UTMB COST
A-HYDROCORT®: Brand of Hydrocortisone Sodium Succinate
ABACAVIR
Ziagen®
Solution, oral 300 mg/15 ml
Tablet
300 mg
Restriction: Infectious Disease Faculty
3.91/300 mg
3.96
ABACAVIR: Ingredient of Epzicom® and Trizivir®
ABCIXIMAB
ReoPro®
Injection
2 mg/ml; 5ml
Restriction: Cardiology Faculty
441.90
ABELCET®: Brand of Amphotericin B Lipid Complex
ABILIFY®: Brand of Aripiprazole
ABRAXANE®: Brand of Paclitaxel Protein-Bound Particles for Inj. Suspension
ABSOLUTE ETHYL ALCOHOL: See Alcohol, Dehydrated
ACCOLATE®: Brand of Zafirlukast
ACCUTANE®: Brand of Isotretinoin
ACCUZYME®: Brand of Papain/Urea
ACETAMINOPHEN (APAP)
Suppository 120 mg
325 mg
650 mg
Syrup
160 mg/5 ml
325 mg/12.5 ml: unit dose
650 mg/20 ml: unit dose
Tylenol®
Drops
80 mg/0.8 ml:
15 ml
Elixir
160 mg/5 ml: 120 ml
Tablet
325 mg
Note: O.T.C., non-legend drug available for inpatients only.
0.24
0.24
0.24
0.60/30 ml
0.25
0.25
3.04
0.03/30 ml
0.01
ACETAMINOPHEN: Ingredient of Tylenol® with Codeine, Tylox®, Norco®, Lortab®, Amaphen®
ACETAZOLAMIDE
Diamox®
Injection
Suspension
Tablet
32
500 mg
50 mg/ml
250 mg
9.08
1.04/100 ml
0.40
UTMB COST
ACETIC ACID
Solution, Topical
0.25%: 4 L
VoSol®
Solution, otic 2%: 15 ml
0.32
1.35
ACETIC ACID: Ingredient of VoSol® HC
ACETYLCHOLINE
Miochol-E®
Solution, Intraocular: 20 mg/2 ml
ACETYLCYSTEINE
Acetadote®
IV
200 mg/ml; 30 ml
Restriction: Endovascular Surgery
Mucomyst®
Solution 20%:
4 ml
10 ml
30 ml
16.70
111.29
0.97
3.21
3.57
Note: For oral inhalation
ACHROMYCIN®: Brand of Tetracycline
ACITRETIN
Soriatane®
Capsule
10 mg
25 mg
Restriction: Dermatology Faculty.
Note: Replaces etretinate which was D/C'd by manufacturer.
4.74
6.23
ACTHAR® GEL: Brand of Corticotropin Gel Injection
ACTHIB®: Brand of Haemophilus b Conjugate Vaccine
ACTIFED®, ACTAGEN®, TRIPHED®
Tablet: each contains
Pseudoephedrine Hydrochloride
60 mg
Triprolidine Hydrochloride
2.5 mg
Syrup: 120 ml
473 ml
each 5 ml contains:
Pseudoephedrine Hydrochloride 30 mg
Triprolidine Hydrochloride
1.25 mg
Note: O.T.C., non-legend drug available for inpatients only.
0.01
0.84/30 ml
ACTIGALL™: Brand of Ursodeoxycholic Acid / Ursodiol
ACTINOMYCIN-D: See Dactinomycin
ACTIVASE®: Brand of Alteplase (tissue plasminogen activator)
33
UTMB COST
ACTOS®: Brand of Pioglitazone
ACYCLOVIR
Zovirax®
Capsule
200 mg
Ointment 5%: 15 g tube
Injection
500 mg/vial
Suspension 200 mg/5ml: 30 ml
Tablet
400 mg
0.14
30.15
4.14
3.60
0.27
ADACEL®: Brand of Diptheria Toxoid, reduced - Tetanus Toxoids and Acellular Pertussis
ADALAT® CC: Brand of Nifedipine
ADDERALL XR®: Brand of Dextroamphetamine / Amphetamine
ADENOCARD®: Brand of Adenosine
ADENOSINE
Adenocard®
Injection
6 mg/2 ml vial
ADEFOVIR
Hepsera®
Tablet
10 mg
Restriction:
Hepatology: Daryl Lau, M.D.
Roger Soloway, M.D.
Ned Snyder, M.D.
Steven Weinman, M.D.
22.14
16.15
ADRENALIN®: Brand of Epinephrine Hydrochloride, Levorotatory
ADRIAMYCIN® RDF: Brand of Doxorubicin Hydrochloride
ADRUCIL®: Brand of Fluorouracil
ADVAIR DISKUS®
Inhaler: each dose contains
Fluticasone
250 mcg
Salmeterol
50 mcg
(contains 28 doses)
Restriction: Allergy and Pulmonary Faculty, Anita Mercado, M.D.
AEROBID®: Brand of Flunisolide
AEROSPORIN®: Brand of Polymyxin B Sulfate
AEROZOIN®: Brand of Benzoin Compound Tincture
AFRIN®: Brand of Oxymetazoline Hydrochloride
34
85.16
UTMB COST
AGLO ENEMA (UTMB Compound):
Contains:
Glycerin
Mineral oil
100 ml
200 ml
1.52
200 mg
0.78
ALBUMIN, NORMAL HUMAN SERUM
Albuminar®, Buminate®, Plasbumin®
Injection 5%:
250 ml
500 ml
Injection 25%:
50 ml
100 ml
50.00
100.00
59.00
98.00
AHF: See Antihemophilic Factor (Human)
ALBENDAZOLE
Albenza®
Tablet
ALBENZA®: Brand of Albendazole
Note: All albumin products are in short supply on a national level.
Restricted to use on Burn Unit Patients, and use by the following physicians:
Jack Alperin, M.D., Blood Bank,
Eric Bedell, M.D., Anethesiology/Critical Care,
Vincent Conti, MD, Cardiothoracic Surgery Chad Davis, M.D, Pediatrics
Susan Gerik, M.D., Pediatrics,
Alexander Indrikovs, M.D., Blood Bank,
Daryl Lau, M.D., Hepatology
William Mileski, M.D. - Surgery
Frances Nesti, M.D., Pediatric Critical Care,
Donald Prough, M.D. - Anesthesiology
Karen Shattuck, M.D., Neonatology,
Ned Snyder, III, M.D., Hepatology
Roger Soloway, M.D., Hepatology
Gagan Sood, M.D. - Transplant Hepatology
Xavier Villa, M.D., Pediatrics
Steven Weinman, M.D., Hepatology
ALBUMINAR®: Brand of Albumin, Normal Human Serum
ALBUTEROL
Proventil®, Ventolin®
Inhaler 17 g
(90mcg/inhalation: 200 inhalations/cannister)
Tablet
2 mg
4 mg
Syrup
2 mg/5 ml:
30 ml
Solution for nebulization
0.083%, 3 ml unit dose
0.5%, 20 ml multidose bottle
5.44
0.04
0.04
0.60
1.32
4.00
ALCAINE®: Brand of Proparacaine Hydrochloride
ALCOHOL, DEHYDRATED (98% - 100%)
Injection
1 ml
2.89
ALCOHOL
5% in D5W Injection
ALCOHOL, ISOPROPYL (99%)
Solution
1000 ml
4L
10.00
6.57
35
UTMB COST
ALCOHOL, USP (Absolute 99%)
Solution
473 ml
0.77
1 gal
4.65
5 gal
15.00
Note: Dispensed from the Inpatient Pharmacy in the Clinical Sciences building.
ALDACTONE®: Brand of Spironolactone
ALDARA®: Brand of Imiquimod
ALDOMET®: Brand of Methyldopa
ALEMTUZUMAB
Campath®
Injection
30 mg/ml
Restriction: Transplant Faculty
ALENDRONATE
Fosamax®
Tablet
1,608.63
5 mg
10 mg
35 mg
70 mg
2.13
2.13
14.90
14.90
150 mg
300 mg
2.03
2.56
ALIMTA®: Brand of Pemetrexed
ALISKIREN
Tekturna®
Tablet
ALKERAN®: Brand of Melphalan
ALLANTOIN
Carrington Dermal Wound Gel™
Gel
3 ounce tube
ALLOPURINOL
Zyloprim®
Tablet
9.00
100 mg
300 mg
0.03
0.07
ALMORA®: Brand of Magnesium Gluconate
ALOE VERA
Dermaide Aloe®
Cream 99%,
4 ounce jar
Cara-Klenz™ Dermal Wound Cleanser
Liquid
6 ounce spray bottle
each contains:
aloe vera gel
vitamin E
Note: for use as an emulsifying detergent
36
8.40
3.84
UTMB COST
ALOXI®: Brand of Palonosetron
ALPHA-1 PROTEINASE INHIBITOR
Prolastin®
Injection
500 mg vial
1000 mg vial
Restriction: For patients with reimbursement
165.00
330.00
ALPHA CHYMAR®: Brand of Chymotrypsin
ALPHAGAN-P®: Brand of Brimonidine tartrate
ALPRAZOLAM CIV
Xanax®
Tablet
0.25 mg
0.5 mg
1 mg
0.04
0.05
0.08
ALPROSTADIL
Prostin VR Pediatric®, Prostaglandin E1
Injection
500 mcg/ml, 1 ml
135.52
Restriction: Transplant Surgery Faculty, also Pediatric Cardiology must countersign orders
within 48 hours.
MUSE®
Urethral Pellet Suppository
125 mcg
250 mcg
500 mcg
1000 mcg
ALTEPLASE
Activase®, TPA
Injection
50 mg/vial
Restriction: Cardiology Faculty
Interventional Radiology
13.64
14.47
15.06
16.30
1080.00
Emergency Room Faculty
ALU-CAP®: Brand of Aluminum Hydroxide
ALUMINUM ACETATE SOLUTION: See Domeboro®
ALUMINUM HYDROXIDE
Alu-Cap®
Capsule
400mg
Suspension
320mg/5ml: 16oz
Note: O.T.C., non-legend drug available for inpatients only.
0.16
2.62
ALUMINUM HYDROXIDE: Ingredient of Maalox® , Maalox® Plus, Alamag® Plus & Mylanta®
ALUPENT®: Brand of Metaproterenol Sulfate
37
UTMB COST
ALURATE®: Brand of Aprobarbital
AMANTADINE
Symmetrel®
Capsule
Syrup
100 mg
50 mg/5 ml;30 ml
0.13
3.30/30 ml
AMAPHEN®: see Esgic®
AMBIEN®: Brand of Zolpidem
AMBISOME®: Brand of Amphotericin B Liposomal
AMERICAINE®: Brand of Benzocaine
AMICAR®: Brand of Aminocaproic Acid
AMIDATE®: Brand of Etomidate
AMIFOSTINE
Ethyol®
Injection
500mg/10ml
234.06
Restriction: Adult Hematology/Oncology Faculty Radiation Therapy Faculty
For FDA labeled indications or for subcutaneous administration for patients receiving
radiation therapy for thoracic malignancies
AMIKACIN SULFATE
Amikin®
Injection
100 mg/2 ml
500 mg/2 ml
1 g/4 ml
9.20
27.46
8.84
AMIKIN®: Brand of Amikacin Sulfate
AMILORIDE
Midamor®
Tablet
5 mg
0.39
AMILORIDE: Ingredient of Moduretic® 5-50
AMINO ACID SOLUTION
Premasol®
Injection
10%: 1000 ml
Note: Replaces Aminosyn-PF 10%
AMINOCAPROIC ACID
Amicar®
Injection
Syrup
Tablet
38
250 mg/ml: 20 ml
250 mg/ml: 480 ml
500 mg
34.81
0.60
19.50/30 ml
1.48
UTMB COST
AMINOPHYLLINE
Injection
Tablet
25 mg/ml:
10 ml
0.20
100 mg
0.06
200 mg
0.07
Liquid
105 mg/5 ml: 500 ml
0.90/30 ml
Note: 105 mg Aminophylline Liquid is equivalent to 90mg theophylline base. Solution
is dye-free, sugar-free and alcohol-free.
AMIODARONE
Cordarone®
Injection
50 mg/ml:
3 ml ampule
Restriction: Cardiology faculty.
Tablet
200 mg
AMITRIPTYLINE
Elavil®
Injection
Tablet
AMLODIPINE
Norvasc®
Tablet
61.98
1.11
10 mg/ml: 10 ml
10 mg
25 mg
50 mg
75 mg
100 mg
150 mg
7.70
0.03
0.03
0.04
0.05
0.05
0.09
2.5 mg
5 mg
10 mg
0.98
1.01
1.71
AMMONIA INHALANT
Ampule 15%: 0.33 ml in 35% alcohol
Note: O.T.C., non-legend drug available for inpatients only.
AMMONIUM CHLORIDE
Injection 5 mEq/ml: 20 ml
0.10
2.00
AMMONIUM LACTATE
LAC-HYDRIN®
Cream 12%: 225 ml
20.25
AMOBARBITAL SODIUM C-II
Amytal® Sodium
Injection
250 mg
500 mg
3.80
6.36
AMOXICILLIN: Ingredient of Augmentin®, Augmentin® ES, Augmentin® XR
39
UTMB COST
AMOXICILLIN
Amoxil®, Polymox®, Trimox®
Capsule
250 mg
0.06
500 mg
0.08
Drops
50 mg/ml:
30 ml
1.50
Suspension 125 mg/5 ml: 150 ml
1.50
250 mg/5 ml: 150 ml
1.50
Note: After reconstitution, the suspension will remain stable for 14 days unrefrigerated.
AMOXIL®: Brand of Amoxicillin Trihydrate
AMPHADASE®: Brand of Hyaluronidase
AMPHOTERICIN B (CONVENTIONAL)
Fungizone®
Injection
50 mg
5.16
AMPHOTERICIN B LIPID COMPLEX
Abelcet ®
Injection
100 mg/20 ml vial
78.60
Restriction: Infectious Disease Faculty - requires order by ID or call in to Restricted
Antibiotic Approval Line.
AMPHOTERICIN B LIPOSOMAL
Ambisome®
Injection
50 mg vial
152.78
Restriction: Infectious Disease Faculty - requires order by ID or call in to Restricted
Antibiotic Approval Line.
AMPICILLIN
Omnipen®, Polycillin®, Principen®
Capsule
250 mg
0.06
500 mg
0.09
Injection
125 mg
0.56
250 mg
0.66
500 mg
0.32
1g
0.39
Suspension 125 mg/5 ml: 5 ml U-D
0.03
200 ml
2.00
250 mg/5 ml: 200 ml
2.00
Note: After reconstitution, the suspension will remain stable for 14 days when refrigerated.
Sodium content per gm of the injectable = 3 mEq.
AMPICILLIN / SULBACTAM
Unasyn®
Injection
1.5 g vial
3 g vial
Note: ampicillin to sulbactam ratio = 2:1.
AMVISC PLUS®: Brand of Hyaluronate sodium
40
5.68
8.76
UTMB COST
AMYL NITRITE
Inhalant ampule
0.3 ml
0.26
AMYLASE: Ingredient of Pancrelipase
AMYTAL® SODIUM: Brand of Amobarbital Sodium
ANADROL®: Brand of Oxymetholone
ANAFRANIL®: Brand of Clomipramine
ANAPROX®: Brand of Naproxen Sodium
ANASTRAZOLE
Arimidex®
Tablet
1 mg
4.38
ANCEF®: Brand of Cefazolin
ANCOBON®: Brand of Flucytosine
ANGIOMAX®: Brand of Bivalirudin
ANIDULAFUNGIN
Eraxis®
Injection
50 mg vial
87.86
Restriction: Infectious Disease Faculty or to Burn Patients up to 48 hours unless ID
consult is received to prolong therapy
ANTABUSE®: Brand of Disulfiram
ANTAZOLINE PHOSPHATE: Ingredient of Vasocon-A®
ANTHRALIN
Anthra-Derm®, Drithocreme®, Drithroscalp
Cream(or ointment)
0.1%:
50gm
23.00
0.2%(or 0.25%):
50gm
20.00
0.4%(or 0.5%):
50gm
27.50
1%:
50 gm
28.50
Note: The base and concentration is dependent on the brand product currently in stock.
ANTICOAGULANT SODIUM CITRATE: see Trisodium Citrate Dihydrate
ANTIHEMOPHILIC FACTOR VII: See Factor VIIa
ANTIHEMOPHILIC FACTOR VIII: See Factor VIII
ANTI-INHIBITOR COAGULANT COMPLEX, VAPOR HEATED
Feiba® VH Immuno
Injection - specify units per dose
Note: Refrigerate
140.40/100 U
41
UTMB COST
ANTILIRIUM®: Brand of Physostigmine Salicylate
ANTIPYRINE: Ingredient of Auralgan®
ANTITHYMOCYTE GLOBULIN (EQUINE)
(ALG, Antilymphoblast Globulin, ATG, Anti thymocyte Globulin)
ATGAM®
Injection
250 mg/5 ml ampule
ANTITHYMOCYTE GLOBULIN (RABBIT)
Thymoglobulin®
Injection
25 mg vial
Restriction: Solid Organ Transplant Faculty
298.07
336.79
ANTIVENIN, BLACK WIDOW SPIDER
Equine Origin
Injection one vial & 2.5 ml diluent
19.90
ANTIVENIN, CROTALIDAE POLYVALENT
Equine Origin
Injection one vial & 10 ml diluent
138.29
ANTIVENIN, NORTH AMERICAN CORAL SNAKE
Equine Origin
Injection one vial & 10 ml diluent
258.96
ANTIVERT®: Brand of Meclizine
ANTIZOL®: Brand of Fomepizole
ANTUITRIN-S®: Brand of Chorionic Gonadotropin
ANTURANE®: Brand of Sulfinpyrazone
ANUSOL®, HEMORRHOIDAL UNISERTS®
Suppository: each in cocoa butter base contains:
Balsam Peru 1.8%
Benzyl Benzoate
1.2%
Bismuth Resorcin 1.75%
Bismuth Subgallate 2.25%
Zinc Oxide
11%
Note: O.T.C., non-legend drug available for inpatients only.
ANUSOL®-HC, HEMORRHOIDAL-HC®
(Topical Hydrocortisone 1% with rectal applicator)
Cream: 30 gm each tube contains
Hydrocortisone 1 %
Mineral Oil & Glyceryl Stearate Base
Suppository: each suppository contains
Hydrocortisone Acetate 25mg
Hydrogenated Vegetable Base
42
0.09
0.90
0.16
UTMB COST
ANZEMET®: Brand of Dolasetron
APAP: See Acetaminophen
APL®: Brand of Chorionic Gonadotropin
APLISOL®: Brand of Tuberculin, Purified Protein Derivative
APRACLONIDINE
Iodipine®
Solution, ophthalmic
0.5%: 5 ml
1%: 0.1 ml
APREPITANT
Emend®
Tablet
80 mg
125 mg
Restriction: Hematology/Oncology Faculty
Note: Dosage regimen is 125 mg Day 1, 80 mg Days 2-3.
31.05
5.13
79.00
85.83
APRESOLINE®: Brand of Hydralazine
APTIVUS®: Brand of Tipranavir
AQUACHLORAL®: Brand of Chloral Hydrate
AQUAMEPHYTON®: Brand of Phytonadione
AQUAPHOR®: Brand of Petrolatum, Hydrophilic. Ingredient of Eucerin®
AQUASOL A®: Brand of Vitamin A, Natural, Water Soluble
AQUASOL E®: Brand of Vitamin E, Natural, Water Soluble
ARA-C: See Cytarabine
ARALEN®: Brand of Chloroquine Phosphate
ARAMINE®: Brand of Metaraminol Bitartrate
ARANESP®: Brand of Darbepoetin
AREDIA®: Brand of Pamidronate Disodium
ARGININE
R-Gene®
Injection
10 gm/100 ml: 300 ml
84.00
ARICEPT®: Brand of Donepezil
43
UTMB COST
ARIMIDEX®: Brand of Anastrazole
ARIPIPRAZOLE
Abilify®
Tablet
5 mg
10 mg
15 mg
20 mg
30 mg
Restriction: Psychiatry Faculty
Abilify® IM
Injection
9.75 mg vial
Restriction: Psychiatry Faculty and ER Faculty
9.40
9.40
9.40
13.29
13.29
10.66
ARISTOCORT®: Brand of Triamcinolone
ARIXTRA®: Brand of Fondaparinux
ARTANE®: Brand of Trihexyphenidyl Hydrochloride
ARTIFICIAL TEARS: See Hydroxypropylmethylcellulose
ASACOL®: Brand of Mesalamine
ASCORBIC ACID: See Vitamin C
ASCRIPTIN®
Tablets: each contains
Aluminum Hydroxide
75 mg
Aspirin
325 mg
Magnesium Hydroxide
75 mg
Note: O.T.C., non-legend drug available for inpatients only.
ASPARAGINASE
Elspar®
Injection
10,000 IU/Vial
0.03
42.78
ASPIRIN
Suppository
Bayer®
Tablets
300 mg
600 mg
0.23
0.23
325 mg
0.02
81 mg Chewable
0.03
Tablets, enteric coated
325 mg
0.02
Note: O.T.C., non-legend drug available for inpatients only.
Salicylates should not be used in pediatric patients with varicellar influenza-like infections
due to an association with an increased risk for the development of Reye’s Syndrome.
ASPIRIN: Ingredient of Ascriptin®
ATACAND®: Brand of Candesartan
44
UTMB COST
ATARAX®: Brand of Hydroxyzine
ATAZANAVIR
Reyataz®
Capsules
100 mg
150 mg
200 mg
Restriction: Infectious Disease Faculty, Occupational Exposure
ATENOLOL
Tenormin®
Tablets
25 mg
50 mg
100 mg
11.62
11.62
11.62
0.09
0.08
0.12
ATGAM®: Brand of Antithymocyte Globulin (Equine)
ATIVAN®: Brand of Lorazepam
ATORVASTATIN
Lipitor®
Tablet
10 mg
20 mg
40 mg
80 mg
Restriction: 80 mg tablet only:
Cardiology Faculty
Hypertension Faculty
ATOVAQUONE
Mepron®
Liquid
2.22
3.22
3.07
3.07
Endocrinology Faculty
Elena Volpi, M.D.
750 mg/5 ml
10.45/5 ml
ATRIPLA
Tablet: Each contains:
Efavirenz
600 mg
Emtricitabine
200 mg
Tenofovir DF
300 mg
Restriction: Infectious Disease Faculty
ATROPINE SULFATE
Injection
1 mg/ml:
0.1 mg/ml:
Ointment, ophthalmic 1%:
Isopto-Atropine®
Drops, ophthalmic 1%:
37.45
1 ml vial
5 ml ready to use syringe
10 ml ready to use syringe
3.5 gm
0.20
1.90
1.50
0.95
5 ml
15 ml
1.22
1.65
ATROVENT®: Brand of Ipratropium Bromide
45
UTMB COST
ATTENUVAX®: Brand of Measles Virus Vaccine, Live, Attenuated
AUGMENTIN®
‘250’ Tablet each contains
Amoxicillin Trihydrate
Clavulanate Potassium
250 mg
125 mg
‘500’ Tablet each contains
Amoxicillin Trihydrate
Clavulanate Potassium
500 mg
125 mg
‘125’ Suspension, 150 ml
each 5ml contains:
Amoxicillin Trihydrate
Clavulanate Potassium
‘250’ Suspension 150ml
each 5 ml contains:
Amoxicillin Trihydrate
Clavulanate Potassium
2.57
3.79
36.55
125 mg
31.25 mg
69.70
250 mg
62.5 mg
AUGMENTIN® ES 600
Oral Suspension 125 ml
each 5 ml contains
Amoxicillin
Clavulanate Potassium
600 mg
42.9 mg
AUGMENTIN® XR
Tablet: each tablet contains
Amoxicillin
Clavulanate Potassium
1000 mg
62.5 mg
55.57
2.32
AURALGAN®, AUROTO®
Drops: each 15 ml glycerin base solution contains
Antipyrine 5.4%
Benzocaine 1.4%
AURANOFIN
Ridaura®
Capsule
3 mg
Restriction: Attending Staff must countersign orders within 48 hours.
AUROTO®: See Auralgan®
AVANDIA®: Brand of Rosiglitazone
AVASTIN®: Brand of Bevacizumab
AVELOX IV®: Brand of Moxifloxacin
AVENTYL®: Brand of Nortriptyline
46
0.90
0.73
UTMB COST
AZACTAM®: Brand of Aztreonam
AZATHIOPRINE
Imuran®
Injection
Suspension
Tablets
AZITHROMYCIN
Zithromax®
Injection
Suspension
Tablet
100 mg/20 ml
15mg/ml (UTMB Compound)
50 mg
84.32
9.00
0.90
500 mg vial
100 mg/5 ml; 15 ml
200 mg/5 ml; 15 ml
200 mg/5 ml; 22.5 ml
250 mg
500 mg
600 mg
23.96
28.61
28.61
28.61
6.75
13.51
16.21
1 g vial
21.48
AZOPT®: Brand of Brinzolamide
AZT: See Zidovudine
AZTREONAM
Azactam®
Injection
AZULFIDINE®: Brand of Sulfasalazine
B & 0 SUPPRETTES® C-II
Suppository: each contains
(15A) Powdered Belladona Extract 16.2 mg
and Opium 30 mg
(16A) Powdered Belladona Extract 16.2 mg
and Opium 60 mg
Restriction: C-II prescription required for ambulatory prescriptions.
1.37
2.37
BACID®: Brand of Lactobacillus Acidophilus
BACILLUS CALMETTE-GUERIN
Tice™ BCG
Injection
50 mg ampule
134.81
BACITRACIN
Injection
Ointment
50,000 Units
9.82
500 U/g:
30 g
1.56
454 g
19.52
Note: The Ointment is an O.T.C., non-legend item available for inpatients only.
BACITRACIN: Ingredient of Neosporin® & Polysporin®
47
UTMB COST
BACLOFEN
Lioresal®
Injection, intrathecal
10 mg/20 ml; 1 amp
195.00
10 mg/5 ml; 2 amps
345.00
Restriction: Anesthesiology faculty trained to surgically implant the baclofen pump and
change the drug ampule.
Tablet
10 mg
0.17
BACTRIM® I.V., SEPTRA® I.V., (TMP/SMZ I.V.)
Injection: each 5 ml vial contains
0.91
Sulfamethoxazole
400 mg
Trimethoprim
80 mg
Note: Orders written for injectable TMP/SMZ should be calculated in terms of TMP
dosage.
BACTRIM®, SEPTRA®, COTRIM®, CO-TRIMOXAZOLE
Suspension: 480 ml
each 5 ml contains:
Sulfamethoxazole
200 mg
Trimethoprim
40 mg
Tablet: each contains
Sulfamethoxazole
400 mg
Trimethoprim
80 mg
BACTRIM®-DS, SEPTRA®-DS, COTRIM®-DS
Tablet: each contains
Sulfamethoxazole
800 mg
Trimethoprim
160 mg
0.87/30 ml
0.06
0.07
BACTROBAN®: Brand of Mupirocin
BAL®: Brand of Dimercaprol
BALANCED SALT SOLUTION
BSS®
Solution, ophthalmic
5 ml
500 ml
1.50
4.44
Note: For inpatients only.
BASILIXIMAB
Simulect®
Injection
20 mg vial
BASALJEL®: Brand of Aluminum Carbonate
BAYER®: Brand of Aspirin
BAYGAM®: Brand of Immune Globulin, Intramuscular
BCG VACCINE : see Bacillus Calmette-Guerin
48
1,383.25
UTMB COST
BCNU: See Carmustine
BECLOMETHASONE DIPROPIONATE
Beconase® AQ
Nasal Spray
0.042%
74.19
25g spray bottle in aqueous base
QVAR®
Oral Inhaler
7.3 gm; 40 mcg/inhalation
47.99
Oral Inhaler, double strength 7.3 gm; 80 mcg/inhalation (DS)
60.48
Note: All Beconase®, Vancenase®, and Vanceril® products have been discontinued by their
manufacturers. Beconase® AQ is still available.
BECONASE® AQ: Brand of Beclomethasone Dipropionate
BEEPEN®-VK: Brand of Penicillin V, Potassium
BELLADONNA ALKALOIDS: Ingredient of Donnatal®
BEMINAL® 500: Brand of Vitamin B Complex with C
BENADRYL®: Brand of Diphenhydramine
BENEMID®: Brand of Probenecid
BENTYL®: Brand of Dicyclomine Hydrochloride
BENTIROMIDE
Chymex®
Solution
500 mg/7.5 ml
BENZOCAINE
Americaine®, Dermoplast®
Aerosol 20%:
60 g
42.49
3.00
BENZOCAINE: Ingredient of Cepacol®, Hurricaine®, Auralgan®
BENZOIN COMPOUND TINCTURE
AeroZoin®
Aerosol
Solution
180 ml
60 ml
BENZOYL PEROXIDE
Ben-aqua® 5, Desquam-X®, Panoxyl® AQ
Gel
5%: 45 g
10%: 45 g
BENZTROPINE MESYLATE
Cogentin®
Injection
Tablet
1 mg/ml: 2 ml
0.5 mg
1 mg
2 mg
10.50
3.68
3.83
1.36
8.99
0.10
0.09
0.21
49
UTMB COST
BETADINE®: Brand of Povidone Iodine
BETAGAN®: Brand of Levobunolol HCl
BETAMETHASONE: Ingredient of Celestone® Soluspan
BETAMETHASONE DIPROPIONATE (Augmented)
Diprolene®
Cream
0.05%:
45 g
Ointment
0.05%:
45 g
Restriction: Requires signature of Dermatology Attending Staff.
51.50
51.50
BETAPACE®: Brand of Sotalol
BETAXOLOL HYDROCHLORIDE
Betoptic®, Betoptic® S
Solution, ophthalmic
Suspension, ophthalmic
BETHANECHOL CHLORIDE
Duvoid®, Urecholine®
Tablet
0.5%: 10 ml dropper bottle
0.25%: 2.5 ml
5 mg
25 mg
32.13
18.31
0.16
0.46
BETOPTIC®: Brand of Betaxolol Hydrochloride
BEXAROTENE
Targretin®
Capsule
75 mg
19.63
Restriction: Hematology/Oncology, Dermatology, and Radiation Therapy Faculty.
BETOPTIC® S: Brand of Betaxolol Hydrochloride
BEVACIZUMAB
Avastin®
Injection
100 mg vial
446.72
400 mg vial
1,786.86
Note: For patients with reimbursement including Manufacturers Assistance Program
BIAXIN®: Brand of Clarithromycin
BICALUTAMIDE
Casodex®
Tablet
50
50 mg
12.50
UTMB COST
BICILLIN® C-R
Injection:
1 ml syringe 600,000 U/ml Pediatric only
2 ml syringe 1.2 MU
Adult and Pediatric
4 ml syringe 2.4 MU
each ml contains:
Benzathine Penicillin G
300,000 U
Procaine Penicillin G
300,000 U
Pediatric and Adult strength syringe (900/300)
each 2 ml contains:
Benzathine Pencillin G
900,000 U
Procaine Penicillin G
300,000 U
12.22
23.99
51.38
24.97
BICILLIN® LA: Brand of Penicillin G, Benzathine
BICITRA®
Shohl’s Solution
Solution
30 ml unit dose
480 ml bottle
0.28
3.36
each 5 ml contains:
Citric Acid (monohydrate) 334 mg
Sodium Citrate
500 mg
Note: each 5 ml contains Sodium 5 mEq and is equivalent to Bicarbonate 5 mEq.
BiCNU®: Brand of Carmustine
BIMATOPROST
Lumigan®
Solution, Ophthalmic
Restriction: Ophthalmology
0.03%; 2.5 ml
51.90
BIP OINTMENT (UTMB Compounded)
Ointment: each 60 g contains
2.79
Bismuth Subnitrate 17%
Iodoform
33%
Petrolatum
50%
Notes: Do not use over more than 5% of body; do not use unless bright yellow.
BISACODYL
Dulcolax®
Suppository
10 mg
Tablet, enteric coated
5 mg
Note: O.T.C., non-legend drug available for inpatients only.
0.06
0.03
BISMUTH SUBSALICYLATE
PeptoBismol®, Kaopectate®
Suspension, Oral
240 ml
1.08
each 15 ml contains:
Bismuth Subsalicylate
262 mg
Note: Replaces Kaolin-Pectin. O.T.C., non-legend drug available for inpatients only.
51
UTMB COST
BIVALIRUDIN
Angiomax®
Injection
250 mg vial
Restriction: Cardiac Cath. Lab
400.24
BLENOXANE®: Brand of Bleomycin Sulfate
BLEOMYCIN SULFATE
Blenoxane®
Injection
Note: Refrigerate
15 units/Vial (Equivalent to 15 mg)
BLEPHAMIDE®
Suspension, ophthalmic: each 5 ml bottle contains
Prednisolone Acetate
0.20%
Sulfacetamide Sodium
10%
31.24
31.40
BNP: see Neosporin®
BONINE®: Brand of Meclizine
BONIVA®: Brand of Ibandronate
BORTEZOMIB
Velcade®
Injection
Restriction: Oncology Faculty
3.5 mg vial
776.67
BOTOX®: Brand of Botulinum Toxin Type A
BOTULINUM TOXIN TYPE A
Botox®
Injection
100 unit vial
Restriction: Dermatology Faculty
Neurology Faculty
Plastic Surgery Faculty
454.91
ENT Faculty
Ophthalmology Faculty
David Yngve, M.D. (Pedi Ortho Faculty)
BOUDREAUX'S BUTT PASTE
Zinc Oxide (Main Ingredient)
16%; 1 oz
1.80
Note: Orders should specify the complete name of Boudreaux's Butt Paste to eliminate any
confusion with the UTMB compounded butt paste.
BRETHINE® Brand of Terbutaline Sulfate
BREVIBLOC®: Brand of Esmolol
BREVITAL®: Brand of Methohexital Sodium
BRICANYL®: Brand of Terbutaline Sulfate
52
UTMB COST
BRIMONIDINE TARTRATE
Alphagan-P®
Ophthalmic solution
0.15%; 5 ml
Note: Alphagan 0.2% product discontinued by manufacturer
BRINZOLAMIDE
Azopt®
Ophthalmic suspension
1%;
BROMOCRIPTINE MESYLATE
Parlodel®
Tablet
Capsule
2.5 mg
5 mg
5 ml
36.09
29.04
1.76
3.98
BROMPHENIRAMINE MALEATE: Ingredient of Dimetapp®
BSS®: Brand of Balanced Salt Solution
BSS PLUS®
Solution 500 ml
Part I: 480 ml containing
KCl
0.395 mg
NaHCO3
2.19 mg
NaCl
7.44 mg
NaPhos
0.433 mg
Part II: 20 ml containing
CaCl2
3.85 mg
Dextrose
23 mg
5 mg
MgCl2
Glutathione disulf.
4.6 mg/ml
Note: Mix just prior to administration. Available for inpatients only.
48.76
BUDESONIDE INHALATION SUSPENSION
Pulmicort® Respules
Respule
0.25mg/2ml
4.04
0.5 mg/2ml
4.36
Restriction: Inpatient use only. Restricted to the following services/areas:
Allergy/Immunology
Asthma/Pulmonary Services in Pediatrics
Internal Medicine
Intensive Care Units
BUDESONIDE: Ingredient in Symbicort®
BUMETANIDE
Bumex®
Injection
Tablet
0.25 mg/ml:
0.5 mg
1 mg
2 ml
10 ml
1.04
3.50
0.26
0.38
BUMEX®: Brand of Bumetanide
BUMINATE®: Brand of Albumin, Normal Human Serum
53
UTMB COST
BUPIVACAINE
Marcaine®, Sensorcaine®
Injection
0.25%: 10 ml single dose vial
50 ml
0.5%: 30ml
0.75%: 2 ml ampule
1.08
1.78
1.53
1.46
0.3 mg/ml
3.34
75 mg
100 mg
0.21
0.24
BUPRENEX®: Brand of Buprenorphine
BUPRENORPHINE
Buprenex®
Injection
Note: For Inpatient use only
BUPROPION
Wellbutrin®
Tablet
BUROW’S SOLUTION, MODIFIED: See Domeboro®
BUSPAR®: Brand of Buspirone
BUSPIRONE
BuSpar®
Tablet
BUSULFAN
Myleran®
Tablet
5 mg
10 mg
0.08
0.10
2 mg
1.91
BUTALBITAL: Ingredient of Amaphen®
BUTOCONAZOLE NITRATE
Gynazole®, Femstat®
Cream, Vaginal
2%: 5 g
Note: O.T.C., non-legend drug available for inpatients only.
BUTORPHANOL TARTRATE
Stadol®
Injection
CADEXOMER IODINE
Iodosorb®, Iodoflex®
Gel, Topical
Pad, Topical
CAFCIT®: Brand of Caffeine Citrate
54
2 mg/ml: 1 ml
0.9%; 40 g
5g
10 g
39.43
1.83
37.09
5.03
10.30
UTMB COST
CAFERGOT®
Ercat®
Tablet: each contains
Caffeine
100 mg
Ergotamine Tartrate 1 mg
CAFFEINE AND SODIUM BENZOATE
Injection
250 mg/ml: 2 ml
CAFFEINE CITRATE
Cafcit®
Injection
Oral Solution
60 mg/3 ml
60 mg/3 ml
0.51
2.67
38.13
38.13
CALAMINE
Lotion
120 ml
Note: O.T.C., non-legend drug available for inpatients only.
1.20
CALAN®: Brand of Verapamil
CALAN® SR: Brand of Verapamil, sustained release
CALCIFEROL®: Brand of Vitamin D2
CALCITONIN SALMON
Miacalcin®
Injection
200 I.U./ml; 2 ml
Nasal Spray
200 I.U./actuation; 3.7 ml
Note: 22 actuations per 2 ml container.
CALCITRIOL
Rocaltrol®, 1,25-dihydroxyvitamin D3, Vitamin D3
Capsule
0.25 mcg
0.5 mcg
35.49
76.61
0.78
1.26
CALCIUM SALTS EQUIVALENCIES TABLE: See Page 219
CALCIUM ACETATE
PhosLo®
Tablet
667 mg
CALCIUM CARBONATE
Os-Cal®
Tablet each contains:
Calcium Carbonate
0.625 g (250 mg or 12.5 mEq Ca++)
Vitamin D
125 unit
Os-Cal 500®
Tablet
1.25 g (500 mg or 25 mEq Ca++)
Note: O.T.C., non-legend drug available for inpatients only.
0.08
0.02
0.02
CALCIUM CARBONATE: Ingredient of Florical® & Titralac®
55
UTMB COST
CALCIUM CHLORIDE
Injection
100 mg/ml: 10 ml ampule
10 ml syringe
Note: 100 mg (27.2 mg or 1.36 mEq Ca++) / ml
CALCIUM CITRATE
Citracal®
Tablet 950 mg (equivalent to 200 mg or 10 mEq Ca++)
Note: O.T.C., non-legend drug available for inpatients only.
0.33
1.70
0.02
CALCIUM DISODIUM VERSENATE®: Brand of Edetate Calcium Disodium
CALCIUM GLUBIONATE
Neo-Calglucon®
Liquid 1.8 g (115 mg or 5.75 mEq Ca++)/5 ml: 473 ml
1.20/30 ml
Note: each 5 ml is also equivalent to 1.2 gm of Calcium Gluconate. O.T.C., non-legend drug
available for inpatients only.
CALCIUM GLUCONATE
Injection
100 mg/ml: 10ml vial
Note: 100mg (9 mg or 0.45 mEq Ca++)/ml
Tablet
500 mg
CALCIUM IPODATE
Oragrafin®
Powder
Note: Contains 61.7% Iodone.
3 g packet
0.31
0.10
5.45
CAMPATH®: Brand of Alemtuzumab
CAMPTOSAR®: Brand of Irinotecan
CANASA®: Brand of Mesalamine Suppository
CANCIDAS®: Brand of Caspofungin
CANDESARTAN
Atacand®
Tablet
CANDIDA ALBICAN SKIN TEST
Intradermal Injection
CAPECITABINE
Xeloda®
Tablet
CAPOTEN®: Brand of Captopril
56
4 mg
8 mg
16 mg
32 mg
1.31
1.31
1.31
1.78
2 ml: 10 dose vial
0.50/dose
150 mg
500 mg
3.55
11.82
UTMB COST
CAPTOPRIL
Capoten®
Tablet
Suspension
12.5 mg
25 mg
50 mg
100 mg
1 mg/ml (compounded)
0.05
0.08
0.09
0.11
0.60/25 ml
CARA-KLENZ™: see Aloe Vera
CARAFATE®: Brand of Sucralfate
CARBACHOL
Isopto® Carbachol
Solution, ophthalmic
Miostat® Intraocular
Injection
CARBAMAZEPINE
Tegretol®
Suspension
Tablet
Tablet, chewable
1.5%: 15 ml
3%: 15 ml
15.13
15.96
0.01%: 1.5 ml
8.88
100 mg/5 ml
200 mg
100 mg
2.39/30 ml
0.07
0.33
CARBIDOPA: Ingredient of Sinemet® and Sinemet® CR
CARBOCAINE®: Brand of Mepivicaine
CARBON DIOXIDE
Ceo-Two®
Suppository
CARBOPLATIN
Paraplatin®
Injection
CARBOPROST
Hemabate®
Injection
0.51
50 mg vial
150 mg vial
450 mg vial
11.00
38.07
80.22
250 mcg/ml; 1 ml ampule
51.62
CARDENE®: Brand of Nicardipine
CARDIAC COCKTAIL, Pediatric Cocktail (UTMB Compounded) C-II
Injection: 2 ml
each ml contains:
Chlorpromazine
6.25 mg
Meperidine
25 mg
Promethazine
6.25 mg
Note: Dose 1 ml/10 Kg (or 22 lbs) to a maximum dose of 2 ml.
0.42
57
UTMB COST
CARDIO-GREEN®: Brand of Indocyanine Green
CARDIZEM®: Brand of Diltiazem
CARIMUNE®: Brand of Immune Globulin, Intravenous (Human)
CARISOPRODOL
Soma®
Tablet
CARMUSTINE
BiCNU®, BCNU
Injection
Note: Refrigerate
CARNITINE
Carnitor®
Suspension
Tablet
350 mg
0.04
100 mg
133.00
1 gm/10 ml
330 mg
6.00/30 ml
0.63
CARRINGTON DERMAL WOUND GEL™: see Allantoin
CARVEDILOL
Coreg®
Tablet
3.125 mg
6.25 mg
12.5 mg
25 mg
Restriction: Cardiology Faculty, Steve Quach, MD - Internal Medicine
CASCARA SAGRADA, AROMATIC
Fluid Extract
5ml, unit dose
Note: O.T.C., non-legend drug available for inpatients only.
1.48
1.48
1.48
1.48
0.20
CASODEX®: Brand of Bicalutamide
CASPOFUNGIN
Cancidas®
Injection
50 mg vial
311.98
70 mg vial
401.91
Restriction: For Burn Unit patients for up to 48 hours unless Infectious Disease consult is
received to prolong therapy. 70 mg vial for Day 1 dose only.
CASTADERM®
Solution: each 30 ml in a water base contains
Acetone
5%
Alcohol
10%
Basic Fuchsin
0.3%
Phenol
4.5%
Resorcinol
10%
58
3.90
UTMB COST
CASTELLANI’S PAINT: See Castaderm®
CASTOR OIL
Oil
60 ml
Note: O.T.C., non-legend drug available for inpatients only.
0.60
CATAPRES®: Brand of Clonidine
CCK synthetic: See Sincalide
CCNU: See Lomustine
CDDP: See Cisplatin
CE-VI-SOL®: Brand of Vitamin C
CEBOCAP®: Brand of Placebo
CECON®: Brand of Vitamin C
CeeNU®: Brand of Lomustine
CEFAZOLIN
Ancef®
Injection
CEFDINIR
Omnicef®
Capsules
Oral Suspension
CEFEPIME
Maxipime®
Injection
500 mg
1g
10 g bulk vial
2.56
1.22
10.58
300 mg
125 mg/5 ml; 60 ml
3.94
39.29
1 gm vial
1 gm piggyback bottle, 100 ml
2 gm vial
2 gm piggyback bottle, 100 ml
12.48
13.38
24.78
25.66
1 g vial
2 g vial
10 g bulk vial
3.35
6.75
32.13
1 g vial
2 g vial
8.20
16.40
Restriction: Febrile neutropenia
CEFOTAN®: Brand of Cefotetan
CEFOTAXIME
Claforan®
Injection
CEFOTETAN
Cefotan®
Injection
59
UTMB COST
CEFOXITIN
Mefoxin®
Injection
1 gm vial
1 gm RTU
2 gm vial
2 gm RTU
5.85
11.71
CEFTAZIDIME
Fortaz®, Tazicef®, Tazidime®
Injection
1 g vial
11.58
2 g vial
23.15
6 g bulk vial
67.36
Restriction: For Neonatal use or for Cystic Fibrosis with Pediatric Infectious Disease Faculty
approval
CEFTRIAXONE DISODIUM
Rocephin®
Injection
250 mg
2.15
500 mg
4.02
1g
5.40
Restriction: Pediatric Faculty, CNS infections in adults, and Sexually Transmitted Diseases
for ER patients. For neonatal patients via ID approval only.
CEFUROXIME SODIUM
Kefurox®, Zinacef®
Injection
750 mg
CELESTONE® SOLUSPAN
Injection:
5 ml repository, each ml contains
Betamethasone Acetate
3 mg
Betamethasone Sodium Phosphate 3 mg
2.84
24.40
CELEXA®: Brand of Citalopram
CELL-CEPT®: Brand of Mycophenolate mofetil
CELONTIN®: Brand of Methsuximide
CENOLATE®: Brand of Vitamin C
CEO-TWO®: Brand of Carbon Dioxide
CEPACOL®
Anesthetic Troches: each contains
Benzocaine
10 mg
Cetylpyridinium Chloride 1:5000
Throat Lozenges: each contains
Benzyl Alcohol
0.3%
Cetylpyridinium Chloride 1:1500
Note: O.T.C., non-legend drug available for inpatients only.
60
0.12
0.07
UTMB COST
CEPHALEXIN
Keflex®
Capsule
250 mg
0.12
500 mg
0.23
Suspension
125 mg/5 ml: 100 ml
4.89
250 mg/5 ml: 200 ml
10.66
Note: After reconstitution the suspension will remain stable for 14 days when refrigerated.
CEPHULAC®: Brand of Lactulose
CEREBYX®: Brand of Fosphenytoin
CERUBIDINE®: Brand of Daunorubicin
CETACAINE® SPRAY: Replaced by Hurricane® Spray
CETAMIDE®: Brand of Sulfacetamide Sodium
CETIRIZINE
Zyrtec®
Syrup
Tablet
5 mg/5 ml
5 mg
10 mg
Restriction: Allergy, Dermatology and Otolaryngology Faculty.
0.85/5 ml
1.80
1.80
CETYLPYRIDINIUM CHLORIDE: Ingredient of Cepacol®
CETUXIMAB
Erbitux®
Injection
100 mg vial
Restriction: Hematology/Oncology, Gyn/Oncology, Pedi/Oncology
CEVIMELINE
Evoxac®
Tablet
30 mg
CHARCOAL, ACTIVATED
Actidose - Aqua®, Super Char® Aqueous Ready-to-use in water
Solution
25 gm/120 ml
50 gm/240 ml
Note: O.T.C., non-legend drug available for inpatients only.
389.87
0.87
2.40
7.20
CHEMET®: Brand of Succimer
CHLOR-TRIMETON®: Brand of Chlorpheniramine Maleate
61
UTMB COST
CHLORAL HYDRATE C-IV
Aquachloral®
Suppository
324 mg
648 mg
Noctec®
Capsule
Syrup
500 mg
500 mg/5 ml: 480 ml
500 mg/5 ml: 5 ml unit dose
Restriction: Requires DEA number on outpatient prescriptions.
CHLORAMBUCIL
Leukeran®
Tablet
CHLORAMPHENICOL
Chloromycetin®
Capsule
Suspension
Chloromycetin®, Mychel®
Injection
2 mg
1.91
1.14
0.05
0.30/30 ml
0.20
1.01
250 mg
150 mg/5 ml: 60 ml
1g
0.91
10.80
4.02
CHLORASEPTIC® SPRAY: Brand of Phenol
CHLORDIAZEPOXIDE C-IV
Librium®
Capsule
Injection
5 mg
10 mg
25 mg
100 mg
0.12
0.11
0.11
20.55
CHLORDIAZEPOXIDE: Ingredient of Librax®
CHLORDINIUM®: See Librax®
CHLORHEXIDINE GLUCONATE
Peridex®
Oral rinse
0.12%; 1 pint
4.80/pint
Note: Approved for use by Oral and Maxillofacial Surgery to be stocked in the O.R.
CHLOROBUTANOL: Ingredient of Lacri-Lube® SOP
CHLOROMYCETIN®: Brand of Chloramphenicol
CHLOROPROCAINE
Nesacaine®, MPF
Injection
CHLOROQUINE PHOSPHATE
Aralen®
Tablet
62
2% :
3% :
20 ml single dose vial
20 ml single dose vial
250 mg
500 mg
8.60
9.00
0.05
2.14
UTMB COST
CHLOROTRIANISENE
Tace®
Capsule
12 mg
0.67
CHLORPHENIRAMINE MALEATE
Chlor-Trimeton®
Tablet
4 mg
0.02
25 mg/ml:
2 ml
25 mg
10 mg/5 ml; 120 ml
100 mg/ml: 240 ml
10 mg
25 mg
50 mg
100 mg
200 mg
0.58
2.55
1.14/30 ml
1.20/30 ml
0.20
0.05
0.03
0.04
0.05
100 mg
250 mg
0.21
0.42
10 mg
25 mg
50 mg
100 mg
0.35
0.46
0.59
0.72
25 mg
50 mg
100 mg
0.04
0.05
0.09
CHLORPROMAZINE
Thorazine®
Injection
Suppository
Syrup
Concentrate
Tablet
CHLORPROPAMIDE
Diabinese®, Glucamide®
Tablet
CHLORPROTHIXENE
Taractan®
Tablet
CHLORTHALIDONE
Hygroton®
Tablet
CHOLECYSTOKININ synthetic: see Sincalide
CHOLEDYL®: Brand of Oxtriphylline Hydrochloride
CHOLESTYRAMINE RESIN
Questran®
Powder packets
9g
Bulk can
378 g
Each 9 g of powder is equivalent to 4 g of resin
CHORIONIC GONADOTROPIN
Antuitrin-S®, APL®, Pregynl®
Injection
10,000 U/ml: 10 ml
1.42
27.00
28.30
63
UTMB COST
CHRONULAC®: Brand of Lactulose
CHYMEX®: Brand of Bentiromide
CHYMOTRYPSIN
Alpha Chymar®, Zolyse®
Solution, ophthalmic
75 U/ml: 10 ml
14.57
75 mg/ml; 5 ml
722.39
CIBALITH-S®: Brand of Lithium Citrate
CIDOFOVIR
Vistide®
Injection
CILASTATIN: See Imipenem - Cilastatin
CIMETIDINE
Injection
300 mg/2 ml
2.91
Restriction: Emergency Department use for moderate-to-severe allergic reactions/urticaria
CIN-QUIN®: Brand of Quinidine Sulfate
CIPRO®: Brand of Ciprofloxacin
CIPROFLOXACIN
Cipro®
Injection
Tablet
400 mg vial
23.43
250 mg
0.15
500 mg
0.20
750 mg
0.53
Restriction: all injectable and oral ciprofloxacin products are restricted to Infectious
Disease Faculty and Vincent Valentine, MD. The restriction requires order by appropriate
physician or call to Restricted Antibiotic Approval Line.
CISATRACURIUM
Nimbex®
Injection
CISPLATIN
Platinol® AQ
Injection
CITALOPRAM
Celexa®
Tablet
CITRACAL®: Brand of Calcium Citrate
64
2 mg/ml; 5 ml SDV
2 mg/ml; 10 ml vial
8.88
15.58
50 mg
100 mg
9.00
18.00
10 mg
20 mg
40 mg
0.11
0.09
0.09
UTMB COST
CITRATE OF MAGNESIA: see Magnesium Citrate
CITRIC ACID: Ingredient of Urologic G Solution, Bicitra®
CLADRIBINE
Leustatin™
Injection
1 mg/ml: 10 ml
299.21
Restriction: Hematology/Oncology faculty co-signature. The drug will not be stocked in the
Pharmacy but can be obtained with 24 hours notice.
CLAFORAN®: Brand of Cefotaxime
CLARITHROMYCIN
Biaxin®
Tablet
Suspension
250 mg
500 mg
125 mg/5 ml; 100 ml
250 mg/5ml; 100 ml
2.04
2.04
33.92
64.66
CLARITIN®: Brand of Loratidine
CLAVULANATE POTASSIUM: Ingredient of Augmentin®
CLEOCIN®: Brand of Clindamycin
CLINDAMYCIN
Cleocin HCl®
Capsule
150 mg
300 mg
0.43
4.92
Cleocin Pediatric®
Suspension
75 mg/5 ml: 100 ml
23.91
Note: After reconstitution, DO NOT REFRIGERATE. Discard after 14 days.
Cleocin Phosphate®
Injection
150 mg/ml: 2 ml
1.43
4 ml
2.44
6 ml
3.23
60 ml bulk vial
80.68
Restriction: All oral and injectable forms of clindamycin are restricted to Infectious Disease
Faculty, OB/Gyn Faculty, and Pediatric Faculty. Restriction also includes Orthopedic
Faculty for use in surgical prophylaxis up to 24 hours in patients with penicillin or
cephalosporin allergies.
Cleocin T®
Solution, topical
Cleocin Vaginal Cream®
Cream, vaginal
10 mg/ml: 30 ml
2%:
40 gm
2.34
41.75
CLIDINIUM BROMIDE: Ingredient of Librax®
CLINORIL®: Brand of Sulindac
CLOMID®: Brand of Clomiphene
65
UTMB COST
CLOMIPHENE
Clomid®, Serophene®
Tablet
50 mg
1.36
Restriction: Attending Staff must countersign orders within 48 hours.
CLOMIPRAMINE
Anafranil®
Capsule
25 mg
50 mg
75 mg
Restiction: Restricted to use by Psychiatry faculty.
0.27
0.09
0.54
CLONAZEPAM C-IV
Klonopin®
Tablet
500 mcg (0.5 mg)
1 mg
2 mg
Special Restriction: Requires DEA number on outpatient prescriptions.
CLONIDINE
Catapres®
Tablet
Catapres TTS®
Transdermal Patch
CLOPIDOGREL
Plavix®
Tablet
100 mcg (0.1 mg)
200 mcg (0.2 mg)
300 mcg (0.3mg)
0.08
0.10
0.12
0.1 mg
0.2 mg
0.3 mg
(Released per day for 7 days.)
13.56
22.83
31.68
75 mg
300 mg
3.66
16.20
Restriction: Cardiology Faculty
Interventional Radiology Faculty
Vascular Surgery Faculty
CLORAZEPATE DIPOTASSIUM C-IV
Tranxene®
Tablet
Geriatric Faculty
Neurology Faculty
Loretta Grumbles, M.D.
3.75 mg
7.5 mg
15 mg
Note: Requires DEA number for outpatient prescriptions.
CLOTRIMAZOLE
Mycelex®, Lotrimin®
Cream
Solution, topical
Troche, oral
66
0.15
0.15
0.18
1%: 30 gm
1%: 30 ml
10 mg
0.07
0.07
0.16
3.35
5.21
0.95
UTMB COST
CLOZAPINE
Clozaril®
Tablet
25 mg
0.52
100 mg
1.49
Restriction: Restricted to use by Psychiatry faculty for inpatient use only. Only a one
week supply upon discharge will be available for outpatient use.
CLOZARIL®: Brand of Clozapine
COAL TAR, CRUDE
Zetar®
Shampoo
1%: 180 ml
Note: O.T.C., non-legend drug available for inpatients only.
5.70
COCAINE HYDROCHLORIDE C-II
Flakes for solution specify strength and quantity
Solution, topical
5%: 5 ml
COCCIDIOIDIN
Injection
1:10, 1 ml
1:100, 1 ml
8.17
2.70
1 ml syringe
2 ml syringe
0.51
1.44
30 mg
60 mg
0.32
0.53
Note: For intradermal use only.
CODEINE PHOSPHATE C-II
Injection 30 mg/ml:
CODEINE SULFATE C-II
Tablet
CODEINE:
Ingredient of Empirin® with Codeine, Guaituss AC®, Robitussin A-C®, Terpin Hydrate with
Codeine & Tylenol® with Codeine
COGENTIN®: Brand of Benztropine Mesylate
COLACE®: Brand of Docusate Sodium
COLCHICINE
Injection
Tablet
0.5 mg/ml:
2 ml
600 mcg (0.6 mg)
COLISTIMETHATE
Coly-Mycin® M
Injection
75 mg/ml:
Note: Injection is for IM and IV use.
2 ml
3.22
0.11
23.38
COLISTIN: Ingredient of Coly-Mycin® S Otic
COLY-MYCIN® M: Brand of Colistimethate
67
UTMB COST
COLY-MYCIN® S Otic
Suspension, otic: 5 ml, each ml comtains
Colistin Sulfate
3 mg
Hydrocortisone Acetate
10 mg
Neomycin Sulfate
3.3 mg
27.16
COLYTE®: see Golytely®
COMBIVENT®
Inhaler, metered dose: each inhalation contains
Ipratropium
18 mcg
Albuterol
90 mcg
200 inhalations per cannister, 14.7 gm
65.97
COMBIVIR®
Tablet: each contains
9.80
Lamivudine
150 mg
Zidovudine
300 mg
Restriction: Infectious Disease Faculty, Ob/Gyn Faculty, or UTMB Occupational Exposure
COMPAZINE®: Brand of Prochlorperazine
CONCERTA®: Brand of Methylphenidate SR
CONDYLOX®: Brand of Podophyllotoxin
CONGO RED
Injection
10 mg/ml: 10 ml
3.60
CORDARONE®: Brand of Amiodarone
COREG®: Brand of Carvedilol
CORTEF®: Brand of Hydrocortisone Acetate
CORTENEMA: Brand of Hydrocortisone
CORTIFOAM®: Brand of Hydrocortisone
CORTICOTROPIN GEL INJECTION
Acthar® Gel
Injection
80 units/ml; 5 ml
23,000.00
Restriction: Joan Richardson, MD, and Carroll King, MD per increased cost
68
UTMB COST
CORTISPORIN®
Ointment, ophthalmic:
3.5 g
each g contains:
Bacitracin Zinc
400 U
Hydrocortisone
10 mg (1%)
Neomycin Sulfate
5 mg
Polymyxin B Sulfate 10,000 U
Suspension, ophthalmic:
7.5 ml
each ml contains:
Hydrocortisone
10 mg (1%)
Neomycin Sulfate
5 mg
Polymyxin B Sulfate 10,000 U
Suspension, otic: 10 ml
each ml contains:
Hydrocortisone
10 mg (1%)
Neomycin Sulfate
5 mg
Polymyxin B Sulfate 10,000 U
Note: 5 mg Neomycin Sulfate is equivalent to 3.5 mg Neomycin base.
2.20
36.01
8.30
CORTOMYCIN® OTIC: See Cortisporin® Suspension, Otic
CORTRIL® ACETATE: Brand of Hydrocortisone Acetate
CORTROSYN®: Brand of Cosyntropin
CORVERT®: Brand of Ibutilide
COSMEGEN®: Brand of Dactinomycin
COSOPT®
Ophthalmic solution
Contains:
Dorzolamide
Timolol
5 ml
42.22
2%
5%
COSYNTROPIN
Cortrosyn®
Injection
250 mcg (0.25 mg)
Note: 250 mcg Cortrosyn® is equivalent to 25 U of activity.
COSTANZI’S FORMULA (UTMB Compounded)
Contains:
Fluocinolone Acetonide
0.01% Topical Soln 20 ml
Tetracycline Suspension
125 mg/5 ml
60 ml
Nystatin Suspension
100,000 U/ml
60 ml
Diphenhydramine Elixir
12.5 mg/5 ml qs 240 ml
Note: Expires in two (2) weeks following mixture of ingredients.
63.50
5.40
CO-TRIMOXAZOLE: See Bactrim®
COUMADIN®: Brand of Warfarin Sodium
69
UTMB COST
COZAAR®: Brand of Losartan
CRESTOR®: Brand of Rosuvastatin
CRIXIVAN®; See Indinavir
CROFAB®: Brand of Crotalidae Polyvalent Immune Fab (ovine)
CROLOM®: Brand of Cromolyn Sodium
CROMOLYN SODIUM
Intal®
Metered Dose Inhaler
800 mcg/inhalation
8.1 g cannister (112 inhalations)
Nasalcrom®
13 ml solution + nasalmatic nebulizer Spray 13 ml
Opticrom®
Solution, Ophthalmic
4%, 10 ml
CROTALIDAE POLYVALENT IMMUNE FAB (Ovine)
CroFab®
Injection
10 ml lyophilized powder
56.91
11.55
3.91
1,000.61
CUBICIN®: Brand of Daptomycin
CUPRIMINE®: Brand of Penicillamine
CYANOCOBALAMIN: See Vitamin B-12
CYANOKIT®: Brand of Hydoxocobalamin
CYCLOBENZAPRINE
Flexeril®
Tablet
5 mg
10 mg
1.31
0.10
CYCLOGYL®: Brand of Cyclopentolate
CYCLOMYDRIL®
Cyclopentolate / Phenylephrine
Solution, ophthalmic
CYCLOPENTOLATE
Cyclogyl®, Pentolair®
Solution, ophthalmic
70
0.2%/0.1%;
2 ml
5.80
0.5%:
1%:
2%:
15 ml
5 ml
5 ml
8.02
2.05
4.88
UTMB COST
CYCLOPHOSPHAMIDE
Cytoxan®, Neosar®
Injection
Tablet
CYCLOSPORIN A
Sandimmune®
Capsule
Injection
Solution
CYCLOSPORINE MICROEMULSION
Neoral®, Gengraf®
Capsule
Neoral®
Solution
2 g lyophilyzed
25 mg
50 mg
25 mg
100 mg
50mg/ml, 5 ml
100 mg/ml, 50 ml
25 mg
100 mg
100 mg/ml;
35.14
0.94
1.72
1.41
5.64
23.72
273.85
1.24
4.96
50 ml
270.76
CYCRIN®: Brand of Medroxyprogesterone Acetate
CYMBALTA®: Brand of Duloxetine
CYPROHEPTADINE
Periactin®
Syrup
Tablet
2 mg/5 ml;
4 mg
480 ml
CYTARABINE
Cytosar-U®, ARA-C, Cytosine Arabinoside
Injection
100 mg
500 mg
2000 mg
0.30/30 ml
0.03
1.31
3.70
13.96
CYTOGAM®: Brand of Immune Globulin, Cytomegalovirus
CYTOMEL®: Brand of Liothyronine
CYTOSAR-U®: Brand of Cytarabine
CYTOSINE ARABINOSIDE: See Cytarabine
CYTOTEC®: Brand of Misoprostol
CYTOVENE®: Brand of Ganciclovir
CYTOXAN®: Brand of Cyclophosphamide
71
UTMB COST
DACARBAZINE
DTIC-Dome®
Injection
100 mg
200 mg
DACLIZUMAB
Zenapax®
Injection
25 mg vial
Restriction: Solid Organ Transplant Faculty
DACTINOMYCIN
Cosmegen®, Actinomycin-D
Injection
500 mcg (0.5 mg)
DAKIN’S SOLUTION, MODIFIED (UTMB Compounded)
Solution: 1 gal, each contains
Clorox half strength:
200 ml (0.25%)
full strength: 400 ml (0.5%)
Sodium Bicarbonate
12 g
Distilled Water
3840 ml
Note: Stable for 7 days.
10.73
18.14
314.52
13.11
0.25/gal
0.37/gal
DALMANE®: Brand of Flurazepam
DANAZOL
Danocrine®
Capsule
50 mg
100 mg
200 mg
0.86
1.58
1.86
20 mg
25 mg
100 mg
34.67
0.72
1.18
0.5%; 5 ml
35.20
DANOCRINE®: Brand of Danazol
DANTRIUM®: Brand of Dantrolene
DANTROLENE
Dantrium®
Injection
Capsule
DAPIPRAZOLE
REV-EYES®
Solution, ophthalmic
DAPSONE
(DDS)
Tablet
72
100 mg
0.16
UTMB COST
DAPTOMYCIN
Cubicin®
Injection
500 mg vial
148.38
Special Restriction: Non-formulary status. Restricted to Infectious Disease Faculty.
Medication will not be stocked by the pharmacy.
DARAPRIM®: Brand of Pyrimethamine
DARBEPOETIN
Aranesp®
Injection
25 mcg/1 ml vial
81.38
40 mcg/1 ml vial
130.21
60 mcg/1 ml vial
195.30
100 mcg/1 ml vial
325.51
200 mcg/1 ml vial
651.03
Restriction: All Inpatient and TDCJ darbepoetin use is restricted to Avi Markowitz, MD Hematology/Oncology, and Robert Beach, MD - Nephrology
DARVON-N®: Brand of Propoxyphene Napsylate
DARUNAVIR
Prezista®
Tablet
300 mg
6.10
Note: Darunavir 600 mg must be co-administered with ritonavir 100 mg twice daily with
food
Restriction: Infectious Disease Faculty
DAUNOMYCIN: See Daunorubicin
DAUNORUBICIN
Cerubidine®, Daunomycin
Injection
20 mg
34.56
DAYPRO®: Brand of Oxaprozin
DDAVP®: Brand of Desmopressin Acetate
DDS: See Dapsone
DECA-DURABOLIN®: Brand of Nandrolone Decanoate
DECADRON®: Brand of Dexamethasone
DECHOLIN®: Brand of Sodium Dehydrocholate
DECLOMYCIN®: Brand of Demeclocycline
DEFEROXAMINE MESYLATE
Desferal® Mesylate
Injection
500 mg
9.78
DEFINITY®: Brand of Perflutren Lipid Microsphere
73
UTMB COST
DELALUTIN®: Brand of Hydroxyprogesterone Caproate
DELATESTRYL®: Brand of Testosterone Enanthate
DELESTROGEN®: Brand of Estradiol Valerate
DELTA-CORTEF®: Brand of Prednisolone
DEMECLOCYCLINE
Declomycin®
Tablet
300 mg
16.62
DEMEROL®: Brand of Meperidine Hydrochloride
DENDROID®: Brand of Idoxuridine
DEPAKENE®: Brand of Valproic Acid
DEPAKOTE®, DEPAKOTE® ER: Brand of Divalproex Sodium
DEPO®-ESTRADIOL: Brand of Estradiol Cypionate
DEPONIT®: Brand of Nitroglycerin Patch
DEPO-MEDROL®: Brand of Methylprednisolone Acetate
DEPO-PROVERA®: Brand of Medroxyprogesterone Acetate
DEPO®-TESTOSTERONE: Brand of Testosterone Cypionate
DERMAGUARD®: Brand of Karaya Gum
DERMAIDE ALOE®: Brand of Aloe Vera
DERMOPLAST®: Brand of Benzocaine
DES: see Diethylstilbesterol
DESFERAL® Mesylate: Brand of Deferoxamine Mesylate
DESFLURANE
Suprane®
Halogentated anesthetic
240 ml
70.00
Restriction: Will be purchased, stored and used by the Department of Anesthesiology.
74
UTMB COST
DESIPRAMINE
Norpramin®
Tablet
25 mg
50 mg
75 mg
100 mg
150 mg
0.05
0.08
0.13
0.15
0.43
DESITIN®
Ointment:
60 g, each contains
Cod Liver Oil, Lanolin, Petrolatum, Talc
Zinc Oxide 40% as Active Ingredient
Note: O.T.C., non-legend drug available for inpatients only.
DESMOPRESSIN ACETATE
DDAVP®
Solution, nasal
Injection
100 mcg (0.1 mg)/ml; 2.5 ml
4 mcg/ml;
1 ml ampule
10 ml vial
0.60
60.89
5.26
48.81
Note: 1 mcg = 4 I.U.
DESOGEN®
Tablets 28's
7 inert tablets plus 21 tablets containing:
Desogestrel
0.15 mg
Ethinyl Estradiol
30 mcg
1.80
DESOGESTREL: See Desogent®
DESENEX® MAX: Brand of Terbinafine
DESOXYRIBONUCLEASE: Ingredient of Elase®
DESQUAM-X®: Brand of Benzoyl Peroxide
DESYREL®: Brand of Trazodone
DEXAMETHASONE
Injection
Decadron Turbinaire®
Aerosol, nasal
Decadron®, Maxidex®
Solution, ophthalmic
Intensol®
Solution, oral
Decadron®, Hexadrol®, Dexone®
Tablet
4 mg/ml:
10 mg/ml:
5 ml vial
1 ml Syringe
10 ml vial
12.6 g
0.1%:
0.35
1.56
1.71
21.92
5 ml
1 mg/ml: 30 ml
500 mcg (0.5 mg)
750 mcg (0.75 mg)
1.5 mg
4 mg
9.12
13.73
0.05
0.10
0.12
0.11
75
UTMB COST
DEXAMETHASONE: Ingredient of Maxitrol®
DEXEDRINE®: Brand of Dextroamphetamine Sulfate
DEXMEDETOMIDINE
Precedex®
Injection
100 mcg/ml, 2 ml
55.84
Restriction: Anesthesia Faculty for use in pediatric patients with cleft palate, cleft lip, and
similar surgeries.
DEXPANTHENOL
ILOPAN®
Injection
Note: For IM or SQ use only.
250 mg/ml:
2 ml
1.18
DEXTOL®: Brand of Dextrose
DEXTRAN 40 (LMW)
Rheomacrodex®
Injection
DEXTRAN 70 (HMW) or 75 (HMW)
Macrodex®
Injection
Hyskon®
Injection
10% in D5W: 500 ml
10% in NS: 500 ml
6% in NS:
17.19
17.95
500 ml
9.81
32% in D10W:100 ml
28.09
DEXTROAMPHETAMINE SULFATE C-II
Dexedrine®
Tablet
5 mg
0.10
Restriction: Requires triplicate prescription form for outpatient prescriptions.
DEXTROAMPHETAMINE / AMPHETAMINE
Adderall XR®
Tablet, XR
5 mg
10 mg
15 mg
20 mg
25 mg
30 mg
1.46
1.44
1.50
1.45
1.47
1.45
DEXTROMETHORPHAN: Ingredient of Robitussin DM®
DEXTROSE
Injection
Dextol®, Tru-Glu®, Limeondex®
Solution, oral
DHPG: see Ganciclovir
76
500 mg/ml (50%):
100 g/300 ml: 300 ml
50 ml, vial
50 ml, syringe
0.50
2.00
1.82
UTMB COST
DIABINESE®: Brand of Chlorpropamide
DIAMOX®: Brand of Acetazolamide
DIAPID®: Brand of Lypressin
DIAZEPAM C-IV
Valium®
Injection
5 mg/ml:
2 ml syringe
10 ml vial
Tablet
2 mg
5 mg
10 mg
Restriction: Requires DEA number on outpatient prescriptions.
DIAZOXIDE
Hyperstat® IV
Injection
15 mg/ml:
20 ml
DIBUCAINE
Nupercainal®
Ointment
1%: 30 g
Note: O.T.C., non-legend drug available for inpatients only.
DICHLOROTETRAFLUOROETHANE
Frigiderm®
Aerosol
240 g
Note: Available for inpatients only.
25 mg
50 mg
75 mg
Restriction: Rheumatology faculty .
DICYCLOMINE HYDROCHLORIDE
Bentyl®
Capsule
Injection
Tablet
1.20
0.10
0.25
0.25
125 mg
250 mg
10 mg
10 mg/ml:
20 mg
105.23
7.27
DICLOFENAC
Voltaren®
Tablet
DICLOXACILLIN
Dycill®, Dynapen®
Capsule
1.61
1.37
0.06
0.06
0.06
0.06
0.11
2 ml
0.08
11.94
0.18
77
UTMB COST
DIDANOSINE
Videx®
Suspension
Capsule, enteric coated
2 gm/120 ml
125 mg
200 mg
250 mg
400 mg
Restriction: Infectious Disease Faculty or Occupational Exposure
DIENESTROL
DV® Cream
Cream, vaginal
DIETHYLSTILBESTROL
DES®
Tablet
0.01%: 78g
1 mg
5 mg
6.43/30 ml
2.83
4.53
5.77
9.01
17.94
0.07
0.11
DIFLUCAN®: see Fluconazole
DIGIBIND®: Brand of Digoxin Immune Fab
DIGIFAB®: Brand of Digoxin Immune Fab
DIGOXIN
Lanoxin®
Elixir
Injection
50 mcg (0.05 mg)/ml: 60 ml
100 mcg (0.1 mg)/ml:1 ml
250 mcg (0.25 mg)/ml: 2 ml
Tablet
125 mcg (0.125 mg)
250 mcg (0.25 mg)
Note: injection for IV or IM use.
21.00
4.19
0.76
0.19
0.19
DIGOXIN IMMUNE Fab
DIGIBIND®, DIGIFAB®
Injection
38 mg/vial (Digibind®)
562.55
40 mg/vial (Digifab®)
467.60
Note: Consultation with Poison Control Center prior to administration is recommended.
Each vial will bind approximately 0.5 mg digoxin or digitoxin. Pharmacy inventory may vary
based on availability.
DIHYDROTACHYSTEROL
Hytakerol®
Tablet
125 mcg (0.125 mg)
200 mcg (0.2 mg)
0.70
0.55
1,25 - DIHYDROXYVITAMIN D3: See Calcitriol
DIIODOHYDROXYQUIN
Yodoxin®
Tablet
78
650 mg
0.36
UTMB COST
DILANTIN®: Brand of Phenytoin Sodium
DILAPAN®: Brand of Polyacrylonitrate
DILAUDID®: Brand of Hydromorphone
DILTIAZEM
Cardizem®, Dilacor™ XR
Capsule, once-daily sustained
120 mg
0.87
180 mg
0.99
240 mg
1.06
Injection
5 mg/ml;
5 ml
3.85
5 mg/ml;
10 ml
18.50
Restriction: Cardiology faculty for patients with NYHA grade III-IV (ejection fraction
< 40%) to be available for use only in CCU and the telemetry units where monitoring
is available. AND intensive care unit settings including telemetry and L&D.
Tablet
30 mg
0.07
60 mg
0.11
90 mg
0.15
120 mg
0.12
DIMENHYDRINATE
Dramamine®
Tablet
50 mg
0.02
Note: Tablet is an O.T.C., non-legend drug available for inpatients only.
DIMERCAPROL
BAL®
Injection, in oil
Note: For IM use only.
DIMETHYL SULFOXIDE
Rimso-50®, DMSO
Liquid
DINOPROSTONE
Prostin E2®
Suppository, vaginal
Note: Store in Freezer.
Prepidil®
Gel, cervical
100 mg/ml: 3 ml
48.86
50% (540 mg ) in water: 50 ml
40.34
20 mg
21.61
0.5 mg dose
182.84
DIOCTYL SODIUM SULFOSUCCINATE: See Docusate Sodium
DIOVAN®: Brand of Valsartan
79
UTMB COST
DIPHENHYDRAMINE
Benadryl®, Hydramine®
Elixir
Capsule
Injection
12.5 mg/5 ml: 5 ml
120 ml
25 mg
50 mg
50 mg/ml:
1 ml ampule
10 ml vial
0.17
0.90/30 ml
0.03
0.03
0.40
7.80
DIPHENOXYLATE: Ingredient of Lomotil®
DIPHTHERIA AND TETANUS TOXOIDS, ADSORBED
Injection, adult
0.5 ml syringe
Injection, pediatric
0.5 ml single dose vial (0.5 ml/dose)
2.36
2.69/dose
DIPHTHERIA, REDUCED TETANUS TOXOIDS AND ACELLULAR PERTUSSIS
Adacel®
Injection
0.5 ml
33.11
Note: For patients less than 18 years old that are insured and as a full pay medication for
patients greater than 18 years old.
DIPHTHERIA-TETANUS TOXOIDS AND ACELLULAR PERTUSSIS VACCINE,
ADSORBED
Infanrix®, Tripedia® (DTaP)
Injection
7.5 ml
11.90/0.5 ml
DIPHTHERIA-TETANUS TOXOID-ACELLULAR PERTUSSIS-HEPATITIS B-POLIO VACCINE
Pediarix®
Injection
0.5 ml
44.91
Note: Only for patients with reimbursement pending addition of vaccine to Vaccine for
Children program
DIPIVEFRIN HYDROCHLORIDE
Propine®
Solution, ophthalmic
0.1%: 10 ml
3.93
DIPRIVAN®: Brand of Propofol
DIPROLENE®: Brand of Betamethasone Dipropionate
DIPYRIDAMOLE
Persantine®
Tablet
25 mg
50 mg
75 mg
0.29
0.51
0.68
DISALCID®: Brand of Salsalate
DISCOVISC
Sodium Chondroitin Sulfate - Sodium Hyaluronate
Ophthalmic Injection
1 mL prefilled syringe
Note: Replaces Duovisc
80
170.84
UTMB COST
DISOPYRAMIDE PHOSPHATE
Norpace®
Capsule
DISULFIRAM
Antabuse®
Tablet
100 mg
150 mg
0.16
0.11
250 mg
1.09
DITROPAN®: Brand of Oxybutinin Chloride
DIVALPROEX SODIUM
Depakote®
Capsule, coated particles
Tablet, enteric coated
Depakote® ER
Tablet
125 mg
125 mg
250 mg
500 mg
0.36
0.35
0.68
1.24
250 mg
500 mg
1.22
2.13
250 mg/20 ml vial
500 mg/250 ml RTU bag
1.64
6.58
DMSO: See Dimethyl Sulfoxide
DOBUTAMINE
Dobutrex®
Injection
DOBUTREX®: Brand of Dobutamine
DOCETAXEL
Taxotere®
Injection
20 mg vial
80 mg vial
DOCUSATE CALCIUM
PRO-CAL-SOF®, Surfak®
Capsule
240 mg
Note: O.T.C., non-legend drug available for inpatients only.
DOCUSATE SODIUM
Colace®, Dioctyl Sodium Sulfosuccinate, DSS®
Capsule
100 mg
Solution
10 mg/ml:
30 ml
100 mg/10 ml:10 ml unit dose
Note: O.T.C., non-legend drug available for inpatients only.
309.11
1,236.43
0.04
0.03
0.30
0.20
81
UTMB COST
DOFETILIDE
Tikosyn®
Capsule
125 mcg
250 mcg
500 mcg
1.83
1.83
1.83
Restriction: David Ware, M.D.
DOLASETRON
Anzemet®
Injection
Tablet
100 mg/5 ml vial
38.07
50 mg
25.38
100 mg
28.31
Restriction: Hematology/Oncology Faculty (adult & pedi), Ob/Gyn Faculty, Radiation
Oncology
DOLOPHINE®: Brand of Methadone
DOME PASTE® BANDAGE
Gelocast®, Medicopaste® Bandage, Modified Unna’s Boot,
Zinc Gelatin Boot
Bandage: 3" and 4" x 10 yds cotton impregnated with
Calamine
Gelatin
Glycerin
Zinc Oxide
Note: O.T.C., non-legend drug available for inpatients only.
10.82
DOMEBORO®
Tablet: each contains
0.15
Aluminum Sulfate
880 mg
Calcium Acetate
600 mg
Note: Dissolving 1 tablet in 500 ml water gives a 1:40 solution for external use.
O.T.C., non-legend drug available for inpatients only.
DONEPEZIL
Aricept®
Tablet
5 mg
4.23
10 mg
4.23
Restriction: Geriatrics: James Goodwin, M.D.
Charanjeev Mann, M.D.
Deepti Mishra, M.D.
Mukaila Raji, M.D.
Geriatric Psychiatry: Jeff Mathews, M.D. Michael O'Boyle, M.D.
All Neurology Faculty
82
UTMB COST
DONNATAL®
Elixir: 5 ml, each 5 ml contains
Atropine Sulfate
19.4 mcg
Hyoscyamine Sulfate
103.7 mcg
Phenobarbital
16.2 mg
Scopolamine Hydrobromide 6.5 mcg
Tablet: each contains
Atropine Sulfate
19.4 mcg
Hyoscyamine Sulfate
103.7 mcg
Phenobarbital
16.2 mg
Scopolamine Hydrobromide 6.5 mcg
Extentab®:
Tablet: extended release, each contains
Atropine Sulfate
58.2 mcg
Hyoscyamine Sulfate
311.1 mcg
Phenobarbital
48.6 mg
Scopolamine Hydrobromide
19.5 mcg
DOPAMINE HYDROCHLORIDE
Injection
80 mg/ml:
5 ml
800 mg/500 ml RTU bag
0.12/30 ml
0.01
0.24
0.36
8.39
DOPRAM®: Brand of Doxapram
DORIBAX®: Brand of Doripenem
DORIPENEM
Doribax®
Injection
500 mg vial
Restriction: Infectious Disease Faculty
38.42
DORNASE ALPHA
Pulmozyme®
Ampule
2.5 mg
Restriction: Indication of Cystic Fibrosis.
DOXAPRAM
Dopram®
Injection
20 mg/ml:
Restriction: Neonatology Faculty
DOXAZOSIN
Cardura®
Tablet
1 mg
2 mg
4 mg
8 mg
Restriction: Requires Faculty co-signature.
44.21
20 ml
25.97
0.09
0.09
0.16
0.06
83
UTMB COST
DOXEPIN
Sinequan®
Capsule
Liquid, Conc
DOXORUBICIN HYDROCHLORIDE
Adriamycin RDF®
Injection
10 mg
25 mg
50 mg
75 mg
100 mg
150 mg
10 mg/ml
10 mg
50 mg
0.07
0.11
0.10
0.13
0.15
0.22
0.23/5 ml
7.32
21.05
DOXORUBICIN LIPOSOMAL INJECTION
Doxil®
Injection
20 mg
494.26
50 mg
1,235.64
Note: Doxil® and Adriamycin® (doxorubicin) are not therapeutically equivalent and should
not be substituted for one another.
DOXY-TABS®: Brand of Doxycycline
DOXYCYCLINE
Doxy-Tabs®, Vibramycin®
Capsule
Injection
50 mg
100 mg
100 mg
0.06
0.08
12.42
DOXIL®: Brand of Doxorubicin Liposomal Injection
DRAMAMINE®: Brand of Dimenhydrinate
DRISDOL®: Brand of Vitamin D
DRITHOCREME®: Brand of Anthralin
DRIXORAL®
Each extended release tablet contains
Dexbrompheniramine maleate
Pseudoephedrine
DROPERIDOL
Inapsine®
Injection
84
0.15
6 mg
120 mg
2.5 mg/ml: 2 ml
0.41
UTMB COST
DROTRECOGIN
Xigris®
Injection
5 mg/vial
232.78
20 mg/vial
931.10
Restriction: Eric Bedell, M.D., Anesthesiology
Victor J. Cardenas, M.D., Internal Med - Pulmonary/Critical Care
Alexander Duarte, M.D., Internal Med - Pulmonary/Critical Care
Dennis Gore, M.D., Surgery
David N. Herndon, M.D., Surgery
Rayman Lee, M.D., Internal Med - Pulmonary/Critical Care
William Mileski, M.D., Surgery
Gulshan Sharma, M.D., Internal Med - Pulmonary/Critical Care
Note: Drotrecogin Alfa Order Forms (3 pages) must be completed and signed by an
approved ICU attending physician listed in the Restriction Section. An APACHE II score
must be calculated and must be greater than 25.
DSS®: Brand of Docusate Sodium
DT: see Diphtheria-Tetanus Toxoids, Adsorbed
DTaP: see Diphtheria-Tetanus Toxoids and Acellular Pertussis Vaccine, Adsorbed
DTIC-DOME®: Brand of Dacarbazine
DULCOLAX®: Brand of Bisacodyl
DULOXETINE
Cymbalta®
Tablet
20 mg
30 mg
60 mg
2.64
2.96
2.96
Restriction: Psychiatry Faculty
DUOFILM®
Solution, topical
15 ml
in a flexible collodion base ; contains:
Lactic Acid
16.7%
Salicylic Acid
16.7%
Note: O.T.C., non-legend drug available for inpatients only.
5.49
DUOVISC® - replaced by DisCoVisc®
DURAGESIC®: Brand of Fentanyl, transdermal
DURAQUIN®: Brand of Quinidine Gluconate
DURAPAM®: Brand of Flurazepam
DUVOID®: Brand of Bethanecol Chloride
DV® CREAM: Brand of Dienestrol
85
UTMB COST
D-XYLOSE: see Xylose
DYCILL®: Brand of Dicloxacillin Sodium
DYNACIRC®: Brand of Isradipine
DYNAPEN®: Brand of Dicloxacillin
DYRENIUM®: Brand of Triamterene
E-MYCIN®: Brand of Erythromycin Base
ECHOTHIOPHATE IODIDE
Phospholine Iodide®
Solution, ophthalmic
0.25%: 5 ml
18.09
EDECRIN®: Brand of Ethacrynic Acid
EDETATE: See Edetate Calcium Disodium & Edetate Disodium
EDETATE CALCIUM DISODIUM
Calcium Disodium Versenate®
Injection
EDETATE DISODIUM
Endrate®
Injection
Note: For slow IV infusion.
EDROPHONIUM CHLORIDE
Tensilon®
Injection
200 mg/ml:
5 ml
37.76
150 mg/ml:
20 ml
21.77
10 mg/ml: 1 ml
3.41
EDTA: See Disodium Edetate
EES®: Brand of Erythromycin Ethylsuccinate
EFAVIRENZ
Sustiva®
Capsule
50 mg
200 mg
600 mg
Restriction: Infectious Disease Faculty
EFAVIRENZ: Ingredient of Atripla®
EFFERSYLLIUM®: Brand of Psyllium Hydrophilic Mucilloid
EFFEXOR®: Brand of Venlafaxine
EFUDEX®·: Brand of Fluorouracil
86
1.08
4.33
13.00
UTMB COST
ELA-MAX®: Brand of Lidocaine 4% Topical
ELAVIL®: Brand of Amitriptyline
ELECTROLYTE SOLUTION: See Golytely®
ELETRIPTAN
Relpax®
Tablet
20 mg
40 mg
Restriction: Neurology and Emergency Department Faculty
13.99
13.99
ELIMITE®: Brand of Permethrin
ELLENCE®: Brand of Epirubicin
ELOXATIN®: Brand of Oxaliplatin
ELSPAR®: Brand of Asparaginase
EMCYT®: Brand of Estramustine Phosphate Sodium
EMEND®: Brand of Aprepitant
EMETINE HYDROCHLORIDE
Injection
65 mg/ml: 1 ml
Restriction: Attending Staff must countersign orders within 48 hours.
2.32
EMLA®: Brand of Lidocaine/Prilocaine
EMPIRIN® WITH CODEINE C-III
Tablet: each contains
No. 3 - Aspirin 325 mg with Codeine 30 mg
No. 4 - Aspirin 325 mg with Codeine 60 mg
EMTRICITABINE
Emtriva®
Capsules
200 mg
Restriction: Infectious Disease Faculty, Occupational Exposure
0.05
0.08
9.03
EMTRICITABINE: Ingredient of Truvada®, Atripla®
EMTRIVA®: Brand of Emtricitabine
ENALAPRIL MALEATE
Tablets
2.5 mg
5 mg
10 mg
20 mg
0.11
0.06
0.07
0.09
87
UTMB COST
ENALAPRILAT
Vasotec® I.V.
Injection
1.25 mg/ml: 2 ml
3.67
ENDRATE®: Brand of Edetate Disodium
ENFUVIRTIDE
Fuzeon®
Injection
90 mg
Restriction: Infectious Disease Faculty
1,808.23
ENGERIX-B®: Brand of Hepatitis B Vaccine (recombinant)
ENOXAPARIN
Lovenox®
Injection
30 mg/0.3 ml syringe
40 mg/0.4 ml syringe
60 mg/0.6 ml syringe
80 mg/0.8 ml syringe
100 mg/ml syringe
120 mg/0.8 ml syringe
150 mg/ml syringe
Restriction: Faculty Physician approval
13.76
18.34
27.55
36.73
45.91
55.12
68.89
EPIFRIN®: Brand of Epinephrine Hydrochloride
EPINAL®: Brand of Epinephryl Borate
EPINEPHRINE: Ingredient of P E® Products
EPINEPHRINE BITARTRATE
Epitrate®
Solution, ophthalmic
2%: 15 ml
12.29
Note: Epinephrine bitartrate 2% is equivalent to epinephrine base 1.1%.
88
UTMB COST
EPINEPHRINE HYDROCHLORIDE, LEVOROTATORY
Adrenalin®
Injection, aqueous
1 mg/ml (1/1000):
1 ml
0.27
30 ml
1.97
Restriction: 30 ml vial is for use in the Emergency Room and for Lifeflight.
Solution, topical
1 mg/ml (1/1000):
30 ml
14.37
Epifrin®, Glaucon®
Solution, ophthalmic
1%: 5 ml
18.18/15 ml
2%: 5 ml
20.78/15 ml
EPIPEN®
Injection, Auto-Injector
1:1000; 0.3 ml/2ml
44.19
allergic response kit
EPIPEN® JR
Injection, Auto-Injector
1:2000; 0.15 ml/2 ml
44.19
allergic response kit
Ready-To-Inject®
Injection 0.1 mg/ml (1/10,000):
10 ml syringe with 18 G x 3-1/2" needle
3.39
10 ml syringe with 21 G x 1-1/2" needle
2.03
EPINEPHRINE HYDROCHLORIDE, PRESERVATIVE FREE
Injection
1:1000, 1 mg/ml
1.37
EPINEPHRINE HYDROCHLORIDE, RACEMIC
Vaponefrin®
Solution, inhalation
2.25%: 15 ml
8.27
EPINEPHRYL BORATE
Epinal®
Solution, ophthalmic
6.03
1%:
7.5 ml
EPI-PEN®: Brand of Epinephine Hydrochloride, Levorotatory
EPIRUBICIN
Ellence®
Injection
50 mg
585.08
200 mg
2,340.29
Restriction: Hematology/Oncology, Gyn/Oncology, Pedi/Oncology Faculty
EPITRATE®: Brand of Epinephrine Bitartrate
EPIVIR®: Brand of Lamivudine
EPLERENONE
Inspra®
Tablets
25 mg
50 mg
3.08
3.08
Restriction: Cardiology Faculty
EPOGEN™: Brand of Erythropoietin Alpha
EPOETIN ALPHA: see Erythropoietin Alpha
89
UTMB COST
EPTIFIBATIDE
Integrelin®
Injection
20 mg/10 ml vial
75 mg/100 ml vial
66.80
209.15
Restriction: Cardiology Faculty.
EPZICOM®
Tablet: Each contains
Abacavir
600 mg
Lamivudine
300 mg
Restriction: Infectious Disease Faculty.
21.18
ERAXIS®: Brand of Anidulafungin
ERBITUX®: Brand of Cetuximab
ERCAF®: See Cafergot®
ERGAMISOL®: Brand of Levamisole
ERGOCALCIFEROL: Ingredient of Os-cal®
ERGOCALCIFEROL: See Vitamin D2
ERGONOVINE MALEATE
ERGOTRATE® MALEATE
Injection
Note: Refrigerate
0.2 mg/ml
ERGOT ALKALOIDS, DIHYDROGENATED
Germinal®, Hydergine®
Tablet
1 mg
Tablet, sublingual
0.5mg
Note: Sublingual tablet for inpatient use only.
1.85
0.07
0.32
ERGOTAMINE TARTRATE: Ingredient of Cafergot®
ERGOTRATE® MALEATE: Brand of Ergonovine Maleate
ERLOTINIB
Tarceva®
Tablets
25 mg
100 mg
150 mg
28.07
77.09
87.19
ERTAPENEM
Invanz®
Injection
1 gram vial
45.04
Note: Does not cover pseudomonas. Do not mix with or co-infuse with dextrose
solutions.
90
UTMB COST
ERY-PED®: Brand of Erythromycin Ethylsuccinate
ERY-TAB®: Brand of Erythromycin Base
ERYDERM®: Brand of Erythromycin Base
ERYTHROCIN® LACTOBIONATE I.V.: Brand of Erythromycin Lactobionate
ERYTHROMYCIN BASE
Ery-Tab®, Erythromycin Filmtab®, E-Mycin®, Robimycin®
Tablet, enteric coated
250 mg
500 mg
EryDerm®
Solution, topical
2%: 60 ml
Ilotycin®
Ointment, Ophthalmic
0.5%
0.04
0.13
1.66
0.81
ERYTHROMYCIN FILMTAB®: Brand of Erythromycin Base
ERYTHROMYCIN ETHYLSUCCINATE
EES®
Tablet
400 mg
0.11
Tablet, chewable
200 mg
0.34
Ery Ped®, Wyamycin-E®, Pediamycin®
Suspension
200 mg/5 ml: 100 ml
7.17
400 mg/5 ml: 100 ml
10.68
200 ml
19.89
Note: After mixing, the susupension remains stable for 35 days unrefrigerated.
ERYTHROMYCIN ETHYLSUCCINATE: Ingredient of Pediazole®
ERYTHROMYCIN LACTOBIONATE
Erythrocin® Lactobionate - I.V.
Injection
500 mg
1g
Note: For IV use only. Reconstitute with sterile water only.
5.83
1.96
ERYTHROPOETIN ALPHA
Procrit®
Injection
2,000 U/ml: 1 ml
24.28
3,000 U/ml: 1 ml
36.43
4,000 U/ml: 1 ml
48.58
10,000 U/ml: 1 ml
66.07
Restriction: Restricted to adult/pediatric Nephrology faculty/fellows, Hematology/Oncology
Faculty, and Infectious Disease Faculty.
Procrit ®
Injection
40,000 U/ml;1 ml
264.27
Restriction: Infectious Disease (Virology), Orthopedic, and Hematology/Oncology Faculty
for patients with third party reimbursement.
91
UTMB COST
ESCITALOPRAM
Lexapro®
Tablets
10 mg
20 mg
Restriction: Psychiatry faculty and residents
ESGIC®
Capsule, each contains:
Acetaminophen
Butalbital
Caffeine
2.08
2.09
0.05
325 mg
50 mg
40 mg
ESIDRIX®: Brand of Hydrochlorothiazide
ESKALITH®: Brand of Lithium Carbonate
ESMOLOL
Brevibloc®
Injection
10 mg/ml:
250 mg/ml:
(contains 25% propylene glycol)
10 ml
10 ml
8.78
49.97
ESTINYL®: Brand of Ethinyl Estradiol
ESTRACE®: Brand of Estradiol
ESTRADERM®: Brand of Estradiol
ESTRADIOL
Estraderm®, Estrace®
Patch, transdermal
Tablet
Vaginal Ring
ESTRADIOL CYPIONATE
Depo® Estradiol
Injection
Note: For IM use.
ESTRADIOL VALERATE
Delestrogen®
Injection
Note: For IM use.
0.05 mg
0.1 mg
0.5 mg
1 mg
2 mg
2 mg/3 month
5 mg/ml:
10 ml
2.13
10 mg/ml:
5 ml
25.00
ESTRAMUSTINE PHOSPHATE SODIUM
Emcyt®
Capsule
140 mg
Note: Refrigerate.
92
0.18
0.18
0.03
0.03
0.03
92.45
2.15
UTMB COST
ESTRING®: Brand of Estradiol, vaginal ring
ESTROGENS, CONJUGATED
Premarin®
Cream, vaginal
Injection
Note: Injection for IV use.
Tablet
625 mcg (0.625 mg)/g: 43 g
25 mg
300 mcg (0.3 mg)
450 mcg (0.45 mg)
625 mcg (0.625 mg)
900 mcg (0.9 mg)
1.25 mg
ESTROSTEP® FE
Tablets 28's
7 inert tablets plus 21 tablets containing:
Days 1-7:
Norethindrone 1 mg/Ethinyl estradiol 20 mcg
Days 8-14: Norethindrone 1 mg/Ethinyl estradiol 30 mcg
Days 15-21: Norethindrone 1 mg/Ethinyl estradidol 35 mcg
ETHACRYNIC ACID
Edecrin®
Injection
50 mg
Tablet
50 mg
Note: The injection is the sodium salt form.
ETHAMBUTOL HYDROCHLORIDE
Myambutol®
Tablet
100 mg
400 mg
23.50
20.93
0.95
0.95
0.95
1.04
1.04
0.01
14.64
0.33
0.32
1.09
ETHAMOLIN®: Brand of Ethanolamine Oleate
ETHANOLAMINE OLEATE
Ethamolin®
Injection
5%:
ETHINYL ESTRADIOL
Estinyl®
Tablet
50 mcg (0.05 mg)
ETHINYL ESTRADIOL:
2 ml ampule
20.10
0.34
Ingredient of Loestrin 1/20, Loestrin 1.5/30, Ovcon® ,
Ortho-Novum® 7/7/7, Ortho-Tri-Cylcin® ,
Desogen® & Estrostep FE®.
ETHIONAMIDE
Trecator®-SC
Tablet
250 mg
1.05
ETHOSUXIMIDE
Zarontin®
Capsule
Syrup
250 mg
250 mg/5 ml; 240 ml
0.52
3.42/30 ml
93
UTMB COST
ETHYOL®: Brand of Amifostine
ETODOLAC
Lodine®
Capsule
200 mg
300 mg
Restriction: Rheumatology faculty.
ETOMIDATE
Amidate®
Injection
0.71
0.80
2 mg/ml: 20 ml
ETONOGESTREL SUBDERMAL IMPLANT
Implanon®
Subdermal Implant, Rod
68 mg
Restriction: For patients with reimbursement
ETOPOSIDE
VePesid®, VP-16
Capsule
Injection
50 mg
20 mg/ml:
ETRAVIRINE
Intelence®
Tablet
100 mg
17.60
523.00
5 ml
27.20
109.52
5.32
EUCERIN®
Cream: 1 lb. jar, contains
Aquaphor
50 %
Water
50 %
Note: O.T.C., non-legend drug available for inpatients only.
9.36
EVOXAC®: Brand of Cevimeline
EXELON®: Brand of Rivastigmine
EXOSURF®: Brand of Surfactant, Lung
EYEWASH IRRIGATION SOLUTION
Solution, ophthalmic irrigant:
30 ml
120 ml
each bottle contains:
Potassium Chloride
Sodium Chloride
Sodium Hydroxide
Sodium Phosphate
Preservatives: Benzalkonium Chloride, Sodium Edetate
Note: O.T.C., non-legend drug available for inpatients only.
94
0.75
6.00
UTMB COST
EZETIMIBE
Zetia®
Tablets
10 mg
2.27
Restriction: All Faculty for patients who have failed to reach target goals with statins as
monotherapy
EZETIMIBE: Ingredient of Vytorin®
FACTOR VIIA
Novoseven®
Injection
1 mg vial
2 mg vial
5 mg vial
Restriction: Jack Alperin, MD, Hematology
David Bessman, MD, Hematology
Peter Hoffman, MD
Avi Markowitz, MD, Hematology/Oncology
Maurice Willis, MD, Hematology/Oncology
1,270.00
2,540.00
6,350.00
FACTOR VIII
Hemofil M®, Factor VIII (Human - monoclonal)
Injection - specify units per dose (100 units)
72.00/100 U
Recombinate®, Factor VIII Recombinant
Injection - specify units per dose (100 units)
106.00/100 U
Humate-P®, Antihemophilic Factor/von Willebrand Factor Complex (Human)
Injection - specify units per dose (100 units)
84.00/100 U
FACTOR IX COMPLEX, (HUMAN) HEAT TREATED
Mononine®
Injection - specify units per dose
85.00/100 U
FACTREL®: Brand of Gonadorelin Hydrochloride, LH-RH
FAMCICLOVIR
Famvir®
Tablet
FAMOTIDINE
Pepcid®
Injection
Suspension
Tablet
500 mg
10 mg/ml:
40 mg/5 ml
20 mg
40 mg
8.03
2 ml
0.40
8.41
0.06
0.12
FAMVIR®: Brand of Famciclovir
FASLODEX®: Brand of Fulvestrant
FAT EMULSION, INTRAVENOUS
Intralipid®, Liposyn II®, Soyacal®
Injection
20%: 500 ml
Note: 1.1 kcal/ml (10%); 2.0 kcal/ml (20%)
9.35
95
UTMB COST
FEIBA®: Brand of Anti-Inhibitor Coagulant Complex
FELBAMATE
Felbatol®
Tablet
Suspension
400 mg
600 mg
600 mg/5 ml; 8 oz.
1.67
1.92
206.04
FELBATOL®: Brand of Felbamate
FELDENE®: Brand of Piroxicam
FELODIPINE
Plendil®
Tablet
2.5 mg
5 mg
10 mg
1.19
1.19
2.13
FEMARA®: Brand of Letrozole
FEMSTAT®: Brand of Butoconazole Nitrate
FENOFIBRATE
Lofibra®
Capsule
FENTANYL CITRATE C-II
Sublimaze®
Injection
FENTANYL, TRANSDERMAL C-II
Duragesic®
Patch, transdermal
67 mg
134 mg
0.69
1.34
50 mcg (0.05 mg)/ml: 2 ml
5 ml
0.32
0.36
25 mcg/hr
50 mcg/hr
75 mcg/hr
100 mcg/hr
9.17
13.75
22.03
27.45
Special Restriction: Signature
Adult Hematology/Oncology Faculty
Pediatric Hematology/Oncology Faculty
Gyn Oncology Faculty
Radiation Oncology Faculty
Neurosurgery Faculty
Geriatrics Faculty - inpatient only (see specific physicians in outpatient formulary)
Patrice Barnum, MD
Gulshan Doulatram, MD
Michael Cook, MD
Maureen Hayes, MD
Kalyan Kuna, MD
Shawn Newlands, MD
David Paar, MD
Govindaraj Ranganathan, MD
Daneshavri Solanki, MD
Denise Wilkes, MD
Courtney Williams, MD
96
UTMB COST
FEOSOL®: Brand of Ferrous Sulfate
FERGON®: Brand of Ferrous Gluconate
FERRALET®: Brand of Ferrous Gluconate
FERRLECIT ®: Brand of sodium ferric gluconate
FERRO BC 500 WITH FOLIC ACID®:
Brand of Vitamin, B complex with C, folic acid and iron
FERROUS GLUCONATE
Ferralet®, Fergon®
Tablet
300 mg (35 mg/tab Fe++)
Tablet
320 mg (37 mg/tab Fe++)
Note: O.T.C., non-legend drug available for inpatients only.
FERROUS SULFATE
Drops
125 mg (25 mg Fe++)/ml:50 ml
Elixir
220 mg (44 mg Fe++)/5 ml: 473 ml
Liquid
300 mg (60 mg Fe++)/5 ml:5 ml Unit Dose
Tablet
300 mg (60 mg Fe++)/tablet
Note: O.T.C., non-legend drug available for inpatients only.
0.02
0.02
1.50
0.09/30 ml
0.13
0.02
FIBRINOLYSIN: Ingredient of Elase®
FILGRASTIM: See Granulocyte Colony Stimulating Factor (G-CSF)
FINASTERIDE
Proscar®
Tablet
5 mg
Restriction: Restricted to Urology faculty co-signature.
1.69
FLAGYL®: Brand of Metronidazole
FLAREX®: Brand of Fluorometholone Acetate
FLECAINIDE
Tambocor®
Tablet
100 mg
1.12
FLEET® ENEMA
Enema: 118 ml, each delivered dose contains
0.49
Sodium Biphosphate 19 g
Sodium Phosphate 7 g
Note: O.T.C., non-legend drug available for inpatients. Each dose contains 4.4 g sodium.
FLEET® PHOSPHO®-SODA: See Phospho®-Soda, Fleet®
FLEXERIL®: Brand of Cyclobenzaprine
FLONASE®: Brand of Fluticasone propionate
97
UTMB COST
FLORICAL®
Capsule: each contains
Calcium Carbonate 364 mg
Sodium Fluoride
8.3 mg
Note: O.T.C., non-legend drug available for inpatients only.
0.08
FLORINEF®: Brand of Fludrocortisone
FLOVENT®: Brand of fluticasone propionate
FLOXIN®: Brand of Ofloxacin otic
FLUCONAZOLE
Diflucan®
Suspension
Tablet
40 mg/ml
50 mg
100 mg
200 mg
Injection
2 mg/ml; 100 ml
Tablet
150 mg
Note: Tablet - one time dose for vaginal candidiasis.
FLUCYTOSINE
Ancobon®
Capsule
250 mg
500 mg
Restriction: Attending Staff must countersign orders within 48 hours.
82.25/35 ml
3.52
5.55
9.10
66.00
8.83
1.55
3.09
FLUDARA®: Brand of Fludarabine
FLUDARABINE
Fludara®
Injection
50 mg vial
Restriction: Hematology/Oncology Faculty co-signature.
FLUDROCORTISONE
Florinef®
Tablet
100 mcg (0.1 mg)
FLUMAZENIL
Mazicon®
Injection
0.1 mg/ml;
5 ml
10 ml
Restriction: Restricted to Emergency Room, Intensive Care Settings
and the Bronchoscopy Suite.
FLUNISOLIDE
Aerobid®
Metered Dose Inhaler
(250 mcg/inhalation: 100 inhalations)
98
174.31
0.45
22.17
50.10
3.71
UTMB COST
FLUOCINOLONE ACETONIDE
Synalar®
Solution
0.01%: 20 ml
60 ml
2.28
6.61
FLUOCINOLONE ACETONIDE INTRAVITREAL IMPLANT
Retisert®
Ocular Implant
0.59 mg
18,000.00
Note: Retisert® will not be stocked by the pharmacy on a regular basis. Patients needing
the implant will require precertification for the surgery, followed by precertification for the
medication. The surgery will not be scheduled until both precertification steps are
complete.
FLUOCINONIDE
Lidex®
Cream
Gel
Ointment
Solution
Note: Formerly called Topsyn®
FLUORESCEIN, SODIUM
Solution
Funduscein®
Injection
0.05%: 60 g
120 g
0.05% 60 g
0.05%: 15 g
0.05%: 60 ml
5.70
13.04
13.20
7.20
12.60
2%:
1 ml
1.46
10%:
25%:
5 ml
3 ml
3.20
3.51
Note: For ophthalmic use only.
FLUORIDE, SODIUM
Luride®
Solution
Tablet
25 mg/5 ml: specify quantity
1 mg
6.19/30 ml
0.04
FLUORIDE, SODIUM: Ingredient of Florical®
FLUORIDE, STANNOUS
Omnii® Gel, Gel-Kam®
Gel
0.4%: 60 ml
10.00
FLUOROMETHOLONE ACETATE
Flarex®
Solution, ophthalmic
0.1%: 15 ml
17.40
FLUOROPLEX®: Brand of Fluorouracil
FLUOROURACIL
Adrucil®, Efudex®, Fluoroplex®, 5-FU
Cream
1%: 30 g
5%: 25 g
Injection
50 mg/ml:
10 ml
Solution
1%: 30 ml
43.50
31.75
1.30
20.70
99
UTMB COST
FLUOTHANE®: Brand of Halothane
FLUOXETINE
Prozac®
Capsules
Liquid
10 mg
20 mg
20 mg/5 ml
2.00
2.16
23.40/30 ml
FLUOXYMESTERONE C-III
Halotestin®
Tablet
10 mg
Restriction: Requires DEA number on outpatient prescriptions.
FLUPHENAZINE DECANOATE
Prolixin Decanoate®
Injection, long acting
Note: For IM use only.
FLUPHENAZINE HYDROCHLORIDE
Prolixin®
Concentrate
Injection
Tablet
1.16
25 mg/ml: 5 ml
52.00
5 mg/ml:
2.5 mg/ml:
1 mg
2.5 mg
5 mg
70.80
2.60
0.19
0.17
0.20
FLURAZEPAM HYDROCHLORIDE C-IV
Dalmane®, Durapam®
Capsule
15 mg
30 mg
FLURBIPROFEN
Ocufen®
Ophthalmic Solution 0.03%: 2.5 ml bottles
120 ml
10 ml
0.07
0.08
4.13
FLUTAMIDE
Capsule
125 mg
1.67
FLUTICASONE PROPIONATE
Flonase®
Nasal Spray
0.05%: 16 gm
61.33
(120 doses/bottle)
Flovent®
Oral Inhaler
13 gm; 220 mcg/inhalation
123.37
(120 inhalations/cannister)
Restriction: The oral inhaler product is restricted to Allergy and Pulmonary Faculty, Anita
Mercado, M.D.
FLUTICASONE: Ingredient of Advair Diskus®
100
UTMB COST
FLUVOXAMINE
Luvox®
Tablet
50 mg
100 mg
0.07
0.35
FML®: Brand of Fluorometholone
FOLATE: See Folic Acid
FOLEX®: Brand of Methotrexate
FOLIC ACID
Folicet®, Folvite®, Folate
Injection
Tablet
5 mg/ml:
1 mg
10 ml
4.80
0.04
1 gm/ml; 1.5 ml vial
1,000.00
FOLICET®: Brand of Folic Acid
FOLINIC ACID: See Leucovorin Calcium
FOLVITE®: Brand of Folic Acid
FOMEPIZOLE
Antizol®
Injection
FOMIVIRSEN
Vitravene®
Injection, intravitreal
6.6 mg/0.25 ml vial
Note: Must have third party reimbursement.
FONDAPARINUX
Arixtra®
Injection
2.5 mg syringe
5 mg syringe
7.5 mg syringe
10 mg syringe
800.00
21.40
62.23
62.23
62.23
Restriction: Hematology Faculty
FORMOTEROL: Ingredient in Symbicort®
FORTAZ®: Brand of Ceftazidime
FOSAMAX®: Brand of Alendronate
FOSAMPRENAVIR
Lexiva®
Tablet
700 mg
Restriction: Infectious Disease Faculty, Occupational Exposure
8.19
101
UTMB COST
FOSCARNET
Foscavir®
Injection
24 mg/ml:
250 ml
57.50
FOSCAVIR®:Brand of Foscarnet
FOSINOPRIL
Monopril®
Tablet
10 mg
20 mg
Restriction: Endocrinology Faculty, Elena Volpi, M.D.
0.68
0.72
FOSPHENYTOIN
Cerebyx®
Injection
100 mg PE/2 ml (fosphenytoin 150mg/2ml);
2ml
14.44
500 mg PE/10 ml (fosphenytoin 750mg/10ml); 10ml
43.30
Special Note: PE = phenytoin equivalents.
A physician's order MUST ALWAYS be written with both the fosphenytoin dose and
the phenytoin dose.
Restriction: Emergency Room
Intensive Care Units
Neurology Faculty
FRIGIDERM®: Brand of Dichlorotetrafluoroethane
FSH: Ingredient of Pergonal®
5-FU: See Fluorouracil
FULVESTRANT
Faslodex®
Injection
50 mg/ml, 5 ml
768.20
Restriction: Hematology/Oncology, Gyn/Oncology. Not for Inpatient use or TDCJ use.
FUNDUSCEIN®: Brand of Fluorescein, Sodium
FUNGIZONE®: Brand of Amphotericin B Conventional
FURADANTIN®: Brand of Nitrofurantoin
FUROSEMIDE
Lasix®
Injection
Solution
Tablet
FUZEON®: Brand of Enfuvirtide
102
10 mg/ml:
10 mg/ml:
20 mg
40 mg
80 mg
2 ml
10 ml
60 ml
0.58
0.30
6.00
0.04
0.05
0.04
UTMB COST
GABAPENTIN
Neurontin®
Capsule
100 mg
300 mg
400 mg
600 mg
800 mg
GALANTAMINE
Razadyne®
Tablet
4 mg
8 mg
12 mg
Restriction: Neurology, Psychiatry, and Geriatric Faculty
0.32
0.29
0.89
0.66
0.81
2.19
2.19
2.19
GAMMA GLOBULIN: See Immune Globulin, Intramuscular
GAMUNEX®: Brand of Immune Globulin, Intravenous (Human)
GANCICLOVIR
Cytovene®
Capsule
500 mg
6.54
Injection
500 mg vial
29.19
Restriction: Restricted to prior approval by Infectious Diseases physicians and Solid
Organ Transplant Faculty only before dispensing and orthotopic heart and lung tranplantation.
GANTRISIN®: Brand of Sulfisoxazole
GARAMYCIN®: Brand of Gentamicin Sulfate
GARDASIL®: Brand of Human Papillomavirus Vaccine
GATIFLOXACIN
Zymar®
Ophthalmic Soln
0.3%; 5 ml
44.07
GELATIN: Ingredient of Dome Paste® Bandage
GEL-KAM®: Brand of Fluoride, Stannous
GELOCAST®: See Dome Paste® Bandage
GEMCITABINE
Gemzar®
Injection
GEMFIBROZIL
Lopid®
Tablet 600 mg
200 mg vial
1000 mg vial
62.14
335.57
0.17
GEMZAR®: Brand of Gemcitabine
103
UTMB COST
GENGRAF®: Brand of Cyclosporine microemulsion
GENTAMICIN SULFATE
Garamycin®
Cream
Injection
0.1%: 15 g
0.99
40 mg/ml: 2 ml
0.22
20 ml bulk vial
8.00
Injection, pediatric
10 mg/ml (perservative free) 2ml
0.83
Note: This product is preservative-free and will replace the intrathecal product which is no
longer available from the manufacturer. Note that this product is 5 times more ®
concentrated than the intrathecal product.
Ointment
0.1%: 15 g
0.99
Genoptic®, Gentafair®, Garamycin®
Ointment, ophthalmic
0.3% (3 mg/g): 3.5 g
10.50
Solution, ophthalmic
0.3% (3 mg/ml): 1 ml
0.85
5 ml
6.95
Note: 1 ml ophthalmic for inpatient use only.
GENTIAN VIOLET
Solution 1%: 30 ml in 10% alcohol
1.44
GEODON®: Brand of Ziprasidone
GLAUCON®: Brand of Epinephrine Hydrochloride
GLEEVEC®: Brand of Imatinib Mesylate
GLIPIZIDE
Glucotrol®
Tablet
Glucotrol XL®
Tablet, extended release
5 mg
10 mg
0.01
0.02
2.5 mg
5 mg
10 mg
0.42
0.22
0.43
GLOBULIN, IMMUNE SERUM: See Immune Globulin, Intramuscular
GLUCAGON
Injection
1U
Note: 1 U is equivalent to 1.09 mg glucagon hydrochloride.
GLUCAMIDE®: Brand of Chlorpropamide
GLUCOPHAGE®: Brand of Metformin
GLUCOTROL®, GLUCOTROL® XL: Brand of Glipizide
104
49.10
UTMB COST
GLUCOVANCE®
Glyburide/Metformin
Tablet
1.25 mg/250 mg
2.5 mg/500 mg
5 mg/500 mg
0.53
0.63
0.63
1.25 mg
2.5 mg
5 mg
0.04
0.05
0.10
GLYBURIDE
Tablet
GLYCERIN
Solution
Suppository
480 ml
adult
infant
Note: O.T.C., non-legend drug available for inpatients only.
Osmoglyn®
Solution, lemon flavor
50% in water: 200 ml
2.40/30 ml
0.09
0.12
17.38
GLYCINE: Ingredient of Titralac®
GLYCOPYRROLATE
Robinul®
Injection
200 mcg/ml: 1 ml
0.21
50 mg/ml:
7.82
GLYCORT®: Brand of Hydrocortisone
GM-CSF: See Sargramostim
GOLD SODIUM THIOMALATE
Myochrysine®
Injection
1 ml
GOLYTELY®
Solution: 4 L, after reconstitution each L contains
3.60
Bicarbonate
20 mM
Chloride
35 mM
PEG 3350
17.6 mM
Potassium
10 mM
Sodium
125 mM
Sulfate
40 mM
Note: Electrolytes mM/L equals mEq/L. Stable for 48 hours after reconstitution.
GONADORELIN HYDROCHLORIDEa
Factrel®, LH-RH
Injection
100 mcg/vial
45.24
Restriction: Adult OB/Gyn, medicine or pediatric endocrinology faculty must countersign
orders within 48 hours.
GOOD SENSE® THROAT SPRAY: Brand of Phenol
105
UTMB COST
GOSERELIN ACETATE
Zoladex®
Injection
3.6 mg
10.8 mg
273.16
816.10
GRANISETRON
Kytril®
Injection
1 mg vial
103.41
Tablet
1 mg
21.58
Restriction: Faculty members of Ob/Gyn, Adult and Pediatric Hematology/Oncology, and
Radiation/Oncology.
Granisetron / Ondansetron Therapeutic Interchange Policy:
When a dose of ≤ 21 mg of ondansetron is ordered, the Pharmacy
will dispense ondansetron, and when a dose of ≥ 22 mg of ondansetron
is ordered, the Pharmacy will dispense a single 1 mg dose of granisetron.
GRANULOCYTE COLONY STIMULATING FACTOR
Neupogen®, G-CSF, Filgrastim
Vial
100 mcg/ml
60.00
300 mcg/ml
132.61
480 mcg/ml
253.24
Restriction: Restricted to use by Hematology/Oncology Faculty (Adult, Pediatric and Ob/
.Gyn) and Infectious Disease Faculty.
GRIFULVIN V®: Brand of Griseofulvin
GRISACTIN®: Brand of Griseofulvin
GRISEOFULVIN
Grifulvin V®,
Tablet, microsize
Suspension, microsize
125 mg
250 mg
125 mg/5 ml: 120 ml
GUAIFENESIN
Robitussin®
Syrup 100 mg/5 ml:
30ml U-D
Note: O.T.C., non-legend drug available for inpatients only.
0.14
0.63
5.49/30 ml
0.18
GUAIFENESIN: Ingredient of Guiatuss AC®, Robitussin AC®, Robitussin DM®
GUANFACINE
Tenex®
Tablet
106
1 mg
0.83
UTMB COST
GUIATUSS AC® C-V
Similar item to Robitussin A-C®
Syrup:
5 ml U-D
120 ml
0.19
0.21/30 ml
each 5 ml contains:
Codeine 10 mg
Guaifenesin 100 mg
Restriction: Requires DEA number on outpatient prescriptions.
GYNAZOLE®: Brand of Butaconazole
H-BIG®: Brand of Hepatitis B Immune Globulin, Human
HAEMOPHILUS b CONJUGATE VACCINE
ActHIB®, HibTITER®, PedvaxHIB®, ProHIBiT®
Injection (IM only)
0.5 ml
each 0.5 ml dose contains:
10mcg of purified Haemophilus b capsular saccharide
conjugated to 25mcg of diphtheria CRM197 protein
21.26
HALDOL®: Brand of Haloperidol
HALOPERIDOL
Haldol®
Injection
Liquid concentrate
Tablet
HALOPERIDOL DECANOATE
Haldol® Decanoate
Injection
Note: For IM use only.
5 mg/ml:
2 mg/ml:
0.5 mg
1 mg
2 mg
5 mg
10 mg
1 ml
120 ml
100 mg/ml:
5 ml
HALOTHANE
Solution
125 ml
Note: Available for inpatients only.
5.58
13.20
0.02
0.02
0.02
0.03
0.03
220.05
8.00
HALOTESTIN®: Brand of Fluoxymesterone
HEALON®: Brand of Hyaluronate, Sodium
HEALON® GV: Brand of Hyaluronate Sodium
HEALON5®: Brand of Hyaluronate Sodium
HEMABATE®: Brand of Carboprost
107
UTMB COST
HEMIN
Panhematin®
Injection
313 mg vial (7 mg/ml reconstituted)
199.68
Restriction: Faculty must countersign order within 48 hours.
Note: Hemin has a 2 month expiration; therefore, when needed, allow 24 hours for ordering
and delivery.
HEMOFIL M®: Brand of Factor VIII
HEMORRHOIDAL UNISERTS®: See Anusol®
HEMORRHOIDAL-HC®: See Anusol® HC
HEPARIN SODIUM
Injection available as:
10 U/ml:
2 ml vial
100 U/ml:
2 ml vial
1,000 U/ml: 10 ml vial
5,000 U/ml: 10 ml vial
5,000 U/ml: 0.5 ml syringe
10,000 U/ml: 1 ml vial
20,000 U/ml: 1 ml vial
250,000 U/250 ml RTU bag
HEPATITIS B IMMUNE GLOBULIN, HUMAN
H-BIG®
Injection
5 ml
Hyper Hep®
Injection
0.5 ml syringe
0.39
0.30
1.10
2.20
0.73
0.72
0.90
2.36
117.25
64.81
HEPATITIS B VACCINE (recombinant)
Recombivax® HB
Injection
5 mcg/0.5 ml
8.50
10 mcg/ml
31.67
40 mcg/ml (dialysis)
97.93
Engerix-B®
Injection
20 mcg/ml
24.79
Note: Engerix-B® is only used for patients who have already received this brand.
HEPSERA®: Brand of Adefovir
HERCEPTIN®: Brand of Trastuzumab
HEXADROL®: Brand of Dexamethasone
HIBTITER®: Brand of Haemophilus b Conjugate Vaccine
HISTAMINE PHOSPHATE
Injection
0.275 mg
(0.1 mg Histamine Base) in 1 ml
Note: For pheochromocytoma test.
Injection
2.75 mg
(1 mg Histamine Base) in 1 ml
Note: For gastric histamine test.
108
9.40/5ml
11.30
UTMB COST
HIVID®: Brand of Zalcitabine
HMS®: Brand of Medrysone
HOMATROPINE
Ophthalmic, solution 5%:
1 ml
1.25
HOMO-TET®: Brand of Tetanus Immune Globulin, Human
HUMALOG®: Brand of Insulin, Lispro
HUMAN PAPILLOMAVIRUS VACCINE
Gardasil®
Injection, IM
0.5 ml
116.90
Note: For clinic use for patients after verification of reimbursement or insurance coverage.
HUMATE-P®: Brand of Factor VIII
HUMATIN®: Brand of Paromomycin
HUMULIN®: Brand of Insulin, Regular
HURRICANE® SPRAY
Aerosol Spray
20% benzocaine, 2 oz
Note: Replaces Cetacaine® Spray
21.22
HU-TET®: Brand of Tetanus Immune Globulin, Human
HYALURONATE, SODIUM
AmVisc Plus®, Healon®
Injection
Healon® GV
Injection
Healon5®
Injection
HYALURONIDASE
Amphadase®
Injection
10 mg/ml:
10 mg/ml:
greater viscosity
150 U/ml:
0.55ml syringe
0.8 ml syringe
0.85 ml
55.78
57.50
97.78
2.3%; 0.6 ml
52.00
1 ml (solution)
17.08
HYDERGINE®: Brand of Ergot Alkaloids, Dihydrogenated
HYDRALAZINE
Apresoline®
Injection
Tablets
20 mg/ml:
10 mg
25 mg
50 mg
100 mg
1 ml
6.68
0.02
0.02
0.06
0.06
109
UTMB COST
HYDREA®: Brand of Hydroxyurea
HYDROCHLOROTHIAZIDE
Esidrix®, Oretic®
Capsule
Suspension
Tablets
12.5 mg
50 mg/5 ml:
25 mg
50 mg
240 ml
0.12
0.72/30 ml
0.04
0.06
HYDROCHLOROTHIAZIDE: Ingredient of Dyazide®, Maxzide®, and
Moduretic® 5/50
HYDROCODONE BITARTRATE: Ingredient of Norco® and Lortab® liquid
HYDROCORTISONE
Cortef®
Injection
Note: Injection is for IM use.
Suspension
Tablets
50 mg/ml:
1 ml
10 mg/5 ml
5 mg
10 mg
Cortifoam®
Rectal foam 20 gm; 80 mg hydrocortisone per application
Cortenema®, Rectoid®
Retention enema
100 mg/60 ml
Hytone®, Hydrotex®
Cream
1%: 30 g
120 g
450 g
Glycort®
Lotion
1%: 60 ml
Note: Lotion is in a propylene glycol base.
1.70
4.20/30 ml
0.08
0.17
41.60
7.32
0.81
3.16
14.40
6.00
HYDROCORTISONE: Ingredient of Cortisporin®, Colymycin-S® Otic,
Vosol® HC and Anusol®-HC
HYDROCORTISONE SODIUM SUCCINATE
Solu-Cortef®, A-Hydrocort®
Injection
100 mg vials without diluent;
Mix-O-Vial® 100 mg/2 ml
250 mg/2 ml
500 mg/4 ml
1.02
1.20
2.33
HYDROGEL
Curasol®
Topical
3.74
110
90 gm tube
UTMB COST
HYDROGEN PEROXIDE
Solution
3%: 240 ml
Note: Moved to Material Management
Solution
10%: 180 ml (UTMB compounded)
Note:For surgical procedures only.
1.60/60 ml
HYDROMORPHONE C-II
Dilaudid®
Injection
2 mg/ml:
1 ml tubex
0.59
4 mg/ml:
1 ml tubex
0.63
Suppository
3 mg
2.34
Tablets
2 mg
0.13
4 mg
0.18
Restriction: All IV hydromorphone products EXCEPT epidurals are restricted to faculty.
Approving faculty must notify pharmacy at extension 72037 prior to dispensing medication.
Exception areas include: all ICUs, all ERs, all ORs, PACUs, Recovery Rooms, L&D, Procedural
Areas. Hydromorphone epidurals are not restricted.
HYDROXOCOBALAMIN
Cyanokit®
Injection
2.5 gram vial x 2/kit
Note: This product replaces the previous Cyanide Antidote Kit
HYDROXYCHLOROQUINE SULFATE
Plaquenil®
Tablet
200 mg
Note: Tablet equivalent to 150 mg base.
HYDROXYPROGESTERONE CAPROATE
Delalutin®
Injection
250 mg/ml: 5 ml vial
HYDROXYPROPYLMETHYLCELLULOSE
Isopto-Tears®
Ophthalmic Solution
0.5%: 15 ml
Note: O.T.C., non-legend drugavailable for inpatients only.
Occucoat®
Injection, intraocular
2%: 1 ml syringe
HYDROXYUREA
Hydrea®
Capsules
HYDROXYZINE
Atarax®, Vistaril®
Injection
Syrup
Tablets
650.00
1.03
2.01
5.07
50.00
500 mg
0.61
50 mg/ml:
2 ml
10 mg/5 ml: 480 ml
10 mg
25 mg
0.20
0.54/30 ml
0.03
0.03
HYGROTON®: Brand of Chlorthalidone
111
UTMB COST
HYPER-SAL®: Brand of Sodium Chloride, Nebulizer Solution
HYPER-TET®: Brand of Tetanus Immune Globulin (Human)
HYPERAB®: Brand of Rabies Immune Globulin (Human)
HYPERHEP®: Brand of Hepatitis B Immune Globulin, Human
HYPERSTAT® IV: Brand of Diazoxide
HYSKON®: Brand of Dextran 70
HYTAKEROL®: Brand of Dihydrotachysterol
HYTONE®: Brand of Hydrocortisone
HYTRIN®: Brand of Terazosin
IBANDRONATE
Boniva®
Injection
3 mg syringe
394.13
Restriction: Geriatric Faculty for Clinic use only. Sponsored patients or Full Pay.
IBUPROFEN
Children’s Advil®
Suspension
100 mg/5 ml: 4 ounce bottle
1.27/30 ml
Note: O.T.C., non-legend drug available for inpatients only.
Motrin®, Rufen®
Tablets
200 mg
0.03
400 mg
0.06
600 mg
0.07
800 mg
0.09
Neoprofen®
Injection
10 mg/ml; 2 ml
471.83
Restriction: Injection product restricted to Neonatology/Pediatrics for PDA Closure
IBUTILIDE
Corvert®
Injection
0.1 mg/ml; 10 ml vial
154.70
Restriction: M.D.s trained in cardiac electrophysiology, specifically, Dr. Ware and Dr.
Sheahan.
IDAMYCIN®: Brand of Idarubicin
IDARUBICIN
Idamycin®
Injection
1 mg/ml;
IDOXURIDINE
Vira-Optic®
Solution, ophthalmic
0.1%: 15 ml
112
5 ml
10 ml
251.26
502.49
10.65
UTMB COST
IFEX®: Brand of Ifosfamide
IFOSFAMIDE
Ifex®
Injection
1 g vial
Note: Should not be given without MESNA.
48.18
IGIV: See Immune Globulin, Intravenous
ILOTYCIN®: Brand of Erythromycin Ophthalmic Ointment
IMATINIB MESYLATE
Gleevec®
Capsule
100 mg
Restriction: Adult Hematology/Oncology
16.01
IMDUR®: Brand of Isosorbide mononitrate
IMFED®: Brand of Iron Dextran
IMIPENEM-CILASTATIN
Primaxin®
Injection
250 mg
11.78
500 mg
20.38
Restriction: Infectious Disease Faculty - requires order by ID or call to Restricted Antibiotic
Approval Line or for Burn Unit/Service.
Note: For IV use only. All doses prepared by IV Room.
IMIPRAMINE
Tofranil®, Janimine®
Tablets
10 mg
25 mg
50 mg
IMIPRAMINE PAMOATE
Tofranil-PM®
Capsules
75 mg
100 mg
150 mg
Note: Doses expressed as imipramine hydrochloride equivalent.
IMIQUIMOD
Aldara®
Cream
5%; unit dose packaging
0.03
0.05
0.04
0.91
1.11
1.58
7.37
IMITREX®: Brand of Sumatriptan
IMMUNE GLOBULIN, CYTOMEGALOVIRUS
Cytogam®
Injection
2.5 gm/vial
Restriction: Transplant Faculty (pedi & adult)
364.50
113
UTMB COST
IMMUNE GLOBULIN, INTRAMUSCULAR
BayGam®
Injection
2 ml
10 ml
23.00
93.80
IMMUNE GLOBULIN, INTRAVENOUS (HUMAN)
Carimune®
43.59/gm
Injection
6 gm (with sucrose as a stabilizer)
12 gm (with sucrose as a stabilizer)
Privigen® (sucrose-free)
45.00/gm
Injection
5 gm (with L-proline as stabilizer)
10 gm (with L-proline as stabilizer)
20 gm (with L-proline as stabilizer)
Gamunex® (sucrose-free)
56.96/gm
Injection
5 gm (with glycine as a stabilizer)
10 gm (with glycine as a stabilizer)
Restriction:
For FDA-Approved Indications:
Jack Alperin, MD, Internal Med - Hematology/Oncology
Bruce Baethge, MD, Internal Med - Rheumatology
David Bessman, MD, Internal Med - Hematology/Oncology
Rana Bonds, MD, Internal Med - Pulmonary/Critical
William Calhoun, MD, Internal Med - Pulmonary/Critical
J. Andrew Grant, MD, Internal Med - Allergy
Meera Gupta, MD, Internal Med - Pulmonary/Critical
Hans Langsjoen, MD, Neurology
Norbert Roberts, MD, Internal Med - Infectious Disease
Judith Rowen, MD, Pediatrics
Frank C. Schmalstieg, Jr., MD, Pedi Immuno-Allergy
Robert G. Smith, MD - Neurology
Neonatology Faculty - for severe alloimmune thrombocytopenia, severe
thrombocytopenia associated with maternal autoimmune thrombocytopenia,
and Rh-hemolytic disease.
For non-FDA-Approved Indications: Contact the IVIG Approval Committee
Kevin McKinney, MD, Internal Med - Endocrinology
Kris Gugliuzza, MD, Surgery
Janak Patel, MD, Pediatric Infectious Disease
IMODIUM®: Brand of Loperamide
IMOVAX®: Brand of Rabies Vaccine, Human Diploid Cell
IMPLANON®: Brand of Etonogestrel Subdermal Implant
IMURAN®: Brand of Azathioprine
INAPSINE®: Brand of Droperidol
INDERAL®: Brand of Propranolol
INDERAL® LA: Brand of Propranolol
114
UTMB COST
INDIGO CARMINE®: Brand of Indigotindisulfonate Sodium
INDIGOTINDISULFONATE SODIUM
Indigo Carmine®
Injection
0.8%: 5 ml
5.50
INDINAVIR
Crixivan®
Capsule
400 mg
Restriction: Infectious Disease Faculty or Occupational Exposure
2.02
INDOCIN®: Brand of Indomethacin
INDOCYANINE GREEN
Cardio-Green®
Injection
INDOMETHACIN
Indocin®
Capsule
25 mg
50 mg
52.37
25.20
25 mg
50 mg
0.03
0.04
INDOMETHACIN SODIUM TRIHYDRATE
Indocin® I.V.
Injection
1 mg Indomethacin equivalent
22.59
INFANRIX®: Brand of Diphtheria-Tetanus Toxoid and Acellular Pertussis Vaccine, Adsorbed
INFLIXIMAB
Remicade®
Injection
100 mg vial
519.35
Restriction: GI and Rheumatology Faculty for patients with third party reimbursement.
INFLUENZA VIRUS VACCINE
Injection: Seasonal formulation and availability
5.88/dose
INH: See Isoniazid
INNUENDO®: See Anusol® Suppository
INSPRA®: Brand of Eplerenone
__________________________________________________________________________________________
INSULIN SUBSTITUTION POLICY
Human Insulin will be provided as the “House” Insulin in ALL cases except when a particular type
of insulin is not available from human sources. HUMULIN® and NOVOLIN® brands of Human Insulin
have been deemed therapeutically equivalent and will be competitively bid to obtain the lowest cost
to the state.
__________________________________________________________________________________________
115
UTMB COST
INSULIN, ASPART
Novolog®
Injection
100 unit/ml:
INSULIN, HUMAN (GLARGINE)
Lantus®
Injection
100 U/ml:
Restriction: Endocrinology Faculty
10 ml
44.20
10 ml
58.15
INSULIN, ISOPHANE (NPH)
Humulin®N, Novolin®N (Human)
Injection
100 U/ml:
10 ml
11.03
INSULIN, LISPRO
Humalog®
Injection
10 ml
44.20
10 ml
11.03
10 ml
11.03
INSULIN, REGULAR
Humulin® R, Novolin® R (Human)
Injection
100 U/ml:
10 ml
500 U/ml:
20 ml
11.03
171.39
100 U/ml:
INSULIN, MIXED (isophane:regular)
Humulin® 70/30, Novolin® 70/30
Injection
100 U/ml:
Humulin® 50/50
Injection
100 U/ml:
INTEGRELIN®: Brand of Eptifibatide
INTELENCE®: Brand of Etravirine
INTENSOL®: Brand of Dexamethasone
INTERFERON:
Alpha-2b Recombinant
Intron® A
Injecton
3 MU/ml: 1 ml
10 MU/vial
INTRALIPID®: Brand of Fat Emulsion, Intravenous
INTRON®-A: Brand of Interferon Alpha-2b Recombinant
INTROPIN®: Brand of Dopamine Hydrochloride
INVANZ®: Brand of Ertapenem
INVEGA®: Brand of Paliperidone
INVIRASE®: Brand of Saquinavir
116
25.73
85.76
UTMB COST
IODINE: Ingredient of Schiller’s Test Solution & Thermometer Solution
IODINE, STRONG SOLUTION
Lugol’s Solution
Solution 473 ml; each 30 ml contains
Iodine
1.5 gm (24 grains)
Potassium Iodide
3 gm (48 grains)
IODINE TINCTURE
Mild: 473 ml; each bottle contains
Alcohol
47%
Iodine
2%
Sodium Iodide
2.35%
Strong: 473 ml; each bottle contains
Alcohol
85%
Iodine
7%
Potassium Iodide
5%
Note: O.T.C., non-legend. drug available for inpatients only.
0.02
0.27/30 ml
0.01/30 ml
IODINE, TITRATABLE - see Povidone Iodine
IODIPINE®: Brand of Apraclonidine
IODOFLEX®: Brand of Cadexomer Iodine
IODOQUINOL: See Diiodohydroxyquin
IODOSORB®: Brand of Cadexomer Iodine
IPECAC
Syrup
30 ml
0.90
Note: O.T.C., non-legend drug available for inpatients only. Contact Poison Center for
consultation at 1-800-222-1222.
IPRATROPIUM BROMIDE
Atrovent®, see also Combivent®
Metered Dose Inhaler
28.56
18 mcg/inhalation: 200 inhalations/cannister
Solution, nebulization 0.02%; 2.5 ml
1.68
Restriction: Solution ONLY - For in-house use only - Inpatient, Emergency Department
and Clinic.
IPV: See Poliomyelitis Vaccine, Inactivated
IRINOTECAN
Camptosar®
Injection
20 mg/ml; 5 ml
422.60
IRON DEXTRAN
Imfed®
Injection
50 mg/ml: 2 ml
19.64
117
UTMB COST
ISDN: See Isosorbide Dinitrate
ISENTRESS®: Brand of Raltegravir
ISG: See Immune Globulin, IM
ISOCOM®: See Midrin®
ISONIAZID
Nydrazid®
Injection
Syrup
Tablet
100 mg/ml: 10 ml
50 mg/5 ml, 473 ml (with Sorbitol 70%)
100 mg
300 mg
ISOPROTERENOL HYDROCHLORIDE
Isuprel®
Tablet, sublingual
10 mg
12.50
0.87/30 ml
0.05
0.05
0.50
ISOPTIN®: Brand of Verapamil
ISOPTO® ATROPINE: Brand of Atropine Sulfate
ISOPTO® CARBACHOL: Brand of Carbachol
ISOPTO® CARPINE: Brand of Pilocarpine Hydrochloride
ISOPTO® HYOSCINE: Brand of Scopolamine Hydrobromide
ISOPTO® TEARS: Brand of Hydroxypropylmethylcellulose
ISORDIL®: Brand of Isosorbide Dinitrate
ISOSORBIDE DINITRATE
Isordil®, Sorbitrate®
Tablet
Tablet, sublingual
ISOTRETINOIN
Accutane®
Capsule
ISOXSUPRINE
Vasodilan®
Tablets
118
10 mg
20 mg
5 mg
0.03
0.03
0.02
10 mg
40 mg
3.09
4.25
10 mg
20 mg
0.02
0.03
UTMB COST
ISRADIPINE
Dynacirc®
Capsules
2.5 mg
5 mg
0.57
0.76
100 mg
10 mg/ml
5.19
5.60/100 mg
ISUPREL®: Brand of Isoproterenol
ITRACONAZOLE
Sporanox®
Capsule
Liquid
JANIMINE®: Brand of Imipramine
JANUVIA®: Brand of Sitagliptin
KABIKINASE®: Brand of Streptokinase
KADIAN®: Brand of Morphine Sulfate, Sustained Release
KALETRA®
Tablet: each contains
Lopinavir
200 mg
Ritonavirr
50 mg
Solution, oral: each ml contains
Lopinavir
80 mg
Ritonavir
20 mg
Restriction: Infectious Disease Faculty, OB/Gyn Faculty
5.18
1.95/ml
KAOCHLOR®: Brand of Potassium Chloride
KAON-CL®: Brand of Potassium Chloride
KAOPECTATE®: Brand of Bismuth Subsalicylate
KARAYA GUM
Dermaguard®
Powder
120 g
Note: O.T.C., non-legend drug available for inpatients only.
4.80
KAY CIEL®: Brand of Potassium Chloride
KAYEXALATE®: Brand of Sodium Polystyrene Sulfonate
K-DUR®: Brand of Potassium Chloride
KEFLEX®: Brand of Cephalexin
KEFZOL®: Brand of Cefazolin
KENACORT®: Brand of Triamcinolone
119
UTMB COST
KENALOG®: Brand of Triamcinolone Acetonide
KEPPRA®: Brand of Levetiracetam
KERASOL®: Brand of Bath Oil
KETALAR®: Brand of Ketamine Hydrochloride
KETAMINE HYDROCHLORIDE
Ketalar®
Injection
KETOCONAZOLE
Nizoral®
Cream
Tablet
KETOROLAC TROMETHAMINE
Toradol®
Injection
50mg/ml:
100mg/ml:
10 ml
5 ml
2%: 30 gm
200mg
4.90
15.90
21.00
2.63
15 mg/ml:
30mg/ml:
1ml
5.60
1ml
7.25
2ml
6.47
Restriction: Day Surgery Faculty, Emergency Room Faculty, and OB/GYN faculty under IRB
approval
Faculty physician for a 24 hours (4 dose) supply
Neurology Faculty for treatment of migraine headache
Tablet
10 mg
0.12
KINEVAC®: Brand of Sincalide
KLONOPIN®: Brand of Clonazepam
KLOTRIX®: Brand of Potassium Chloride
KONAKION®: Brand of Phytonadione
KONYNE® H.T.: Brand of Factor IX Complex, (Human), Heat Treated
KWELL®: Brand of Lindane
KYTRIL®: Brand of Granisetron
LABETALOL
Normodyne®, Trandate®
Injection
Tablets
5 mg/ml:
100 mg
200 mg
300 mg
LAC-HYDRIN®: Brand of Ammonium Lactate
120
20 ml
8.80
0.42
0.58
0.88
UTMB COST
LACRI-LUBE® S.O.P., TEARFAIR®
Ointment, ophthalmic: 3.5 g, each tube contains
Chlorobutanol
0.5%
Mineral Oil
42.5%
Nonionic Lanolin Derivatives
2%
White Petrolatum
55%
Note: O.T.C., non-legend drugavailable for inpatients only.
0.80
LACRIL®: Brand of Methylcellulose
LACTOBACILLUS ACIDOPHILUS
Bacid®
Capsules
0.03
Note: Each capsule also contains 100 mg sodium carboxymethyl cellulose.
Requires refrigeration.
LACTULOSE
Cephulac®, Chronulac®
Liquid
10 g/15 ml:
30 ml unit dose
480 ml
0.60
0.60/30 ml
LAMICTAL®: Brand of Lamotrigine
LAMISIL®: Brand of Terbinafine
LAMIVUDINE
3TC,Epivir®
Solution, oral
10 mg/ml; 240 ml
6.00/30 ml
Tablet
150 mg
3.35
Restriction: Infectious Disease Faculty, Hepatology Faculty, or Occupational Exposure
LAMIVUDINE: Ingredient of Combivir® and Epzicom®
LAMOTRIGINE
Lamictal®
Tablet
25 mg
100 mg
150 mg
200 mg
Restriction: Neurology and Psychiatry Faculty.
LANOLIN, ANHYDROUS
Ointment
1 oz. tube
2.85
3.15
1.95
2.08
0.02
LANOXIN®: Brand of Digoxin
LANTUS®: Brand of Insulin, Glargine
LATANOPROST
Xalatan®
Solution, ophthalmic 0.005%:
2.5 ml
33.35
121
UTMB COST
LARIUM®: Brand of Mefloquine
LASIX®: Brand of Furosemide
LAVACOL®: Brand of Alcohol, Ethyl (68% - 71%)
LEECHES
LETROZOLE
Femara®
Tablet
2.5 mg
5.58
Restriction: Hematology/Oncology Faculty for patients who have failed tamoxifen and/or
anastrazole therapy
LEUCOVORIN CALCIUM, FOLINIC ACID
Powder
50 mg vial
Tablet
5 mg
10 mg
2.45
1.54
2.31
LEUKERAN®: Brand of Chlorambucil
LEUKINE®: Brand of Sargramostim
LEUPROLIDE ACETATE
Lupron®
Injection
Injection, depot
1 mg/0.2 ml: 2.8 ml vial
3.75 mg
7.5 mg
11.25 mg
Restriction: Ob/Gyn Faculty for the 11.25 mg strength.
22.5 mg
30 mg
245.00
387.14
467.16
1143.43
1817.33
1119.48
LEUSTATIN™: Brand of Cladribine
LEVALBUTEROL
Xopenex®
Nebulizer
0.31 mg
1.83
0.63 mg
1.83
1.25 mg
1.83
Restriction: PICU area, all APICS Faculty (Allergy, Pulmonary, Immunology, Critical Care,
and Sleep)
LEVAMISOLE
Ergamisol®
Tablet
50 mg
LEVAQUIN®: Brand of Levofloxacin
LEVARTERENOL BITARTRATE: See Norepinephrine
122
4.59
UTMB COST
LEVETIRACETAM
Keppra®
Tablets
250 mg
500 mg
750 mg
Keppra® IV
Injection
500 mg vial
Restriction: Neurology Faculty
LEVOBUNOLOL
Betagan®
Ophthalmic Drops
0.5% : 15 ml bottle
1.65
2.01
2.73
264.00
47.55
LEVO-DROMORAN®: Brand of Levorphanol Tartrate
LEVODOPA: Ingredient of Sinemet® and Sinemet® CR
LEVOFLOXACIN
Levaquin®
Injection
Oral Suspension
Tablet
250 mg Premix in D5W
500 mg Premix in D5W
750 mg Premix in D5W
500 mg;20 ml vial
25 mg/ml; 20 ml
250 mg
500 mg
750 mg
7.81
15.62
17.36
15.62
11.41
2.39
2.39
4.78
LEVONORGESTREL RELEASING INTRAUTERINE SYSTEM
Mirena®
IUD
52 mg/device
402.44
Restricted to fhe following physicians with insertion training:
Michele Blackwell, M.D., OB/Gyn
Daniel Breitkopf, M.D., OB/Gyn
Leslie Chupp, M.D., OB/Gyn
Perry Fulcher, M.D., OB/Gyn
Kathleen Griffis, M.D., OB/Gyn
Russell Snyder, M.D., OB/Gyn
LEVOPHED®: Brand of Norepinephrine Bitartrate
LEVORPHANOL TARTRATE C-II
Levo-Dromoran®
Injection
Tablet
2 mg/ml: 10 ml
2 mg
17.20
0.41
LEVOTHROID®: Brand of Levothyroxine
123
UTMB COST
LEVOTHYROXINE
Levothroid®, Synthroid®
Injection
Tablet
200 mcg
500 mcg
25 mcg
50 mcg
75 mcg
88 mcg
100 mcg
112 mcg
125 mcg
137 mcg
150 mcg
6.47
3.53
0.11
0.12
0.14
0.14
0.14
0.16
0.16
0.16
0.17
LEXAPRO®: Brand of Escitalopram
LEXIVA®: Brand of Fosamprenavir
LH-RH: See Gonadorelin
LIBRAX®, CHLORDINIUM®
Capsule: each contains
Chlordiazepoxide Hydrochloride
Clidinium Bromide
LIBRIUM®: Brand of Chlordiazepoxide
LIDEX®: Brand of Fluocinonide
124
0.10
5 mg
2.5 mg
UTMB COST
LIDOCAINE
Xylocaine®
Injection:
Local Anesthetic MDV
0.5% 50 ml
1.50
1%
50 ml
0.03/dose
2%
30 ml
1.20/dose
Single Dose Vial or Amp
0.5% 50 ml
1.50
1%
2 ml
0.22
1%
30 ml
0.24/dose
1.5% 20 ml
1.96
2% 10 ml
4.61
IV for Cardiac Arrythmia
1 gm/25 ml
0.50
50 mg/5 ml syr.
1.35
100 mg/5 ml syr.
1.25
RTU bag
2 gm/250 ml
3.85
2 gm/500 ml
2.89
Spinal Anesthesia Amps 5% with Dextrose 7.5% 2ml
1.56
Jelly 2%:
30 g
7.80
Ointment 5%:
35 g
2.95
ELA-Max®
Cream, topical 4%
5 gram
5.58
30 gram
27.65
Restrictionfor ELA-Max: Inpatient use only. Division of Plastic Surgery for clinic patients
having surgical procedures performed in clinic.
Solution, topical 4%:
50 ml
2.35
Solution, viscous 2%:
100 ml
2.20
LIDOCAINE WITH EPINEPHRINE
Injection
0.5% with Epinephrine
1% with Epinephrine
1% with Epinephrine
1.5% with Epinephrine
2% with Epinephrine
2% with Epinephrine
1:200,000
1:100,000
1:200,000
1:200,000
1:100,000
1:200,000
50 ml MDV
30 ml Amp
30 ml MDV
30 ml Amp
1.8 ml Dental Cartridge
20 ml Amp
1.80
5.91
0.69
6.12
0.26
6.40
LIDOCAINE/PRILOCAINE
EMLA®
Cream
5 gm w/2 dressings
4.62
Restriction: For use on pediatric patients who are undergoing I.V. anesthetic induction,
faculty members of Pediatric Hematology/Oncology, Pediatric and Adult Dermatology,
Otolaryngology, Dr. Marcia Levetown, Dr. Richard Wagner, and Infusion Therapy personnel
who insert PICC lines.
LINCOCIN®: Brand of Lincomycin Hydrochloride
LINCOMYCIN HYDROCHLORIDE
Lincocin®
Injection
300 mg/ml: 2 ml
2.02
125
UTMB COST
LINDANE
Kwell®
Lotion
Shampoo
1%
1%
60 ml
480 ml
60 ml
480 ml
2.28
0.99/30 ml
4.14
0.84/30 ml
Note: Specify quantity needed.
LINEZOLID
Zyvox®
Injection
600 mg/300 ml premixed bag
66.73
Oral Suspension
20 mg/ml; 150 ml
320.12
Tablet
600 mg
52.82
Restriction: Infectious Disease Faculty - requires order by ID or call in to Restricted
Antibiotic Approval Line or to Pulmonary/Critical Care Faculty in MICU for treatment of
ventilator-associated pneumonia caused by MRSA
LIORESAL®: Brand of Baclofen
LIOTHYRONINE
Cytomel®
Tablet
25 mcg (0.025 mg)
0.19
LIPASE: Ingredient of Pancrelipase
LIPITOR®: Brand of Atorvastatin
LIPOSYN II®: Brand of Fat Emulsion, Intravenous
LITHIUM CARBONATE
Eskalith®, Lithonate®
Capsules
300 mg
Eskalith®, Lithane®, Lithotab®
Tablets
300 mg
Lithobid®
Tablets, slow release
300 mg
Note:300 mg Lithium Carbonate equals 8.12 mEq Lithium
LITHIUM CITRATE
Cibalith-S®, Lithonate-S®
Solution
8 mEq/5 ml: 473 ml
Note: 8 mEq Lithium Citrate equals 300 mg Lithium Carbonate.
LITHOBID®: Brand of Lithium Carbonate
LITHONATE®: Brand of Lithium Carbonate
LITHONATE-S®: Brand of Lithium Citrate
LODINE®: Brand of Etodolac
126
0.15
0.15
0.24
0.27/30 ml
UTMB COST
LOESTRIN® FE 1/20
Tablet 28's
7 tablets containing only ferrous fumarate 75 mg
plus 21 tablets containing:
Ethinyl Estradiol
20 mcg
Norethindrone acetate
1 mg
LOESTRIN® 1.5/30
Tablet 28s
7 inert tablets plus 21 tablets containing:
Ethinyl Estradidol
30 mcg
Norinthindrone
1.5 mg
0.01
0.01
LOFIBRA®: Brand of Fenofibrate
LOGEN®: See Lomotil®
LOMOTIL® C-V
Tablet: each contains
Atropine Sulfate
Diphenoxylate Hydrochloride
LOMUSTINE
CeeNU®, CCNU
Dose Pack
2 capsules
2 capsules
2 capsules
0.29
0.025 mg
2.5 mg
100 mg
40 mg
10 mg
23.80/capsule
12.52/capsule
4.00/capsule
LONITEN®: Brand of Minoxidil
LOPERAMIDE
Imodium®
Capsule
2 mg
0.10
LOPID®: Brand of Gemfibrozil
LOPINAVIR: Ingredient of Kaletra®
LOPRESSOR®: Brand of Metoprolol
LORABID®: Brand of Loracarbef
LORATADINE
Claritin®
Suspension
10 mg/10 ml
Tablet
10 mg
Restriction: Allergy and Otolaryngology faculty.
5.97/30 ml
1.73
127
UTMB COST
LORAZEPAM C-IV
Ativan®
Injection
2 mg/ml
1ml vial
4 mg/ml
1ml vial
Tablet
0.5 mg
1 mg
2 mg
Restriction: Requires DEA number on outpatient prescriptions.
Note: Injectable requires refrigeration.
1.18
2.33
0.03
0.41
0.50
LORELCO®: Brand of Probucol
LORTAB® Liquid C-III
Liquid: each 5 ml contains
Acetaminophen
167 mg
Hydrocodone bitartrate
2.5 mg
Restriction: Requires DEA number on outpatient prescriptions.
LOSARTAN
Cozaar®
Tablet
25 mg
50 mg
100 mg
0.30/30 ml
0.89
0.92
0.85
LOSOSPAN®: Brand of Magaldrate
LOTEMAX®: Brand of Loteprednol etabonate
LOTEPREDNOL ETABONATE
Lotemax®
Ophthalmic suspension
0.5%: 5 ml
Restriciton: Opthalmology Faculty.
16.19
LOTRIMIN®: Brand of Clotrimazole
LO-TROL®: See Lomotil®
LOVENOX®: Brand of Enoxaparin
LOXAPINE
Loxitane®
Capsules
LOXITANE®: Brand of Loxapine
LSH: Ingredient of Pergonal®
LUBATH®: Brand of Bath Oil
128
10 mg
25 mg
50 mg
0.41
0.62
0.81
UTMB COST
LUBRICANT, STERILE
Surgilube®
Jelly:
3 g foil packs
4.5 ounce tubes
Note: O.T.C., non-legend drug available for inpatients only.
0.04
0.64
LUCENTIS®: Brand of Ranibizumab
LUGOL’S SOLUTION: See Iodine, Strong Solution
LUMIGAN®: Brand of Bimatoprost
LUMINAL®: Brand of Phenobarbital
LUPRON®: Brand of Leuprolide Acetate
LURIDE®: Brand of Fluoride, Sodium
LUVOX®: Brand of Fluvoxamine
LYPRESSIN
Diapid®
Spray, nasal
0.185 mg/ml: 8 ml
33.52
Note: 0.185 mg is equivalent to 50 USP posterior pituitary pressor units.
LYRICA®: Brand of Pregabalin
LYSODREN®: Brand of Mitotane
LYTIC COCKTAIL: See Cardiac Cocktail
MAALOX®, MAALOX® PLUS, ALAMAG® PLUS, MYLANTA®
Suspension:
each 5 ml to minimally contain:
Aluminum Hydroxide
200 mg
Magnesium Hydroxide
200 mg
Simethicone
20 mg
Note: O.T.C., non-legend drug available for inpatients only. Pharmacy stock will be based on
availability and cost.
MAALOX® PLUS: See Maalox®
MACROBID®: Brand of Nitrofuratoin, monohydrate macrocrystals
MACRODANTIN®: Brand of Nitrofurantoin
MACRODEX®: Brand of Dextran 70
MACUGEN®: Brand of Pegaptanib
129
UTMB COST
MAFENIDE ACETATE
Sulfamylon®
Cream
411 gm
106.86
Note: each gram mafenide acetate is equivalent to 85 mg mafenide base.
MAG-OX®: Brand of Magnesium Oxide
MAGALDRATE
Losospan®, Riopan®
Suspension
30 ml unit dose
360 ml
Note: O.T.C., non-legend drug available for inpatients only.
MAGNESIUM CITRATE
Solution
300 ml
Note: O.T.C., non-legend drug available for inpatients only.
0.15
1.80
0.60
MAGNESIUM GLUCONATE
Almora®
Tablet
500 mg
0.02
(equivalent to 2.2 mEq elemental magnesium)
Note: The two strengths (500 mg and 577 mg) are used interchangably depending on the
contract price. O.T.C., non-legend drugavailable for inpatients only.
MAGNESIUM HYDROXIDE: Ingredient of Maalox® & Mylanta®
MAGNESIUM OXIDE
Mag-Ox®
Tablet
420 mg
(equivalent to 26.25 mEq elemental magnesium)
0.07
MAGNESIUM OXIDE: Ingredient of Urologic G® Solution
MAGNESIUM SULFATE
Injection
10% (0.1 gm/ml; 0.8 mEq/ml):
50% (0.5 gm/ml; 4.06 mEq/ml):
2 ml
2 ml
10 ml
0.20
0.20
0.28
MANDELAMINE®: Brand of Methenamine Mandelate
MANNITOL
Osmitrol®
Injection
MARAVIROC
Selzentry®
Tablets
10%: 1000 ml
20%: 500 ml
25%: 50 ml
150 mg
300 mg
Restriction: Infectious Disease Faculty
130
9.70
9.50
0.60
14.15
14.15
UTMB COST
MARCAINE®: Brand of Bupivacaine
MAXAIR™: Brand of Pirbuterol
MATULANE®: Brand of Procarbazine
MAXIDEX®: Brand of Dexamethasone
MAXIPIME®: Brand of Cefepime
MAXITROL®
Ointment, ophthalmic 3.5 g tubes: each gm contains
Dexamethasone
0.1%
Neomycin Suflate
3.5 mg
Polymyxin B Sulfate 6000 U
Suspension, ophthalmic: 5 ml: each ml contains
Dexamethasone
0.1 %
Neomycin Sulfate
3.5 mg
Polymyxin B Sulfate 10,000 U
1.26
1.26
MAXZIDE-25®
Tablet: each contains
1.22
Hydrochlorothiazide 25 mg
Triamterene
37.5 mg
Note: Replaces old formulation of Dyazide® (HCTZ 25 mg/ Triamterene 50 mg)
MAXZIDE®
Tablet: each contains
Hydrochlorothiazide 50 mg
Triamterene
75 mg
0.14
MAZICON®: Brand of Flumazenil
MCT OIL®, MEDIUM CHAIN TRIGLYCERIDES
Lipid fraction of coconut oil: 32 oz.
contains Fatty Acids
Shorter than C-8
≅
6%
C- 8 (octanoic)
≅
67%
C-10 (decanoic)
≅
23%
Longer than C-lO
≅
4%
Note: 115 calories/15 ml.
0.05/30 ml
MEASLES (RUBELLA) VIRUS VACCINE: See Rubella Virus Vaccine, Live
MEASLES VIRUS VACCINE LIVE, ATTENUATED
Attenuvax®
Injection
Note: Rubeola Virus Vaccine Live, Attenuated
MEASLES, MUMPS AND RUBELLA VIRUS VACCINE LIVE
M-M-R® II
Injection
9.73/dose
25.73
131
UTMB COST
MEBARAL®: Brand of Mephobarbital
MEBENDAZOLE
Vermox®
Tablet, chewable
100 mg
3.95
MECHLORETHAMINE HYDROCHLORIDE
Mustargen®, Nitrogen Mustard
Injection
10 mg
MECLIZINE
Antivert®
Tablet
9.27
12.5 mg
25 mg
0.03
0.05
MEDICORTEN®: Brand of Prednisone
MEDIUM CHAIN TRIGLYCERIDES: Ingredient of MCT Oil®
MEDROL® DOSEPACK: Brand of Methylprednisolone
MEDROXYPROGESTERONE ACETATE
Depo-Provera®
Injection
150 mg/ml:
400 mg/ml:
Cycrin®, Provera®
Tablet
2.5 mg
5 mg
10 mg
MEDRYSONE
HMS®
Suspension, ophthalmic
1%:
MEFLOQUINE
Larium®
Tablet
250 mg
10 ml
1 ml
2.5 ml
34.94
63.13
0.05
0.06
0.09
15.42
6.27
MEFOXIN®: Brand of Cefoxitin
MEGACE®: Brand of Megestrol
MEGESTROL
Megace®
Suspension
Tablet
MELLARIL®: Brand of Thioridazine
132
40 mg/ml
20 mg
40 mg
13.50/30 ml
0.25
0.44
UTMB COST
MELPHALAN
Alkeran®
Tablet
2 mg
1.45
MEMANTINE
Namenda®
Tablet
5 mg
10 mg
Restriction: Neurology, Psychiatry, and Geriatric Faculty
1.98
1.98
MENACTRA®: Brand of Meningococcal Conjugate Vaccine
MENADIOL SODIUM DIPHOSPHATE
Synkavite®
Injection
10 mg/ml:
1 ml
MENINGOCOCCAL CONJUGATE VACCINE
Menactra®, Menomune®
Injection
0.5 ml
Note: For clinic use
2.22
82.00
MENOMUNE®: Brand of Meningococcal Conjugate Vaccine
MEPERIDINE HYDROCHLORIDE C-II
Demerol®, Pethadol®
Injection
25 mg/0.5 ml: 0.5 ml
50 mg/ml:
1 ml
75 mg/ml:
1 ml
100 mg/ml: 1ml
Tablet
50 mg
Syrup
50 mg/5 ml: 473 ml
MEPHOBARBITAL C-IV
Mebaral®
Tablet
0.23
0.21
0.35
0.16
0.22
2.40/30 ml
32 mg
50 mg
100 mg
0.12
0.21
0.24
1%: 30 ml vial
1.5%: 30 ml vial
2%: 50 ml vial
3.30
4.20
6.50
50 mg
1.89
MEPHYTON®: Brand of Phytonadione
MEPIVICAINE
Carbocaine®, Polocaine®
Injection
MEPRON : Brand of Atovaquone
MERCAPTOPURINE
Purinethol®, 6-MP
Tablet
133
UTMB COST
MEROPENEM
Merrem® IV
Injection
1 gram vial
Restriction: Infectious Disease Faculty
40.71
MERREM® IV: Brand of Meropenem
MERUVAX®-II: Brand of Rubella Virus Vaccine, Live
MESALAMINE
Rowasa®, Asacol®, Pentasa®, Canasa®
Capsule
250 mg
Enema
4 g/60 ml
Suppository
1000 mg
Tablet
400 mg
Restriction: Adult and Pediatric Gastroenterology Faculty
MESNA
Mesnex®
Injection
200 mg
1g
0.32
9.00
6.18
0.54
12.34
60.60
MESNEX®: Brand of Mesna
MESTINON®: Brand of Pyridostigmine Bromide
MESTRANOL: Ingredient of Ortho-Novum® 1/80
METAMUCIL®: Brand of Psyllium Hydrophilic Mucilloid
METANDREN®: Brand of Methyltestosterone
METAPREL®: Brand of Metaproterenol Sulfate
METAPROTERENOL SULFATE
Alupent®, Metaprel®
Inhaler
225 mg: 15 ml
(0.65 mg/inhalation: 300 inhalations)
Solution, nebulizer 0.6%: 2.5 ml U-D preservative free
Syrup
10 mg/5 ml: 473 ml
Tablet
20 mg
METFORMIN
Glucophage®
Tablet
9.17
0.35
0.60/30 ml
0.06
500 mg
0.13
850 mg
0.15
Note: Should be used for patients who have failed sulfonylurea therapy. Caution in patients
with acute or chronic renal dysfunction - lactic acidosis.
134
UTMB COST
METHADONE HYDROCHLORIDE C-II
Dolophine®, Westadone®
Injection
10 mg/ml:
10 ml
10.00
Solution
2 mg/ml:
500 ml
2.37/30 ml
Tablet
5 mg
0.25
10 mg
0.29
Tablet, effervescent
40 mg
0.21
Restriction: Requires triplicate prescription form for outpatient prescriptions.
METHAZOLAMIDE
Neptazane®
Tablet
METHENAMINE MANDELATE
Mandelamine®
Suspension
Tablet, enteric coated
50 mg
0.30
500 mg/5 ml: 273 ml
500 mg
1 gm
2.16/30 ml
0.08
0.14
METHERGINE®: Brand of Methylergonovine
METHIMAZOLE
Tapazole®
Tablet
10 mg
0.17
500 mg
750 mg
0.06
0.07
500 mg
16.98
Injection, solution
20-25 mg
1 gm
25 mg/ml:
Tablet
2.5 mg
3.58
27.50
2.70
4.98
13.12
1.69
METHOCARBAMOL
Robaxin®
Tablet
METHOHEXITAL SODIUM C-IV
Brevital®
Injection
Note: For I.V. use only.
METHOTREXATE
Folex®, Mexate®
Injection, powder
METHOXAMINE HYDROCHLORIDE
Vasoxyl®
Injection
20 mg/ml:
2 ml
4 ml
8 ml
1 ml
10.05
135
UTMB COST
METHOXSALEN
Oxsoralen Ultra®
Capsule
10 mg
3.99
Restriction: Dermatology Staff must countersign orders within 48 hours.
Oxsoralen®
Lotion
1%: 1 ounce amber bottle
88.20
Restriction: Dermatology Faculty for use in Dermatology Clinic only.
METHSUXIMIDE
Celontin®
Capsule
METHYLDOPA
Aldomet®
Injection
Tablet
METHYLENE BLUE
Injection
Urolene Blue®
Tablets
300 mg
0.67
50 mg/ml: 5 ml
125 mg
250 mg
500 mg
0.95
0.20
0.07
0.13
1%:
9.22
10 ml
65 mg
METHYLERGONOVINE
Methergine®
Injection
0.2 mg/ml:
Tablet
0.2 mg
Note: Injectable requires refrigeration.
METHYLPHENIDATE C-II
Ritalin®
Tablet
Tablet sustained release
Concerta
Tablet SR
0.49
1 ml
5 mg
10 mg
20 mg
2.60
0.55
0.31
0.43
0.92
18 mg
1.43
36 mg
1.51
54 mg
1.53
Restriction: All dosage forms require C-II prescription form for outpatient prescriptions.
METHYLPREDNISOLONE
Medrol® Dosepack
Tablets
4 mg x 21 tablets
Note: Must follow titration directions per instruction sheet
METHYLPREDNISOLONE ACETATE
Depo-Medrol®
Injection, suspension
Note: IM administration
136
40 mg/ml:
80 mg/ml:
1 ml
1 ml
19.31/pack
3.63
5.93
UTMB COST
METHYLPREDNISOLONE SODIUM SUCCINATE
Solu-Medrol®
Injection
40 mg/ml:
1 ml
125 mg/2 ml
500 mg/8 ml
1 gm/16 ml
0.87
1.20
3.10
5.78
METHYLROSANILINE: Ingredient of Gentian Violet
METHYSERGIDE
Sansert®
Tablet
METOCLOPRAMIDE
Reglan®
Injection
Tablet
Syrup
METOCURINE
Metubine®
Injection
METOLAZONE
Diulo®, Zaroxolyn®
Tablet
2 mg
1.25
5 mg/ml:
10 ml
30 ml
5 mg
10 mg
5 mg/5 ml:
2 ml
473 ml
2 mg/ml:
20 ml
0.38
1.40
4.50
0.11
0.11
0.18/30 ml
20.20
2.5 mg
5 mg
10 mg
0.50
0.55
0.64
5 mg/5 ml amp
25 mg
50 mg
100 mg
25 mg
50 mg
100 mg
200 mg
1.45
0.08
0.05
0.11
0.04
0.04
0.06
0.12
METOPIRONE®: Brand of Metyrapone
METOPROLOL
Lopressor®, Toprol®
Injection
Tablet
Tablet XL
METRAZOL®: Brand of Pentylenetetrazol
METRODIN®: Brand of Urofollitropin
METRO-GEL®: Brand of Metronidazole
137
UTMB COST
METRONIDAZOLE
Flagyl®
Injection
Tablet
Vaginal gel
5 mg/ml:
500 mg/vial
250 mg
0.75%:
100 ml ready-to-use
70 gm
1.20
14.83
0.06
26.60
METUBINE®: Brand of Metocurine
METYRAPONE
Metopirone®
Capsule
250 mg
2.31
150 mg
200 mg
250 mg
0.15
0.82
0.34
MEXATE®: Brand of Methotrexate
MEXILETINE
Mexitil®
Capsule
Restriction: Cardiology Faculty
MEZLIN®: Brand of Mezlocillin
MEZLOCILLIN
Mezlin®
Injection
4 gm
Note: Sodium Content = 1.8 mEq/gm.
10.50
MIACALCIN®: Brand of Calcitonin Salmon
MICONAZOLE NITRATE
Desenex®
Powder
2%: 85 gram
Note: O.T.C., non-legend drug available for inpatients only
4.14
MICRO-K 10 EXTENCAP®: Brand of Potassium Chloride
MICRONOR®: Brand of Norethindrone
MIDAMOR®: Brand of Amiloride
MIDAZOLAM HYDROCHLORIDE C-IV
Versed®
Injection
1 mg/ml:
5 mg/ml:
138
5 ml
1 ml
2 ml
10 ml vial
9.15
9.14
9.14
71.89
UTMB COST
MIDRIN®, ISOCOM®
Capsules: each contains
Acetaminophen
Dichloralphenazone
Isometheptene mucate
0.36
325 mg
100 mg
65 mg
MILK OF MAGNESIA
Suspension
10 ml concentrate Unit Dose
equivalent to 30 ml non-concentrate
Non-concentrate
120 ml
Note: O.T.C., non-legend drug available for inpatients only.
0.13
1.05
MILONTIN®: Brand of Phensuximide
MILRINONE
Primacor®
Injection
1mg/ml; 10 ml
20 mg/100 ml RTU bag
46.70
107.00
Restriction: Cardiology faculty.
MINERAL OIL, HEAVY
Liquid
30 ml Unit Dose
473 ml
Note: O.T.C., non-legend drug available for inpatients only.
MINERAL OIL, LIGHT, STERILE
Liquid
10 ml vial
Note: O.T.C., non-legend drug available for inpatients only.
0.18
1.41
0.98
MINIPRESS®: Brand of Prazosin
MINOCIN®: Brand of Minocycline
MINOCYCLINE
Minocin®
Capsule
MINOXIDIL
Loniten®
Tablet
50 mg
100 mg
1.54
2.62
2.5 mg
10 mg
0.04
0.07
MINTEZOL®: Brand of Thiabendazole
MIOCHOL®: Brand of Acetylcholine
MIOSTAT® INTRAOCULAR: Brand of Carbachol
MIRENA®: Brand of Levonorgestrel Releasing Intrauterine System
139
UTMB COST
MIRTAZAPINE
Remeron®
Tablet
15 mg
30 mg
0.24
0.37
100 mcg
200 mcg
0.52
0.76
MIRAPEX®: Brand of Pramipexole
MISOPROSTOL
Cytotec®
Tablet
MISSION PRENATAL-S®: Brand of Vitamins, Prenatal
MITHRACIN®: Brand of Plicamycin
MITHRAMYCIN: See Plicamycin
MITOMYCIN
Mutamycin®
Injection
5 mg
20 mg
MITOTANE
Lysodren®
Tablet
500 mg
MITOXANTRONE
Novantrone®
Injection
2 mg/ml:
39.28
137.48
1.94
10 ml vial
464.72
M-M-R® II: Brand of Measles, Mumps and Rubella Vaccine
MOBAN®: Brand of Molindone
MODANE® BULK: Brand of Psyllium Hydrophilic Mucilloid
MODICON®
Tablets: 28’s
7 inert tablets plus 21 tablets containing:
Ethinyl Estradiol
0.035 mg (35 mcg)
Norethindrone
0.5 mg
MODURETIC® 5-50
Tablet: each contains
Amiloride
5 mg
Hydrochlorothiazide 50 mg
140
8.40
0.44
UTMB COST
MOLINDONE
Moban®, Lidone®
Tablet
5 mg
10 mg
25 mg
50 mg
0.52
0.75
1.12
1.50
MOM: See Milk of Magnesia
MONOCLATE®: Brand of Antihemophilic Factor (Human)
MONONINE®: Brand of Factor IX Complex, (Human) Heat Treated
MONOPRIL®: Brand of Fosinopril
MORPHINE SULFATE C-II
Kadian®
Capsule, sustained release 20 mg
2.31
30 mg
2.51
50 mg
4.48
60 mg
4.79
100 mg
8.01
Restriction: Pain Service Faculty, Susan McCammon, MD - Otolaryngology
Note: This dosage form is given once or twice daily.
MS Contin®
Capsule, immediate release 15 mg
0.09
30 mg
0.26
Tablet, controlled release
15 mg
0.08
30 mg
0.19
60 mg
0.37
100 mg
0.57
200 mg
1.06
Injection
2 mg/ml:
1 ml
0.42
4 mg/ml:
1 ml
0.44
8 mg/ml:
1 ml
0.45
10 mg/ml:
1 ml
0.44
15mg/ml:
1 ml
0.17
Roxanol®
Oral Concentrate
20 mg/ml: 120 ml
49.20
Solution
10 mg/5 ml: 473 ml
0.83/30 ml
RMS®
Suppository
5 mg
0.99
10 mg
0.57
20 mg
1.34
Restriction: Requires C-II prescription form for outpatient prescriptions.
MORRHUATE SODIUM
Injection
5%:
30 ml
48.60
MOTRIN®: Brand of Ibuprofen
141
UTMB COST
MOXIFLOXACIN
Avelox® IV
Injection
400 mg
Restriction: Infectious Disease Faculty
Vigamox®
Ophthalmic Solution
0.5%; 3 ml
34.17
43.85
6-MP: See Mercaptopurine
MSIR®: Brand of Morphine
MS CONTIN®: Brand of Morphine Sulfate
MUCOSIL®: Brand of Acetylcysteine
MUCOMYST®: Brand of Acetylcysteine
MUMPS VACCINE: Ingredient of Measles, Mumps, and Rubella Virus Vaccine Live
MUMPS VIRUS VACCINE
Mumpsvax®
Injection:
0.5 ml
6.25
MURO 128®: Brand of Sodium Chloride
MUROMONAB-CD3
Orthoclone® OKT-3
Injection
1 mg/ml:
5 ml
499.20
Note: Should be given by IV bolus over < 1 minute. Should not be mixed with other medications.
MUPIROCIN
Bactroban®
Ointment
2%: 22 gm
Ointment, nasal
2%: 1 gm
Restriction: Burn Faculty
Dermatology Faculty
Infectious Disease Faculty
Employee Health
Vascular Surgery (Drs. Hunter, Pounds, Killewich)
MUSE®: Brand of Alprostadil Urethral Pellet Suppositories
MUSTARGEN®: Brand of Mechlorethamine Hydrochloride
MUTAMYCIN®: Brand of Mitomycin
MVC PLUS®: Brand of Vitamin, Multiple Injectable - Adult
M.V.I.® - 12: Brand of Vitamin, Multiple Injectable - Adult
M.V.I.® Pediatric: Brand of Vitamin, Multiple Injectable - Pediatric
MYAMBUTOL®: Brand of Ethambutol
142
10.62
3.88
UTMB COST
MYCELEX®: Brand of Clotrimazole
MYCHEL®: Brand of Chloramphenicol
MYCIFRADIN®: Brand of Neomycin Sulfate
MYCIGUENT®: Brand of Neomycin Sulfate
MYCO-TRI-ACET® II: See Mycolog® II
MYCOBUTIN®: Brand of Rifabutin
MYCOLOG® II, MYCO-TRI-ACET® II, MYKACET
Cream or Ointment:
30 gm
each gram contains:
Nystatin
100,000 U
Triamcinolone Acetonide
0.1% (1 mg)
MYCOPHENOLATE
CellCept®
Capsule
Injection
Suspension
Tablet
Myfortic®
Tablet, delayed release
250 mg
500 mg/20 ml
200 mmg/ml
500 mg
1.50
1.34
21.80
1.23/200 mg
2.70
180 mg
1.42
360 mg
2.85
Restriction: Nephrology (adult and pediatrics), Gastroenterology and Transplant Surgery.
Note: Preferred mycophenolate products will be switched from Cellcept to Myfortic. Both
products will be available for use for patients who were previously initiated on Cellcept therapy.
MYCOSTATIN®: Brand of Nystatin
MYDFRIN®: Brand of Phenylephrine Hydrochloride
MYDRIACYL®: Brand of Tropicamide
MYFORTIC®: Brand of Mycophenolate
MYKACET: See Mycolog® II
MYLERAN®: Brand of Busulfan
MYLICON®: Brand of Simethicone
MYLANTA®: See MAALOX®
MYOCHRYSINE®: Brand of Gold Sodium Thiomalate
MYSOLINE®: Brand of Primidone
143
UTMB COST
NABUMETONE
Relafen®
Tablet
500 mg
750 mg
Restriction: Rheumatology and Orthopedics faculty.
NAFARELIN
Synarel®
Intranasal Inhaler
2 mg/ml:
(200 mcg/inhalation: 60 inhalations)
10 ml
0.91
1.07
124.81
NAFCIL®: Brand of Nafcillin Sodium
NAFCILLIN SODIUM
Unipen®, Nafcil®
Injection
500 mg
1g
10 g bulk vial
Note: Sodium content per 1 gm = 2.9 mEq
NAFTIFINE
Naftin®
Cream
1%:
0.76
0.87
6.97
30 g tube
29.97
NAFTIN®: Brand of Naftifine
NALBUPHINE HYDROCHLORIDE
Nubain®
Injection
NALOXONE HYDROCHLORIDE
Narcan®
Injection
NALIDIXIC ACID
NegGram®
Tablets
10 mg/ml:
1 ml
0.37
0.4 mg/ml:
1 mg/ml:
1 ml
2ml
2.55
3.44
500 mg
0.77
NALTREXONE
Trexan®
Tablet
50 mg
Restriction: Restricted to faculty physicians.
NANDROLONE DECANOATE C-III
Deca-Durabolin®
Injection
100 mg/ml:
200 mg/ml:
3.82
2 ml
1 ml
Note: Injection for IM use only.
NAPHAZOLINE HYDROCHLORIDE: Ingredient of Vasocon A®
144
19.32
17.81
UTMB COST
NAPROSYN®: Brand of Naproxen
NAPROXEN
Naprosyn®
Tablet
Suspension
250 mg
500 mg
125 mg/5 ml
NAPROXEN SODIUM
Anaprox®
Tablet
275 mg
Note: 275 mg of naproxen sodium is equivalent to 250 mg base.
0.11
0.15
1.76/30 ml
0.10
NARCAN®: Brand of Naloxone Hydrochloride
NARDIL®: Brand of Phenelzine
NASALCROM®: Brand of Cromolyn Sodium
NATABEC Rx: Brand of Vitamins Prenatal
NATAMYCIN
Natacyn®
Suspension, ophthalmic 5%
Note: Must refrigerate.
82.05
NATRECOR®: Brand of Nesiritide
NAVANE®: Brand of Thiothixene
NEBCIN®: Brand of Tobramycin Sulfate
NEGGRAM®: Brand of Nalidixic Acid
NEMBUTAL®: Brand of Pentobarbital Sodium
NELFINAVIR
Viracept®
Powder, for oral solution
50 mg/gm; 144 gm
Tablet
625 mg
Restriction: Infectious Disease Faculty or Occupational Exposure
48.53/144gm
3.79
NEO-CALGLUCON®: Brand of Calcium Glubionate
NEOMYCIN: Ingredient of Maxitrol® and Neosporin®
NEOMYCIN SULFATE
Tablet
500 mg
Mycifradin®, Neo-IM®
Injection
250 mg/ml: 2 ml
Solution, oral
125 mg/5 ml
Note: Injection for IM use only.
0.15
4.60
0.25/5 ml
145
UTMB COST
NEOPROFEN®: Brand of Ibuprofen, Injection
NEORAL®: Brand of Cyclosporine, microemulsion
NEOSAR®: Brand of Cyclophosphamide
NEOSPORIN®
GU Irrigant:
1 ml
Neomycin Base
40 mg
Polymyxin B
200,000 U
Ointment ophthalmic
1/8 oz.
each gram of ointment contains:
Polymyxin B
10,000 U
Bacitracin
400 U
Neomycin Sulfate
5 mg
Solution, ophthalmic:
10 ml
each ml contains:
Gramicidin
25 mcg (0.025 mg)
Neomycin Sulfate
2.5 mg
Polymyxin B
10,000 U
Note: 100 mg neomycin sulfate is equivalent to 70 mg base.
NEOSTIGMINE METHYLSULFATE
Prostigmin®
Injection
250 mcg/ml (1:4000):1 ml
1 mg/ml (1:1000): 10 ml
6.23
0.94
1.11
1.18
3.18
NEO-SYNEPHRINE®: Brand of Phenylephrine Hydrochloride
NEPAPHENAC
Nevanac®
Ophthalmic Drops
0.1%; 3 ml
61.20
NEPHRO-VITE®: Brand of Vitamin, B complex with C, folic acid
NEPTAZANE®: Brand of Methazolamide
NESACAINE®: Brand of Chlorprocaine
NESIRITIDE
Natrecor®
Injection
1.5 mg vial
426.79
Restriction: Cardiology and Emergency Room Faculty/Fellows regardless of area of
administration. Therapy must be initiated where hemodynamic monitoring is available including
ICUs, telemetry units, emergency department.
NEULASTA®: Brand of Pegfilgrastim
NEUPOGEN®: Brand of Granulocyte Colony Stimulating Factor (G-CSF)
NEURONTIN®: Brand of Gabapentin
146
UTMB COST
NEUTRA-PHOS®
Packet: 1.25 gm dissolved in 75 ml of water yields
0.26
Phosphorus
250 mg (8 mM)
Potassium
278 mg (7.125 mEq)
Sodium
164 mg (7.125 mEq)
Note: Packet contents must be dissolved in 75 ml of water before administration.
NEUTRA-PHOS®-K
Packet: 1.45 gm dissolved in 75 ml of water yields
0.32
Phosphorus
250 mg (8 mM)
Potassium
556 mg (14.25 mEq)
Note: Packet contents must be dissolved in 75 ml of water before administration. The capsule
is sodium-free.
NEVANAC®: Brand of Nepaphenac
NEVIRAPINE
Viramune®
Tablet
200 mg
NIACIN (Nicotinic Acid) (Vitamin B-3)
Tablet
100 mg
Note: O.T.C., non-legend drug available for inpatients only.
NICARDIPINE
Cardene®
Injection
Restriction: Faculty signature
2.5 mg/ml; 10 ml ampule
3.48
0.02
136.55
NICLOCIDE®: Brand of Niclosamide
NICLOSAMIDE
Niclocide®
Tablet
500 mg
2.18
NICORETTE® GUM: Brand of Nicotine Polacrilex
NICOTINE POLACRILEX
Nicorette®
Chewing Gum
Note: For Inpatient Use Only.
2 mg: 96 pieces/box
0.27/piece
NICOTINIC ACID: See Niacin
NIFEDIPINE
Procardia®, Adalat®, Adalat® CC
Capsule
10 mg
0.19
20 mg
0.10
Tablet , extended release 30 mg
0.77
60 mg
1.31
90 mg
1.59
Restriction: Tablets are restricted to Renal/Transplant Faculty, Cardiology Faculty
147
UTMB COST
NILSTAT®: Brand of Nystatin
NIMBEX®: Brand of Cisatracurium
NIMODIPINE
Nimotop®
Capsule
30 mg
Restriction: Restricted to neurosurgery faculty.
5.12
NIMOTOP®: Brand of Nimodipine
NIPENT®: Brand of Pentostatin
NIPRIDE®: Brand of Nitroprusside Sodium
NITROCINE®: Brand of Nitroglycerin Patch
NITRODISC®: Brand of Nitroglycerin
NITROFURANTOIN
Furadantin®
Suspension
Macrodantin®
Capsule, macrocrystals
25 mg/5 ml:
60 ml
473 ml
25 mg
50 mg
Macrobid®
Capsule, monohydrate/macrocrystals
3.67/30 ml
0.48
0.66
100 mg
1.17
NITROGEN MUSTARD: See Mechlorethamine Hydrochloride
NITROGLYCERIN
NitroDisc®, Nitro-Dur® II, Transderm-Nitro®, Deponit®
Patch, transdermal
5 mg: 30’s
0.01/patch
10 mg: 30’s
0.01/patch
Nitrostat®, Nitrol®
Ointment
2%:
60 g tube
3.96
Note: 3 g unit dose is available for inpatients only (15 mg NTG per inch of paste).
Tablet, sublingual
0.3 mg (1/200 gr.)
6.40/100
0.4 mg (1/150 gr)
3.60/100
Tridil®, Nitrostat® IV
Injection
5 mg/ml:
10 ml
0.41
50 mg/250 ml RTU bag
4.78
100 mg/250 ml RTU bag
5.26
NITROPRUSSIDE SODIUM
Injection
NITROSTAT®: Brand of Nitroglycerin
NIZORAL®: Brand of Ketoconazole
148
50 mg/vial
0.84
UTMB COST
NOCTEC®: Brand of Chloral Hydrate
NOLVADEX®: Brand of Tamoxifen
NORCO 5® C-III
Ingredients per tablet:
Acetaminophen
325 mg
Hydrocodone Bitartrate
5 mg
Note: Requires DEA number on outpatient prescriptions
0.26
NORCURON®: Brand of Vecuronium Bromide
NOREPINEPHRINE BITARTRATE
Levophed®
Injection
1 mg Base/ml:
NORETHINDRONE
Micronor®, Nor-Q.D.®
Tablet
0.35 mg: 42 tablets/pack
4 ml
7.36
0.92
NORETHINDRONE: Ingredient of Modicon®, Ortho-Novum® 7/7/7,
Ortho-Novum 1/35, and Ortho-Novum®1/80
NORFLEX®: Brand of Orphenadrine Citrate
NORGESTREL: Ingredient of Lo/Ovral®
NORMODYNE®: Brand of Labetalol
NOROXIN®: Brand of Norfloxacin
NORPACE®: Brand of Disopyramide Phosphate
NORPRAMIN®: Brand of Desipramine
NORTRIPTYLINE
Aventyl®, Pamelor®
Capsule
10 mg
25 mg
75 mg
0.08
0.16
0.34
NORVASC®: Brand of Amlodipine
NORVIR®: Brand of Ritonavir
NOVAFED®: Brand of Pseudoephedrine Hydrochloride
NOVANTRONE®: Brand of Mitoxantrone
NOVOCAINE®: Brand of Procaine Hydrochloride
NOVOLOG®: Brand of Insulin, Aspart
149
UTMB COST
NOVOSEVEN®: Brand of Factor VIIa
NOXAFIL®: Brand of Posaconazole
NPGU IRRIGANT: See Neosporin GU Irrigant
NTG: See Nitroglycerin
NUBAIN®: Brand of Nalbuphine Hydrochloride
NUPERCAINAL®: Brand of Dibucaine
NYDRAZID®: Brand of Isoniazid
NYSTATIN
Mycostatin®, Nilstat®
Cream
Ointment
Powder, topical
Suspension
Tablet, oral
Tablet, vaginal
100,000 U/g: 30 g
100,000 U/g: 30 g
100,000 U/g: 15 g
100,000 U/ml: 60 ml
480 ml
500,000 U
100,000 U
0.87
1.60
14.73
2.16
0.69/30 ml
0.07
0.88
OCCUCOATE®: Brand of Hydroxypropylmethlycellulose
OCTREOTIDE ACETATE
Sandostatin®
Injection
50 mcg/ml: 1 ml
100 mcg/ml: 1 ml
500 mcg/ml: 1 ml
4.92
9.54
46.02
0.3%: 5 ml
10 ml
29.68
43.84
OCUFEN®: Brand of Flurbiprofen
OFLOXACIN
Floxin®
Suspension, Otic
OKT-3: See Muromonab-CD3
150
UTMB COST
OLANZAPINE
Zyprexa®
Injection
10 mg vial
18.85
Restriction: Psychiatry and Emergency Department Faculty, Kris Williams MD - Neurology
Tablet, Film Coated
2.5 mg
3.21
5 mg
3.85
7.5 mg
3.84
10 mg
5.67
15 mg
8.76
Restriction: Psychiatry Faculty, Kris Williams MD - Neurology
Zyprexa Zydis®
Tablet, Rapid Disintegrating 5 mg
6.85
10 mg
9.84
15 mg
14.28
20 mg
18.71
Restriction: Psychiatry Faculty
OMALIZUMAB
Xolair®
Injection
150 mg/1.2 ml
541.25
Restriction: Edward Brooks, M.D., Allergy/Immunology
Randall Goldblum, M.D., Allergy/Immunology
Andrew Grant, M.D., Allergy/Immunology
Frank Schmalstieg, M.D., Allergy/Immunology
Sanjiv Sur, M.D., Allergy/Immunology
Note: All omalizumab doses will be purchased through the pharmacy and will be
distributed upon receipt of a patient-specific order.
OMEPRAZOLE
PriLosec®
Capsule
20 mg
Restriction: All forms for use in Pediatric patients only.
2.81
OMNI® GEL: Brand of Stannous Flouride
OMNICEF®: Brand of Cefdinir
OMNIPEN®: Brand of Ampicillin
ONCASPAR®: Brand of Pegaspargase
ONCOVIN®: Brand of Vincristine Sulfate
151
UTMB COST
ONDANSETRON HYDROCHLORIDE
Zofran®
Injection
2 mg/ml:
2 ml
16.69
2 mg/ml:
20 ml
164.78
Tablet
4 mg
17.88
8 mg
29.78
Tablet Restriction: All faculty for use in patients with documented treatment failures to less
expensive antiemetic agents. Additional M.D.s approved without documented treatment
failures:
Jack Alperin, M.D.
J. David Bessman, M.D.
Concepcio Diaz-Arrastia, M.D Frank Gardner, M.D.
Granisetron / Ondansetron Therapeutic Interchange Policy:
When a dose of ≤ 21 mg of ondansetron is ordered, the Pharmacy will dispense ondansetron, and
when a dose of ≥ 22 mg of ondansetron is ordered, the Pharmacy will dispense a single 1 mg dose
of granisetron.
OPHTHALMIC IRRIGANT: See Eyewash Irrigant Solution
OPHTHETIC®: Brand of Proparacaine Hydrochloride
OPIUM: Ingredient of B & 0 Supprettes®
OPIUM TINCTURE C-II
Tincture 1% anhydrous morphine: 120 ml
Note: Contains 19% alcohol.
9.66/30 ml
OPTICROM®: Brand of Cromolyn Sodium
OPTILETS-M® 500: Brand of Vitamin, Multiple with Minerals
OPTISON®
Injection
3 ml single use vial
Note: This product is stocked in the Echo Lab.
110.00
OPV: See Polio Virus Vaccine
ORAGRAFIN®: Brand of Calcium Ipodate
ORAP®: Brand of Pimozide
ORAZINC®: Brand of Zinc Sulfate
ORETIC®: Brand of Hydrochlorothiazide
ORTHOCLONE OKT-3: Brand of Muromonab-CD3
ORPHENADRINE CITRATE
Norflex®
Tablet
152
100 mg
1.56
UTMB COST
ORTHO-NOVUM® 7/7/7-28
Tablet 28’s
7 inert green tablets plus 21 tablets containing:
days 1-7:
0.5 mg norethindrone / 35 mcg ethinyl estradiol
days 8-14:
0.75 mg norethindrone / 35 mcg ethinyl estradiol
days 15-21: 1 mg norethindrone / 35 mcg ethinyl estradiol
1.00
OS-CAL®: See Calcium Carbonate
OSMITROL®: Brand of Mannitol
OSMOGLYN®: Brand of Glycerin
ORTHO-TRI-CYCLEN®
Tablet 28’s
7 inert green tablets plus 21 tablets containing:
days 1-7:
0.18 mg norgestimate / 35 mcg ethinyl estradiol
days 8-14:
0.215 mg norgestimate / 35 mcg ethinyl estradiol
days 15-21: 0.25 mg norgestimate / 35 mcg ethinyl estradiol
OVCON®
Tablets 28's
7 inert tablets plus 21 tablets containing:
Ethinyl estradiol
50 mcg
Noethindrone
1 mg
1.00
2.20
OVRAL® 50
Tablet: each contains
0.25
Ethinyl estradiol
50 mcg
Norgestril
0.5 mg
Note: For use in the ER for post-coital contraception as an outpatient prescription, patient
specific.
OXACILLIN SODIUM
Bactocill®, Prostaphlin®
Injection
1g
Note: Sodium content per gm of injection = 2.8 mEq
OXALIPLATIN
Eloxatin®
Injection
50 mg
100 mg
0.42
671.57
1,342.78
Restriction: Oncology Faculty
OXAPROZIN
Daypro®
Tablet
600 mg
Restriction: Rheumatology faculty.
1.17
153
UTMB COST
OXAZEPAM C-IV
Serax®
Capsules
10 mg
15 mg
Restriction: Requires DEA number for outpatient prescriptions.
0.20
0.10
OXSORALEN®: Brand of Methoxysalen
OXSORALEN® ULTRA: Brand of Methoxysalen
OXTRIPHYLLINE
Choledyl®
Tablet
200 mg
0.22
Note: 200 mg Oxtriphylline HCl is equivalent to 128 mg anhydrous Theophylline.
OXYBUTYNIN
Ditropan®
Syrup
Tablet
5 mg/5 ml:
5 mg
473 ml
1.53/30 ml
0.51
OXYCODONE: Ingredient of Tylox®
OXYCODONE CII
Oxycontin®, Roxicodone®
Capsule
Solution
Oral Concentrate
Tablet, controlled release
5 mg
0.19
5 mg/5 ml
1.05/5 mg
20 mg/ml
1.19/20 mg
10 mg
1.13
20 mg
2.16
40 mg
3.78
80 mg
7.03
Restriction: Medicine Hematology/Oncology Faculty
Pain Service Faculty which includes the following:
Gulshan Doulatram, MD
Michael Cook, MD
Maureen Hayes, MD
Kalyan Kuna, MD
Daneshvari Solanki, MD
Govindaraj Ranganathan, MD
Courtney Williams, MD
Denise Wilkes, MD
And Other Faculty:
Patrice Barnum, MD
David Paar, MD
Juan Carlos Sarria, MD
Note: Requires C-II prescription form for outpatient prescriptions.
OXYCONTIN®: Brand of Oxycodone
OXYMETAZOLINE
Afrin®, 12 Hour Nasal®, Genasal®
Spray, nasal 0.05%:
15 ml
Note: O.T.C., non-legend drug. Available only for Inpatients.
OXYMETHOLONE
Anadrol®
Tablet
50 mg
Restriction: Adult and Pediatric Hematology/Oncology Faculty.
154
0.87
9.64
UTMB COST
OXYTOCIN
Pitocin®, Syntocinon®
Injection
Spray, nasal
10 U/ml:
40 U/ml:
1 ml
5 ml
0.40
52.95
PABA: Ingredient of PreSun® 15
PACLITAXEL
Taxol®
Injection
30 mg
100 mg
143.45
478.29
PACLITAXEL PROTEIN-BOUND PARTICLES FOR INJECTABLE SUSPENSION
Abraxane®
Injection
100 mg vial
587.43
Note: Abraxane and Taxol (paclitaxel) are not therapeutically equivalent and should not be
substituted for one another.
PALIPERIDONE
Invega®
Tablet
3 mg
6 mg
9 mg
9.53
9.53
14.29
Restriction: Psychiatry Faculty
PALIVIZUMAB
Synagis®
Injection
100 mg vial
Restriction: Pediatric Infectious Disease and Neonatology Faculty.
PALONOSETRON
Aloxi®
Injection, IV
Restriction: Oncology Faculty
1069.00
0.25 mg/5 ml
170.84
30 mg
198.29
PAM: See Pralidixime
PAMELOR®: Brand of Nortriptyline
PAMIDRONATE
Aredia®
Injection, vial
PANAFIL®: Brand of Papain/Urea/Chlorophyllin Copper Complex Sodium
PANOXYL® AQ 5: Brand of Benzoyl Peroxide
155
UTMB COST
PANCRELIPASE
Ultrase®
Each capsule contains:
Lipase
4,500 units
Protease
25,000 units
Amylase
20,000 units
Ultrase® MT12
Each capsule contains:
Lipase
12,000 units
Protease
39,000 units
Amylase
39,000 units
Ultrase® MT18
Each capsule contains:
Lipase
18,000 units
Protease
58,500 units
Amylase
58,500 units
Ultrase® MT20
Each capsule contains:
Lipase
20,000 units
Protease
65,000 units
Amylase
65,000 units
PANCURONIUM BROMIDE
Pavulon®
1 mg/ml:
2 mg/ml:
0.25
0.75
1.00
1.25
10 ml
2 ml
5 ml
1.36
1.36
2.08
PANHEMATIN®: Brand of Hemin
PANTOPRAZOLE
Protonix®
Injection
Tablet, Delayed Release
PAPAIN/UREA
Accuzyme®
Topical
40 mg vial
20 mg
40 mg
3.90
0.17
0.17
30 gm
34.56
PAPAIN/UREA/CHLOROPHYLLIN COPPER COMPLEX SODIUM
Panafil®
Ointment
30 gm
Spray
30 ml
53.25
53.25
PARA-AMINOBENZOIC ACID (PABA): Ingredient of PreSun® 15
PAPAVERINE
Pavabid®
Capsule, sustained release 150 mg
Injection
30 mg/ml:
PARAGARD® 380T COPPER IUD
Copper IUD
156
2 ml
0.04
0.41
150.00
UTMB COST
PARAPLATIN®: Brand of Carboplatin
PAREGORIC C-III
Tincture, 2 mg anhydrous morphine equiv./5ml:
5 ml
0.15
480 ml
0.21/30 ml
Note: Requires DEA number on outpatient prescriptions. Tincture is 44% alcohol.
PARLODEL®: Brand of Bromocryptine Mesylate
PARNATE®: Brand of Tranylcypromine
PAROMOMYCIN
Humatin®
Capsule
PAROXETINE
Paxil®
Oral Suspension
Tablet
250 mg
10 mg/5 ml
10 mg
20 mg
30 mg
40 mg
1.65
123.18/250 ml
0.45
1.36
0.52
0.54
PAVABID®: Brand of Papaverine Hydrochloride
PAVULON®: Brand of Pancuronium Bromide
PAXIL®: Brand of Paroxetine
P1E1®, P2E1®, P3E1®, P4E1®, P6E1®
Solution, ophthalmic: each bottle contains:
Pilocarpine Hydrochloride 1%, Epinephrine Bitartrate 1%
Pilocarpine Hydrochloride 2%, Epinephrine Bitartrate 1%
Pilocarpine Hydrochloride 3%, Epinephrine Bitartrate 1%
Pilocarpine Hydrochloride 4%, Epinephrine Bitartrate 1%
Pilocarpine Hydrochloride 6%, Epinephrine Bitartrate 1%
12.70/10 ml
13.00/10 ml
14.25/15 ml
3.00/10 ml
15.71/15 ml
PECTIN: Ingredient of Kaopectate®
PEDIARIX®: Brand of Diphtheria/Tetanus Toxoid/Acellular Pertussis/Hepatitis B/Polio Vaccine
PEDIATRIC COCKTAIL: See Cardiac Cocktail
PEDIAZOLE®
Suspension:
100 ml
200 ml
9.40
18.60
each 5 ml contains:
Erythromycin Ethylsuccinate
200 mg
Sulfisoxazole
600 mg
Note: After reconstitution, the suspension remains stable 14 days when refrigerated.
PedvaxHIB®: Brand of Haemophilus B Conjugate Vaccine
157
UTMB COST
PEGAPTANIB
Macugen®
Injection, Ophthalmic
Restriction: Retina Faculty:
PEGASPARGASE
Oncaspar®
Injection
0.3 mg syringe
Garvin Davis, M.D.
Frederick van Kuijk, M.D.
750 IU/ml:
5 ml
995.00
Helen Li, M.D.
1071.05
PEGFILGRASTIM
Neulasta®
Injection, IV
6 mg syringe
1,680.00
Restricted: NOT for Inpatient use , TDCJ use, or unsponsored use not covered by Manufacturers
Assistance Program
PEMETREXED
Alimta®
Injection
500 mg vial
1,951.18
PENAPAR VK®: Brand of Penicillin V, Potassium
PENICILLIN ALLERGY TEST: See Benzoylpenicilloyl-polylysine
PENICILLAMINE
Cuprimine®
Capsule
250 mg
0.78
PENICILLIN G: Ingredient of Bicillin® CR
PENICILLIN G, BENZATHINE
Bicillin® LA, Permapen®
Injection
300,000 U/ml: 10 ml
2.25/1 ml
600,000 U/ml: 1 ml Pediatric only
7.08
2 ml Adult only
4.70
4 ml
26.00
Note: Deep IM use only. 1 mg benzathine, penicillin G is equivalent to 1211 USP penicillin units.
PENICILLIN G, POTASSIUM
Pfizerpen®
Injection
1 mil U/vial
1.41
5 mil U/vial
3.05
20 mil U/vial
7.49
Note: 1 mg potassium penicillin G is equivalent to 1595 USP penicillin units. Sodium content
per 1 milllion units = 0.3 mEq.
Potassium content per 1 million units = 1.7 mEq.
PENICILLIN G, PROCAINE
Wycillin®
Injection 600,000 U/ml:
1 ml tubex
2.59
2 ml tubex
4.32
Note: Deep IM use only. 1 mg procaine penicillin G is equivalent to 1009 USP penicillin units.
158
UTMB COST
PENICILLIN V, POTASSIUM
Beepen® VK, Penapar VK®, Pen-Vee® K
Suspension
125 mg/5 ml: 200 ml
0.60
250 mg/5 ml: 200 ml
1.80
Veetids®, V-Cillin K®
Tablet
250 mg
0.02
500 mg
0.10
Note: 1 mg penicillin V potassium is equivalent to 1600 USP penicillin units. Potassium
content per 125 mg = 0.325 mEq
PENTAERYTHRITOL TETRANITRATE
Peritrate®
Tablet
10 mg
20 mg
0.09
0.17
PENTAM® 300: See Pentamidine
PENTAMIDINE ISETHIONATE
Nebupent®
Inhalation
Pentam® 300
Injection
300 mg
16.69/150 mg
300 mg
19.45
PENTASA®: Brand of Mesalamine
PENTAZOCINE: Ingredient of Talwin® NX
PENTOBARBITAL SODIUM C-II
Nembutal®
Capsule
50 mg
0.28
100 mg
0.14
Elixir
18.2 mg/5 ml: 480 ml
1.72/30 ml
Injection
50 mg/ml:
2 ml
2.05
20 ml
10.28
50 ml
19.00
Note: 18.2 ml pentobarbital is equivalent to 20 mg pentobarbital sodium.
PENTOLAIR®: Brand of Cyclopentolate
PENTOSTATIN
Nipent®
Injection
10 mg
1567.13
Restriction: Hematology/Oncology faculty co-signature. The drug will not be stocked in the
Pharmacy but can be obtained with 24 hours notice.
PENTOTHAL® SODIUM: Brand of Thiopental Sodium
PENTOXIFYLLINE
Trental®
Tablet, controlled release
400 mg
0.56
PENTRAX®: Brand of Tar Extract
159
UTMB COST
PEN-VEE® K: Brand of Penicillin V, Potassium
PEPCID®: Brand of Famotidine
PEPTOBISMOL®: Brand of Bismuth Subsalicylate
PERFLUTREN LIPID MICROSPHERE
Definity®
Injection
2 ml vial
Restriction: Cardiology Echo Lab
125.00
PERIACTIN®: Brand of Cyproheptadine
PERIDEX®: Brand of Chlorhexidine Gluconate
PERITRATE®: Brand of Pentaerythritol Tetranitrate
PERMAPEN®: Brand of Penicillin G, Benzathine
PERMETHRIN
Elimite®
Cream
PERPHENAZINE
Trilafon®
Tablet
5%:
60 gm tube
2 mg
4 mg
8 mg
16 mg
15.30
0.15
0.25
0.46
0.26
PERPHENAZINE: Ingredient of Triavil®
PERSANTINE®: Brand of Dipyridamole
PETHADOL®: Brand of Meperidine Hydrochloride
PETROLATUM GAUZE, STERILE
Vaseline® Gauze
Gauze Pad 3" x 9"
Note: O.T.C., non-legend drug available for inpatients only.
PETROLATUM, HYDROPHILIC
Aquaphor®
Ointment
1 lb
Note: O.T.C., non-legend drug available for inpatients only.
PETROLATUM, WHITE
Ointment
0.53
0.22/30 gm
5 g unit dose
30 gm
1 lb
Note: O.T.C., non-legend drug available for inpatients only. Product transferred to Material
Management.
160
UTMB COST
PFIZERPEN®: Brand of Penicillin G, Potassium
PHARMADINE®: Brand of Povidone Iodine
PHENASEPTIC® SPRAY: Brand of Phenol
PHENAZOPYRIDINE
Pyridium®
Tablet
100 mg
0.09
PHENELZINE
Nardil®
Tablet
15 mg
0.33
PHENERGAN®: Brand of Promethazine
PHENOBARBITAL C-IV
Luminal®
Elixir
Injection
Tablet
20 mg/5 ml: 5 ml
130 mg/ml: 1 ml
15 mg
30 mg
60 mg
100 mg
Restriction: Requires DEA number on outpatient prescriptions.
PHENOL
Good Sense® Throat Spray, Chloraseptic® Spray, Phenaseptic® Spray
Oral Spray
1.4%; 180 ml
PHENOL DISINFECTANT (UTMB Compounded)
Solution 4 L , each contains Phenol 0.39%
Note: For general use, DO NOT DILUTE.
PHENTOLAMINE MESYLATE
Regitine®
Injection
5 mg
PHENYLEPHRINE HYDROCHLORIDE
Mydfrin®, Dilatair®
Drops, ophthalmic
2.5% 3 ml
5 ml
Neo-Synephrine®
Injection
1%: 1 ml
Spray, Nasal
0.25%: 15 ml
0.5%: 15 ml
Note: O.T.C. - non-legend drugs available for inpatients only.
0.01
2.74
0.03
0.02
0.02
0.03
1.97
11.01
37.75
1.32
1.33
0.40
2.98
2.98
PHENYLPROPANOLAMINE: Ingredient of Dimetapp®
161
UTMB COST
PHENYTOIN
Dilantin®
Suspension
Tablet, chewable
30 mg/5 ml: 240 ml
125 mg/5 ml: 240 ml
50 mg
PHENYTOIN SODIUM
Dilantin®
Capsule, Extended Release 30 mg
100 mg
Injection
50 mg/ml:
2 ml
5 ml
Note: 100 mg phenytoin sodium is equivalent to 93 mg phenytoin.
1.65/30 ml
3.36/30 ml
0.26
0.21
0.27
3.08
3.66
PHISOHEX®: Brand of Hexachlorophene Detergent Emulsion - Available from Materials Management
PHOSLO®: Brand of Calcium Acetate
PHOSPHO-SODA®, FLEET®
Solution, oral:
30 ml
240 ml
0.45
0.49
each 5 ml contains:
Sodium Biphosphate 2.4 g
Sodium Phosphate 0.9 g
Note: O.T.C., non-legend drug available for inpatients only. Sugar free.
PHOSPHOLINE IODIDE®: Brand of Echothiophate Iodide
PHOSPHORUS: Ingredient of Neutra-Phos® and Neutra-Phos-K®
PHYSOSTIGMINE SALICYLATE
Antilirium®
Injection
PHYTONADIONE
AquaMephyton®, Mephyton®
Injection
Tablet
PILOCARPINE HYDROCHLORIDE
Isopto® Carpine, Salagen®
Gel, ophthalmic
Solution, ophthalmic
1 mg/ml: 2 ml
1 mg/0.5 ml: 0.5 ml
10 mg/ml:
1 ml
5 ml
5 mg
2.04
2.95
3.19
16.50
0.46
4%;
3.5 gm
23.52
1%: 15 ml
1.41
2%: 15 ml
11.85
3%: 15 ml
2.41
4%: 15 ml
2.85
6%: 15 ml
2.55
Tablet
5 mg
0.94
Restriction: Tablet is restricted to Radiation Therapy & Otolaryngology faculty.
162
UTMB COST
PILOCARPINE HYDROCHLORIDE: Ingredient of P E® products
PIMOZIDE
Orap®
Tablet
PINDOLOL
Visken®
Tablet
2 mg
0.63
5 mg
10 mg
0.35
0.46
PIOGLITAZONE
Actos®
Tablet
15 mg
3.06
Restriction: Endocrinology Faculty, Elena Volpi MD, Steve Quach MD, Paul Remmers MD,
William Harper MD
PIPERACIL®: Brand of Piperacillin Sodium
PIPERACILLIN SODIUM
Piperacil®
Injection
4 g vial
Note: sodium content per 1 g = 1.85 mEq.
PIPERACILLIN/TAZOBACTAM
Zosyn®
Injection
3.375 gr
Note: Replaces Timentin® on formulary
PIRBUTEROL
Maxair®
Oral inhaler
200 mcg/inhalation
300 inhalations/cannister
PIROXICAM
Feldene®
Capsule
10 mg
20 mg
10.80
13.62
18.43
0.10
0.12
PITOCIN®: Brand of Oxytocin
PLACEBO
Cebocap®
Capsule
0.08
PLAQUENIL®: Brand of Hydroxychloroquine Sulfate
PLASMA PROTEIN FRACTION, HUMAN
Plasmanate®, Protenate®
Injection
5%:
50 ml
250 ml
500 ml
26.00
107.50
98.00
163
UTMB COST
PLASMANATE®: Brand of Plasma Protein Fraction, Human
PLATINOL®: Brand of Cisplatin
PLAVIX®: Brand of Clopidogrel
PLENDIL®: Brand of Felodipine
PLICAMYCIN
Mithracin®, Mithramycin
Injection
2500 mcg/vial
PNEUMOCOCCAL CONJUGATE VACCINE
Prevnar®
Injection
Restriction: For high risk children under 2 years of age.
High risk categories include sickle cell disease,
functional and anatomic asplenia, immunodeficiencies or
immunocompromised status, including HIV.
PNEUMOCOCCAL VACCINE, POLYVALENT
Pnu-Immune® 23, Pneumovax® 23
Injection
0.5 ml
Note: 0.5 ml provides a single dose.
68.53
56.54/dose
8.66
PNEUMOVAX® 23: Brand of Pneumococcal Vaccine, Polyvalent
PNU-IMMUNE® 23: Brand of Pneumococcal Vaccine, Polyvalent
PODOPHYLLOTOXIN
Condylox®
Solution
0.5%: 3.5 ml
POLYACRYLONITRATE
Dilopan®
Cervical Dilator
4 mm X 55 mm
POLIOMYELITIS INACTIVATED VACCINE
Types 1, 2 & 3 Monkey Kidney Cell Culture Origin
Injection 1 ml ampule
58.63
5.50
31.32
POLY-VI-SOL®: Brand of Vitamin, Multiple
POLYCILLIN®: Brand of Ampicillin
POLYMOX®: Brand of Amoxicillin Trihydrate
POYLMYXIN B: Ingredient of Maxitrol®, Neosporin®, & Polysporin®
POYLMYXIN B SULFATE
Aerosporin®
Injection
164
500,000 units
4.67
UTMB COST
POLYSPORIN®
Ointment, ophthalmic: 3.5 gm, each gram contains
Bacitracin
500 U
Polymyxin B 10,000 U
Ointment, topical:
30 gm, each gram contains
Bacitracin
500 U
Polymyxin B 10,000 U
Note: O.T.C., non-legend drug available for inpatients only.
1.11
4.02
POLYTRIM®: Brand of Trimethoprim/Polymyxin
PONTOCAINE®: Brand of Tetracaine Hydrochloride with or without Dextrose
POSACONAZOLE
Noxafil®
Oral Suspension
200 mg/5 ml
20.00
Restriction: Infectious Disease Faculty and Hematology/Oncology Faculty
POTASSIUM: Ingredient of Neutra-Phos-K®
POTASSIUM ACETATE
Injection
2 mEq/ml:
20 ml
0.28
POTASSIUM CHLORIDE
Injection
2 mEq/ml:
10 ml
20 ml
0.19
0.20
Kaochlor®, Kaon-Cl®
20 mEq:
15 ml Unit Dose
0.30
30 mEq:
15 ml Unit Dose
0.10
40 mEq:
15 ml Unit Dose
0.13
Klotrix®, Kaon-Cl®, TEN K®
Tablet, controlled release
10 mEq
0.01
K-Dur®
Tablet, Controlled Release 20 mEq
0.39
Note: K-Dur® readily dissolves in liquid to form a tasteless suspension to be used in place of
elixirs or powder packets.
POTASSIUM CITRATE
Urocit® K
Tablet
10 mEq
POTASSIUM IODIDE
Solution
1 gm/ml:
0.31
30 ml
240 ml (SSKI)
4.20
POTASSIUM PERMANGANATE
Solution,
Specify quantity and strength
Note: Use only freshly prepared solutions.
O.T.C., non-legend drug available for inpatients only.
POTASSIUM PHOSPHATE
Injection, contains:
+
++
K 4.4 mEq/ml and P 3 mM/ml,
5 ml vial
0.07
165
UTMB COST
POTASSIUM PHOSPHATE, ORAL: See Neutro-Phos®-K
POVIDONE IODINE
Betadine®, Pharmadine®, Prepodyne®
Ophthalmic Solution
5%: 50 ml
7.50
Ointment
10%: 30 gm
454 gm
Topical Solution
1 %: 60 ml
1 gal
Topical Scrub
0.75%: 180 ml
1 gal
Note: O.T.C., non-legend drug. Ointment, Topical Solution, and Topical Scrub products have
been moved to Material Management.
POVIDONE IODINE, VAGINAL PREP SOLUTION: Brand of Providone Iodine
PPD: See Tuberculin, Purified Protein Derivative
PRALIDOXIME CHLORIDE
Protopam®, PAM
Injection
PRAMIPEXOLE
Mirazpex®
Tablet
2 gram
25.32
0.125 mg
0.25 mg
0.5 mg
1 mg
1.5 mg
0.54
0.72
0.99
1.57
1.40
10 mg
20 mg
40 mg
1.61
1.73
2.80
1 mg
2 mg
5 mg
0.05
0.05
0.10
Restriction: Neurology Faculty.
PRAVACHOL®: Brand of Pravastatin
PRAVASTATIN
Pravachol®
Tablet
PRAZOSIN
Minipress®
Capsule
PRECEDEX®: Brand of Dexmedetomidine
PRED FORTE®: Brand of Prednisolone Acetate
166
UTMB COST
PREDNISOLONE
Syrup
Tablet
15mg/5ml:
5 mg
PREDNISOLONE ACETATE
Pred Forte®, l-Prednicet®
Suspension, ophthalmic 1%:
240 ml
1 ml
5 ml
PREDNISONE
Liquid Pred®
Syrup
5 mg/5 ml:
Deltasone®, Meticorten®, Orasone®
Tablet
1 mg
5 mg
10 mg
20 mg
50 mg
7.26/30 ml
0.02
4.02
0.98
240 ml
PREGABALIN C-V
Lyrica®
Capsule
25 mg
50 mg
75 mg
100 mg
150 mg
200 mg
225 mg
300 mg
Restriction: Pain Service, Neurology, Oncology, Endocrinology
2.40/30 ml
0.02
0.02
0.03
0.04
0.09
1.71
1.88
1.88
1.88
1.88
1.71
1.71
1.71
PREMARIN®: Brand of Estrogens, Conjugated
PREMASOL®: Brand of Amino Acid Solution
PREMPHASE®
Tablets: two blister packs:
Blister pack 1:
14 x Premarin® 0.625 mg
Blister pack 2:
14 x Premarin® 0.625 mg + 14 x Provera® 5 mg
PREMPRO®
Tablets: 28's
each 0.45/1.5 tablet contains:
Estrogens, conjugated
Medroxyprogesterone
each 0.625/5 tablet contains:
Estrogens, conjugated
Medroxyprogesterone
12.87/pack
35.24/pack
0.45 mg
1.5 mg
35.24/pack
0.625 mg
5 mg
PRENATAL VITAMINS W/FA: See Vitamin, Prenatal
PREPIDIL®: Brand of Dinoprostone
167
UTMB COST
PREPODYNE® SCRUB: Brand of Povidone Iodine
PREPODYNE® SOLUTION: Brand of Povidone Iodine
PRESUN® - 15
Sunscreen Protection Factor 15; Lotion: 120 ml
PRETTY FEET AND HANDS®
Lotion, debriding
90 ml
Note: O.T.C., non-legend drug available for inpatients only.
4.08
4.32
PREVNAR®: Brand of Pneumoccoccal conjugate vaccine
PREZISTA®: Brand of Darunavir
PRILOSEC®: Brand of omeprazole
PRIMACOR®: Brand of milrinone
PRIMAQUINE PHOSPHATE
Tablets
26.3 mg
Note: 26.3 mg primaquine phosphate is equivalent to 15 mg base.
0.59
PRIMAXIN®: Brand of Imipenem-Cilastatin
PRIMIDONE
Mysoline®
Tablet
50 mg
250 mg
0.16
0.46
PRINCIPEN®: Brand of Ampicillin
PRISCOLINE®: Brand of Tolazoline
PRIVIGEN®: Brand of Immune Globulin, Intravenous (Human)
PRO-BANTHINE®: Brand of Propantheline Bromide
PRO-CAL-SOF®: Brand of Docusate Calcium
PROBENECID
Benemid®
Tablet
500 mg
0.06
PROBUCOL
Lorelco®
Tablet
250 mg
0.55
168
UTMB COST
PROCAINAMIDE
Procan® SR
Tablet, sustained release
Pronestyl®
Capsule
Injection
PROCAINE HYDROCHLORIDE
Novocain®
Injection
500 mg
750 mg
0.12
0.13
250 mg
375 mg
100 mg/ml:
500 mg/ml:
0.06
0.05
0.54
0.44
10 ml
2 ml
10 mg/ml (1%):
2 ml
6 ml
1.38
4.29
PROCAN®-SR: Brand of Procainamide
PROCARBAZINE
Matulane®
Capsule
50 mg
0.58
PROCARDIA®: Brand of Nifedipine
PROCHLORPERAZINE
Compazine®
Injection
Suppository
Tablet
5 mg/ml:
25 mg
5 mg
10 mg
2 ml
0.57
1.96
0.29
0.46
PROCRIT®: Brand of Erythropoetin
PROFILNINE® SD: Brand of Prothrombin Complex Concentrate
PROGESTERONE
Cream
0.33%:
60 gm
Suppository, vaginal
25 mg
Notes: Suppositories are compounded by UTMB.
7.11
0.30
PROGRAF®: Brand of Tacrolimus
PROHIBIT®: Brand of Haemophilus b Conjugate Vaccine
PROLASTIN®: Brand of Alpha-1 Proteinase Inhibitor
PROLIXIN®: Brand of Fluphenazine
PROLIXIN® DECANOATE: Brand of Fluphenazine Decanoate
PROLOPRIM®: Brand of Trimethoprim
169
UTMB COST
PROMETHAZINE
Phenergan®
Injection
Suppository
Syrup
Tablet
25 mg/ml:
1 ml
12.5 mg
25 mg
6.25 mg/5 ml: 480 ml
25 mg/5 ml: 480 ml
25 mg
1.01
1.78
2.04
0.12/30 ml
2.64/30 ml
0.02
PRONESTYL®: Brand of Procainamide
PROPACET®-lOO: See Darvocet-N® 100
PROPAFENONE
Rythmol®
Tablet
150 mg
225 mg
300 mg
0.90
1.29
1.64
15 mg
0.13
Restriction: Cardiology Faculty.
PROPANTHELINE BROMIDE
Pro-Banthine®
Tablet
PROPARACAINE HYDROCHLORIDE
Alcaine®, Ophthetic®
Solution, ophthalmic
0.5%: 15 ml
5.24
PROPINE®: Brand of Dipivefrin Hydrochloride
PROPOFOL
Diprivan®
Injection
10 mg/ml: 10 ml
4.29
10 mg/ml: 20 ml
4.13
Restriction: Restricted to use by faculty members of the Department of Anesthesiology and
MICU and CCU faculty, and Emergency Department Faculty for intubated patients.
PROPOXYPHENE HYDROCHLORIDE C-IV
Capsule
65 mg
0.18
Note: This product replaces propoxyphene napsylate (Darvon N) 100 mg tablet
Restriction: Requires DEA number on outpatient prescriptions.
170
UTMB COST
PROPRANOLOL HYDROCHLORIDE
Inderal®
Injection
Suspension
Tablet
1 mg/ml:
20 mg/5 ml
10 mg
20 mg
40 mg
80 mg
1 ml
Inderal® LA
Capsule, extended release 80 mg
120 mg
160 mg
4.37
1.47/30 ml
0.01
0.01
0.01
0.02
0.83
0.52
1.46
PROPYLENE GLYCOL: Ingredient of Keralyt® & Vehicle-N®
PROPYLTHIOURACIL (PTU)
Tablet
50 mg
0.03
PROQUAD®
Combination of Measles, Mumps, Rubella, and Varicella
Injection, subcutaneous
0.5 ml
114.87
PROSCAR®: Brand of Finasteride
PROSTAGLANDIN E1: See Alprostadil
PROSTAPHLIN®: Brand of Oxacillin Sodium
PROSTIGMIN®: Brand of Neostigmine Methylsulfate
PROSTIN E2®: Brand of Dinoprostone
PROSTIN VR PEDIATRIC®: Brand of Alprostadil
PROTAMINE SULFATE
Injection
10 mg/ml:
25 ml
1.72
PROTAMINE, ZINC AND ILETIN I®: Brand of Insulin, Protamine Zinc, Mixed
PROTEASE: Ingredient of Pancrelipase & Cotazyme®
PROTENATE®: Brand of Plasma Protein Fraction, Human
PROTHROMBIN COMPLEX CONCENTRATE
Profilnine® SD
Injection
Contains factors II, VII, IX, and X
Average vial size based on factor IX
500 factor IX IU
1000 factor IX IU
1500 factor IX IU
380.00
760.00
1,140.00
171
UTMB COST
PROTIRELIN
Thyrel-TRH®, TRH (synthetic), Relefact TRH®
Injection
500 mcg (0.5 mg)/ml: 1 ml
27.55
PROTONIX®: Brand of Pantoprazole
PROTOPAM®: Brand of Pralidoxime Chloride
PROTRIPTYLINE
Vivactil®
Tablet
5 mg
10 mg
0.40
0.51
PROVENTIL®: Brand of Albuterol
PROVERA®: Brand of Medroxyprogesterone Acetate
PROZAC®: Brand of Fluoxetine
PSEUDOEPHEDRINE HYDROCHLORIDE
Sudafed®
Syrup
30 mg/5 ml: 120 ml
Tablet
60 mg
Novafed®, Sudafed S.A.®
Capsule, sustained release 120 mg
Note: O.T.C., non-legend drug available for inpatients only.
0.15/30 ml
0.03
0.23
PSEUDOEPHEDRINE HYDROCHLORIDE: Ingredient of Actifed®
PSYLLIUM HYDROPHILIC MUCILLOID
Metamucil®, Modane Bulk®, Effer-Syllium®
Powder
6.4 g/packet (0.19 oz.)
0.13
Note: O.T.C., non-legend drug available for inpatients only. (One packet approximately equal
to one rounded tbsp.)
PTU: See Propylthiouracil
PULMICORT® RESPULES: Brand of Budesonide Inhalation Suspension
PULMOZYME®: Brand of Dornase Alpha
PURINETHOL®: Brand of Mercaptopurine
PYRAZINAMIDE
Tablet
500 mg
0.85
PYRIDIUM®: Brand of Phenazopyridine
PYRIDOSTIGMINE BROMIDE
Mestinon®, Regonol®
Injection
Tablet
Tablet, time span
172
5 mg/ml:
60 mg
180 mg
2 ml
1.20
0.38
0.76
UTMB COST
PYRIDOXINE: See Vitamin B-6
PYRIMETHAMINE
Daraprim®
Tablet
25 mg
0.32
QUELICIN®: Brand of Succinylcholine Chloride
QUESTRAN®: Brand of Cholestyramine Resin
QUETIAPINE
Seroquel®
Tablet
25 mg
100 mg
200 mg
300 mg
Seroquel® XR
Tablet
200 mg
300 mg
Restriction: Psychiatry Faculty, Kris Williams MD - Neurology
1.53
2.68
5.05
6.63
6.23
8.00
QUINAGLUTE® DURA-TAB®: Brand of Quinidine Gluconate
QUINAMM®: Brand of Quinine Sulfate
QUINIDEX® EXTENTABS®: Brand of Quinidine Sulfate
QUINIDINE GLUCONATE
Injection
80 mg/ml: 10 ml
Quinaglute® Dura-tab®
Tablet, extended release
324 mg
Note: 80 mg quinidine gluconate is equivalent to 50 mg base.
QUINIDINE SULFATE
Cin-Quin®
Tablet
Quinidex® Extentab®
Tablet, extended release
QUININE SULFATE
Capsule
1.15/1 ml
0.11
200 mg
300 mg
0.04
0.10
300 mg
0.15
324 mg
0.09
QUINUPRISTIN/DALFOPRISTIN: See Synercid®
QVAR®: Brand of Beclomethasone Dipropionate
R-GENE®: Brand of Arginine
173
UTMB COST
RABIES IMMUNE GLOBULIN, HUMAN
Hyperab®
Injection
150 IU/2 ml: 2 ml
RABIES VACCINE, HUMAN DIPLOID CELL
Imovax®, Wyvac®
Injection
2.5 IU/ml:
1 ml
Note: Complete post-exposure treatment requires 5 doses.
RALTEGRAVIR
Isentress®
Tablets
400 mg
Restriction: Infectious Disease Faculty
116.66
58.82
13.18
RANIBIZUMAB
Lucentis®
Ophth. Injection
2 ml vial
1,950.00
Restriction: Retina Subspecialty Faculty (Drs. Godley, Li, van Kuijk, Davis, Baalhaness)
Note: Intravitreal syringe to be prepared in the IV room
RAPAMUNE®: Brand of Sirolimus
RAZADYNE®: Brand of Galantamine
RECLAST®: Brand of Zoledronic Acid
RECOMBINATE®: Brand of Factor VIII
REGITINE®: Brand of Phentolamine Mesylate
REGLAN®: Brand of Metoclopramide
REGONOL®: Brand of Pyridostigmine Bromide
RELAFEN®: Brand of Nabumetone
RELEFACT-TRH®: Brand of Protirelin
RELPAX®: Brand of Eletriptan
REMERON®: Brand of Mirtazapine
REMICADE®: Brand of Infliximab
REMIFENTANIL
Ultiva®
Injection
1 mg/vial
Restriction: Anesthesia Faculty
Note: 2 mg/vial strength was replaced by 1 mg/vial
RENAGEL®: Brand of Sevelamer
174
9.32
UTMB COST
REOPRO®: Brand of Abciximab
RESERPINE
Tablet
0.25 mg
Restriction: Psychiatry staff must countersign orders within 48 hours.
0.04
RESORCINOL: Ingredient of Castaderm®
RESTORIL®: Brand of Temazepam
RETAVASE®: Brand of reteplase
RETEPLASE
Retavase®
Injection
10.8 Unit/vial: 2 vial kit
2160.40
Restriction: Restricted to use by Cardiology and Emergency Room Faculty and Interventional
Radiology.
RETIN-A®: Brand of Tretinoin
RETINOIC ACID: See Tretinoin
RETISERT®: Brand of Fluocinolone Acetonide Intravitreal Implant
RETROVIR®: Brand of Zidovudine
REVATIO®: Brand of Sildenafil
REV-EYES®: Brand of Dapiprazole
REVIA®: Brand of Naltrexone
REYATAZ®: Brand of Atazanavir
Rho (D) IMMUNE GLOBULIN
WinRho®
Injection, intravenous
1,500 I.U.
Note: The RhoGAM product is available through the Blood Bank
104.79
RHEOMACRODEX®: Brand of Dextran 40
RHOGAM®: Brand of Rho (D) Immune Globulin - available through the Blood Bank
RIBAVIRIN
Virazole®
Powder for aerosolization 6 gm vial
1097.68
Note: Small particle aerosol generator to administer and drug supplied by Pulmonary Care
Services.
RIDAURA®: Brand of Auranofin
175
UTMB COST
RIFABUTIN
Mycobutin®
Capsule
150 mg
3.34
RIFADIN®: Brand of Rifampin
RIFAMPIN
Rifadin®, Rimactane®
Capsule
Injection
150 mg
300 mg
500 mg/25 ml
1.15
0.52
61.06
RIMACTANE®: Brand of Rifampin
RIMS0-50®: Brand of Dimethyl Sulfoxide
RIOPAN®: Brand of Magaldrate
RISPERDAL®: Brand of Risperidone
RISPERDAL CONSTA®: Brand of Risperidone Injection
RISPERIDONE
Risperdal®, Risperdal Consta®
Injection
25 mg
37.5 mg
50 mg
Restriction: Psychiatry Faculty - inpatient/clinic use only
Liquid
1 mg/ml
Tablet
0.25 mg
0.5 mg
1 mg
2 mg
3 mg
4 mg
Restriction: Psychiatry Faculty.
Risperdal M-Tab®
Orally Disintegrating Tabs 0.5 mg
1 mg
2 mg
3 mg
4 mg
Restriction: Psychiatry and Emergency Department Faculty
223.21
334.84
446.44
3.44/ml
2.64
2.89
3.07
4.91
5.77
7.74
3.33
3.89
6.32
7.98
10.72
RITALIN®: Brand of Methylphenidate Hydrochloride
RITONAVIR
Norvir®
Capsule
100 mg
Solution, oral
80 mg/ml: 240 ml
Restriction: Infectious Disease Faculty
176
1.46
30.60/30 ml
UTMB COST
RITONAVIR: Ingredient of Kaletra®
RITUXAN®: Brand of Rituximab
RITUXIMAB
Rituxan®
Injection
100 mg
300.22
500 mg
1,501.10
Note: For patients with reimbursement including Manufacturers Assistance Programs
RIVASTIGMINE
Exelon®
Capsule
1.5 mg
3 mg
4.5 mg
6 mg
2 mg/ml: 30 ml
1.62
1.62
1.62
1.62
48.83/30 ml
Solution, Oral
Restriction:
All Adult Neurology Faculty
Gatekeepers in:
Geriatrics: James Goodwin, M.D., Mukaila Raji, M.D., Shiva Shatish, M.D.
Geriatric Psychiatry: Michael O'Boyle, M.D., Jeff Matthews, M.D.
RMS®: Brand of Morphine Sulfate, Rectal
ROBAXIN®: Brand of Methocarbamol
ROBINUL®: Brand of Glycopyrrolate
ROBITUSSIN®: Brand of Guaifenesin
ROBITUSSIN A-C®: See Similar Item Guiatuss AC
ROBITUSSIN-DM®
Syrup: 5 ml unit dose
10 ml unit dose
120 ml
each 5 ml contains:
Dextromethorphan 15 mg
Guaifenesin
100 mg
Note: O.T.C., non-legend drug available for inpatients only.
0.13
0.15
0.15/30 ml
ROCALTROL®: Brand of Calcitriol
ROCEPHIN®: Brand of Ceftriaxone
ROCURONIUM
Zemuron®
Injection
10 mg/ml: 5 ml
Restriction: Anesthesiology Faculty.
12.10
177
UTMB COST
ROSIGLITAZONE
Avandia®:
Tablet
2 mg
1.20
4 mg
1.63
8 mg
1.49
Restriction: Adult and Pedi Endocrinology Faculty and following physicians:
Kristene Gugliuzza, M.D.
William Harper, M.D.
Pamela Havlen, M.D.
Ellen Kelver, M.D. (Ob/Gyn Reproductive)
Manubai Nagamani, M.D.
Steve Quach, M.D.
Paul Remmers, M.D.
Elena Volpi, M.D.
Note: ONCE DAILY DOSING ONLY.
ROSUVASTATIN
Crestor®
Tablet
5 mg
10 mg
20 mg
40 mg
2.42
2.42
2.42
2.41
ROTATEQ®: Brand of Rotavirus Oral Vaccine
ROTAVIRUS ORAL VACCINE
RotaTeq
Oral Vaccine Suspension
2 ml
65.65
ROWASA®: Brand of Mesalamine
ROXANOL®: Brand of Morphine Sulfate
ROXICODONE®: Brand of Oxycodone
RUBELLA VACCINE: Ingredient of Measles, Mumps, and Rubella Vaccine
RUBELLA VIRUS VACCINE, LIVE
Meruvax® II
Injection
0.5 ml
10.81
RUFEN®: Brand of Ibuprofen
RYTHMOL®: Brand of Propafenone
SALAGEN®: Brand of Pilocarpine Hydrochloride
SALICYLIC ACID: Ingredient of Duofilm® and Keralyt® Gel
SALIVA SUBSTITUTE SOLUTION
Xero-Lube®
Solution
178
120 ml
1.02/30 ml
UTMB COST
SALMETEROL
Serevent® Diskus®
Powder Inhaler
50 mcg/inhalation
53.73
28 inhalations/package
Restriction: Allergy and Pulmonary Faculty and Anita Mercado, M.D.
Note: This therapy is additive and does not replace PRN use of other short acting beta-2agonists. Serevent® MDI products were discontinued by the manufacturer.
SALSALATE
Disalcid®
Tablet
500 mg
750 mg
0.07
0.07
SANDIMMUNE®: Brand of Cyclosporin A
SANDOGLOBULIN®: Brand of Immune Globulin, I.V.
SANDOSTATIN®: Brand of Octreotide Acetate
SANSERT®: Brand of Methysergide Maleate
SAQUINAVIR
Fortase®, Invirase®
Capsule, soft gel
200 mg
Tablet
500 mg
Restriction: Infectious Disease Faculty
1.95
4.87
SARGRAMOSTIM
Leukine®, GM-CSF
Injection
250 mcg/ml vial
500 mcg/ml vial
Restriction: Hematology/Oncology faculty.
SCHILLER’S TEST SOLUTION (UTMB Compounded)
Solution
30 ml
each distilled water based solution contains:
Iodine
0.3 gm
Potassium Iodide 0.5 gm
SCOPOLAMINE HYDROBROMIDE
Injection
Isopto® Hyoscine
Solution, ophthalmic
SECOBARBITAL SODIUM C-II
Seconal®
Capsule
1 mg/ml:
1 ml
99.00
198.01
0.15
0.71
0.25%: 15 ml
4.62
100 mg
0.22
SECONAL®: Brand of Secobarbital Sodium
SECREFLO®: Brand of Secretin
179
UTMB COST
SECRETIN
Secreflo®
Injection
2 mcg/ml; 8 ml vial
325.00
SELENIUM
Injection
SELENIUM SULFIDE
Selsun®, Exsel®
Suspension, topical
40 mcg/ml: 10 ml
0.49
2.5%: 120 ml
3.12
SELSUN®: Brand of Selenium Sulfide
SELZENTRY®: Brand of Maraviroc
SENNA FRUIT EXTRACT
X-Prep®
Liquid 7.5 mg Sennosides/5 ml:
75 ml
Note: O.T.C., non-legend drug available for inpatients only.
SENOKOT® S
Tablet: each contains
Senna concentrate
Docusate sodium
5.55
0.32
SENSORCAINE®: Brand of Bupivacaine
SEPTRA®: See Bactrim®
SEPTRA-DS®: See Bactrim-DS®
SERAX®: Brand of Oxazepam
SEREVENT® DISKUS®: Brand of Salmeterol
SEROQUEL®, SEROQUEL® XR: Brand of Quetiapine
SERTRALINE
Zoloft®
Tablet
25 mg
50 mg
100 mg
2.36
2.36
2.36
400 mg
800 mg
Restriction: Nephrology Faculty.
0.40
0.81
SEVELAMER
Renagel®:
Tablet
SHOHL’S SOLUTION: See Bicitra®
180
UTMB COST
SILDENAFIL
Revatio®
Tablet
20 mg
Suspension (compound)
2.5 mg/ml
Restriction: Pulmonary hypertension
8.72
SILVADENE®: Brand of Silver Sulfadiazine
SILVER NITRATE
Applicator
75%: 100/box
Note: Only available for inpatients.
SILVER SULFADIAZINE
Silvadene®, SSD®, Thermazene®
Cream
1%:
400 g
SIMETHICONE
Mylicon®
Liquid
40 mg/0.6 ml
Tablet, chewable
80 mg
Note: O.T.C., non-legend drug available for inpatients only.
0.05/each
13.44
1.62/30 ml
0.03
SIMETHICONE: Ingredient of Mylanta®
SIMULECT®: Brand of Basiliximab
SIMVASTATIN
Zocor®
Tablet
5 mg
10 mg
20 mg
40 mg
80 mg
0.74
1.01
1.80
1.93
1.65
SINCALIDE
Kinevac®, 8-CCK (synthetic CCK)
Injection
5 mcg
21.12
SIMVASTATIN: Ingredient of Vytorin®
SINEMET®
Tablet: each contains
10/100: Carbidopa 10 mg and Levodopa 100 mg
25/100: Carbidopa 25 mg and Levodopa 100 mg
25/250: Carbidopa 25 mg and Levodopa 250 mg
0.28
0.27
0.32
25/100: Carbidopa 25 mg and Levodopa 100 mg
50/200: Carbidopa 50 mg and Levodopa 200 mg
0.86
1.24
SINEMET® CR
Tablet: each contains
SINEQUAN®: Brand of Doxepin
181
UTMB COST
SIROLIMUS
Rapamune®
Oral Concentration 1 mg/ml:
60 ml
Tablet
1 mg
Restriction: solid organ transplant and heart-lung transplant faculty.
SITAGLIPTIN
Januvia®
Tablet
448.37
5.35
25 mg
50 mg
100 mg
4.78
4.78
4.78
SOAP, LIQUID
Solution
40%: 4 L
3.84
SODIUM ACETATE
Injection
2 mEq/l ml:
SODIUM BICARBONATE
Injection
84 mg(1 mEq)/ml:
SLO-BID®: Brand of theophylline
20 ml
50 ml vial
50 ml syringe
Injection Infant
42 mg (0.5 mEq)/ml: 10 ml syringe
Tablet
650 mg
Notes: Injection available as syringe or vial.
0.28
0.40
1.60
1.80
0.06
SODIUM BIPHOSPHATE: Ingredient of Fleet® Enema
SODIUM CARBONATE: Ingredient of Urologic G Solution
SODIUM CHLORIDE
Injection
2.5 mEq/ml: 40 ml
0.47
3%:
500ml (UTMB compounded)
0.97
5%:
500 ml (UTMB compounded)
1.39
Solution
1.7 mEq/ml (10%) specify quantity
0.10/30 ml
+
Tablets, enteric coated
1 gm (17 mEq Na )
0.04
Note: Solution and tablets are O.T.C., non-legend drugs available for inpatients only.
Muro 128®
Ointment, ophthalmic
5%: 3.5 gm
8.54
Absorbonac®
Solution, ophthalmic
5%: 15 ml
2.10
Hyper-Sal®
Nebulizer Solution
7%: 4 ml
0.79
SODIUM CHONDROITIN SULFATE: Ingredient of DisCoVisc®
SODIUM FERRIC GLUCONATE
Ferrlecit®
Injection
62.5 mg elemental iron/5 ml
20.57
Restriction: Nephrology faculty for patients who have a demonstrated allergy to iron dextran.
182
UTMB COST
SODIUM FLUORIDE: See Fluoride, Sodium
SODIUM HYALURONATE: Ingredient of DisCoVisc®
SODIUM HYPOCHLORITE: Ingredient of Dakin’s Solution
SODIUM LACTATE
Injection
5 mEq/l ml: 10 ml
SODIUM NITRITE
Injection
30 mg/ml; 10 ml vial
Note: Second line agent for cyanide exposure
SODIUM PHOSPHATE
Injection
SODIUM PHOSPHATE:
+
3mM (4 mEq Na )/l ml: 15 ml
2.14
33.63
0.51
Ingredient of Phospho®-Soda, Fleet® and
Neutra-Phos®
SODIUM POLYSTYRENE SULFONATE
Kayexalate®
Premixed Unit Dose
15 gm/60 ml in Sorbitol (20%)
Powder
454 gm
specify amount
SODIUM TETRADECYL SULFATE
Sotradecol®
Injection
Note: For IV use only.
1%:
2 ml
SODIUM THIOSULFATE
Injection
25%; 50 ml
Note: Second line agent for cyanide exposure
2.40
146.88
10.90
7.91
SOLU-CORTEF®: Brand of Hydrocortisone Sodium Succinate
SOLU-MEDROL®: Brand of Methylprednisolone Sodium Succinate
SOMA®: Brand of Carisoprodol
SOMOPHYLLIN®-DF: Brand of Aminophylline
SORBITOL
Solution 70%: specify strength and quantity
0.09/30 ml
SORBITRATE®: Brand of Isosorbide Dinitrate
SOTALOL
Betapace®
Tablet
80 mg
160 mg
240 mg
Restriction: Cardiology Faculty and Fellows.
1.76
2.56
3.32
183
UTMB COST
SOTRADECOL®: Brand of Sodium Tetradecyl Sulfate
SOYACAL®: Brand of Fat Emulsion, Intravenous
SPECTINOMYCIN HYDROCHLORIDE
Trobicin®
Injection
400 mg/l ml: 5 ml
10 ml
Note: For IM use only.
10.01
16.39
SPIRIVA®: Brand of Tiotropium
SPIRONOLACTONE
Aldactone®
Tablet
25 mg
0.10
SPORANOX®: Brand of Itraconazole
SSD®: Brand of Silver Sulfadiazine
STADOL®: Brand of Butorphanol Tartrate
STANNOUS FLOURIDE: See Flouride, Stannous
STAVUDINE
Zerit®
Capsule
15 mg
20 mg
30 mg
40 mg
Restriction: Infectious Disease Faculty
3.30
3.44
3.59
3.72
STELAZINE®: Brand of Trifluoperazine
STREPTOMYCIN SULFATE
Injection
1 gm
0.03
STREPTOZOCIN
Zanosar®
Injection
1 gm
43.53
STRONG IODINE SOLUTION: See Iodine, Strong Solution
STUARTNATAL® 1 + 1: Brand of Vitamins, Prenatal
SUBLIMAZE®: Brand of Fentanyl Citrate
SUBY’S - G: See Urologic G Solution
184
UTMB COST
SUCCIMER
Chemet®
Capsule
SUCCINYLCHOLINE CHLORIDE
Quelicin®
Injection
Note: Refrigerate.
SUCRALFATE
Carafate®
Suspension
Tablet
100 mg
20 mg/ml:
3.18
10 ml
1 gm/10 ml
1 gm
0.04/1 ml
0.67/1 gm
0.46
SUDAFED®: Brand of Pseudoephedrine Hydrochloride
SUDAFED® SA: Brand of Pseudoephedrine Hydrochloride
SUFENTA®: Brand of Sufentanil
SUFENTANIL C-II
Sufenta®
Injection
0.05 mg/ml;
1 ml
5 ml
4.03
14.63
SULFABENZAMIDE: Ingredient of Sultrin®
SULFACETAMIDE: Ingredient of Blephamide® & Sultrin®
SULFACETAMIDE SODIUM
Cetamide®, Sulamyd®
Ointment, ophthalmic
Solution, ophthalmic
10%: 3.5 g
10%: 15 ml
0.87
1.47
SULFADIAZINE TABLETS, USP
Tablets
500 mg
0.78
SULFADIAZINE: Ingredient of Terfonyl®
SULFAMETHAZINE: Ingredient of Terfonyl®
SULFAMYLON®: Brand of Mafenide Acetate
SULFASALAZINE
Azaline®, Azulfidine®
Tablet
500 mg
0.07
200 mg
100 mg
0.10
0.34
SULFATHIAZOLE: Ingredient of Sultrin®
SULFINPYRAZONE
Anturane®
Capsule
Tablet
185
UTMB COST
SULFISOXAZOLE
Gantrisin®
Suspension
Tablet
500 mg/5 ml: 473 ml
500 mg
2.13/30 ml
0.05
SULFISOXAZOLE: Ingredient of Pediazole®
SULINDAC
Clinoril®
Tablet
200 mg
0.19
SULTRIN®
Cream, vaginal: 78 g, each tube contains
Sulfabenzamide
3.7%
Sulfacetamide
2.86%
Sulfathiazole
3.42%
Urea
0.64%
3.43
SUMATRIPTAN
Imitrex®
Injection
6 mg/0.5 ml; 2 syringe kit
68.95
Tablet
50 mg
15.14
Restriction: Neurology Faculty & Emergency Department faculty for on-site use only for
diagnosis of migraine headache, Anesthesiology Faculty
SUMYCIN®: Brand of Tetracycline
SUN SCREEN: See PreSun® 15
SUPRANE®: Brand of Desflurane
SURBEX®: Brand of Vitamin B Complex
SURFACTANT, LUNG
Exosurf®
Vial 10 ml
476.68
Restriction: Restricted to use by Neonatology faculty for FDA approved indications only.
Restricted to use by Neonatology faculty ONLY in babies transferred to UTMB who have
already received a dose(s) of Exosurf®.
Survanta®
Vial 4 ml
244.12
10 ml
432.08
Restriction: Restricted to use by Neonatology faculty.
Infasurf®
Vial 6 ml
432.06
Restriciton: Restricted to use by Neonatology faculty.
SURFAK®: Brand of Docusate Calcium
SURGILUBE®: Brand of Lubricant, Sterile
186
UTMB COST
SURVANTA®: Brand of Surfactant, Lung
SUSTIVA®: Brand of Efavirenz
SUTILAINS
Travase®
Ointment 82,000 casein units per gram: 15 gm
14.80
Note: Not recommended for burns greater than 20% of total body surface.
SYMBICORT®
Budesonide/Formoterol
Oral Inhaler - 60 actuations/inhaler
Two strengths available
Budesonide
80 mcg/actuation
Formoterol
4.5 mcg/actuation
Budesonide
Formoterol
160 mcg/actuation
4.5 mcg/actuation
96.49
110.99
SYMMETREL®: Brand of Amantadine
SYNAGIS®: Brand of Palivizumab
SYNALAR®: Brand of Fluocinolone Acetonide
SYNAREL®: Brand of Nafarelin
SYNERCID®:
Quinupristin/Dalfopristin
Injection
500 mg vial
Restriction: Infectious Disease Faculty - requires order by ID or call in
to Restricted Antibiotic Approval Line.
83.55
SYNKAVITE®: Brand of Menadiol Sodium Diphosphate
SYNTHROID®: Brand of Levothyroxine
SYNTOCINON®: Brand of Oxytocin
SYRIVITE®: Brand of Vitamin, Multiple, Liquid
TACROLIMUS
Prograf®
Capsule
Injection
Restriction: Transplant faculty.
0.5 mg
1 mg
5 mg
5 mg/ml:
1 ml ampule
1.77
2.87
14.37
97.66
TACE®: Brand of Chlorotrianisene
187
UTMB COST
TALC, PERFUMED
Powder
Note: O.T.C., non-legend drug available for inpatients only.
TALC, STERILE
Aerosol Syringe
Powder
4 gram syringe
5 gram vial
TALWIN® NX - CIV
Tablet, each contains:
Pentazocine Hydrochloride 50 mg
Naloxone
0.5 mg
0.02/gm
110.00
87.50
0.69
TAMBOCOR®: Brand of Flecainide
TAMOXIFEN
Nolvadex®
Tablet
10 mg
1.20
TAPAZOLE®: Brand of Methimazole
TAR EXTRACT
Pentrax®
Shampoo
4.3% crude coal tar: 120 ml
Note: O.T.C., non-legend drug available for inpatients only.
5.37
TARACTAN®: Brand of Chlorprothixene
TARCEVA®: Brand of Erlotinib
TARGRETIN®: Brand of Bexarotene
TAXOL®: Brand of Paclitaxel
TAXOTERE®: Brand of Docetaxel
TAZICEF®: Brand of Ceftazidime
TAZIDIME®: Brand of Ceftazidime
TEARFAIR®: See Lacrilube®
TEGISON®: Brand of Etretinate
TEGRETOL®: Brand of Carbamazepine
TEKTURNA®: Brand of Aliskiren
TEMAZEPAM C-IV
Restoril®
Capsule
Tablet
188
15 mg
30 mg
7.5 mg
0.09
0.13
2.58
UTMB COST
TEMODAR®: Brand of temozolomide
TEMOZOLOMIDE
Temodar®
Capsule
TEMSIROLIMUS
Torisel®
Injection
Restriction: Oncology Faculty
5 mg
20 mg
100 mg
250 mg
270.50/day
25 mg
1,125.26
TEN K®: Brand of Potassium Chloride
TENEX®: Brand of Guanfacine
TENOFOVIR DISOPROXIL FUMARATE
Viread®
Tablet
300 mg
9.21
Restriction: Infectious Disease Faculty, Gastroenterology Faculty, or UTMB Occupational
Exposure
TENOFOVIR: Ingredient of Truvada®, Atripla®
TENORMIN®: Brand of Atenolol
TENSILON®: Brand of Edrophonium Chloride
TERAZOSIN
Hytrin®
Tablet
1 mg
2 mg
5 mg
10 mg
Restriction: For use in Benign Prostatic Hyperplasia (BPH).
TERBINAFINE
Lamisil®, Desenex® Max
Cream
1%: 24 gram
Note: Cream is O.T.C., non-legend drug available for inpatients only
Tablet
250 mg
Tablet Restriction: All Faculty
TERBUTALINE SULFATE
Brethine®
Tablet
Bricanyl®
Injection
2.5 mg
5 mg
1 mg/l ml:
1.49
1.49
1.49
1.49
5.72
5.85
0.24
0.35
1 ml
3.90
189
UTMB COST
TESTOSTERONE C-III
Cream
2%:
30 gm (UTMB Compounded)
Injection, aqueous
100 mg/l ml: 10 ml
Note: Requires a DEA number for outpatient prescriptions.
TESTOSTERONE CYPIONATE C-III
Depo®-Testosterone
Injection, in oil
Testronate CP®-200
Injection, in oil
Note: For IM Use Only.
TESTOSTERONE ENANTHATE C-III
Testronate®-200, Delatestryl®
Injection, in oil
Note: For IM Use Only.
2.21
3.43
200 mg/l ml: 1 ml
3.17
200 mg/l ml: 10 ml
31.67
200 mg/l ml: 10 ml
9.27
TESTRONATE®-200: Brand of Testosterone Enanthate
TESTRONATE CP®-200: Brand of Testosterone Cypionate
TETANUS AND DIPHTHERIA TOXOIDS, ADSORBED: See Diphtheria and
Tetanus Toxoids, Adsorbed
TETANUS IMMUNE GLOBULIN (HUMAN)
Homo-Tet®, Hu-Tet®, Hyper-Tet®
Injection 250 U/ml: 1 ml
Note: Available as vial or syringe.
TETRACAINE HYDROCHLORIDE
Pontocaine®
Injection
Solution, ophthalmic
TETRACYCLINE HYDROCHLORIDE
Achromycin®
Capsule
78.56
1%:
2 ml (20 mg ampule)
0.5%: 1 ml Unit Dose
15 ml
3.61
2.00
1.29
250 mg
500 mg
0.04
0.03
6-TG: See Thioguanine
THALIDOMIDE
Thalomid®
Capsule
50 mg
6.02
Restriction: Physicians registered with the manufacturer's S.T.E.P.S. program. Proper
authorization number is required.
THALOMID®: Brand of Thalidomide
THAM®: Brand of Tromethamine
190
UTMB COST
TH & C: See Terpin Hydrate and Codeine
THEO-DUR®: Brand of Theophylline
THEOPHYLLINE
Solution
80 mg/15 ml: 500 ml
0.21/30 ml
(Dye, Alcohol, and sugar free)
Tablet
100 mg
0.18
125 mg
0.23
Slo-Bid® Gyrocap
Gyrocap, sustained release 100 mg
0.23
125 mg
0.30
200 mg
0.35
300 mg
0.42
Note: Gyrocaps are in capsule form, which can be opened and the beads sprinkled over food
or swallowed whole. Beads should not be chewed.
Tablet, sustained release
100 mg
0.19
200 mg
0.27
300 mg
0.02
450 mg
0.41
THERADET®: Brand of Vitamin, Multiple
THERAPEUTIC B COMPLEX WITH VITAMIN C: Brand of Vitamin B Complex With C
THERAPEUTIC MULTIVITAMINS AND MINERALS: Brand of Vitamin, Multiple With Minerals
THERAVEE®: Brand of Vitamin, Multiple
THERAGRAN HEMATINIC®: Brand of Vitamin, Hematinic
THERMAZENE®: Brand of Silver Sulfadiazine
THIABENDAZOLE
Mintezol®
Suspension
Tablets
500 mg/5 ml: 120 ml
500 mg
3.90/30 ml
0.88
40 mg
2.59
500 mg
1 gm
2.59
1.42
THIAMINE: See Vitamin B-1
THIOGUANINE
6-TG
Tablet
THIOPENTAL SODIUM C-III
Pentothal® Sodium
Injection
THIOPHOSPHORAMIDE
Thiotepa, Triethylene thiophosphoramide
Injection
15 mg
84.46
191
UTMB COST
THIORIDAZINE
Mellaril®
Concentrate
Tablet
30 mg/ml:
10 mg
25 mg
50 mg
100 mg
200 mg
120 ml
9.60
0.09
0.12
0.10
0.22
0.13
THIOTEPA: Brand of Thiophosphoramide
THIOTHIXENE
Navane®
Capsule
1 mg
2 mg
5 mg
10 mg
0.04
0.04
0.05
0.10
THORAZINE®: Brand of Chlorpromazine
THROMBIN
Thrombin Gelfoam Plus®, Thrombin-JMI®
Topical
1,000 U vial
5,000 U vial
20,000 U spray kit
5.16
16.65
34.36
THROMBIN GELFOAM PLUS®: Brand of Thrombin
THROMBIN-JMI®: Brand of Thrombin
THYMOGLOBULIN®: Brand of Anti-thymocyte Globulin
THYMOL SOLUTION (UTMB Compounded)
Solution, topical 4% in Alcohol
0.40/30 ml
THYREL-TRH®: Brand of Protirelin
THYROID
Tablet
15 mg (1/4 gr.)
30 mg (1/2 gr.)
60 mg (1 gr.)
180 mg (3gr.)
THYROID RELEASING HORMONE, SYNTHETIC: See Protirelin®, TRH
THYROID STIMULATING HORMONE, SYNTHETIC: See Thyrotropin, TSH
TICAR®: Brand of Ticarcillin
192
0.03
0.01
0.03
0.10
UTMB COST
TICARCILLIN SODIUM
Ticar®
Injection
1g
3g
6g
Note: Sodium content per gm = 5.2 mEq.
2.18
8.42
12.37
TICE BCG: Brand of Bacillus Calmette-Guerin
TICLID®: Brand of Ticlopidine
TICLOPIDINE
Ticlid®
Tablet
250 mg
Restriction: Neurology and Cardiology Faculty.
1.52
TYGACIL®: Brand of Tigecycline
TIGAN®: Brand of Trimethobenzamide Hydrochloride
TIGECYCLINE
Tygacil®
Injection
50 mg vial
Restriction: Infectious Disease Faculty
44.15
TIKOSYN®: Brand of Dofetilide
TIMOLOL MALEATE
Timoptic® XE
Gel, ophthalmic
0.25%:
0.5%:
2.5 ml
2.5 ml
9.85
11.68
TIMOPTIC® XE: Brand of Timolol Maleate
TINDAL®: Brand of Acetophenazine
TIOTROPIUM
Spiriva®
Capsule for inhalation
18 mcg
Restriction: Pulmonary and Allergy Faculty, and Anita Mercado, M.D.
4.44
TIPRANAVIR
Aptivus®
Capsule
250 mg
7.27
Restriction: Infectious Disease Faculty - dispensing tipranavir 500 mg twice daily requires an
accompanying order for the boosted dose of 400 mg ritonavir (200 mg twice daily).
TISSUE PLASMINOGEN ACTIVATOR: See Alteplase
193
UTMB COST
TITRALAC®
Titralac® Plus Liquid
Suspension: 360 ml, each 10 ml contains
++
Calcium Carbonate 1 g (400 mg elemental Ca )
Glycine
300 mg
Simethicone
40 mg
Tablet: each contains
++
Calcium Carbonate 420 mg (168 mg elemental Ca )
Glycine
180 mg
Note: O.T.C., non-legend drug. Available for inpatients only.
0.13
0.03
TMP/SMZ: See Bactrim®
TOBRADEX®
Suspension, ophthalmic
Dexamethasone
Tobramycin
TOBRAMYCIN SULFATE
Nebcin®
Injection
10 mg/ml:
40 mg/ml:
Powder
1.2 gm/vial
Tobrex®
Ointment, ophthalmic
Solution, ophthalmic 0.3 %:
2.5 ml
0.1%
0.3%
4.30
2 ml
2 ml
1.04
2.07
104.92
3.5 g
5 ml
20.02
2.51
TOBREX®: Brand of Tobramycin
TOCAINIDE
Tonocard®
Tablet
400 mg
600 mg
0.51
1.03
TOFRANIL®: Brand of Imipramine
TOFRANIL-PM®: Brand of Imipramine Pamoate
TOLAZOLINE
Priscoline®
Injection
TONOCARD®: Brand of Tocainide
TOPAMAX®: Brand of Topiramate
194
25 mg/ml: 10 ml
9.62
UTMB COST
TOPIRAMATE
Topamax®
Capsules
Tablets
15 mg
25 mg
25 mg
50 mg
100 mg
200 mg
1.56
1.88
1.65
3.30
4.51
5.27
Restriction: Neurology Faculty
TOPROL®: Brand of Metoprolol XL
TOPSYN®: Former Brand of Fluocinonide
TORADOL®: Brand of Ketorolac tromethamine
TORISEL®: Brand of Temsirolimus
TPA: See Alteplase
TPN: See Amino Acid Products Section
TRACE ELEMENT CONCENTRATES
Adult: each ml to contain
Chromium 4 mcg
Copper
0.4 mg
Manganese 0.1 mg
Zinc
1 mg
Usual Adult Dose: 3 ml per day
Pediatric: each ml to contain
Chromium 1 mcg
Copper
0.1 mg
Manganese 25 mcg
Zinc
1 mg
Usual Dose: 0.3 ml/Kg per day up to 12 Kg
TRAMADOL
Ultram®
Tablet
0.43
1.47/3 ml
50 mg
0.07
TRANDATE®: Brand of Labetalol
TRANXENE®: Brand of Clorazepate
TRANYLCYPROMINE
Parnate®
Tablet
10 mg
Restriction: Attending staff must countersign orders within 48 hours.
TRASTUZUMAB
Herceptin®
Injection
440 mg vial
Note: Payment code D = third party reimbursement.
0.43
1,478.87
195
UTMB COST
TRAVASE®: Brand of Sutilains
TRAZODONE
Desyrel®
Tablet
50 mg
100 mg
0.05
0.06
TRECATOR®-SC: Brand of Ethionamide
TREMIN®: Brand of Trihexyphenidyl
TRENTAL®: Brand of Pentoxifylline
TRETINOIN
Retin-A®, Vesanoid®
Capsule
10 mg
Gel: 0.01% in 90% ETOH:
15 gm
0.025% in 90% ETOH:
15 gm
10.46
21.99
22.17
TREXAN®: Brand of Naltrexone
TRH: See Protirelin
TRIAMCINOLONE
Kenacort®, Aristocort®
Tablet
4 mg
0.05
TRIAMCINOLONE: Ingredient of Mycolog®
TRIAMCINOLONE ACETONIDE
Kenalog®, Aristocort®
Aerosol
0.007%:
63 gm
21.42
Cream
0.1%:
60 gm
4.80
Injection
10 mg/ml:
5 ml
5.17
40 mg/ml:
5 ml
1.66
Note: 10 mg/ml injectable is for intradermal use. 40 mg/ml is for IM use.
Ointment
0.1%:
15 gm
6.93
Paste(in orabase)
0.1%:
5 gm
2.70
TRIAMTERENE
Dyrenium®
Capsule
100 mg
TRIAMTERENE: Ingredient of Maxzide®
TRICITRASOL®: Brand of Trisodium Citrate Dihydrate
TRIDIL®: Brand of Nitroglycerin
TRIETHYLENETHIOPHOSPHORAMIDE: See Thiophosphoramide
196
0.38
UTMB COST
TRIFLUOPERAZINE
Stelazine®
Tablet
TRIFLURIDINE
Viroptic®
Solution, ophthalmic 1%:
TRIHEXYPHENIDYL
Artane®, Tremin®
Tablet
1 mg
2 mg
5 mg
10 mg
0.12
0.31
0.19
0.42
7.5 ml
24.79
2 mg
5 mg
0.11
0.29
TRILAFON®: Brand of Perphenazine
TRIMETHOBENZAMIDE HYDROCHLORIDE
Tigan®
Capsule
100 mg
250 mg
Injection
100 mg/ml:
TRIMETHOPRIM
Proloprim®, Trimpex®
Tablet
2 ml
100 mg
0.25
0.30
1.97
0.10
TRIMETHOPRIM: Ingredient of Bactrim®, Cotrimoxazole®, Septra®
TRIMETHOPRIM/POLYMYXIN
Polytrim®
Solution, Ophthalmic
10 ml
12.00
TRIMOX®: Brand of Amoxicillin Trihydrate
TRIPEDIA®: Brand of Diphtheria/Tetanus/Acellular Pertussis
TRIMPEX®: Brand of Trimethoprim
TRIPHASIL®
Tablets 28’s
7 inert tablets plus 21 tablets containing:
Days 1- 6: 0.05mg levonorgestre1 / 0.03 mg ethinyl estradiol
Days 7-11: 0.075mg levonorgestre1 / 0.04 mg ethinyl estradiol
Days 12-21: 0.125mg levonorgestre1/0.03 mg ethinyl estradiol
TRIPLE DYE®
Solution 1 ml unit dose
1.06
0.36
TRIPLE SULFA TABLETS: See Terfonyl®
197
UTMB COST
TRIPLE SULFA VAGINAL CREAM: See Sultrin®
TRIPLE SULFONAMIDES: Ingredient of Sultrin®
TRIPROLIDINE: Ingredient of Actifed®
TRISODIUM CITRATE DIHYDRATE
Tricitrasol®, Anticoagulant Sodium Citrate Concentration
Injection 46.7% : 14 gm/30 ml
0.28
Restriction: Nephrology Faculty and Fellows, and Alexander Indrikovs, M.D.
TRISULFAPYRIMIDINES: Ingredient of Terfonyl®
TRIZIVIR®
Tablet: each contains
Zidovudine 300 mg
Lamivudine 150 mg
Abacavir
300 mg
Restriction: Infectious Disease Faculty
13.63
TROBICIN®: Brand of Spectinomycin Hydrochloride
TROMETHAMINE
Tham®
Injection
TROPICAMIDE
Mydriacyl®
Solution, ophthalmic
18 g (150 mEq)/500 ml:500 ml
0.5%: 15ml
1.0%: 15 ml
136.50
1.86
6.87
TRU-GLU®: Brand of Dextrose, Oral
TRUVADA®
Tablet: each contains
Tenofovir
300 mg
Emtricitabine 200 mg
Restriction: Infectious Disease Faculty, Gastroenterology Faculty
TRYPAN BLUE
Vision Blue®
Ophthalmic Solution
0.06%; 0.5 ml syringe
TRYPSIN/BALSAM PERU/CASTOR OIL
Xenaderm®
Ointment
60 gram tube
Each gram contains:
Trypsin
90 USP units
Balsam Peru 87 mg
Castor Oil
788 mg
TSH: See Thyrotropin
198
22.60
40.00
31.97
UTMB COST
TUBERCULIN, OLD TINE TEST
Injection
Comparable or more potent than 5 TU Mantoux
TUBERCULIN, PURIFIED PROTEIN DERIVATIVE
Aplisol®
Injection
Standard Strength 5 TU
5 U/0.1 ml: 1 ml
1.38
62.36
TYLENOL®: Brand of Acetaminophen
TYLENOL® WITH CODEINE
Elixir C-V:
120 ml, each 5 ml contains
Acetaminophen
120 mg
Codeine
12 mg
Tablet C-III: each contains
#2 Acetaminophen 300 mg and Codeine 15 mg
#4 Acetaminophen 300 mg and Codeine 60 mg
Restriction: Requires DEA number on outpatient prescriptions.
TYLOX® C-II
0.36/30 ml
0.04
0.06
0.08
Acetaminophen
Oxycodone Hydrochloride
TYPHOID VACCINE
Injection
Vivotif® Berna
Capsule
500 mg
5 mg
5 ml
9.24/5 ml
4.60
ULTIVA®: Brand of Remifentanil
ULTRAM®: Brand of Tramadol
ULTRASE®: Brand of Pancrelipase
UNASYN®: Brand of Ampicillin/Sulbactam
UNDECYLENIC ACID: Ingredient of Desenex®
UNIPEN®: Brand of Nafcillin sodium
UNIPHYL®: Brand of Extended Release Theophylline
UNNA’S BOOT, MODIFIED: See Dome Paste® Bandage
UREA CREAM
Aquacare HP®
Cream
10%: 75 gm
3.30
URECHOLINE®: Brand of Bethanechol Chloride
199
UTMB COST
UROCIT® K: Brand of Potassium Citrate
UROFOLLITROPIN
Metrodin®
Injection
75 IU vial of FSH
Restriction: Restricted to faculty physicians.
48.83
UROLENE BLUE®: Brand of Methylene Blue
UROLOGIC G SOLUTION, SUBY’S G
Solution, irrigating
each bottle contains:
Citric Acid
Magnesium Oxide
Sodium Carbonate
Note: For irrigation only.
URSODEOXYCHOLIC ACID
Actigall™, URSO®
Capsule
Tablet
1000 ml
2.00
3.24 g
380 mg
430 mg
300 mg
250 mg
1.62
1.40
500 mg
1 gm
2.13
1.82
URSO®: Brand of Ursodeoxycholic Acid
URSODIOL: see Ursodeoxycholic Acid
VALACYCLOVIR
Valtrex®
Caplet
VALCYTE®: Brand of Valganciclovir
VALGANCICLOVIR
Valcyte®
Tablet
450 mg
23.36
Restriction: Infectious Disease Faculty and Solid Organ Transplant Faculty
VALIUM®: Brand of Diazepam Hydrochloride
VALPROATE SODIUM
Depakene®
Syrup
250 mg/5 ml: 473 ml
1.41/30 ml
VALPROIC ACID: See Divalproex Sodium
VALSARTAN
Diovan®
Tablet
Restriction: Cardiology Faculty
200
40 mg
80 mg
160 mg
1.31
1.46
1.99
UTMB COST
VALTREX®: Brand of Valacyclovir
VANCOCIN®: Brand of Vancomycin
VANCOMYCIN
Vancocin®
Capsule
Injection
125 mg
250 mg
1g
10 g bulk vial
2.46
4.91
4.16
127.66
CDC Guidelines:
* Treatment of documented MRSA & MRSE
* Patients colonized with MRSA & MRSE(undergoing surgery,
particularly skin, joint) would be considered an approved use.
* Treatment of serious infections caused by beta-lactam-resistant
gram positive microorganisms.
* Treatment of infections caused by gram-positive microorganisms
in patients who have serioud allergies to beta-lactam
antimicrobials.
* When antibiotic-associated colitis fails to respond to
metronidazole therapy or is severe and potentially life threatening.
* Prophylaxis, as recommeneded by the American Heart
Association, for endocarditis following certain procedures in
patients at high risk for endocarditis.
* Prophylaxis, for major surgical procedures involving implantation
of prosthetic materials or devices (e.g. cardiac and vascular
procedures and total hip replacement) where there is a high rate
of infections caused by MRSA or MRSE. A single dose of
vancomycin administered immediately before surgery is sufficient
unless the procedure lasts > 6 hours, in which case the dose
should be repeated. Prophylaxis should be DC'd after
a maximum of two doses.
Note: Oral dosage form for pseudomembranous colitis due to C. difficile.
VAPONEFRIN®: Brand of Epinephrine Hydrochloride, Racemic
VARICELLA VIRUS VACCINE LIVE
Varivax®
Injection
0.5 ml single dose vial
39.44
VARIVAX®: Brand of Varicella Virus Vaccine LIve
VASELINE® GAUZE: Brand of Petrolatum Gauze, Sterile
VASOCON-A®
Solution, ophthalmic: 15 ml, each contains
Antazoline Phosphate
0.5%
Naphazoline Hydrochloride 0.05%
Note: OTC, non-legend drug available for inpatients only.
6.18
VASODILAN®: Brand of Isoxsuprine
201
UTMB COST
VASOPRESSIN, SYNTHETIC
Pitressin®
Injection, aqueous
20 U: 1 ml
1.14
VASOTEC®: Brand of Enalapril Maleate
VASOXYL®: Brand of Methoxamine Hydrochloride
V-CILLIN K®: Brand of Penicillin V, Potassium
VECTRIN®: Brand of Minocycline Hydrochloride
VECURONIUM BROMIDE
Norcuron®
Injection
10 mg w/diluent
12.73
VEETIDS®: Brand of Penicillin V, Potassium
VEHICLE N®
Solution
50 ml, contains
Alcohol
47.5%
Laureth-4-Isopropyl Alcohol 4%
Propylene Glycol
48.5%
4.00
VELBAN®: Brand of Vinblastine Sulfate
VELCADE®: Brand of Bortezomib
VELOSULIN®: Brand of Insulin, Regular
VENLAFAXINE
Effexor® XR
Tablet
37.5 mg
75 mg
150 mg
Restriction: Psychiatry faculty and residents
1.38
1.55
1.69
VENTOLIN®: Brand of Albuterol
VEPESID®: Brand of Etoposide
VERAPAMIL
Calan®, Isoptin®
Tablets
Calan® SR, Isoptin® SR
Tablet, sustained release
Injection
202
40 mg
80 mg
120 mg
0.10
0.05
0.09
120 mg
180 mg
240 mg
5 mg/2 ml:
0.54
0.19
0.19
0.71
2 ml
UTMB COST
VERMOX®: Brand of Mebendazole
VERSED®: Brand of Midazolam Hydrochloride
VERSENATE®: Brand of Edetate Calcium Disodium
VERTEPORFIN
Visudyne®
Injection
1 vial
1,228.00
Restrction: Patients with third party reimbursement. Availability is limited to physicians
who have completed specialty training in retina and phlebotomy (Drs. Godley, Davis, Li, and
van Kuijk)
VESANOID®: Brand of Tretinoin
VFEND®: Brand of Voriconazole
VIBRAMYCIN®: Brand of Doxycycline Hyclate
VI-DAYLIN®: Brand of Vitamin, Multiple (liquid)
VIDEX®: Brand of Didanosine
VIGAMOX®: Brand of Moxifloxacin
VINBLASTINE SULFATE
Velban®
Injection
VINCRISTINE SULFATE
Oncovin®
Injection
10 mg
7.47
1 mg
2 mg
8.80
6.39
VIRAMUNE®: Brand of Nevirapine
VIRAZOLE®: Brand of Ribavirin
VIRACEPT®: Brand of Nelfinavir
VIREAD®: Brand of Tenofovir disoproxil fumarate
VIROPTIC®: Brand of Trifluridine
VISION BLUE®: Brand of Trypan Blue
VISKIN®: Brand of Pindolol
VISTARIL®: Brand of Hydroxyzine
VISTIDE®: Brand of Cidofovir
203
UTMB COST
VITAMIN A AND D
Ointment:
5 gm Unit Dose Packet
60 gm Tube
each tube contains:
Lanolin
Norwegian Cod Liver Oil (Vitamin A & D)
Petrolatum
Note: O.T.C., non-legend drug available for inpatients only.
VITAMIN A, NATURAL, WATER SOLUBLE
Aquasol A®
Capsule
10,000 IU
Drops
5,000 IU/0.1 ml:
Injection
50,000 IU/ml:
Note: 50,000 IU = 15 mg Retinol
30 ml
2 ml
VITAMIN B-l (Thiamine)
Injection
100 mg/ml: 1 ml tubex
Tablet
100 mg
Note: Tablet is O.T.C., non-legend drug available for inpatients only.
0.04
0.60
0.01
20.13
16.45
0.78
0.03
VITAMIN B-3: See Niacin
VITAMIN B-6 (Pyridoxine)
Injection
100 mg/ml:
Tablet
50 mg
10 ml
VITAMIN B-12 (Cyanocobalamin)
Injection
100 mcg/ml: 1 ml
1 mg/ml:
1 ml
2.70
0.02
0.39
0.58
VITAMIN B COMPLEX: See Vitamins, Multiple
VITAMIN C (Ascorbic Acid)
Injection
500 mg:
Tablet
500 mg
Cecon®
Liquid
100 mg/ml:
2 ml
0.32
0.02
50 ml
11.60
VITAMIN D-2
Injection, in oil 500,000 IU (12.5 mg)/ml: 1 ml
Note: Injection Is For IM Use Only.
Calciferol®, Drisdol®
Liquid
200 IU (5 mcg)/drop: 60 ml
Capsule
50,000 IU (1.25 mg)
Note: 40,000 IU = 1 mg
VITAMIN D-3: See Calcitriol
204
11.36
32.22
0.05
UTMB COST
VITAMIN E
Aquasol E®
Capsule
Drops
100 IU
400 IU
15 IU/0.3 ml: 30 ml
0.36
0.04
27.48
VITAMIN K: See Phytonadione
VITAMINS, MULTIPLE ORAL
Notes:
(1) The only multiple vitamin products available through Outpatient
Pharmacy are Prenatal Vitamin with Folic Acid and Vitamin B complex
with Vitamin C, Folic Acid, and Iron (similar item to Iberet-Folic500®).
(2) The following products contain at least the minimum standards as
required by the State of Texas Purchasing and General Services
Commission. Actual contents will vary with the product selected.
VITAMIN B COMPLEX WITH VITAMIN C, FOLIC ACID,
each tablet to minimally contain:
Folic Acid
0.8 mg
Vitamin B-l
1.5 mg
Vitamin B-2
1.7 mg
Niacin
20 mg
Vitamin B-5
10 mg
Vitamin B-6
10 mg
Vitamin B-12
6 mcg
Vitamin C
60 mg
Biotin
300 mcg
VITAMIN B COMPLEX WITH C AND ZINC (STRESS FORMULA)
each tablet to minimally contain:
(Similar Item - Stresstab®)
Vitamin B-l
15 mg
Vitamin B-2
10 mg
Niacin
100 mg
Vitamin B-5
20 mg
Vitamin B-6
5 mg
Vitamin C
300 mg
Zinc Sulfate
80 mg
Special Note: May contain Vitamin E and/or other minerals.
THERAPEUTIC MULTIPLE VITAMIN
each tablet to minimally contain:
(Similar Item - Theragran®)
Vitamin A
5000 IU
Vitamin B-l
2 mg
Vitamin B-2
3 mg
Niacin
20 mg
Vitamin C
75 mg
Vitamin D
400 IU
0.24
0.07
1.47/30 ml
205
UTMB COST
THERAPEUTIC MULTIPLE VITAMIN
each 5 ml to minimally contain:
Liquid (Adult)
Vitamin A
2500 IU
Vitamin B-l
1 mg
Vitamin B-2
1.2 mg
Niacin
13.5 mg
Vitamin B-6
1 mg
Vitamin B-12
4.5 mcg
Vitamin C
60 mg
Vitamin D
400 IU
Vitamin E
150 IU
Note: Also contains 5% alcohol
THERAPEUTIC MULTIPLE VITAMIN
each chewable tablet to minimally contain:
Tablets, Chewable (Pediatric)
Vitamin A
2500 IU
Vitamin B-1
1.05 mg
Vitamin B-2
1.2 mg
Niacin
13.5 mg
Vitamin B-6
1.05 mg
Vitamin B-12
4.5 mcg
Vitamin C
60 mg
Vitamin D
400 IU
Vitamin E
15 IU
Folic Acid
0.3 mg
THERAPEUTIC MULTIPLE VITAMIN
each 1 ml to minimally contain:
Drops (Pediatric)
Vitamin A
1500 IU
Vitamin B-1
0.5 mg
Vitamin B-2
0.6 mg
Niacin
8 mg
Vitamin B-6
0.4 mg
Vitamin B-12
2 mcg
Vitamin C
35 mg
Vitamin D
400 IU
Vitamin E
5 IU
206
1.47/30 ml
0.03
0.13
UTMB COST
THERAPEUTIC MULTIPLE VITAMIN WITH IRON & MINERALS
each table tablet to minimally contain:
(Similar Item - Theragran-M®)
Elemental Iron
12 mg
Minerals
Iodine, Mangenese, Copper,
Zinc, & Magnesium
Vitamin A
10,000 IU
Vitamin B-1
1.5 mg
Vitamin B-2
10 mg
Niacin
100 mg
Vitamin B-6
5 mg
Vitamin B-12
5 mcg
Vitamin C
200 mg
Vitamin D
400 IU
Vitamin E
15 IU
HEMATINIC MULTIPLE VITAMIN WITH IRON AND MINERALS
each table to minimally contain:
(Similar Item - Theragran Hematinic®)
Folic Acid
0.33 mg
Iron (Fe++)
66 mg
Minerals
Copper, Magnesium
Vitamin A
8333 IU
Vitamin B-1
3.3 mg
Vitamin B-2
3.3 mg
Niacin
33.3 mg
Vitamin B-5
11.7 mg
Vitamin B-6
3.3 mg
Vitamin B-12
50 mcg
Vitamin C
100 mg
Vitamin D
133 IU
Vitamin E
5 IU
PRENATAL MULTIPLE VITAMIN WITH FOLIC ACID
each table to minimally contain:
Calcium
50 mg
Folic Acid
1 mg
Iron (Fe++)
30 mg
Minerals
Iodine, Magnesium, Zinc
Vitamin A
4000 IU
Vitamin B-1
2.5 mg
Vitamin B-2
2 mg
Niacin
10 mg
Vitamin B-6
1 mg
Vitamin B-12
1 mcg
Vitamin C
50 mg
Vitamin D
400 IU
0.06
0.30
0.20
207
UTMB COST
VITAMINS, MULTIPLE INJECTABLE
each vial when mixed to minimally contain:
M.V.I.®-12 (Adult)
Ascorbic Acid (C) 100 mg
Vitamin A
1 mg (3,300 IU)
Vitamin D
5 mcg (200 IU)
Thiamine (B-l)
3 mg
Riboflavin (B-2)
3.6 mg
Pyridoxine (B-6)
4 mg
Niacinamide
40 mg
Dexpanthenol
15 mg
Vitamin E
10 mg (10 IU)
Biotin
60 mcg
Folic Acid
400 mcg
Vitamin B-12
5 mcg
Note: For dilution in IV solutions only.
VITAMINS, MULTIPLE INJECTABLE
each vial to minimally contain:
M.V.I.® (Pediatric)
Biotin
20 mcg
Dexpanthenol
5 mg
Folic Acid
140 mcg
Niacinamide
17 mg
Phytonadione (K-1) 200 mcg
Vitamin A
0.7 mg (2,300 IU)
Vitamin B-1
1.2 mg
Vitamin B-2
1.4 mg
Vitamin B-6
1.0 mg
Vitamin B-12
1 mcg
Vitamin C
80 mg
Vitamin D
10 mcg (400 IU)
Vitamin E
7 mg (7 IU)
Note: For dilution in IV solutions only.
3.61
5.09
VITRAVEN®: Brand of Fomevirsen
VIVACTIL®: Brand of Protriptyline
VIVOTIF® BERNA: Brand of Oral Typhoid
VOLTAREN®: Brand of Diclofenac
VORICONAZOLE
VFEND®
Injection
200 mg
85.47
Tablet
200 mg
28.77
Restriction: Infectious Disease Faculty - requires order by ID or call in to Restricted
Antibiotic Approval Line or Burn Unit patients for up to 48 hours unless an Infectious
Disease consult is received to prolong therapy.
VOSOL®: Brand of Acetic Acid
208
UTMB COST
VOSOL® HC
Solution, otic:
10 ml
each bottle contains:
Acetic Acid
2%
Hydrocortisone
1%
1.88
VP-16: See Etoposide
VYTORIN®
Tablet:
each tablet contains 10 mg ezetimibe/10 mg simvastatin
2.29
10 mg ezetimibe/20 mg simvastatin
2.29
10 mg ezetimibe/40 mg simvastatin
2.29
10 mg ezetimibe/80 mg simvastatin
2.29
Restriction: For all faculty for patients who have failed to reach target goals with statins as
monotherapy.
WARFARIN
Coumadin®
Tablet
1 mg
2 mg
2.5 mg
3 mg
4 mg
5 mg
6 mg
7.5 mg
10 mg
0.04
0.03
0.03
0.04
0.04
0.04
0.05
0.05
0.05
WELLBUTRIN®: Brand of Bupropion
WELLCOVORIN®: Brand of Leucovorin Calcium
WESTADONE®: Brand of Methadone Hydrochloride
WINRHO SD®: Brand of Rho (D) Immune globulin intravenous
WOOL FAT: See Lanolin, Anhydrous
WYCILLIN®: Brand of Penicillin G, Procaine
WYVAC®: Brand of Rabies Vaccine, Human Diploid Cell (HDCV)
X-PREP®: Brand of Senna Fruit Extract
XALATAN®: Brand of Latanoprost
XANAX®: Brand of Alprazolam
XELODA®: Brand of Capecitabine
209
UTMB COST
XENADERM®: Brand of Trypsin/Balsam Peru/Castor Oil
XERO-LUBE®: See Saliva Substitute Solution
XIGRIS®: Brand of Drotrecogin Alfa
XOLAIR®: Brand of Omalizumab
XOPENEX®: Brand of Levalbuterol
XYLOCAINE®: Brand of Lidocaine
XYLOPHAN®: Brand of Xylose
XYLOSE
Xylophan®, D-Xylose, Xylo-Pfam
Powder
25 gm
21.47
Z-BEC®: Brand of Vitamin, Stress Formula Plus Zinc
ZAFIRLUKAST
Accolate®
Tablet
20 mg
1.14
Restriction: Adult/Pediatric Allergy Faculty and Pulmonary Faculty, and Anita Mercado,
M.D.
ZALCITABINE
HIVID®
Tablet
0.375 mg
0.75 mg
Restriction: Infectious Disease Faculty
ZANOSAR®: Brand of Streptozocin
ZARONTIN®: Brand of Ethosuximide
ZAROXOLYN®: Brand of Metolazone
ZEMURON®: Brand of Rocuronium
ZENAPAX®: Brand of Daclizumab
ZERIT®: Brand of Stavudine
ZETAR®: Brand of Coal Tar, Crude
ZETIA®: Brand of Ezetimibe
ZIAGEN®: Brand of Abacavir
210
1.54
1.88
UTMB COST
ZIDOVUDINE
Retrovir®, Azidothymidine (AZT), see also Combivir®
Capsule
100 mg
1.30
Solution
10 mg/ml
3.90/30 ml
Tablet
300 mg
3.91
Restriction: Infectious Disease Faculty, Pediatric Approval for neonates born to HIV mothers,
Ob/Gyn Faculty, Neonatology Faculty, or Occupational Exposure
ZINACEF®: Brand of Cefuroxime
ZINC GELATIN: See Dome Paste® Bandage
ZINC OXIDE
Ointment
20%: 60 gm
Note: O.T.C., non-legend drug available for inpatients only.
0.72
ZINC OXIDE: Ingredient of Aluminum Paste, USP, Anusol®, Dome Paste® Bandage, Lassar’s Paste,
Boudreaux's Butt Paste®
ZINC SULFATE
Orazinc®
Capsule
Suspension
ZIPRASIDONE
Geodon®
Capsule
220 mg (Zn++ 50 mg)
220 mg/lO ml (UTMB compounded)
0.05
0.14/30 ml
20 mg
40 mg
60 mg
80 mg
4.01
4.01
4.37
4.37
Restriction: Psychiatry Faculty
Injection
20 mg/ml:
single dose vial
37.38
Restriction: Psychiatry Faculty and West Side ER for Psychiatry Patients
ZITHROMAX®: Brand of Azithromycin
ZOCOR®: Brand of Simvastatin
ZOFRAN®: Brand of Ondansetron
ZOLADEX®: Brand of Goserelin Acetate
ZOLEDRONIC ACID
Reclast®
Injection
5 mg
1,016.75
Restriction: Endocrinology, Rheumatology, Geriatrics - for patients with a history of
esophageal ulcers and digestive tract abnormality
Zometa®
Injection
4 mg
681.49
Restriction: Adult/Pediatric Hematology/Oncology
211
UTMB COST
ZOLOFT®: Brand of Sertraline
ZOLPIDEM
Ambien®
Tablet
5 mg
10 mg
2.76
2.84
ZOLYSE®: Brand of Chymotrypsin
ZOMETA®: Brand of Zoledronic Acid
ZOSTAVAX®: Brand of Zoster Vaccine
ZOSTER VACCINE
Zostavax®
Injection, subcutaneous
Single dose vial
148.00
Note: Product must be stored in a freezer that has a separate sealed freezer door.
Injection must be used within 30 minutes of reconstitution. For clinic use for patients
after verification of reimbursement or insurance coverage.
ZOSYN®: Brand of Piperacillin/Tazobactam
ZOVIRAX®: Brand of Acyclovir
ZYMAR®: Brand of Gatifloxacin
ZYPREXA®: Brand of Olanzapine
ZYRTEC®: Brand of Cetirizine
ZYVOX®: Brand of Linezolid
212