healthpac formulary - alameda county...healthpac formulary current as of april 2015 class i class ii...

HealthPAC Formulary Current as of April 2015

Class I Class II Generic Name Brand Name Strength

Adrenals Fludrocortisone Florinef 0.2 mg

Analgesic Misc Butalbital-APAP-Caffeine Fioricet 50/325/40

Analgesic Misc Tramadol Ultram, Rybix 50 mg

Analgesic Muscle Relaxant Baclofen Lioresal 10 mg

Analgesic Muscle Relaxant Baclofen Lioresal 20 mg

Analgesic Muscle Relaxant Cyclobenzaprine Flexeril 10 mg

Analgesic Muscle Relaxant Methocarbamol Robaxin 500 mg

Analgesic Muscle Relaxant Methocarbamol Robaxin 750 mg

Analgesic Narcotic Acetaminophen/Oxycodone Percocet 325/5 and 325/10

Analgesic Narcotic Acetaminophen/Codeine #3 Tylenol #3 300 / 30 mg

Analgesic Narcotic Acetaminophen/Hydrocodone Norco 325/10 mg

Analgesic Narcotic Acetaminophen/Hydrocodone Norco 325/5 mg

Analgesic Narcotic Acetaminophen/Hydrocodone Norco 325/7.5 mg

Analgesic NarcoticAcetaminophen/Hydrocodone

bitartrateVicodin 500 mg - 5 mg

Analgesic Narcotic Methadone 10 mg

Analgesic Narcotic Methadone 5 mg

Analgesic Narcotic Morphine sulfate Liquid MS 20mg/ 5 ml

Analgesic Narcotic Morphine sulfate short acting MS 15,30mg

Analgesic Narcotic Morphine sulfate SR Oramorph SR 100 mg




Analgesic NSAID Diclofenac Voltaren 50 mg

Analgesic NSAID Diclofenac Voltaren 75 mg

Analgesic NSAID Ibuprofen Motrin 400 mg



Analgesic NSAID Indomethacin Indocin 25 mg

Analgesic NSAID Indomethacin Indocin 50 mg

Analgesic NSAID Nabumetone Relafen 750 mg

Analgesic NSAID Naproxen Naprosyn 250 mg


Disclaimer: Doses / routes of administration are the responsibility of the prescribing provider based on the medical home's practice guidelines. of 22




Analgesic NSAID Sulindac Clinoril 150 mg

Analgesic NSAID Sulindac Clinoril 200 mg

Analgesic Opiate Agonist Buprenorphine Butrans 10 mcg/hr



Analgesic Opiate Agonist Buprenorphine Butrans 7.5 mcg/hr

Analgesic Opiate Agonist Buprenorphine Subutex 2 mg

AnalgesicMixed Opiate

Agonist/AntagonistBuprenorphine/naloxone Suboxone 2-0.5 mg

AnalgesicMixed Opiate

Agonist/AntagonistBuprenorphine/naloxone Suboxone 8-2 mg

Analgesic Salicyclates Salsalate 500 mg

Analgesic Salicyclates Salsalate 750 mg

Analgesic Salicylates Acetylsalicylic acid (ASA) 81, 325 mg

Anthelmintics Praziquantel Biltricide 600mg

Antibiotic Mupirocin Bactroban 2%ointment

Antihistamine Loratidine Claritin 10mg

Anti-inflammatory Agents Alclometasone Cream Aclovate 45gm

Anti-inflammatory Agents Alclometasone Ointment Aclovate 45gm

Antimicrobials Antifungals Econazole Spectazole 1% crm 30 Gm (30 Gm)



Antimicrobials Antifungals Fluconazole Diflucan 100 mg



Antimicrobials Antifungals Griseofulvin micro liquid Grifulvin V 125 mg / 5 mL (120 ml)

Antimicrobials Antifungals Griseofulvin ultramicro Grisactin Fulvicin 125 mg

Antimicrobials Antifungals Griseofulvin ultramicro Grisactin Fulvicin 250 mg

Antimicrobials Antifungals Ketoconazole Nizoral 2% crm (15 Gm)



Antimicrobials Antifungals Ketoconazole Nizoral 2% shampoo




Antimicrobials Antifungals Ketoconazole Nizoral 200 mg (tabs)

Antimicrobials Antifungals Nystatin oral suspension 100,000 units/ml

Antimicrobials Antitubercular Ethambutol Myambutol 100 mg

Antimicrobials Antitubercular Ethambutol Myambutol 400 mg

Antimicrobials Antitubercular Isoniazid INH 10 mg / ml

Antimicrobials Antitubercular Isoniazid INH 100 mg

Antimicrobials Antitubercular Isoniazid INH 300 mg

Antimicrobials Antitubercular Pyrazinamide 500 mg

Antimicrobials Antitubercular Rifampin Rifadin 150 mg

Antimicrobials Antitubercular Rifampin Rifadin 300 mg

Antimicrobials Antiviral Acyclovir Zovirax 200 mg



Antimicrobials Antiviral Oseltamivir Tamiflu 12mg/ml

Antimicrobials Antiviral Oseltamivir Tamiflu 75mg

Antimicrobials Cephalosporins Cephalexin Keflex 125 mg / 5 ml (200 ml)

Antimicrobials Cephalosporins Cephalexin Keflex 250 mg

Antimicrobials Cephalosporins Cephalexin Keflex 250 mg / 5 ml (100 ml)

Antimicrobials Cephalosporins Cephalexin Keflex 500 mg

Antimicrobials Macrolides Azithromycin Zithromax 250 mg

Antimicrobials Macrolides Erythromycin stearate Ery-Tab 250 mg



Antimicrobials Misc Clindamycin Cleocin 150 mg

Antimicrobials Misc Clindamycin Cleocin 300 mg

Antimicrobials Misc Metronidazole Flagyl 250 mg

Antimicrobials Misc Metronidazole Flagyl 500 mg

Antimicrobials Misc Metronidazole cream Metrocream 0.075%

Antimicrobials Misc Nitrofurantoin macrocryst Macrodantin 100 mg

Antimicrobials Misc Nitrofurantoin macrocryst Macrodantin 50 mg

Antimicrobials Misc Nitrofurantoin monohydrate Macrobid 100 mg

Antimicrobials Penicillins Amoxicillin Amoxil 125 mg / 5 cc (80 cc)

Antimicrobials Penicillins Amoxicillin Amoxil 250 mg




Antimicrobials Penicillins Amoxicillin Amoxil 250 mg / 5 cc (150 cc)

Antimicrobials Penicillins Amoxicillin Amoxil 400 mg/ 5 cc

Antimicrobials Penicillins Amoxicillin Amoxil 500 mg

Antimicrobials Penicillins Amoxicillin-clavulanate Augmentin 200 mg / 5 cc (100 ml)

Antimicrobials Penicillins Amoxicillin-clavulanate Augmentin 500 mg-125 mg

Antimicrobials Penicillins Amoxicillin-clavulanate Augmentin 875 mg

Antimicrobials Penicillins Dicloxacillin Dynapen 250 mg

Antimicrobials Penicillins Dicloxacillin Dynapen 500 mg

Antimicrobials Penicillins Penicillin VK 125 mg / 5 cc (200 cc)

Antimicrobials Penicillins Penicillin VK Veetids 250 mg



Antimicrobials Penicillins Penicillin VK 500 mg

Antimicrobials Quinolones Ciprofloxacin Cipro 250 mg

Antimicrobials Quinolones Ciprofloxacin Cipro 500 mg

Antimicrobials Sulfas Sulfamethxzl Trimethoprim Bactrim 40mg / 5ml - 200mg / 5-ml (60 ml)

Antimicrobials Sulfas Sulfamethxzl Trimethoprim Septra 80 / 400 mg

Antimicrobials Sulfas Sulfamethxzl Trimethoprim DS Septra 160 / 800 mg

Antimicrobials Tetracyclines Doxycycline Doryx Vibramycin 100 mg

Antimicrobials Tetracyclines Doxycycline Doryx Vibramycin 50 mg

Antimicrobials Tetracyclines Tetracycline Sumycin 250 mg

Antimicrobials Tetracyclines Tetracycline Sumycin 500 mg

Antimicrobials Clarithromycin Biaxin 500 mg

Antimicrobials Levofloxacin Levaquin 500 mg

Cardiovascular ACE Inhibitor Captopril Capoten 100 mg

Cardiovascular ACE Inhibitor Captopril Capoten 12.5 mg



Cardiovascular ACE Inhibitor Enalapril maleate Vasotec 10 mg

Cardiovascular ACE Inhibitor Enalapril maleate Vasotec 2.5 mg



Cardiovascular ACE Inhibitor Lisinopril Prinivil, Zestril 10 mg




Cardiovascular ACE Inhibitor Lisinopril Prinivil, Zestril 2.5 mg





Cardiovascular Alpha-1 blocker Doxazosin mesylate Cardura 1 mg




Cardiovascular Alpha-blockers Prazosin Minipress 1 mg



CardiovascularAngiotensin II

BlockerLosartan Cozaar 100 mg


BlockerLosartan Cozaar 25 mg


BlockerLosartan Cozaar 50mg

Cardiovascular Antiarrythmic Amiodarone Cordarone 200 mg

Cardiovascular Antiarrythmic Amiodarone Cordarone 400 mg

Cardiovascular Anticoagulants Dipyridamole Persantine 25 mg



Cardiovascular Anticoagulants Warfarin sodium Coumadin 1 mg



Cardiovascular Anticoagulants Warfarin sodium Coumadin 2.5 mg





Cardiovascular Anticoagulants Warfarin sodium Coumadin 7.5 mg

Cardiovascular AntihypertensiveEnalapril

maleate/HydrochlorothiazideVaseretic 10 - 25 mg




Cardiovascular AntihypertensiveEnalapril

maleate/HydrochlorothiazideVaseretic 5 - 12.5 mg

Cardiovascular Antihypertensive Lisinopril/Hydrochlorothiazide Zestoretic 10 - 12.5 mg

Cardiovascular Antihypertensive Lisinopril/Hydrochlorothiazide Zestoretic 20 - 12.5 mg

Cardiovascular Antihypertensive Lisinopril/Hydrochlorothiazide Zestoretic 20 - 25 mg

Cardiovascular Beta Blockers Atenolol Tenormin 100 mg



Cardiovascular Beta Blockers Carvedilol Coreg 12.5 mg

Cardiovascular Beta Blockers Carvedilol Coreg 25 mg



Cardiovascular Beta Blockers Labetalol HCL Trandate 100 mg



Cardiovascular Beta Blockers Metoprolol succinate Toprol XL 100 mg



Cardiovascular Beta Blockers Metoprolol tartrate Lopressor 100 mg



Cardiovascular Beta Blockers Propranolol HCL Inderal 10 mg





CardiovascularCalcium Channel

BlockersAmlodipine Norvasc 10 mg


BlockersAmlodipine Norvasc 2.5 mg


BlockersAmlodipine Norvasc 5 mg


BlockersDilitiazem HCI Cardizem LA 180 mg





BlockersDiltiazem Cardizem 120 mg


BlockersDiltiazem

Cardizem CD,

Dilacor Xr, Cartia

XL, Dilt-CD

60 mg


BlockersDiltiazem

Cardizem CD,

Dilacor Xr, Cartia

XL, Dilt-CD

90 mg


BlockersDiltiazem SR Cardizem SR 120 mg








BlockersDiltiazem CD Cardizem CD 120 mg










BlockersDiltiazem CD Cardizem CD 360mg









BlockersNifedipine SR

Procardia, Adalat

CC, Nifediac30 mg



Procardia, Adalat

CC, Nifediac60 mg



Procardia, Adalat

CC, Nifediac90 mg


BlockersVerapamil Isoptin 120 mg


BlockersVerapamil LA Isoptin 180 mg


BlockersVerapamil SR Calan SR 120 mg





CardiovascularCentral Alpha

AgonistClonidine HCI tabs Catapres 0.1 mg






AgonistMethyldopa Aldomet 250 mg


AgonistMethyldopa Aldomet 500 mg

CardiovascularCholesterol

Lowering AgentsGemfibrozil Lopid 600 mg


Lowering AgentsLovastatin Mevacor 10, 20, 40 mg


Lowering AgentsPravastatin Pravachol 20, 40, 80 mg tabs





Lowering AgentsSimvastatin Zocor 10 mg





Cardiovascular Diurectics Metolazone Zaroxolyn 10 mg

Cardiovascular Diurectics Metolazone Zaroxolyn 2.5 mg

Cardiovascular Diurectics Metolazone Zaroxolyn 5 mg

Cardiovascular Diuretics Chlorthalidone Thalitone 25mg

Cardiovascular Diuretics Chlorthalidone Thalitone 50 mg

Cardiovascular Diuretics Furosemide Lasix 20 mg



Cardiovascular Diuretics Hydrochlorothiazide Microzide 12.5 mg cap

Cardiovascular Diuretics Hydrochlorothiazide Esidrix 25 mg

Cardiovascular Diuretics Hydrochlorothiazide Esidrix 50 mg

Cardiovascular Diuretics Spironolactone Aldactone 25 mg

Cardiovascular Diuretics Spironolactone Aldactone 50 mg

Cardiovascular Diuretics Spironolatone Aldactone 100 mg

Cardiovascular Diuretics Triamterene hctz Maxzide 37.5/25 mg

Cardiovascular Diuretics Triamterene hctz Maxzide 75 / 50 mg

Cardiovascular Glycosides Digoxin Lanoxin 0.125 mg

Cardiovascular Glycosides Digoxin Lanoxin 0.25 mg

Cardiovascular Nitrate Vasodilators Isosorbide dinitrate Isordil 10 mg




Cardiovascular Nitrate Vasodilators Isosorbide mononitrate IR, SR Imdur 10 mg








Cardiovascular Nitrate Vasodilators Nitroglycerine SL Nitrostat 0.4 mg

Cardiovascular Other Vasodilators Hydralazine Apresoline 10 mg




CardiovascularPotassium

SupplementPotassium chloride 10% (480 cc)


SupplementPotassium chloride tabs

K-Tab, K-Dur,

Slow-K, Klor-con10 mEq



K-Tab, K-Dur,




K-Tab, K-Dur,


Cardiovascular Niacin IR & ER tabs only 100 mg



Chemotherapy Methotrexate Rheumatrex 2.5 mg

Cold, Cough, Allergy Antihistamine Diphenhydramine Benadryl 12.5 mg/ 5ml

Cold, Cough, Allergy Antihistamine Diphenhydramine Benadryl 25, 50 mg capsules

Cold, Cough, Allergy Antihistamine Diphenhydramine Benadryl 50 mg/cc (inj)

Cold, Cough, Allergy Antihistamine Hydroxyzine HCL Atarax 10 mg

Cold, Cough, Allergy Antihistamine Hydroxyzine HCL Atarax 10 mg / 5 cc (120 ml)



Cold, Cough, Allergy Antitussive Guaifenesin + Codeine Robitussin AC 100 mg - 10mg / 5 ml

Cold, Cough, Allergy Antitussive Promethazine/VC/DM

Cold, Cough, Allergy Nasal Steroids Flunisolide Nasarel 25 mcg/spray (0.025%)

Derm Acne Clindamycin topical gel, lotion Cleocin 1%

Derm Acne Clindamycin topical solution Cleocin-T 1% (60 ml)

Derm Acne Erythromycin gel or solution Erygel 2%

Derm Acne Metronidazole cream Metrocream 0.75%

Derm Acne Metronidazole topical gel Metrogel 0.75%




Derm Acne Tretinoin Retin-A0.01%, 0.025%, 0.05%, 0.1%

cream, gel

Derm Antifungals Nystatin (cream or ointment)

Derm Antiinflammatory Clobetasol propionate Temovate 0.05% crm (15 Gms)

Derm Antiinflammatory Clobetasol propionate Temovate 0.05% oint (15 Gms)

Derm Antiinflammatory Clobetasol propionate Temovate 0.05% oint (30 Gms)

Derm Antiinflammatory Fluocinolone acetonide Synalar 0.01% cream

Derm Antiinflammatory Fluocinolone acetonide Synalar 0.01% ointment

Derm Antiinflammatory Fluocinolone acetonide Synalar 0.025% cream

Derm Antiinflammatory Fluocinolone acetonide Synalar 0.025% ointment

Derm Antiinflammatory Fluocinolone acetonide Synalar 0.025%, 0.01% solution, 60 ml

Derm Antiinflammatory Fluocinonide Lidex 0.05% solution 60ml

Derm Antiinflammatory Fluocinonide Lidex 0.05% gel (60gm)

Derm Antiinflammatory Fluocinonide Lidex 0.05% cream (30 gm)

Derm Antiinflammatory Fluocinonide Lidex 0.05% cream (60 gm)

Derm Antiinflammatory Fluocinonide Lidex 0.05% oint (15 gm)



Derm Antiinflammatory Hydrocortisone HC 10mg

Derm Antiinflammatory Hydrocortisone HC 2.5% lotion


Derm Antiinflammatory Hydrocortisone cream Cortizone 2.5%

Derm Antiinflammatory Hydrocortisone ointment Cortizone 2.50%

Derm AntiinflammatoryTriamcinolone cream, ointment, or

lotionKenalog, Aristocort 0.025%

Derm AntiinflammatoryTriamcinolone cream, ointment, or

lotionKenalog, Aristocort 0.10%

Derm Anti-seborrhea Selenium sulfide lotion Selsun 2.50%

Derm Other Silver sulfadiazineFlint SSD,

Silvadene1% crm

Derm Scabicide and Lice Permethrin cream Elimite 5% (60 Gm)

Derm Clobetasol lotion Temovate 0.05%





Diabetes Biguanides Metformin Glucophage 1000 mg



Diabetes Biguanides Metformin ER Glucophage XR 1000 mg



Diabetes Insulin Product Insulin 70/30 Humulin, Novolin U100 (10 ml)

Diabetes Insulin Product Insulin glargine Lantus 100 IU/mL

Diabetes Insulin Product Insulin Lispro Humalog 100U/mL

Diabetes Insulin Product Insulin NPH Humulin N U100 (10 ml)

Diabetes Insulin Product Insulin Regular Humulin R U100 (10 ml)

Diabetes Sulfonylureas Glipizide Glucotrol 10 mg

Diabetes Sulfonylureas Glipizide Glucotrol 5 mg

Diabetes Sulfonylureas Glyburide Micronase Diabeta 1.25 mg

Diabetes Sulfonylureas Glyburide Micronase Diabeta 2.5 mg

Diabetes Sulfonylureas Glyburide Micronase Diabeta 5 mg

Diabetes Thiazolidinediones Pioglitazone hydrochloride Actos 15 mg



Diabetes Diabetes supplies - glucometer

Diabetes Diabetes supplies - lancets

Diabetes Diabetes supplies - syringes/needles

Diabetes Diabetes supplies - test strips

DiabetesDiabetes supplies - testing control

solution

Endocrine Glucocorticoids Prednisolone Prelone 15mg/5ml oral sol

Endocrine Glucocorticoids Prednisone Deltasone 1 mg


Endocrine Glucocorticoids Prednisone Deltasone 2.5 mg




Endocrine Thyroid Levothyroxine Levoxyl 0.025 mg















Endocrine Thyroid Methimazole Tapazole 10 mg

Endocrine Thyroid Methimazole Tapazole 5 mg

Endocrine Thyroid Propylthiouracil PTU 50 mg

Endocrine Fludrocortisone Florinef 0.1 mg

Genitourinary5-alpha reductase

inhibitorFinasteride Proscar 5 mg

Genitourinary Oxybutynin Ditropan 5 mg

Genitourinary Phenazopyridine HCL Pyridium 100 mg

Genitourinary Phenazopyridine HCL Pyridium 200 mg

Genitourinary Alpha-blockers Tamsulosin Flomax 0.4 mg

Genitourinary Terazosin HCL Hytrin 1 mg




GI Antidiarrhea Diphenoxylate-atropine Lomotil 2.5 mg

GI Antidiarrhea Diphenoxylate-atropine (SCH V) Lomotil 2.5 / .025 / 5 (60 ml)

GI Antiemetic Metoclopramide Reglan 10 mg

GI Antiemetic Metoclopramide hcl Reglan 5 mg

GI Antiemetic Prochlorperazine Compazine 10 mg

GI Antiemetic Prochlorperazine Compazine 25 mg supp

GI Antiemetic Prochlorperazine Compazine 5 mg

GI Antiemetic Promethazine HCI Phenergan 12.5 mg




GI Antiemetic Promethazine HCI Phenergan 12.5 mg supp

GI Antiemetic Promethazine HCI Phenergan 25 mg

GI Antiemetic Promethazine HCIPhenergan

suppositor25 mg supp

GI Antiemetic Promethazine HCI Phenergan 50 mg

GI Antiemetic Promethazine HCI Phenergan syrup 6.25 / 5 ml (120 ml)

GI Antiinflammatory Hydrocortisone Suppositories Cortizone 25mg

GIAnti-inflammatory

bowelMesalamine Asacol 400 mg

GIAnti-inflammatory

bowelSulfasalazine Azulfidine 500 mg

GI Antispasmodics Belladona alkaloids, phenobarbital Donnatal 16.2 mg

GI Antispasmodics Dicyclomine Bentyl 10 mg

GI Antispasmodics Dicyclomine Bentyl 20 mg

GI H2 Antagonists Famotidine Pepcid 20 mg

GI H2 Antagonists Famotidine Pepcid 40 mg

GI H2 blockers Cimetidine Tagamet 400 mg

GI H2 blockers Ranitidine Zantac 150 mg

GI H2 blockers Ranitidine Zantac 300 mg

GI Laxatives Lactulose Duphalac 10g/15 ml syrup

GI PPI Omeprazole Prilosec 20 mg

GI PrepPolyethylene glycol electrolyte

solutionMix Golytely 240g

GI Miralax polyethylene glycol 238g

GI Miralax polyethylene glycol 510g

GI Misoprostol Cytotec 100mg

GI Misoprostol Cytotec 200mg

GI Sucralfate Carafate 1 Gm

GI ursodiol Actigall 300mg

Gout Allopurinol Zyloprim 100 mg

Gout Allopurinol Zyloprim 300 mg

Gout Colchicine Colcrys 0.6 mg

Gout Probenecid Benemid 500 mg




Helicobacter pylori agentbismuth subsalicylate-metronidazole-

tetracyclineHelidac

Hemorrheologic Agents Pentoxifylline ER Trental 400 mg

Hormone Replacement Conjugated Estrogen Cream Premarin 0.625 mg/g crm (43 Gm)

Hormone Replacement Estradiol Estrace 0.5 mg

Hormone Replacement Estradiol Estrace 1 mg

Hormone Replacement Estradiol Estrace 2 mg

Hormone Replacement Medroxyprogesterone Provera 10 mg

Hormone Replacement Medroxyprogesterone Provera 2.5 mg

Hormone Replacement Medroxyprogesterone Provera 5 mg

Hormone Replacement Tamoxifen Soltamox 10mg

Hormone Replacement Testosterone Inj Depo Testosterone 100 mg/ml

Hormone Replacement Testosterone Inj Depo Testosterone 200mg/ml

Hypoprolactinemic Bromocriptine Parlodel 2.5mg

Immunosupressive Azathioprine Imuran 50mg

muscle relaxant Carisoprodol Soma 250mg

Neurologic Anticonvulsant Gabapentin Neurontin 100 mg




Neurologic Anticonvulsant Lamotrigine Lamictal 100 mg tab




Neurologic Anticonvulsant Phenobarbital (SCH IV) 100 mg




Neurologic Anticonvulsant Phenytoin Dilantin 100 mg

Neurologic Anticonvulsant Phenytoin Dilantin 50 mg

Neurologic Anticonvulsant Primidone Mysoline 250 mg

Neurologic Anticonvulsant Primidone Mysoline 50 mg

Neurologic Migraine Sumatriptan Imitrex 100 mg






Neurologic Misc Meclizine Antivert 25mg tabs

Neurologic Parkinson Amantadine Symmetrel 100 mg

Neurologic Parkinson Amantadine Symmetrel 50 mg / 5 ml (120 ml)

Neurologic Parkinson Benztropine mesylate Cogentin 0.5 mg

Neurologic Parkinson Benztropine mesylate Cogentin 1 mg

Neurologic Parkinson Benztropine mesylate Cogentin 1 mg/cc (inj)

Neurologic Parkinson Benztropine mesylate Cogentin 2 mg

Neurologic Parkinson Carbidopa - levodopa Sinemet 10 - 100 mg



Neurologic Parkinson Carbidopa - levodopa LA Sinemet CR 25 - 100 mg

Neurologic Parkinson Carbidopa - levodopa LA Sinemet CR 50 - 200 mg

Neurologic Parkinson Trihexyphenidyl Artane 2 mg

Neurologic Parkinson Trihexyphenidyl Artane 2 mg / 5 cc

Neurologic Parkinson Trihexyphenidyl Artane 5 mg

Neurologic Levetiracetam Keppra 1000 mg



Ophthalmic Glaucoma Brimonidine tartrate solution Alphagan 0.2%

Ophthalmic Glaucoma Brimonidine tartrate solution Alphagan 0.2%

Ophthalmic Glaucoma Brinzolamide Azopt 1% solution

Ophthalmic Glaucoma Timolol Maleate eye drops 0.25%

Ophthalmic Glaucoma Timolol Maleate eye drops 0.5%

Ophthalmic Ciprofloxacin eye drop Ciloxan 0.3%

Ophthalmic Erythromycin eye ointment 5 mg / Gm (3.5 Gm)

Ophthalmic Gentamicin eye drops Garamycin 0.3% (5 ml)

Ophthalmic Ketotifen Alaway 0.025%

Ophthalmic Latanoprost Xalatan 0.005%

Ophthalmic Polymyxin b- trimethoprim Polytrim 10 mL drops




Ophthalmic Polymyxin b- trimethoprim Polytrim 3.5 gm ointment

Ophthalmic Prednisolone ophth solu or susp 1%

Ophthalmic Sulfacetamide sodium eye drop sol Sulamyd 10%

Ophthalmic Sulfacetamide sodium eye ointment Sulamyd 10%

Ophthalmic Tobramycin ophthal soln. 0.30%

Osteoporosis Alendronate Fosamax 35 mg

Osteoporosis Alendronate Fosamax 70 mg

Otic Acetic acid Vosol 15 ml drops

Otic Acetic acid/Hydrocortisone Vosol HC 2%-1%

OticAntipyrene, Benzodine, Glycerine

dehydAuralgan 10 ml drops

Otic Cortisporin otic soln 1%-0.35%-10000u/mL (10 ml)

Otic Cortisporin otic susp drops (10 ml)

Phosphate binder Calcium acetate Phoslo 667mg

Platelet aggregation

inhibitorClopidogrel Plavix 75 mg

Platelet aggregation

inhibitorTiclopidine Ticlid 250mg

Psychiatric Antidepressant Amitriptyline Elavil 10 mg





Psychiatric Antidepressant Bupropion XL Wellbutrin XL 150 mg, 300 mg

Psychiatric Antidepressant Buproprion IR, SR Wellbutrin SR 100 mg





Psychiatric Antidepressant Citalopram Hydrobromide Celexa 10 mg

Psychiatric Antidepressant Citalopram Hydrobromide Celexa 10 mg / 5 cc






Psychiatric Antidepressant Clomipramine Anafranil 25 mg



Psychiatric Antidepressant Doxepin HCL Sinequan 10 mg






Psychiatric Antidepressant Fluoxetine Prozac 10 mg


Psychiatric Antidepressant Fluoxetine Prozac 20 mg / 5 ml


Psychiatric Antidepressant Imipramine Tofranil 10 mg



Psychiatric Antidepressant Mirtazapine Remeron 15 mg



Psychiatric Antidepressant Nortriptyline Pamelor 10 mg




Psychiatric Antidepressant Paroxetine Paxil 10 mg

Psychiatric Antidepressant Paroxetine Paxil 10 mg / 5 ml




Psychiatric Antidepressant Sertraline Zoloft 100 mg

Psychiatric Antidepressant Sertraline Zoloft 20 mg/ml



Psychiatric Antidepressant Trazodone Desyrel 100 mg






Psychiatric Antidepressant Venlafaxine Effexor IR 25 mg

Psychiatric Antidepressant Venlafaxine XR Effexor XR 100 mg

Psychiatric Antidepressant Venlafaxine XR Effexor XR 37.5 mg

Psychiatric Antidepressant Venlafaxine XR Effexor XR 75 mg

Psychiatric Antipsychotic Chlorpromazine Thorazine 10 mg


Psychiatric Antipsychotic Chlorpromazine Thorazine 100 mg/ml



Psychiatric Antipsychotic Chlorpromazine Thorazine 30 mg/ml


Psychiatric Antipsychotic Fluphenazine Prolixin 0.5 mg/ml

Psychiatric Antipsychotic Fluphenazine Prolixin 1 mg

Psychiatric Antipsychotic Fluphenazine Prolixin 10 mg

Psychiatric Antipsychotic Fluphenazine Prolixin 2.5 mg

Psychiatric Antipsychotic Fluphenazine Prolixin 5 mg / cc

Psychiatric Antipsychotic Fluphenazine decanoate Prolixin 25 mg/cc (inj)

Psychiatric Antipsychotic Haloperidol Haldol 0.5 mg

Psychiatric Antipsychotic Haloperidol Haldol 1 mg



Psychiatric Antipsychotic Haloperidol Haldol 2 mg / cc (120 cc)

Psychiatric Antipsychotic Haloperidol Haldol 2 mg / cc (15 cc)



Psychiatric Antipsychotic Haloperidol decanoate Haldol 100 mg/cc (inj)

Psychiatric Antipsychotic Haloperidol decanoate Haldol 50 mg/cc (inj)

Psychiatric Antipsychotic Loxapin Loxitane 5, 10, 25, 50 mg

Psychiatric Antipsychotic Olanzapine Zyprexa 2.5mg

Psychiatric Antipsychotic Olanzapine Zyprexa 5 mg

Psychiatric Antipsychotic Perphenazine Trilafon 16 mg




Psychiatric Antipsychotic Perphenazine Trilafon 16 mg / 5 cc (120 ml)




Psychiatric Antipsychotic Quetiapine fumarate Seroquel 100 mg






Psychiatric Antipsychotic Risperidone Risperdal 0.5 mg

Psychiatric Antipsychotic Risperidone Risperdal 1 mg

Psychiatric Antipsychotic Risperidone Risperdal 1 mg/ml solution




Psychiatric Antipsychotic Thiothixene Navane 1 mg





Psychiatric Antipsychotic Thiothixene Navane 5 mg/ml

Psychiatric Antipsychotic Trifluoperazine Stelazine 10 mg



Psychiatric Benzos Clonazepam (SCH IV) Klonopin 0.5 mg

Psychiatric Benzos Clonazepam (SCH IV) Klonopin 1 mg

Psychiatric Benzos Clonazepam (SCH IV) Klonopin 2 mg

Psychiatric Benzos Diazepam (SCH IV) Valium 10 mg






Psychiatric Benzos Lorazepam (SCH IV) Ativan 0.5 mg



Psychiatric Hypnotic Temazepam (SCH IV) Restoril 15 mg

Psychiatric Hypnotic Temazepam (SCH IV) Restoril 30 mg

Psychiatric Hypnotic Zolpidem Ambien 10 mg tabs

Psychiatric Hypnotic Zolpidem Ambien 5 mg tabs

Psychiatric Mood Stabilizer Carbamazepine Tegretol 100 mg

Psychiatric Mood Stabilizer Carbamazepine Tegretol 100 mg / 5 cc

Psychiatric Mood Stabilizer Carbamazepine Tegretol 200 mg

Psychiatric Mood Stabilizer Divalproex sodium Depakote DR 125 mg


Psychiatric Mood Stabilizer Divalproex sodium Depakote ER 250 mg


Psychiatric Mood Stabilizer Divalproex sodium Depakote ER 500 mg

Psychiatric Mood Stabilizer Lithium carbonate Eskalith CR 150 mg

Psychiatric Mood Stabilizer Lithium carbonate Eskalith CR 300 mg

Psychiatric Mood Stabilizer Lithium carbonate Eskalith SR 300 mg

Psychiatric Mood Stabilizer Lithium carbonate Eskalith SR 450 mg

Psychiatric Other Buspirone HCI BuSpar 10 mg




Psychiatric Stimulant Dextroamphetamine/amphetamine Adderall XR 10 mg

Psychiatric Stimulant Dextroamphetamine/amphetamine Adderall XR 15mg



Psychiatric Stimulant Methylphenidate long-acting Ritalin LA 10 mg




Psychiatric Stimulant Methylphenidate short acting Ritalin 10 mg






Respiratory Asthma Ipratropium MDI Atrovent 18mcg/dose MDI (14gm)

Respiratory Asthma Salmeterol xinafoate Serevent Diskus 50 mcg

Respiratory InhalerAlbuterol HFA (IDP) tablet, MDI,

solution, UD

Proventil HFA

(IDP)90 mcg

Respiratory Nasal Inhaler Fluticasone propionate Flonase 50 mcg/spray

Respiratory Nebulizer soln Albuterol solution neb Proventil 5 mg/ml (20 ml bottle)

Respiratory Nebulizer soln Ipratropium bromide 0.02% Atrovent Inh Sol 500 mcg (3 cc/amp)

Respiratory Steroid inhaler Beclomethasone dipropinate Qvar 40 mcg

Respiratory Steroid inhaler Beclomethasone dipropinate Qvar 80 mcg

Respiratory Albuterol liquid Ventolin, Proventil 2 mg / 5 cc (120 ml)

Respiratory Albuterol Unit Dose Proventil 0.83 mg/ml

Respiratory Albuterol-ipratropium Inhaler Combivent MDI

Respiratory Cromolyn inhaler Intal 14.2 Gm

Respiratory Montelukast Singulair 10 mg

Respiratory Montelukast Singulair 5 mg chew

Respiratory Theophylline Theo-Dur 200 mg

Respiratory Theophylline Theo-Dur 300 mg

Rheumatology Hydroxychloroquine Plaquenil 200 mg

Smoking deterrents Nicotine Patches- 28 weeks NicoDerm 14mg

Smoking deterrents Nicotine Patches- 28 weeks NicoDerm 21mg

Smoking deterrents Nicotine Patches- 28 weeks NicoDerm 7 mg

Toxicology Agents Opiate Antagonists Naloxone Narcan 0.4 mg/ ml

Toxicology Agents Opiate Antagonists Naloxone Narcan 1 mg/ ml

Vitamin Calcitriol Rocaltrol 0.25 mcg

Vitamin Calcitriol Rocaltrol 0.5 mcg

Vitamin Folic Acid 800 MicroGrams

Vitamin Pyridoxine Vitamin B6 100 mg

Vitamin Pyridoxine Vitamin B5 25 mg

Vitamin Vitamin B6 50 mg

Vitamin Vitamin D Calciferol 50,000 units

Vitamin Vitamin K Phytonadione 5 mg tab


healthpac formulary - alameda county...healthpac formulary current as of april 2015 class i class ii...

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