MG INJ
ENOXAPARIN 120MG INJ
WARFARIN SODIUM 1MG TAB
WARFARIN SODIUM 2.5MG TAB
WARFARIN SODIUM 3MG TAB
WARFARIN SODIUM 4MG TAB
WARFARIN SODIUM 5MG TAB
LOVENOX 30MG INJ
LOVENOX 40MG INJ
LOVENOX 60MG INJ
LOVENOX 80MG INJ
LOVENOX 100MG INJ
LOVENOX 120MG INJ
COUMADIN 1MG TAB
COUMADIN 2.5MG TAB
COUMADIN 3MG TAB
COUMADIN 4MG TAB
COUMADIN 5MG TAB
Subcategory: Hemorrheologic Agents
PENTOXIFYLLINE 400MG TAB SA
TRENTAL 400MG TAB SA
Category: CAROIOVASCULAR DRUGS
Subcategory: Cardiac Drugs
AMIODARONE 200MG TAB
AMLODIPINE BESYLATE 10MG TAB
AMLODIPINE BESYLATE 5MG TAB
ATENOLOL 50MG TAB
CAPTOPRIL 12.5MG TAB
CAPTOPRIL 25MG TAB
DIGOXIN 0.05MG/ML ELIXIR
DIGOXIN 0.125MG TAB
DIGOXIN 0.25MG TAB
DILTIAZEM 180MG CR CAP
DILTIAZEM 30MG TAB
DILTIAZEM 60MG TAB
DILTIAZEM HCL 240MG CR CAP
DILTIAZEM HCL 300MG CR CAP
FOSINOPRIL SODIUM 10MG TAB
FOSINOPRIL SODIUM 20MG TAB
CORDARONE 200MG TAB
NORVASC 10MG TAB
NORVASC 5MG TAB
TENORMIN 50MG TAB
CAPOTEN 12.5MG TAB
CAPOTEN 25MG TAB
LANOXIN 0.05MG/ML ELIXIR
LANOXIN 0.125MG TAB
LANOXIN 0.25MG TAB
TIAZAC 180MG CR CAP
CARDIZEM 30MG TAB
CARDIZEM 60MG TAB
TIAZAC 240MG CR CAP
TIAZAC 300MG CR CAP
MONOPRIL 10MG TAB
MONOPRIL 20MG TAB
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
FOSINOPRIL SODIUM 40MG TAB
LISINOPRIL 10MG TAB
LISINOPRIL 20MG TAB
LISINOPRIL 5MG TAB
METOPROLOL 50MG TAB
NIFEDIPINE 10MG CAP
NIFEDIPINE CC 30MG TAB
NIFEDIPINE CC 60MG TAB
NIFEDIPINE CC 90MG TAB
PROCAINAMIDE 250MG CAP
PROCAINAMIDE SR 500MG TAB
PROPRANOLOL 10MG TAB
PROPRANOLOL 40MG TAB
PROPRANOLOL LA l20MG CAP
PROPRANOLOL LA l60MG CAP
PROPRANOLOL LA 80MG CAP
QUINIDINE GLUCONATE 324MG TAB
QUINIDINE SULFATE 200MG TAB
VERAPAMIL l20MG TAB
VERAPAMIL 240MG CAP SA
VERAPAMIL 80MG TAB
MONOPRIL 40MG TAB
ZESTRIL 10MG TAB
ZESTRIL 20MG TAB
ZESTRIL 5MG TAB
LOPRESSOR 50MG TAB
PROCARDIA 10MG CAP
ADALAT CC 30MG TAB
ADALAT CC 60MG TAB
ADALAT CC 90MG TAB
PROCAN 250MG CAP
PROCAN SR 500MG TAB
INDERAL 10MG TAB
INDERAL 40MG TAB
INDERAL LA l20MG CAP
INDERAL LA l60MG CAP
INDERAL LA 80MG CAP
QUINAGLUTE 324MG TAB
QUINORA 200MG TAB
CALAN l20MG TAB
VERELAN 240MG CAP SA
CALAN 80MG TAB
Subcategory: Antilipemic Agents
ATORVASTATIN 80MG TAB
CHOLESTYRAMINE LIGHT PKT
SIMVASTATIN 5MG TAB
SIMVASTATIN 10MG TAB
SIMVASTATIN 20MG TAB
SIMVASTATIN 40MG TAB
SIMVASTATIN 80MG TAB
LIPITOR 80MG TAB
QUESTRAN LIGHT PKT
ZOCOR 5MG TAB
ZOCOR 10MG TAB
ZOCOR 20MG TAB
ZOCOR 40MG TAB
ZOCOR 80MG TAB
Subcategory: Hypotensive Agents
CLONIDINE HCL 0.1MG TAB
CLONIDINE HCL 0.2MG TAB
CLONIDINE HCL 0.3MG TAB
CLONIDINE-TTS 1 PATCH
CLONIDINE-TTS 2 PATCH
CLONIDINE-TTS 3 PATCH
DOXAZOSIN MESYLATE 1MG TAB
DOXAZOSIN MESYLATE 2MG TAB
DOXAZOSIN MESYLATE 4MG TAB
HYDRALAZINE 25MG TAB
HYDRALAZINE 50MG TAB
LABETALOL 100MG TAB
LABETALOL 200MG TAB
METHYLDOPA 250MG TAB
MINOXIDIL 2.5MG TAB
TELMISARTAN 40MG TAB
TELMISARTAN 80MG TAB
CATAPRES 0.1MG TAB
CATAPRES 0.2MG TAB
CATAPRES 0.3MG TAB
CATAPRES-TTS 1 PATCH
CATAPRES-TTS 2 PATCH
CATAPRES-TTS 3 PATCH
CARDURA 1MG TAB
CARDURA 2MG TAB
CARDURA 4MG TAB
APRESOLINE 25MG TAB
APRESOLINE 50MG TAB
NORMODYNE 100MG TAB
NORMODYNE 200MG TAB
ALDOMET 250MG TAB
LONITEN 2.5MG TAB
MICARDIS 40MG TAB
MICARDIS 80MG TAB
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
MINOXIDIL 2.5MG TAB
TELMISARTAN 40MG TAB
TELMISARTAN 80MG TAB
LONITEN 2.5MG TAB
MICARDIS 40MG TAB
MICARDIS 80MG TAB
Subcategory: Vasodilating Agents
DIPYRIDAMOLE 25MG TAB
ISOSORBIDE MONONIT l20MG TB CR
ISOSORBIDE MONONIT 30MG TAB CR
ISOSORBIDE MONONIT 60MG TAB CR
NITROGLYCERIN 0.2MG/HR PATCH
NITROGLYCERIN 0.4MG TAB SL
NITROGLYCERIN 0.4MG/HR PATCH
NITROGLYCERIN 0.6MG TAB SL
NITROGLYCERIN 2% OINT
Subcategory:
PERSANTINE 25MG TAB
IMDUR l20MG TAB CR
IMDUR 30MG TAB CR
IMDUR 60MG TAB CR
TRANSDERM-NITRO 0.2MG/HR PATCH
NITROSTAT 0.4MG TAB SL
NITRO-DUR 0.4MG/HR PATCH
NITROSTAT 0.6MG TAB SL
NITROL 2% OINT
Beta Adrenergic Blocking Agents
CARVEDILOL
CARVEDILOL
CARVEDILOL
CARVEDILOL
3.125MG TAB
6.25MG TAB
12.5MG TAB
25MG TAB
COREG
COREG
COREG
COREG
3.125MG TAB
6.25MG TAB
12.5MG TAB
25MG TAB
Category: CENTRAL NERVOUS SYSTEM DRUGS
Subcategory: Analgesics and Antipyretics
Subcategory: Nonsteroidal Anti-inflammatory Agents
BUTALB 50/CAFF 40/ASA 325 TAB
IBUPROFEN 400MG TAB
IBUPROFEN 600MG TAB
INDOMETHACIN 25MG CAP
KETOPROFEN 50MG CAP
NAPROXEN 250MG TAB
NAPROXEN 375MG TAB
PIROXICAM 10MG CAP
PIROXICAM 20MG CAP
SULINDAC 150MG TAB
SULINDAC 200MG TAB
TOLMETIN 400MG DS CAP
FIORINAL TAB
MOTRIN 400MG TAB
MOTRIN 600MG TAB
INDOCIN 25MG CAP
ORUDIS 50MG CAP
NAPROSYN 250MG TAB
NAPROSYN 375MG TAB
FELDENE 10MG CAP
FELDENE 20MG CAP
CLINORIL 150MG TAB
CLINORIL 200MG TAB
TOLECTIN DS 400MG CAP
Subcategory: Salicylates
ASPIRIN 81MG ENT COATED TAB
ASPIRIN 81MG ENT COATED TAB
Subcategory: Opiate Agonists
ACETAMINO 120/COD 12MG/5ML ELX
ACETAMINO 300/CODEINE 30MG TAB
CODEINE SULFATE 30MG TAB
HYDROMORPHONE 2MG TAB
MEPERIDINE 50MG TAB
TYLENOL W/CODEINE ELIXIR
TYLENOL W/ CODEINE NO.3 TAB
CODEINE 30MG TAB
DILAUDID 2MG TAB
DEMEROL 50MG TAB
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
MORPHINE SUL 20MG/ML-120ML SOL
MORPHINE SULFATE 20MG/ML SOLN
MORPHINE SULFATE 30MG SA TAB
OXYCODONE 5/ACETAMIN 325MG TAB
ROXANOL 20MG/ML-12-ML SOL
ROXANOL 20MG/ML SOLN
MS CONTIN 30MG SA TAB
PERCOCET 5/325MG TAB
Subcategory: Misc Analgesics and Antipyretics
ACETAMINOPHEN 100MG/ML DROP
ACETAMINOPHEN 160MG/5ML LIQ
TYLENOL 100MG/ML DROP
TYLENOL 160MG/5ML ELX
Subcategory: Anticonvulsants
Subcategory: Barbiturates
PRIMIDONE 250MG TAB
MYSOLINE 250MG TAB
Subcategory: Benzodiazepines
CLONAZEPAM 0.5MG TAB
CLONAZEPAM 1MG TAB
CLONAZEPAM 2MG TAB
KLONOPIN 0.5MG TAB
KLONOPIN 1MG TAB
KLONOPIN 2MG TAB
Subcategory: Hydantoins
PHENYTOIN
PHENYTOIN
PHENYTOIN
PHENYTOIN
100MG CAP
125MG/SML SUSP
50MG TAB
SOD 30MG SR CAP
DILANTIN
DILANTIN
DILANTIN
DILANTIN
100MG CAP
125MG/SML SUSP
50MG TAB
30MG SR CAP
Subcategory: Misc Anticonvulsants
CARBAMAZEPINE 100MG TAB
CARBAMAZEPINE 100MG/SML SUSP
CARBAMAZEPINE 200MG TAB
GABAPENTIN 300MG CAP
GABAPENTIN 400MG CAP
LAMOTRIGINE 100MG TAB
LAMOTRIGINE 25MG TAB
VALPROIC ACID 250MG CAP
TEGRETOL 100MG TAB
TEGRETOL 100MG/SML SUSP
TEGRETOL 200MG TAB
NEURONTIN 300MG CAP
NEURONTIN 400MG CAP
LAMICTAL 100MG TAB
LAMICTAL 25MG TAB
DEPAKENE 250MG CAP
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
Subcategory: Psychotherapeutic Agents
Subcategory: Antidepressants
AMITRIPTYLINE 10MG TAB
AMITRIPTYLINE 25MG TAB
AMITRIPTYLINE HCL 50MG TAB
DESIPRAMINE 10MG TAB
DESIPRAMINE 25MG TAB
DESIPRAMINE 50MG TAB
IMIPRAMINE 25MG TAB
IMIPRAMINE HCL 10MG TAB
NORTRIPTYLINE HCL 10MG CAP
NORTRIPTYLINE HCL 25MG CAP
SERTRALINE 50MG TAB
SERTRALINE HCL 100MG TAB
ELAVIL 10MG TAB
ELAVIL 25MG TAB
ELAVIL 50MG TAB
NORPRAMIN 10MG TAB
NORPRAMINE 25MG TAB
NORPRAMIN 50MG TAB
TOFRANIL 25MG TAB
TOFRANIL 10MG TAB
PAMELOR 10MG CAP
PAMELOR 25MG CAP
ZOLOFT 50MG TAB
ZOLOFT 100MG TAB
Subcategory: Antipsychotic Agents
CHLORPROMAZINE 25MG TAB
CHLORPROMAZINE 50MG TAB
FLUPHENAZINE 5MG TAB
FLUPHENAZINE HCL 1MG TAB
HALOPERIDOL 1MG TAB
HALOPERIDOL 5MG TAB
THIORIDAZINE 100MG TAB
THIORIDAZINE 25MG TAB
TRIFLUOPERAZINE 5MG TAB
THORAZINE 25MG TAB
THORAZINE 50MG TAB
PROLIXIN 5MG TAB
PROLIXIN 1MG TAB
HALDOL 1MG TAB
HALDOL 5MG TAB
MELLARIL 100MG TAB
MELLARIL 25MG TAB
STELAZINE 5MG TAB
Subcategory: Respiratory and Cerebral Stimulants
METHYLPHENIDATE 10MG TAB
RITALIN 10MG TAB
Subcategory: Anxiolytics, Sedatives and Hypnotics
Subcategory: Barbiturates
PHENOBARBITAL 20MG/5ML EXIXIR
PHENOBARBITAL 30MG TAB
PHENOBARBITAL 20MG/5ML ELIXIR
PHENOBARBITAL 30MG TAB
Subcategory: Benzodiazepines
ALPRAZOLAM 0.25MG TAB
ALPRAZOLAM 0.5MG TAB
ALPRAZOLAM 1MG TAB
CHLORDIAZEPOXIDE 10MG CAP
CHLORDIAZEPOXIDE 25MG CAP
CHLORDIAZEPOXIDE 5MG CAP
XANAX 0.25MG TAB
XANAX 0.5MG TAB
XANAX 1MG TAB
LIBRIUM 10MG CAP
LIBRIUM 25MG CAP
LIBRIUM 5MG CAP
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
DIAZEPAM 5MG TAB
FLURAZEPAM 15MG CAP
LORAZEPAM 0.5MG TAB
LORAZEPAM 1MG TAB
LORAZEPAM 2MG TAB
VALIUM 5MG TAB
DALMANE 15MG CAP
ATIVAN 0.5MG TAB
ATIVAN 1MG TAB
ATIVAN 2MG TAB
Subcategory: Misc Anxiolytics, Sedatives and Hypnotics
HYDROXYZINE 10MG/5ML SYRUP
HYDROXYZINE HCL 10MG TAB
HYDROXYZINE HCL 25MG TAB
ATARAX 10MG/5ML SYRUP
ATARAX 10MG TAB
ATARAX 25MG TAB
Subcategory: Antimanic Agents
LITHIUM CARBONATE 300MG CAP
ESKALITH 300MG CAP
Subcategory: Misc Central Nervous System Agents
CARBIDOPA/LEVODOPA-10/100 TAB
CARBIDOPA/LEVADOPA-25/100 TAB
CARBIDOPA/LEVADOPA-25/250 TAB
SUMATRIPTAN 25MG TAB
SUMATRIPTAN 50MG TAB
SUMATRIPTAN 100MG TAB
SINEMET-10/100 TABLET
SINEMET-25/100 TABLET
SINEMET-25/250 TABLET
IMITREX 25MG TAB
IMITREX 50MG TAB
IMITREX 100MG TAB
Category: CONTRACEPTIVES (e.g., Foams, Devices)
CONDOMS LUBRICATED/SPERMICIDAL
DELFEN FOAM 12.5% VAGINAL
DIAPHRAGM ARC-SPRING 65MM
DIAPHRAGM ARC-SPRING 70MM
DIAPHRAGM ARC-SPRING 75MM
DIAPHRAGM ARC-SPRING 80MM
DIAPHRAGM ARC-SPRING 85MM
CONDOMS LUBRICATED/SPERMICIDAL
DELFEN FOAM 12.5% VAGINAL
ORTHO-DIAPHRAGM ALLFLX 65MM
ORTHO-DIAPHRAGM ALLFLX 70MM
ORTHO-DIAPHRAGM ALLFLX 75MM
ORTHO-DIAPHRAGM ALLFLX 80MM
ORTHO-DIAPHRAGM ALLFLX 85MM
Category: DIAGNOSTIC AGENTS
Subcategory: Roentgenography
GASTROGRAFFIN SOLUTION
GASTROGRAFFIN SOLUTION
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
Category: ELECTROLYTIC CALORIC AND WATER BALANCE
Subcategory: Alkalinizing Agents
BICITRA SUGAR FREE SOLUTION
BICITRA SUGAR FREE SOLUTION
Subcategory: Ammonia Detoxicants
LACTULOSE 10GM/15ML SYRUP
CEPHULAC 10GM/15ML SYRUP
Subcategory: Replacement Solutions
CALCIUM CARBONATE 650MG TAB
POTASSIUM CHLORIDE 10% SOL
POTASSIUM CHLORIDE 20MEQ PKT
POTASSIUM CHLORIDE 20MEQ TAB
POTASSIUM CL 10MEQ SA TAB
CALCIUM CARBONATE 650MG TAB
POTASSIUM CHLORIDE 10% SOL
KLOR 20MEQ PKT
KLORVESS 20MEQ TAB
TEN-K 10MEQ SA TAB
Subcategory: Potassium-Removing Resins
SOD POLYSTYRENE SULF 15GM/60ML
SOD POLYSTYRENE SULF 15GM/60ML
Subcategory: Diuretics
BUMETANIDE 1MG TAB
FUROSEMIDE 20MG TAB
FUROSEMIDE 40MG TAB
HYDROCHLOROTHIAZIDE 12.5MG CAP
HYDROCHLOROTHIAZIDE 25MG TAB
HYDROCHLOROTHIAZIDE 50MG TAB
METOLAZONE 5MG TAB
TRIAMTERENE 37.5/HCTZ 25 TAB
BUMEX 1MG TAB
LASIX 20MG TAB
LASIX 40MG TAB
MICROZIDE 12.5MG CAP
ESIDREX 25MG TAB
ESIDREX 50MG TAB
DIULO 5MG TAB
MAXZIDE 37.5MG/25MG TAB
Subcategory: Potassium-sparing Diuretics
SPIRONOLACTONE 25MG TAB
SPIRONOLACTONE/HCTZ 25/25 TAB
ALDACTONE 25MG TAB
ALDACTAZIDE 25/25 TAB
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
Subcategory: Uricosuric Agents
PROBENECID 500MG TAB
BENEMID 500MG TAB
Category: ENZYMES
GRANULEX SPRAY
GRANULEX SPRAY
Category: ANTITUSSIVES, EXPECTORANTS AND MUCYOLYTIC AGENTS
Subcategory: Antitussives
GUAIFENSIN/CODEINE SYRUP
PSEUDOEPHED/CARBINOX DM DROP
PSEUDOEPHED/CARBINOX DM SYRUP
ROBITUSSIN AC SYRUP
RONDEC DM DROP
RONDEC DM SYRUP
Subcategory: Expectorants
LUGOLS SOLUTION
LUGOLS SOLUTION
Category: EYE, EAR, NOSE AND THROAT (EENT) PREPARATIONS
Subcategory: Anti-infectives
Subcategory: Antibiotics
BACITRACIN 500U/GM EYE OINT
CIPROFLOXACIN 0.3% EYE OINT
CIPROFLOXACIN 0.3% OPTH DROP
COLY-MYCIN S OTIC DROP
ERYTHROMYCIN EYE OINT
GENTAMICIN 3MG/ML OPTH DROP
GENTAMICIN SULF EYE OINT
MAXITROL OPTHALMIC DROP
NEOMYC/POLYM B/HC OTIC SUSP
OFLOXACIN OTIC 0.3% DROP
TOBRAMYCIN 0.3% EYE OINT
TOBRAMYCIN 0.3% OPTH DROP
TOBRAMYCIN/DEXAMETHA OPTH DROP
TOBRAMYCIN/DEXMETHA EYE OINT
TRIMETHOPRIM/POLYMIX OPTH DROP
BACITRACIN 500U/GM EYE OINT
CILOXAN 0.3% EYE OINT
CILOXAN 0.3% OPTH DROP
COLY-MYCIN S OTIC DROP
ILOTYCIN EYE OINT
GARAMYCIN 3MG/ML OPTH DROP
GARAMYCIN EYE OINT
MAXITROL OPTHALMIC DROP
CORTISPORIN OTIC SUSP
FLOXIN OTIC 0.3% DROP
TOBREX 0.3% EYE OINT
TOBREX 0.3% OPTH DROP
TOBRADEX OPTH DROP
TOBRADEX EYE OINT
POLYTRIM OPHTHALMIC DROP
Subcategory: Antivirals
TRIFLURIDINE 1% OPTH DROP
VIROPTIC 1% OPTH DROP
Subcategory: Sulfonamides
SULFACETAMIDE 10% OPTH DROP
SULAMYD 10% OPTH DROP
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
Subcategory: Misc Anti-Infectives
ACETIC ACID 2% OTIC SOL
ACETIC ACID 2%/HC 1% OTIC SOL
VOSOL 2% OTIC SOL
VOSOL HC OTIC SOL
Subcategory: Anti-Inflammatory Agents
FLUNISOLIDE 0.025% NASAL INH
FLUOROMETHOLONE EYE OINT
KETOROLAC TROM 0.5% OPTH DROP
PREDNISOLONE ACET 1% OPTH DROP
NASALIDE 0.025% NASAL INH
FML EYE OINT
ACULAR 0.5% OPTH DROP
PRED FORTE 1% OPTH DROP
Subcategory: Carbonic Anhydrase Inhibitors
ACETAZOLAMIDE 250MG TAB
ACETAZOLAMIDE 500MG CAP SA
DORZOLAMIDE HCL 2% OPTH DROP
METHAZOLAMIDE 50MG TAB
DIAMOX 250MG TAB
DIAMOX SEQUELS 500MG
TRUSOPT 2% OPTH DROP
NEPTAZANE 50MG TAB
Subcategory: Local Anesthetics
AURALGAN EAR DROP
LIDOCAINE 2% VISCOUS SOLUTION
LIDOCAINE HCL 2% JELLY
PROPARACAINE 0.5% OPTH DROP
AURALGAN EAR DROP
LIDOCAINE 2% VISCOUS SOLUTION
XYL0CAINE 2% JELLY
OPHTHETIC 0.5% OPTH DROP
Subcategory: Miotics
PILOCARPINE 2% OPTH DROP
PILOCARPINE 4% EYE GEL
PILOCARPINE 4% OPTH DROP
PILOCAR 2% OPTH DROP
PILOPINE HS 4% EYE GEL
PILOCAR 4% OPTH DROP
Subcategory: Mydriatics
ATROPINE 1% OPTH DROP
CYCLOPENTOL/PHENYLEPH OPTH SOL
CYCLOPENTOLATE 1% OPTH DROP
DIPIVEFRIN 0.1% OPTH DROP
HOMATROPINE 2% OPTH DROP
HOMATROPINE 5% OPTH DROP
SCOPOLAMINE 0.25% OPTH DROP
TROPICAMIDE 1% OPTH DROP
ATROPINE 1% OPTH DROP
CYCLOMYDRIL OPTH SOLUTION
CYCLOGYL 1% OPTH DROP
PROPINE 0.1% OPTH DROP
ISOPTO HOMATROPIN 2% OPTH DROP
ISOPTO HOMATROPIN 5% OPTH DROP
ISOPTO HYOSCIN 0.25% OPTH DROP
MYDRIACYL 1% OPTH DROP
Subcategory: Mouthwashes and Gargles
MAGIC MOUTHWASH SOL
MAGIC MOUTHWASH SOL
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
Subcategory: Vasoconstrictors
PHENYLEPHRINE 2.5% OPTH DROP
NAPHAZOLINE 0.1% OPHTH DROP
NEOSYNEPHRINE 2.5% OPTH DROP
AK CON OPHTHALMIC DROP
Subcategory: Misc EENT Drugs
BETAXOLOL HCL 0.25% OPTH DROP
BRIMONIDINE 0.2% OPHTH DROP
CERUMENEX 10% EAR DROP
HYDROXYPROPYLMETH 2.5% OPT SOL
HYPOTEARS OPTH DROP
LACRILUBE EYE OINT
LATANOPROST 0.005% OPHTH DROP
SODIUM CHLORIDE 5% OPTH DROP
TIMOLOL 0.5% OPTH DROP
BETOPTIC S 0.25% OPTH DROP
ALPHAGAN 0.2% OPHTH DROP
CERUMENEX 10% EAR DROP
GONIOSOL 2.5% OPTH SOLUTION
HYPOTEARS OPTH DROP
LACRILUBE S.O.P. EYE OINT
XALATAN 0.005% OPHTH DROP
ADSORBONAC 5% OPTH DROP
TIMOPTIC 0.5% OPTH DROP
Category: GASTROINTESTINAL DRUGS
Subcategory: Antacids and Adsorbents
MAALOX EXTRA STRENGTH LIQUID
SODIUM BICARBONATE 650MG TAB
MAALOX EXTRA STRENGTH LIQUID
SODIUM BICARBONATE 650MG TAB
Subcategory: Antidiarrhea Agents
DIPHENOXYLATE/ATROPINE TAB
LOPERAMIDE 2MG CAP
PAREGORIC LIQ
LOMOTIL TAB
IMODIUM 2MG CAP
PAREGORIC LIQ
Subcategory: Cathartics and Laxatives
BISACODYL 10MG SUPP
COLYTE SOLUTION
DULCAGEN 10MG SUPP
COLYTE SOLUTION
Subcategory: Digestants
PANCRELIPASE CAP
COTAZYM CAP
Subcategory: Antiemetics
MECLIZINE HCL 12.5MG TAB
MECLIZINE HCL 25MG TAB
BONINE 12.5MG TAB
BONINE 25MG TAB
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
PROCHLORPERAZINE 25MG SUPP
PROCHLORPERAZINE 5MG TAB
TRIMETHOBENZAMIDE 100MG SUPP
TRIMETHOBENZAMIDE 200MG SUPP
COMPAZINE 25MG SUPP
COMPAZINE 5MG TAB
TIGAN 100MG SUPP
TIGAN 200MG SUPP
Subcategory: Misc GI Drugs
METOCLOPRAMIDE 10MG TAB
METOCLOPRAMIDE 5MG/5ML SYRUP
OMEPRAZOLE 20MG OTC TAB 14’s
OMEPRAZOLE 20MG OTC TAB 28’s
RANITIDINE 150MG TAB
SUCRALFATE 1GM TAB
METOCLOPRAMIDE 10MG TAB
REGLAN 5MG/5ML SYRUP
PRILOSEC 20MG OTC TAB 14’s
PRILOSEC 20MG OTC TAB 28’s
ZANTAC 150MG TAB
CARAFATE 1GM TAB
Category: GOLD COMPOUNDS
AURANOFIN 3MG CAP
RIDAURA 3MG CAP
Category: HEAVY METAL ANTAGONISTS
PENICILLAMINE 250MG CAP
SUCCIMER 100MG CAP
CUPRIMINE 250MG CAP
CHEMET 100MG CAP
Category: HORMONES AND SYNTHETIC SUBSTITUTES
Subcategory: Adrenals
BECLOMETHASONE INHALER
VANCERIL INHALER
BUDESONIDE INH SUSP 0.25MG
PULMICORT RESPULES 0.25 INH SUSP
** Restriction: Patient less than 4 years old **
BUDESONIDE INH SUSP 0.5MG
PULMICORT RESPULES 0.5 INH SUSP
** Restriction: Patient less than 4 years old **
DEXAMETHASONE 0.5MG TAB
DECADRON 0.5MG TAB
DEXAMETHASONE 4MG TAB
DECADRON 4MG TAB
FLUDROCORTISONE 0.1MG TAB
FLORINEF 0.1MG TAB
FLUTICASONE PROPIO 110 INHALER
FLOVENT 110MCG INHALER
FLUTICASONE PROPION 44 INHALER
FLOVENT 44MCG INHALER
METHYLPREDNISOLONE 4MG DOSEPAK
MEDROL 4MG DOSEPAK
METHYLPREDNISOLONE 4MG TAB
MEDROL 4MG TAB
PREDNISONE 20MG TAB
DELTASONE 20MG TAB
PREDNISONE 5MG TAB
DELTASONE 5MG TAB
PREDNISONE 5MG/5ML ORAL SOL
PREDNISONE 5MG/5ML ORAL SOL
Subcategory: Contraceptives
LEVONORGESTREL 0.75MG TAB
LO/OVRAL-28 TAB
NORDETTE-28 TAB
NORETHINDRONE 0.35MG TAB
ORTHO EVRA PATCH
ORTHO NOVUM-1/35 28 DAYS TAB
PLAN B 0.75MG TAB
LO/OVRAL-28 TAB
NORDETTE-28 TAB
MICRONOR 0.35MG TAB
ORTHO EVRA PATCH
ORTHO NOVUM-1/35 28 DAYS TAB
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
ORTHO NOVUM-777 28 DAYS TAB
ORTHO-NOVUM 1/50 TAB
TRIPHASIL-28 TAB
ORTHO NOVUM-777 28 DAYS TAB
ORTHO-NOVUM 1/50 TAB
TRIPHASIL-28 TAB
Subcategory: Estrogens
ESTROGENS, CONJ 0.625MG TAB
ESTROGENS, CONJ 1.25MG TAB
ESTROGENS, CONJ VAG CR W/APP
CONJ ESTROG/MEDROXYPROG 2.5MG
PREMARIN 0.625MG TAB
PREMARIN 1.25MG TAB
PREMARIN VAG CR W/APP
PREMPRO 2.5MG TAB
Subcategory: Antidiabetic Agents
Subcagetory: Biguanides
METFORMIN HCL 500MG TAB
METFORMIN HCL 850MG TAB
METFORMIN XR 500MG TAB
GLUCOPHAGE 500MG TAB
GLUCOPHAGE 850MG TAB
GLUCOPHAGE XR 500MG TAB
Subcategory: Insulins
INSULIN
INSULIN
INSULIN
INSULIN
INSULIN
INSULIN
INSULIN
ASPART 100U/ML INJ. VL
ASPART FLEX PEN 3x5
GLARGINE 100U/ML VIAL
HUMAN SEMI NPH 100U/ML
HUMAN SEMISY L 100U/ML
HUMAN SEMISY R 100U/ML
HUMAN SEMISYNTH 70/30
NOVOLOG INJ. 100U/ML VIAL
NOVOLOG INJ. FLEX PEN 3x5
LANTUS 100U/ML VIAL
NOVOLIN NPH 100U/ML VIAL
NOVOLIN LENTE 100U/ML VIAL
NOVOLIN REGULAR 100U/ML VIAL
NOVOLIN 70/30 100U/ML VIAL
Subcategory: Sulfonylureas
GLIMEPERIDE 1MG TAB
GLIMEPERIDE 2MG TAB
GLIMEPERIDE 4MG TAB
GLIPIZIDE 5MG TAB
GLYBURIDE 5MG TAB
GLYBURID/METFORMN 1.25/250 TAB
GLYBURIDE/METFORMN 2.5/500 TAB
GLYBURIDE/METFORMN 5/500 TAB
AMARYL 1MG TAB
AMARYL 2MG TAB
AMARYL 4MG TAB
GLUCOTROL 5MG TAB
MICRONASE 5MG TAB
GLUCOVANCE 1.25/250 TAB
GLUCOVANCE 2.5/500 TAB
GLUCOVANCE 5/500 TAB
Subcategory: Thiazolinediones
PIOGLITAZONE 15MG TAB
PIOGLITAZONE 30MG TAB
PIOGLITAZONE 45MG TAB
ACTOS 15MG TAB
ACTOS 30MG TAB
ACTOS 45MG TABS
Subcategory: Progestins
MEDROXYPROGESTERONE 10MG TAB
PROVERA 10MG TAB
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
Subcategory: Thyroid and Antithyroid Agents
Subcategory: Thyroid Agents
LEVOTHYROXINE 0.025MG TAB
LEVOTHYROXINE 0.05MG TAB
LEVOTHYROXINE 0.075MG TAB
LEVOTHYROXINE 0.125MG TAB
LEVOTHYROXINE 0.15MG TAB
LEVOTHYROXINE 0.1MG TAB
LIOTHYRONINE 25MCG TAB
LEVOTHROID 0.025MG TAB
SYNTHROID 0.05MG TAB
SYNTHROID 0.075MG TAB
SYNTHROID 0.125MG TAB
SYNTHROID 0.15MG TAB
SYNTHROID 0.1MG TAB
CYTOMEL 25MCG TAB
Subcategory: Antithyroid Agents
PROPYLTHIOURACIL 50MG TAB
PROPYLTHIOURACIL 50MG TAB
Category: OXYTOCICS
METHYLERGONOVINE 0.2MG TAB
METHERGINE 0.2MG TAB
Category: SKIN AND MUCCOUS MEMBRANE AGENTS
Subcategory: Anti-infectives
Subcategory: Antibiotics
CLINDAMYCIN T 1% SOLUTION
GENTAMICIN 0.1% TOPICAL CREAM
MUPIROCIN 2% OINT
NEOMYCI/BACITRACI/POLYMIX OINT
CLEOCIN T 1% SOLUTION
GARAMYCIN 0.1% TOPICAL CREAM
BACTROBAN 2% OINT
MYCITRACIN OINT
Subcategory: Antivirals
ACYCLOVIR 5% OINT
ZOVIRAX 5% OINT
Subcategory: Antifungals
CLOTRIMAZOLE 10MG TROCHE
ECONAZOLE 1% TOPICAL CREAM
KETOCONAZOLE 2% CREAM
NYSTATIN 100000U/GM CREAM
NYSTATIN 100000U/GM OINT
TERCONAZOLE VAG 0.4% CREAM
TERCONAZOLE VAG 0.8% CREAM
MYCELEX 10MG TROCHE
SPECTAZOLE 1% TOPICAL CREAM
NIZORAL 2% CREAM
NILSTAT 100000U/GM CREAM
NILSTAT 100000U/GM OINT
TERAZOL-7 VAG CREAM
TERAZOL-3 VAG CREAM
Subcategory: Scabicides and Pediculicides
PERMETHRIN 1% CREME RINSE LIQ
PERMETHRIN 5% CREAM
PIPERONYL/PYRETHRIN LIQUID
NIX 1% CREME RINSE LIQUID
ELIMITE 5% CREAM
RID LIQUID
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
Subcategory: Misc. Local Anti-infectives
SELENIUM 2.5% LOTION SHAMPOO
SILVER SULFADIAZINE 1% CREAM
SELSUN 2.5% LOTION SHAMPOO
SSD 1% CREAM
Subcategory: Anti-inflammatory Agents
DIFLORASONE 0.05% CREAM
DIFLORASONE 0.05% OINT
FLUOCINOLONE ACETONI 0.025% CR
HYDROCORTISONE 1% CREAM
HYDROCORTISONE 1% OINT
HYDROCORTISONE 100MG ENEMA
HYDROCORTISONE 25MG SUPP
HYDROCORTISONE ACET 2.5% CREAM
TRIAMCINOLONE 0.1% PASTE
MAXIFLOR 0.05% CREAM
MAXIFLOR 0.05% OINT
SYNEMOL 0.025% CREAM
HYDROCORTISONE 1% CR
HYDROCORTISONE 1% OINT
CORTENEMA 100MG ENEMA
ANUSOL HC 25MG SUPP
ANUSOL-HC 2.5% CREAM
KENALOG IN ORABASE 0.1% PASTE
Subcategory: Antipruritics and Local Anesthetics
CETACAINE 56GM SPRAY
LIDOCAINE HCL 5% OINT
PHENAZOPYRIDINE 100MG TAB
CETACAINE 56GM SPRAY
XYLOCAINE 5% OINT
PYRIDIUM 100MG TAB
Subcategory: Keratolytic Agents
SALICYLIC ACID 5% IN AQUAPHOR
SALICYLIC ACID 5% IN AQUAPHOR
Subcategory: Keratoplastic Agents
LCD 5% IN AQUAPHOR
LCD 5% IN AQUAPHOR
Subcategory: Misc. Skin and Mucous Membrane Agents
MENTHOL 1/4% IN AQUAPHOR
PAPAIN-UREA 1.lMU-100MG/GM OIN
MENTHOL 1/4% IN AQUAPHOR
ACCUZYME TOPICAL OINT
Category: SMOOTH MUSCLE RELAXANTS
Subcategory: Genitourinary Smooth Muscle Relaxants
OXYBUTYNIN 5MG TAB
DITROPAN 5MG TAB
DRUG LISTING BY GENERIC NAME
WITHIN CATEGORY AND SUBCATEGORY
Generic Name
Trade Name
Subcategory: Respiratory Smooth Muscle Relaxants
AMINOPHYLLINE 200MG TAB
THEOPHYLLINE 200MG TAB SR
THEOPHYLLINE 300MG TAB SR
THEOPHYLLINE 80MG/15ML ELIX
AMINOPHYLLINE 200MG TAB
THEODUR 200MG TAB SR
THEODUR 300MG TAB SR
ELIXOPHYLLIN 80MG/15ML ELIX
Category: VITAMINS
Subcategory: Vitamin B Complex
FOLIC ACID 1MG TAB
PYRIDOXINE 50MG TAB
THIAMINE 100MG TAB
FOLIC ACID 1MG TAB
VITAMIN B-6 50MG TAB
THIAMINE 100MG TAB
Subcategory: Vitamin D
CALCITRIOL 0.25MCG CAP
VITAMIN D 1000 UNIT TAB
ROCALTROL 0.25MCG CAP
VITAMIN D 1000 UNIT TAB
Subcategory: Vitamin K Activity
PHYTONADIONE 5MG TAB
MEPHYTON 5MG TAB
Subcategory: Multivitamin Preparations
STUARTNATAL 1+1 TABLET
VIT B COMPLX/VIT C/PLUS FE TAB
STUARTNATAL 1+1 TABLET
NEPHRO-VITE PLUS IRON TAB
Category: MISCELLANEOUS THERAPEUTIC AGENTS
ALENDRONATE 35MG TABS
ALENDRONATE 70MG TAB
ALLOPURINOL 100MG TAB
ALLOPURINOL 300MG TAB
AZATHIOPRINE 50MG TAB
BROMOCRIPTINE 2.5MG TAB
CLOPIDOGREL 75MG TAB
COLCHICINE 0.6MG TAB
CYCLOSPORINE 100MG/ML SOLN
ETIDRONATE 200MG TAB
LEUCOVORIN CALCIUM 25MG TAB
LEUCOVORIN CALCIUM 5MG TAB
MONTELUKAST 10MG TAB
MONTELUKAST 5MG CHEW TAB
FOSAMAX 35MG TAB
FOSAMAX 70MG TAB
ZYLOPRIM 100MG TAB
ZYLOPRIM 300MG TAB
IMURAN 50MG TAB
PARLODEL 2.5MG TAB
PLAVIX 75MG TAB
COLCHICINE 0.6MG TAB
SANDIMMUNE 100MG/ML SOLN
DIDRONEL 200MG TAB
WELLCOVORIN 25MG TAB
WELLCOVORIN 5MG TAB
SINGULAIR 10MG TAB
SINGULAIR 5MG CHEW TAB
Category: DEVICES
INSULIN 1ML U-100 SYRINGE
INSULIN(NOVOFINE)30G DSP NEEDLE
INSULIN 1ML U-100 SYRINGE
NOVOFINE DSP 30G NEEDLE
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
GENERIC TO BRAND
02/22/2010
**************************************************************************
GENERIC NAME
BRAND NAME
ACETAMINO 120/COD 12MG/5ML ELIX
TYLENOL W/CODEINE ELIXIR
ACETAMINO 300/CODEINE 30MG TAB
TYLENOL w/ CODEINE NO.3 TAB
ACETAMINOPHEN 100MG/ML DROP
TYLENOL 100MG/ML DROP
ACETAMINOPHEN 160MG/5ML LIQ
TYLENOL 160MG/5ML ELX
ACETAZOLAMIDE 250MG TAB
DIAMOX 250MG TAB
ACETAZOLAMIDE 500MG CAP
DIAMOX SEQUELS 500MG CAP
ACETIC ACID 2% OTIC SOL
VOSOL 2% OTIC SOL
ACETIC ACID 2%/HC 1% OTIC SOL
VOSOL HC OTIC SOL
ACYCLOVIR 200MG CAP
ZOVIRAX 200MG CAP
ACYCLOVIR 5% OINT
ZOVIRAX 5% OINT
ALBUTEROL 2MG TAB
PROVENTIL 2MG TAB
ALBUTEROL 2MG/5ML SYRUP
PROVENTIL 2MG/5ML SYRUP
ALBUTEROL 4MG REPETAB
PROVENTIL 4MG REPETAB
ALBUTEROL 4MG TAB
PROVENTIL 4MG TAB
ALBUTEROL METERED INHALER
PROVENTIL METERED INHALER
ALBUTEROL 0.083% NEB UD SOL
PROVENTIL 0.083% NEB UD SOL
ALBUTEROL/IPRATROPIUM INH
COMBIVENT INHALER
ALENDRONATE 35MG TAB
FOSAMAX 35MG TAB
ALENDRONATE 70MG TAB
FOSAMAX 70MG TAB
ALLOPURINOL 100MG TAB
ZYLOPRIM 100MG TAB
ALLOPURINOL 300MG TAB
ZYLOPRIM 300MG TAB
ALPRAZOLAM 0.25MG TAB
XANAX 0.25MG TAB
ALPRAZOLAM 0.5MG TAB
XANAX 0.5MG TAB
ALPRAZOLAM 1MG TAB
XANAX 1MG TAB
AMINOPHYLLINE 200MG TAB
AMINOPHYLLINE 200MG TAB
AMIODARONE 200MG TAB
CORDARONE 200MG TAB
AMITRIPTYLINE 10MG TAB
ELAVIL 10MG TAB
AMITRIPTYLINE 25MG TAB
ELAVIL 25MG TAB
AMITRIPTYLINE HCL 50MG TAB
ELAVIL 50MG TAB
AMLODIPINE BESYLATE 10MG TAB
NORVASC 10MG TAB
AMLODIPINE BESYLATE 5MG TAB
NORVASC 5MG TAB
AMOXICILLIN 125/CLAV 31.2 SUSP
AUGMENTIN 125 SUSP
AMOXICILLIN 125MG/5ML SUSP
TRIMOX 125/5ML SUSP
AMOXICILLIN 250/CLAV 125 TAB
AUGMENTIN 250MG TAB
AMOXICILLIN 250/CLAV 62.5MG SUSP
AUGMENTIN 250 SUSP
AMOXICILLIN 250MG CAP
AMOXICILLIN 250MG CAP
AMOXICILLIN 250MG/5ML SUSP
TRIMOX 250MG/5ML SUSP
AMOXICILLIN 500/CLAV 125 TAB
AUGMENTIN 500MG TAB
AMOXICILLIN 500MG CAP
AMOXICILLIN 500MG CAP
AMOXICILLIN 875/CLAV 125 TAB
AUGMENTIN 875MG TAB
ASPIRIN 81MG ENT COATED TAB
ASPIRIN 81MG ENT COATED TAB
ATENOLOL 50MG TAB
TENORMIN 50MG TAB
ATORVASTATIN 80MG TAB
LIPITOR 80MG TAB
** PRIOR AUTHORIZATION REQUIRED **
ATROPINE 1% OPTH DROP
ATROPINE 1% OPTH DROP
AURALGAN EAR DROP
AURALGAN EAR DROP
AURANOFIN 3MG CAP
RIDAURA 3MG CAP
AZATHIOPRINE 50MG TAB
IMURAN 50MG TAB
AZITHROMYCIN 250MG CAP (Z-PAK)
ZITHROMAX 250MG CAP (Z-PAK
AZITHROMYCIN 600MG/15ML SUSP
ZITHROMAX 600MG/15ML ORAL
AZITHROMYCIN 900MG/22.5ML SUSP
ZITHROMAX 900MG/22.5ML SUSP
PAGE
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13
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18
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14
10
10
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11
11
11
11
11
11
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14
15
22
22
23
28
10
10
10
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
GENERIC TO BRAND
02/22/2010
**************************************************************************
GENERIC NAME
BRAND NAME
BACITRACIN 500U/GM EYE OINT
BACITRACIN 500U/GM EYE OINT
BACLOFEN 10MG TAB
LIORESAL 10MG TAB
BECLOMETHASONE INHALER
VANCERIL INHALER
BENZTROPINE 1MG TAB
COGENTIN 1MG TAB
BENZTROPINE 2MG TAB
COGENTIN 2MG TAB
BETAXOLOL HCL 0.25% OPTH
BETOPTIC S 0.25% OPTH DROP
BETHANECHOL 25MG TAB
URECHOLINE 25MG TAB
BETHANECHOL 5MG TAB
URECHOLINE 5MG TAB
BETHANECOL 10MG TAB
URECHOLINE 10MG TAB
BICITRA SUGAR FREE SOL
BICITRA SUGAR FREE SOLUTION
BISACODYL 10MG SUPP
DULCAGEN 10MG SUPP
BRIMONIDINE 0.2% OPHTH DROP
ALPHAGAN 0.2% OPHTH DROP
BROMOCRIPTINE 2.5MG TAB
PARLODEL 2.5MG TAB
BUDESONIDE INH SUSP 0.25MG
PULMCORT RESPULS 0.25MG INH SUSP
** Restriction: Patient less than 4 years old **
BUDESONIDE INH SUSP 0.5MG
PULMCORT RESPULS 0.5MG INH SUSP
** Restriction: patient less than 4 years old **
BUMETANIDE 1MG TAB
BUMEX 1MG TAB
BUSULFAN 2MG TAB
MYLERAN 2MG TAB
BUTALB 50/CAFF 40/ASA 325 TAB
FIORINAL TAB
CALCITRIOL 0.25MCG CAP
ROCALTROL 0.25MCG CAP
CALCIUM CARBONATE 650MG TAB
CALCIUM CARBONATE 650MG TAB
CAPTOPRIL 12.5MG TAB
CAPOTEN 12.5MG TAB
CAPTOPRIL 25MG TAB
CAPOTEN 25MG TAB
CARBAMAZEPINE 100MG TAB
TEGRETOL 100MG TAB
CARBAMAZEPINE 100MG/5ML SUSP
TEGRETOL 100MG/5ML SUSP
CARBAMAZEPINE 200MG TAB
TEGRETOL 200MG TAB
CARBIDOPA/LEVADOPA 10/100 TAB
SINEMET-10/100 TABLET
CARBIDOPA/LEVADOPA 25/100 TAB
SINEMET-25/100 TABLET
CARBIDOPA/LEVADOPA 25/250 TAB
SINEMET-25/250 TABLET
CARVEDILOL 3.125 MG TAB
COREG 3.125MG TAB
CARVEDILOL 6.25MG TAB
COREG 6.25MG TAB
CARVEDILOL 12.5MG TAB
COREG 12.5MG TAB
CARVEDILOL 25MG TAB
COREG 25MG TAB
CEPHALEXIN 125MG/5ML ORAL
KEFLEX 125MG/5ML ORAL SUSP
CEPHALEXIN 250MG CAP
KEFLEX 250MG CAP
CEPHALEXIN 500MG CAP
KEFLEX 500MG CAP
CERUMENEX 10% EAR DROP
CERUMENEX 10% EAR DROP
CETACAINE 56GM SPRAY
CETACAINE 56GM SPRAY
CHLORAMBUCIL 2MG TAB
LEUKERAN 2MG TAB
CHLORDIAZEPOXIDE 10MG CAP
LIBRIUM 10MG CAP
CHLORDIAZEPOXIDE 25MG CAP
LIBRIUM 25MG CAP
CHLORDIAZEPOXIDE 5MG CAP
LIBRIUM 5MG CAP
CHLORPROMAZINE 25MG TAB
THORAZINE 25MG TAB
CHLORPROMAZINE 50MG TAB
THORAZINE 50MG TAB
CHOLESTYRAMINE LIGHT PKT
QUESTRAN LIGHT PKT
CIPROFLOXACIN 0.3% EYE OINT
CILOXAN 0.3% EYE OINT
CIPROFLOXACIN 0.3% OPTH DROP
CILOXAN 0.3% OPTH DROP
CIPROFLOXACIN HCL 250MG TAB
CIPRO 250MG TAB
CIPROFLOXACIN HCL 500MG TAB
CIPRO 500MG TAB
CIPROFLOXACIN HCL 750MG TAB
CIPRO 750MG TAB
CLARITHROMYCIN 250MG TAB
BIAXIN 250MG TAB
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10
10
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27
12
18
18
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18
15
21
21
12
12
12
10
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
GENERIC TO BRAND
02/22/2010
**************************************************************************
GENERIC NAME
BRAND NAME
CLARITHROMYCIN 500MG TAB
BIAXIN 500MG TAB
CLINDAMYCIN 150MG CAP
CLEOCIN 150MG CAP
CLINDAMYCIN T 1% SOLUTION
CLEOCIN T 1% SOLUTION
CLONAZEPAM 0.5MG TAB
KLONOPIN 0.5MG TAB
CLONAZEPAM 1MG TAB
KLONOPIN 1MG TAB
CLONAZEPAM 2MG TAB
KLONOPIN 2MG TAB
CLONIDINE HCL 0.1MG TAB
CATAPRES 0.1MG TAB
CLONIDINE HCL 0.2MG TAB
CATAPRES 0.2MG TAB
CLONIDINE HCL 0.3MG TAB
CATAPRES 0.3MG TAB
CLONIDINE-TTS 1 PATCH
CATAPRES-TTS 1 PATCH
CLONIDINE-TTS 2 PATCH
CATAPRES-TTS 2 PATCH
CLONIDINE-TTS 3 PATCH
CATAPRES-TTS 3 PATCH
CLOPIDOGREL 75MG TAB
PLAVIX 75MG TAB
CLOTRIMAZOLE 10MG TROCHE
MYCELEX 10MG TROCHE
CODEINE SULFATE 30MG TAB
CODEINE 30MG TAB
COLCHICINE 0.6MG TAB
COLCHICINE 0.6MG TAB
COLY-MYCIN S OTIC DROP
COLY-MYCIN S OTIC DROP
COLYTE SOLUTION 4000ML
COLYTE SOLUTION 4000ML
CONDOMS LUBRICATED/SPERMICIDAL
CONDOMS LUBRICATED/SPERM
CONJ ESTROG/MEDROXYPROG 2.5MG TAB
PREMPRO 2.5MG TAB
COREG 3.125MG TAB
CARVEDILOL 3.125MG TAB
COREG 6.25MG TAB
CARVEDILOL 6.25MG TAB
COREG 12.5MG TAB
CARVEDILOL 12.5MG TAB
COREG 25MG TAB
CARVEDILOL 25MG TAB
CYCLOBENZAPRINE 10MG TAB
FLEXERIL 10MG TAB
CYCLOPENTOL/PHENYLEPH OPTH SOL
CYCLOMYDRIL OPTH SOL
CYCLOPENTOLATE 1% OPTH DROP
CYCLOGYL 1% OPTH DROP
CYCLOSPORINE 100MG/ML SOL
SANDIMMUNE 100MG/ML SOL
DAPSONE 100MG TAB
DAPSONE 100MG TAB
DAPSONE 25MG TAB
DAPSONE 25MG TAB
DELFEN FOAM 12.5% VAGINAL
DELFEN FOAM 12.5% VAGINAL
DESIPRAMINE 10MG TAB
NORPRAMIN 10MG TAB
DESIPRAMINE 25MG TAB
NORPRAMINE 25MG TAB
DESIPRAMINE 50MG TAB
NORPRAMIN 50MG TAB
DEXAMETHASONE 0.5MG TAB
DECADRON 0.5MG TAB
DEXAMETHASONE 4MG TAB
DECADRON 4MG TAB
DIAPHRAGM ARC-SPRING 65MM
ORTHO-DIAPHRAGM ALLFLX 65
DIAPHRAGM ARC-SPRING 70MM
ORTHO-DIAPHRAGM ALLFLX 70
DIAPHRAGM ARC-SPRING 75MM
ORTHO-DIAPHRAGM ALLFLX 75
DIAPHRAGM ARC-SPRING 80MM
ORTHO-DIAPHRAGM ALLFLX 80
DIAPHRAGM ARC-SPRING 85MM
ORTHO-DIAPHRAGM ALLFLX 85
DIAZEPAM 5MG TAB
VALIUM 5MG TAB
DICLOXACILLIN 250MG CAP
PATHOCIL 250MG CAP
DICYCLOMINE 10MG CAP
BENTYL 10MG CAP
DIFLORASONE 0.05% CREAM
MAXIFLOR 0.05% CREAM
DIFLORASONE 0.05% OINT
MAXIFLOR 0.05% OINT
DIGOXIN 0.05MG/ML ELIXIR
LANOXIN 0.05MG/ML ELIXIR
DIGOXIN 0.125MG TAB
LANOXIN 0.125MG TAB
DIGOXIN 0.25MG TAB
LANOXIN 0.25MG TAB
DILTIAZEM 180MG CR CAP
TIAZAC 180MG CR CAP
DILTIAZEM 30MG TAB
CARDIZEM 30MG TAB
DILTIAZEM 60MG TAB
CARDIZEM 60MG TAB
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27
14
14
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14
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14
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
GENERIC TO BRAND
02/22/2010
**************************************************************************
GENERIC NAME
BRAND NAME
PAGE
DILTIAZEM HCL 240MG CR CAP
DILTIAZEM HCL 300MG CR CAP
DIPHENHYDRAMINE 12.5MG/5ML ELIXIR
DIPHENHYDRAMINE 25MG CAP
DIPHENOXYLATE/ATROPINE TAB
DIPIVEFRIN 0.1% OPTH DROP
DIPYRIDAMOLE 25MG TAB
DORZOLAMIDE HCL 2% OPTH DROP
DOXAZOSIN MESYLATE 1MG TAB
DOXAZOSIN MESYLATE 2MG TAB
DOXAZOSIN MESYLATE 4MG TAB
DOXYCYCLINE 100MG CAP
ECONAZOLE 1% TOPICAL CREAM
ENOXAPARIN 30MG INJ
ENOXAPARIN 40MG INJ
ENOXAPARIN 60MG INJ
ENOXAPARIN 80MG INJ
ENOXAPARIN 100MG INJ
ENOXAPARIN 120MG INJ
ERGOTAMINE 1MG/CAFF 100MG
ERYTHROMYCIN 200MG/5ML SUSP
ERYTHROMYCIN 250MG FILMTAB
ERYTHROMYCIN EYE OINT
ERYTHROMYCIN/SULFISOX ORAL SUSP
ESTROGENS, CONJ 0.625MG TAB
ESTROGENS, CONJ 1.25MG TAB
ESTROGENS, CONJ VAG CR W/APP
ETHAMBUTOL 100MG TAB
ETHAMBUTOL 400MG TAB
ETIDRONATE 200MG TAB
FERROUS SULF 325MG TAB UD
FERROUS SULF 220MG/5ML ELIXIR
FLUCONAZOLE 150MG TAB
FLUDROCORTISONE 0.1MG TAB
FLUNISOLIDE 0.025% NASAL INH
FLUOCINOLONE ACETONI 0.025% CREAM
FLUOROMETHOLONE EYE OINT
FLUPHENAZINE 5MG TAB
FLUPHENAZINE HCL 1MG TAB
FLURAZEPAM 15MG CAP
FLUTICASONE PROPIO 110MCG INHALER
FLUTICASONE PROPION 44MCG INHALER
FOLIC ACID 1MG TAB
FOSINOPRIL SODIUM 10MG TAB
FOSINOPRIL SODIUM 20MG TAB
FOSINOPRIL SODIUM 40MG TAB
FUROSEMIDE 20MG TAB
FUROSEMIDE 40MG TAB
GABAPENTIN 300MG CAP
GABAPENTIN 400MG CAP
GASTROGRAFFIN SOLUTION
GENTAMICIN 0.1% TOPICAL CREAM
TIAZAC 240MG CR CAP
TIAZAC 300MG CR CAP
BENADRYL 12.5MG/5ML ELIXIR
BENADRYL 25MG CAP
LOMOTIL TAB
PROPINE 0.1% OPTH DROP
PERSANTINE 25MG TAB
TRUSOPT 2% OPTH DROP
CARDURA 1MG TAB
CARDURA 2MG TAB
CARDURA 4MG TAB
VIBRAMYCIN 100MG CAP
SPECTAZOLE 1% TOPICAL CREAM
LOVENOX 30MG INJ
LOVENOX 40MG INJ
LOVENOX 60MG INJ
LOVENOX 80MG INJ
LOVENOX 100MG INJ
LOVENOX 120MG INJ
CAFERGOT TABLET
E.E.S. 200MG/5ML SUSP
E.E.S 250MG FILMTAB
ILOTYCIN EYE OINT
PEDIAZOLE ORAL SUSP
PREMARIN 0.625MG TAB
PREMARIN 1.25MG TAB
PREMARIN VAG CR W/APP
MYAMBUTOL 100MG TAB
MYAMBUTOL 400MG TAB
DIDRONEL 200MG TAB
FERROUS SULF 325MG TAB UD
FERROUS SULF 220MG/5ML ELIX
DIFLUCAN 150MG TAB
FLORINEF 0.1MG TAB
NASALIDE 0.025% NASAL INH
SYNEMOL 0.025% CREAM
FML EYE OINT
PROLIXIN 5MG TAB
PROLIXIN 1MG TAB
DALMANE 15MG CAP
FLOVENT 110MCG INHALER
FLOVENT 44MCG INHALER
FOLIC ACID 1MG TAB
MONOPRIL 10MG TAB
MONOPRIL 20MG TAB
MONOPRIL 40MG TAB
LASIX 20MG TAB
LASIX 40MG TAB
NEURONTIN 300MG CAP
NEURONTIN 400MG CAP
GASTROGRAFFIN SOLUTION
GARAMYCIN 0.1% TOPICAL CR
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24
24
28
14
14
15
20
20
17
17
19
26
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
GENERIC TO BRAND
02/22/2010
**************************************************************************
GENERIC NAME
BRAND NAME
PAGE
GENTAMICIN 3MG/ML OPTH DROP
GENTAMICIN SULF EYE OINT
GLIMEPERIDE 1MG TAB
GLIMEPERIDE 2MG TAB
GLIMEPERIDE 4MG TAB
GLIPIZIDE 5MG TAB
GLYBURIDE 5MG TAB
GLYBURIDE/METFORMIN 1.25/250 TAB
GLYBURIDE/METFORMIN 2.5/500 TAB
GLYBURIDE/METFORMIN 5/500 TAB
GRANULEX SPRAY
GRISEOFULVIN 125MG/5ML SUSP
GRISEOFULVIN 250MG TAB
GUAIFENSIN/CODEINE SYRUP
HALOPERIDOL 1MG TAB
HALOPERIDOL 5MG TAB
HOMATROPINE 2% OPTH DROP
HOMATROPINE 5% OPTH DROP
HOMATROPINE 5% OPTH DROP
HYDRALAZINE 25MG TAB
HYDRALAZINE 50MG TAB
HYDROCHLOROTHIAZIDE 12.5MG CAP
HYDROCHLOROTHIAZIDE 25MG TAB
HYDROCHLOROTHIAZIDE 50MG TAB
HYDROCORTISONE 1% CREAM
HYDROCORTISONE 1% OINT
HYDROCORTISONE 100MG ENEMA
HYDROCORTISONE 25MG SUPP
HYDROCORTISONE ACET 2.5% CREAM
HYDROMORPHONE 2MG TAB
HYDROXYCHLOROQUINE 200MG TAB
HYDROXYPROPYLMETH 2.5% OPTH SOL
HYDROXYUREA 500MG CAP
HYDROXYZINE 10MG/5ML SYRUP
HYDROXYZINE HCL 10MG TAB
HYDROXYZINE HCL 25MG TAB
HYPOTEARS OPTH DROP
IBUPROFEN 400MG TAB
IBUPROFEN 600MG TAB
IMIPRAMINE 25MG TAB
IMIPRAMINE HCL 10MG TAB
INDOMETHACIN 25MG CAP
INSULIN 1ML U-100 SYRINGE
INSULIN ASPART 100U/ML INJ VIAL
INSULIN ASPART INJ FLEX PEN 3x5
INSULIN GLARGINE 100U/ML VIAL
INSULIN HUMAN SEMI NPH 100U/ML VIAL
INSULIN HUMAN SEMISY L 100U/ML VIA L
INSULIN HUMAN SEMISY R 100U/ML VIA L
INSULIN HUMAN SEMISYNTH 70/30 VIAL
INSULIN(NOVOFINE) DSP 30G NEEDLE
IPRATROPIUM BR INHALER
GARAMYCIN 3MG/ML OPTH DROP
21
GARAMYCIN EYE OINT
21
AMARYL 1MG TAB
25
AMARYL 2MG TAB
25
AMARYL 4MG TAB
25
GLUCOTROL 5MG TAB
25
MICRONASE 5MG TAB
25
GLUCOVANCE 1.25/250 TAB
25
GLUCOVANCE 2.5/500 TAB
25
GLUCOVANCE 5/500 TAB
25
GRANULEX SPRAY
21
GRIFULVIN V 125MG/5ML SUSP
10
GRIFULVIN V 250MG TAB
10
ROBITUSSIN AC SYRUP
21
HALDOL 1MG TAB
18
HALDOL 5MG TAB
18
ISOPTO HOMATROPIN 2% OPTH
22
ISOPTO HOMATROPIN 5% OPTH
22
ISOPTO HOMATROPIN 5% OPTH
22
APRESOLINE 25MG TAB
15
APRESOLINE 50MG TAB
15
MICROZIDE 12.5MG CAP
20
ESIDREX 25MG TAB
20
ESIDREX 50MG TAB
20
HYDROCORTISONE 1% CREAM
27
HYDROCORTISONE 1% OINT
27
CORTENEMA 100MG ENEMA
27
ANUSOL HC 25MG SUPP
27
ANUSOL-HC 2.5% CREAM
27
DILAUDID 2MG TAB
16
PLAQUENIL 200MG TAB
11
GONIOSOL 2.5% OPTH SOL
23
HYDREA 500MG CAP
12
ATARAX 10MG/5ML SYRUP
19
ATARAX 10MG TAB
19
ATARAX 25MG TAB
19
HYPOTEARS OPTH DROP
23
MOTRIN 400MG TAB
16
MOTRIN 600MG TAB
16
TOFRANIL 25MG TAB
18
TOFRANIL 10MG TAB
18
INDOCIN 25MG CAP
16
INSULIN 1ML U-100 SYRINGE
28
NOVOLOG 100U/ML INJ VIAL
25
NOVOLOG INJ. FLEX PEN 3x5
25
LANTUS 100U/ML VIAL
25
NOVOLIN NPH 100U/ML VIAL
25
NOVOLIN LENTE 100U/ML VIAL
25
NOVOLIN REGULAR 100U/ML VIAL 25
NOVOLIN 70/30 100U/ML VIAL
25
NOVOFINE 30G DSP NEEDLE
28
ATROVENT INHALER
13
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
GENERIC TO BRAND
02/22/2010
**************************************************************************
GENERIC NAME
BRAND NAME
PAGE
ISONIAZID 100MG TAB
ISONIAZID 300MG TAB
ISONIAZID 50MG/5ML SYRUP
ISOSORBIDE MONONIT 120MG TAB
ISOSORBIDE MONONIT 30MG TAB CREAM
ISOSORBIDE MONONIT 60MG TAB CREAM
KETOCONAZOLE 2% CREAM
KETOPROFEN 50MG CAP
KETOROLAC TROM 0.5% OPTH DROP
LABETALOL 100MG TAB
LABETALOL 200MG TAB
LACRILUBE EYE OINT
LACTULOSE 10GM/15ML SYRUP
LAMOTRIGINE 100MG TAB
LAMOTRIGINE 25MG TAB
LATANOPROST 0.005% OPHTH DROP
LCD 5% IN AQUAPHOR
LEUCOVORIN CALCIUM 25MG TAB
LEUCOVORIN CALCIUM 5MG TAB
LEVOFLOXACIN 250MG TAB
LEVOFLOXACIN 500MG TAB
LEVOFLOXACIN 750MG TAB
LEVONORGESTREL 0.75MG TAB
LEVOTHYROXINE 0.025MG TAB
LEVOTHYROXINE 0.05MG TAB
LEVOTHYROXINE 0.075MG TAB
LEVOTHYROXINE 0.125MG TAB
LEVOTHYROXINE 0.15MG TAB
LEVOTHYROXINE 0.1MG TAB
LIDOCAINE 2% VISCOUS SOL
LIDOCAINE HCL 2% JELLY
LIDOCAINE HCL 5% OINT
LIOTHYRONINE 25MCG TAB
LISINOPRIL 10MG TAB
LISINOPRIL 20MG TAB
LISINOPRIL 5MG TAB
LITHIUM CARBONATE 300MG CAP
LO/OVRAL-28 TAB
LOPERAMIDE 2MG CAP
LORATADINE 10MG TAB
LORATADINE 5MG/5ML SYRUP
LORAZEPAM 0.5MG TAB
LORAZEPAM 1MG TAB
LORAZEPAM 2MG TAB
LUGOLS SOLUTION
MAALOX EXTRA STRENGTH LIQ
MAGIC MOUTHWASH SOL
MAXITROL OPTHALMIC DROP
MEBENDAZOLE 100MG CHEWABLE TAB
MECLIZINE HCL 12.5MG TAB
MECLIZINE HCL 25MG TAB
MEDROXYPROGESTERONE 10MG TAB
ISONIAZID 100MG TAB
ISONIAZID 300MG TAB
ISONIAZID 50MG/5ML SYRUP
IMDUR 120MG TAB CREAM
IMDUR 30MG TAB CREAM
IMDUR 60MG TAB CREAM
NIZORAL 2% CREAM
ORUDIS 50MG CAP
ACULAR 0.5% OPTH DROP
NORMODYNE 100MG TAB
NORMODYNE 200MG TAB
LACRILUBE S.O.P. EYE OINT
CEPHULAC 10GM/15ML SYRUP
LAMICTAL 100MG TAB
LAMICTAL 25MG TAB
XALATAN 0.005% OPHTH DROP
LCD 5% IN AQUAPHOR
WELLCOVORIN 25MG TAB
WELLCOVORIN 5MG TAB
LEVAQUIN 250MG TAB
LEVAQUIN 500MG TAB
LEVAQUIN 750MG TAB
PLAN B 0.75MG TAB
LEVOTHROID 0.025MG TAB
SYNTHROID 0.05MG TAB
SYNTHROID 0.075MG TAB
SYNTHROID 0.125MG TAB
SYNTHROID 0.15MG TAB
SYNTHROID 0.1MG TAB
LIDOCAINE 2% VISCOUS SOL
XYLOCAINE 2% JELLY
XYLOCAINE 5% OINT
CYTOMEL 25MCG TAB
ZESTRIL 10MG TAB
ZESTRIL 20MG TAB
ZESTRIL 5MG TAB
ESKALITH 300MG CAP
LO/OVRAL-28 TAB
IMODIUM 2MG CAP
CLARITIN 10MG TAB
CLARITIN 5MG/5ML SYRUP
ATIVAN 0.5MG TAB
ATIVAN 1MG TAB
ATIVAN 2MG TAB
LUGOLS SOLUTION
MAALOX EXTRA STRENGTH LIQ
MAGIC MOUTHWASH SOL
MAXITROL OPTHALMIC DROP
VERMOX 100MG CHEWABLE TAB
BONINE 12.5MG TAB
BONINE 25MG TAB
PROVERA 10MG TAB
11
11
11
16
16
16
26
16
22
15
16
23
20
17
17
23
27
28
28
12
12
12
24
26
26
26
26
26
26
22
22
27
26
15
15
15
19
24
23
10
10
19
19
19
21
23
22
21
10
23
23
25
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
GENERIC TO BRAND
02/22/2010
**************************************************************************
GENERIC NAME
BRAND NAME
PAGE
MEGESTROL 40MG TAB
MEGESTROL 40MG/ML ORAL SUSP
MELPHALAN 2MG TAB
MENTHOL 1/4% IN AQUAPHOR
MEPERIDINE 50MG TAB
METAPROTERENOL 10MG TAB
METAPROTERENOL 5% INH SOLUTION
METAPROTERENOL METERED INHALER
METFORMIN XR 500MG TAB
METFORMIN HCL 500MG TAB
METFORMIN HCL 850MG TAB
METHAZOLAMIDE 50MG TAB
METHOTREXATE 2.5MG TAB
METHYLDOPA 250MG TAB
METHYLERGONOVINE 0.2MG TAB
METHYLPHENIDATE 10MG TAB
METHYLPREDNISOLONE 4MG DOSEPACK
METHYLPREDNISOLONE 4MG TAB
METOCLOPRAMIDE 10MG TAB
METOCLOPRAMIDE 5MG/5ML SYRUP
METOLAZONE 5MG TAB
METOPROLOL 50MG TAB
METRONIDAZOLE 250MG TAB
MINOXIDIL 10MG TAB
MINOXIDIL 2.5MG TAB
MONTELUKAST 10MG TAB
MONTELUKAST 5MG CHEW TAB
MORPHINE SUL 20MG/ML-120ML SOL
MORPHINE SULFATE 20MG/ML SOL
MORPHINE SULFATE 30MG SA TAB
MUPIROCIN 2% OINT
NAPHAZOLINE 0.1% OPHTH DROP
NAPROXEN 250MG TAB
NAPROXEN 375MG TAB
NEOMYC/POLYM B/HC OTIC SUSP
NEOMYCI/BACITRACI/POLYMIX OINT
NIFEDIPINE 10MG CAP
NIFEDIPINE CC 30MG TAB
NIFEDIPINE CC 60MG TAB
NIFEDIPINE CC 90MG TAB
NITROFURANTOIN 100MG CAP
NITROFURANTOIN 50MG CAP
NITROGLYCERIN 0.2MG/HR PATCH
NITROGLYCERIN 0.4MG TAB SL
NITROGLYCERIN 0.4MG/HR PATCH
NITROGLYCERIN 0.6MG TAB SL
NITROGLYCERIN 2% OINT
NORDETTE-28 TAB
NORETHINDRONE 0.35MG TAB
NORTRIPTYLINE HCL 10MG CAP
NORTRIPTYLINE HCL 25MG CAP
NYSTATIN 100000U/GM CREAM
MEGACE 40MG TAB
MEGACE 40MG/ML ORAL SUSP
ALKERAN 2MG TAB
MENTHOL 1/4% IN AQUAPHOR
DEMEROL 50MG TAB
ALUPENT 10MG TAB
ALUPENT 5% INH SOLUTION
ALUPENT METERED INHALER
GLUCOPHAGE XR 500MG TAB
GLUCOPHAGE 500MG TAB
GLUCOPHAGE 850MG TAB
NEPTAZANE 50MG TAB
METHOTREXATE 2.5MG TAB
ALDOMET 250MG TAB
METHERGINE 0.2MG TAB
RITALIN 10MG TAB
MEDROL 4MG DOSEPAK
MEDROL 4MG TAB
REGLAN 10MG TAB
REGLAN 5MG/5ML SYRUP
DIULO 5MG TAB
LOPRESSOR 50MG TAB
FLAGYL 250MG TAB
LONITEN 10MG TAB
LONITEN 2.5MG TAB
SINGULAIR 10MG TAB
SINGULAIR 5MG CHEW TAB
ROXANOL 20MG/ML-120ML SOL
ROXANOL 20MG/ML SOLN
MS CONTIN 30MG SA TAB
BACTROBAN 2% OINT
AK CON 0.1% OPHTH DROP
NAPROSYN 250MG TAB
NAPROSYN 375MG TAB
CORTISPORIN OTIC SUSP
MYCITRACIN OINT
PROCARDIA 10MG CAP
ADALAT CC 30MG TAB
ADALAT CC 60MG TAB
ADALAT CC 90MG TAB
MACRODANTIN 100MG CAP
MACRODANTIN 50MG CAP
TRANSDERM-NITRO 0.2MG/HR
NITROSTAT 0.4MG TAB SL
NITRO-DUR 0.4MG/HR PATCH
NITROSTAT 0.6MG TAB SL
NITROL 2% OINT
NORDETTE-28 TAB
MICRONOR 0.35MG TAB
PAMELOR 10MG CAP
PAMELOR 25MG CAP
NILSTAT 100000U/GM CREAM
12
12
12
27
16
13
13
13
25
25
25
22
12
16
26
18
24
24
24
24
20
15
12
16
16
28
28
17
17
17
26
23
16
16
21
26
15
15
15
15
12
12
16
16
16
16
16
24
24
18
18
26
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
GENERIC TO BRAND
02/22/2010
**************************************************************************
GENERIC NAME
NYSTATIN 100000U/GM OINT
NYSTATIN 100000U/ML SUSP
OFLOXACIN OTIC 0.3% DROP
OMEPRAZOLE OTC 20MG TAB 14’s
OMEPRAZOLE OTC 20MG TAB 28’s
ORTHO EVRA PATCH
ORTHO NOVUM-1/35 28 DAY
ORTHO NOVUM-777 28 DAY TAB
ORTHO-NOVUM 1/50 28 DAY
OXYBUTYNIN 5MG TAB
OXYCODONE 5/ACETAMIN 325MG TAB
PANCRELIPASE CAP
PAPAIN-UREA 1.1MU-100MG/GM OINT
PAREGORIC LIQ
PENICILLAMINE 250MG CAP
PENICILLIN VK 250MG TAB
PENICILLIN VK 250MG/5ML SUSP
PENTOXIFYLLINE 400MG TAB SA
PERMETHRIN 1% CREME RINSE
PERMETHRIN 5% CREAM
PHENAZOPYRIDINE 100MG TAB
PHENOBARBITAL 20MG/5ML ELIXIR
HENOBARBITAL 30MG TAB
PHENYLEPHRINE 2.5% OPTH DROP
PHENYTOIN 100MG CAP
PHENYTOIN 125MG/5ML SUSP
PHENYTOIN 50MG TAB
PHENYTOIN SOD 30MG SR CAP
PHYTONADIONE 5MG TAB
PILOCARPINE 2% OPTH DROP
PILOCARPINE 4% EYE GEL
PILOCARPINE 4% OPTH DROP
PIOGLITAZONE 15MG TAB
PIOGLITAZONE 30MG TAB
PIOGLITAZONE 45MG TAB
PIROXICAM 10MG CAP
PIROXICAM 20MG CAP
POTASSIUM CHLORIDE 10% SOL
POTASSIUM CHLORIDE 20MEQ PKT
POTASSIUM CHLORIDE 20MEQ TAB
POTASSIUM CL 10MEQ SA TAB
PREDNISOLONE ACET 1% OPTH DROP
PREDNISONE 20MG TAB
PREDNISONE 5MG TAB
PREDNISONE 5MG/5ML ORAL SOL
PRIMAQUINE 26.3MG TAB
PRIMIDONE 250MG TAB
PROBENECID 500MG TAB
PROCAINAMIDE 250MG CAP
PROCAINAMIDE SR 500MG TAB
PROCHLORPERAZINE 25MG SUP
PROCHLORPERAZINE 5MG TAB
BRAND NAME
NILSTAT 100000U/GM OINT
NILSTAT 100000U/ML SUSP
FLOXIN OTIC 0.3% DROP
PRILOSEC OTC 20MG TAB 14’s
PRILOSEC OTC 20MG TAB 28’s
ORTHO EVRA PATCH
ORTHO NOVUM-1/35 28 DAY
ORTHO NOVUM-777 28 DAY TAB
ORTHO-NOVUM 1/50 28 DAY
DITROPAN 5MG TAB
PERCOCET 5/325MG TAB
COTAZYM CAP
ACCUZYME TROPICAL OINT
PAREGORIC LIQ
CUPRIMINE 250MG CAP
PENICILLIN VK 250MG TAB
LEDERCILLIN VK 250MG/5ML
TRENTAL 400MG TAB SA
NIX 1% CREME RINSE LIQUID
ELIMITE 5% CREAM
PYRIDIUM 100MG TAB
PHENOBARBITAL 20MG/5ML ELIXIR
PHENOBARBITAL 30MG TAB
NEOSYNEPHRINE 2.5% OPTH DROP
DILANTIN 100MG CAP
DILANTIN 125MG/5ML SUSP
DILANTIN 50MG TAB
DILANTIN 30MG SR CAP
MEPHYTON 5MG TAB
PILOCAR 2% OPTH DROP
PILOPINE HS 4% EYE GEL
PILOCAR 4% OPTH DROP
ACTOS 15MG TAB
ACTOS 30MG TAB
ACTOS 45MG TAB
FELDENE 10MG CAP
FELDENE 20MG CAP
POTASSIUM CHLORIDE 10% SOL
KLOR 20MEQ PKT
KLORVESS 20MEQ TAB
TEN-K 10MEQ SA TAB
PRED FORTE 1% OPTH DROP
DELTASONE 20MG TAB
DELTASONE 5MG TAB
PREDNISONE 5MG/5ML ORAL SOL
PRIMAQUINE 26.3MG TAB
MYSOLINE 250MG TAB
BENEMID 500MG TAB
PROCAN 250MG CAP
PROCAN SR 500MG TAB
COMPAZINE 25MG SUPP
COMPAZINE 5MG TAB
PAGE
26
10
21
24
24
24
24
25
25
27
17
23
27
23
24
11
11
14
26
26
27
18
18
23
17
17
17
17
28
22
22
22
25
25
25
16
16
20
20
20
20
22
24
24
24
11
17
21
15
15
24
24
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
GENERIC TO BRAND
02/22/2010
**************************************************************************
GENERIC NAME
BRAND NAME
PROMETHAZINE HCL 25MG SUPP
PHENERGAN 25MG SUPP
PROMETHAZINE HCL 50MG SUPP
PHENERGAN 50MG SUPP
PROPANTHELINE 15MG TAB
PROBANTHINE 15MG TAB
PROPARACAINE 0.5% OPTH DROP
OPHTHETIC 0.5% OPTH DROP
PROPRANOLOL 10MG TAB
INDERAL 10MG TAB
PROPRANOLOL 40MG TAB
INDERAL 40MG TAB
PROPRANOLOL LA 120MG CAP
INDERAL LA 120MG CAP
PROPRANOLOL LA 160MG CAP
INDERAL LA 160MG CAP
PROPRANOLOL LA 80MG CAP
INDERAL LA 80 MG CAP
PSEUDOEPHED/CARBINOX DM DROP
RONDEC DM DROP
PROPYLTHIOURACIL 50MG TAB
PROPYLTHIOURACIL 50MG TAB
PYRAZINAMIDE 500MG TAB
PYRAZINAMIDE 500MG TAB
PSEUDOEPHED/CARBINOX DM SYRUP
RONDEC DM SYRUP
PYRIDOSTIGMINE 60MG TAB
MESTINON 60MG TAB
PYRIDOXINE 50MG TAB
VITAMIN B-6 50MG TAB
PYRIMETHAMINE 25MG TAB
DARAPRIM 25MG TAB
QUINIDINE GLUCONATE 324MG
QUINAGLUTE 324MG TAB
QUINIDINE SULFATE 200MG TAB
QUINORA 200MG TAB
RANITIDINE 150MG TAB
ZANTAC 150MG TAB
PIPERONYL/PYRETHRIN LIQUID
RID LIQUID
RIFAMPIN 300MG CAP
RIMACTANE 300MG CAP
SALICYLIC ACID 5% IN AQUAPHOR
SALICYLIC ACID 5% IN AQUAPH
SALMETEROL XINAFOATE DISKUS 50MCG INH
SEREVENT DISKUS 50MCG INH
SALMETROL-FLUTICASON 100/50 DISK INH
ADVAIR 100/50 DISK INH
SALMETROL-FLUTICASON 250/50 DISK INH
ADVAIR 250/50 DISK INH
SALMETROL-FLUTICASON 500/50 DISK INH
ADVAIR 500/50 DISK INH
SCOPOLAMINE 0.25% OPTH DROP
ISOPTO HYOSCIN 0.25% OPTH
SELENIUM 2.5% LOTION SHAMPOO
SELSUN 2.5% LOTION SHAMPOO
SERTRALINE 50MG TAB
ZOLOFT 50MG TAB
SERTRALINE HCL 100MG TAB
ZOLOFT 100MG TAB
SILVER SULFADIAZINE 1% CREAM
SSD 1% CREAM
SIMVASTATIN 5MG TAB
ZOCOR 5MG TAB
SIMVASTATIN 10MG TAB
ZOCOR 10MG TAB
SIMVASTATIN 20MG TAB
ZOCOR 20MG TAB
SIMVASTATIN 40MG TAB
ZOCOR 40MG TAB
SIMVASTATIN 80MG TAB
ZOCOR 80MG TAB
SOD POLYSTYRENE SULF 15GM
SOD POLYSTYRENE SULF 15GM
SODIUM BICARBONATE 650MG TAB
SODIUM BICARBONATE 650MG
SODIUM CHLORIDE 5% OPTH DROP
ADSORBONAC 5% OPTH DROP
SPIRONOLACTONE 25MG TAB
ALDACTONE 25MG TAB
SPIRONOLACTONE/HCTZ 25/25 TAB
ALDACTAZIDE 25/25 TAB
STUARTNATAL 1+1 TABLET
STUARTNATAL 1+1 TABLET
SUCCIMER 100MG CAP
CHEMET 100MG CAP
SUCRALFATE 1GM TAB
CARAFATE 1GM TAB
SULFACETAMIDE 10% OPTH DROP
SULAMYD 10% OPTH DROP
SULFADIAZINE 500MG TAB
SULFADIAZINE 500MG TAB
SULFAMETH 200/TRIMETH 40MG/5ML SUSP
BACTRIM PEDIATRIC ORAL SUSP
SULFAMETH 800/TRIMET 160MG TAB
BACTRIM DS TAB
SULFASALAZINE 500MG TAB
AZULFIDINE 500MG TAB
SULINDAC 150MG TAB
CLINORIL 150MG TAB
SULINDAC 200MG TAB
CLINORIL 200MG TAB
SUMATRIPTAN 25MG TAB
IMITREX 25MG TAB
PAGE
10
10
13
22
15
15
15
15
15
21
26
11
21
13
28
11
15
15
24
26
11
27
13
13
13
13
22
27
18
18
27
15
15
15
15
15
20
23
23
20
20
28
24
24
21
12
12
12
12
16
16
19
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
GENERIC TO BRAND
02/22/2010
**************************************************************************
GENERIC NAME
BRAND NAME
SUMATRIPTAN 50MG TAB
IMITREX 50MG TAB
SUMATRIPTAN 100MG TAB
IMITREX 100MG TAB
TAMOXIFEN 10MG TAB
NOLVADEX 10MG TAB
TELMISARTAN 40MG TAB
MICARDIS 40MG TAB
TELMISARTAN 80MG TAB
MICARDIS 80MG TAB
TERBUTALINE 2.5MG TAB
BRETHINE 2.5MG TAB
TERBUTALINE 5MG TAB
BRETHINE 5MG TAB
TERCONAZOLE VAG 0.4% CREAM
TERAZOL-7 VAG CREAM
TERCONAZOLE VAG 0.8% CREAM
TERAZOL-3 VAG CREAM
TETRACYCLINE 250MG CAP
SUMYCIN 250MG CAP
THEOPHYLLINE 200MG TAB SR
THEODUR 200MG TAB SR
THEOPHYLLINE 300MG TAB SR
THEODUR 300MG TAB SR
THEOPHYLLINE 80MG/15ML ELIXIR
ELIXOPHYLLIN 80MG/15ML ELIX
THIAMINE 100MG TAB
THIAMINE 100MG TAB
THIORIDAZINE 100MG TAB
MELLARIL 100MG TAB
THIORIDAZINE 25MG TAB
MELLARIL 25MG TAB
TIMOLOL 0.5% OPTH DROP
TIMOPTIC 0.5% OPTH DROP
TOBRAMYCIN 0.3% EYE OINT
TOBREX 0.3% EYE OINT
TOBRAMYCIN 0.3% OPTH DROP
TOBREX 0.3% OPTH DROP
TOBRAMYCIN/DEXAMETHA OPTH DROP
TOBRADEX OPTH DROP
TOBRAMYCIN/DEXMETHA EYE OINT
TOBRADEX EYE OINT
TOLMETIN 400MG DS CAP
TOLECTIN DS 400MG CAP
TRIAMCINOLONE 0.1% PASTE
KENALOG IN ORABASE 0.1% P
TRIAMTERENE 37.5/HCTZ 25 TAB
MAXZIDE 37.5MG/25MG TAB
TRIFLUOPERAZINE 5MG TAB
STELAZINE 5MG TAB
TRIFLURIDINE 1% OPTH DROP
VIROPTIC 1% OPTH DROP
RIMETHOBENZAMIDE 100MG SUPP
TIGAN 100MG SUPP
TRIMETHOBENZAMIDE 200MG SUPP
TIGAN 200MG SUPP
TRIMETHOPRIM 100MG TAB
TRIMPEX 100MG TAB
TRIMETHOPRIM/POLYMIX OPTH
POLYTRIM OPHTHALMIC DROP
TRIPHASIL-28 TAB
TRIPHASIL-28 TAB
TROPICAMIDE 1% OPTH DROP
MYDRIACYL 1% OPTH DROP
VALPROIC ACID 250MG CAP
DEPAKENE 250MG CAP
VERAPAMIL 120MG TAB
CALAN 120MG TAB
VERAPAMIL 240MG CAP SA
VERELAN 240MG CAP SA
VERAPAMIL 80MG TAB
CALAN 80MG TAB
VIT B COMPLX/VIT C/PLUS FE TAB
NEPHRO-VITE PLUS IRON TAB
VITAMIN D 1000 UNIT TAB
VITAMIN D 1000 UNIT TAB
WARFARIN SODIUM 1MG TAB
COUMADIN 1MG TAB
WARFARIN SODIUM 2.5MG TAB
COUMADIN 2.5MG TAB
WARFARIN SODIUM 3MG TAB
COUMADIN 3MG TAB
WARFARIN SODIUM 4MG TAB
COUMADIN 4MG TAB
WARFARIN SODIUM 5MG TAB
COUMADIN 5MG TAB
**** REPORT COMPLETED ****
PAGE
19
19
12
16
16
13
13
26
26
11
28
28
28
28
18
18
23
21
21
21
21
16
27
20
18
21
24
24
12
21
25
22
17
15
15
15
28
28
14
14
14
14
14
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
BRAND TO GENERIC
02/22/2010
*************************************************************************
BRAND NAME
GENERIC NAME
ACTOS 15MG TAB
ACTOS 30MG TAB
ACTOS 45MG TAB
ACCUZYME TOPICAL OINT
ACULAR 0.5% OPTH DROP
ADALAT CC 30MG TAB
ADALAT CC 60MG TAB
ADALAT CC 90MG TAB
ADSORBONAC 5% OPTH DROP
ADVAIR 100/50 DISK INH
ADVAIR 250/50 DISK INH
ADVAIR 500/50 DISK INH
AK CON 0.1% OPHTH DROP
ALDACTAZIDE 25/25 TAB
ALDACTONE 25MG TAB
ALDOMET 250MG TAB
ALKERAN 2MG TAB
ALPHAGAN 0.2% OPHTH DROP
ALUPENT 10MG TAB
ALUPENT 5% INH SOLUTION
ALUPENT METERED INHALER
AMARYL 1MG TAB
AMARYL 2MG TAB
AMARYL 4MG TAB
AMINOPHYLLINE 200MG TAB
AMOXICILLIN 250MG CAP
AMOXICILLIN 500MG CAP
ANUSOL HC 25MG SUPP
ANUSOL-HC 2.5% CREAM
APRESOLINE 25MG TAB
APRESOLINE 50MG TAB
ASPIRIN 81MG EC TAB
ATARAX 10MG TAB
ATARAX 10MG/5ML SYRUP
ATARAX 25MG TAB
ATIVAN 0.5MG TAB
ATIVAN 1MG TAB
ATIVAN 2MG TAB
ATROPINE 1% OPTH DROP
ATROVENT INHALER
AUGMENTIN 125 SUSP
AUGMENTIN 250 SUSP
AUGMENTIN 250MG TAB
AUGMENTIN 500MG TAB
AUGMENTIN 875MG TAB
AURALGAN EAR DROP
AZULFIDINE 500MG TAB
BACITRACIN 500U/GM EYE OINT
BACTRIM DS TAB
BACTRIM PEDIATRIC ORAL SUSP
BACTROBAN 2% OINT
PIOGLITAZONE 15MG TAB
PIOGLITAZONE 30MG TAB
PIOGLITAZONE 45MG TAB
PAPAIN-UREA 1.lMU-100MG/GM OINT
KETOROLAC TROM 0.5% OPTH DROP
NIFEDIPINE CC 30MG TAB
NIFEDIPINE CC 60MG TAB
NIFEDIPINE CC 90MG TAB
SODIUM CHLORIDE 5% OPTH DROP
SALMTROL-FLUTCASON 100/50 DISK INH
SALMTROL-FLUTCASON 250/50 DISK INH
SALMTROL-FLUTCASON 500/50 DISK INH
NAPHAZOLINE 0.1% OPHTH DROPS
SPIRONOLACTONE/HCTZ 25/25 TAB
SPIRONOLACTONE 25MG TAB
METHYLDOPA 250MG TAB
MELPHALAN 2MG TAB
BRIMONIDINE 0.2% OPHTH DROP
METAPROTERENOL 10MG TAB
METAPROTERENOL 5% INH SOLUTION
METAPROTERENOL METERED INHALER
GLIMEPERIDE 1MG TAB
GLIMEPERIDE 2MG TAB
GLIMEPERIDE 4MG TAB
AMINOPHYLLINE 200MG TAB
AMOXICILLIN 250MG CAP
AMOXICILLIN 500MG CAP
HYDROCORTISONE 25MG SUPP
HYDROCORTISONE ACET 2.5% CREAM
HYDRALAZINE 25MG TAB
HYDRALAZINE 50MG TAB
ASPIRIN 81MG EC TAB
HYDROXYZINE HCL 10MG TAB
HYDROXYZINE 10MG/5ML SYRUP
HYDROXYZINE HCL 25MG TAB
LORAZEPAM 0.5MG TAB
LORAZEPAM 1MG TAB
LORAZEPAM 2MG TAB
ATROPINE 1% OPTH DROP
IPRATROPIUM BR INHALER
AMOXICILLIN 125/CLAV 31.2 SUSP
AMOXICILLIN 250/CLAV 62.5 SUSP
AMOXICILLIN 250/CLAV 125 TAB
AMOXICILLIN 500/CLAV 125 TAB
AMOXICILLIN 875/CLAV 125 TAB
AURALGAN EAR DROP
SULFASALAZINE 500MG TAB
BACITRACIN 500U/GM EYE OINT
SULFAMETH 800/TRIMET 160MG/5ML TAB
SULFAMETH 200/TRIMET 40MG/5ML SUSP
MUPIROCIN 2% OINT
PAGE
25
25
25
27
22
15
15
15
23
13
13
13
23
20
20
16
12
23
13
13
13
25
25
25
28
11
11
27
27
15
15
16
19
19
19
19
19
19
22
13
10
11
11
11
11
22
12
21
12
12
26
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
BRAND TO GENERIC
02/22/2010
*************************************************************************
BRAND NAME
GENERIC NAME
BENADRYL 12.5MG/5ML ELIXIR
BENADRYL 25MG CAP
BENEMID 500MG TAB
BENTYL 10MG CAP
BETOPTIC S 0.25% OPTH DROP
BIAXIN 250MG TAB
BIAXIN 500MG TAB
BICITRA SUGAR FREE SOLUTION
BONINE 12.5MG TAB
BONINE 25MG TAB
BRETHINE 2.5MG TAB
BRETHINE 5MG TAB
BUMEX 1MG TAB
CAFERGOT TAB
CALAN 120MG TAB
CALAN 80MG TAB
CALCIUM CARBONATE 650MG TAB
CAPOTEN 12.5MG TAB
CAPOTEN 25MG TAB
CARAFATE 1GM TAB
CARDIZEM 30MG TAB
CARDIZEM 60MG TAB
CARDURA 1MG TAB
CARDURA 2MG TAB
CARDURA 4MG TAB
CATAPRES 0.1MG TAB
CATAPRES 0.2MG TAB
CATAPRES 0.3MG TAB
CATAPRES-TTS 1 PATCH
CATAPRES-TTS 2 PATCH
CATAPRES-TTS 3 PATCH
CEPHULAC 10GM/15ML SYRUP
CERUMENEX 10% EAR DROP
CETACAINE 56GM SPRAY
CHEMET 100MG CAP
CILOXAN 0.3% EYE OINT
CILOXAN 0.3% OPTH DROP
CIPRO 250MG TAB
CIPRO 500MG TAB
CIPRO 750MG TAB
CLARITIN 10MG TAB
CLARITIN 5MG/5ML SYRUP
CLEOCIN 150MG CAP
CLEOCIN T 1% SOLUTION
CLINORIL 150MG TAB
CLINORIL 200MG TAB
CODEINE 30MG TAB
COGENTIN 1MG TAB
COGENTIN 2MG TAB
COLCHICINE 0.6MG TAB
COLY-MYCIN S OTIC DROP
COLYTE SOLUTION 4000ML
DIPHENHYDRAMINE 12.5MG/5ML ELIXIR
DIPHENHYDRAMINE 25MG CAP
PROBENECID 500MG TAB
DICYCLOMINE 10MG CAP
BETAXOLOL HCL 0.25% OPTH
CLARITHROMYCIN 250MG TAB
CLARITHROMYCIN 500MG TAB
BICITRA SUGAR FREE SOLUTION
MECLIZINE HCL 12.5MG TAB
MECLIZINE HCL 25MG TAB
TERBUTALINE 2.5MG TAB
TERBUTALINE 5MG TAB
BUMETANIDE 1MG TAB
ERGOTAMINE 1MG/CAFF 100MG
VERAPAMIL 120MG TAB
VERAPAMIL 80MG TAB
CALCIUM CARBONATE 650MG TAB
CAPTOPRIL 12.5MG TAB
CAPTOPRIL 25MG TAB
SUCRALFATE 1GM TAB
DILTIAZEM 30MG TAB
DILTIAZEM 60MG TAB
DOXAZOSIN MESYLATE 1MG TAB
DOXAZOSIN MESYLATE 2MG TAB
DOXAZOSIN MESYLATE 4MG TAB
CLONIDINE HCL 0.1MG TAB
CLONIDINE HCL 0.2MG TAB
CLONIDINE HCL 0.3MG TAB
CLONIDINE-TTS 1 PATCH
CLONIDINE-TTS 2 PATCH
CLONIDINE-TTS 3 PATCH
LACTULOSE 10GM/15ML SYRUP
CERUMENEX 10% EAR DROP
CETACAINE 56GM SPRAY
SUCCIMER 100MG CAP
CIPROFLOXACIN 0.3% EYE OINT
CIPROFLOXACIN 0.3% OPTH DRP
CIPROFLOXACIN HCL 250MG TAB
CIPROFLOXACIN HCL 500MG TAB
CIPROFLOXACIN HCL 750MG TAB
LORATADINE 10MG TAB
LORATADINE 5MG/5ML SYRUP
CLINDAMYCIN 150MG CAP
CLINDAMYCIN T 1% SOLUTION
SULINDAC 150MG TAB
SULINDAC 200MG TAB
CODEINE SULFATE 30MG TAB
BENZTROPINE 1MG TAB
BENZTROPINE 2MG TAB
COLCHICINE 0.6MG TAB
COLY-MYCIN S OTIC DROP
COLYTE SOLUTION 4000ML
PAGE
10
10
21
13
23
10
10
20
23
23
13
13
20
13
15
15
20
14
14
24
14
14
15
15
15
15
15
15
15
15
15
20
23
27
24
21
21
12
12
12
10
10
11
26
16
16
16
13
13
28
21
23
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
BRAND TO GENERIC
02/22/2010
*************************************************************************
BRAND NAME
GENERIC NAME
PAGE
COMBIVENT INHALER
COMPAZINE 25MG SUPP
COMPAZINE 5MG TAB
CONDOMS LUBRICATED/SPERMICIDAL
CORDARONE 200MG TAB
CORTENEMA 100MG ENEMA
CORTISPORIN OTIC SUSP
COTAZYM CAP
COUMADIN 1MG TAB
COUMADIN 2.5MG TAB
COUMADIN 3MG TAB
COUMADIN 4MG TAB
COUMADIN 5MG TAB
CUPRIMINE 250MG CAP
CYCLOGYL 1% OPTH DROP
CYCLOMYDRIL OPTH SOLUTION
CYTOMEL 25MCG TAB
DALMANE 15MG CAP
DAPSONE 100MG TAB
DAPSONE 25MG TAB
DARAPRIM 25MG TAB
DECADRON 0.5MG TAB
DECADRON 4MG TAB
DELFEN FOAM 12.5% VAGINAL
DELTASONE 20MG TAB
DELTASONE 5MG TAB
DEMEROL 50MG TAB
DEPAKENE 250MG CAP
DIAMOX 250MG TAB
DIAMOX SEQUELS 500MG CAP
DIDRONEL 200MG TAB
DIFLUCAN 150MG TAB
DILANTIN 100MG CAP
DILANTIN 125MG/5ML SUSP
DILANTIN 50MG TAB
DILANTIN 30MG SR CAP
DILAUDID 2MG TAB
DITROPAN 5MG TAB
DIULO 5MG TAB
DULCAGEN 10MG SUPP
E.E.S 250MG FILMTAB
E.E.S. 200MG/5ML SUSP
ELAVIL 10MG TAB
ELAVIL 25MG TAB
ELAVIL 50MG TAB
ELIMITE 5% CREAM
ELIXOPHYLLIN 80MG/15ML ELIXIR
ESIDREX 25MG TAB
ESIDREX 50MG TAB
ESKALITH 300MG CAP
FELDENE 10MG CAP
FELDENE 20MG CAP
ALBUTEROL/IPRATROPIUM INH
PROCHLORPERAZINE 25MG SUPP
PROCHLORPERAZINE 5MG TAB
CONDOMS LUBRICATED/SPERMICIDAL
AMIODARONE 200MG TAB
HYDROCORTISONE 100MG ENEMA
NEOMYC/POLYM B/HC OTIC SUSP
PANCRELIPASE CAP
WARFARIN SODIUM 1MG TAB
WARFARIN SODIUM 2.5MG TAB
WARFARIN SODIUM 3MG TAB
WARFARIN SODIUM 4MG TAB
WARFARIN SODIUM 5MG TAB
PENICILLAMINE 250MG CAP
CYCLOPENTOLATE 1% OPTH DROP
CYCLOPENTOL/PHENYLEPH OPTH SOL
LIOTHYRONINE 25MCG TAB
FLURAZEPAM 15MG CAP
DAPSONE 100MG TAB
DAPSONE 25MG TAB
PYRIMETHAMINE 25MG TAB
DEXAMETHASONE 0.5MG TAB
DEXAMETHASONE 4MG TAB
DELFEN FOAM 12.5% VAGINAL
PREDNISONE 20MG TAB
PREDNISONE 5MG TAB
MEPERIDINE 50MG TAB
VALPROIC ACID 250MG CAP
ACETAZOLAMIDE 250MG TAB
ACETAZOLAMIDE 500MG CAP
ETIDRONATE 200MG TAB
FLUCONAZOLE 150MG TAB
PHENYTOIN 100MG CAP
PHENYTOIN 125MG/5ML SUSP
PHENYTOIN 50MG TAB
PHENYTOIN SOD 30MG SR CAP
HYDROMORPHONE 2MG TAB
OXYBUTYNIN 5MG TAB
METOLAZONE 5MG TAB
BISACODYL 10MG SUPP
ERYTHROMYCIN 250MG FILMTAB
ERYTHROMYCIN 200MG/5ML SUSP
AMITRIPTYLINE 10MG TAB
AMITRIPTYLINE 25MG TAB
AMITRIPTYLINE HCL 50MG TAB
PERMETHRIN 5% CREAM
THEOPHYLLINE 80MG/15ML ELIXIR
HYDROCHLOROTHIAZIDE 25MG TAB
HYDROCHLOROTHIAZIDE 50MG TAB
LITHIUM CARBONATE 300MG CAP
PIROXICAM 10MG CAP
PIROXICAM 20MG CAP
13
24
24
19
14
27
21
23
14
14
14
14
14
24
22
22
26
19
12
12
11
24
24
19
24
24
16
17
22
22
28
10
17
17
17
17
16
27
20
23
10
10
18
18
18
26
28
20
20
19
16
16
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
BRAND TO GENERIC
02/22/2010
*************************************************************************
BRAND NAME
FERROUS SULF 325MG TAB UD
FERROUS SULF 220MG/5ML ELIXIR
FIORINAL TAB
FLAGYL 250MG TAB
FLEXERIL 10MG TAB
FLORINEF 0.1MG TAB
FLOVENT 110MCG INHALER
FLOVENT 44MCG INHALER
FLOXIN OTIC 0.3% DROP
FML EYE OINT
FOLIC ACID 1MG TAB
FOSAMAX 35MG TAB
FOSAMAX 70MG TAB
GARAMYCIN 0.1% TOPICAL CREAM
GARAMYCIN 3MG/ML OPTH DROP
GARAMYCIN EYE OINT
GASTROGRAFFIN SOLUTION
GLUCOPHAGE 500MG TAB
GLUCOPHAGE 850MG TAB
GLUCOPHAGE XR 500MG TAB
GLUCOTROL 5MG TAB
GLUCOVANCE 1.25/250 TAB
GLUCOVANCE 2.5/500 TAB
GLUCOVANCE 5/500MG TAB
GONIOSOL 2.5% OPTH SOLUTION
GRANULEX SPRAY
GRIFULVIN V 125MG/5ML SUSP
GRIFULVIN V 250MG TAB
HALDOL 1MG TAB
HALDOL 5MG TAB
HYDREA 500MG CAP
HYDROCORTISONE 1% CREAM
HYDROCORTISONE 1% OINT
HYPOTEARS OPTH DROP
ILOTYCIN EYE OINT
IMDUR 120MG TAB CR
IMDUR 30MG TAB CR
IMDUR 60MG TAB CR
IMITREX 25MG TAB
IMITREX 50MG TAB
IMITREX 100MG TAB
IMODIUM 2MG CAP
IMURAN 50MG TAB
INDERAL 10MG TAB
INDERAL 40MG TAB
INDERAL LA 120MG CAP
INDERAL LA 160MG CAP
INDERAL LA 80MG CAP
INDOCIN 25MG CAP
INSULIN 1ML U-100 SYRINGE
ISONIAZID 100MG TAB
ISONIAZID 300MG TAB
GENERIC NAME
PAGE
FERROUS SULF 325MG TAB UD
14
FERROUS SUL 220MG/5ML ELIX
14
BUTAL 50/CAFF 40/ASA 325 TAB 16
METRONIDAZOLE 250MG TAB
12
CYCLOBENZAPRINE 10MG TAB
13
FLUDROCORTISONE 0.1MG TAB
24
FLUTICASONE PROPIO 110 INH
24
FLUTICASONE PROPION 44 INH
24
OFLOXACIN OTIC 0.3% DROP
21
FLUOROMETHOLONE EYE OINT
22
FOLIC ACID 1MG TAB
28
ALENDRONATE 35MG TAB
28
ALENDRONATE 70MG TAB
28
GENTAMICIN 0.1% TOPICAL CR
26
GENTAMICIN 3MG/ML OPTH DROP 21
GENTAMICIN SULF EYE OINT
21
GASTROGRAFFIN SOLUTION
19
METFORMIN HCL 500MG TAB
25
METFORMIN HCL 850MG TAB
25
METFORMIN XR 500MG TAB
25
GLIPIZIDE 5MG TAB
25
GLYBUR/METFORM 1.25/250 TAB 25
GLYBUR/METFORMN 2.5/500 TAB 25
GLYBURID/METFORMN 5/500 TAB 25
HYDROXYPROPYLMETH 2.5% OPTH 23
GRANULEX SPRAY
21
GRISEOFULVIN 125MG/5ML SUSP 10
GRISEOFULVIN 250MG TAB
10
HALOPERIDOL 1MG TAB
18
HALOPERIDOL 5MG TAB
18
HYDROXYUREA 500MG CAP
12
HYDROCORTISONE 1% CREAM
27
HYDROCORTISONE 1% OINT
27
HYPOTEARS OPTH DROP
23
ERYTHROMYCIN EYE OINT
21
ISOSORBIDE MONONIT 120MG
16
ISOSORBIDE MONONIT 30MG TAB 16
ISOSORBIDE MONONIT 60MG TAB 16
SUMATRIPTAN 25MG TAB
19
SUMATRIPTAN 50MG TAB
19
SUMATRIPTAN 100MG TAB
19
LOPERAMIDE 2MG CAP
23
AZATHIOPRINE 50MG TAB
28
PROPRANOLOL 10MG TAB
15
PROPRANOLOL 40MG TAB
15
PROPRANOLOL LA 120MG CAP
15
PROPRANOLOL LA 160MG CAP
15
PROPRANOLOL LA 80MG CAP
15
INDOMETHACIN 25MG CAP
16
INSULIN 1ML U-100 SYRINGE
28
ISONIAZID 100MG TAB
11
ISONIAZID 300MG TAB
11
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
BRAND TO GENERIC
02/22/2010
*************************************************************************
BRAND NAME
GENERIC NAME
PAGE
ISONIAZID 50MG/5ML SYRUP
ISOPTO HOMATROPIN 2% OPTH SUSP
ISONIAZID 50MG/5ML SYRUP
ISOPTO HOMATROPIN 2% OPTH SUSP
ISOPTO HOMATROPIN 5% OPTH SUSP
ISOPTO HYOSCIN 0.25% OPTH SUSP
KEFLEX 125MG/5ML ORAL SUSP
KEFLEX 250MG CAP
KEFLEX 500MG CAP
KENALOG IN ORABASE 0.1% PASTE
KLONOPIN 0.5MG TAB
KLONOPIN 1MG TAB
KLONOPIN 2MG TAB
KLOR 20MEQ PKT
KLORVESS 20MEQ TAB
LACRILUBE S.O.P. EYE OINT
LAMICTAL 100MG TAB
LAMICTAL 25MG TAB
LANOXIN 0. 05MG/ML ELIXIR
LANOXIN 0.125MG TAB
LANOXIN 0.25MG TAB
LANTUS 100U/ML VIAL
LASIX 20MG TAB
LASIX 40MG TAB
LCD 5% IN AQUAPHOR
LEDERCILLIN VK 250MG/5ML SUSP
LEUKERAN 2MG TAB
LEVAQUIN 250 MG TAB
LEVAQUIN 500 MG TAB
LEVAQUIN 750 MG TAB
LEVOTHROID 0.025MG TAB
LIBRIUM 10MG CAP
LIBRIUM 25MG CAP
LIBRIUM 5MG CAP
LIDOCAINE 2% VISCOUS SOLUTION
LIORESAL 10MG TAB
LIPITOR 80MG TAB
LO/OVRAL-28 TAB
LOMOTIL TAB
LONITEN 10MG TAB
LONITEN 2.5MG TAB
LOPRESSOR 50MG TAB
LOVENOX 30MG INJ
LOVENOX 40MG INJ
LOVENOX 60MG INJ
LOVENOX 80MG INJ
LOVENOX 100MG INJ
LOVENOX 120MG INJ
LUGOLS SOLUTION
MAALOX EXTRA STRENGTH LIQ
MACRODANTIN 100MG CAP
MACRODANTIN 50MG CAP
ISONIAZID 50MG/5ML SYRUP
HOMATROPINE 2% OPTH DROP
ISONIAZID 50MG/5ML SYRUP
HOMATROPINE 2% OPTH DROP
HOMATROPINE 5% OPTH DROP
SCOPOLAMINE 0.25% OPTH DROP
CEPHALEXIN 125MG/5ML ORAL
CEPHALEXIN 250MG CAP
CEPHALEXIN 500MG CAP
TRIAMCINOLONE 0.1% PASTE
CLONAZEPAM 0.5MG TAB
CLONAZEPAM 1MG TAB
CLONAZEPAM 2MG TAB
POTASSIUM CHLORIDE 20MEQ
POTASSIUM CHLORIDE 20MEQ
LACRILUBE EYE OINT
LAMOTRIGINE 100MG TAB
LAMOTRIGINE 25MG TAB
DIGOXIN 0.05MG/ML ELIXIR
DIGOXIN 0.125MG TAB
DIGOXIN 0.25MG TAB
INSULIN GLARGINE 100U/ML VL
FUROSEMIDE 20MG TAB
FUROSEMIDE 40MG TAB
LCD 5% IN AQUAPHOR
PENICILLIN VK 250MG/5ML
CHLORAMBUCIL 2MG TAB
LEVOFLOXACIN 250MG TAB
LEVOFLOXACIN 250MG TAB
LEVOFLOXACIN 250MG TAB
LEVOTHYROXINE 0.025MG TAB
CHLORDIAZEPOXIDE 10MG CAP
CHLORDIAZEPOXIDE 25MG CAP
CHLORDIAZEPOXIDE 5MG CAP
LIDOCAINE 2% VISCOUS SOL
BACLOFEN 10MG TAB
ATORVASTATIN 80MG TAB
LO/OVRAL-28 TAB
DIPHENOXYLATE/ATROPINE TAB
MINOXIDIL 10MG TAB
MINOXIDIL 2.5MG TAB
METOPROLOL 50MG TAB
ENOXAPARIN 30MG INJ
ENOXAPARIN 40MG INJ
ENOXAPARIN 60MG INJ
ENOXAPARIN 80MG INJ
ENOXAPARIN 100MG INJ
ENOXAPARIN 120MG INJ
LUGOLS SOLUTION
MAALOX EXTRA STRENGTH
NITROFURANTOIN 100MG CAP
NITROFURANTOIN 50MG CAP
11
22
11
22
22
22
10
10
10
27
17
17
17
20
20
23
17
17
14
14
14
25
20
20
27
11
12
12
12
12
25
18
18
18
22
13
15
24
23
16
16
15
14
14
14
14
14
14
21
23
12
12
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
BRAND TO GENERIC
02/22/2010
*************************************************************************
BRAND NAME
GENERIC NAME
PAGE
MAGIC MOUTHWASH SOL
MAXIFLOR 0.05% CR
MAXIFLOR 0.05% OINT
MAXITROL OPTHALMIC DROP
MAXZIDE 37.5MG/25MG TAB
MEDROL 4MG DOSEPAK
MEDROL 4MG TAB
MEGACE 40MG TAB
MEGACE 40MG/ML ORAL SUSP
MELLARIL 100MG TAB
MELLARIL 25MG TAB
MENTHOL 1/4% IN AQUAPHOR
MEPHYTON 5MG TAB
MESTINON 60MG TAB
METHERGINE 0.2MG TAB
METHOTREXATE 2.5MG TAB
MICARDIS 40MG TAB
MICARDIS 80MG TAB
MICRONASE 5MG TAB
MICRONOR 0.35MG TAB
MICROZIDE 12.5MG CAP
MONOPRIL 10MG TAB
MONOPRIL 20MG TAB
MONOPRIL 40MG TAB
MOTRIN 400MG TAB
MOTRIN 600MG TAB
MS CONTIN 30MG SA TAB
MYAMBUTOL 100MG TAB
MYAMBUTOL 400MG TAB
MYCELEX 10MG TROCHE
MYCITRACIN OINT
MYDRIACYL 1% OPTH DROP
MYLERAN 2MG TAB
MYSOLINE 250MG TAB
NAPROSYN 250MG TAB
NAPROSYN 375MG TAB
NASALIDE 0.025% NASAL INH
NEOSYNEPHRINE 2.5% OPTH DROP
NEPHRO-VITE PLUS IRON TAB
NEPTAZANE 50MG TAB
NEURONTIN 300MG CAP
NEURONTIN 400MG CAP
NILSTAT 100000U/GM CREAM
NILSTAT 100000U/GM OINT
NILSTAT 100000U/ML SUSP
NITRO-DUR 0.4MG/HR PATCH
NITROL 2% OINT
NITROSTAT 0.4MG TAB SL
NITROSTAT 0.6MG TAB SL
NIX 1% CREME RINSE LIQUID
NIZORAL 2% CREAM
NOLVADEX 10MG TAB
MAGIC MOUTHWASH SOL
DIFLORASONE 0.05% CREAM
DIFLORASONE 0.05% OINT
MAXITROL OPTHALMIC DROP
TRIAMTERENE 37.5/HCTZ 25
METHYLPREDNISOLONE 4MG DOSE
METHYLPREDNISOLONE 4MG TAB
MEGESTROL 40MG TAB
MEGESTROL 40MG/ML ORAL SUSP
THIORIDAZINE 100MG TAB
THIORIDAZINE 25MG TAB
MENTHOL 1/4% IN AQUAPHOR
PHYTONADIONE 5MG TAB
PYRIDOSTIGMINE 60MG TAB
METHYLERGONOVINE 0.2MG TAB
METHOTREXATE 2.5MG TAB
TELMISARTAN 40MG TAB
TELMISARTAN 80MG TAB
GLYBURIDE 5MG TAB
NORETHINDRONE 0.35MG TAB
HYDROCHLOROTHIAZIDE 12.5MG
FOSINOPRIL SODIUM 10MG TAB
FOSINOPRIL SODIUM 20MG TAB
FOSINOPRIL SODIUM 40MG TAB
IBUPROFEN 400MG TAB
IBUPROFEN 600MG TAB
MORPHINE SULFATE 30MG SA
ETHAMBUTOL 100MG TAB
ETHAMBUTOL 400MG TAB
CLOTRIMAZOLE 10MG TROCHE
NEOMYCI/BACITRACI/POLYMIX
TROPICAMIDE 1% OPTH DROP
BUSULFAN 2MG TAB
PRIMIDONE 250MG TAB
NAPROXEN 250MG TAB
NAPROXEN 375MG TAB
FLUNISOLIDE 0.025% NASAL
PHENYLEPHRINE 2.5% OPTH DRP
VIT B COMPLX/VIT C/PLUS FE
METHAZOLAMIDE 50MG TAB
GABAPENTIN 300MG CAP
GABAPENTIN 400MG CAP
NYSTATIN 100000U/GM CREAM
NYSTATIN 100000U/GM OINT
NYSTATIN 100000U/ML SUSP
NITROGLYCERIN 0.4MG/HR PAT
NITROGLYCERIN 2% OINT
NITROGLYCERIN 0.4MG TAB SL
NITROGLYCERIN 0.6MG TAB SL
PERMETHRIN 1% CREME RINSE
KETOCONAZOLE 2% CREAM
TAMOXIFEN 10MG TAB
22
27
27
21
20
24
24
12
12
18
18
27
28
13
26
12
16
16
25
24
20
14
14
15
16
16
17
11
11
26
26
22
12
17
16
16
22
23
28
22
17
17
26
26
10
16
16
16
16
26
26
12
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
BRAND TO GENERIC
02/22/2010
*************************************************************************
BRAND NAME
GENERIC NAME
PAGE
NORDETTE-28 TAB
NORMODYNE 100MG TAB
NORMODYNE 200MG TAB
NORPRAMIN 10MG TAB
NORPRAMIN 50MG TAB
NORPRAMINE 25MG TAB
NORVASC 10MG TAB
NORVASC 5MG TAB
NOVOFINE DSP 30G NEEDLE
NOVOLIN 70/30 100U/ML VIAL
NOVOLIN LENTE 100U/ML VIAL
NOVOLIN NPH 100U/ML VIAL
NOVOLIN REGULAR 100U/ML VIAL
NOVOLOG INJ. 100U/ML VIAL
NOVOLOG INJ. FLEX PEN 3x5
OPHTHETIC 0.5% OPTH DROP
ORTHO-DIAPHRAGM ALLFLX 65
ORTHO-DIAPHRAGM ALLFLX 70
ORTHO-DIAPHRAGM ALLFLX 75
ORTHO-DIAPHRAGM ALLFLX 80
ORTHO-DIAPHRAGM ALLFLX 85
ORTHO EVRA PATCH
ORTHO NOVUM-1/35 28 DAY
ORTHO NOVUM-777 28 DAY TAB
ORTHO-NOVUM 1/50 28 DAY TAB
ORUDIS 50MG CAP
PAMELOR 10MG CAP
PAMELOR 25MG CAP
PAREGORIC LIQ
PARLODEL 2.5MG TAB
PATHOCIL 250MG CAP
PEDIAZOLE ORAL SUSP
PENICILLIN VK 250MG TAB
PERCOCET 5/325MG TAB
PERSANTINE 25MG TAB
PHENERGAN 25MG SUPP
PHENERGAN 50MG SUPP
HENOBARBITAL 20MG/5ML ELIXIR
PHENOBARBITAL 30MG TAB
PILOCAR 2% OPTH DROP
PILOCAR 4% OPTH DROP
PILOPINE HS 4% EYE GEL
PLAQUENIL 200MG TAB
PLAN B 0.75MG TAB
PLAVIX 75MG TAB
POLYTRIM OPHTHALMIC DROP
POTASSIUM CHLORIDE 10% SOLUTION
PRED FORTE 1% OPTH DROP
PREDNISONE 5MG/5ML ORAL SOLUTION
PREMARIN 0.625MG TAB
PREMARIN 1.25MG TAB
PREMARIN VAG CR W/APP
NORDETTE-28 TAB
24
LABETALOL 100MG TAB
15
LABETALOL 200MG TAB
16
DESIPRAMINE 10MG TAB
18
DESIPRAMINE 50MG TAB
18
DESIPRAMINE 25MG TAB
18
AMLODIPINE BESYLATE 10MG
14
AMLODIPINE BESYLATE 5MG TAB
14
INSULIN(NOVOFINE)30G DSP NDL
28
INSULIN HUMAN SEMISYN 70/30U
25
INSULIN HUMAN SEMISY L 100U/ML 25
INSULIN HUMAN SEMI NPH 10OU/ML 25
INSULIN HUMAN SEMISY R 10OU/ML 25
INSULIN ASPART 100U/ML INJ. VL 25
INSULIN ASPART INJ FLEX PEN 3x5 25
PROPARACAINE 0.5% OPTH DROP
22
DIAPHRAGM ARC-SPRING 65MM
19
DIAPHRAGM ARC-SPRING 70MM
19
DIAPHRAGM ARC-SPRING 75MM
19
DIAPHRAGM ARC-SPRING 80MM
19
DIAPHRAGM ARC-SPRING 85MM
19
ORTHO EVRA PATCH
24
ORTHO NOVUM-1/35 28 DAY TAB
24
ORTHO NOVUM-777 28 DAY TAB
25
ORTHO-NOVUM 1/50 28 DAY TAB
25
KETOPROFEN 50MG CAP
16
NORTRIPTYLINE HCL 10MG CAP
18
NORTRIPTYLINE HCL 25MG CAP
18
PAREGORIC LIQ
23
BROMOCRIPTINE 2.5MG TAB
28
DICLOXACILLIN 250MG CAP
11
ERYTHROMYCIN/SULFISOX SUSP
12
PENICILLIN VK 250MG TAB
11
OXYCODONE 5/ACETAMIN 325MG TAB 17
DIPYRIDAMOLE 25MG TAB
16
PROMETHAZINE HCL 25MG SUPP
10
PROMETHAZINE HCL 50MG SUPP
10
PHENOBARBITAL 20MG/5ML ELIXIR
18
PHENOBARBITAL 30MG TAB
18
PILOCARPINE 2% OPTH DROP
22
PILOCARPINE 4% OPTH DROP
22
PILOCARPINE 4% EYE GEL
22
HYDROXYCHLOROQUINE 200MG TAB
11
LEVONORGESTREL 0.75MG TAB
24
CLOPIDOGREL 75MG TAB
28
TRIMETHOPRIM/POLYMIX OPTH DROP
21
POTASSIUM CHLORIDE 10% SOL
20
PREDNISOLONE ACET 1% OPTH
22
PREDNISONE 5MG/5ML ORAL SOL
24
ESTROGENS, CONJ 0.625MG TAB
25
ESTROGENS, CONJ 1.25MG TAB
25
ESTROGENS, CONJ VAG CR W/ APP
25
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
BRAND TO GENERIC
02/22/2010
*************************************************************************
BRAND NAME
GENERIC NAME
PREMPRO 2.5MG TAB
CONJ ESTROG/MEDROXYPROG 2.5 TAB
PRILOSEC OTC 20MG TAB 14’s
OMEPRAZOLE OTC 20MG TAB 14’s
PRILOSEC OTC 20MG TAB 28’s
OMEPRAZOLE OTC 20MG TAB 28’s
PRIMAQUINE 26.3MG TAB
PRIMAQUINE 26.3MG TAB
PROBANTHINE 15MG TAB
PROPANTHELINE 15MG TAB
PROCAN 250MG CAP
PROCAINAMIDE 250MG CAP
PROCAN SR 500MG TAB
PROCAINAMIDE SR 500MG TAB
PROCARDIA 10MG CAP
NIFEDIPINE 10MG CAP
PROLIXIN 1MG TAB
FLUPHENAZINE HCL 1MG TAB
PROLIXIN 5MG TAB
FLUPHENAZINE 5MG TAB
PROPINE 0.1% OPTH DROPS
DIPIVEFRIN 0.1% OPTH DROP
PROPYLTHIOURACIL 50MG TAB
PROPYLTHIOURACIL 50MG TAB
PROVENTIL 2MG TAB
ALBUTEROL 2MG TAB
PROVENTIL 2MG/5ML SYRUP
ALBUTEROL 2MG/5ML SYRUP
PROVENTIL 4MG REPETAB
ALBUTEROL 4MG REPETAB
PROVENTIL 4MG TAB
ALBUTEROL 4MG TAB
PROVENTIL METERED INHALER
ALBUTEROL METERED INHALER
PROVENTIL 0.083% NEB UD SOL
PROVENTIL 0.083% NEB UD SOL
PROVERA 10MG TAB
MEDROXYPROGESTERONE 10MG
PULMICORT REPULES 0.25MG INH SUSP
BUDESONIDE 0.25MG INH SUSP
** Restriction: Patient less than 4 years old **
PULMICORT REPULES 0.5MG INH SUSP
BUDESONIDE 0.5MG INH SUSP
** Restriction: Patient less than 4 years old **
PYRAZINAMIDE 500MG TAB
PYRAZINAMIDE 500MG TAB
PYRIDIUM 100MG TAB
PHENAZOPYRIDINE 100MG TAB
QUESTRAN LIGHT PKT
CHOLESTYRAMINE LIGHT PKT
QUINAGLUTE 324MG TAB
QUINIDINE GLUCONATE 324MG TAB
QUINORA 200MG TAB
QUINIDINE SULFATE 200MG TAB
REGLAN 5MG/5ML SYRUP
METOCLOPRAMIDE 5MG/5ML SYRUP
REGLAN 10MG TAB
METOCLOPRAMIDE 10MG TAB
RID LIQUID
PIPERONYL/PYRETHRIN LIQUID
RIDAURA 3MG CAP
AURANOFIN 3MG CAP
RIMACTANE 300MG CAP
RIFAMPIN 300MG CAP
RITALIN 10MG TAB
METHYLPHENIDATE 10MG TAB
ROBITUSSIN AC SYRUP
GUAIFENSIN/CODEINE SYRUP
ROCALTROL 0.25MCG CAP
CALCITRIOL 0.25MCG CAP
RONDEC DM DROP
PSEUDOEPHED/CARBINOX DM DROP
RONDEC DM SYRUP
PSEUDOEPHED/CARBINOX DM SYRUP
ROXANOL 20MG/ML SOLUTION
MORPHINE SULFATE 20MG/ML SOL
ROXANOL 20MG/ML-12-ML SOLUTION
MORPHINE SUL 20MG/ML-120ML SOL
SALICYLIC ACID 5% IN AQUAPHOR
SALICYLIC ACID 5% IN AQUAPHOR
SANDIMMUNE 100MG/ML SOLUTION
CYCLOSPORINE 100MG/ML SOL
SELSUN 2.5% LOTION SHAMPOO
SELENIUM 2.5% LOTION SHAMPOO
SEREVENT DISKUS 50MCG INH
SALMETEROL DISKUS 50MCG INH
SINEMET-10/100 TAB
CARBIDOPA/LEVODOPA 10/100 TAB
SINEMET-25/100 TAB
CARBIDOPA/LEVODOPA 25/100 TAB
SINEMET-25/250 TAB
CARBIDOPA/LEVODOPA 25/250 TAB
SINGULAIR 10MG TAB
MONTELKAST 10MG TAB
SINGULAIR 5MG CHEW TAB
MONTELKAST 5MG CHEW TAB SOD
SODIUM BICARBONATE 650MG TAB
SODIUM BICARBONATE 650MG TAB
SOD POLYSTYRENE SULF 15GM
SOD POLYSTYRENE SULF 15GM
SPECTAZOLE 1% TOPICAL CREAM
ECONAZOLE 1% TOPICAL CREAM
PAGE
25
24
24
11
13
15
15
15
18
18
22
26
13
13
13
13
13
13
25
24
24
11
27
15
15
15
24
24
26
24
11
18
21
28
21
21
17
17
27
28
27
13
19
19
19
28
28
23
20
26
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
BRAND TO GENERIC
02/22/2010
*************************************************************************
BRAND NAME
GENERIC NAME
PAGE
SSD 1% CREAM
STELAZINE 5MG TAB
STUARTNATAL 1+1 TABLET
SULAMYD 10% OPTH DROP
SULFADIAZINE 500MG TAB
SUMYCIN 250MG CAP
SYNEMOL 0.025% CREAM
SYNTHROID 0.05MG TAB
SYNTHROID 0.075MG TAB
SYNTHROID 0.125MG TAB
SYNTHROID 0.15MG TAB
SYNTHROID 0.1MG TAB
TEGRETOL 100MG TAB
TEGRETOL 100MG/5ML SUSP
TEGRETOL 200MG TAB
TEN-K 10MEQ SA TAB
TENORMIN 50MG TAB
TERAZOL-3 VAG 0.8% CREAM
TERAZOL-7 VAG CREAM
THEODUR 200MG TAB SR
THEODUR 300MG TAB SR
THIAMINE 100MG TAB
THORAZINE 25MG TAB
THORAZINE 50MG TAB
TIAZAC 180MG CR CAP
TIAZAC 240MG CR CAP
TIAZAC 300MG CR CAP
TIGAN 100MG SUPP
TIGAN 200MG SUPP
TIMOPTIC 0.5% OPTH DROP
TOBRADEX EYE OINT
TOBRADEX OPTH DROP
TOBREX 0.3% EYE OINT
TOBREX 0.3% OPTH DROP
TOFRANIL 10MG TAB
TOFRANIL 25MG TAB
TOLECTIN DS 400MG CAP
TRANSDERM-NITRO 0.2MG/HR PATCH
TRENTAL 400MG TAB SA
TRIMOX 125/5ML SUSP
TRIMOX 250MG/5ML SUSP
TRIMPEX 100MG TAB
TRIPHASIL-28 TAB
TRUSOPT 2% OPTH DROP
TYLENOL 100MG/ML DROP
TYLENOL 160MG/5ML ELXILIR
TYLENOL W/ CODEINE NO.3 TAB
TYLENOL W/CODEINE ELIXIR
URECHOLINE 10MG TAB
URECHOLINE 25MG TAB
URECHOLINE 5MG TAB
SILVER SULFADIAZINE 1% CREAM
TRIFLUOPERAZINE 5MG TAB
STUARTNATAL 1+1 TABLET
SULFACETAMIDE 10% OPTH DROP
SULFADIAZINE 500MG TAB
TETRACYCLINE 250MG CAP
FLUOCINOLON ACETON 0.02 CRM
LEVOTHYROXINE 0.05MG TAB
LEVOTHYROXINE 0.075MG TAB
LEVOTHYROXINE 0.125MG TAB
LEVOTHYROXINE 0.15MG TAB
LEVOTHYROXINE 0.1MG TAB
CARBAMAZEPINE 100MG TAB
CARBAMAZEPINE 100MG/5ML SUS
CARBAMAZEPINE 200MG TAB
POTASSIUM CL 10MEQ SA TAB
ATENOLOL 50MG TAB
TERCONAZOLE VAG 0.8% CREAM
TERCONAZOLE VAG 0.4% CREAM
THEOPHYLLINE 200MG TAB SR
THEOPHYLLINE 300MG TAB SR
THIAMIN 100MG TAB
CHLORPROMAZINE 25MG TAB
CHLORPROMAZINE 50MG TAB
DILTIAZEM 180MG CR CAP
DILTIAZEM HCL 240MG CR CA
DILTIAZEM HCL 300MG CR CA
TRIMETHOBENZAMIDE 100MG SUPP
TRIMETHOBENZAMIDE 200MG SUPP
TIMOLOL 0.5% OPTH DROPS
TOBRAMYCIN/DEXMETHA EYE O
TOBRAMYCIN/DEXAMETHA OPTH
TOBRAMYCIN 0.3% EYE'OINT
TOBRAMYCIN 0.3% OPTH DROP
IMIPRAMINE HCL 10MG TAB
IMIPRAMINE 25MG TAB
TOLMETIN 400MG DS CAP
NITROGLYCERIN 0.2MG/HR PA
PENTOXIFYLLINE 400MG TAB
AMOXICILLIN 125MG/5ML SUSP
AMOXICILLIN 250MG/5ML SUSP
TRIMETHOPRIM 100MG TAB
TRIPHASIL-28 TAB
DORZOLAMIDE HCL 2% OPTH DROP
ACETAMINOPHEN 100MG/ML DROP
ACETAMINOPHEN 160MG/5ML ELX
ACETAMINO 300/CODEINE 30MG
ACETAMINO 120/COD 12MG/5ML
BETHANECOL 10MG TAB
BETHANECHOL 25MG TAB
BETHANECHOL 5MG TAB
27
18
28
21
12
11
27
26
26
26
26
26
17
17
17
20
14
26
26
28
28
28
18
18
14
14
14
24
24
23
21
21
21
21
18
18
16
16
14
10
11
12
25
22
17
17
16
16
13
13
13
DISTRICT OF COLUMBIA
HEALTHCARE ALLIANCE
BRAND TO GENERIC
02/22/2010
*************************************************************************
BRAND NAME
GENERIC NAME
PAGE
VALIUM 5MG TAB
VANCERIL INHALER
VERELAN 240MG CAP SA
VERMOX 100MG CHEWABLE TAB
VIBRAMYCIN 100MG CAP
VIROPTIC 1% OPTH DROP
VITAMIN B-6 50MG TAB
VITAMIN D 1000 UNITS TAB
VOSOL 2% OTIC SOL
VOSOL HC OTIC SOL
WELLCOVORIN 25MG TAB
WELLCOVORIN 5MG TAB
XALATAN 0.005% OPHTH DROP
XANAX 0.25MG TAB
XANAX 0.5MG TAB
XANAX 1MG TAB
XYLOCAINE 2% JELLY
XYLOCAINE 5% OINT
ZANTAC 150MG TAB
ZESTRIL 10MG TAB
ZESTRIL 20MG TAB
ZESTRIL 5MG TAB
ZITHROMAX 250MG CAP (Z-PAK)
ZITHROMAX 600MG/15ML ORAL SUSP
ZITHROMAX 900MG/22.5ML ORAL SUSP
ZOCOR 5MG TAB
ZOCOR 10MG TAB
ZOCOR 20MG TAB
ZOCOR 40MG TAB
ZOCOR 80MG TAB
ZOLOFT 100MG TAB
ZOLOFT 50MG TAB
ZOVIRAX 200MG CAP
ZOVIRAX 5% OINT
ZYLOPRIM 100MG TAB
ZYLOPRIM 300MG TAB
DIAZEPAM 5MG TAB
BECLOMETHASONE INHALER
VERAPAMIL 240MG CAP SA
MEBENDAZOLE 100MG CHEWABLE
DOXYCYCLINE 100MG CAP
TRIFLURIDINE 1% OPTH DROP
PYRIDOXINE 50MG TAB
VITAMIN D 1000 UNITS TAB
ACETIC ACID 2% OTIC SOL
ACETIC ACID 2%/HC 1% OTIC
LEUCOVORIN CALCIUM 25MG TAB
LEUCOVORIN CALCIUM 5MG TAB
LATANOPROST 0.005% OPHTH
ALPRAZOLAM 0.25MG TAB
ALPRAZOLAM 0.5MG TAB
ALPRAZOLAM 1MG TAB
LIDOCAINE HCL 2% JELLY
LIDOCAINE HCL 5% OINT
RANITIDINE 150MG TAB
LISINOPRIL 10MG TAB
LISINOPRIL 20MG TAB
LISINOPRIL 5MG TAB
AZITHROMYCIN 250MG CAP(Z-PK)
AZITHROMYCIN 600MG/15ML
AZITHROMYCIN 900MG/22.5ML
SIMVASTATIN 5MG TAB
SIMVASTATIN 10MG TAB
SIMVASTATIN 20MG TAB
SIMVASTATIN 40MG TAB
SIMVATATTIN 80MG TAB
SERTRALINE HCL 100MG TAB
SERTRALINE 50MG TAB
ACYCLOVIR 200MG CAP
ACYCLOVIR 5% OINT
ALLOPURINOL 100MG TAB
ALLOPURINOL 300MG TAB
19
24
15
10
11
21
28
28
22
22
28
28
23
18
18
18
22
27
24
15
15
15
10
10
10
15
15
15
15
15
18
18
11
26
28
28
**** REPORT COMPLETED ****
APPENDIX
AIDS DRUG ASSISTANCE PROGRAM FORMULARY...…………………..
POUND-KILOGRAM CONVERSIONS………………………………………..
PHARMACOKINETIC FORMULAS…………………………………………..
A. Ideal Body Weight…………………………………………………..
B. Creatinine Clearance (CrCl)……………………………………….
C. Creatinine Clearance Values In Renal Dysfunction……………...
D. Body Surface Area………………………………………………….
TEMPERATURE CONVERSION………………………………………………
GLUCOCORTICOID EQUIVALENCIES, POTENCIES, & HALF-LIFE….
APPROXIMATE DOSAGE EQUIVALENTS OF THYROID PRODUCTS..
NARCOTIC AGONISTS (COMPARATIVE PHARMACOKINETICS) …..
GUIDELINE FOR DRUG LEVELS COMMONLY MONITORED…………
ADJUSTMENT OF SERUM CONC. WITH LOW SERUM ALBUMIN…….
STANDARD LABORATORY VALUES
DRUGS WHICH MAY CAUSE DISCOLORATION OF THE FECES……...
DRUGS WHICH MAY CAUSE DISCOLORATION OF URINE……………
DRUGS WHICH AFFECT LABORATORY VALUES……………………….
REQUEST FOR FORMULARY CHANGE.……………………….……….…
50/51
52
53
53
53
54
54
54
54
55
55
56
57
57/58
59
60
61/63
64
ADAP FORMULARY
The following drugs are available through the District of Columbia AIDS Drug Assistance Program.
ANTI-RETROVIRALS
FUSION INHIBITORS
Enfurvirtide (Fuzeon)
Maraviroc (Selzentry)
INTREGRASE INHIBITOR
Raltegravir (Isentress)
NUCLEOSIDE and NUCLEOTIDE
REVERSE TRANSCRIPTASE
INHIBITORS (NNRTI)
Abacavir (Ziagen)
Abacavir Sulfate/Lamivudine/Zidovudine
(Trizivir)
Abacavir/Lamivudine (Epzicom)
Didanosine (Videx)
Emtricitabine (Emtriva)
Etravirine (Intelence)
Lamivudine (3TC, Epivir)
Lamivudine/Zidovudiine (Combivir)
Stavudine (Zerit)
Tenofovir (Viread)
Tenofovir/Emtricitabine (Truvada)
Zidovudine (Retrovir, AZT)
NON-NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS (NRTI)
Delaviridine Mesylate (Rescriptor)
Efavirenz (Sustiva)
Nevirapine (Viramune)
PROTEASE INHIBITORS (PI)
Atazanavir Sulfate (Reyataz)
Darunavir (Prezista)
Fosamprenavir (Lexiva)
Indinavir (Crixivan)
Lopinavir/Ritonavir (Kaletra)
Nelfinavir (Viracept)
Ritonavir (Norvir)
Saquinavir (Invirase)
Tipranavir (Aptivus)
NNRTI/NRTI COMBINATION
Atripla (Efavirenz/Emtricitabine/Tenofovir)
ADDITIONAL DRUGS
ANALGESICS
Acetaminophen w/ Codeine**
(Tylenol III & Tylenol IV)
Quetiapine (Seroquel)
Fentanyl (Duragesic) Patch**
Risperidone (Risperdal)
Ibuprofen (400mg, 600mg, 800mg) Ziprasidone (Geodon)
Morphine Sulfate (MS Contin)**
ANTI-VIRALS
ANTIBIOTICS
Acyclovir (Zovirax)
Amoxicillin/Clavulanate
Cidofovir (Vistide)
(Augmentin)
Oseltamivir (Tamiflu)
Azithromycin (Zithromax)
Valacyclovir (Valtrex)
Ciprofloxacin (Cipro)
Valganciclovir (Valcyte)
Clarithromycin (Biaxin)
HEPATITIS
Clindamycin HCL (Cleocin)
Adelfovir (Hepsera)
Doxycycline (Vibramycin)
Entecavir (Baraclude)
Ethambutol (Myambutol)
Peg Interferon Alfa-2a (Peyasys)
Isoniazid (INH)
Pegylated Intrerferon (Peg-Intron)
Levofloxacin (Levaquin)
Ribavirin (Rebetron, Copegus)
Linezolid (Zyvox)
Pyrazinamide (Pyrazinamide)
HYPOGLYCEMICS
Primethamine (Daraprim)
Glipizide (Glucotrol)
Rifabutin (Mycobutin)
Metformin (Glucophage)
Rifampin (Rimactane)
Metformin/Pioglitazone (Actoplusmet)
Sulfazdiazine
Metformin/Glipizide (Metaglip)
ANTI-CANCER
Alpha-Interferon (Intron A)
Doxorubicin (Doxil)
KAPOSI’S SARCOMA TREATMENTS
Alpha Interferon (Intron A)
Doxorubicin (Doxil)
ANTI-DEPRESSANTS
Amitriptyline HCL (Elavil)
Bupropion (Wellbutrin SR)
Duloxetine (Cymbalta)
Fluoxetine (Prozac)
Sertraline (Zoloft)
LIPIC LOWERING AGENTS
Atorvastatin (Lipitor)
Ezetimibe (Zetia)
Fenofibrate (Tricor)
Pravastatin (Pravachol)
ANTI-DIARRHEAL
Diphenoxylate/Atropine
(Lonox, Lomotil)
ANTI-FUNGALS
Clotrimazole (Mycelex, Lotrimin)
Fluconazole (Diflucan)
Itraconazole (Sporonox)
Ketoconazole (Nizoral)
Voriconazole (Vfend)
ANTI -PSYCHOTIC
Aripiprazole (Abilify)
Haloperidol (Haldol)
Olanzapine (Zyprexa)
PCP PROPHYLAXIS
Aerosolized Pentamidine (NebuPent)
Atovaquone Suspension (Mepron)
Dapsone
Sulfamethoxazole/Trimethoprim
(Bactrim)
TOPICAL STEROIDS
Hydrocortisone 1% Cream, Oint, Lotion
Hydrocortisone 2.5% Cream, Oint, Lotion
Hydrocortisone valerate 0.2% Cream
TOPICAL ANESTHETICS
Lidocaine (Lidoderm) Patch
** DENOTES CONTROLLED SUBSTANCES, AVAILABLE AT ANY CARE PHARMACY
Updated 02/11/09
64 New York Avenue, NE, Washington, DC 20002 Suite 5001 Tel (202) 671-4900
Fax (202) 673-4365
ADAP FORMULARY
The following drugs are available through the District of Columbia AIDS Drug Assistance Program.
WEIGHT LOSS/WASTING
Dronabinol (Marinol)**
Megestrol Acetate (Megace, Megace ES)
Oxandrolone (Oxandrin)**
Somatropin (Serostim)
MISCELLANEOUS
Therobec Plus (Berocca Plus)
Erythropoietin Alpha
(Epogen, Procrit)
Gabapentin (Neurontin)
Testosterone, topical (Androgel)**
ANTI-PARKINSON’S AGENT
Benztropine (Cogentin)
OPIOID ADDICTION TREATMENT
[Prior authorization required]
Buprenorphine (Subutex)**
Buprenorphine/naloxone (Suboxone)**
** DENOTES CONTROLLED SUBSTANCES, AVAILABLE AT ANY CARE PHARMACY
Updated 02/11/09
64 New York Avenue, NE, Washington, DC 20002 Suite 5001 Tel (202) 671-4900
Fax (202) 673-4365
POUNDS -KILOGRAMS CONVERSION TABLE
1 POUND = 0.45359 kilogram
1 KILOGRAM = 2.2 pounds
Pounds
=
Kilograms
Pounds
=
Kilograms
1
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
0.45
2.27
4.54
6.80
9.07
11.34
13.61
15.88
18.14
20.41
22.68
24.95
27.22
29.48
31.75
34.02
36.29
38.56
40.82
43.09
100
105
110
115
120
125
130
135
140
145
150
155
160
165
170
175
180
185
190
195
200
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
45.36
47.63
49.90
52.16
54.43
56.70
58.91
61.24
63.50
65.77
68.04
70.31
72.58
74.84
77.11
79.38
81.65
83.92
86.18
88.45
90.72
PHARMACOKINETIC FORMULAS
A.
Ideal Body Weight
For dosing purposes, ideal body weight (IBW) can be estimated
using the following equations:
Adults
IBWmale
= 50
+ (2.3 kg per inch > 5 feet)
IBWfemale
= 45.5 + (2.3 kg per inch > 5 feet)
Children
IBW = (Height2 x 1.65)/1000
where IBW is expressed in kilograms, height in centimeters
B.
Creatinine Clearance
A patient's renal function can be estimated by using the following equations:
For patients > 18 years old (Cockcroft-Gault Equation)
Clcr =
(140- age) x IBW x G
72 x Scr
For patients 1-18 years of age
Clcr =
0.48 x height x BSA
1.73 x Scr
Where age is in years, IBW is ideal body weight in kilograms, Scr is the patient's serum
creatinine in milligrams per deciliter, G is the gender factor (1.0 if male and 0.85 if female),
height is in centimeters, and BSA is body surface area in square meters. The use of the patient's
ideal body weight (IBW) is recommended for the Cockcroft-Gault equation. If the patient's
actual body weight is less than ideal, actual weight should be used in the calculation. Daily
creatinine production is approximately 15% less in females than males; therefore creatinine
clearance estimates should be adjusted for gender. The normal creatinine clearance for females is
100mL/min and 125 mL/min for males. Calculated creatinine clearance provides an acceptable
estimate of the patient's renal function except when the patient:
 is younger than 25 years of age or older than 90 years of age
 is undergoing dialysis
 is uremic (Scr>8 mg/dL)
 is markedly emaciated or morbidly obese
 has a rapidly changing (either up or down) serum creatinine
Elderly patients generally have less muscle mass resulting in decreased endogenous creatinine
production. Utilizing the serum creatinine in these patients to estimate creatinine clearance may
overestimate renal function. In emaciated patients, although their actual creatinine clearance is
less than calculated (because of decreased creatinine production), it is not possible to predict
easily how much less. In patients with rapidly rising serum creatinines (i.e., >0.5-0.7mg/dL/d) it
is best to assume that the patient's creatinine clearance is <10mL/min.
The estimated creatinine clearance is used clinically to guide dosage adjustments for renally
eliminated drugs.
C.
Creatinine Clearance Values in Renal Dysfunction
Renal Function
Normal
Mild impairment
Moderate impairment
Severe impairment
Marked impairment
D.
Clcr
(ML/min)
>80
50-80
30-50
10-30
<10
0.725
BODY SURFACE AREA (square meters)
BSA = 0.007184 x (height in cm)
0.425
x (weight in kg)
TEMPERATURE CONVERSION:
Centigrade to Fahrenheit: F = 32 + 9/5 x C
Fahrenheit to Centigrade: C = 5/9 x (F -32)
Glucocorticoid Equivalencies, Potencies, and Half-Life
Glucocorticoid
Equivalent
potency
dose (mg)1
AntiSodiuminflammatory retaining
potency1
potency
Half-life
plasma
(min)
Short-acting
Cortisone
Hydrocortisone
25
20
0.8
1
2
2
30
80-118
1
1
0
0
60
115-212
200+
78-188
0
0
110-210
300+
Intermediate-acting
Prednisone
Prednisolone
Triamcinolone
Methylprednisolone
5
5
4
4
4
4
5
5
Long-acting
Dexamethasone
Betamethasone
1
0.75
0.6-0.75
20-30
20-30
When converting doses, use only equivalent potency column, not anti-inflammatory potency column.
Reference:
“Adrenocortical Steroids”, Facts and Comparison, 2010, pg 321.
Approximate Dosage Equivalents of Thyroid Products1
Composition Ratio
Preparation
Thyroid desiccated
T4
T3
Dosage Equivalents
4
1
1
0
0
1
4
1
≈ 60 to 65 mg (1 grain)
≈ 50 to 60 mcg
(range, 50 to 100 mcg)
≈ 25 mcg
(range, 15 to 37.5 mcg)
≈ 1 grain (12.5 mcg
T3/50 mcg T4
Levothyroxine
Liothyronine
Liotrix
1
References may vary in dosage equivalent recommendations.
References:
“Thyroid Drugs,” Facts and Comparisons, 2010, pg 334
NARCOTIC AGONISTS
Comparative Pharmacokinetics
Oneset (min)
Peak (h)
Duration
(h)
Half-Life
(h)
Immediate
ND
ND
1-2
15
1
4-8
2-3
I.M.: 30-60; I.V.: 4-5
0.5-1
3-5
2.5-3.5
3
Codeine
P.O.: 30-60; I.M.: 10-30
0.5-1
4-6
3-4
Fentanyl
I.M.: 7-15
I.V.: Immediate
ND
1-2
ND
ND
Hydromorphone
P.O.: 15-30
Levorphanol
Meperidine
Drug
Average Dosing Interval
(h)
Equianalgesic Doses1 (mg)
I.M.
Oral
ND
NA
0.4
––
(3-6)
2
––
3
(3-6)
120
200
1.5-6
1
(0.5-2)
0.1
NA
4-8
3.3-4.4
6
(4-8)
ND
ND
0.5-1
4-6
2-4
4
(3-6)
1.5
7.5
P.O.: 10-60
0.5-1
4-8
12-16
6
(6-24)
2 (A)
1 (C)
4 (A)
1 (C)
P.O./I.M./Sub-Q: 10-15
I.V.: ≤5
0.5-1
2-4
3-4
3
(2-4)
75
300
P.O.: 30-60; I.V.: 10-20
0.5-1
4-6 (acute);
>8
(chronic)
15-30
8
(6-12)
10 (A)
2-4 (C)
20 (A)
2-4 (C)
P.O.: 15-60
I.V.: ≤5
P.O./I.M./Sub-Q:
0.5-1; I.V.: 0.3
3-6
2-4
4
(3-6)
10
602 (A)
30 (C)
Nalbuphine
I.M.: 30; I.V.: 1-3
1
3-6
5
––
10
––
Oxycodone
P.O.: 10-15
0.5-1
4-6
3-4
(3-6)
NA
20
Oxymorphone
5-15
0.5-1
3-6
1
103
Pentazocine
15-20
0.25-1
3-4
2-3
3
(3-6)
P.O.: 30-60
2-2.5
4-6
3.5-15
6
(4-8)
ND
1304-2005
1-3
<0.3
0.1-0.2
0.15-0.3
––
––
ND
ND
1.3-3
ND
ND
2.5-3
––
––
0.02
NA
Alfentanil
Buprenorphine
Butorphanol
Hydrocodone
Methadone
Morphine
Propoxyphene
Remifentanil
Sufentanil
––
4
––
ND = no data available. NA = not applicable. (A) = acute, (C) = chronic.
1
Based on acute, short-term use. Chronic administration may alter pharmacokinetics and decrease the oral
parenteral dose ratio. The morphine oral-parenteral ratio decreases to ~1.5-2.5:1 upon chronic dosing.
2
Extensive survey data suggest that the relative potency of I.M.:P.O. morphine of 1:6 changes to 1:2-3 with chronic dosing.
3
Rectal
4
HCl salt
5
Napsylate salt
GUIDELINES FOR DRUG LEVELS
COMMONLY MONITORED
Drug
When to Sample
Therapeutic
Levels
Antibiotics
Gentamicin
Tobramycin
30 min after infusion
Trough <0.5 h before next dose
Amikacin
Vancomycin
Anticonvulsants
Carbamazepine
Peak 1 h after 1 h infusion
Trough <0.5 h before next dose
Peak 4-10 mcg/mL Trough <2.0
mcg/mL
Peak 20-35 mcg/mL
Trough<8mcg/mL
Peak 25-40 mcg/mL
Trough 5-10 mcg/mL
Trough just before next oral dose
4-12 mcg/mL
Ethosuximide
Trough just before next oral dose
40-100mcg/mL
Phenobarbital
Trough just before next dose
15-40 mcg/mL
Phenytoin (free)
Trough just before next dose
1-2 mcg/mL
Phenytoin (total)
Trough just before next dose
10-20 mcg/mL
Trough Just before next dose
(Note: Primidone is metabolized to
phenobarb. Order levels separately)
5-12 mcg/mL
Primidone
Valproic acid
Bronchodilators
Aminophylline
(I.V.)
Theophylline
(P.O)
Trough just before next dose
50-100 mcg/mL
18-24h after starting or changing a
maintenance dose given as a constant
infusion
10-20 mcg/mL
Peak levels: Not recommended trough
level. Just before next dose
10-20 mcg/mL
Cardiovascular Agents
Digoxin
Trough just before next dose
8-24 hours after dose administered
0.5-2ng/mL
Lidocaine
Stead-state levels are usually
achieved after 6-12h
15-5.0 mcg/mL
Procainamide
Trough just before next oral dose
I.V. 6-12h after infusion started
4-10 mcg/mL
NAPA 6-20 mcg/mL
Quinidine
Trough just before next oral dose
2-5 mcg/mL
Trough: just before next dose
80-250 ng/mL
Nortriptyline
Trough: just before next dose
50-150 ng/mL
Lithum
Trough just before next dose
0.6-1.5 mEq/mL
imipramine
plus desipramine
Trough: just before next dose
150-250 ng/mL
desipramine
Trough: just before next dose
125-300 ng/mL
Other Agents
Amitriptyline
Plus nortriptyline
Adjustment of Serum concentration in Patients With Low
Serum Albumin
Measured Total
Phenytoin
Concentration
(mcg/mL)
5
10
15
3.5
Patient’s Serum Albumin (g/dL)
3
2.5
2
Adjusted Total Phenytoin Concentration
(mcg/mL)*
6
13
19
7
14
21
8
17
25
10
20
30
*Adjusted concentration = measured total concentration  [(0.2 x albumin) + 0.1]
STANDARD LABORATORY VALUES
The following laboratory values should be used as a reference only. Values may differ between
laboratories. Please note that a “normal” laboratory value does not always indicate an optimal
value. Healthcare professionals should refer to current literature and clinical practice guidelines
for target values.
Component
Alanine aminotransferase (ALT; previously SGPT)
Albumin
Alkaline Phosphatase
Ammonia
Aspartate Aminotransferase (AST; previously SGOT)
Bicarbonate
Bilirubin
Total
Direct
Indirect
Complete Blood Count (CBC)
Hemoglobin
Male
Female
Hematocrit
Male
Female
Red Blood Cell (RBC) count
Male
Female
Mean corpuscular volume (MCV)
Mean corpuscular hemoglobin (MCH)
Mean corpuscular hemoglobin concentration (MCHC)
Coagulation
Activated partial thromboplastin time (APTT)
Bleeding time
Prothrombin time (PT)
Platelet count
Creatinine serum
Creatinine kinase (CK)
Male
Female
Reference Range
<35 U/L
3.2-5.5 g/dL
30-120 U/L
10-80 ug/dL
<35 U/L
20-30 mEq/L
0.1-1.2 mg/dL
0.0-0.3 mg/dL
0.2-0.7 mg/dL
13.5-17.5 g/dL
12-16 g/dL
41-53%
36-46%
4.5-5.5 x 106 / uL
4.0-4.9 x 106 / uL
80-100 fl
26-34 pg
31-37 g/dL
25-.35 sec
2.0-9.5 min
11-13.5 sec
150-450 x 103 /uL
<1.5 mg/dL
60-400 U/L
40-150 U/L
Electrolytes
Calcium
Calcium Ionized
Chloride
Magnesium
Phosphorous, inorganic
Potassium
Sodium
Erythrocyte sedimentation rate
Male
<50 yo
>50 yo
Female
<50 yo
>50 yo
Ferritin
Male
Female
Folate
Glucose
Fasting
2-hr postprandial
Hemoglobin A1C
Iron
Iron binding capacity
Lipoproteins and Triglycerides
Cholesterol total
Desirable
Borderline high
High
High-density lipoprotein (HDL) cholesterol
Low-density lipoprotein (LDL) cholesterol
Optimal
Near or above normal
Borderline high
High
Very high
Triglycerides
Osmolality
Thyroid function tests
Triiodothyronine, total (T3)
Triiodothyronine, total (FT3)
Thyroxine, total (T4)
Thyroxine, free (FT4)
Thyroid stimulating hormone (TSH)
Transferrin
Urea Nitrogen (BUN)
Uric acid
Male
Female
WBC +differential (number fraction)
White blood cell (WBC) count
Neutrophils
Band forms
Basophils
Eosinophils
Lymphocytes
Monocytes
8.6-10.5 mg/dL
4.4-5.6 mg/dL
95-108 mEq/L
1.6-30.0 mEq/L
2.5-4.5 mg/dL
3.5-5.2 mEq/L
135-149 mEq/L
<15 mm/hr
<20 mm/hr
<20 mm/hr
<30 mm/hr
15-300 ng/mL
10-200 ng/mL
3.1-20 ng/mL
75-115 mg/dL
<120 mg/dL
3.8%-6.4%
65-150 ug/dL
250-420 ug/dL
<200 mg /dL
200-239 mg/dL
>240 mg/dL
30-70 mg/dL
<100 mg’dL
100-129 mg/dL
130-159 mg/dL
160-189 mg/dL
>190 mg/dL
<160 mg/dL
285-308 mOsn/kg H2O
60-200 ng/dL
140-440 pg/dL
4.0-12.0 ug/dL
0.8-2.7 ng/dL
0.25-4.30 uIU/mL
230-390 mg/dL
7-20 mg/dL
2.0-8.0 mg/dL
1.5-7.5 mg/dL
4-11 x 103/uL
40%-70%
0%-10%
0%-3%
0%-8%
24%-44%
4%-11%
Sources: Adapted from: Kratz A, Ferraro M, Sluss PM, Levandrowski, KB, Laboratory Reference Values.
N Eng J Med. 2004;351:1548-63. MedlinePlus Medical Encyclopedia. Semla TP, Beizer JL, Higbee MD.
Geriatric Dosage Handbook, 11th Ed., Hudson, OH: Lexi-Comp 2005.
DRUGS WHICH MAY CAUSE DISCOLORATION OF THE FECES:
Therapeutic
Category
Analgesiscs (CNS)
Analgesics
(urinary)
Antacids
Anthelminthics
Antibacterial
agents
Color Imparted
To the Feces
Pink to red to black
(Resulting from internal
Bleeding)
Orange-red
Whitish discoloration or
speckling of feces
Blue
Red
Black
Anticoagulants
Pink to red to black
(Resulting from internal
bleeding)
Antiprotozoal
agents
Hermatinic
agents
Black
Laxatives, cathartics
Can lead to a brownish
staining of the rectal mucosa
Black
Drug(s)
Responsible
salicylates
Phenazopyridine
(Pyridium)
e.g., aluminum
hydroxide preparations
dithiazinine (Delvex)
pyrvinium pamoate (Povan)
bismuth sodium
triglycollamate
(Bistrimate )
All anti- coagulants
bismuth glycoly- larsanilate
(Milibis )
iron preparations
(e.g. ferrous sulfate)
1, 8-dihydroxyanthraquinone
(Dorbane; Doxan)
DRUGS WHICH MAY CAUSE DISCOLORATION OF THE URINE:
Therapeutic
Category
Analgesics (urinary)
Color Imparted
To the Urine
Orange to orange-red
Antibacterial
agents
Orange-yellow
(in alkaline urine)
Drug(s)
Responsible
ethoxazene (Serenium)
phenazopyridine
(Pyridium)
salicylazosulfapyridine
(Azulfidine)
Discoloration
(No specific effect)
p-aminosalicylic acid and
derivatives
Rust yellow or brownish
Blue-green
Blue or green
sulfonamides nitrofurantoin
and derivatives, e.g.
furazolidone (Furoxone)
indanedione derivatives
(e.g. anisindione (Hedulin)
diphenylhydantoin (Dilantin)
phensuximide (Milontin)
amitriptyline (Elavil)
methylene blue
Brown to black
quinine and derivatives
Rust yellow or brown
pamaquine naphthoate
(Plasmochin) primaquine
chloroquine (Aralen)
quinacrine (Atabrine )
metronidazole (Flagyl)
Anticoagulants
Anticonvulsants
Antidepressants
Antidote to cyanide
poisoning
Antiprotozoal
agents
Orange (in alkaline urine),
pink or red to red-brown
Pink or red to red-brown
Yellow
Diuretics
Hemostatic
agents
Hematinic
agents
Laxatives,
cathartics
Dark
Pale blue
Fluorescence
Blue-green
triamterene
(Dyrenium)
tolonium (Blutene)
Black
iron-sorbitolcitric
acid complex (Jectofer)
Brown to black
cascara; rhubarb
Pink to red or red-brown
1,8- dihydroxyanthraquinone
emodin (in alkaline urine )
phenolphthalein
chlorzaxazone (Paraflex)
Skeletal muscle relaxants
Orange or purplish-red
Tranquilizers
Vitamins
Dark, brown to black or
green on standing
Pink to red or red-brown
Yellow
methocarbamol (Robaxin)
Phenothiazines
riboflavin
DRUGS WHICH AFFECT LABORATORY VALUES
Drugs can and do influence laboratory diagnostic tests. Those involved in patient care must be
aware of these effects and the misleading results they cause.
The following chart lists some of the drugs and procedures which are known to affect laboratory
determinations. The chart is not intended to represent a complete listing of such effects, but to
serve as a guide.
TEST
Urine:
Acetone
Kidney
Function
Urine:
Diacetic acid
Urine:
Albumin
Urine:
Amino
Acids
Urine:
Catecholamines
DRUG
Sulfobromophthalein
(BROMSULPHALEIN),
Phenolsulfonphthalein
Sulfobromophthalein(BROMSULPHALEIN)
Phenothiazines & Salicylates
Penicillin (massive doses),
Salicylates, Tolbutamide, XRay contrast media
Cortropin (Acth), Cortisone,
Sulfonamides
Epinephrine, Insulin
Erythromycin, Methyldopa
(ALDOMET), Quinidine,
Tetracyclines, Hypertensive
agents, B-complex vitamins
Epinephrine-like agents used
in asthma
EFFECT
Increase value
Interferes with reading of
phenolsulfonphtalein test (24
hours required between drugs)
Increases values
Increases albumin excretion
causing false positive
Increase excretion of Amino
acids
Decrease excretion of amino
acids
Increse catecholamine content
Blood: Enzymes
Acid Phosphatase
Alkaline Phasphatase
Androgens, Prostate Massage
Methyldopa (ALDOMET)
Increase blood level
Variable effect
Serum Amylase
Morphine, Codeine,
Meperidine (DEMEROL)
Alcohol
Increase level up to 24 hours
SGOT
Opiates, Salicylates
Methicillin, Ampicillin
Methyldopa
Increase level
Increase level
Variable effect
DRUGS WHICH AFFECT LABORATORY VALUES (Cont’d.)
TEST
Liver Function
Serum Bilirubin
Blood Ammonia
Prothrombin
Serum Albumin
Blood Urea
Nitrogen
Serum Proteins
Serum Calcium
Serum Sodium
Serum Potassium
Serum Phosphorous
Serum Chloride
Serum Copper
Serum Iron and Iron Binding
Capacity
DRUG
Anabolic steroids, Barbiturates
Estrogens, Morphine,
Probenecid, Phenazopyridine
(PYRIDUM) Iopanoic Acid
(TELAPAQUE)
Caffeine
Methyldopa
Sodium salts
Ion exchange (e.g.
KAYEXALATE)
Barbiturates
Antibiotics, Globulin,
Salicylates, sulfonamides,
Hydroxyzine (VISTARIL)
Methyldopa
EFFECT
Increase retention of
Sulfobromophtalein
Decrease level
Variable effect
may cause increase
may cause increase
Increase prothrombin activity
Decrease prothrombin activity
Variable effect
Penicillin (massive doses),
Salicylates, Tolbutamide, Xray contrast media
Chloral Hydrate, Triamterene
(DYRINIUM) Methyldopa
Glucose infusion
Increase values
Decrease BUN
Sulfobromophthalein
Elevated value
Ammonium salts
Decrease value
Heparin, Insulin
Calcium salts, Potassium salts,
Seroids
Diuretics, paracentesis
May decrease levels
May increase levels
Hyperventilation, Cortropin
(ACTH), steroids, Sulfates and
Phosphates
Epinephrine, Insulin, general
anesthetics
Acetazolamide (DIAMOX),
Bromides, Ion exchange
resins, steroids
Cortropin (ACTH), diuretics
Decrease levels
Iron and Cobalt preparations
Cortropin (ACTH) and
steroids
Iron-Dextran Complex
(IMFERON)
Increase values
Decrease values
Increase BUN
May decrease levels
Decrease levels
Increase values
Decrease levels
Increase values
DRUGS WHICH AFFECT LABORATORY VALUES (cont’d.)
TEST
Blood Cholesterol
Blood Glucose
DRUG
Cortropin (ACTH), Cortisone,
Vitamin A, Bromides
Androgens, Thyroid, Heparin,
Clofibrate (ATROMID-S)
Oral Contraceptives
Cortropin (ACTH)
Protein-Bound
Iodine
X-ray contrast media
Barium Sulfate, Oral
Contraceptives, Estrogens,
Amebacides (e.g.
FLORAQUIN, VIOFORM),
Suntan Oil, Mouthwashes,
Vitamin preparations, Iodized
salt
Liothyronine (CYTOMEL),
Testosterone, Cortropin
(ACTH), Chlorates, Cortisone,
Mercurial Diuretics,
Salicylates, Sulfonamides
Sulfobromophthalein
Uric Acid
Creatinine
Blood Cross Match:
Direct Coombs Test
EFFECT
Usually raise level
Decrease level
Decrease glucose
Tolerance curve
Increase level
Increases values for as long as
10 years
Increase values
Decrease values
Variable effect
Dicumarol, Piperazine
(ANTEPAR), Cortropin
(ACTH)
Nitrogen Mustard
(MUSTARGEN),
Chlorothiazide (DIURIL),
Pyrazinamide
Methyldopa
Decrease values
Ascorbic Acid,
Sulfobromophthalein,
Phenolsulfonphthalein
Methyldopa (ALDOMET)
Cephalothin (KEFLIN)
Penicillin
Increase level
Increase values
Variable effects
False positive
(up to one year)
District of Columbia Health Care Alliance
Request For Formulary Change
PHYSICIAN: _______________________________,MD DATE: ______________________
ADDRESS: ________________________________
________________________________
PHONE#: ______________________
FAX#: _________________________
Requesting physician must complete “A” thru “H” in full.
INSTRUCTIONS:
The completed form should be forwarded to: Department of Health Warehouse, #4 D.C.
Village Lane S.W., Washington D.C. 20032 Fax: 202 645-5909
A. Name of Drug: ___________________________ B. Manufacturer:_______________
C. Dosage Form Desired:
Tablet ( ) Capsule ( ) Ointment ( )
Ampule ( ) Liquid ( ) Powder ( )
Other (Specify) _____________________
D. Dosage Strength(s) Desired: ___________________________________________________
E. Technical Information:
1. Indication(s) _________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2. Action(s) ____________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
3. Uses: ________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
4. Contraindications: _____________________________________________________
_____________________________________________________________________
_____________________________________________________________________
5. Adverse Reactions – Frequency and Intensity: _______________________________
_____________________________________________________________________
_____________________________________________________________________
F. Is there a Similar-Acting Drug now carried on formulary? Yes____
No____
G. Formulary Drug it may replace: _________________________________________________
___________________________________________________________________________
H. What are the advantages of the drug requested over the one now stocked? _______________
___________________________________________________________________________
___________________________________________________________________________
Action of the Pharmacy and Therapeutics Committee:
Accepted ( ); Rejected ( ); Other ( ) – Explain _______________________________________
Remarks: _____________________________________________________________________
Date: ________________________
__________________________________________
Chairman