lista de medicamentos asegurados y encargados de grupo ......se ofrece también como una alternativa...

Programa de Farmacia de Triple-S Salud, Inc. TRIPLE-S SALUD, INC.

Pharmacy Program from Triple-S Salud, Inc. TRIPLE-S SALUD, INC.

Lista de Medicamentos Asegurados y Encargados de Grupo

2013-2014

Drug List Members and Group Administrators

2013-2014

Rev. 12/ 2013

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TABLA DE CONTENIDO TABLE OF CONTENTS

PREFACIO / Preface ..................................................................................................... 3

INTRODUCCIÓN / Introduction ..................................................................................... 5

PARTE I - DISEÑO DE LA LISTA DE MEDICAMENTOS / Part I – Drug List Design ..... 7

Presentación de la Lista de Medicamentos / Drug List Presentation ................. 7

Guías de Referencia / Reference guidelines .................................................... 11

Éditos de análisis de utilización (DUR) / Edits for Utilization Analysis ............... 14

Derechos Reservados / Reserved rights ........................................................ 17

Leyenda para los Símbolos y Abreviaturas / Legend for symbols and

abbreviations ................................................................................................. 18

PARTE II - MEDICAMENTOS POR CLASIFICACIÓN TERAPÉUTICA / Drugs by Therapeutic Class ....................................................................................................... 20

PARTE III – INDICE / Index ....................................................................................... 93

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PREFACIO

Estimado Asegurado y Encargado de Grupo: El costo de los medicamentos tanto en Puerto Rico como en los Estados Unidos continúa registrando un aumento sostenido. Su cubierta de farmacia utiliza una Lista de Medicamentos para ayudar a reducir el continuo aumento en los costos de los medicamentos y a la vez ofrecerle una amplia selección de opciones de tratamiento costo-efectivas. Se ofrece también como una alternativa para continuar ofreciendo a nuestros asegurados planes de farmacia más accesibles. La Lista de Medicamentos es una guía de los medicamentos seleccionados por el Comité de Farmacia y Terapéutica de Triple-S Salud, la cual representa los medicamentos necesarios para un tratamiento de alta calidad. Nuestro Comité de Farmacia y Terapéutica está compuesto por médicos, farmacéuticos clínicos y otros profesionales de la salud, quienes se reúnen periódicamente para evaluar y seleccionar aquellos medicamentos que serán incluidos en esta Lista de Medicamentos. Esta selección se hace a base de la seguridad, efectividad y costo de los medicamentos. De ahí la importancia de que su médico y usted seleccionen los medicamentos en la Lista. El Comité revisa la Lista de Medicamentos dos veces al año, en los meses de febrero y agosto. Los cambios a la Lista de Medicamentos le serán notificados a través de comunicaciones emitidas por Triple-S Salud. Además, puede obtener una copia de nuestra Lista a través de nuestro portal en la Internet www.ssspr.com o nuestro Departamento de Servicio al Cliente, llamando al 787-774-6060. En las páginas a continuación presentamos la Lista de Medicamentos, con toda la información requerida para facilitarle su lectura e interpretación. Le exhortamos a que evalúe con su médico los medicamentos disponibles en nuestra Lista para tratar su condición. Nuestra Lista contiene un sinnúmero de medicamentos por condición, los cuales incluyen medicamentos genéricos y de marca preferidos, entre otros. Al utilizarla, usted contribuye a mantener los costos del beneficio de farmacia en un nivel razonable, además que sus copagos serán menores. Cordialmente, Pablo Almodóvar Presidente y Principal Oficial Ejecutivo Triple-S Salud, Inc.

http://www.ssspr.com/

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PREFACE

Dear Member and Group Administrator: The drugs costs continue recording a continuous increase both in Puerto Rico and the United States. Your plan uses a Drug List to help reduce the continuous increase in drug costs while offering a wide variety of cost-effective medication choices for you treatment. It is also offered as an alternative to continue offering our members accessible prescription drug plans. The Drug List is a guide of prescription drugs selected by the Pharmacy and Therapeutic Committee which represents the drugs necessary for a high quality treatment. Our Pharmacy and Therapeutic Committee is composed of specialized doctors, clinical pharmacists and other health care professionals, who meet periodically and select the prescription drugs to be included in the Drug List. Such selection is made based on security, effectiveness and cost of the drugs. That is why it is so important that you and your doctor choose drugs on the List. The Committee will review the Drug List twice a year, in February and August. The changes to the Drug List will be notified through communications issued by Triple-S Salud. In addition, you can obtain a copy of your Drug List through our web portal at www.ssspr.com or by calling Customer Services at 787- 774-6060. In the pages immediately after, we introduce the Drug List with all the required information to make easy its reading and interpretation. We recommend that you evaluate with your doctor the prescription drugs available in our Drug List to treat your condition. Our List contains a great amount of drugs per condition, which include generic and preferred brand drugs, among others. By using the List, you contribute to maintain pharmacy benefit costs at a reasonable level, and your cost-sharing will be lower. Cordially, Pablo Almodóvar President and Chief Executive Office Triple-S Salud, Inc.


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INTRODUCCIÓN INTRODUCTION

Esta Lista de Medicamentos se divide en tres partes. This Drug List is divided into three parts. La primera parte es un resumen que le provee información sobre la forma en que se diseñó la Lista de Medicamentos. También se incluye una descripción de los éditos de análisis de utilización para validar dosis e identificar terapias duplicadas. Estos éditos están disponibles a través del sistema de procesamiento y adjudicación de reclamaciones de MC-21 Corporation. The first part is a summary that provides with information about the way the Drug List was designed. It includes a description of the utilization analysis edits used to validate dosage and identify duplicate therapies. These edits are available through the claim adjudication and processing system of MC-21 Corporation. La segunda parte contiene los medicamentos por clasificación terapéutica. The second part contains the drugs by therapeutic categories. La tercera parte contiene una lista por orden alfabético (Índice) de los medicamentos de marca y genéricos, disponibles en la Lista de Medicamentos. The third part contains a list in alphabetical order (Index) of brand and generic drugs available in the Drug List. La inclusión de un medicamento a la Lista de Medicamentos no indica que el medicamento es un medicamento cubierto. La cubierta de farmacia es la que determina si el medicamento está cubierto o excluido en la póliza. Por ejemplo, los medicamentos para dejar de fumar, los agentes para la disfunción eréctil, las hormonas de crecimiento y los medicamentos sin leyenda federal (OTC) usualmente están excluidos de la cubierta de farmacia. The inclusion of a drug in the Drug List does not mean that the medication is covered. The pharmacy insurance coverage is the one that determines if the drug is covered or excluded by the policy. For example, the smoking cessation drugs, erectile dysfunction drugs, growth hormones and the medications with no federal legend (OTC) usually are excluded from the pharmacy coverage. El Comité de Farmacia y Terapéutica revisa la Lista de Medicamentos continuamente. The Therapeutics and Pharmacy Committee reviews the Drug List continuously.

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Los cambios a la Lista por medicamentos que se mueven al Nivel 4: No Preferidos serán efectivos a la fecha de revisión, febrero y agosto de cada año. The changes to the Drug List for drugs that are moved to Level 4: Non-Preferred will be effective on the review date; February and August of each year. Para estos medicamentos existirá un período de gracia de 90 días a partir de la fecha de efectividad de los cambios a la Lista. Durante este período de gracia, el asegurado continuará pagando el copago o coaseguro que aplica a los Niveles del 1 al 3 por este medicamento que se mueve al Nivel 4: No Preferido. Una vez terminado el período de gracia, el asegurado pagará el copago o coaseguro que corresponda a su cubierta para los medicamentos No Preferidos (Nivel 4), los cuales son mayores. For these drugs there will be a 90-day grace period which begins on the effective date of the Drug List changes. During this grace period, our insured will continue to pay the copayments or coinsurances applicable to Levels 1 to 3 in the Drug List for the one that has been moved to Level 4 (Non-Preferred). Once the grace period ends, the insured will have to pay the corresponding copayments or coinsurances as indicated in his/her pharmacy benefits coverage for Non-Preferred drugs (Level 4), which are higher.

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PARTE I - DISEÑO DE LA LISTA DE MEDICAMENTOS

PART I- DRUG LIST DESIGN

Presentación de la Lista de Medicamentos

Drug List Presentation En el ejemplo a continuación se ilustra la información que se provee para los medicamentos incluidos en la Lista de Medicamentos. The following example shows the information provided for those drugs included in the Drug List.

Medicamentos Drugs

Presentación Dosage Form

Nombre Comercial

Brand Name

Nivel Level

Inst

DERMATOLOGICALS (DERMATOLÓGICOS)

Acne (Acné)

adapalene topical cream 0.1 % DIFFERIN 4

adapalene topical gel 0.3 % DIFFERIN 4 SL AL

adapalene topical gel 0.1 % DIFFERIN 4

azelaic acid topical cream 20 % AZELEX 4

benzoyl peroxide topical gel 2.5 %,

topical liq 5 %

DESQUAM 1

Para cada medicamento incluido en la Lista de Medicamentos aparece su presentación, el nombre comercial, el nivel y si tiene alguna instrucción especial. For every medication included in the Drug List the dosage form, trademark name of the drug, level, and any special instruction will appear.

¿Cómo usar la Lista de Medicamentos? How do I use the Drug List? La manera más fácil en que usted puede conseguir los medicamentos en la Lista de Medicamentos es buscando el medicamento en el Índice que comienza en la página 93. El Índice provee una lista por orden alfabético de todos los medicamentos incluidos en este documento. Ambos, medicamentos de marca como genéricos están incluidos en el Índice. Busque el Índice y encuentre el medicamento. Al lado del medicamento, usted encontrará el número de la página donde encontrará cómo está cubierto. Voltee a la página indicada en el Índice y encuentre el nombre del medicamento en las columnas. The easiest way that you can find the prescription drugs is seeking it in the Index that begins on page 93. The Index provides an alphabetical list of all of the drugs included in this document. Both brand-name drugs and generic drugs are listed in the Index. Look in the Index and find the drug. Next to the drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of the drug in the columns.

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¿Cuánto usted paga por los medicamentos cubiertos? How much you will pay for covered drugs? Los medicamentos en la lista de medicamentos se clasifican por niveles. Estos niveles identifican los diferentes niveles de costo compartido, o sea, lo que usted paga por los medicamentos en la receta. Estos niveles son los siguientes:

Nivel 1 – Medicamentos Genéricos

Nivel 2 – Medicamentos Preferidos

Nivel 3 – Medicamentos de Marca

Nivel 4 – Medicamentos No Preferidos

Nivel 5 – Medicamentos Especializados o Biotecnológicos The prescription drugs in the Drug List are classified by levels. These levels identify the different levels of cost-sharing, that is, what you pay, for the drugs in the prescription. These levels are the following:

Level 1 – Generic Drugs Level 2 – Preferred Drugs Level 3 – Brand drugs Level 4 – Non-Preferred Drugs Level 5 – Specialty or Biotech Drugs

El 23 de marzo de 2010, entro en vigor la Affordable Care Act (ACA). Efectivo el 1ro de enero del 2014, como parte de los requisitos de esta ley, y dependiendo de su cubierta, usted tendrá acceso a unos medicamentos preventivos específicos, a los cuales les aplican $0 copago, si son recetados o suministrados por proveedores participantes según requiere el gobierno federal. A continuación los medicamentos incluidos en esta ley:

Anticonceptivos aprobados por la FDA (incluyendo OTC y con receta médica)1 Fluoruro (hasta los 6 años) Aspirina (con límite de cantidad de una 1 tab / diaria; pacientes mayores de 18 años) Hierro (hasta los 12 meses) Ácido fólico (sólo para mujeres)

Este beneficio aplicará a los planes de salud que no tienen estatus protegido (nongrandfather plans). Usted debe comunicarse con nuestro Departamento del Servicio al Cliente al 787-749-4949 para verificar si su cubierta es acreedora de este beneficio. The Affordable Care Act (ACA), entered into force March 23, 2010. Effective January 1, 2014, as part of the requirements of this law, and depending on your pharmacy benefit, you will have access to some specific preventive drugs for which $ 0 copay will apply, if prescribed or provided by participating providers, as required by Federal Law. The following drugs are included in this law:

1 Aplica a los siguientes anticonceptivos: Condón Femenino, Contaceptivos Orales, Dispositivo Intrauterino (IUD),

Diafragma, Mirena IUD®, Plan B

®, Espermicidas (OTC foam), Ortho Evra Patc

®, Nuvaring

®.

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FDA approved contraceptives (including OTC and prescription)2

Fluoride (up to 6 years)

Aspirin (with quantity limit of 1 tab / day; over 18 years)

Iron (up to 12 months)

Folic acid (females only)

This benefit applies to health plans that are not protected status (nongrandfather plans). You must contact our Customer Service Department at 787-749-4949 to see if your pharmacy coverage is deserving of this benefit.

¿Qué son medicamentos genéricos (Nivel 1)? What are generic drugs (Level 1)? Un medicamento genérico tiene el mismo ingrediente activo en la fórmula que un medicamento de marca. Los medicamentos genéricos usualmente cuestan menos que un medicamento de marca y están aprobados por la Administración Federal de Drogas y Alimentos (FDA, por sus siglas en inglés). A generic drug has the same active-ingredient formula as the brand name drug. Generic drugs usually cost less than brand name drugs and are approved by the Food and Drug Administration (FDA). Los medicamentos genéricos están escritos en letras negrillas pequeñas en la Lista de Medicamentos (ejemplo, nabumetone). Medicamentos de marca están escritos en letras mayúsculas (ejemplo, RELAFEN). Generic drugs are listed in bold lower-case (e.g., nabumetone) within the Drug List. Brand-name drugs are capitalized in the Drug List (e.g., RELAFEN). Recomendamos que utilice los medicamentos genéricos. Estos son iguales en potencia y dosis y también son aprobados por la FDA. We recommend that you use generic drugs. They are equal in strength and dosage, are also approved by the FDA.

¿Qué son medicamentos preferidos (Nivel 2)? What are preferred drugs (Level 2)? Hay ciertos medicamentos de marca que han sido seleccionados por el Comité de Farmacia y Terapéutica como agentes preferidos luego de su evaluación de seguridad, eficacia y costo. Los mismos están identificados a la derecha como Nivel 2. En aquellas clases terapéuticas donde no hay genéricos disponibles, les exhortamos a que utilice como primera alternativa aquellos medicamentos identificados como preferidos.

2 Applies to the following contraceptives: Female Condom, Oral Contaceptivos, Intrauterine Device (IUD), Diaphragm,

IUD Mirena ®

, Plan B ®,

Spermicides (Foam OTC), Ortho Evra Patc ®

, NuvaRing ®

.

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There are certain brand name drugs classified by the Therapeutics and Pharmacy Committee as preferred agents after a thorough evaluation in terms of safety, efficiency and cost. These are identified with a Level 2 placed to the right of the name of the drug identifies these as Preferred. In those therapeutic classes where there are no generic drugs available, we urge you to use as first alternative those drugs identified as preferred.

¿Qué son medicamentos de Marca (Nivel 3)? What are Brand drugs (Level 3)? Son los medicamentos que se ofrecen al público bajo un nombre comercial o marca de fábrica. Estos medicamentos están identificados como Nivel 3. Los medicamentos de marca están asociados a un copago mayor que los productos de marca preferidos que son los del Nivel 2 y que los productos genéricos (Nivel 1) incluidos en la Lista de Medicamentos. Those are prescription drugs offered to the public under a commercial name or manufacturing brand. These drugs are identified as Level 3. The brand drugs have a higher copayment than the preferred drugs, which are those in Level 2, and generic drugs (Level 1) included in the Drug List.

¿Qué son medicamentos No Preferidos (Nivel 4)? What are Non-Preferred Drugs (Level 4)? Un medicamento es clasificado como No Preferido porque existen alternativas en los niveles anteriores con menos efectos secundarios o son más costo-efectivos. Si el asegurado obtiene un medicamento de marca del Nivel 4, tendrá que pagar un costo mayor por el medicamento. A drug is classified as Non-preferred because there are other options in previous levels with lesser side effects or are more cost effective. If the insured obtain a brand drug from Level 4, will have to pay more for that drug.

¿Qué son medicamentos Especializados o Biotecnológicos? What are Specialty or Biotech Drugs? Algunos medicamentos para condiciones crónicas y de alto riesgo requieren una administración y/o un manejo especial, por su composición compleja. Estos medicamentos se ofrecen a través de las farmacias de la red o del Programa de Medicamentos para Condiciones Especiales, el cual cuenta con una red de farmacias especializadas dedicadas a que estos medicamentos sean despachados y administrados correctamente. Los mismos se incluyen en este documento al final de la tabla de los medicamentos y en algunas pólizas componen el Nivel 5 de la cubierta de farmacia. Si su beneficio de farmacia no establece un nivel específico para estos productos aplicará el primer nivel indicado en la columna de la tabla de productos especializados (Página 66).

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Certain medications for chronic and high-risk conditions require special administration and/or management, due to their complex composition. These drugs are offer through the pharmacy network or through the Medication Program for Special Conditions, which boasts a network of specialized pharmacies dedicated to ensuring that these medications are dispensed and administered correctly. These drugs are included in this document at the end of the table of medications and they represent Level 5 of the pharmacy coverage in some policies. If your Pharmacy benefit does not establish a specific level for these products, the first level indicated in the column of the Specialty Products table will apply (Page 66).

Guías de Referencia Reference Guidelines

Medicamentos que requieren preautorización (PA) Medications that require pre-authorization (PA) Ciertos medicamentos necesitan una preautorización para ser adquiridos por el paciente. Los mismos se han identificado a la derecha con PA (requiere preautorización), en cuyo caso, la farmacia gestiona la preautorización con MC-21 Corporation previo al despacho del medicamento al asegurado. There are certain drugs that require a preauthorization before being acquired by the patient. A PA (preauthorization is required) placed to the right of the name of the drug identifies them, for which, the pharmacy will process the preauthorization directly to MC-21 Corporation before dispensing it to the insured member. Los medicamentos que requieren preautorización usualmente son aquellos que presentan efectos adversos, son candidatos al uso inapropiado o están relacionados con un costo elevado. The medications that require a preauthorization usually are those that present adverse effects, have a potential for inappropriate use or are related to a higher cost. Aquellos medicamentos que han sido identificados que requieren preautorización deben satisfacer los criterios clínicos establecidos según lo haya determinado el Comité de Farmacia y Terapéutica. Estos criterios clínicos se han desarrollado de acuerdo a la literatura médica actual. Those medications identified as requiring preauthorization must meet the established clinical criteria as determined by the Therapeutics and Pharmacy Committee. These criteria have been developed according to current medical literature. Medicamentos cuyo costo excedan $500.00 requerirán una preautorización para su despacho. La farmacia enviará copia de la receta a MC-21 Corporation a través del fax 1-866-387-3487 ó 1-866-277-6556 para la autorización de la misma.

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Medications whose cost exceeds $500.00 will require a pre-authorization in order to be dispensed. The pharmacy will send MC-21 Corporation a copy of the prescription via fax at 1-866-387-3487 ó 1-866-277-6556 for authorization.

Programa de Terapia Escalonada Step Therapy Program En algunos casos, requerimos que usted utilice primero un medicamento como terapia para su condición antes de que cubramos otro medicamento para esa condición (Terapia Escalonada). Por ejemplo, si el Medicamento A y el Medicamento B se usan ambos para tratar su condición médica, nosotros requerimos que usted utilice primero el Medicamento A. Si el Medicamento A no funciona para usted, entonces cubriremos el Medicamento B. In some cases, we require you to first try one drug to treat your medical condition before we will cover another drug for that condition (Step Therapy). For example, if Drug A and Drug B both treat their medical condition, we may require you use Drug A first. If Drug A does not work for you, then we will cover Drug B. Este programa requiere la utilización de medicamentos sin leyenda federal (OTC, por sus siglas en inglés) o medicamentos genéricos antes de utilizar otros medicamentos para tratar su condición médica. Algunas clasificaciones que requieren un medicamento OTC como primer paso incluyen los inhibidores de la bomba de protón (PPI, por sus siglas en inglés), antihistamínicos no-sedantes y agentes para alergias oculares. Otras clasificaciones que requieren un medicamento genérico como primer paso incluyen las estatinas para el colesterol, los bifosfonatos orales para la osteoporosis y los corticosteroides nasales para las alergias. This program will require the utilization of Over-The-Counter (OTC) drugs or Generic drugs before using other drugs to treat your medical condition. Some of the "OTC First" portion includes Proton Pump Inhibitors (PPI), Non-sedating antihistamines, and Ocular allergies agents. Others in the "Generic First" portion includes Cholesterol drugs-Statins, Osteoporosis-Oral Bisphosphonates, and Allergies-Nasal Corticosteroids.

Límites de cantidad (QL) Limits on the amount to be dispensed Ciertos medicamentos tienen un límite en la cantidad a despacharse. Estas cantidades se establecen de acuerdo a lo sugerido por el manufacturero como la cantidad máxima adecuada que no está asociada a efectos adversos y la cual es efectiva para el tratamiento de una condición. Certain medications have a limit on the amount to be dispensed. These amounts are established according to the manufacturer’s recommendation as to the adequate maximum amount that will not cause adverse effects and which is effective for the treatment of a condition. El Apéndice I contiene la lista de los medicamentos que tienen límites en la cantidad a despacharse. La misma es vigente al momento de imprimirse esta Lista y está sujeta a cambios.

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Appendix I includes a list of the medications that currently have a limit amount for dispensing. The list is effective at the moment of the publication of this List and is subject to changes.

Límites de especialidad médica (SL) Medical specialty limits Algunos medicamentos tienen un límite en la especialidad médica. Estos límites de especialidad se establecen de acuerdo a la literatura médica actual. Some medications have a limit in the medical specialty. These medical specialty limits are established in accordance with the current medical literature. El Apéndice II contiene la lista de los medicamentos que tienen límite de especialidad médica. La misma es vigente al momento de imprimirse esta Lista y está sujeta a cambios. Appendix II contains the list of medications that has a medical specialty limit. The list is effective at the moment of the impression of this List and is subject to changes.

Límites de edad (AL) Age limits Algunos medicamentos tienen un límite de edad. El Apéndice III contiene la lista de los medicamentos que tienen un límite de edad. La misma es vigente al momento de imprimirse esta Lista y está sujeta a cambios. Some medications have a limit due to age. Appendix III contains the list of medications that has an age limit. The list is effective at the moment of the impression of this document and is subject to changes.

Límite de Acceso (LA) Limited Access Algunos medicamentos requieren manejo, seguimientos o dosis especiales, los cuales deben ser monitoreados por un profesional de la salud. Existen un número reducido de medicamentos especializados con acceso limitado o distribución limitada. Debido al seguimiento, monitoreo y observando la seguridad de los pacientes, los manufactureros y la Administración de Drogas y Alimentos (FDA), limitan la obtención de estos medicamentos a uno o un número muy limitado de farmacias. Entre los beneficios de limitar el acceso se encuentran: Some drugs require special handling, tracking or special doses, which should be monitored by a health professional. There are a small number of specialty drugs with limited access or limited distribution. Due to tracking, monitoring and observing the patient safety, manufacturers and the Food and Drug Administration (FDA) limit the acquisition of these drugs to one or a very limited number of pharmacies. Among the benefits of limiting access are:

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Los manufactureros pueden mantener un seguimiento del inventario de medicamentos Manufacturers can keep track of the drug’s inventory

Los profesionales de la salud son educados adecuadamente sobre cualquier monitoreo necesario Health professionals are properly educated about any neccessary monitoring

Educación individualizada del paciente Patient's individualized education

Se asegura de que los riesgos que se asocian con estos medicamentos se reduzcan al mínimo. Ensures that the risks associated with these drugs are minimized.

Uso de medicamentos en investigación o experimentales Use of investigational or experimental medications Los medicamentos recetados para propósitos de investigación, experimentales o no aprobados por la FDA, no se cubren en ningún plan de salud o cubierta de farmacia. Investigational or experimental drugs, or those not approved by the FDA, are not covered by all health plans or pharmacy coverage.

Recetas de compuestos Compounded prescriptions Las recetas de compuestos se consideran medicamentos cubiertos si contienen por lo menos un medicamento de la Lista, siempre y cuando no sea para propósitos cosméticos. Compounded prescriptions are considered covered drugs if they contain at least one of the drugs on this List, as long as they are not for cosmetic purposes.

Éditos de análisis de utilización (DUR) Edits for Drug Utilization Analysis A través del Programa de Beneficio de Farmacia de Triple-S Salud, Inc. se han implantado los siguientes éditos de análisis de utilización (DUR, por sus siglas en inglés) con el propósito de evitar complicaciones a los asegurados, ofreciendo un mejor cuidado. Through the Pharmacy Benefit Management Program, Triple-S Salud has implemented the following edits for drug utilization (DUR) in order to avoid complications to the insured persons while offering a better care. Édito de Validación de Dosis - coteja para dosis máximas diarias usando como

referencia las dosis pediátricas, de adultos y geriátricas de acuerdo a la información suministrada por Medi-Span®. En la mayoría de los casos, la dosis máxima es aquella aprobada por la FDA.

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Dose check edits - verify for daily maximum dosages using as reference the pediatric, adult and geriatric dosages according to Medi-Span®. In the majority of cases, the maximum dosage is the one approved by the FDA.

Édito de Terapia Duplicada - verifica el historial de medicamentos del paciente

asegurado para recetas duplicadas, de dos formas: Duplicate Therapy edits - verify the insured person’s drug history for duplicate prescriptions, in two ways:

1. el paciente asegurado recibe el mismo medicamento (Ej. mismo ingrediente activo)

con dos recetas distintas (Ej. número de receta distinto, puede ser la misma farmacia o farmacias diferentes). The insured person receives the same medication (e.g. same active ingredient) with two different prescriptions (e.g. Prescription number is different; it could be through the same pharmacy or different ones).

2. el paciente asegurado recibe dos medicamentos de la misma clase terapéutica,

como por ejemplo, dos antidepresivos o dos analgésicos, entre otros. The insured person receives two drugs of the same therapeutic class, for example: two anti-depressants or two analgesics.

Hay ciertas excepciones a estos éditos. Para evitar que el sistema rechace servicio a los asegurados, nosotros les solicitamos a los médicos y dentistas que incluyan la siguiente información en la receta del paciente: There are exceptions to these edits. In order to prevent the system from denying the service, we suggest that physicians include the following information in the patient’s prescription:

Cambio en dosis Change in dosage

Si aumentó la dosis y usted necesita más medicamentos antes de tiempo, en este caso se necesitará una carta de justificación de parte del médico indicando el cambio en dosis. La farmacia requerirá una preautorización a MC-21 Corporation, luego de que se reciba la información necesaria de la receta. If the dosage increases and the insured person needs medication right away, a letter from the physician justifying the dosage change will be required. The pharmacy will require a pre-authorization from MC-21 Corporation after receipt of the necessary information regarding that prescription.

- Si la dosis se determina por su peso, el médico debe indicar su peso y estatura en la receta. If the dosage is determined by your weight, the physician must indicate your weight and height in the prescription.

- Cuando la dosis del medicamento se ajuste de acuerdo a los niveles en sangre, el médico debe indicarlo así en la receta (Ej. Ajuste de niveles para tiroides, teofilina, anticonvulsivos, warfarina). When the dosage of the drug is adjusted accordingly to blood levels, the physician must indicate it in the prescription (e.g.: adjustments for thyroid, theophyline, anti-convulsivants, and warfarins).

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- Cuando para la dosis indicada en la receta no existe su presentación farmacéutica.

Por ejemplo, la tableta viene de 25 mg y 50 mg pero el paciente necesita 75 mg (dosis indicada y aceptada). La farmacia requerirá una preautorización a MC-21 Corporation, luego de que se reciba la información necesaria en la receta (se requiere copia de la receta y hoja de preautorizaciones de MC-21). When the dosage indicated in the prescription does not exist in the pharmaceutical dosage form of the medication. For example, the tablet exists in 25 mg and 50 mg, but the patient needs a 75 mg dosage (dose required and accepted). The pharmacy will require a pre-authorization from MC-21 Corporation after the receipt of the necessary information for the prescription (a copy of the prescription will be required and copy of the pre-authorization form from MC-21 Corporation).

Procedimiento para solicitar una Excepción Médica

Procedure to request a Medical Exception

El asegurado o representante legal autorizado podrán solicitar cobertura para un

medicamento que no esté excluido del formulario de forma categórica3 utilizando la forma

que se encuentra en el Apéndice VII (página 85). Esta forma se encuentra disponible

también en nuestra página web www.ssspr.com.

The insured or legally authorized representative may request coverage for a drug that is not

expressly excluded on the form using the form found in Appendix VII (page 85). This form is

also available on our website www.ssspr.com

Las razones por las cuales un asegurado puede solicitar una excepción médica son:

The reasons why an insured may request a medical exception are:

Medicamentos no cubiertos por el formulario Medications not covered by the formulary

Descontinuación de medicamento por motivos que no sean de seguridad o retiro del mercado por su fabricante Drug discontinuation for reasons other than safety or recall by the manufacturer

Excepción al procedimiento de terapia escalonada o limitación de dosis. Exception to the step therapy or dose limitation)

3 Exclusión de forma categórica significa que el nombre científico o comercial del medicamento solicitado no

está en la lista de exclusiones del formulario. 3

Exclusion categorically means that the scientific name or trade name requested drug is not on the exclusion list of the formulary.



2013-2014 | 17

Se requerirá una certificación que incluya la siguiente información:

Certification will be required to include the following information:

Nombre, número de grupo o número de contrato. Name, group or contract number

Historial del paciente. Patient History

Diagnóstico primario relacionado con el medicamento de receta objeto de la solicitud Primary diagnosis related to prescription drug subject of the request

Razón para la solicitud de excepción. Reason for Exception Request

Razón por la cual el medicamento solicitado se necesita, o por la cual la excepción en cuanto al procedimiento de terapia escalonada o limitación de dosis es necesaria para el cuidado del paciente. The reason why the requested drug is needed, or why the exception for the step therapy procedure or dose limitation is necessary for patient care.

Firma del prescribiente. Prescriber signature

La solicitud de excepción médica será revisada por profesionales de la salud con

experiencia en el manejo de medicamentos. Las determinaciones tomadas corresponderán

a los beneficios y exclusiones que se disponen en su cubierta. El asegurado será notificado

de la decisión mediante carta o correo electrónico (según solicitado).

The medical exception request will be reviewed by health professionals with expertise in

medication management. The determinations made will correspond to the benefits and

exclusions that are available in your coverage. The insured will be notified of the decision by

letter or email (as requested).

Derechos Reservados

Reserved Rights La Lista de medicamentos es una propiedad literaria. MC-21 Corporation y Triple-S Salud, Inc. son los propietarios de los derechos de autor. Bajo ninguna circunstancia se podrá copiar o distribuir la Lista de Medicamentos ni cualquier porción de éste sin el consentimiento escrito de MC-21 Corporation y Triple-S Salud, Inc. The Drug List is a literary property. MC-21 Corporation and Triple-S Salud, Inc. are the proprietors of the author’s rights. Under no circumstances may this material be copied or distributed in whole or any part without the written consent of MC-21 Corporation and Triple-S Salud, Inc.

2013-2014 | 18

Leyenda para los Símbolos y Abreviaturas

Legend for Symbols and Abbreviations

Símbolo / Abreviatura

Descripción

AL Identifica aquellos medicamentos para los cuales existe algún límite de edad / Identifies those medications for which an age limit exists

Cap Cápsula / Capsule

Conc Concentrado / Concentrated

Cr Crema / Cream

ER, SR, CR Acción prolongada, acción sostenida, acción controlada / Extended release, sustained release, controlled release

Inh Inhalador / Inhaler

Inj Inyectable / Injectable

QL Identifica aquellos medicamentos para los cuales existe algún límite en la cantidad que la farmacia puede despachar / Identifies those medications for which a dispensing limit exists

SL Identifica aquellos medicamentos para los cuales existe algún límite en la especialidad médica que debe manejar la terapia con estos productos / Identifies those medications for which a limit in the medical specialty exists that must manage the therapy with these products

LA Identifica a aquellos medicamentos con límite de Acceso o Limite de Distribución/ Identify those medications which have a limited access o limited distribution

Lot Loción / Lotion

Negrilla (Bold) Identifica que el medicamento tiene genérico disponible en todas las presentaciones / Identifies if the medication has a generic available in all its dosage forms

Nivel 1 Identifica los medicamentos genéricos / Identifies Generic drugs

Nivel 2 Identifica los medicamentos de marca preferidos / Identifies Preferred drugs

Nivel 3 Identifica los medicamentos de marca / Identifies Brand drugs.

Nivel 4 Identifica los medicamentos no preferidos / Identifies Non-Preferred drugs

Oint Ungüento / Ointment

Oph Oftálmico / Ophthalmic

OTC Medicamentos fuera del Recetario / Over the Counter Drug

PA Preautorización. La farmacia es responsable de solicitar y obtener una preautorización con MC-21 Corporation o Triple-S Salud, Inc., antes de despacharse el medicamento / Preauthorization. The pharmacy is responsible to request and obtain a prior authorization from MC-21 Corporation or Triple-S Salud, Inc., before dispensing the prescription drug.

SHA Champú / Shampoo

Sl Sublingual / Sublingual

SNC Sistema Nervioso Central / Central Nervous System

Soln Solución / Solution

ST Terapia Escalonada / Step Therapy

2013-2014 | 19

Símbolo / Abreviatura

Descripción

Supp Supositorio / Suppository

Susp Suspensión / Suspension

Tab Tableta / Tablet

Td Transdermal / Transdermal

2013-2014 | 20

PARTE II - MEDICAMENTOS POR CLASIFICACIÓN TERAPÉUTICA

PART II - DRUGS BY THERAPEUTIC CATEGORY Medicamentos

Drugs Presentación Dosage Form

Nombre Comercial Brand Name

Nivel Level

Inst

ANESTHETICS (ANESTÉSICOS)

lidocaine inj 1 %, 2 % XYLOCAINE 4

ANTI-ADDICTION/SUBSTANCE AUSE TREATMENT AGENTS (TRATAMIENTO DE ABUSO DE SUSTANCIAS/CONTRA LA ADDICION)

Opioid Antagonist (Antagonista de Opioides)

buprenorphine sl tabs 2 mg, 8 mg SUBUTEX 1 PA

buprenorphine & naloxone

sl film 12-3 mg, 2-0.5 mg, 4-1 mg, 8-2 mg, sl tabs 2-0.5 mg, 8-2 mg

SUBOXONE 3 PA

ANTI-INFECTIVES (ANTI-INFECCIOSOS)

Antifungals (Antifungales)

clotrimazole troche 10 mg MYCELEX 1

fluconazole susp 10 mg/ml, 40 mg/ml, tabs 100 mg, 150 mg, 200 mg, 50 mg

DIFLUCAN 1

flucytosine caps 250 mg, 500 mg ANCOBON 1

griseofulvin microsize susp 125 mg/5ml, tabs 500 mg GRIFULVIN 4

griseofulvin ultramicrosize

tabs 125 mg, tabs 250 mg GRIS-PEG 1

itraconazole caps 100 mg SPORANOX 1

itraconazole soln 10 mg/ml SPORANOX 3

ketoconazole tabs 200 mg NIZORAL 1

nystatin powder , susp 100000 u/ml, tabs 500000 u

NYSTATIN 1

posaconazole susp 40 mg/ml NOXAFIL 4

terbinafine tabs 250 mg LAMISIL 1

voriconazole susp 40 mg/ml VFEND 4

voriconazole tabs 200 mg, 50 mg VFEND 4

Antimarials (Antimaláricos)

artemether & lumefantrine

tabs 20-120 mg COARTEM 4

atovaquone & proguanil tabs 62.5-25 mg MALARONE 4

atovaquone & proguanil tabs 250-100 mg MALARONE 4

chloroquine tabs 250 mg, 500 mg ARALEN 1

hydroxychloroquine tabs 200 mg PLAQUENIL 1

mefloquine tabs 250 mg LARIAM 1

primaquine tabs 26.3 mg PRIMAQUINE 3

pyrimethamine tabs 25 mg DARAPRIM 3

quinine caps 324 mg QUALAQUIN 4

Antiparasitics (Antiparasitarios)

albendazole tabs 200 mg ALBENZA 3

bacitracin inj 50000 u BACITRACIN 1

iodoquinol tabs 210 mg, 650 mg YODOXIN 3

ivermectin tabs 3 mg STROMECTOL 4

2013-2014 | 21

Medicamentos Drugs



Nivel Level

Inst

mebendazole chew tab 100 mg VERMOX 3

nitazoxanide susp 100 mg/5ml, tabs 500 mg ALINIA 3

praziquantel tabs 600 mg BILTRICIDE 4

Antituberculosis (Antituberculosis)

aminosalicylic acid pack 4 gm PASER 4

cycloserine caps 250 mg SEROMYCIN 3

ethambutol tabs 100 mg, 400 mg MYAMBUTOL 1

ethionamide tabs 250 mg TRECATOR 3

isoniazid tabs 100 mg, 300 mg ISONIAZID 1

isoniazid syrup 50 mg/5ml ISONIAZID 3

isoniazid & pyrazinamide & rifampin

tabs 50-300-120 mg RIFATER 4

isoniazid & rifampin caps 150-300 mg RIFAMATE 4

pyrazinamide tabs 500 mg PYRAZINAMIDE 1

rifabutin caps 150 mg MYCOBUTIN 3

rifampin caps 150 mg, 300 mg RIFADIN 1

rifapentine tabs 150 mg PRIFTIN 4

Antivirals (Antivirales)

Antiherpes Virus (Infecciones Herpéticas)

acyclovir caps 200 mg, susp 200 mg/5ml, tabs 400 mg, 800 mg

ZOVIRAX 1

famciclovir tabs 125 mg, 250 mg, 500 mg FAMVIR 1

valacyclovir tabs 1000 mg, 500 mg VALTREX 1

HIV/AIDS (VIH/SIDA)

Entry Inhibitors (Inhibidores de Entrada)

maraviroc tabs 150 mg, 300 mg SELZENTRY 3 PA SL

raltegravir chew tab 100 mg, 25 mg, tabs 400 mg

ISENTRESS 3

Non-Nucleoside Reverse Transcriptase Inhibitors (Inhibidores No Nucleósidos de la Transcriptasa Reversa)

delavirdine tabs 100 mg, 200 mg RESCRIPTOR 3

efavirenz caps 200 mg, 50 mg, tabs 600 mg SUSTIVA 3

etravirine tabs 100 mg, 200 mg, 25 mg INTELENCE 3 PA SL

nevirapine tabs 200 mg VIRAMUNE 1

nevirapine susp 50 mg/5ml, tab sr 24hr 100 mg, 400 mg

VIRAMUNE/ VIRAMUNE XR

3

rilpivirine tabs 25 mg EDURANT 3

Nucleoside-Nucleotide Reverse Transcriptase Inhibitors (Inhibidores Nucleósidos-Nucleótidos de la Transcriptasa Reversa)

abacavir soln 20 mg/ml, tabs 300 mg ZIAGEN 3

abacavir & lamivudine tabs 600-300 mg EPZICOM 3

abacavir & lamivudine & zidovudine

tabs 300-150-300 mg TRIZIVIR 3

didanosine soln 2 gm, 4 gm

VIDEX 3

didanosine dr caps 125 mg, 200 mg, 250 mg, 400 mg

VIDEX EC 1

efavirenz & emtricitabine & tenofovir

tabs 600-200-300 mg ATRIPLA 3

2013-2014 | 22

Medicamentos Drugs



Nivel Level

Inst

elvitegravir & cobicistat & emtricitabine & tenofovir

tabs 150-150-200-300 mg STRIBILD 3

emtricitabine caps 200 mg EMTRIVA 3

emtricitabine soln 10 mg/ml EMTRIVA 4

emtricitabine & rilpivirine & tenofovir df

tabs 200-25-300 mg COMPLERA 3

emtricitabine & tenofovir tabs 200-300 mg TRUVADA 3

lamivudine tabs 150 mg, 300 mg EPIVIR 1

lamivudine soln 10 mg/ml EPIVIR 3

lamivudine & zidovudine

tabs 150-300 mg COMBIVIR 1

stavudine caps 15 mg, 20 mg, 30 mg, 40 mg, soln 1 mg/ml

ZERIT 1

tenofovir powder 40 mg/ml, tabs 150 mg, 200 mg, 250 mg

VIREAD 3

tenofovir 300 mg VIREAD 3 PA, SL

zidovudine caps 100 mg, syrup 50 mg/5ml, tabs 300 mg

RETROVIR 1

Protease Inhibitors (Inhibidores de Proteasa)

atazanavir caps 100 mg, 150 mg, 200 mg, 300 mg

REYATAZ 3

darunavir tabs 150 mg, 400 mg, 600 mg, 75 mg, 800 mg

PREZISTA 3

fosamprenavir susp 50 mg/ml, tabs 700 mg LEXIVA 3

indinavir caps 100 mg, 200 mg, 400 mg CRIXIVAN 3

lopinavir & ritonavir soln 400-100 mg/5ml, tabs 100-25 mg, 200-50 mg

KALETRA 3

nelfinavir powder 50 mg/gm, tabs 250 mg, 625 mg

VIRACEPT 3

ritonavir caps 100 mg, soln 80 mg/ml, tabs 100 mg

NORVIR 3

saquinavir caps 200 mg, tabs 500 mg INVIRASE 3

tipranavir caps 250 mg, soln 100 mg/ml APTIVUS 3 PA, SL

Influenza (Influenza)

amantadine caps 100 mg, syrup 50 mg/5ml SYMMETREL 1

amantadine tabs 100 mg AMANTADINE 3

oseltamivir caps 30 mg, 45 mg, 75 mg, susp 12 mg/ml, susp 6 mg/ml

TAMIFLU 4

rimantadine tabs 100 mg FLUMADINE 1

zanamivir inhal 5 mg/blister RELENZA DISKHALER

4

Miscellaneous (Misceláneos)

ganciclovir caps 250 mg, 500 mg CYTOVENE 3

Cephalosporins (Cefalosporinas)

First Generation (Primera Generación)

cefadroxil caps 500 mg, susp 250 mg/5ml, 500 mg/5ml

DURICEF 1

2013-2014 | 23

Medicamentos Drugs



Nivel Level

Inst

cefadroxil tabs 1 gm DURICEF 4

cephalexin caps 250 mg, 500 mg, susp 125 mg/5ml, 250 mg/5ml

KEFLEX 1

cephalexin tabs 250 mg, 500 mg CEPHALEXIN 4

Second Generation (Segunda Generación)

cefaclor caps 250 mg, 500 mg CECLOR 1

cefaclor sr tabs 12h 500 mg CECLOR CD 4

cefprozil susp 125 mg/5ml, 250 mg/5ml, tabs 250 mg, 500 mg

CEFZIL 1

cefuroxime axetil susp 125 mg/5ml, tabs 250 mg, 500 mg

CEFTIN 1

cefuroxime axetil susp 250 mg/5ml CEFTIN 3

Third Generation (Tercera Generación)

cefdinir caps 300 mg, susp 125 mg/5ml, 250 mg/5ml

OMNICEF 1

cefditoren tabs 200 mg, 400 mg SPECTRACEF 4

cefixime tabs 400 mg SUPRAX 4

cefpodoxime susp 100 mg/5ml, 50 mg/5ml, tabs 100 mg, 200 mg

VANTIN 4

ceftibuten caps 400 mg, susp 90 mg/5ml CEDAX 4

ceftriaxone inj 1 gm, 10 gm, 2 gm, 250 mg, 500 mg

ROCEPHIN 4

Macrolides (Macrólidos)

azithromycin susp 100 mg/5ml, 200 mg/5ml, tabs 250 mg, 500 mg, 600 mg

ZITHROMAX 1

azithromycin pack 1 gm ZITHROMAX 3

azithromycin susp 2 gm ZMAX 4

clarithromycin susp 125 mg/5ml, 250 mg/5ml, tabs 250 mg, 500 mg

BIAXIN 1

clarithromycin sr tabs 24h 500 mg BIAXIN XL 1

erythromycin tabs 250 mg, 500 mg ERYTHROMYCIN 3

erythromycin & sulfisoxazole

susp 200-600 mg/5ml PEDIAZOLE 1

erythromycin dr tabs 250 mg, 333 mg, 500 mg ERY-TAB DR 3

erythromycin dr caps 250 mg ERYTHROMYCIN DR 4

erythromycin ec tabs 333 mg, 500 mg PCE 4

erythromycin ethylsuccinate

tabs 400 mg E.E.S. 1

erythromycin ethylsuccinate

susp 200 mg/5ml, 400 mg/5ml E.E.S./ ERYPED 3

erythromycin stearate tabs 250 mg ERYTHROCIN 3


atovaquone susp 750 mg/5ml MEPRON 3

cilastatin sodium & imipenem

inj 500-500 mg PRIMAXIN 4

clindamycin caps 150 mg, 300 mg, 75 mg, soln 75 mg/5ml

CLEOCIN 1

dapsone tabs 100 mg, 25 mg DAPSONE 3

fosfomycin pack 5.631 gm MONUROL 4

2013-2014 | 24

Medicamentos Drugs



Nivel Level

Inst

gentamicin inj 10 mg/ml, 40 mg/ml GENTAMICIN 4

lincomycin inj 300 mg/ml LINCOCIN 4

metronidazole tabs 250 mg, 500 mg FLAGYL 1

metronidazole caps 375 mg FLAGYL 4

metronidazole sr tabs 24h 750 mg FLAGYL ER 4

neomycin tabs 500 mg NEOMYCIN 4

nitrofurantoin susp 25 mg/5ml FURADANTIN 1

nitrofurantoin macrocrystalline

caps 25mg 100 mg, 50 mg MACRODANTIN 1

nitrofurantoin monohydrate macrocrystals

caps 100 mg MACROBID 4

pentamidine neb 300 mg NEBUPENT 3

pentamidine inj 300 mg PENTAM 4

rifaximin tabs 550 mg XIFAXAN 4

streptomycin inj 1 gm STREPTOMYCIN 3

trimethoprim tabs 100 mg PROLOPRIM 4

vancomycin caps 125 mg, 250 mg VANCOCIN 1

Penicillins (Penicilinas)

amoxicillin caps 250 mg, 500 mg, susp 125 mg/5ml, 200 mg/5ml, 250 mg/5ml, 400 mg/5ml, tabs 500 mg, 875 mg

AMOXIL 1

amoxicillin chew tab 125 mg, 250 mg AMOXIL 3

amoxicillin & k clavulanate

chew tab 200-28.5 mg, 400-57 mg, susp 125-31.25 mg/5ml 200- 28.5 mg/5ml, 250-62.5 mg/5ml, 400-57 mg/5ml, 600-42.9 mg/5ml, tabs 250-125 mg, 500-125 mg, 875- 125 mg

AUGMENTIN 1

amoxicillin & k clavulanate sr

tabs 12h 1000-62.5 mg AUGMENTIN XR 4

ampicillin caps 250 mg, 500 mg PRINCIPEN 1

ampicillin susp 125 mg/5ml, 250 mg/5ml AMPICILLIN 3

ampicillin sodium inj 1 gm, 125 mg, 2 gm, 250 mg, 500 mg

AMPICILLIN SODIUM 4

dicloxacillin sodium caps 250 mg, 500 mg DICLOXACILLIN SODIUM

4

nafcillin sodium inj 1 gm, 2 gm NAFCILLIN SODIUM 1

nafcillin sodium inj IV soln 1 gm, 2 gm NAFCILLIN SODIUM 3

penicillin g benzathine inj 1200000 unit/2ml, 2400000 unit/4ml, 600000 u/ml

BICILLIN L-A 3

penicillin g benzathine & penicillin g procaine

inj 1200000 unit/2ml, 300000- 900000 u/ml

BICILLIN C-R 3

penicillin g procaine inj 600000 u/ml PENICILLIN G PROCAINE

4

penicillin v potassium soln 125 mg/5ml, 250 mg/5ml, tabs 250 mg, 500 mg

VEETIDS 1

2013-2014 | 25

Medicamentos Drugs



Nivel Level

Inst

Quinolones (Quinolonas)

ciprofloxacin tabs 100 mg, 250 mg, 500 mg, 750 mg

CIPRO 1

ciprofloxacin susp 250 mg/5ml, 500 mg/5ml CIPRO 3

ciprofloxacin sr tabs 24h 1000 mg, 500 mg CIPRO XR 4

levofloxacin tabs 250 mg, 500 mg, 750 mg LEVAQUIN 4

moxifloxacin tabs 400 mg AVELOX 2

norfloxacin tabs 400 mg NOROXIN 4

ofloxacin tabs 200 mg, 300 mg, 400 mg FLOXIN 4

Sulfonamides (Sulfonamidas)

sulfadiazine tabs 500 mg SULFADIAZINE 3

sulfamethoxazole & trimethoprim

susp 200-40 mg/5ml, tabs 400-80 mg, 800-160 mg

SEPTRA 1

Tetracyclines (Tetraciclinas)

demeclocycline tabs 150 mg, 300 mg DECLOMYCIN 1

doxycycline calcium syrup 50 mg/5ml VIBRAMYCIN 4

doxycycline hyclate caps 100 mg, 50 mg, tabs 100 mg VIBRAMYCIN/ VIBRATAB

1

doxycycline hyclate caps 50 mg ORAXYL 3

doxycycline hyclate inj 100 mg, tabs 20 mg DOXYCYCLINE 4

doxycycline hyclate dr caps 100 mg DORYX 4

doxycycline monohydrate susp 25 mg/5ml VIBRAMYCIN 4

doxycycline monohydrate

caps 100 mg, 50 mg, tabs 100 mg, 150 mg, 50 mg, 75 mg

MONODOX 4

minocycline caps 100 mg, 50 mg, 75 mg MINOCIN 1

minocycline tabs 100 mg, 50 mg, 75 mg DYNACIN 4

tetracycline caps 250 mg 500 mg ACHROMYCIN V 1

CANCER (CÁNCER)

Alkylating Agents (Agentes Alquilantes)

altretamine caps 50 mg HEXALEN 3

busulfan tabs 2 mg MYLERAN 3

chlorambucil tabs 2 mg LEUKERAN 3

cyclophosphamide tabs 25 mg, 50 mg CYTOXAN 3

lomustine caps 10 mg, 100 mg, 40 mg CEENU 3

melphalan tabs 2 mg ALKERAN 3

Androgens/Estrogens/Progestins (Andrógenos/Estrógenos/Progestinas)

Androgens (Andrógenos)

fluoxymesterone tabs 10 mg ANDROXY 3

methyltestosterone caps 10 mg ANDROID 4

methyltestosterone tabs 10 mg METHITEST 4

Antiandrogens (Antiandrógenos)

bicalutamide tabs 50 mg CASODEX 1

enzalutamide caps 40 mg XTANDI 4

flutamide caps 125 mg EULEXIN 1

nilutamide tabs 150 mg NILANDRON 3

Antiestrogens (Antiestrógenos)

tamoxifen citrate tabs 10 mg, 20 mg NOLVADEX 1

toremifene citrate tabs 60 mg FARESTON 4

2013-2014 | 26

Medicamentos Drugs



Nivel Level

Inst

Aromatase Inihibitor (Inihibidores de la Aromatasa)

anastrozole tabs 1 mg ARIMIDEX 1

exemestane tabs 25 mg AROMASIN 4

letrozole tabs 2.5 mg FEMARA 1

Progestins (Progestinas)

megestrol acetate susp 40 mg/ml, tabs 20 mg, 40 mg MEGACE 1

Antimetabolites (Antimetabólitos)

mercaptopurine tabs 50 mg PURINETHOL 1

methotrexate tabs 2.5 mg METHOTREXATE 1

methotrexate tabs 10 mg, 15 mg, 2.5 mg, 5 mg, 7.5 mg

TREXALL 3

Immunosuppressives (Inmunosupresores)

azathioprine tabs 50 mg IMURAN 1

mycophenolate mofetil caps 250 mg, tabs 500 mg CELLCEPT 1

mycophenolate mofetil susp 200 mg/ml CELLCEPT 3


bexarotene caps 75 mg TARGRETIN 4

estramustine phosphate caps 140 mg EMCYT 3

etoposide caps 50 mg VEPESID 3

hydroxyurea caps 500 mg HYDREA 1

hydroxyurea caps 200 mg, 300 mg, 400 mg DROXIA 3

leuprolide inj 5 mg/ml LUPRON 1 PA SL

leuprolide inj 11.25 mg, 15 mg, 22.5 mg, 3.75 mg, 30 mg, 7.5 mg

LUPRON DEPOT 3 PA SL

mitotane tabs 500 mg LYSODREN 3

procarbazine hcl caps 50 mg MATULANE 3

tretinoin caps 10 mg VESANOID 1

CARDIOVASCULARS (CARDIOVASCULARES)

Antiarrhythmics (Antiarrítmicos)

amiodarone tabs 200 mg CORDARONE 1

amiodarone tabs 100 mg PACERONE 3

amiodarone tabs 400 mg CORDARONE 4

disopyramide caps 100 mg, 150 mg NORPACE 1

disopyramide sr caps 12h 100 mg, 150 mg NORPACE CR 3

flecainide tabs 100 mg, 150 mg, 50 mg TAMBOCOR 1

mexiletine caps 150 mg, 200 mg, 250 mg MEXILETINE 3

propafenone tabs 150 mg, 225 mg, 300 mg RYTHMOL 1

propafenone sr caps 12h 225 mg, 325 mg, 425 mg RYTHMOL SR 4

quinidine gluconate cr tabs 324 mg QUINAGLUTE 1

quinidine sulfate tabs 200 mg, 300 mg QUINIDINE SULFATE 4

quinidine sulfate cr tabs 300 mg QUINIDINE SULFATE CR

4

sotalol tabs 120 mg, 160 mg, 240 mg, 80 mg

BETAPACE/BETAPACE AF

1

Antihyperlipidemics (Antihiperlipidémicos)

atorvastatin tabs 10 mg, 20 mg, 40 mg, 80 mg LIPITOR 1

cholestyramine pack 4 gm, powder 4 gm/dose QUESTRAN 1

choline fenofibrate caps dr 135 mg, 45 mg TRILIPIX 3

2013-2014 | 27

Medicamentos Drugs



Nivel Level

Inst

colesevelam pack 3.75 gm, tabs 625 mg WELCHOL 3

colestipol granules 5 gm, tabs 1 gm COLESTID 1

ezetimibe tabs 10 mg ZETIA 2

ezetimibe & simvastatin tabs 10-10 mg, 10-20 mg, 10-40 mg VYTORIN 2

ezetimibe & simvastatin tabs 10-80 mg VYTORIN 2 PA

fenofibrate caps 134 mg, 200 mg, 67 mg, tabs 160 mg, 54 mg

LOFIBRA 1

fenofibrate tabs 145 mg, 48 mg, 160 mg TRICOR 1

fenofibrate tabs 160 mg, 50 mg TRIGLIDE 4

fluvastatin sodium caps 20 mg, 40 mg LESCOL 4

fluvastatin sr tabs 24h 80 mg LESCOL XL 4

gemfibrozil tabs 600 mg LOPID 1

icosapent ethyl caps 1 gm VASCEPA 3

lovastatin tabs 10 mg, 20 mg, 40 mg MEVACOR 4

lovastatin & niacin sr tabs 24h 20-1000 mg, 20-500 mg, 20-750 mg, 40-1000 mg

ADVICOR 4

lovastatin sr tabs 24h 20 mg ALTOPREV 4

niacin & simvastatin sr tab 24 hr 1000-20 mg, 1000-40 mg, 500-20 mg, 500-40 mg, 750-20 mg

SIMCOR 4

niacin cr tabs 1000 mg, 500 mg, 750 mg NIASPAN 2

omega-3-acid ethyl esters

caps 1 gm LOVAZA 3

pravastatin tabs 10 mg, 20 mg, 40 mg, 80 mg PRAVACHOL 1

rosuvastatin tabs 10 mg, 20 mg, 40 mg, 5 mg CRESTOR 2

simvastatin tabs 10 mg, 20 mg, 40 mg, 5 mg ZOCOR 1

simvastatin tabs 80 mg ZOCOR 1 PA

Antihypertensives (Antihipertensivos)

ACE Inhibitors (Inhibidores de la Enzima Convertidora de Angiotensina)

benazepril tabs 10 mg, 20 mg, 40 mg, 5 mg LOTENSIN 1

captopril tabs 100 mg, 12.5 mg, 25 mg, 50 mg CAPOTEN 1

enalapril tabs 10 mg, 2.5 mg, 20 mg, 5 mg VASOTEC 1

fosinopril tabs 10 mg, 20 mg, 40 mg MONOPRIL 1

lisinopril tabs 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg

PRINIVIL / ZESTRIL 1

moexipril tabs 15 mg, 7.5 mg UNIVASC 4

perindopril tabs 2 mg, 4 mg, 8 mg ACEON 4

quinapril tabs 10 mg, 20 mg, 40 mg, 5 mg ACCUPRIL 1

ramipril caps 1.25 mg, 10 mg, 2.5 mg, 5 mg ALTACE 4

trandolapril tabs 1 mg, 2 mg, 4 mg MAVIK 4

Alpha-Adrenergic Receptor Blockers (Bloqueadores del Receptor Alfa-Adrenérgico)

doxazosin tabs 1 mg, 2 mg, 4 mg, 8 mg CARDURA 1

prazosin caps 1 mg, 2 mg, 5 mg MINIPRESS 1

terazosin caps 1 mg, 10 mg, 2 mg, 5 mg HYTRIN 1

Angiotensin Receptor Blockers (ARBs) (Bloqueadores del Receptor de la Angiotensina)

candesartan tabs 16 mg, 32 mg, 4 mg, 8 mg ATACAND 4

eprosartan tabs 400mg, 600 mg TEVETEN 4

irbesartan tabs 150 mg, 300 mg, 75 mg AVAPRO 1

losartan tabs 100 mg, 25 mg, 50 mg COZAAR 1

2013-2014 | 28

Medicamentos Drugs



Nivel Level

Inst

olmesartan tabs 20 mg, 40 mg, 5 mg BENICAR 4

telmisartan tabs 20 mg, 40 mg, 80 mg MICARDIS 3

valsartan tabs 160 mg, 320 mg, 40 mg, 80 mg DIOVAN 2

Beta Blockers (Bloqueadores Beta)

acebutolol caps 200 mg, 400 mg SECTRAL 4

atenolol tabs 100 mg, 25 mg, 50 mg TENORMIN 1

betaxolol tabs 10 mg, 20 mg KERLONE 4

bisoprolol tabs 10 mg, 5 mg ZEBETA 4

carvedilol tabs 12.5 mg, 25 mg, 3.125 mg, 6.25 mg

COREG 1

labetalol tabs 100 mg, 200 mg, 300 mg NORMODYNE 4

metoprolol succinate sr tabs 24h 100 mg, 200 mg, 25 mg, 50 mg

TOPROL XL 1

metoprolol tartrate tabs 100 mg, 25 mg, 50 mg LOPRESSOR 1

nadolol tabs 20 mg, 40 mg, 80 mg CORGARD 4

penbutolol tabs 20 mg LEVATOL 4

pindolol tabs 10 mg, 5 mg VISKEN 4

propranolol tabs 10 mg, 20 mg, 40 mg, 60 mg, 80 mg

INDERAL 1

propranolol soln 20 mg/5ml, 40 mg/5ml INDERAL 3

propranolol sr caps 24h 120 mg, 160 mg, 60 mg, 80 mg

INDERAL LA 1

timolol tabs 10 mg, 20 mg, 5 mg BLOCADREN 4

Calcium Channel Blockers (Antagonistas de los Canales de Calcio)

amlodipine tabs 10 mg, 2.5 mg, 5 mg NORVASC 1

diltiazem tabs 120 mg, 30 mg, 60 mg, 90 mg CARDIZEM 1

diltiazem er beads caps 24h 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg

TIAZAC ER 1

diltiazem sr caps 12h 120 mg, 60 mg, 90 mg, caps 24h 120 mg, 180 mg, 240 mg

CARDIZEM SR 1

diltiazem sr coated beads

caps 24h 120 mg, 180 mg, 240 mg, 300 mg, 360 mg

CARDIZEM CD 1

felodipine sr tabs 24h 10 mg, 2.5 mg, 5 mg PLENDIL 1

isradipine caps 2.5 mg 5 mg DYNACIRC 1

isradipine sr tabs 24h 10 mg, 5 mg DYNACIRC-CR 4

nicardipine caps 20 mg, 30 mg CARDENE 1

nicardipine sr caps 12h 30 mg, 45 mg, 60 mg CARDENE SR 4

nifedipine caps 10 mg, 20 mg PROCARDIA 4

nifedipine sr tabs 24h 30 mg, 60 mg, 90 mg ADALAT CC / PROCARDIA XL

1

nimodipine caps 30 mg NIMOTOP 4

nisoldipine sr tabs 24h 20 mg, 30 mg, 40 mg SULAR 3

verapamil tabs 120 mg, 40 mg 80 mg CALAN 1

verapamil cr tabs 120 mg, 180 mg, 240 mg CALAN SR / ISOPTIN SR

1

verapamil sr caps 24h 120 mg, 180 mg, 240 mg, 360 mg

VERELAN 1

verapamil sr tabs 24h 180 mg, 240 mg COVERA-HS 4

2013-2014 | 29

Medicamentos Drugs



Nivel Level

Inst

verapamil sr caps 24h 100 mg, 200 mg, 300 mg VERELAN PM 4

Centrally Acting Antiadrenergics (Antiadrenérgicos de Acción Central)

clonidine tabs 0.1 mg, 0.2 mg, 0.3 mg, weekly patch 0.1 mg/24hr, 0.2 mg/24hr, 0.3 mg/24hr

CATAPRES 1

guanabenz tabs 4 mg, 8 mg WYTENSIN 4

guanfacine tabs 1 mg, 2 mg TENEX 4

methyldopa tabs 250 mg, 500 mg ALDOMET 1

midodrine tabs 10 mg, 2.5 mg, 5 mg PROAMATINE 4

reserpine tabs 0.1mg, 0.25 mg RESERPINE 4

Combinations (Combinaciones)

amlodipine & atorvastatin tabs 10-10 mg, 10-20 mg, 10-40 mg, 10-80 mg, 2.5-10 mg, 2.5-20 mg, 2.5-40 mg, 5-10 mg, 5-20 mg, 5- 40 mg, 5-80 mg

CADUET 4

amlodipine & benazepril

caps 10-20 mg, 10-40 mg, 2.5- 10 mg, 5-10 mg, 5-20 mg, 5-40 mg

LOTREL 4

amlodipine & olmesartan tabs 10-20 mg, 10-40 mg, 5-20 mg, 5-40 mg

AZOR 2

amlodipine & valsartan tabs 10-160 mg, 10-320 mg, 5-160 mg, 5-320 mg

EXFORGE 4

amlodipine & valsartan & hydrochlorthiazide

tabs 10-160-12.5 mg, 10-160-25 mg, 10-320-25 mg, 5-160-12.5 mg, 5-160-25 mg

EXFORGE HCT 4

atenolol & chlorthalidone

tabs 100-25 mg, 50-25 mg TENORETIC 4

benazepril & hydrochlorothiazide

tabs 10-12.5 mg, 20-12.5 mg, 20-25 mg, 5-6.25 mg

LOTENSIN HCT 4

bisoprolol & hydrochlorothiazide

tabs 10-6.25 mg, 2.5-6.25 mg, 5-6.25 mg

ZIAC 4

candesartan & hydrochlorothiazide

tabs 16-12.5 mg, 32-12.5 mg, 32-25 mg

ATACAND HCT 4

captopril & hydrochlorothiazide

tabs 25-25 mg, 50-25 mg tabs, 25-15 mg, 50-15 mg

CAPOZIDE 1

clonidine & chlorthalidone tabs 0.1-15 mg, 0.2-15 mg, 0.3-15 mg

CLORPRES 4

enalapril & hydrochlorothiazide

tabs 10-25 mg, 5-12.5 mg VASERETIC 4

eprosartan & hydrochlorothiazide

tabs 600-12.5 mg, 600-25 mg TEVETEN HCT 4

fosinopril & hydrochlorothiazide

tabs 10-12.5 mg, 20-12.5 mg MONOPRIL HCT 4

irbesartan & hydrochlorothiazide

tabs 150-12.5 mg, 300-12.5 mg AVALIDE 1

lisinopril & hydrochlorothiazide

tabs 10-12.5 mg, 20-12.5 mg, 20-25 mg

PRINZIDE / ZESTORETIC

1

losartan & hydrochlorothiazide

tabs 100-12.5 mg, 100-25 mg, 50-12.5 mg

HYZAAR 1

methyldopa & hydrochlorothiazide

tabs 250-15 mg, 250-25 mg ALDORIL 4

2013-2014 | 30

Medicamentos Drugs



Nivel Level

Inst

metoprolol tartrate & hydrochlorothiazide

tabs 100-50 mg, tabs 100-25 mg, 50-25 mg

LOPRESSOR HCT 1

moexipril & hydrochlorothiazide

tabs 15-12.5 mg, 15-25 mg, 7.5-12.5 mg

UNIRETIC 4

nadolol & bendroflumethiazide

tabs 5-40 mg, 5-80 mg CORZIDE 4

olmesartan & hydrochlorothiazide

tabs 20-12.5 mg, 40-12.5 mg, 40-25 mg

BENICAR HCT 4

propranolol & hydrochlorothiazide

tabs 40-25 mg, 80-25 mg INDERIDE 4

quinapril & hydrochlorothiazide

tabs 10-12.5 mg, 20-12.5 mg, 20-25 mg

ACCURETIC 4

telmisartan & hydrochlorothiazide

tabs 40-12.5 mg, 80-12.5 mg, 80-25 mg

MICARDIS HCT 3

trandolapril & verapamil cr

tabs 1-240 mg, 2-180 mg, 2-240 mg, 4-240 mg

TARKA 2

valsartan & hydrochlorothiazide

tabs 160-12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg

DIOVAN HCT 1

Diuretics (Diuréticos)

Carbonic Anhydrase Inhibitors (Inhibidores de la Anhidrasa Carbónica)

acetazolamide tabs 125mg, 250 mg DIAMOX 1

acetazolamide sr caps 12h 500 mg DIAMOX SR 1

methazolamide tabs 25 mg, 50 mg NEPTAZANE 1

Loop Diuretics (Diuréticos del Asa de Henle)

bumetanide tabs 0.5 mg, 1 mg, 2 mg BUMEX 1

ethacrynic acid tabs 25 mg EDECRIN 4

furosemide soln 10 mg/ml, tabs 20 mg, 40 mg, 80 mg

LASIX 1

furosemide soln 8 mg/ml LASIX 3

furosemide inj 10 mg/ml LASIX 4

torsemide tabs 10 mg, 100 mg, 20 mg, 5 mg DEMADEX 4


eplerenone tabs 25 mg, 50 mg INSPRA 1

indapamide tabs 1.25 mg, 2.5 mg LOZOL 1

Potassium Sparing/Combinations (Conservadores de Potasio/Combinaciones)

amiloride tabs 5 mg MIDAMOR 1

amiloride & hydrochlorothiazide

tabs 5-50 mg MODURETIC 1

spironolactone tabs 100 mg, 25 mg, 50 mg ALDACTONE 1

spironolactone & hydrochlorothiazide

tabs 25-25 mg, 50-50 mg ALDACTAZIDE 1

triamterene caps 100 mg, 50 mg DYRENIUM 4

triamterene & hydrochlorothiazide

caps 37.5-25 mg, tabs 37.5-25 mg, 50-75 mg

DYAZIDE/MAXZIDE 1

Thiazides (Tiazidas)

chlorothiazide tabs 250 mg, 500 mg DIURIL 1

chlorothiazide susp 250 mg/5ml DIURIL 4

chlorthalidone tabs 25 mg CHLORTHALIDONE 1

chlorthalidone tabs 100mg, 15 mg, 50 mg THALITONE 3

2013-2014 | 31

Medicamentos Drugs



Nivel Level

Inst

hydrochlorothiazide tabs 12.5 mg, 25 mg, 50 mg HYDROCHLOROTHIAZIDE

1

hydrochlorothiazide caps 12.5 mg HYDRODIURIL 4

methyclothiazide tabs 5 mg METHYCLOTHIAZIDE 4

metolazone tabs 10 mg, 2.5 mg, 5 mg ZAROXOLYN 1

Vasodilators (Vasodilatores)

hydralazine tabs 10 mg, 100 mg, 25 mg, 50 mg APRESOLINE 1

isosorbide dinitrate tabs 10 mg, 20 mg, 30 mg, 5 mg ISORDIL 1

isosorbide dinitrate subl 2.5 mg, 5 mg, tabs 40 mg ISORDIL 3

isosorbide dinitrate cr tabs 40 mg ISORDIL 1

isosorbide dinitrate cr caps 40 mg DILATRATE SR 3

isosorbide mononitrate tabs 10 mg, 20 mg ISMO / MONOKET 1

isosorbide mononitrate sr

tabs 24h 120 mg, 30 mg, 60 mg IMDUR 1

isoxsuprine tabs 10 mg VASODILAN 4

minoxidil tabs 10 mg, 2.5 mg LONITEN 1

nitroglycerin topical oint 2 % NITRO-BID 3

nitroglycerin 24h patch 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr

NITRO-DUR 1

nitroglycerin 24h patch 0.3 mg/hr, 0.8 mg/hr, subl 0.3 mg, 0.4 mg, topical oint 2 %

NITRO-DUR 3

nitroglycerin subl 0.6 mg NITROSTAT 1

nitroglycerin subl 0.3 mg, 0.4 mg NITROSTAT 3

nitroglycerin translingual spray 0.4 mg/spray NITROLINGUAL PUMPSPRAY

4

nitroglycerin cr caps 2.5 mg, 6.5 mg, 9 mg NITRO-TIME 4

papaverine hcl caps 150mg PAPAVERINE 4

ranolazine sr tabs 12h 1000 mg, 500 mg RANEXA 3 PA SL

Glycosides (Glicósidos)

digoxin tabs 0.125 mg, 0.25 mg LANOXIN 1

digoxin soln 0.05 mg/ml DIGOXIN 3

CENTRAL NERVOUS SYSTEM (SISTEMA NERVIOSO CENTRAL)

Alzheimer (Alzheimer)

donepezil odt 10 mg, 5 mg, tabs 10 mg, 5 mg ARICEPT 1

galantamine soln 4 mg/ml, tabs 12mg, 4 mg, 8 mg RAZADYNE 4

galantamine sr caps 24h 16 mg, 24 mg, 8 mg RAZADYNE ER 1

memantine soln 2 mg/ml, tabs 10 mg, 5 mg, 5&10 mg pack

NAMENDA 2

rivastigmine caps 1.5 mg, 3 mg, 4.5 mg, 6 mg EXELON 1

rivastigmine 24h patch 13.3 mg/24hr, 4.6 mg/24hr, 9.5 mg/24hr

EXELON 2

rivastigmine soln 2 mg/ml EXELON 3

Analgesics/Narcotics/Combinations (Analgésicos/Narcóticos/Combinaciones)

acetaminophen & butalbital & caffeine & codeine

caps 325-50-40-30 mg FIORICET/CODEINE 4

acetaminophen & caffeine & dihydrocodeine

caps 356.4-30-16 mg, tabs 712.8-60-32 mg

PANLOR 4

2013-2014 | 32

Medicamentos Drugs



Nivel Level

Inst

acetaminophen & codeine

soln 120-12 mg/5ml, tabs 300- 15 mg, 300-30 mg, 300-60 mg

TYLENOL/CODEINE 1


susp 120-12 mg/5ml CAPITAL/CODEINE 3


tabs 650-30 mg VOPAC 4

acetaminophen & hydrocodone

caps 500-5 mg, soln 500- 7.5 mg/15ml, tabs 325-10 mg, 325- 5 mg, 325-7.5 mg, 500-10 mg, 500-2.5 mg, 500-5 mg, 500-7.5 mg, 650-10 mg, 650-7.5 mg, 660-10 mg, 750-10 mg, 750-7.5 mg

LORTAB/VICODIN 1

acetaminophen & hydrocodone

tabs 400-10 mg, 400-5 mg, 400-7.5 mg

ZYDONE 3

acetaminophen & oxycodone

caps 500-5 mg, tabs 325-10 mg, 325-2.5 mg, 325-5 mg, 325-7.5 mg, 500-7.5 mg, 650-10 mg

PERCOCET 1

acetaminophen & oxycodone

soln 325-5 mg/5ml, tabs 500-10 mg, 500-5 mg

ROXICET 4

acetaminophen & tramadol

tabs 325-37.5 mg ULTRACET 4

aspirin & butalbital & caffeine & codeine

caps 325-50-40-30 mg FIORINAL/CODEINE 1

aspirin & meprobamate tabs 325-200 mg EQUAGESIC 4

butalbital & acetaminophen

tabs 50-325 mg PHRENILIN 1


caps 50-650 mg, tabs 50-650 mg PHRENILIN 3

butalbital & acetaminophen & caffeine

caps 50-325-40 mg, 50-500-40 mg, tabs 50-325-40 mg, 50-500-40 mg

FIORICET 1

butalbital & aspirin & caffeine

caps 50-325-40 mg, tabs 50-325- 40 mg

FIORINAL 1

codeine tabs 30 mg, 60 mg CODEINE 3

codeine phosphate inj 15 mg/ml CODEINE PHOSPHATE

4

codeine sulfate tabs 15 mg CODEINE SULFATE 3

fentanyl 72h patch 100 mcg/hr, 12.5 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr

DURAGESIC 1

fentanyl tabs 100 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg

FENTORA 4

fentanyl lollipop 1200 mcg, 1600 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg

ACTIQ 4

fentanyl citrate inj 0.05 mg/ml FENTANYL 4

hydrocodone & ibuprofen

tabs 5-200 mg VICOPROFEN 1

hydrocodone & ibuprofen

tabs 10-200 mg, 7.5-200 mg IBUDONE 4

2013-2014 | 33

Medicamentos Drugs



Nivel Level

Inst

hydromorphone inj 1 mg/ml, 10 mg/ml, 2 mg/ml, 4 mg/ml, liq 1 mg/ml, tabs 2 mg, 4 mg, 8 mg

DILAUDID 1

hydromorphone rectal supp 3 mg DILAUDID 3

levorphanol tabs 2 mg LEVORPHANOL 4

meperidine inj 10 mg/ml, 100 mg/ml, 25 mg/ml, 50 mg/ml, tabs 100 mg, 50 mg, 100 mg/2ml , 25 mg/0.5ml , 75 mg/1.5ml , 75 mg/ml, soln 50 mg/5ml

DEMEROL 1

methadone conc 10 mg/ml, soln 10 mg/5ml, 5 mg/5ml, tabs 10 mg, 5 mg

METHADONE 1

methadone inj 10 mg/ml METHADONE 3

morphine inj 0.5 mg/ml, 1 mg/ml, 10 mg/ml, 15 mg/ml, 8 mg/ml, soln 10 mg/5ml, 20 mg/5ml, 20 mg/ml, rectal supp 10 mg, 20 mg, 5 mg

MORPHINE SULFATE 1

morphine inj 1 mg/ml, 2 mg/ml, 25 mg/ml, 4 mg/ml, 5 mg/ml, 50 mg/ml, inj 8 mg/ml, rectal supp 30 mg, tabs 15 mg, 30 mg

MORPHINE SULFATE 3

morphine beads sr caps 24h 120 mg, 30 mg, 60 mg, 90 mg

AVINZA 4

morphine sr tabs 12h 100 mg, 15 mg, 200 mg, 30 mg, 60 mg

MS CONTIN 1

morphine sr caps 24h 10 mg, 100 mg, 130 mg, 20 mg, 200 mg, 30 mg, 50 mg, 60 mg, 70mg, 80 mg

KADIAN SR 4

oxycodone caps 5 mg ROXICODONE 1

oxycodone conc 20 mg/ml OXYCODONE 1

oxycodone tabs 10 mg, 15 mg, 30 mg, 5 mg, 20 mg, soln 5 mg/5ml

ROXICODONE 4

oxycodone sr tabs 12h 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg

OXYCONTIN 4

oxymorphone inj 1 mg/ml OPANA 4

oxymorphone tabs 10 mg, 5 mg OPANA 4

oxymorphone sr tabs 12h 10 mg, 15 mg, 20 mg, 30 mg, tabs 12h 30 mg, 40 mg, 5 mg, 7.5 mg

OPANA ER 4

tramadol tabs 50 mg ULTRAM 4

Antianxiety/Hypnotics (Ansiolíticos/Hipnóticos)

alprazolam tabs 0.25 mg, 0.5 mg, 1 mg, 2 mg XANAX 1

alprazolam sr tabs 24h 0.5 mg, 1 mg, 2 mg, 3 mg XANAX XR 4

buspirone tabs 7.5 mg, 10 mg, 15 mg, 30 mg, 5 mg

BUSPAR 1

chloral hydrate caps 500 mg, syrup 500 mg/5ml SOMNOTE 4

chlordiazepoxide caps 10 mg, 25 mg, 5 mg LIBRIUM 1

clorazepate tabs 15 mg, 3.75 mg, 7.5 mg TRANXENE T 1

diazepam tabs 10 mg, 2 mg, 5 mg VALIUM 1

diazepam inj 5 mg/ml VALIUM 3

estazolam tabs 1 mg, 2 mg PROSOM 4

2013-2014 | 34

Medicamentos Drugs



Nivel Level

Inst

flurazepam caps 15 mg, 30 mg DALMANE 1

hydroxyzine hydrochloride

inj 25 mg/ml, 50 mg/ml VISTARIL 4

hydroxyzine pamoate caps 25 mg, 50 mg, 100 mg

VISTARIL 4

lorazepam inj 2 mg/ml, 4 mg/ml, tabs 0.5 mg, 1 mg, 2 mg

ATIVAN 1

meprobamate tabs 200 mg, 400 mg EQUANIL 4

midazolam inj 10 mg/10ml , 10 mg/2ml , 2 mg/2ml , 25 mg/5ml , 5 mg/5ml , 5 mg/ml, 50 mg/10ml , syrup 2 mg/ml

VERSED 4

oxazepam caps 10 mg, 15 mg, 30 mg SERAX 1

quazepam tabs 15 mg DORAL 4

temazepam caps 15 mg, 30 mg, 7.5 mg, 22.5 mg RESTORIL 1

triazolam tabs 0.125 mg, 0.25 mg HALCION 4

zaleplon caps 10 mg, 5 mg SONATA 4

zolpidem tabs 10 mg, 5 mg AMBIEN 1

zolpidem tartrate tabs 12.5 mg, 6.25 mg AMBIEN CR 4

Anticonvulsants (Anticonvulsivos)

carbamazepine chew tab 100 mg, susp 100 mg/5ml, tabs 200 mg

TEGRETOL 1

carbamazepine sr tabs 12h 100 mg, 200 mg, 400 mg TEGRETOL XR 1

carbamazepine sr caps 12h 100 mg, 200 mg, 300 mg CARBATROL SR 4

clonazepam tabs 0.5 mg, 1 mg, 2 mg KLONOPIN 1

clonazepam odt 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg

KLONOPIN 4

diazepam rectal gel 10 mg, 2.5 mg, 20 mg DIASTAT 4

divalproex sprinkle caps 125 mg DEPAKOTE 1

divalproex dr tabs 125 mg, 250 mg, 500 mg DEPAKOTE EC 1

divalproex sr tabs 24h 250 mg, 500 mg DEPAKOTE ER 1

ethosuximide caps 250 mg, soln 250 mg/5ml ZARONTIN 1

ethotoin tabs 250 mg PEGANONE 3

ezogabine tabs 200 mg, 300 mg, 400 mg, 50 mg

POTIGA 4 SL

felbamate susp 600 mg/5ml, tabs 400 mg, 600 mg

FELBATOL 1

gabapentin caps 100 mg, 300 mg, 400 mg, soln 250 mg/5ml, tabs 600 mg, 800 mg

NEURONTIN 1

lacosamide soln 10 mg/ml, tabs 100 mg, 150 mg, 200 mg, 50 mg

VIMPAT 4 AL, PA SL

lamotrigine odt 25 mg, 5 mg, tabs 100 mg, 150 mg, 200 mg, 25 mg

LAMICTAL 1

lamotrigine kit 25 mg, 25&100 mg, 25&100 mg LAMICTAL 3

levetiracetam soln 100 mg/ml, tabs 1000 mg, 250 mg, 500 mg, 750 mg

KEPPRA 1

methsuximide

caps 300 mg CELONTIN 3

oxcarbazepine susp 300 mg/5ml, tabs 150 mg, 300 mg, 600 mg

TRILEPTAL 1

2013-2014 | 35

Medicamentos Drugs



Nivel Level

Inst

phenobarbital elixir 20 mg/5ml, tabs 100 mg, 15 mg, 16.2 mg, 30 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg

PHENOBARBITAL 1

phenytoin caps 30 mg,100 mg, 200 mg, 300 mg, chew tab 50 mg, susp 125 mg/5ml

DILANTIN 1

phenytoin inj 50 mg/ml DILANTIN 4

pregabalin caps 100 mg, 150 mg, 200 mg, 225 mg, 25 mg, 300 mg, 50 mg, 75 mg, soln 20 mg/ml

LYRICA 3

primidone tabs 250 mg, 50 mg MYSOLINE 1

rufinamide susp 40 mg/ml, tabs 200 mg, 400 mg BANZEL 4 PA,SL

tiagabine tabs 2 mg, 4 mg, 12 mg, 16 mg GABITRIL 1

topiramate sprinkle caps 15 mg, 25 mg, tabs 100 mg, 200 mg, 25 mg, 50 mg

TOPAMAX 1

valproate sodium syrup 250 mg/5ml DEPAKENE 1

valproate sodium inj 100 mg/ml DEPACON 4

valproic acid caps 250 mg DEPAKENE 1

zonisamide caps 100 mg, 25 mg, 50 mg ZONEGRAN 1

Antiparkinsons (Antiparkinson)

Anticholinergics (Anticolinérgicos)

benztropine tabs 0.5 mg, 1 mg, 2 mg COGENTIN 1

trihexyphenidyl elixir 0.4 mg/ml, tabs 2 mg, 5 mg ARTANE 1

COMT Inhibitors (Inhibidores de COMT)

entacapone tabs 200 mg COMTAN 1

Dopamine Receptor Agonists (Agonistas del Receptor de Dopamina)

pramipexole tabs 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg

MIRAPEX 1

ropinirole tabs 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg

REQUIP 1

rotigotine 24h patch 1 mg/24hr, 2 mg/24hr, 3 mg/24hr, 4 mg/24hr, 6 mg/24hr, 8 mg/24hr

NEUPRO 3

Dopaminergics (Dopaminérgicos)

bromocriptine tabs 2.5 mg PARLODEL 1

bromocriptine caps 5 mg PARLODEL 4

carbidopa tabs 25 mg LODOSYN 4

carbidopa & levodopa tabs 10-100 mg, 25-100 mg, 25-250 mg

SINEMET 1

carbidopa & levodopa cr

tabs 25-100 mg, 50-200 mg SINEMET CR 1

selegiline caps 5 mg, tabs 5 mg ELDEPRYL 4

Dopaminergics - COMT Inhibitors (Dopaminérgicos - Inhibidores de COMT)

carbidopa & entacapone & levodopa

tabs 12.5-50-200 mg, 18.75-75- 200 mg, 25-100-200 mg, 31.25-125-200 mg, 37.5-150-200 mg, 50-200-200 mg

STALEVO 3


amantadine caps 100 mg, syrup 50 mg/5ml SYMMETREL 1

2013-2014 | 36

Medicamentos Drugs



Nivel Level

Inst

amantadine tabs 100 mg AMANTADINE 3

Antivertigo/Antiemetic (Antivértigo/Antieméticos)

aprepitant caps 125 mg, 80 mg, pack 80& 125 mg

EMEND 3 PA, QL,SL

dolasetron inj 20 mg/ml, tabs 100 mg, 50 mg ANZEMET 4

dronabinol caps 10 mg, 2.5 mg, 5 mg MARINOL 4

granisetron tabs 1 mg KYTRIL 4

meclizine tabs 12.5 mg, 25 mg, 50 mg ANTIVERT 1

meclizine tabs 32 mg VERTIN-32 4

ondansetron odt 4 mg, 8 mg, tabs 24 mg, 4 mg, 8 mg

ZOFRAN 1

ondansetron inj 4 mg/2ml, soln 4 mg/5ml ZOFRAN 4

prochlorperazine rectal supp 25 mg, tabs 10 mg, 5 mg COMPAZINE 1

promethazine inj 25 mg/ml, 50 mg/ml, rectal supp 12.5 mg, 25 mg, syrup 6.25 mg/5ml, tabs 12.5 mg, 25 mg, 50 mg, rectal supp 50 mg

PHENERGAN 1

scopolamine 72h patch 1.5 mg TRANSDERM-SCOP 4

trimethobenzamide caps 300 mg, inj 100 mg/ml TIGAN 1

Migraine (Migraña)

acetaminophen & butalbital & caffeine & codeine

caps 325-50-40-30 mg FIORICET/CODEINE 4

almotriptan tabs 12.5 mg, 6.25 mg AXERT 4 QL

apap & isometheptene & caffeine

caps 325-65-100 mg MIGRALAM 4

apap & isometheptene & dichloral

caps 325-65-100 mg MIDRIN 4

aspirin & butalbital & caffeine & codeine

caps 325-50-40-30 mg FIORINAL/CODEINE 1


tabs 50-325 mg, 50-650 mg PHRENILIN 1


caps 50-650 mg PHRENILIN 3

butalbital & acetaminophen & caffeine

caps 50-325-40 mg, 50-500-40 mg, tabs 50-325-40 mg, 50-500-40 mg

FIORICET 1


tabs 50-325-40 mg BUTALBITAL & ASPIRIN & CAFFEINE

1


caps 50-325-40 mg FIORINAL 1

dihydroergotamine nasal soln 4 mg/ml MIGRANAL 3

dihydroergotamine

inj 1 mg/ml D.H.E. 45 4




eletriptan tabs 20 mg, 40 mg RELPAX 2 QL

ergotamine subl 2 mg ERGOMAR 3

2013-2014 | 37

Medicamentos Drugs



Nivel Level

Inst

ergotamine tartrate & caffeine

tabs 1-100 mg CAFERGOT 1

ergotamine tartrate & caffeine

rectal supp 2-100 mg CAFERGOT 3

frovatriptan tabs 2.5 mg FROVA 4 QL

naratriptan tabs 1 mg, 2.5 mg AMERGE 1 QL

rizatriptan odt 10 mg, 5 mg MAXALT 1 QL

rizatriptan tabs 10 mg, 5 mg MAXALT 3 QL

sumatriptan inj 6 mg/0.5ml, tabs 100 mg, 25 mg, 50 mg

IMITREX 1 QL

sumatriptan nasal soln 20 mg/act, 5 mg/act IMITREX 3 QL

sumatriptan inj 4 mg/0.5ml IMITREX 3 QL

zolmitriptan odt 2.5 mg, 5 mg, tabs 2.5 mg, 5 mg ZOMIG 4 QL


ergoloid mesylates tabs 1 mg HYDERGINE 3

guanidine tabs 125 mg GUANIDINE 4

neostigmine bromide tabs 15 mg PROSTIGMIN 3

pimozide tabs 1 mg, 2 mg ORAP 4

pyridostigmine tabs 60 mg MESTINON 1

pyridostigmine syrup 60 mg/5ml MESTINON 3

pyridostigmine cr tabs 180 mg MESTINON TIMESPAN

3

riluzole tabs 50 mg RILUTEK 4

Psychotropics (Sicotrópicos)

Antidepressants (Antidepresivos)

MAO Inhibitors (Inhibidores de MAO)

isocarboxazid tabs 10 mg MARPLAN 4

phenelzine tabs 15 mg NARDIL 1

tranylcypromine tabs 10 mg PARNATE 1


bupropion tabs 100 mg, 75 mg WELLBUTRIN 1

bupropion sr tabs 12h 100 mg, 150 mg, 200 mg WELLBUTRIN SR 1

bupropion sr tabs 24h 150 mg, 300 mg WELLBUTRIN XL 4

duloxetine ec caps 20 mg, 30 mg, 60 mg CYMBALTA 3

maprotiline tabs 25 mg, 50 mg, 75 mg LUDIOMIL 4

mirtazapine tabs 15 mg, 30 mg, 45 mg, 7.5 mg REMERON 1

mirtazapine odt 15 mg, 30 mg, 45 mg REMERON 4

nefazodone tabs 100 mg, 150 mg, 200 mg, 250 mg, 50 mg

SERZONE 4

trazodone tabs 100 mg, 150 mg, 300 mg, 50 mg

DESYREL 1

venlafaxine tabs 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg

EFFEXOR 1

venlafaxine sr caps 24h 150 mg, 37.5 mg, 75 mg EFFEXOR XR 1

Selective Serotonine Reuptake Inhibitors (SSRIs) (Inhibidores Selectivos de la Recaptación de Serotonina)

citalopram tabs 10 mg, 20 mg, 40 mg CELEXA 1

citalopram

soln 10 mg/5ml CELEXA 4

2013-2014 | 38

Medicamentos Drugs



Nivel Level

Inst

escitalopram soln 5 mg/5ml, tabs 10 mg, 20 mg, 5 mg

LEXAPRO 4

fluoxetine caps 10 mg, 20 mg, 40 mg, soln 20 mg/5ml, tabs 10 mg, 20 mg

PROZAC 1

fluvoxamine tabs 100 mg, 25 mg, 50 mg LUVOX 4

paroxetine hcl tabs 10 mg, 20 mg, 30 mg, 40 mg PAXIL 1

paroxetine hcl susp 10 mg/5ml PAXIL 3

paroxetine hcl sr tabs 24h 12.5 mg, 25 mg, 37.5 mg PAXIL CR 1

sertraline conc 20 mg/ml, tabs 100 mg, 25 mg, 50 mg

ZOLOFT 1

Tricyclics (Tricíclicos)

amitriptyline tabs 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

ELAVIL 1

amoxapine tabs 100 mg, 150 mg, 25 mg, 50 mg AMOXAPINE 4

clomipramine caps 25 mg, 50 mg, 75 mg ANAFRANIL 1

desipramine tabs 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

NORPRAMIN 1

doxepin caps 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

SINEQUAN 1

imipramine hydrochloride

tabs 10 mg, 25 mg, 50 mg TOFRANIL 1

imipramine pamoate caps 100 mg, 125 mg, 150 mg, 75 mg

TOFRANIL-PM 4

nortriptyline caps 10 mg, 25 mg, 50 mg, 75 mg PAMELOR 1

nortriptyline soln 10 mg/5ml PAMELOR 3

protriptyline tabs 10 mg, 5 mg VIVACTIL 4

trimipramine caps 100 mg, 25 mg, 50 mg SURMONTIL 4

Antipsychotics (Antisicóticos)

Atypicals (Atípicos)

aripiprazole tabs 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg

ABILIFY 2

clozapine tabs 100 mg, 25 mg, 50 mg CLOZARIL 1

olanzapine odt 10 mg, 15 mg, 20 mg, 5 mg, tabs 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg

ZYPREXA 1

quetiapine tabs 100 mg, 200 mg, 25 mg, 300 mg, 400 mg, 50 mg

SEROQUEL 1

quetiapine fumarate tabs 24h 150 mg, 200 mg, 300 mg, 400 mg, 50 mg

SEROQUEL XR 4 ST

risperidone odt 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, soln 1 mg/ml, tabs 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg

RISPERDAL 1

risperidone inj 12.5 mg, 25 mg, 37.5 mg, 50 mg RISPERDAL CONSTA 4

ziprasidone caps 20 mg, 40 mg, 60 mg, 80 mg GEODON 1

Butyrophenones (Butirofenonas)

haloperidol tabs 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg

HALDOL 1

2013-2014 | 39

Medicamentos Drugs



Nivel Level

Inst

haloperidol decanoate inj 100 mg/ml, 50 mg/ml HALDOL DECANOATE

1

haloperidol lactate conc 2 mg/ml HALDOL 1

haloperidol lactate inj 5 mg/ml HALDOL 4


loxapine caps 10 mg, 25 mg, 5 mg, 50 mg LOXITANE 1

thiothixene caps 1 mg, 10 mg, 2 mg, 5 mg, 20 mg

NAVANE 1

Phenothiazines (Fenotiazinas)

chlorpromazine tabs 10 mg, 100 mg, 200 mg, 25 mg, 50 mg

THORAZINE 1

chlorpromazine inj 25 mg/ml THORAZINE 4

fluphenazine tabs 1 mg, 10 mg, 2.5 mg, 5 mg PROLIXIN 1

fluphenazine conc 5 mg/ml, elixir 2.5 mg/5ml FLUPHENAZINE 3

fluphenazine decanoate inj 25 mg/ml FLUPHENAZINE 3

perphenazine tabs 16 mg, 2 mg, 4 mg, 8 mg TRILAFON 4

thioridazine tabs 10 mg, 100 mg, 25 mg, 50 mg MELLARIL 4

trifluoperazine tabs 1 mg, 10 mg, 2 mg, 5 mg STELAZINE 1

Attention Deficit and Hyperactivity (Déficit de Atención e Hiperactividad)

amphetamine & dextroamphetamine

tabs 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg

ADDERALL 1

amphetamine & dextroamphetamine sr

caps 24h 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 5 mg

ADDERALL XR 1

atomoxetine caps 10 mg, 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg

STRATTERA 4 PA ST AL

dexmethylphenidate tabs 10 mg, 2.5 mg, 5 mg FOCALIN 1

dexmethylphenidate sr caps 24h 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 5 mg

FOCALIN XR 2

dextroamphetamine sr caps 24h 10 mg, 15 mg, 5 mg DEXEDRINE SR 4

dextroamphetamine sulfate

tabs 5 mg, 10 mg DEXTROSTAT 1

lisdexamfetamine dimesylate

caps 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg

VYVANSE 2

methamphetamine tabs 5 mg DESOXYN 4

methylphenidate tabs 10 mg, 20 mg, 5 mg RITALIN 1

methylphenidate cr caps 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, tabs 20 mg

METADATE CD 1

methylphenidate cr tabs 20 mg RITALIN SR/METADATE ER

1

methylphenidate cr tabs 10 mg RITALIN SR/METADATE ER

3

methylphenidate sa tabs 18 mg, 27 mg, 36 mg, 54 mg CONCERTA 1

methylphenidate sr caps 24h 10 mg, 20 mg, 30 mg, 40 mg

RITALIN LA 1

modafinil tabs 100 mg, 200 mg PROVIGIL 4


amitriptyline & perphenazine

tabs 10-2 mg, 10-4 mg, 25-2 mg, 25-4 mg, 50-4 mg

PERPHENAZINE/AMITRIPTYLINE

4

2013-2014 | 40

Medicamentos Drugs



Nivel Level

Inst

chlordiazepoxide & amitriptyline

tabs 10-25 mg, 5-12.5 mg LIMBITROL 4

Mood Stabilizers (Estabilizadores del Ánimo)




lithium carbonate caps 150 mg, 300 mg, 600 mg, tabs 300 mg

LITHIUM CARBONATE

1

lithium carbonate cr tabs 300 mg, 450 mg LITHOBID 1

lithium citrate soln 8 meq/5ml LITHIUM CITRATE 3

valproate sodium syrup 250 mg/5ml DEPAKENE 1

valproic acid caps 250 mg DEPAKENE 1

DERMATOLOGICALS (DERMATOLÓGICOS)

Acne (Acné)

adapalene topical gel 0.3 % DIFFERIN 4 SL AL

adapalene topical cream 0.1 %, topical gel 0.1% DIFFERIN 4

adapalene-benzoyl peroxide

gel 0.1-2.5 % EPIDUO 3 SL AL

azelaic acid topical cream 20 % AZELEX 4

benzoyl peroxide topical liq 2.5 %, 5 % BENZOYL PEROXIDE 1

benzoyl peroxide topical gel 2.5 % BENZOYL PEROXIDE 3

benzoyl peroxide topical liq 4 %, 8%, topical cream 5 %, topical gel 2.75 %, 4 %, 5.25 %, 7 %, 8 %, topical lot 8 %

PANOXYL-8 / BENZASHAVE / BENZIQ

4

benzoyl peroxide liq 5.25 %, topical cream 10 %, topical liq 7 %, topical lot 3 %, 4 %, 6 %, 9 %

BENZIQ WASH 4

benzoyl peroxide & clindamycin

topical gel 5-1 % BENZACLIN 4

benzoyl peroxide & erythromycin

topical gel 5-3 % BENZAMYCIN 1

benzoyl peroxide & urea topical cream 6.5-10 %, 8.5-10 % ZODERM 4

benzoyl peroxide & urea

topical cleanser 4.5-10 %, 5.75- 10 %, 6.5-10 %, 8.5-10 %, topical pads 4.5-10 %

ZODERM 4

clindamycin topical gel 1 %, topical lot 1 %, topical soln 1 %

CLEOCIN 1

clindamycin topical swab 1 % CLEOCIN 4

erythromycin topical gel 2 %, topical soln 2 % ERYGEL 1

erythromycin topical oint 2 % AKNE-MYCIN 3

erythromycin topical pads 2 % ERYTHROMYCIN 4

sulfacetamide sodium topical lot 10 % KLARON 4

sulfacetamide sodium & sulfur

topical cream 10-5 %, topical emulsion 10-5 %, 10-1 %, topical lot 10-5 %

PLEXION 1


susp 10-5 %, topical gel 10-5 % PLEXION 3


topical cloth 10-5 % PLEXION 4

2013-2014 | 41

Medicamentos Drugs



Nivel Level

Inst

sulfacetamide sodium & sulfur & sunscreens

topical cream 10-5 % ROSAC 4

sulfacetamide sodium & sulfur & urea

topical emulsion 10-4 % ROSULA 1


topical emulsion 10-5 % ROSULA 3


topical gel 10-5 % ROSULA 4

tretinoin topical cream 0.025 %, 0.05 %, 0.1 %, topical gel 0.01 %, 0.025 %

RETIN-A 1 SL AL

Antibacterials, Topicals (Antibacterianos, Tópicos)

bacitracin & hydrocortisone & neomycin & polymyxin b

topical oint 1 % CORTISPORIN 4

gentamicin topical cream 0.1 %, topical oint 0.1 %

GARAMYCIN 1

hydrocortisone & neomycin & polymyxin b

topical cream 0.5 % CORTISPORIN 4

mupirocin calcium topical cream 2 %, topical oint 2 %, BACTROBAN 1

mupirocin calcium nasal oint 2 % BACTROBAN 4

silver sulfadiazine topical cream 1 % SILVADENE 1

Antifungals, Topical (Antifungales, Tópicos)

butenafine topical cream 1 % MENTAX 4

ciclopirox topical cream 0.77 %, topical gel 0.77 %, topical susp 0.77 %

LOPROX 4

ciclopirox topical nail lacquer 8 % PENLAC 4 QL

clioquinol & hc topical cream 3-0.5 % ALA-QUIN 4

clotrimazole topical cream 1 %, topical soln 1 % LOTRIMIN 1

clotrimazole & betamethasone

topical cream 1-0.05 %, topical lot 1-0.05 %

LOTRISONE 4 AL

doxepin topical cream 5 % ZONALON 4

econazole topical cream 1 % SPECTAZOLE 4

haloprogin topical cream 1% HALOTIN 4

iodoquinol & hydrocortisone

topical cream 1 % VYTONE 4

iodoquinol & hydrocortisone & aloe polysaccharide

topical gel 1-2-1 % ALCORTIN A 4

ketoconazole topical cream 2 %, topical shampoo 2 %

NIZORAL 1

naftifine topical cream 1 %, 2 %, topical gel 1 %

NAFTIN 4

nystatin topical cream 100000 u/gm, topical oint 100000 u/gm

NYSTATIN 1

nystatin topical powder 100000 u/gm MYCOSTATIN 4

nystatin & triamcinolone

topical cream 100000 u/gm-0.1 % MYCOLOG II 1

nystatin & triamcinolone topical oint 100000 u/gm-0.1 % MYCOLOG II 3

oxiconazole topical cream 1 %, topical lot 1 % OXISTAT 3

2013-2014 | 42

Medicamentos Drugs



Nivel Level

Inst

sodium thiosulfate & salicylic acid

topical lot 25-1 % TINVER 4

sulconazole topical cream 1 %, topical soln 1 % EXELDERM 4

terbinafine topical soln 1 % LAMISIL 3

Antivirals, Topical (Antivirales, Tópicos)

acyclovir topical oint 5 % ZOVIRAX 3

acyclovir topical cream 5 % ZOVIRAX 4

penciclovir topical cream 1 % DENAVIR 4 QL

Corticosteroids, Topical (Corticosteroides, Tópicos)

High Potency (Alta Potencia)

amcinonide topical lot 0.1 %, topical oint 0.1 % AMCINONIDE 4 AL

amcinonide topical cream 0.1 % CYCLOCORT 4 AL

augmented betamethasone dipropionate

topical cream 0.05 %, topical gel 0.05 %, topical lot 0.05 %, topical oint 0.05 %

DIPROLENE 1 AL

betamethasone dipropionate

topical cream 0.05 %, topical lot 0.05 %, topical oint 0.05 %

DIPROSONE 1 AL

diflorasone topical cream 0.05 % PSORCON E 4 AL

diflorasone topical oint 0.05 % PSORCON 4 AL

fluocinonide topical cream 0.05 , topical gel 0.05 %, topical oint 0.05 %, topical soln 0.05 %

LIDEX 4 AL

halcinonide topical cream 0.1 %, topical oint 0.1 %

HALOG 4 AL

Low Potency (Baja Potencia)

alclometasone topical cream 0.05 %, topical oint 0.05 %

ACLOVATE 4

clorcortolone topical cream 0.1 % CLODERM 4

desonide topical cream 0.05 %, topical lot 0.05 %, topical oint 0.05 %

DESOWEN 1

hydrocortisone topical cream 2.5 %, topical lot 2.5 %, topical oint 2.5 %

HYTONE 1

hydrocortisone topical soln 2.5 % TEXACORT 4

hydrocortisone topical cream 1 % PROCTOCORT 4

Medium Potency (Mediana Potencia)

betamethasone valerate topical cream 0.1 %, topical lot 0.1 % VALISONE / BETAVAL

1

betamethasone valerate topical oint 0.1 % VALISONE / BETAVAL

3

betamethasone valerate topical foam 0.12 % LUXIQ 4 AL

desoximetasone topical cream 0.05 % TOPICORT 4

desoximetasone topical cream 0.25 %, topical gel 0.05 %, topical oint 0.25 %

TOPICORT 4 AL

fluocinolone topical oil 0.01 %, topical soln 0.01 % DERMA-SMOOTHE 1

fluocinolone topical shampoo 0.01 % CAPEX 4

fluocinolone topical cream 0.01 %, 0.025 %, topical oint 0.025 %

SYNALAR 4

flurandrenolide topical cream 0.05 %, topical lot 0.05 %, topical tape 4 mcg/sqcm

CORDRAN 4

2013-2014 | 43

Medicamentos Drugs



Nivel Level

Inst

fluticasone topical cream 0.05 %, topical oint 0.005 %

CUTIVATE 4

hydrocortisone butyrate

topical cream 0.1 %, topical oint 0.1 %, topical soln 0.1 %

LOCOID 1

hydrocortisone butyrate topical cream 0.1 %, topical lot 0.1% LOCOID 4

hydrocortisone probutate

topical cream 0.1 % PANDEL 4 AL

hydrocortisone valerate topical cream 0.2%, topical oint 0.2% WESTCORT 1

mometasone topical cream 0.1 %, topical oint 0.1 %, topical soln 0.1 %

ELOCON 4

prednicarbate topical cream 0.1 %, topical oint 0.1 %

DERMATOP 4

triamcinolone topical aerosol 0.147 mg/gm, topical oint 0.05 %

KENALOG 4

triamcinolone topical oint 0.5 % TRIAMCINOLONE 4 AL

triamcinolone topical cream 0.025 %, 0.1 %, topical lot 0.025 %, 0.1 %, topical oint 0.025 %, 0.1 %

KENALOG 4

triamcinolone topical cream 0.5 % KENALOG 4 AL

Very High Potency (Muy Alta Potencia)

clobetasol topical cream 0.05 %, topical gel 0.05 %, topical oint 0.05 %, topical soln 0.05 %

TEMOVATE 1 AL

clobetasol topical foam 0.05 % OLUX 4 AL

halobetasol topical cream 0.05 %, topical oint 0.05 %

ULTRAVATE 4 AL

Dermatologicals, Orals (Dermatológicos, Orales)

acitretin caps 10 mg, 17.5 mg, 25 mg SORIATANE 3

bexarotene caps 75 mg TARGRETIN 4

isotretinoin caps 10 mg, 20 mg, 40 mg ACCUTANE 1

isotretinoin caps 30 mg CLARAVIS 3

methoxsalen caps 10 mg 8-MOP 3


aluminum chloride topical soln 6.25 % XERAC-AC 4

aluminum chloride soln 20% DRYSOL 4

anthralin topical cream 0.5 %, 1 % DRITHO-SCALP 3

bexarotene topical gel 1 % TARGRETIN 4

calcipotriene topical soln 0.004 % DOVONEX 1

calcipotriene topical cream 0.004 % DOVONEX 3

calcitriol oint 3 mcg/gm VECTICAL 3

emollient - cream topical cream MIMYX 4

fluorouracil topical cream 5 %, topical soln 2 %, 5 %

EFUDEX 1

fluorouracil topical cream 0.5 %, 1 % CARAC 4

imiquimod topical cream 5 % ALDARA 4

lactic acid (ammonium lactate)

topical cream 12 %, topical lot 12 % LAC-HYDRIN 4

mafenide topical cream 85 mg/gm , topical soln 5% (50 gm)

SULFAMYLON 4

2013-2014 | 44

Medicamentos Drugs



Nivel Level

Inst

podofilox topical gel 0.5 %, topical soln 0.5 % CONDYLOX 4

salicylic acid topical lot 6 % SALEX 4

tazarotene topical cream 0.05 %, 0.1 %, topical gel 0.05 %, 0.1 %

TAZORAC 4

urea

topical oint 40% GORDON'S UREA/ REMEVEN

4

urea topical cream 40%, topical gel 40%, topical lot 40%, topical soln 50%

CARMOL 40 4

urea & hydrocortisone topical cream 1-10 % CARMOL-HC 4

Rosacea (Rosácea)

azelaic acid kit 15 %, topical gel 15 % FINACEA / FINACEA PLUS

4

metronidazole topical cream 0.75 %, topical gel 0.75 %, topical lot 0.75 %

METROCREAM / METROGEL / METROLOTION

1

metronidazole topical cream 1 %, topical gel 1 % METROGEL/ NORITATE

3

Scabicides/Pediculicides (Escabicidas/Pediculosis)

lindane topical lot 1 %, topical shampoo 1 % LINDANE 1

permethrin topical cream 5 % ELIMITE 1

Topical Anesthetics (Anestésicos Tópicos)

lidocaine patch 5 % LIDODERM 4

lidocaine topical cream 3 %, topical gel 2 %, topical oint 5 %

LIDAMANTLE 4

lidocaine & hydrocortisone

topical cream 3-0.5 %, topical lot 3-0.5 %

LIDAMANTLE 4

lidocaine & prilocaine topical cream 2.5-2.5 % EMLA 4

lidocaine hcl topical lot 3 % LIDAMANTLE 1

pramoxine & hc topical cream 1-1 %, 1-2.5 % PRAMOSONE 1

pramoxine & hc oint 1-1 %, 1-2.5 %, topical lot 1-1 %, 1-2.5 %

PRAMOSONE 3

pramoxine & hc topical foam 1-1 % EPIFOAM 4

Wound Care (Cuidado de Heridas)

becaplermin topical gel 0.01 % REGRANEX 4 PA

collagenase topical oint 250 u/gm SANTYL 4

hexachlorophene topical liq 3 % PHISOHEX 4

physiological irrigation soln PHYSIOLYTE 4

ringer's irrigation soln , RINGER'S 4

water irrigation soln IRRIGATION WATER 4

EAR/NOSE/THROAT (OÍDO/NARIZ/GARGANTA)

Mouth/Throat (Boca/Garganta)

antiseptic products soln , topical spray BUCALSEP 4

benzocaine & menthol & cetylpyridinium cl & tannic acid

soln 2-0.5-0.1 % ORASEP 4

chlorhexidine gluconate

buccal soln 0.12 % PERIDEX 1

lidocaine topical soln 2 %, 4% XYLOCAINE VISCOUS

1

2013-2014 | 45

Medicamentos Drugs



Nivel Level

Inst

pilocarpine tabs 5 mg, 7.5 mg SALAGEN 4

sodium fluoride buccal soln 0.05%, 0.2% NAFRINSE 4

sodium fluoride dental cream 1.1 %, dental gel 1.1%, dental paste 1.1%, soln 0.2 %

PREVIDENT 4

stannous fluoride

conc 0.63 % GEL-KAM 4

triamcinolone oral paste 0.1 % KENALOG IN ORABASE

1

Otics (Oticos)

acetic acid otic soln 2 % VOSOL 1

acetic acid & aluminum acetate

otic soln 2 % DOMEBORO 1

acetic acid & hydrocortisone

otic soln 2-1 % VOSOL-HC 1

benzocaine & antipyrine

otic soln 1.4-5.4 % BENZOTIC 4

benzocaine-pe-antipyrine otic soln EAR-GESIC 4

ciprofloxacin & dexamethasone

otic susp 0.3-0.1 % CIPRODEX 3

ciprofloxacin & hydrocortisone

otic susp 0.2-1 % CIPRO HC 4

colistin & hydrocortisone & neomycin & thonzonium

otic susp 3-10-3.3-0.5 mg/ml CORTISPORIN-TC 4

cresyl acetate otic soln 25 % CRESYLATE 4

fluocinolone acetonide otic oil 0.01 % DERMOTIC 4

hydrocortisone & neomycin & polymyxin b

otic soln 1 %, otic susp 1 % CORTISPORIN / PEDIOTIC

1

ofloxacin otic soln 0.3 % FLOXIN 1

pramoxine & hc & chloroxylenol aqueous

otic soln 10-10-1 mg/ml CORTANE-B 4

pramoxine & hydrocortisone & chloroxylenol

otic soln 10-10-1 mg/ml OTICIN HC 4

ENDOCRINOLOGY (ENDOCRINOLOGÍA)

Corticosteroids (Corticosteroides)

betamethasone soln 0.6 mg/5ml CELESTONE 4

betamethasone acetate & sod phosphate

inj 3-3 mg/ml CELESTONE 1

cortisone acetate tabs 25 mg CORTONE 3

dexamethasone elixir 0.5 mg/5ml, tabs 0.5 mg, 0.75 mg, 1.5 mg, 4 mg, 6 mg

DEXAMETHASONE 1

dexamethasone tabs 1 mg, 2 mg DEXAMETHASONE 3

dexamethasone conc 1 mg/ml, soln 0.5 mg/5ml, tabs 1.5 mg

DEXAMETHASONE 4

dexamethasone sodium phosphate

inj 10 mg/ml, 4 mg/ml DEXAMETHASONE 1

fludrocortisone tabs 0.1 mg FLORINEF 1

2013-2014 | 46

Medicamentos Drugs



Nivel Level

Inst

hydrocortisone tabs 10 mg, 20 mg, 5 mg CORTEF 1

hydrocortisone sodium succinate

inj 1000 mg, 250 mg, 500 mg SOLU-CORTEF 4

hydrocortisone sodium succinate

inj 100 mg SOLU-CORTEF 4

methylprednisolone

tabs 2mg, 16 mg, 32 mg, 4 mg, 8 mg MEDROL 1

methylprednisolone acetate

inj 20 mg/ml, 40 mg/ml, 80 mg/ml DEPO-MEDROL 1

methylprednisolone sodium succinate

inj 1000 mg, 2000 mg, 125 mg, 40 mg, 500 mg

SOLU-MEDROL 4

prednisolone syrup 15 mg/5ml PRELONE 1

prednisolone tabs 50 mg PREDNISONE 3

prednisolone conc 5 mg/ml, tabs 5 mg PREDNISONE 4

prednisolone sod phosphate

soln 15 mg/5ml, 5 mg/5ml ORAPRED/PEDIAPRED

1

prednisone tabs 1mg, 10mg, 2.5 mg, 20mg, 5mg PREDNISONE 1

prednisone soln 5 mg/5ml PREDNISONE 4

triamcinolone acetonide

inj 10 mg/ml, 40 mg/ml KENALOG 1

Diabetes (Diabetes)

Antihyperglycemics (Antihiperglicémicos)

Alpha-Glucosidase Inhibitors (Inhibidores de la Alfa-Glucosidasa)

acarbose tabs 100 mg, 25 mg, 50 mg PRECOSE 1

miglitol tabs 100 mg, 25 mg, 50 mg GLYSET 4

Biguanides (Biguanidas)

metformin tabs 1000 mg, 500 mg, 850 mg GLUCOPHAGE 1

metformin sr tabs 24h 500 mg, 750 mg GLUCOPHAGE XR 1


glipizide & metformin tabs 2.5-250 mg, 2.5-500 mg, 5-500 mg

METAGLIP 1

glyburide & metformin tabs 1.25-250 mg, 2.5-500 mg, 5-500 mg

GLUCOVANCE 1

pioglitazone & glimepiride

tabs 30-2 mg, 30-4 mg DUETACT 4

pioglitazone & metformin

tabs 15-500 mg, 15-850 mg ACTOPLUS MET 4 ST

rosiglitazone & glimepiride

tabs 4-1 mg, 4-2 mg, 4-4 mg, 8-2 mg, 8-4 mg

AVANDARYL 3 ST

rosiglitazone & metformin tabs 2-1000 mg, 2-500 mg, 4-1000 mg, 4-500 mg

AVANDAMET 3 ST

saxagliptin&metfomin hcl tabs 24h 2.5-1000 mg, 5-1000 mg, 5-500 mg

KOMBIGLYZE XR 2 ST

sitagliptin & metformin tabs 50-1000 mg, 50-500 mg JANUMET 2 ST

sitagliptin & metformin tabs 24h 100-1000 mg, 50-1000 mg, 50-500 mg

JANUMET XR 2 ST

sitagliptin & simvastatin tabs 100-10mg, 100-20mg, 100- 40mg, 50-10mg, 50-20 mg, 50-40mg

JUVISYNC 2 ST

2013-2014 | 47

Medicamentos Drugs



Nivel Level

Inst

Human Insulin (Insulina Humana)

insulin-(pen) inj 70-30, N HUMULIN 2

insulin-(vial) inj 70-30, N, R HUMULIN 2

insulin-(vial) inj R 500 u/ml HUMULIN 3

insulin--(pen) inj 70-30, N, R NOVOLIN 2

insulin--(vial) inj 70-30, N, R NOVOLIN 2

Insulin Analog (Insulinas Análogas)

insulin aspart (pen) inj 100 u/ml NOVOLOG 2

insulin aspart (vial) inj 100 u/ml

NOVOLOG 2

insulin aspart prot & aspart (pen)

inj 70-30 NOVOLOG MIX 2

insulin aspart prot & aspart (vial)

inj 70-30 NOVOLOG MIX 2

insulin detemir (pen) inj 100 u/ml LEVEMIR 2

insulin detemir (vial) inj 100 u/ml LEVEMIR 2

insulin glargine (pen) inj 100 u/ml LANTUS 2

insulin glargine (vial) inj 100 u/ml LANTUS 2

insulin glulisine (pen) inj 100 u/ml APIDRA 3

insulin glulisine (vial) inj 100 u/ml APIDRA 3

insulin lispro (pen) inj 100 u/ml HUMALOG 2

insulin lispro (vial) inj 100 u/ml HUMALOG 2

insulin lispro prot & lispro (pen)

inj 50-50, 75-25 HUMALOG MIX 2

insulin lispro prot & lispro (vial)

inj 50-50, 75-25 HUMALOG MIX 2

Meglitinides (Meglitinidas)

repaglinide tabs 0.5 mg, 1 mg, 2 mg PRANDIN 3

Sulfonylureas (Sulfonilureas)

chlorpropamide tabs 100 mg, 250mg DIABINESE 1

glimepiride tabs 1 mg, 2 mg, 4 mg AMARYL 4

glipizide tabs 10 mg, 5 mg GLUCOTROL 1

glipizide sr tabs 24h 10 mg, 2.5 mg, 5 mg GLUCOTROL XL 1

glyburide tabs 1.25 mg, 2.5 mg, 5 mg MICRONASE 1

glyburide tabs 1.25 mg, 2.5 mg, 5 mg DIABETA 3

glyburide micronized tabs 1.5 mg, 3 mg, 6 mg GLYNASE 1

glyburide micronized tabs 4.5 mg GLYCRON 4

tolazamide tabs 250 mg TOLINASE 1

tolazamide tabs 500 mg TOLAZAMIDE 4

tolbutamide tabs 500 mg TOLBUTAMIDE 4

Thiazolidinediones (Tiazolidinedionas)

pioglitazone tabs 15 mg, 30 mg, 45 mg ACTOS 1 ST

rosiglitazone tabs 2 mg, 4 mg, 8 mg AVANDIA 3 ST

Antihyperglycemics, Others (Antihiperglicémicos, Otros)

exenatide inj 5 mcg/0.02ml , 10 mcg/0.04ml BYETTA 2 ST

exenatide inj 2 mg BYDUREON 2 ST

linagliptin tabs 5 mg

TRADJENTA 3 ST

2013-2014 | 48

Medicamentos Drugs



Nivel Level

Inst

linagliptin & metformin tabs 2.5-1000 mg, 2.5-500 mg, 2.5-850 mg

JENTADUETO 3 ST

liraglutide inj 18 mg/3ml (6 mg/ml) VICTOZA 2 ST

saxagliptin hcl tabs 2.5 mg, 5 mg ONGLYZA 2 ST

sitagliptin tabs 100 mg, 25 mg, 50 mg JANUVIA 2 ST

Hyperglicemics (Hiperglicémicos)

diazoxide susp 50 mg/ml PROGLYCEM 4

glucagon inj 1 mg GLUCAGON 3


Androgens (Andrógenos)

danazol caps 100 mg, 200 mg, 50 mg DANOCRINE 1

fluoxymesterone tabs 10 mg ANDROXY 3

methyltestosterone caps 10 mg ANDROID 4

methyltestosterone tabs 10 mg METHITEST 4

testosterone 24h patch 2 mg/24hr, 2.5 mg/24hr, 4 mg/24hr, 5 mg/24hr, transdermal gel 1.25 gm/act , 25 mg/2.5gm, 50 mg/5gm

ANDRODERM / ANDROGEL / TESTIM

3

testosterone transdermal gel 20.25 mg/act (1.62%)

ANDROGEL PUMP 3 QL

testosterone cypionate inj 100 mg/ml, 200 mg/ml DEPO-TESTOSTERONE

1

testosterone enanthate inj 200 mg/ml TESTOSTERONE ENANTHATE

4

Others (Otros)

cabergoline tabs 0.5 mg DOSTINEX 1

calcitonin, salmon inj MIACALCIN 3

desmopressin nasal soln 0.01%, tabs 0.1mg, 0.2mg DESMOPRESSIN 1

desmopressin inj 4 mcg/ml DDAVP 4

etidronate tabs 200 mg, 400 mg DIDRONEL 1

methylergonovine tabs 0.2 mg METHERGINE 4

nafarelin nasal soln 2 mg/ml SYNAREL 4

Thyroid (Tiroides)

Antithyroid (Antitiroideos)

methimazole tabs 10 mg, 5 mg TAPAZOLE 1

propylthiouracil tabs 50 mg PROPYLTHIOURACIL 1

Thyroid Hormones (Hormonas Tiroideas)

levothyroxine tabs 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

LEVOTHYROXINE 1

levothyroxine tabs 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

SYNTHROID 3

liothyronine tabs 25 mcg, 5 mcg, 50 mcg CYTOMEL 1

thyroid tabs 30 mg, 60 mg, 90 mg, 120 mg, 15 mg, 180 mg, 240 mg, 300 mg

ARMOUR THYROID 4

2013-2014 | 49

Medicamentos Drugs



Nivel Level

Inst

ENZYME REPLACEMENTS/MODIFIERS (REEMPLAZO DE ENZIMAS/MODIFICADORES)

Enzyme Replacements/Modifiers (Reemplazo de Enzimas/Modificadores)

Urea Cycle Disorder Treatment (Desorden del Ciclo de Urea)

mifepristone tabs 300 mg KORLYM 4 PA SL

GASTROENTEROLOGY (GASTROENTEROLOGÍA)

Antidiarrheals (Antidiarreicos)

atropine & difenoxin tabs 1-0.025 mg MOTOFEN 4

diphenoxylate & atropina

tabs 2.5-0.025 mg LOMOTIL 1

diphenoxylate & atropine liq 2.5-0.025 mg/5ml LOMOTIL 3

loperamide caps 2 mg IMODIUM 1

paregoric elixir 2 mg/5ml PAREGORIC 1

Antispasmodics (Antiespasmódicos)

atropine inj 0.05 mg/ml ATROPINE 4

atropine inj 0.1 mg/ml ATROPINE 4

atropine & hyoscyamine & scopolamine & simethicone

elixir 0.0194-0.1037-0.0065- 40 mg/5ml

SIMETYL 4

atropine sulfate inj 0.8 mg/ml ATROPINE 4

atropine sulfate tabs 0.4 mg SAL-TROPINE 4

atropine sulfate inj 0.4 mg/ml, 1 mg/ml ATROPINE 4

belladonna alkaloids & phenobarbital

elixir 16 mg/5ml, tabs 16.2 mg DONNATAL 1

belladonna alkaloids & phenobarbital cr

tabs 48 mg DONNATAL 4

clidinium & chlordiazepoxide

caps 2.5-5 mg LIBRAX 4

dicyclomine caps 10 mg, tabs 20 mg BENTYL 1

dicyclomine inj 10 mg/ml, soln 10 mg/5ml BENTYL 3

glycopyrrolate inj 0.2 mg/ml, 4 mg/20ml (0.2 mg/ml), tabs 1 mg, 2 mg

ROBINUL 1

hyoscyamine elixir 0.125 mg/ml, soln 0.125 mg/ml, subl 0.125 mg, tabs 0.125 mg

LEVSIN 1

hyoscyamine odt 0.125 mg LEVSIN 4

hyoscyamine sulfate sr tabs 12h 0.375 mg LEVSINEX 1

hyoscyamine sulfate inj 0.5 mg/ml LEVSIN 3

methscopolamine tabs 2.5 mg, 5 mg PAMINE 4

propantheline tabs 15 mg PROPANTHINE 3

Antiulcers (Úceras)

H2 Blockers (Antagonistas H2)

cimetidine soln 300 mg/5ml, tabs 300 mg, 400 mg, 800 mg

TAGAMET 1

cimetidine inj 150 mg/ml TAGAMET 4

famotidine inj 10 mg/ml, susp 40 mg/5ml, tabs 20 mg, 40 mg

PEPCID 4

nizatidine

caps 150 mg, 300 mg AXID 4

ranitidine caps 150 mg, 300 mg, syrup 15 mg/ml, tabs 150 mg, 300 mg

ZANTAC 1

2013-2014 | 50

Medicamentos Drugs



Nivel Level

Inst

ranitidine inj 1000 mg/40ml , 150 mg/6ml , 50 mg/2ml

ZANTAC 4


amoxicillin & clarithromycin & lansoprazole dr

pack 500&500&30 mg PREVPAC 3

bismuth subsalicylate & metronidazole & tetracycline

pack 262.4&250&500 mg HELIDAC 4

misoprostol tabs 100 mcg, 200 mcg CYTOTEC 1

sucralfate tabs 1 gm CARAFATE 1

sucralfate susp 1 gm/10ml CARAFATE 3

Proton Pump Inhibitors (PPI`s) (Inhibidores de la Bomba de Protónes)

lansoprazole dr caps 1 mg, 30 mg, odt 15 mg, 30 mg

PREVACID 1

lansoprazole dr caps 15 mg PREVACID 24H OTC

omeprazole dr caps 10 mg, 20 mg, 40 mg PRILOSEC 1

omeprazole dr tabs 20 mg PRILOSEC OTC OTC

omeprazole magnesium cpdr 20.6 mg PRILOSEC OTC OTC

omeprazole-sodium bicarbonate

caps 20-1100 mg ZEGERID OTC OTC

pantoprazole ec tabs 20 mg, 40 mg PROTONIX 1

rabeprazole ec tabs 20 mg ACIPHEX 4

Digestive Enzymes (Enzimas Digestivas)

digestive enzymes w/ anticholinergics

caps GASTRINEX 4

pancrelipase (lip-prot-amyl)

caps 12000-38000-60000 u, 24000-76000-120000 u, 3000-9500-15000 u, 36000-114000-180000 u, 6000-19000-30000 u

CREON 2

Laxatives (Laxantes)

lactulose soln 10 gm/15ml ENULOSE 1

lactulose pack 10 gm, 20 gm KRISTALOSE 4

polyethylene glycol pack , powder 17 gm/1.7ml GLYCOLAX 4

polyethylene glycol & potassium chloride & sodium bicarbonate & sodium chloride

soln 420 gm NULYTELY 4

polyethylene glycol & potassium chloride & sodium bicarbonate & sodium chloride & sodium sulfate

soln 227.1 gm GOLYTELY 4

polyethylene glycol & potassium chloride & sodium bicarbonate & sodium chloride & sodium sulfate

soln 236 gm, 240 gm GOLYTELY 4

2013-2014 | 51

Medicamentos Drugs



Nivel Level

Inst

sodium phosphate, dibasic & monobasic monohydrate

tabs 0.398-1.102 gm VISICOL 4


alosetron tabs 0.5 mg, 1 mg LOTRONEX 4

balsalazide caps 750 mg COLAZAL 4

budesonide sr caps 24h 3 mg ENTOCORT EC 1 PA SL

cromolyn conc 100 mg/5ml GASTROCROM 4

hydrocortisone enema 100 mg/60ml, rectal cream 2.5 %, rectal supp 25 mg

CORTENEMA 1

hydrocortisone rectal foam 90 mg CORTIFOAM 3

hydrocortisone rectal supp 30 mg PROCTOCORT 4

hydrocortisone acetate & pramoxine

rectal cream 1-1 %, 2.5-1 % ANALPRAM-HC 1

hydrocortisone acetate & pramoxine

rectal foam 1-1 %, rectal lot 2.5-1 % PROCTOFOAM HC 3


rectal cream 2-2 % ANAMANTLE HC 4


rectal cream 3-0.5 %, 3-0.5 %, 3-1 %, 3-2.5 %

ANAMANTLE HC 4

linaclotide caps 145 mg, 290 mg LINZESS 2

lubiprostone caps 24 mcg, 8 mcg AMITIZA 4 QL SL

mesalamine enema 4 gm ROWASA/ sfROWASA

1

mesalamine rectal supp 1000 mg CANASA 2

mesalamine caps 0.375 gm, 400 mg, enema 4 gm/60ml

APRISO 3

mesalamine cr caps 250 mg, 500 mg PENTASA 2

mesalamine dr tabs 1.2 gm LIALDA 2

mesalamine dr tabs 800 mg ASACOL HD 3

mesalamine dr tabs 400 mg DELZICOL 3

methylnaltrexone inj RELISTOR 4 QL PA

metoclopramide inj 5 mg/ml, soln 5 mg/5ml, tabs 10 mg, 5 mg

REGLAN 1

olsalazine caps 250 mg DIPENTUM 3

sulfasalazine tabs 500 mg AZULFIDINE 1

sulfasalazine dr tabs 500 mg AZULFIDINE EN 1

ursodiol caps 300 mg ACTIGALL 1

ursodiol tabs 250 mg, 500 mg URSO 4

OBSTETRICS/GYNECOLOGY (OBSTETRICIA/GINECOLOGÍA)

Estrogens/Progestins (Estrógenos/Progestinas)

Combinations, Estrogens (Combinaciones, Estrógenos)

esterified estrogens & methyltestosterone

tabs 0.625-1.25 mg, 1.25-2.5 mg ESTRATEST HS 1

estradiol & norethindrone

tabs 0.5-0.1 mg, 1-0.5 mg ACTIVELLA 1

estradiol & norgestimate tabs 1&1-0.09 mg PREFEST 4

estrogens, conjugated & tabs 0.3-1.5 mg, 0.45-1.5 mg, PREMPRO/ 2

2013-2014 | 52

Medicamentos Drugs



Nivel Level

Inst

medroxyprogesterone 0.625&0.625-5 mg, 0.625-2.5 mg, 0.625-5 mg

PREMPHASE

estrogens, conjugated synthetic b

tabs 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg

ENJUVIA 3

ethinyl estradiol & norethindrone

tabs 2.5-0.5 mg, 5-1 mg FEMHRT 4

Estrogens (Estrógenos)

estradiol tabs 0.5 mg, 1 mg, 2 mg ESTRACE 1

estradiol tabs 0.45 mg, 0.9 mg, 1.8 mg, transdermal gel 0.06 %

FEMTRACE 4

estradiol hemihydrate transdermal emulsion 4.35 mg/1.74gm

ESTRASORB 4

estrogens, conjugated tabs 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg

PREMARIN 2

estrogens, conjugated inj 25 mg PREMARIN 3

estrogens, conjugated synthetic a

tabs 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg

CENESTIN 3

estrogens, esterified tabs 0.3 mg, 0.625 mg, 1.25 mg, 2.5 mg

MENEST 3

estropipate tabs 0.75 mg, 1.5 mg OGEN 1

estropipate tabs 3 mg ESTROPIPATE 3

Progesterones (Progesteronas)

medroxyprogesterone tabs 10 mg, 2.5 mg, 5 mg PROVERA 1

norethindrone tabs 5 mg AYGESTIN 4

progesterone caps 100 mg, 200 mg, inj 50 mg/ml PROMETRIUM 4


Osteoporosis (Osteoporosis)

Bisphosphonates (Bifosfonatos)

alendronate tabs 10mg, 35mg, 40mg, 5mg, 70mg FOSAMAX 1

alendronate soln 70 mg/75ml FOSAMAX 3

alendronate & cholecalciferol

tabs 70 mg-2800u, 70 mg-5600u FOSAMAX PLUS D 3

ibandronate sodium

tabs 150 mg BONIVA 1

risedronate tabs 150 mg, 30 mg, 35 mg, 5 mg ACTONEL 2

tiludronate tabs 240 mg SKELID 4

Others (Otros)

calcitonin, salmon nasal soln 200 u/act MIACALCIN 1

Selective Estrogen Receptor Modulator (Modulador Selectivo del Receptor de Estrógeno)

raloxifene tabs 60 mg EVISTA 2

Others (Otros)

danazol caps 100 mg, 200 mg, 50 mg DANOCRINE 1

Topicals (Tópicos)

Transdermal Patch (Parchos Transdermales)

estradiol weekly patch 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.06 mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr

CLIMARA 1

2013-2014 | 53

Medicamentos Drugs



Nivel Level

Inst

estradiol biweekly patch 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.05 mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr, 0.1 mg/24hr

VIVELLE-DOT 4

estradiol & levonorgestrel weekly patch 0.045-0.015 mg/day CLIMARA PRO 3

estradiol & norethindrone patch 0.05-0.14 mg/day, 0.05- 0.25 mg/day

COMBIPATCH 4

Vaginal, Topical (Vaginales, Tópicos)


acetic acid vaginal gel ACID JELLY 4

acetic acid-oxyquinoline vaginal gel RELAGARD 4

clindamycin vaginal cream 2 % CLEOCIN 1

clindamycin vaginal supp 100 mg CLEOCIN 4

metronidazole vaginal gel 0.75 % METROGEL 1

miconazole vaginal supp 200 mg MICONAZOLE 3 3

nystatin tabs 100000 u NYSTATIN 3

sulfanilamide vaginal cream 15 % AVC 4

terconazole vaginal cream 0.4 %, 0.8 %, vaginal supp 80 mg

TERAZOL 1

Hormonal Replacement (Reemplazo Hormonal)

estradiol vaginal tabs 10 mcg VAGIFEM 3

estradiol vaginal cream 0.1 mg/gm, vaginal ring 2 mg

ESTRACE 4

estrogens, conjugated vaginal cream 0.625 mg/gm PREMARIN 3

progesterone vaginal gel 8 % CRINONE 3 QL

Vitamins, Prenatals (Vitaminas, Prenatales)

prenatal vit w/ iron & omega

pack OBTREX DHA 3

prenatal vit w/ iron carbonyl-fa

tabs ATABEX 4

prenatal vitamin tabs NOVASTART 1

prenatal vitamin caps, tabs MATERNA 3

prenatal vitamin pak, tabs Femecal OB Plus DHA 4

OPHTHALMICS (OFTÁLMICOS)

Allergy (Alergia)

Antihistamines (Antihistamínicos)

emedastine ophth soln 0.05 % EMADINE 3

Antihistamines - Mast Cell Stabilizers (Antihistamínicos -Estabilizadores de Mastocitos)

azelastine ophth soln 0.05 % OPTIVAR 1

ketotifen ophth soln 0.025 % KETOTIFEN OTC

olopatadine ophth soln 0.1 %, 0.2 % PATADAY/ PATANOL 2

Mast Cell Stabilizers (Estabilizadores de Mastocitos)

cromolyn ophth soln 4 % CROLOM 1

lodoxamide ophth soln 0.1 % ALOMIDE 4

nedocromil ophth soln 2 % ALOCRIL 3

Antibiotics (Antibióticos)

bacitracin ophth oint 500 u/gm

BACITRACIN 1

2013-2014 | 54

Medicamentos Drugs



Nivel Level

Inst


ophth oint 1 % CORTISPORIN 1


topical oint 1 % CORTISPORIN 4

bacitracin & neomycin & polymyxin b

ophth oint 400 u/gm-5 mg/gm-10000u/gm

NEOSPORIN 1

bacitracin & polymyxin b

ophth oint 500-10000 u/gm POLYSPORIN 4

ciprofloxacin ophth soln 0.3 % CILOXAN 1

ciprofloxacin ophth oint 0.3 % CILOXAN 4

dexamethasone & tobramycin

ophth susp 0.1-0.3 % TOBRADEX 1

dexamethasone & tobramycin

ophth oint 0.1-0.3 % TOBRADEX 3

erythromycin ophth oint 5 mg/gm ILOTYCIN 1

gentamicin ophth oint 0.3 %, ophth soln 0.3 % GARAMYCIN 1

gentamicin & prednisolone acetate

ophth oint 0.3-0.6 %, ophth susp 0.3-1 %

PRED-G 4

moxifloxacin ophth soln 0.5 % VIGAMOX 2

moxifloxacin ophth soln 0.5 % MOXEZA 2

natamycin ophth susp 5 % NATACYN 4

neomycin & polymyxin & dexamethasone

ophth oint 0.1 %, ophth susp 0.1 % MAXITROL 4

neomycin & polymyxin & gramicidin

ophth soln NEOSPORIN 1

neomycin & polymyxin & hydrocortisone

ophth susp 1 % CORTISPORIN 3

ofloxacin ophth soln 0.3 % OCUFLOX 1

polymyxin b & trimethoprim

ophth soln 10000 u/ml-0.1 % POLYTRIM 4

sulfacetamide sodium ophth soln 10 % BLEPH-10 4

sulfacetamide sodium & prednisolone

ophth oint 10-0.2 %, ophth susp 10-0.2 %

BLEPHAMIDE 4

sulfacetamide sodium & prednisolone

ophth soln 10-0.23 % VASOCIDIN 4

tobramycin ophth soln 0.3 % TOBREX 1

tobramycin ophth oint 0.3 % TOBREX 3

trifluridine ophth soln 1 % VIROPTIC 1

Corticosteroids (Corticosteroides)

dexamethasone ophth susp 0.1 % MAXIDEX 3

dexamethasone sodium phosphate

ophth soln 0.1 % DECADRON 1

fluorometholone ophth susp 0.1 % FML 1

fluorometholone ophth oint 0.1 %, ophth susp 0.25 % FML 3

fluorometholone acetate ophth susp 0.1 % FLAREX 4

loteprednol ophth susp 0.2 %, 0.5 % ALREX / LOTEMAX 4

2013-2014 | 55

Medicamentos Drugs



Nivel Level

Inst

prednisolone acetate ophth susp 0.12 % PRED MILD 3

prednisolone sodium phosphate

ophth soln 1 % INFLAMASE 4

rimexolone ophth susp 1 % VEXOL 4

Glaucoma (Glaucoma)

Adrenergic Selective Agonists (Agonistas Adrenérgicos Selectivos)

apraclonidine ophth soln 1 % IOPIDINE 4

apraclonidine ophth soln 0.5 % IOPIDINE 4

brimonidine ophth soln 0.15 %, 0.2 % ALPHAGAN / ALPHAGAN P

1

brimonidine ophth soln 0.1 % ALPHAGAN P 3

Beta Blockers (Bloqueadores Beta)

betaxolol ophth soln 0.5 % BETOPTIC-S / BETAXOLOL

1

betaxolol ophth susp 0.25 % BETOPTIC-S / BETAXOLOL

4

carteolol ophth soln 1 % OCUPRESS 4

levobunolol ophth soln 0.5 %, 0.25 % BETAGAN 4

metipranolol ophth soln 0.3 % OPTIPRANOLOL 4

timolol ophth gel soln 0.25 %, 0.5 %, ophth soln 0.25 %, 0.5 %

TIMOPTIC / TIMOPTIC-XE

1

timolol ophth soln 0.25 %, 0.5 % BETIMOL 3

Carbonic Anhydrase Inhibitors (Inhibidores de la Anhidrasa Carbónica)

brinzolamide ophth susp 1 % AZOPT 2

dorzolamide ophth soln 2 % TRUSOPT 1


brimonidine & timolol ophth soln 0.2-0.5 % COMBIGAN 2

dorzolamide & timolol ophth soln 2-0.5 % COSOPT 1

dorzolamide & timolol ophth soln 22.3-6.8 % COSOPT PF 2

Miotics (Mióticos)

pilocarpine ophth soln 1 %, 2 %, 4 % ISOPTO CARPINE 1

pilocarpine ophth gel 4 % PILOPINE HS 4

Prostaglandins (Prostaglandinas)

bimatoprost ophth soln 0.01 % LUMIGAN 2

bimatoprost ophth soln 0.03 % LUMIGAN 3

latanoprost ophth soln 0.005 % XALATAN 1

tafluprost ophth soln 0.0015 % ZIOPTAN 3

travoprost ophth soln 0.004 % TRAVATAN Z 2


atropine ophth soln 1 % ISOPTO ATROPINE 1

cyclopentolate ophth soln 0.5 % CYCLOGYL 4

cyclopentolate ophth soln 1 %, 2 % CYCLOGYL 4

cyclosporine ophth emulsion 0.05 % RESTASIS 4 PA SL

naphazoline ophth soln 0.1 % AK-CON 3

tropicamide ophth soln 0.5 %, 1 % MYDRIACYL 4

Non-Steroidal Anti-Inflammatory Drugs (NSAID`s) (Anti-Inflamatorios No-Esteroidales)

diclofenac ophth soln 0.1 % VOLTAREN 1

flurbiprofen ophth soln 0.03 % OCUFEN 1

2013-2014 | 56

Medicamentos Drugs



Nivel Level

Inst

ketorolac ophth soln 0.4 %, 0.5 % ACULAR 1

nepafenac ophth susp 0.1 % NEVANAC 2

RESPIRATORY (RESPIRATORIOS)

Antihistamines/Decongestants (Antihistamínicos/Descongestionantes)

Descongestants (Descongestionantes)

acrivastine & pseudoephedrine

caps 8-60 mg SEMPREX-D 4

brompheniramine & phenylephrine

elixir 2-5 mg/5ml, liq 2-7.5 mg/5ml DECON-A 4

brompheniramine & phenylephrine

liq 4-7.5 mg/5ml VAZOL-D 4

brompheniramine & pseudoephedrine

liqd 1-7.5 mg/ml J-TAN 4

brompheniramine & pseudoephedrine sr

tabs 12h 6-45 mg LODRANE 1

brompheniramine & pseudoephedrine sr

caps 12h 9-90 mg BROVEX SR 4

cetirizine & pseudoephedrine sr

tabs 12h 5-120 mg ZYRTEC-D OTC

chlorphen tan & phenyleph tan

tabs 9-25 mg RYNATAN 4

chlorpheniramine & phenylephrine

liq 1-2 mg/ml ED A-HIST 4


liq 1-3.5 mg/ml RONDEC 4


liq 4-10 mg/5ml NOHIST-LQ 4


syrup 4-12.5 mg/5ml RONDEC 4

chlorpheniramine & phenylephrine cr

tabs 8-20 mg ED A-HIST 4

chlorpheniramine & phenylephrine sr

caps 12h 4-20 mg DALLERGY JR 4

chlorpheniramine & pseudoephedrine

liq 2-30 mg/5ml HISTEX 4

chlorpheniramine & pseudoephedrine sr

tabs 12h 12-120 mg BIOHIST LA 4

chlorpheniramine tan & phenylephrine tan

susp 4.5-5 mg/5ml RYNATAN 4

desloratadine & pseudoephedrine sr

tabs 12h 2.5-120 mg, tabs 24h 5-240 mg

CLARINEX-D 2

dexchlorpheniramine syrup 2 mg/5ml DEXCHLORPHENIRAMINE

4

diphenhydramine & phenyleph hcl tannate

tabs chew 12.5-5 mg ALDEX-CT 4

fexofenadine & pseudoephedrine sr

tabs 12h 60-120 mg, tabs 24h 180-240 mg

ALLEGRA-D 4

loratadine & pseudoephedrine sr

tabs 12h 5-120 mg, tabs 24h 10-240 mg

CLARITIN-D OTC

2013-2014 | 57

Medicamentos Drugs



Nivel Level

Inst

phenylephrine & promethazine

syrup 5-6.25 mg/5ml PROMETHAZINE VC 4

pyrilamine tan & phenyleph tan

tabs 60-25 mg RYNA-12 4

tetrahydrozoline nasal soln 0.05 %, 0.1 % TYZINE 4

Low Sedation Antihistamines (Anti-histamínicos de Baja Sedación)

carbinoxamine liq 4 mg/5ml, tabs 4 mg PALGIC 4

cetirizine syrup 5 mg/5ml, tabs 10 mg, 5 mg ZYRTEC OTC

clemastine syrup 0.67 mg/5ml CLEMASTINE 1

clemastine tabs 2.68 mg CLEMASTINE 4

cyproheptadine syrup 2 mg/5ml, tabs 4 mg CYPROHEPTADINE 1

diphenhydramine caps 50 mg DIPHENHYDRAMINE 1

diphenhydramine inj 50 mg/ml DIPHENHYDRAMINE 4

fexofenadine tabs 60 mg ALLEGRA 1

fexofenadine tabs 180 mg, 30 mg ALLEGRA 4

fexofenadine & pseudoephedrine

tabs 12h 60-120 mg, tabs 24h 180-240 mg

ALLEGRA-D ALLERGY & CONGESTION

OTC

fexofenadine hcl odt 30 mg, susp 30 mg/5ml (6 mg/ml), tabs 30 mg

ALLEGRA ALLERGY CHILDRENS

OTC

fexofenadine hcl tabs 180 mg, 60 mg ALLEGRA ALLERGY OTC

hydroxyzine hydrochloride

syrup 10 mg/5ml, tabs 10 mg, 25 mg, 50 mg

HYDROXYZINE HCL 1

Non-Sedative Antihistamines (Anti-histamínicos No Sedantes)

desloratadine odt 2.5 mg, 5 mg, tabs 5 mg CLARINEX 1

desloratadine syrup 0.5 mg/ml CLARINEX 2

loratadine caps 10 mg, chew tab 5 mg CLARITIN OTC

loratadine odt 10 mg, syrup 10 mg/10ml, tabs 10 mg

CLARITIN OTC

Antitussives/Expectorants (Antitusivos/Expectorantes)

acetylcysteine inhal 10 %, 20 % ACETYLCYSTEINE 4

benzonatate caps 100 mg, 200 mg TESSALON 1

brompheniramine w/ dm-gg

caps 2-15-200 mg, liq 2-15- 200 mg/5ml

TUSNEL 4

carbetapentane & guaifenesin

liq 20-75 mg/5ml EXPECTUSS 4

chlorphen tan & carbetapentane tan

tabs 5-60 mg TUSSIZONE-12 4

chlorphen tan & carbetapentane tan

susp 4-30 mg/5ml TUSSI-12 4

chlorphen-pe-methscopolamine

tabs 12h 8-20-2.5 mg DALLERGY PE 4

codeine & guaifenesin liq 200-10 mg/5ml TUSSO-C 4

codeine & guaifenesin liq 300-10 mg/5ml, syrup 10- 100 mg/5ml

TUSSI-ORGANIDIN NR

4

codeine & guaifenesin syrup 10-100 mg/5ml TUSSI-ORGANIDIN-S NR

4

dextromethorphan & guaifenesin

liq 20-200 mg/5ml, soln 25-225 mg/5ml

NORTUSS-EX 4

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Inst

dextromethorphan & guaifenesin

liq 10-100 mg/5ml GANI-TUSS DM NR 4

dextromethorphan & guaifenesin sr

tabs 12h 60-1200 mg MUCINEX DM 4

hydrocod polst-chlorphen polst cr

susp 10-8 mg/5ml TUSSIONEX 1

hydrocodone & homatropine

syrup 5-1.5 mg/5ml, tabs 5-1.5 mg HYCODAN 4

phenyleph tan-pyrilamine tan-carbeta tan

susp 5-30-30 mg/5ml, tabs 10-40- 60 mg

TUSSI-12D S 4

phenyleph tan-pyrilamine tan-guaifenesin

tabs 25-60-200 mg RYNA-12X 4

phenyleph-chlorphen w/ dm-gg

liq 5-2-15-150 mg/5ml LARTUS 4

phenyleph-dm-pyril-pot guai-sod cit-cit acid

liq ALBATUSSIN 4

phenyleph-ephed-cpm w/ carbetapentane

tabs 10-10-5-60 mg RYNATUSS 4

phenylephrine & guaifenesin

liq 7.5-200 mg/5ml LUSAIR 4

phenylephrine & guaifenesin

liq 7.5-100 mg/5ml DONATUSSIN 4

phenylephrine & guaifenesin sr

caps 12h 30-400 mg GENEXA LA 4

phenylephrine & guaifenesin sr

tabs 12h 25-1200 mg SIMUC-GP 4

phenylephrine w/ codeine-gg

liq 2.5-3-50 mg/ml GILTUSS PED-C 4

phenylephrine w/ dm-gg liq 10-30-200 mg/5ml TUSSAFED EX 4

phenylephrine w/ dm-gg syrup 10-15-350 mg/5ml BIOBRON SF 4

phenylephrine w/ dm-gg syrup 5-15-100 mg/5ml DESPEC DM 4

phenylephrine w/ dm-gg tabs 12h 20-30-600 mg GILTUSS TR 4

phenylephrine w/ dm-gg

liq 2.5-5-75 mg/5ml TUSSI-PRES 4

phenylephrine-brompheniramine-guaifenesin

liq 2-1-40 mg/ml DECON-G 4

phenylephrine-chlorphen-dihydrocodeine

syrup 7.5-2-3 mg/5ml DESPEC-PD 4

phenylephrine-chlorphen-dm

liq 10-4-15 mg/5ml , 3.5-1-3 mg/ml, syrup 10-2-15 mg/5ml, 12.5-4- 15 mg/5ml, tabs 12h 20-8-30 mg

ED-A-HIST 4

promethazine & codeine

syrup 6.25-10 mg/5ml PROMETHAZINE/ CODEINE

1

promethazine dm syrup 6.25-15 mg/5ml PROMETHAZINE/DEXTROMETHORPHAN

1

promethazine vc & codeine

syrup 5-6.25-10 mg/5ml PROMETHAZINE VC /CODEINE

4

2013-2014 | 59

Medicamentos Drugs



Nivel Level

Inst

pseudoephed-bromphen-dm

syrup 45-4-15 mg/5ml CARBOFED DM 4

pseudoephed-chlorphen w/ dm-gg

liq 30-2-30-200 mg/5ml NEOTUSS-D 4

pseudoephedrine & guaifenesin sr

tabs 12h 60-550 mg, 75-1200 mg PSEUDOEPHEDRINE-GUAIFENESIN

4

pseudoephedrine w/ cod-gg

syrup 15-5-50 mg/5ml TUSNEL PED-C 4

pseudoephedrine w/ cod-gg

soln 30-10-100 mg/5ml , syrup 30-10-100 mg/5ml

CHERATUSSIN 4

pseudoephedrine w/ dm-gg

liq 15-5-50 mg/5ml TUSNEL PEDIATRIC 4

pseudoephedrine w/ dm-gg

liq 30-15-200 mg/5ml TUSNEL 4

pseudoephedrine-dihydrocodeine-gg

syrup 15-7.5-100 mg/5ml DESPEC-EXP 4

sodium chloride neb 3 % SODIUM CHLORIDE 4

Asthma (Asma)

Anticholinergics (Anticolinérgicos)

aclidinium bromide inhal 400 mcg/act TUDORZA PRESSAIR 2

ipratropium neb 0.02 % ATROVENT 1

ipratropium inhal 17 mcg/act ATROVENT HFA 3

ipratropium nasal soln 0.03 %, 0.06 % ATROVENT 4

tiotropium inhal caps 18 mcg SPIRIVA 2

Beta Agonists, Inhaled (Agonistas Beta, Inhalados)

albuterol neb 0.083 %, 0.5 % PROVENTIL 1

albuterol neb 0.63 mg/3ml, 1.25 mg/3ml ACCUNEB 4

albuterol inhal 108 mcg/act PROAIR HFA 2

albuterol inhal 108 mcg/act PROVENTIL HFA 2

albuterol inhal 108 mcg/act VENTOLIN HFA 3

formoterol inhal caps 12 mcg FORADIL 2

formoterol neb 20 mcg/2ml PERFOROMIST 4

levalbuterol neb 0.31 mg/3ml , neb 0.63 mg/3ml, 1.25 mg/3ml

XOPENEX 1

levalbuterol inhal 45 mcg/act XOPENEX HFA 2

levalbuterol nebu 1.25 mg/0.5ml XOPENEX CONC 4

pirbuterol inhal 200 mcg/inh MAXAIR 4

salmeterol inhal 50 mcg/dose SEREVENT 3

Beta Agonists, Oral (Agonistas Beta, Orales)

albuterol syrup 2 mg/5ml, tabs 2 mg, 4 mg PROVENTIL 1

albuterol sr tabs 12h 4 mg, 8 mg VOSPIRE ER 4

metaproterenol syrup 10 mg/5ml ALUPENT 1

metaproterenol tabs 10 mg, 20 mg METAPROTERENOL 4

terbutaline

tabs 2.5 mg, 5 mg BRETHINE 1


albuterol & ipratropium inhal 103-18 mcg/act, 20-100 mcg/act

COMBIVENT/ COMBIVENT RESPIMAT

4

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Inst

budesonide & formoterol inhal 160-4.5 mcg/act, 80-4.5 mcg/act

SYMBICORT 2

fluticasone & salmeterol inhal 100-50 mcg/dose, 115- 21 mcg/act, 230-21 mcg/act, 250- 50 mcg/dose, 45-21 mcg/act, 500- 50 mcg/dose

ADVAIR DISKUS / ADVAIR HFA

2

mometasone & formoterol

inhal 100-5 mcg/act, 200-5 mcg/act DULERA 2

Inhaled Corticosteroids (Corticosteroides Inhalados)

beclomethasone inhal 40 mcg/act, 80 mcg/act QVAR 2

budesonide inhal 0.25 mg/2ml, 0.5 mg/2ml, 1 mg/2ml

PULMICORT 1

budesonide inhal 180 mcg/act, 90 mcg/act PULMICORT FLEXHALER

4

fluticasone inhal 110 mcg/act, 220 mcg/act, 44 mcg/act

FLOVENT HFA 2

fluticasone propionate inhal 100 mcg, 250 mcg, 50 mcg FLOVENT DISKUS 2

mometasone inhal 110 mcg, 220 mcg ASMANEX 2


cromolyn neb 20 mg/2ml

INTAL 1

montelukast chew tab 4 mg, 5 mg, pack 4 mg, tabs 10 mg

SINGULAIR 1

zafirlukast tabs 10 mg, 20 mg ACCOLATE 4

zileuton tabs 600 mg ZYFLO 4

Xanthines (Xantinas)

aminophylline tabs 100 mg, 200 mg AMINOPHYLLINE 4

dyphylline elixir 100 mg/15ml, tabs 200 mg, 400 mg

DYLIX 4

dyphylline-guaifenesin liq 100-100 mg/15ml BRONDIL 4

dyphylline-guaifenesin elixir 100-100 mg/15ml, tabs 200- 200 mg, 200-400 mg

LUFYLLIN-GG 4

theophylline elixir 80 mg/15ml ELIXOPHYLLIN 3

theophylline sr tabs 12h 100 mg, 200 mg, 300 mg, 450 mg, tabs 24h 400 mg, 600 mg

THEO-DUR 1

theophylline sr caps 24h 100 mg, 200 mg, 300 mg, 400 mg

THEO-24 SR 3

Intranasal Steroids (Esteroides Intranasales)

beclomethasone nasal susp 42 mcg/spray BECONASE AQ 4

budesonide nasal susp 32 mcg/act RHINOCORT AQUA 4

flunisolide nasal soln 0.025 %, 29 mcg/act NASAREL 4

fluticasone furoate nasal susp 27.5 mcg/spray VERAMYST 4

fluticasone propionate nasal susp 50 mcg/act FLONASE 1

mometasone nasal susp 50 mcg/act NASONEX 2

triamcinolone nasal aerosol 55 mcg/act NASACORT AQ 1

Others (Otros)

azelastine nasal soln 137 mcg/spray ASTELIN 4

olopatadine nasal soln 0.6 % PATANASE 3

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Medicamentos Drugs



Nivel Level

Inst

SKELETAL-MUSCULE SYSTEM/RHEUMATOLOGY (SISTEMA MÚSCULO-ESQUELETAL/REUMATOLOGÍA)

Gout (Gota)

allopurinol tabs 100 mg, 300 mg ZYLOPRIM 1

colchicine tabs 0.6 mg COLCRYS 3

colchicine & probenecid

tabs 0.5-500 mg COLCHICINE/PROBENECID

4

probenecid tabs 500 mg BENEMID 1


acetaminophen & salicylamide

tabs 250-600 mg FRENADOL 4

acetaminophen & salicylamide & phenyltoloxamine

caps 300-200-20 mg LOBAC 4

choline & magnesium salicylates

liq 500 mg/5ml, tabs 1000 mg, 500 mg, 750 mg

TRILISATE 4

leflunomide tabs 10 mg, 20 mg ARAVA 4

magnesium salicylate tabs 600 mg MST 600 4

phenyltoloxamine & acetaminophen

liq 30-500 mg/15ml, tabs 50-650 mg, 60-500 mg

DOLOGESIC 4

phenyltoloxamine & acetaminophen cr

tabs 30-500 mg, 50-500 mg, 60- 650 mg 66-600 mg

RELAGESIC 4

Rheumatology (Reumatología)

auranofin caps 3 mg RIDAURA 3

azathioprine tabs 50 mg IMURAN 1 SL

methotrexate tabs 2.5 mg METHOTREXATE 1

methotrexate inj 25 mg/ml, 25 mg/ml METHOTREXATE 1 SL

methotrexate tabs 10 mg, 15 mg, 2.5 mg, 5 mg, 7.5 mg

TREXALL 3

penicillamine caps 250 mg, tabs 250 mg CUPRIMINE 3

Muscle Relaxants (Relajantes Musculares)

ambenonium tabs 10 mg MYTELASE 4

baclofen tabs 10 mg, 20 mg LIORESAL 1

carisoprodol tabs 350 mg SOMA 1

carisoprodol & aspirin tabs 200-325 mg SOMA COMPOUND 4

carisoprodol & aspirin & codeine

tabs 200-325-16 mg SOMA COMPOUND/CODEINE

4

chlorzoxazone tabs 500 mg PARAFON 1

cyclobenzaprine tabs 5mg, 10 mg FLEXERIL 1

dantrolene caps 100 mg, 25 mg, 50 mg DANTRIUM 1

metaxalone tabs 800 mg SKELAXIN 4

methocarbamol tabs 500 mg, 750 mg ROBAXIN 1

methocarbamol inj 100 mg/ml ROBAXIN 3

orphenadrine inj 30 mg/ml NORFLEX 4

orphenadrine & aspirin & caffeine

tabs 25-385-30 mg, 50-770-60 mg ORPHENADRINE/ASA/CAFFEINE

4

orphenadrine sr tabs 12h 100 mg NORFLEX 4

tizanidine tabs 2 mg, 4 mg ZANAFLEX 4

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Inst


celecoxib caps 100 mg, 200mg, 50 mg, 400mg CELEBREX 2

diclofenac dr tabs 25 mg, 50 mg, 75 mg VOLTAREN DR 1

diclofenac potassium tabs 50 mg CATAFLAM 4

diclofenac sr tabs 24h 100 mg VOLTAREN-XR 4

diflunisal tabs 500mg DIFLUNISAL 1

etodolac caps 200 mg, 300 mg, tabs 400 mg, 500 mg

LODINE 1

etodolac sr tabs 24h 400 mg, 500 mg, 600 mg LODINE XL 4

fenoprofen caps 200 mg, tabs 600 mg NALFON 4

flurbiprofen tabs 100 mg, 50 mg ANSAID 4

ibuprofen tabs 400 mg, 600 mg, 800 mg MOTRIN 1

indomethacin caps 25 mg, 50 mg INDOCIN 1

indomethacin susp 25 mg/5ml INDOCIN 3

indomethacin rectal supp 50 mg INDOCIN 4

indomethacin cr caps 75 mg INDOCIN SR 1

ketoprofen caps 50 mg, 75 mg ORUDIS 4

ketoprofen sr caps 24h 200 mg KETOPROFEN SR 4

ketorolac inj 15 mg/ml, 30 mg/ml, 60 mg/2ml, tabs 10 mg

KETOROLAC 1 QL

meclofenamate caps 100 mg, 50 mg MECLOFENAMATE 4

mefenamic acid caps 250 mg PONSTEL 4

meloxicam tabs 15 mg, 7.5 mg MOBIC 1

meloxicam susp 7.5 mg/5ml MOBIC 4

nabumetone tabs 500 mg, 750 mg RELAFEN 1

naproxen susp 125 mg/5ml, tabs 250 mg, 375 mg, 500 mg

NAPROSYN 1

naproxen ec tabs 375 mg, 500 mg EC-NAPROSYN 1

naproxen sodium tabs 275 mg, 550 mg ANAPROX 1

naproxen sodium sr tabs 24h 375 mg, 500 mg NAPRELAN 4

oxaprozin tabs 600 mg DAYPRO 1

piroxicam caps 10 mg, 20 mg FELDENE 1

salsalate tabs 500 mg, 750 mg DISALCID 1

sulindac tabs 150 mg, 200 mg CLINORIL 1

tolmetin tabs 200 mg, 600 mg TOLMETIN 4

tolmetin caps 400 mg TOLECTIN DS 4

UROLOGY (UROLOGÍA)

5-Alpha Reductase Inhibitors (Inhibidores de la 5-Alpha Reductasa)

dutasteride caps 0.5 mg AVODART 4

finasteride tabs 5 mg PROSCAR 1

Analgesics (Analgésicos)

phenazopyridine tabs 100 mg, 200 mg PYRIDIUM 1

Antispasmodics (Antiespasmódicos)

flavoxate tabs 100 mg URISPAS 1

hyoscyamine tabs 0.15 mg CYSTOSPAZ 1

mirabegron tabs 24h 25 mg, 50 mg MYRBETRIQ 3 ST

oxybutynin syrup 5 mg/5ml, tabs 5 mg DITROPAN 1

oxybutynin sr tabs 24h 10 mg, 15 mg, 5 mg DITROPAN XL 1

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Nivel Level

Inst

tolterodine tabs 1 mg, 2 mg DETROL 1

tolterodine sr caps 24h 2 mg, 4 mg DETROL LA 2

Cholinergics (Colinérgicos)

bethanechol tabs 10 mg, 25 mg, 5 mg, 50 mg URECHOLINE 1

Erectil Dysfunction (Disfunción Eréctil)

sildenafil citrate tabs 100 mg, 25 mg, 50 mg VIAGRA 3 QL SL

tadalafil tabs 10 mg, 2.5 mg, 20 mg, 5 mg CIALIS 3 QL SL

vardenafil hcl odt 10 mg STAXYN 4 QL,SL

vardenafil hcl tabs 10 mg, 2.5 mg, 20 mg, 5 mg LEVITRA 4 QL SL


acetohydroxamic acid tabs 250 mg LITHOSTAT 4

methenamine & hyosc & meth blue & sod phos

tabs 81.6 mg UROGESIC BLUE 1

methenamine & hyosc & meth blue & sod phos & phenyl sal

tabs 81.6 mg URIN D/S 1

methenamine & hyosc & meth blue & sod phos & phenyl sal

tabs 120 mg URETRON D/S 3

methenamine hippurate tabs 1 gm HIPREX/UREX 4

pentosan caps 100 mg ELMIRON 4

sodium chloride soln 0.9 % SODIUM CHLORIDE 4

tamsulosin sr caps 24h 0.4 mg FLOMAX 1

tiopronin tabs 100 mg THIOLA 4

Renal Disease (Enfermedad Renal)

calcium acetate caps 667 mg PHOSLO 1

cinacalcet tabs 30 mg, 60 mg, 90 mg SENSIPAR 3 PA SL

doxercalciferol caps 0.5 mcg, 1 mcg, 2.5 mcg, inj 2 mcg/ml

HECTOROL 3 PA SL

lanthanum chew tab 1000 mg, 500 mg, 750 mg FOSRENOL 4 PA SL

paricalcitol caps 1 mcg, 2 mcg, 4 mcg ZEMPLAR 2 PA SL

sevelamer tabs 400 mg, 800 mg RENAGEL 3 PA SL

sevelamer carbonate powder pack 0.8 gm, 2.4 gm, tabs 800 mg

RENVELA 2 PA SL

VITAMINS/HEMATINICS/ELECTROLYTES (VITAMINAS/HEMATÍNICOS/ELECTRÓLITOS)

Alkalinizer (Alcalinizantes)

pot & sod citrates & citric acid

syrup 550-500-334 mg/5ml POLYCITRA 4

potassium & sodium citrates

tabs 50-950 mg CITROLITH 4

potassium citrate & citric acid

powder 3300-1002 mg, soln 1100-334 mg/5ml

POLYCITRA 1

potassium citrate cr tabs 10 meq, 5 meq POTASSIUM CITRATE CR

1

sodium citrate & citric acid

soln 500-334 mg/5ml BICITRA 1

sodium citrate & citric acid

soln 490-640 mg/5ml ORACIT 4

2013-2014 | 64

Medicamentos Drugs



Nivel Level

Inst

Antidotes (Antídotos)

deferasirox susp tab 125 mg, 250 mg, 500 mg EXJADE 3 PA SL

flumazenil inj 0.5 mg/5ml , 1 mg/10ml ROMAZICON 4

naloxone inj 0.4 mg/ml NALOXONE 4

naltrexone tabs 50 mg REVIA 4

sodium polystyrene sulfonate

powder 454 gm, susp 15 gm/60ml KAYEXALATE 1

succimer caps 100 mg CHEMET 4

Coagulant Therapy (Terapia de Coagulación)

Anticoagulant (Anticoagulantes)

apixaban tabs 2.5 mg, 5 mg ELIQUIS 4 PA

dabigatran caps 150 mg, 75 mg PRADAXA 3 PA

dalteparin inj 10000 u/ml , 12500 unit/0.5ml, 15000 unit/0.6ml, 18000 unit/0.72ml, 2500 unit/0.2ml, 25000 unit/ml, 5000 unit/0.2ml, 7500 unit/0.3ml

FRAGMIN 4

enoxaparin inj 150 mg/ml, 300 mg/3ml LOVENOX 1

fondaparinux inj 10 mg/0.8ml, 2.5 mg/0.5ml, 5 mg/0.4ml, 7.5 mg/0.6ml

ARIXTRA 1

heparin sodium (porcine)

inj 20000 u/ml HEPARIN SODIUM 1

heparin sodium (porcine) inj 1000 u/ml, 10000 u/ml, 2000 u/ml, 2500 u/ml, 5000 u/ml

HEPARIN SODIUM 4

rivaroxaban tabs 10 mg XARELTO 3

rivaroxaban tabs 15 mg, 20 mg XARELTO 3 PA

tinzaparin inj 20000 u/ml INNOHEP 4

warfarin tabs 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

COUMADIN 1

Antiplatelet (Antiplaquetarios)

anagrelide caps 0.5 mg, 1 mg AGRYLIN 4

aspirin & dipyridamole sr caps 12h 25-200 mg AGGRENOX 4

cilostazol tabs 100 mg, 50 mg PLETAL 4

clopidogrel tabs 75 mg PLAVIX 1

dipyridamole tabs 25 mg, 50 mg, 75 mg PERSANTINE 1

prasugrel hcl tabs 10 mg, 5 mg EFFIENT 3 PA SL

ticlopidine tabs 250 mg TICLID 1


aminocaproic acid tabs 1000 mg AMICAR 4

aminocaproic acid syrup 25 %, tabs 500 mg AMICAR 4

pentoxifylline cr tabs 400 mg TRENTAL 1

Vitamins/Hematinics/Other Supplements (Vitaminas/Hematínicos/Otros Suplementos)

Nutrients (Nutrientes)

dextrose & sodium chloride

inj 5-0.45 %, 5-0.9 % DEXTROSE/SODIUM CHLORIDE

4

levocarnitine soln 1 gm/10ml, tabs 330 mg CARNITOR 1

levocarnitine inj 200 mg/ml CARNITOR 4

pot bicarbonate & chloride

tabs 25 meq K-LYTE 4

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Inst

pot phos monobasic & sod phos dibasic & monobasic

tabs 155-852-130 mg K-PHOS NEUTRAL 4

potassium & sodium acid phosphates

tabs 155-350 mg, 305-700 mg K-PHOS 4

potassium bicarbonate tabs 25 meq K-LYTE 4

potassium chloride liq 10 %, 2 %, powder 20 meq, 25 meq

KAON 1

potassium chloride cr caps 10 meq, 8 meq, tabs 10 meq, 8 meq

MICRO-K/SLOW-K 1

potassium chloride microencapsulated cr

tabs 10 meq, 20 meq K-DUR 1

potassium chloride microencapsulated cr

tabs 15 meq KLOR-CON 3

sodium chloride inj 0.45 %, 0.9 % SODIUM CHLORIDE 4

sodium fluoride lozenge 1mg, soln 0.25 mg/drop, tabs 0.5 gm, 1 mg

LOZI-FLUR 4

sodium fluoride chew tab 0.25 mg, 0.5 mg, 1 mg, soln 0.125 mg/drop, 0.5 mg/ml

LURIDE 4

Vitamins (Vitaminas)

ascorbic acid inj 500 mg/ml ASCORBIC ACID 1

b-complex & iron inj ALBAFORT S 3

b-complex vitamin inj B-COMPLEX 4

calcitriol caps 0.25 mcg, 0.5 mcg ROCALTROL 1

calcitriol inj 1 mcg/ml, soln 1 mcg/ml CALCITRIOL 4

cyanocobalamin inj 1000 mcg/ml CYANOCOBALAMIN 1

ergocalciferol caps 50000 u DRISDOL 4

ferric ammon cit-vit b12-liver

inj ALBAFORT 3

folic acid tabs 1 mg FOLVITE 1

folic acid inj 5 mg/ml FOLIC ACID 4

hydroxocobalamin inj 1000 mcg/ml HYDROXOCOBALAMIN

4

iron dextran inj 50 mg/ml INFED 4

leucovorin tabs 25 mg, 10 mg, 15 mg, 5 mg LEUCOVORIN 1

multiple vitamin inj M.V.I. PEDIATRIC 4

phytonadione inj 2 mg/ml VITAMIN K1 1

phytonadione inj 10 mg/ml, tabs 5 mg VITAMIN K1 3

potassium aminobenzoate

caps 500 mg, packet 2 gm, tabs 500 mg

POTABA 4 SL

pyridoxine hcl inj 100 mg/ml PYRIDOXINE HCL 1

sodium ascorbate inj 250 mg/ml, 500 mg/ml VITAMIN C 4

thiamine hcl inj 100 mg/ml THIAMINE HCL 1

vitamin a inj 50000/ml AQUASOL A 4

2013-2014 | 66

Condiciones Crónicas y de Alto Riesgo por Clasificación Terapéutica

Chronic and High Risk Conditions by Therapeutic Clasifications Medicamentos

Drugs Presentación Dosage Form


Nivel Level

Inst

CHRONIC AND HIGH RISK CONDITIONS (CONDICIONES CRÓNICAS Y DE ALTO RIESGO)

Anti-Infectives (Anti-Infecciosos)


amphotericin b inj 100 mg, 5 mg/ml, 50 mg, 50 mg, 50 mg

AMPHOTEC 4, 5 *

anidulafungin inj 100 mg, 50 mg ERAXIS 4, 5 * SL

caspofungin inj 50 mg, 70 mg CANCIDAS 4, 5 * SL

fluconazole & dextrose inj 200 mg/100ml, 400 mg/200ml DIFLUCAN 4, 5 * SL

fluconazole & sodium chloride

inj 200 mg/100ml, 400 mg/200ml DIFLUCAN 4, 5 * SL

micafungin inj 100 mg, 50 mg MYCAMINE 4, 5 * SL

voriconazole inj 200 mg VFEND 4, 5 * SL


tobramycin inj 1.2 gm, 1.2 gm/30ml , 10 mg/ml, 2 gm/50ml , 80 mg/2ml

TOBRAMYCIN 1, 5 *

tobramycin neb 300 mg/5ml TOBI 3, 5 *

Antivirals (Antivirales)

Hepatitis B (Hepatitis B)

adefovir tabs 10 mg HEPSERA 3, 5 * PA SL

entecavir soln 0.05 mg/ml, tabs 0.5 mg, 1mg

BARACLUDE 3, 5 * PA SL

lamivudine soln 5 mg/ml, tabs 100 mg EPIVIR HBV 3, 5 * PA SL

telbivudine tabs 600 mg TYZEKA 3, 5 * PA SL

Hepatitis C (Hepatitis C)

interferon alfacon-1 inj 15 mcg/0.5ml, 9 mcg/0.3ml INFERGEN 3, 5 *

inj 10 mu/0.2ml, 3 mu/0.2ml, 6 mu/ml

inj 10 mu/0.2ml, 3 mu/0.2ml, 6 mu/ml

INTRON-A 4, 5 * PA SL

peginterferon alfa-2a inj 135 mcg/0.5ml, 180 mcg/0.5ml, 180 mcg/ml

PEGASYS PROCLICK 4, 5 * PA SL

peginterferon alfa-2b inj 120 mcg/0.5ml, 150 mcg/0.5ml, 50 mcg/0.5ml, 80 mcg/0.5ml

PEG-INTRON 2, 5 * PA SL

ribavirin inhal 6 gm VIRAZOLE 3, 5 *

ribavirin tabs 400 mg, 600 mg RIBASPHERE 4, 5 * PA SL

ribavirin pack 200 & 400 mg dosepack, 400&600 mg

RIBAPAK 4, 5 * PA SL

ribavirin caps 200 mg, tabs 200 mg COPEGUS/ REBETOL 4, 5 * PA SL

HIV/AIDS (VIH/SIDA)

Fusion Inhibitor (Inhibidores de la Fusión)

enfuvirtide inj 90 mg FUZEON 3, 5 * PA SL

Biotechnology (Biotecnología)

Enzyme Replacement (Remplazo Enzimático)

betain soln CYSTADANE 4, 5 *

cysteamine caps 150 mg, 50 mg CYSTAGON 4, 5 *

2013-2014 | 67

Medicamentos Drugs



Nivel Level

Inst

imiglucerase inj 200 u, 400 u CEREZYME 4, 5 * PA LA SL

miglustat caps 100 mg ZAVESCA 4, 5 * PA LA SL

pegademase inj 250 u/ml ADAGEN 4, 5 *

proteinase inhibitor inj 1000 mg, 500 mg PROLASTIN 4, 5 *

sodium phenylbutyrate tabs 500 mg BUPHENYL 4, 5 *

sodium phenylbutyrate powder 3 gm/5ml BUPHENYL 4, 5 *

taliglucerase inj 200 u ELELYSO 4, 5 * PA LA SL

velaglucerase inj 400 u VPRIV 4, 5 * PA LA SL

Erythropoiesis Stimulating Proteins (Estimulantes de la Eritopoyesis)

darbepoetin alfa-polysorbate

inj 25 mcg/ml, 25 mcg/0.42ml, 40 mcg/ml, 40 mcg/0.4ml, 60 mcg/ml, 60 mcg/0.3ml, 100 mcg/ml

ARANESP 4, 5 * PA

epoetin alfa inj 10000 u/ml, 2000 u/ml, 20000 u/ml, 3000 u/ml, 4000 u/ml, 40000 u/ml

PROCRIT 2, 5 * PA

epoetin alfa inj 10000 u/ml, 2000 u/ml, 20000 u/ml, 3000 u/ml, 4000 u/ml, 40000 u/ml

EPOGEN 3, 5 * PA

oprelvekin inj 5 mg NEUMEGA 4, 5 *

Multiple Sclerosis (Esclerosis Múltiple)

dalfampridine tab sr 12hr 10 mg AMPYRA 4, 5 * SL

fingolimod caps 0.5 mg GILENYA 4, 5 * PA SL

glatiramer inj 20 mg/ml COPAXONE 2, 5 *

interferon beta-1a inj 30 mcg, 30 mcg/0.5ml AVONEX 2, 5 *

interferon beta-1a inj 22 mcg/0.5ml, 44 mcg/0.5ml, 8.8 mcg/0.2ml&22 mcg/0.5ml

REBIF 3, 5 *

interferon beta-1b inj 0.3 mg EXTAVIA 2, 5 *

interferon beta-1b inj 0.3 mg BETASERON 3, 5 *

natalizumab inj 300 mg/15ml TYSABRI 4, 5 *

teriflunomide tabs 7mg, 14mg AUBAGIO 4, 5 *

Myeloid Stimulating Agents (Estimulantes Mieloides)

filgrastim inj 300 mcg/0.5ml , 300 mcg/ml, 480 mcg/0.8ml , 480 mcg/1.6ml

NEUPOGEN 3, 5 *

pegfilgrastim inj 6 mg/0.6ml NEULASTA 4, 5 *

sargramostim inj 250 mcg LEUKINE 3, 5 *

sargramostim inj 500 mcg/ml LEUKINE 4, 5 *

Cancer (Cáncer)

Alkylating Agents (Agentes Alquilantes)

temozolomide caps 100 mg, 140 mg, 180mg, 20 mg, 250 mg, 5 mg

TEMODAR 4, 5 *

Antimetabolites (Antimetabolitos)

capecitabine tabs 150 mg, 500 mg XELODA 4, 5 *

fludarabine tabs 10 mg OFORTA 4, 5 * PA SL

2013-2014 | 68

Medicamentos Drugs



Nivel Level

Inst


axitinib tabs 1mg, 5 mg INLYTA 4, 5 * PA SL AL

bosutinib tabs 100 mg, 500 mg BOSULIF 4, 5 * PA SL AL

crizotinib caps 200 mg, 250 mg XALKORI 4, 5 * PA SL

dasatinib tabs 100 mg, 140 mg, 20 mg, 50 mg, 70 mg, 80 mg

SPRYCEL 4, 5 * PA SL

erlotinib tabs 100 mg, 150 mg, 25 mg TARCEVA 3, 5 * PA SL

everolimus tabs 10 mg, 2.5 mg, 5 mg, 7.5 mg AFINITOR 4, 5 * PA SL

imatinib mesylate tabs 100 mg, 400 mg GLEEVEC 3, 5 * PA SL

lapatinib ditosylate tabs 250 mg TYKERB 3, 5 * PA SL

lenalidomide caps 10 mg, 15 mg, 2.5 mg, 25 mg, 5 mg

REVLIMID 4, 5 * PA SL

mitoxantrone inj 20 mg/10ml , 25 mg/12.5ml , 30 mg/15ml

NOVANTRONE 4, 5 *

nilotinib caps 150 mg, 200 mg TASIGNA 4, 5 * PA SL

pazopanib tabs 200 mg VOTRIENT 4, 5 * PA SL

peginterferon alfa-2b inj 296 mcg, 4 x 296 mcg, 4 x 444 mcg, 4 x 888 mcg, 444 mcg, 888 mcg

SYLATRON 4, 5 * PA, SL

regorafenib tabs 40 mg STIVARGA 4, 5 * PA SL

sorafenib tosylate tabs 200 mg NEXAVAR 4, 5 * PA SL

sunitinib malate caps 12.5 mg, 25 mg, 50 mg SUTENT 4, 5 * PA SL

thalidomide caps 100 mg, 150 mg, 200 mg, 50 mg

THALOMID 4, 5 *

vemurafenib tabs 240 mg ZELBORAF 4, 5 * PA SL AL

vismodegib caps 150 mg ERIVEDGE 4, 5 * PA SL

vorinostat caps 100 mg ZOLINZA 4, 5 * PA SL

Cardiovasculars (Cardiovasculares)

ambrisentan tabs 10 mg, 5 mg LETAIRIS 4, 5 * PA SL

bosentan tabs 125 mg, 62.5 mg TRACLEER 4, 5 * PA SL epoprostenol sodium inj 0.5 mg, 1.5 mg FLOLAN 4, 5 * PA SL iloprost inhal 10 mcg/ml, 20 mcg/ml VENTAVIS 4, 5 * PA SL sildenafil tabs 20 mg REVATIO 4, 5 * AL,

PA SL

treprostinil inj 1 mg/ml, 10 mg/ml, 2.5 mg/ml, 5 mg/ml

REMODULIN 4, 5 * PA SL

Central Nervous System (Sistema Nervioso Central)

sodium oxybate soln 50 mg/5ml XYREM 4, 5 * PA SL

Endocrinology (Endocrinológicos)

Growth Hormones (Hormonas de Crecimiento)

somatropin inj 8.8 mg ZORBTIVE 4, 5 * PA SL

somatropin inj 5 mg, 8.8 mg SAIZEN 3, 5 * PA SL

somatropin inj 0.2 mg, 0.4 mg, 0.6 mg, 0.8 mg, 1 mg, 1.2 mg, 1.4 mg, 1.6 mg, 1.8 mg, 13.8 mg, 2 mg

GENOTROPIN 3, 5 * PA SL

2013-2014 | 69

Medicamentos Drugs



Nivel Level

Inst

somatropin inj 4 mg, 5 mg, 6 mg SEROSTIM 3, 5 * PA SL

somatropin inj 10 mg, 20 mg/2ml, 5 mg, 5 mg/ml

NUTROPIN 3, 5 * PA SL

somatropin inj 12 mg, 24 mg, 5 mg, 6 mg HUMATROPE 4, 5 * PA SL

somatropin inj 5 mg/1.5ml, 5.8 mg OMNITROPE 3, 5 * PA SL

somatropin inj 5 mg TEV-TROPIN 3, 5 * PA SL

somatropin inj 10 mg/1.5ml, 15 mg/1.5ml, 30 mg/3ml, 5 mg/1.5ml

NORDITROPIN 3, 5 * PA SL


lanreotide acetate inj 120 mg/0.5ml, 60 mg/0.2ml, 90 mg/0.3ml

SOMATULINE DEPOT 4, 5 * PA SL

octreotide inj 10 mg, 20 mg, 30 mg SANDOSTATIN LAR 3, 5 * PA SL

octreotide inj 0.05 mg/ml, 0.1 mg/ml, 0.2 mg/ml, 0.5 mg/ml, 1 mg/ml

SANDOSTATIN 4, 5 * PA SL

Others (Otros)

desmopressin nasal soln 1.5 mg/ml STIMATE 3, 5 *

Obstetrics/Gynecology (Obstetricia/Ginecología)

Osteoporosis (Osteoporosis)

Biphosphonates (Bifosfonatos)

denosumab inj 60 mg/ml PROLIA 4, 5 * QL PA SL

ibandronate inj 3 mg/3ml BONIVA 4, 5 * PA

pamidronate inj 6 mg/ml AREDIA 4, 5 *

pamidronate inj 3 mg/ml, 30 mg, 9 mg/ml, 90 mg

AREDIA 4, 5 *

zoledronic soln 5 mg/100ml RECLAST 4, 5 * QL PA


teriparatide inj 750 mcg/3ml FORTEO 3, 5 * PA SL

Respiratory (Respiratorios)

Others (Otros)

dornase alfa inhal 1 mg/ml PULMOZYME 4, 5 *

Skeletal-Muscule System/Rheumatology (Sistema Músculo-Esqueletal/Reumatología)


abatacept inj 125 mg/1ml, 250 mg ORENCIA 3, 5 * PA SL

adalimumab inj 20 mg/0.4ml, 40 mg/0.8ml HUMIRA 2, 5 * PA SL

etanercept inj 25 mg, 25 mg/0.5ml, 50 mg/ml ENBREL 2, 5 * PA SL

infliximab inj 100 mg REMICADE 4, 5 * PA

tocilizumab inj 200 mg/10ml, 400 mg/20ml, 80 mg/4ml

ACTEMRA 4, 5 * PA, SL

tofacitinib citrate tabs 5 mg XELJANZ 4, 5 * PA, SL

Vitamins/Hematinics/Other Supplements (Vitaminas/Hematínicos/OtrosSuplementos)

Chelating Agents (Agentes Quelantes)

deferiprone tabs 500 mg FERRIPROX 4, 5 * PA SL AL

Coagulant Therapy (Terapia de Coagulación)


antihemophilic factor inj 401-800 u HEMOFIL M 3, 5 * PA SL

2013-2014 | 70

Medicamentos Drugs



Nivel Level

Inst

antihemophilic factor inj 500 u KOATE-DVI 4, 5 * PA SL

antihemophilic factor (human)

inj 220-400 u, 4000 u, 401-800 u HEMOFIL M 3, 5 * PA SL

antihemophilic factor (human)

inj 1000 u, 1000-1000 u, 1500 u, 250 u, 450-450 u, 500 u, 500- 500 u, 900-900 u

MONOCLATE-P 4, 5 * PA SL

antihemophilic factor (recombinant)

inj 1241-1800 u, 1801-2400 u, 801-1240 u

RECOMBINATE 3, 5 * PA SL


inj 1000 u, 2000 u, 250 u, 500 u REFACTO 4, 5 * PA, SL


inj 3000 u XYNTHA 4, 5 * PA SL

antihemophilic factor rahf-pfm

inj 1000 u, 1500 u, 2000 u, 250 u, 3000 u, 500 u

ADVATE 3, 5 * PA SL

antihemophilic factor/vwf inj 250-600 u HUMATE-P 4, 5 * PA SL

antihemophilic factor/vwf (human)

inj 1000 u, 1000-2400 u, 1500 u, 250 u, 500 u, 500-1200 u

ALPHANATE 4, 5 * PA SL

antiinhibitor coagulant complex

inj FEIBA VH 4, 5 * PA SL

coagulation factor ix inj , 1000 u, 1500 u, 500 u MONONINE 4, 5 * PA SL

coagulation factor ix (recombinant)

inj 1000 u, 2000 u, 250 u, 3000 u, 500 u

BENEFIX 4, 5 * PA SL

coagulation factor viia (recombinant)

inj 1 mg, 1200 mcg, 2 mg, 2400 mcg, 4800 mcg, 5 mg, 8 mg

NOVOSEVEN 4, 5 * PA SL

factor ix complex inj 1000 u, 1500 u, 200-1200 u, 500 u

PROFILNINE 4, 5 * PA SL

2013-2014 | 71

APENDICE I - LIMITES DE CANTIDAD APPENDIX I - QUANTITY LIMITS

Producto (Product)

Nombre genérico (Generic Name)

Cantidad (Quantity)

Días (Days)

AMERGEf

NARATRIPTAN HCL TAB 1 MG, 2.5MG 9 tab 30

AMITIZA LUBIPROSTONE CAP 8 MCG, 24MCG 60 cap 30

ANDROGEL PUMP

TESTOSTERONE TD GEL 20.25 MG/ACT (1.62%) 75 gm 30

AXERTi

ALMOTRIPTAN MALATE TAB 6.25 MG, 12.5 MG 6 tab 30

CIALIS TADALAFIL TAB 2.5 MG, 5MG, 10MG, 20MG 6 tab 30

CIPRO XR CIPROFLOXACIN-CIPROFLOXACIN HCL TAB SR 24HR 500 MG

** 3

CIPRO XR CIPROFLOXACIN-CIPROFLOXACIN HCL TAB SR 24HR 1000 MG

** 14

COARTEM ARTEMETHER-LUMEFANTRINE TAB 20-120 MG 24 tab 365

CRINONE PROGESTERONE VAGINAL GEL 8% 21.75 gm 15

DENAVIR PENCICLOVIR CREAM 1% 5 gm 15

EMEND APREPITANT CAPSULE 80 MG 2 Cap 7

EMEND APREPITANT CAPSULE 125 MG 1 Cap 7

EMEND APREPITANT CAPSULE THERAPY PACK 80 & 125 MG

3 Cap 7

FROVAj

FROVATRIPTAN SUCCINATE TAB 2.5 MG 9 tab 30

IMITREXb

SUMATRIPTAN NASAL SPRAY 1 caja/ 1 box 30

IMITREXc,d

SUMATRIPTAN SUCCINATE TAB 25 MG, 50MG 18 tab 30

IMITREXc,d

SUMATRIPTAN SUCCINATE TAB 100 MG 9 tab 30

IMITREXa SUMATRIPTAN SUCCINATE INJ 5 ampolletas / 5

ampoule 30

LAMISIL TERBINAFINE HCL TAB 250 MG 84 tab 365

LEVITRA VARDENAFIL HCL TAB 2.5 MG, 5 MG, 10 MG, 20MG

6 tab 30

MALARONE ATOVAQUONE-PROGUANIL HCL TAB 62.5- 25MG 48 tab 365

MARONE ATOVAQUONE-PROGUANIL HCL TAB 250-100MG 12 tab 365

MAXALTg,h

RIZATRIPTAN BENZOATE TAB 5 MG 24 or 12 tab* 30

MAXALTg,h

RIZATRIPTAN BENZOATE TAB 10 MG 12 tab* 30

MAXALTg,h

RIZATRIPTAN BENZOATE ORALLY DISINTEGRATING TAB 5 MG

24 or 12 tab* 30

MAXALTg,h

RIZATRIPTAN BENZOATE ORALLY DISINTEGRATING TAB 10 MG

12 tab* 30

PENLAC CICLOPIROX SOLUTION 8% 1 Botella/Bottle 90

PROLIA DENOSUMAB INJ 60 MG/ML 1 ml 135

Qualaquin QUININE SULFATE CAP 324 MG 42 Cap 365

RECLAST ZOLEDRONIC ACID IV SOLN 5 MG/100ML 100 ml 274

RELISTOR METHYLNALTREXONE BROMIDE INJ 8 MG/0.4ML (20 MG/ML)

2.8 ml 15

2013-2014 | 72

Producto (Product)


Cantidad (Quantity)

Días (Days)

RELISTOR METHYLNALTREXONE BROMIDE INJ 12 MG/0.6ML (20 MG/ML)

4.2 ml 15

RELISTOR METHYLNALTREXONE BROMIDE INJ KIT 12 MG/0.6ML

1 box (7 Inj) 15

RELPAXk

ELETRIPTAN HYDROBROMIDE TAB 20 MG, 40MG 6 tab 30

STAXYN VARDENAFIL HCL ORALLY DISINTEGRATING TAB 10 MG

4 tab 30

TORADOL KETOROLAC TROMETHAMINE ** 5

VIAGRA SILDENAFIL CITRATE TAB 25 MG 2 tab 30



ZOMIGe

ZOLMITRIPTAN TAB 2.5 MG, 5 MG, ODT 2.5MG, 5MG

6 tab 30

* No se debe utilizar en pacientes que toman propranolol concurrentemente / should not be used concurrently with propranolol

** Se despachará una cantidad máxima de suplido según establecido en la tabla de limites de cantidad / A máximum supply for days of therapy will be dispensed as establish in the table of quantity limits.

Triptanos a. Si no se observa respuesta adecuada, se puede repetir la dosis una vez luego de 2 horas hasta un máximo de 12mg en

24 horas. / If adequate response is not observed, the dose can be repeated once again alter two hours up to a maximum of 12 mg in 24 hours.

b. Si no se observa respuesta adecuada, se puede repetir la dosis una vez luego de 2 horas hasta un máximo de 40mg en 24 horas. /If adequate response is not observed, the dose can be repeated once again alter two hours up to a maximum of 40 mg in 24 hours.

c. Si no se observa respuesta adecuada, se puede repetir la dosis una vez luego de 2 horas hasta un máximo de 200mg en 24 horas. / If adequate response is not observed, the dose can be repeated once again alter two hours up to a maximum of 200 mg in 24 hours.

d. Si el producto inyectable se usa concomitantemente, la dosis oral máxima no debe exceder 100mg / If the injectable product is used jointly, the maximum oral dose should not exceed 100mg.

e. Los estudios clínicos no han establecido la efectividad de una segunda dosis si la primera es inefectiva. Si no se observa respuesta adecuada, se puede repetir la dosis una vez luego de 2 horas hasta un máximo de 10mg en 24 horas. / The clinical studies have not established the effectiveness of a second dose if the first one is ineffective. If adequate response is not observed, the dose can be repeated once again after two hours up to a maximum of 10mg in 24 hours.

f. Si no se observa respuesta adecuada, se puede repetir la dosis una vez luego de 4 horas hasta un máximo de 5mg en 24 horas. / If adequate response is not observed, the dose can be repeated after four hours up to a maximum of 5mg in 24 hours.

g. Si no se observa respuesta adecuada, se puede repetir la dosis luego de 2 horas hasta un máximo de 30mg en 24 horas. / If adequate response is not observed, the dose can be repeated after two hours up to a maximum of 30mg in 24 hours.

h. En pacientes que reciben propranolol concomitantemente, la dosis de 5mg de rizatriptan debe usarse hasta un máximo de 3 dosis (15mg) en 24 horas. / In patients that receive propranolol jointly, the 5mg dose of rizatriptan should be up to a maximum of three doses (15mg) in 24 hours.

i. Si no se observa respuesta adecuada, se puede repetir la dosis una vez luego de 2 horas hasta un máximo de 25mg en 24 horas. / If adequate response is not observed, the dose can be repeated after two hours up to a maximum of 25mg in 24 hours.

j. Si no se observa respuesta adecuada, se puede repetir la dosis en 2 horas hasta un máximo de 7.5mg en 24 horas. / If adequate response is not observed, the dose can be repeated after two hours up to a maximum of 7.5mg in 24 hours.

k. Si no se observa respuesta adecuada, se puede repetir la dosis en 2 horas hasta un máximo de 80mg en 24 horas. No exceder de 40mg por dosis. / If adequate response is not observed, the dose can be repeated after two hours up to a maximum of 80mg in 24 hours. Do not exceed 40mg per dose.

2013-2014 | 73

APENDICE II - LIMITES DE ESPECIALIDAD APPENDIX II - SPECIALTY LIMITS

Dentro del formulario se encuentran incluidos medicamentos asociados a las iniciales SL. SL

significa que estos medicamentos requieren que un especialista evalúe el paciente y los recete. La

siguiente tabla enumera cuales son estos productos y señala el especialista que debe prescribirlos.

The formulary includes drugs associated to the LE initials. LE means that those medications require

that a specialist evaluates the patient and prescribe it. The following table enumerates which are

those products and indicate the specialist that must prescribe it.

Producto (Product)

Especialista (Specialist)

Actemra Reumatólogo / Rheumatologist

Afinitor Hematólogo-Oncólogo, Urólogo, Neurólogo, Neurocirujano / Hematologist-Oncologist, Urologist, Neurologist, Neurosurgeon

Amitiza Gastroenterólogo, Medicina Interna / Gastroenterologist, Internal Medicine

Ampyra Neurólogo, Medicina Física y Rehabilitación / Neurologist, Physical Medicine and Rehabilitation

Antihemophilic & Coagulation Factors

Hematólogo /Hematologist

Aptivus Infectólogo / Infectologist

Banzel Neurólogo, Neurólogo Pediatrico/ Neurologist, Pediatric Neurologist

Baraclude Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist

Bosulif Hematólogo-Oncológo / Hematologist-Oncologist

Cancidas Infectólogo, Hematólogo-Oncólogo / Infectologist, Hematologist-Oncologist

Cellcept Reumatólogo / Rheumatologist

Cialis Urólogo, Endocrinólogo / Urologist, Endocrinologist

Copegus Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist

Differin gel 0.3% Dermatólogo/ Dermatologist

Diflucan inj Infectólogo, Hematólogo-Oncólogo / Infectologist, Hematologist-Oncologist

Elelyso Desordenes Genéticos y Metabólicos / Metabolic and Genetic Desorders

Emend Oncólogo / Oncologist

Enbrel Reumatólogo, Dermatólogo / Rheumatologist, Dermatologist

Entocort EC Gastroenterólogo / Gastroenterologist

Epiduo Dermatólogo / Dermatologist

Epivir HBV Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist

Eraxis Infectólogo, Hematólogo-Oncólogo / Infectologist, Hematologist-Oncologist

Erivedge Hematólogo-Oncológo / Hematologist-Oncologist

Dermatólogo / Dermatologist

Exjade Hematólogo-Oncológo / Hematologist-Oncologist

2013-2014 | 74

Producto (Product)


Flolan Cardiólogo, Neumólogo, Intensivista/ Cardiologist, Pneumologist, Intensivist

Forteo Endocrinólogo, Reumatólogo / Endocrinologist, Rheumatologist

Fosrenol Nefrólogo/ Nephrologist

Fuzeon Infectólogo / Infectologist

Gilenya Neurólogo / Neurologist

Gleevec Oncólogo / Oncologist

Hectorol Nefrólogo / Nephrologist

Hepsera Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist

Hormonas de Crecimiento / Growth Hormone

Endocrinólogo / Endocrinologist

Humira Reumatólogo, Dermatólogo, Gastroenterólogo / Rheumatologist, Dermatologist, Gastroenterologist

Imuran Reumatólogo, Dermatólogo, Nefrólogo, Neumólogo, Gastroenterólogo / Rheumatologist, Dermatologist, Nephrologist, Pneumologist, Gastroenterologist

Inlyta Hematólogo-Oncológo, Urólogo / Hematologist-Oncologist, Urologist

Intelence Infectólogo / Infectologist

Korlym Endocrinólogo / Endocrinologist

Letairis Cardiólogo, Neumólogo, Intensivista/ Cardiologist, Pneumologist, Intensivist

Levitra Urólogo, Endocrinólogo / Urologist, Endocrinologist

Methotrexate inj. Reumatólogo, Gastroenterólogo / Rheumatologist, Gastroenterologist

Mycamine Infectólogo, Hematólogo-Oncólogo / Infectologist, Hematologist-Oncologist

Nexavar Gastroenterólogo, Hematólogo-Oncólogo, Urólogo / Gastroenterologist, Hematologist-Oncologist, Urologist

Noxafil Infectólogo / Infectologist

Oforta Hematólogo-Oncológo / Hematologist-Oncologist

Orencia Reumatólogo / Rheumatologist

Pegasys Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist

Peg-Intron / Intron-A Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist

Potaba Reumatólogo, Dermatólogo, Uólogo / Rheumatologist, Dermatologist, Urologist

Potiga Neurólogo, Neurólogo Pediátrico / Neurologist, Pediatric Neurologist

Prolia Endocrinólogo, Reumatólogo / Endocrinologist, Rheumatologist

Ranexa Cardiólogo / Cardiologist

Rebetol Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist

Remodulin Cardiólogo, Neumólogo, Intensivista/ Cardiologist, Pneumologist, Intensivist

Renagel / Renvela Nefrólogo/ Nephrologist

Restasis Oftalmólogo/ Ophthalmologist

Retin A Dermatólogo / Dermatologist

Revatio Cardiólogo, Neumólogo, Intensivista/ Cardiologist, Pneumologist, Intensivist

2013-2014 | 75

Producto (Product)


Revlimid Hematólogo-Oncológo / Hematologist-Oncologist

Ribapak / Ribasphere Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist

Sandostatin / Sandostatin LAR

Endocrinólogo, Gastroenterólogo, Hematólogo-Oncólogo/ Endocrinologist, Gastroenterologist, Hematologist-Oncologist

Selzentry Infectólogo / Infectologist

Sensipar Nefrólogo / Nephrologist

Somatuline Endocrinólogo/ Endocrinologist

Sprycel Hematólogo-Oncólogo / Hematologist-Oncologist

Staxyn Urólogo, Endocrinólogo / Urologist, Endocrinologist

Stivarga Hematólogo-Oncológo / Hematologist-Oncologist

Sutent Hematólogo-Oncólogo, Gastroenterólogo, Urólogo / Hematologist-Oncologist, Gastroenterologist, Urologist

Sylatron Hematólogo-Oncólogo / Hematologist-Oncologist

Tarceva Oncólogo / Oncologist

Tasigna Hematólogo-Oncológo / Hematologist-Oncologist

Tracleer Cardiólogo, Neumólogo, Intensivista/ Cardiologist, Pneumologist, Intensivist

Tykerb Hematólogo-Oncológo / Hematologist-Oncologist

Tyzeka Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist

Ventavis Cardiólogo, Neumólogo, Intensivista/ Cardiologist, Pneumologist, Intensivist

Vfend / Voriconazole Infectólogo, Hematólogo-Oncólogo / Infectologist, Hematologist-Oncologist

Viagra Urólogo, Endocrinólogo / Urologist, Endocrinologist

Vimpat Neurólogo, Neurólogo Pediatrico/ Neurologist, Pediatric Neurologist

Viread Gastroenterólogo, Infectólogo / Gastroenterologist, Infectologist

Votrient Hematólogo-Oncológo, Urólogo / Hematologist-Oncologist, Urologist

Vpriv Desordenes Genéticos y Metabólicos / Metabolic and Genetic Desorders

Xalkori Hematólogo-Oncológo / Hematologist-Oncologist

Xtandi Hematólogo-Oncológo / Hematologist-Oncologist

Xeljanz Reumatólogo / Rheumatologist

Xyrem Neumólogo, Neurólogo, Siquiatra / Pneumologist, Neurologist, Psychatrist

Zavesca Desordenes Genéticos y Metabólicos / Metabolic and Genetic Desorders

Zelboraf Hematólogo-Oncológo / Hematologist-Oncologist

Zemplar Nefrólogo / Nephrologist

Zolinza Dermatólogo, Hematólogo-Oncólogo / Dermatologist, Hematologist-Oncologist

2013-2014 | 76

APENDICE III - LIMITES DE EDAD

APPENDIX III - AGE LIMITS Dentro del formulario se encuentran incluidos medicamentos asociados a las iniciales AL. AL

significa que estos medicamentos tienen a un límite de edad.

The formulary includes medications associated to the initials AL. AL means that those medications

have a limit in the age.


Productos (Product)

Límites de Edad (Age Limits)

ADAPALENE GEL DIFFERIN ≤ 25 años/≤ 25 years

ADAPALENE-BENZOYL PEROXIDE GEL

EPIDUO ≤ 24 años/≤ 24 years

AMCINONIDE AMCINONIDE ≥ 12 años/≥ 12 years

AMCINONIDE CREAM CYCLOCORT ≥ 12 años/≥ 12 years

ATOMOXETINE HCL STRATTERA ≥ 6-18 años; ≥ 19 años requiere PA / PA required

AUGMENTED BETAMETHASONE DIPROPIONATE

DIPROLENE ≥ 12 años/≥ 12 years

AXITINIB INLYTA ≥ 18 años/ ≥ 18 years

BETAMETHASONE DIPROPIONATE

DIPROSONE ≥ 12 años/≥ 12 years

BETAMETHASONE VALERATE LUXIQ ≥ 12 años/≥ 12 years

BOSUTINIB BOSULIF ≥ 18 años/ ≥ 18 years

CLOBETASOL PROPIONATE TEMOVATE ≥ 12 años/≥ 12 years

CLOBETASOL PROPIONATE TEMOVATE ≥ 12 años/≥ 12 years

CLOBETASOL PROPIONATE FOAM

OLUX ≥ 12 años/≥ 12 years

CLOTRIMAZOLE W/ BETAMETHASONE

LOTRISONE ≥ 18 años/ ≥ 18 years

DEFERIPRONE FERRIPROX ≥ 18 años/≥ 18 years

DESOXIMETASONE TOPICORT ≥ 12 años/≥ 12 years

DIFLORASONE DIACETATE PSORCON ≥ 12 años/≥ 12 years

FLUOCINONIDE LIDEX ≥ 12 años/≥ 12 years

HALCINONIDE HALOG ≥ 12 años/≥ 12 years

HALOBETASOL PROPIONATE ULTRAVATE ≥ 12 años/≥ 12 years

HYDROCORTISONE PROBUTATE

PANDEL ≥ 18 años/ ≥ 18 years

LACOSAMIDE VIMPAT ≥ 17 años/≥ 17 years

SILDENAFIL CITRATE REVATIO ≥ 18 años/≥ 18 years

TRETINOIN RETIN-A ≤ 24 años/≤ 24 years

TRIAMCINOLONE ACETONIDE KENALOG ≥ 12 años/≥ 12 years

VEMURAFENIB ZELBORAF ≥ 18 años/ ≥ 18 years

2013-2014 | 77

APENDICE IV - PREAUTORIZACION APPENDIX IV- PRIOR AUTHORIZATION

Dentro del formulario se encuentran incluidos medicamentos asociados a las iniciales PA. PA

significa pre-autorización. Triple-S debe aprobar estos medicamentos antes de que sean

despachados. La siguiente tabla enumera cuales son estos productos.

The formulary includes drugs associated to the PA initials. PA means preauthorization. Triple S must

authorize those medications before the pharmacy dispense it. The following table enumerates which

are those products.

Nombre genérico (Generic Name) Producto (Product)

ABATACEPT ORENCIA

ADALIMUMAB HUMIRA

ADEFOVIR HEPSERA

AMBRISENTAN LETAIRIS

ANTIHEMOPHILIC FACTOR HEMOFIL M

ANTIHEMOPHILIC FACTOR KOATE-DVI

ANTIHEMOPHILIC FACTOR KOATE-DVI

ANTIHEMOPHILIC FACTOR HEMOFIL M

ANTIHEMOPHILIC FACTOR MONOCLATE-P

ANTIHEMOPHILIC FACTOR RECOMBINATE

ANTIHEMOPHILIC FACTOR REFACTO

ANTIHEMOPHILIC FACTOR ADVATE

ANTIHEMOPHILIC FACTOR XYNTHA

ANTIHEMOPHILIC FACTOR HUMATE-P

ANTIHEMOPHILIC FACTOR WILATE

ANTIHEMOPHILIC FACTOR HUMATE-P

ANTIHEMOPHILIC FACTOR ALPHANATE

ANTIINHIBITOR COAGULANT COMPLEX FEIBA VH

APIXABAN ELIQUIS

APREPITANT EMEND

ATOMOXETINE HCL STRATTERA

AXITINIB TAB 1 MG INLYTA

AXITINIB TAB 5 MG INLYTA

BECAPLERMIN REGRANEX

BOSENTAN TRACLEER

BOSUTINIB BOSULIF

BUDESONIDE BUDESONIDE

BUPRENORPHINE SUBUTEX

BUPRENORPHINE & NALOXONE SUBOXONE

CINACALCET HCL SENSIPAR

COAGULATION FACTOR IX MONONINE / ALPHANINE / BENEFIX

2013-2014 | 78


COAGULATION FACTOR VIIA NOVOSEVEN / NOVOSEVEN RT

CRIZOTINIB XALKORI

CYCLOSPORINE RESTASIS

DABIGATRAN ETEXILATE MESYLATE PRADAXA

DARBEPOETIN ALFA-POLYSORBATE ARANESP

DASATINIB SPRYCEL

DEFERASIROX EXJADE

DEFERIPRONE FERRIPROX

DENOSUMAB PROLIA

DOXERCALCIFEROL HECTOROL

ENFUVIRTIDE FOR INJ FUZEON

ENTECAVIR BARACLUDE

ENZALUTAMIDE XTANDI

EPOETIN ALFA EPOGEN/PROCRIT

EPOPROSTENOL SODIUM FLOLAN

ERLOTINIB TARCEVA

ETANERCEPT ENBREL

ETRAVIRINE INTELENCE

EVEROLIMUS AFINITOR

EZETIMIBE & SIMVASTATINA 10/80 mg VYTORIN

FACTOR IX COMPLEX PROFILNINE/PROFILNINE SD / BEBULIN VH

FINGOLIMOD GILENYA

FLUDARABINE PHOSPHATE OFORTA

IBANDRONATE SODIUM IV SOLN BONIVA

ILOPROST INHALATION VENTAVIS

IMATINIB MESYLATE GLEEVEC

INFLIXIMAB REMICADE

INTERFERON ALFA INTRON-A

LACOSAMIDE VIMPAT

LAMIVUDINE EPIVIR HBV

LANREOTIDE ACETATE SOMATULINE DEPOT

LANTHANUM CARBONATE FOSRENOL

LAPATINIB DITOSYLATE TYKERB

LENALIDOMIDE REVLIMID

LEUPROLIDE ACETATE LUPRON DEPOT-PED

LEUPROLIDE ACETATE FOR INJ LUPRON, LUPRON DEPOT

MARAVIROC SELZENTRY

METHYLNALTREXONE BROMIDE RELISTOR

MIFEPRISTONE KORLYM

MIGLUSTAT ZAVESCA

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NILOTINIB TASIGNA

OCTREOTIDE ACETATE SANDOSTATIN, SANDOSTATIN LAR

PARICALCITOL ZEMPLAR

PAZOPANIB HCL VOTRIENT

PEGINTERFERON ALFA-2A PEGASYS. PEGASYS PROCLICK

PEGINTERFERON ALFA-2B PEG-INTRON

PEGINTERFERON ALFA-2B SYLATRON

PRASUGREL HCL EFFIENT

RANOLAZINE RANEXA

REGORAFENIB STIVARGA

RIBAVIRIN RIBASPHERE

RIBAVIRIN & RIBAVIRIN RIBAPAK

RIBAVIRIN CAP REBETOL

RIBAVIRIN TAB COPEGUS

RIVAROXABAN XARELTO

RUFINAMIDE BANZEL

SEVELAMER CARBONATE RENVELA

SEVELAMER HCL RENAGEL

SILDENAFIL CITRATE SILDENAFIL CITRATE

SIMVASTATINA 80 mg ZOCOR

SODIUM OXYBATE XYREM

SOMATROPIN NUTROPIN

SOMATROPIN OMNITROPE

SOMATROPIN NORDITROPIN FLEXPRO

SOMATROPIN NORDITROPIN

SOMATROPIN NUTROPIN

SOMATROPIN NORDITROPIN NORDIFLEX PEN

SOMATROPIN HUMATROPE

SOMATROPIN GENOTROPIN

SOMATROPIN TEV-TROPIN

SOMATROPIN OMNITROPE

SOMATROPIN HUMATROPE

SOMATROPIN SEROSTIM

SOMATROPIN SAIZEN

SOMATROPIN ZORBTIVE

SORAFENIB TOSYLATE NEXAVAR

SUNITINIB MALATE SUTENT

TALIGLUCERASE ALFA ELELYSO

TELBIVUDINE TYZEKA

TENOFOVIR DISOPROXIL FUMARATE 300MG VIREAD

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TERIPARATIDE (RECOMBINANT) FORTEO

TIPRANAVIR APTIVUS

TOCILIZUMAB ACTEMRA

TOFACITINIB XELJANZ

TREPROSTINIL SODIUM REMODULIN

VELAGLUCERASE ALFA VPRIV

VEMURAFENIB ZELBORAF

VISMODEGIB ERIVEDGE

VORINOSTAT ZOLINZA

ZOLEDRONIC ACID IV SOLN ZOLEDRONIC ACID

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APENDICE V - TERAPIA ESCALONADA APPENDIX V - STEP THERAPY

Dentro del formulario se encuentran incluidos medicamentos asociados a las iniciales ST. ST

significa terapia escalonada donde el paciente utiliza medicamentos del primer paso antes de utilizar

los medicamentos identificados como segundo paso. En la siguiente tabla se identifican los

medicamentos del primer y segundo paso.

The formulary includes drugs associated to the ST initials. ST means step therapy, where the patient

uses step one drugs before using the drugs identified as second step. The following table identified

the medications used as first and second step.

Nombre de la Terapia

Escalonada (Step Therapy Description)

Medicamentos (Drugs)

Antihypertensive Agents Amlodipine besylate –Valsartan-HCT (Exforge, Exforge HCT) Amlodipine-Olmesartan (Azor)

Paso 1/ Step 1: Alternative #1: Calcium Channel Blockers (CCB)/Angiotensin Converting Enzymes Inhibitors (ACEI) Combinations OR ACEI/HCT Combinations OR CCB/ Angiotensin Receptor Blocker (ARB) Combinations OR ARB/HCT Combinations Alternative #2: Angiotensin Converting Enzymes Inhibitors (ACEI) OR Angiotensin Receptor Blocker (ARB) PLUS Calcium Channel Blocker (CCB) Alternative #3: Angiotensin Converting Enzymes Inhibitors (ACEI) OR Angiotensin Receptor Blocker (ARB) PLUS Diuretic or Diuretic Combination Alternative #4: Angiotensin Converting Enzymes Inhibitors (ACEI) OR Angiotensin Receptor Blocker (ARB) PLUS Diuretic OR Diuretic Combination PLUS Calcium Channel Blockers (CCB) Paso 2/ Step 2: Amlodipine besylate -Valsartan (Exforge), Amlodipine besylate –Valsartan- HCT (Exforge HCT), AmAmlodipine-Olmesartan (Azor)

Biguanides Metformin tab SR osmotic (Fortamet)

Paso 1/ Step 1: metformin immediate release (Glucophage), metformin sustained release (Glucophage XR), metformin combinations Paso 2/ Step 2: Metformin tab SR osmotic (Fortamet)

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

Paso 1/ Step 1: Biguanides, Biguanides/Combinations, Sulfonylureas, Sulfonylurea/Combinations, Glitazonas, Inhibidores de la enzima dipeptil peptidase-4 (DPP-4), Thiazolidinediones, Combinations Paso 2/ Step 2: Januvia, Janumet XR, Onglyza, Kombiglyze,Tradjenta, Jentadueto

2013-2014 | 82




Dipeptidyl Peptidase-4 (DPP-4) Inhibitors/ Statin

Paso 1/ Step 1: Biguanides, Biguanides/Combinations, Sulfonylureas, Sulfonylurea/Combinations, Thiazolidinediones, Thiazolidinediones/Combinations, Statins Paso 2/ Step 2: Juvisync

Thiazolidinediones/ Thiazolidinediones Combinations

Paso 1/ Step 1: Biguanides, Biguanides/Combinations, Sulfonylureas, Sulfonylurea/Combinations Paso 2/ Step 2: Rosiglitazone (Avandia), Rosiglitazone-metformin (Avandamet), Rosiglitazone-glimepiride (Avandaryl), Pioglitazone (Actos), Pioglitazone-metformin (Actoplus Met, Actoplus Met XR), Rosiglitazone-glimepiride (Duetact)

Aldosterone Receptor Antagonist Eplerenone (Inspra)

Paso 1/Step 1: Spironolactone (Aldactone), Spironolactone- HCT (Aldactazide) Paso 2/ Step 2: Eplerenone (Inspra)

ADHD Agents Atomoxetine (Strattera)

Paso 1/Step 1: Methylphenidate OR Amphetamines Paso 2/ Step 2: Atomoxetine (Strattera)

Antidepressants Fluoxetine HCl DR (Prozac Weekly)

Paso 1/Step 1: Fluoxetine (Prozac) Paso 2/Step 2: Fluoxetine HCl DR (Prozac Weekly)

Muscle Relaxants Cyclobenzaprine HCl (Amrix, Fexmid)

Paso 1/Step 1: Cyclobenzaprine (Flexeril) Paso 2/Step 2: Cyclobenzaprine HCl (Amrix, Fexmid)

Inhibidores de Calcineurina/ Calcineurin inhibitors

Paso 1/ Step 1: Topical corticosteroids, Lactic acid (ammonium lactate). Paso 2/ Step 2: Elidel, Protopic

Estatinas/Statins Paso 1/ Step 1: Lovastatin (Mevacor), Pravastatin Sodium (Pravachol), Simvastatin (Zocor), Atorvastatin Calcium (Lipitor) Paso 2/ Step 2: Altoprev, Crestor, Lescol, Lescol XR, Vytorin

Corticosteroides Intranasales/ Intranasal Corticosteroids

Paso 1/ Step 1: Fluticasone Propionate-Nasal, Flunisolide Paso 2/ Step 2: Beconase AQ, Rhinocort, Nasarel, Veramyst, Nasacort, Nasonex

Antihistamínicos de Baja o Ninguna Sedación /Histamine1(H1) Blocking Agents, Mildly/Non-sedating

Paso 1/ Step 1: Allegra-OTC, Fexofenadine-OTC, Allegra/D, Allegra/D OTC, Claritin-OTC, Loratadine-OTC, Claritin/D-OTC, Loratadine/D-OTC, Zyrtec-OTC, Cetirizine-OTC, Zyrtec/D-OTC, Cetirizine/D-OTC Paso 2/ Step 2: Clarinex, Clarinex D, Xyzal, Levocetirizine

Alergias Oculares/Ocular Allergies - OTC First

Paso 1/ Step 1: Alaway OTC, Claritin Eye OTC, Zaditor OTC, Zyrtec Itchy OTC. Paso 2/ Step 2: Optivar, Emadine, Elestat, Patanol, Pataday, Alocril.

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Inhibidores de la Bomba de Protones/ Proton Pump Inhibitors

Paso 1/ Step 1: Prilosec-OTC, Omeprazole-OTC, Omeprazole-RX, Pantoprazole-RX, Prevacid 24HR OTC Zegerid OTC Paso 2/ Step 2: Aciphex, Protonix, Prevacid, Nexium

Bifosfonatos/ Bisphosphonates

Paso 1/ Step 1: Alendronate (Fosamax) Paso 2/ Step 2: Actonel, Actonel with Calcium, Atelvia, Boniva, Fosamax soln, Fosamax Plus D

Bloqueadores del Receptor de Angiotensina (ARBs)/Angiotensin Receptor Blockers (ARB)

Paso 1/ Step 1: Avapro (Irbesartan), (Irbesartan HCT), Avalide, Valsartan (Diovan), Valsartan HCT (Diovan HCT) Losartan (Cozaar), Losartan Potassium (Hyzaar) Paso 2/ Step 2:, Atacand, Atacand HCT, Benicar, Benicar HCT, Micardis, Micardis HCT, Teveten, Teveten HCT

Programa de terapia escalonada aplica a algunas cubiertas. Comuniquese al Departamento de Servicios al Cliente para saber si su cubieta de farmacia tiene este programa. Step therapy program applies to some pharmacy benefit. Communicate to the Customer Service Department to see if your pharmacy benefit applies this program.

2013-2014 | 84

APENDICE VI - PRODUCTOS OTC APPENDIX VI - OTC PRODUCTS

Dentro del formulario se encuentran incluidos medicamentos OTC. La siguiente tabla enumera

cuales son estos productos.

The formulary includes OTC drugs. The following table enumerates which are those products.

Categoria Category

Producto Product

Limitación Limit

H1 BLOCKING AGENTS, MIDLY/NON-SEDATING

ALAVERT® / ALAVERT-D® OTC

ALLEGRA® / ALLEGRA-D® OTC

CETIRIZINE / CETIRIZINE-D OTC

CLARITIN® / CLARITIN-D OTC

FEXOFENADINE / FEXOFENADINE-D OTC

LORATADINE / LORATADINE-D OTC

ZYRTEC® / ZYRTEC-D® OTC

OCULAR ALLERGIES ALAWAY® OTC

ZADITOR® OTC OTC

PROTON PUMP INHIBITORS

LANSOPRAZOLE OTC OTC

OMEPRAZOLE OTC OTC

PREVACID 24H® OTC

PRILOSEC® OTC OTC

ZEGERID® OTC OTC

Nota: Triple-S, Inc., en su programa de cubierta para medicamentos OTC, requiere una receta para el despacho de los mismos. Note: Triple-S, Inc. requires a prescription for dispensing OTC drugs included in their OTC Coverage Program.

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APENDICE VII – SOLICITUD DE EXCEPCION MÉDICA APPENDIX VII – Medical Exception Application

Nombre del Paciente y Representante Personal (si aplica): __________________________________

Núm. Contrato ______________________ Núm. de Grupo: ____________________

Se solicita la aprobación de:

Medicamento no está incluido en el formulario

Cubierta continuada para medicamento que se descontinuar

Excepción a un procedimiento de manejo de medicamento (ei, terapia escalonada)

Excepción a un procedimiento de limitación de dosis

Razones para la solicitud de excepción médica:

En el formulario no figura un medicamento clínicamente aceptable para tratar la condición del

paciente.

El medicamento que procede conforme a la terapia escalonada es ineficaz para la condición o

el paciente, es probable que cause daño al paciente o y ya el paciente se encontraba en un

nivel más avanzado bajo otro plan médico.

La dosis disponible para medicamento probablemente es ineficaz para la condición o el

paciente.

Historial breve del paciente:

Diagnóstico primario relacionado con el medicamento de receta objeto de la solicitud (incluya código y

descripción):

Descripción de la necesidad médica de medicamento para el cual se solicita la excepción:

(Incluya hoja adicional de ser necesario)

____________________________________ __________________________

Nombre de la Persona que expide la receta # de Proveedor (NPI)

____________________________________ __________________________

Firma Fecha

Forma: CSS-AS-04-002

2013-2014 | 86

Tabla de Contenido /Table of Contents

PREFACIO ................................................................................................................... 3

INTRODUCCIÓN ......................................................................................................... 5

DERMATOLOGICALS (DERMATOLÓGICOS) ............................................................ 7

Acne (Acné) ........................................................................................................................... 7

ANESTHETICS (ANESTÉSICOS) ............................................................................. 20

ANTI-ADDICTION/SUBSTANCE AUSE TREATMENT AGENTS (TRATAMIENTO DE ABUSO DE SUSTANCIAS/CONTRA LA ADDICION) ................................................ 20

Opioid Antagonist (Antagonista de Opioides) .................................................................... 20

ANTI-INFECTIVES (ANTI-INFECCIOSOS) ............................................................... 20

Antifungals (Antifungales) .................................................................................................. 20

Antimarials (Antimaláricos) ................................................................................................ 20

Antiparasitics (Antiparasitarios) .......................................................................................... 20

Antituberculosis (Antituberculosis) ..................................................................................... 21

Antivirals (Antivirales) ........................................................................................................ 21

Antiherpes Virus (Infecciones Herpéticas) ...................................................................... 21

HIV/AIDS (VIH/SIDA) ................................................................................................... 21

Influenza (Influenza) ........................................................................................................ 22

Miscellaneous (Misceláneos) ........................................................................................... 22

Cephalosporins (Cefalosporinas) ......................................................................................... 22

First Generation (Primera Generación) ............................................................................ 22

Second Generation (Segunda Generación) ...................................................................... 23

Third Generation (Tercera Generación) ........................................................................... 23

Macrolides (Macrólidos) ..................................................................................................... 23

Miscellaneous (Misceláneos) .............................................................................................. 23

Penicillins (Penicilinas) ....................................................................................................... 24

Quinolones (Quinolonas) ..................................................................................................... 25

Sulfonamides (Sulfonamidas) .............................................................................................. 25

Tetracyclines (Tetraciclinas) ............................................................................................... 25

CANCER (CÁNCER) .................................................................................................. 25

Alkylating Agents (Agentes Alquilantes) ............................................................................ 25

Androgens/Estrogens/Progestins (Andrógenos/Estrógenos/Progestinas) ........................... 25

Androgens (Andrógenos) ................................................................................................. 25

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Antiandrogens (Antiandrógenos) ..................................................................................... 25

Antiestrogens (Antiestrógenos) ........................................................................................ 25

Aromatase Inihibitor (Inihibidores de la Aromatasa) ...................................................... 26

Progestins (Progestinas) ................................................................................................... 26

Antimetabolites (Antimetabólitos) ...................................................................................... 26

Immunosuppressives (Inmunosupresores) .......................................................................... 26


CARDIOVASCULARS (CARDIOVASCULARES) ...................................................... 26

Antiarrhythmics (Antiarrítmicos) ........................................................................................ 26

Antihyperlipidemics (Antihiperlipidémicos) ....................................................................... 26

Antihypertensives (Antihipertensivos) ................................................................................ 27

ACE Inhibitors (Inhibidores de la Enzima Convertidora de Angiotensina) .................... 27

Alpha-Adrenergic Receptor Blockers (Bloqueadores del Receptor Alfa-Adrenérgico) .. 27

Angiotensin Receptor Blockers (ARBs) (Bloqueadores del Receptor de la Angiotensina)

.......................................................................................................................................... 27

Beta Blockers (Bloqueadores Beta) ................................................................................. 28

Calcium Channel Blockers (Antagonistas de los Canales de Calcio) .............................. 28

Centrally Acting Antiadrenergics (Antiadrenérgicos de Acción Central) ....................... 29

Combinations (Combinaciones) ....................................................................................... 29

Diuretics (Diuréticos) ....................................................................................................... 30

Vasodilators (Vasodilatores) ............................................................................................ 31

Glycosides (Glicósidos) ....................................................................................................... 31

CENTRAL NERVOUS SYSTEM (SISTEMA NERVIOSO CENTRAL) ........................ 31

Alzheimer (Alzheimer) ........................................................................................................ 31

Analgesics/Narcotics/Combinations (Analgésicos/Narcóticos/Combinaciones) ................ 31

Antianxiety/Hypnotics (Ansiolíticos/Hipnóticos) ............................................................... 33

Anticonvulsants (Anticonvulsivos) ..................................................................................... 34

Antiparkinsons (Antiparkinson) .......................................................................................... 35

Anticholinergics (Anticolinérgicos) ................................................................................. 35

COMT Inhibitors (Inhibidores de COMT) ...................................................................... 35

Dopamine Receptor Agonists (Agonistas del Receptor de Dopamina) ........................... 35

Dopaminergics (Dopaminérgicos) ................................................................................... 35

Dopaminergics - COMT Inhibitors (Dopaminérgicos - Inhibidores de COMT) ............. 35


Antivertigo/Antiemetic (Antivértigo/Antieméticos) ........................................................... 36

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Migraine (Migraña) ............................................................................................................. 36


Psychotropics (Sicotrópicos) ............................................................................................... 37

Antidepressants (Antidepresivos) .................................................................................... 37

Antipsychotics (Antisicóticos) ......................................................................................... 38

Attention Deficit and Hyperactivity (Déficit de Atención e Hiperactividad) .................. 39


Mood Stabilizers (Estabilizadores del Ánimo) ................................................................ 40

DERMATOLOGICALS (DERMATOLÓGICOS) .......................................................... 40

Acne (Acné) ......................................................................................................................... 40

Antibacterials, Topicals (Antibacterianos, Tópicos) ........................................................... 41

Antifungals, Topical (Antifungales, Tópicos) ..................................................................... 41

Antivirals, Topical (Antivirales, Tópicos) ........................................................................... 42

Corticosteroids, Topical (Corticosteroides, Tópicos) .......................................................... 42

High Potency (Alta Potencia)........................................................................................... 42

Low Potency (Baja Potencia) ........................................................................................... 42

Medium Potency (Mediana Potencia) .............................................................................. 42

Very High Potency (Muy Alta Potencia) ......................................................................... 43

Dermatologicals, Orals (Dermatológicos, Orales) .............................................................. 43


Rosacea (Rosácea) ............................................................................................................... 44

Scabicides/Pediculicides (Escabicidas/Pediculosis) ............................................................ 44

Topical Anesthetics (Anestésicos Tópicos) ......................................................................... 44

Wound Care (Cuidado de Heridas) ..................................................................................... 44

EAR/NOSE/THROAT (OÍDO/NARIZ/GARGANTA) .................................................... 44

Mouth/Throat (Boca/Garganta) ........................................................................................... 44

Otics (Oticos) ....................................................................................................................... 45

ENDOCRINOLOGY (ENDOCRINOLOGÍA) ............................................................... 45

Corticosteroids (Corticosteroides) ....................................................................................... 45

Diabetes (Diabetes) .............................................................................................................. 46

Antihyperglycemics (Antihiperglicémicos) ..................................................................... 46

Antihyperglycemics, Others (Antihiperglicémicos, Otros) ............................................. 47


Androgens (Andrógenos) ................................................................................................. 48

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Others (Otros)................................................................................................................... 48

Thyroid (Tiroides) ............................................................................................................... 48

Antithyroid (Antitiroideos) .............................................................................................. 48

Thyroid Hormones (Hormonas Tiroideas) ....................................................................... 48

ENZYME REPLACEMENTS/MODIFIERS (REEMPLAZO DE ENZIMAS/MODIFICADORES) ................................................................................... 49

Enzyme Replacements/Modifiers (Reemplazo de Enzimas/Modificadores) ...................... 49

Urea Cycle Disorder Treatment (Desorden del Ciclo de Urea) ....................................... 49

GASTROENTEROLOGY (GASTROENTEROLOGÍA) ............................................... 49

Antidiarrheals (Antidiarreicos) ............................................................................................ 49

Antispasmodics (Antiespasmódicos) ................................................................................... 49

Antiulcers (Úceras) .............................................................................................................. 49

H2 Blockers (Antagonistas H2) ....................................................................................... 49


Proton Pump Inhibitors (PPI`s) (Inhibidores de la Bomba de Protónes) ......................... 50

Digestive Enzymes (Enzimas Digestivas) ........................................................................... 50

Laxatives (Laxantes) ............................................................................................................ 50


OBSTETRICS/GYNECOLOGY (OBSTETRICIA/GINECOLOGÍA) ............................. 51

Estrogens/Progestins (Estrógenos/Progestinas) ................................................................... 51

Combinations, Estrogens (Combinaciones, Estrógenos) ................................................. 51

Estrogens (Estrógenos)..................................................................................................... 52

Progesterones (Progesteronas) ......................................................................................... 52


Osteoporosis (Osteoporosis) ............................................................................................ 52

Others (Otros)................................................................................................................... 52

Topicals (Tópicos) ............................................................................................................... 52

Transdermal Patch (Parchos Transdermales) ................................................................... 52

Vaginal, Topical (Vaginales, Tópicos) ................................................................................ 53

Antifungals (Antifungales)............................................................................................... 53

Hormonal Replacement (Reemplazo Hormonal) ............................................................. 53

OPHTHALMICS (OFTÁLMICOS) ............................................................................... 53

Allergy (Alergia) ................................................................................................................. 53

Antihistamines (Antihistamínicos)................................................................................... 53

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Antihistamines - Mast Cell Stabilizers (Antihistamínicos -Estabilizadores de Mastocitos)

.......................................................................................................................................... 53

Mast Cell Stabilizers (Estabilizadores de Mastocitos) ..................................................... 53

Antibiotics (Antibióticos) .................................................................................................... 53

Corticosteroids (Corticosteroides) ....................................................................................... 54

Glaucoma (Glaucoma) ......................................................................................................... 55

Adrenergic Selective Agonists (Agonistas Adrenérgicos Selectivos) ............................. 55

Beta Blockers (Bloqueadores Beta) ................................................................................. 55

Carbonic Anhydrase Inhibitors (Inhibidores de la Anhidrasa Carbónica) ....................... 55


Miotics (Mióticos) ............................................................................................................ 55

Prostaglandins (Prostaglandinas) ..................................................................................... 55



............................................................................................................................................. 55

RESPIRATORY (RESPIRATORIOS) ......................................................................... 56

Antihistamines/Decongestants (Antihistamínicos/Descongestionantes) ............................. 56

Descongestants (Descongestionantes) ............................................................................. 56

Low Sedation Antihistamines (Anti-histamínicos de Baja Sedación) ............................. 57

Non-Sedative Antihistamines (Anti-histamínicos No Sedantes) ..................................... 57

Antitussives/Expectorants (Antitusivos/Expectorantes) ...................................................... 57

Asthma (Asma) .................................................................................................................... 59

Anticholinergics (Anticolinérgicos) ................................................................................. 59

Beta Agonists, Inhaled (Agonistas Beta, Inhalados) ........................................................ 59

Beta Agonists, Oral (Agonistas Beta, Orales) .................................................................. 59


Inhaled Corticosteroids (Corticosteroides Inhalados) ...................................................... 60


Xanthines (Xantinas) ........................................................................................................ 60

Intranasal Steroids (Esteroides Intranasales) ....................................................................... 60

Others (Otros) ...................................................................................................................... 60

SKELETAL-MUSCULE SYSTEM/RHEUMATOLOGY (SISTEMA MÚSCULO-ESQUELETAL/REUMATOLOGÍA) ............................................................................. 61

Gout (Gota) .......................................................................................................................... 61


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Rheumatology (Reumatología) ........................................................................................ 61

Muscle Relaxants (Relajantes Musculares) ......................................................................... 61


............................................................................................................................................. 62

UROLOGY (UROLOGÍA) ........................................................................................... 62

5-Alpha Reductase Inhibitors (Inhibidores de la 5-Alpha Reductasa) ................................ 62

Analgesics (Analgésicos) .................................................................................................... 62

Antispasmodics (Antiespasmódicos) ................................................................................... 62

Cholinergics (Colinérgicos) ................................................................................................. 63

Erectil Dysfunction (Disfunción Eréctil) ............................................................................. 63


Renal Disease (Enfermedad Renal) ..................................................................................... 63

VITAMINS/HEMATINICS/ELECTROLYTES (VITAMINAS/HEMATÍNICOS/ELECTRÓLITOS) ........................................................ 63

Alkalinizer (Alcalinizantes) ................................................................................................. 63

Antidotes (Antídotos) .......................................................................................................... 64

Coagulant Therapy (Terapia de Coagulación) ..................................................................... 64

Anticoagulant (Anticoagulantes) ..................................................................................... 64

Antiplatelet (Antiplaquetarios) ........................................................................................ 64


Vitamins/Hematinics/Other Supplements (Vitaminas/Hematínicos/Otros Suplementos) .. 64

Nutrients (Nutrientes)....................................................................................................... 64

Vitamins (Vitaminas) ....................................................................................................... 65

CHRONIC AND HIGH RISK CONDITIONS (CONDICIONES CRÓNICAS Y DE ALTO RIESGO) .................................................................................................................... 66

Anti-Infectives (Anti-Infecciosos) ....................................................................................... 66

Antifungals (Antifungales)............................................................................................... 66


Antivirals (Antivirales) ........................................................................................................ 66

Hepatitis B (Hepatitis B) .................................................................................................. 66

Hepatitis C (Hepatitis C) .................................................................................................. 66

HIV/AIDS (VIH/SIDA) ................................................................................................... 66

Biotechnology (Biotecnología) ............................................................................................ 66

Enzyme Replacement (Remplazo Enzimático) ................................................................ 66

Erythropoiesis Stimulating Proteins (Estimulantes de la Eritopoyesis) ........................... 67

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Multiple Sclerosis (Esclerosis Múltiple) .......................................................................... 67

Myeloid Stimulating Agents (Estimulantes Mieloides) ................................................... 67

Cancer (Cáncer) ................................................................................................................... 67

Alkylating Agents (Agentes Alquilantes) ........................................................................ 67

Antimetabolites (Antimetabolitos) ................................................................................... 67


Cardiovasculars (Cardiovasculares) .................................................................................... 68

Central Nervous System (Sistema Nervioso Central) ......................................................... 68

Endocrinology (Endocrinológicos) ...................................................................................... 68

Growth Hormones (Hormonas de Crecimiento) .............................................................. 68


Others (Otros)................................................................................................................... 69

Obstetrics/Gynecology (Obstetricia/Ginecología) .............................................................. 69

Osteoporosis (Osteoporosis) ............................................................................................ 69

Respiratory (Respiratorios) .................................................................................................. 69

Others (Otros)................................................................................................................... 69

Skeletal-Muscule System/Rheumatology (Sistema Músculo-Esqueletal/Reumatología) ... 69


Vitamins/Hematinics/Other Supplements (Vitaminas/Hematínicos/OtrosSuplementos) ... 69

Chelating Agents (Agentes Quelantes) ............................................................................ 69

Coagulant Therapy (Terapia de Coagulación) ................................................................ 69

APENDICE I - LIMITES DE CANTIDAD ..................................................................... 71

APENDICE II - LIMITES DE ESPECIALIDAD ........................................................... 73

APENDICE III - LIMITES DE EDAD ........................................................................... 76

APENDICE IV - PREAUTORIZACION ....................................................................... 77

APENDICE V - TERAPIA ESCALONADA .................................................................. 81

APENDICE VI - PRODUCTOS OTC ......................................................................... 84

2013-2014 | 93

PARTE III / PART III

INDICE / INDEX

8

8-MOP, 43

A

A, 55 abacavir, 21 abatacept, 69 ABILIFY, 38 acarbose, 46 ACCOLATE, 60 ACCUNEB, 59 ACCUPRIL, 27 ACCURETIC, 30 ACCUTANE, 43 acebutolol, 28 ACEON, 27 acetaminophen, 31, 32, 36, 61 acetazolamide, 30 acetic, 45, 53 acetohydroxamic, 63 acetylcysteine, 57 ACETYLCYSTEINE, 57 ACHROMYCIN, 25 ACID, 53 ACIPHEX, 50 acitretin, 43 aclidinium, 59 ACLOVATE, 42 acrivastine, 56 ACTEMRA, 69 ACTIGALL, 51 ACTIQ, 32 ACTIVELLA, 51 Actonel, 83 ACTONEL, 52 ACTOPLUS, 46 ACTOS, 47 ACULAR, 56 acyclovir, 21, 42 ADAGEN, 67 ADALAT, 28 adalimumab, 69 adapalene, 7, 40 adapalene-benzoyl, 40 ADDERALL, 39 adefovir, 66 ADVAIR, 60 ADVATE, 70 ADVICOR, 27 AFINITOR, 68

AGGRENOX, 64 AGRYLIN, 64 AK-CON, 55 AKNE-MYCIN, 40 ALA-QUIN, 41 ALAVERT, 84 ALAWAY, 84 Alaway OTC, 82 ALBAFORT, 65 ALBATUSSIN, 58 albendazole, 20 ALBENZA, 20 albuterol, 59 albuterol., 59 albuterol.., 59 albuterol..., 59 alclometasone, 42 ALCORTIN, 41 ALDACTAZIDE, 30 ALDACTONE, 30 ALDARA, 43 ALDEX-CT, 56 ALDOMET, 29 ALDORIL, 29 alendronate, 52 Alendronate, 83 ALINIA, 21 ALKERAN, 25 ALLEGRA, 57, 84 Allegra/D, 82 Allegra/D OTC, 82 ALLEGRA-D, 56, 57 Allegra-OTC, 82 allopurinol, 61 almotriptan, 36 ALOCRIL, 53 ALOMIDE, 53 alosetron, 51 ALPHAGAN, 55 ALPHANATE, 70 alprazolam, 33 ALREX, 54 ALTACE, 27 ALTOPREV, 27 altretamine, 25 aluminum, 43 ALUPENT, 59 amantadine, 22, 35, 36 AMANTADINE, 22, 36 AMARYL, 47 ambenonium, 61 AMBIEN, 34 ambrisentan, 68

amcinonide, 42 AMCINONIDE, 42 AMERGE, 37 AMICAR, 64 amiloride, 30 aminocaproic, 64 aminophylline, 60 AMINOPHYLLINE, 60 aminosalicylic, 21 amiodarone, 26 AMITIZA, 51 amitriptyline, 38, 39 amlodipine, 28, 29 amoxapine, 38 AMOXAPINE, 38 amoxicillin, 24, 50 AMOXIL, 24 amphetamine, 39 AMPHOTEC, 66 amphotericin, 66 ampicillin, 24 AMPICILLIN, 24 AMPYRA, 67 ANAFRANIL, 38 anagrelide, 64 ANALPRAM-HC, 51 ANAMANTLE, 51 ANAPROX, 62 anastrozole, 26 ANCOBON, 20 ANDRODERM, 48 ANDROGEL, 48 ANDROID, 25, 48 ANDROXY, 25, 48 anidulafungin, 66 ANSAID, 62 anthralin, 43 antihemophilic, 69, 70 antiinhibitor, 70 antiseptic, 44 ANTIVERT, 36 ANZEMET, 36 apap, 36 APIDRA, 47 apixaban, 64 apraclonidine, 55 aprepitant, 36 APRESOLINE, 31 APRISO, 51 APTIVUS, 22 AQUASOL, 65 ARALEN, 20 ARANESP, 67

2013-2014 | 94

ARAVA, 61 AREDIA, 69 ARICEPT, 31 ARIMIDEX, 26 aripiprazole, 38 ARIXTRA, 64 ARMOUR, 48 AROMASIN, 26 ARTANE, 35 artemether, 20 ASACOL, 51 ascorbic, 65 ASCORBIC, 65 ASMANEX, 60 aspirin, 32, 36, 64 ASTELIN, 60 ATABEX, 53 Atacand, 83 ATACAND, 27, 29 atazanavir, 22 Atelvia, 83 atenolol, 28, 29 ATIVAN, 34 atomoxetine, 39 atorvastatin, 26 Atorvastatin, 82 atovaquone, 20, 23 ATRIPLA, 21 atropine, 49, 55 ATROPINE, 49 ATROVENT, 59 AUBAGIO, 67 augmented, 42 AUGMENTIN, 24 auranofin, 61 Avalide, 83 AVALIDE, 29 AVANDAMET, 46 AVANDARYL, 46 AVANDIA, 47 Avapro, 83 AVAPRO, 27 AVC, 53 AVELOX, 25 AVINZA, 33 AVODART, 62 AVONEX, 67 AXERT, 36 AXID, 49 axitinib, 68 AYGESTIN, 52 azathioprine, 26, 61 azelaic, 7, 40, 44 azelastine, 53, 60 AZELEX, 7, 40 azithromycin, 23 AZOPT, 55 AZOR, 29

AZULFIDINE, 51

B

bacitracin, 20, 41, 53, 54 BACITRACIN, 20, 53 baclofen, 61 BACTROBAN, 41 balsalazide, 51 BANZEL, 35 BARACLUDE, 66 b-complex, 65 B-COMPLEX, 65 becaplermin, 44 beclomethasone, 60 BECONASE, 60 belladonna, 49 benazepril, 27, 29 BENEFIX, 70 BENEMID, 61 Benicar, 83 BENICAR, 28, 30 BENTYL, 49 BENZACLIN, 40 BENZAMYCIN, 40 BENZIQ, 40 benzocaine, 44, 45 benzocaine-pe-antipyrine, 45 benzonatate, 57 BENZOTIC, 45 benzoyl, 7, 40 BENZOYL, 40 benztropine, 35 BETAGAN, 55 betain, 66 betamethasone, 42, 45 BETAPACE/BETAPACE, 26 BETASERON, 67 betaxolol, 28, 55 bethanechol, 63 BETIMOL, 55 BETOPTIC-S, 55 bexarotene, 26, 43 BIAXIN, 23 bicalutamide, 25 BICILLIN, 24 BICITRA, 63 Biguanides, 81, 82 BILTRICIDE, 21 bimatoprost, 55 BIOBRON, 58 BIOHIST, 56 bismuth, 50 bisoprolol, 28, 29 BLEPH-10, 54 BLEPHAMIDE, 54 BLOCADREN, 28 Boniva, 83

BONIVA, 52, 69 bosentan, 68 BOSULIF, 68 bosutinib, 68 BRETHINE, 59 brimonidine, 55 brinzolamide, 55 bromocriptine, 35 brompheniramine, 56, 57 BRONDIL, 60 BROVEX, 56 BUCALSEP, 44 budesonide, 51, 60 bumetanide, 30 BUMEX, 30 BUPHENYL, 67 buprenorphine, 20, 77 BUPRENORPHINE, 20, 77 buprenorphine&naloxone, 20,

77 bupropion, 37 BUSPAR, 33 buspirone, 33 busulfan, 25 butalbital, 32, 36 BUTALBITAL, 36 butenafine, 41 BYDUREON, 47 BYETTA, 47

C

cabergoline, 48 CADUET, 29 CAFERGOT, 37 CALAN, 28 calcipotriene, 43 calcitonin,, 48, 52 calcitriol, 43, 65 CALCITRIOL, 65 calcium, 63 CANASA, 51 CANCIDAS, 66 candesartan, 27, 29 capecitabine, 67 CAPEX, 42 CAPITAL/CODEINE, 32 CAPOTEN, 27 CAPOZIDE, 29 captopril, 27, 29 CARAC, 43 CARAFATE, 50 carbamazepine, 34 CARBATROL, 34 carbetapentane, 57 carbidopa, 35 carbinoxamine, 57 CARBOFED, 59

2013-2014 | 95

CARDENE, 28 CARDIZEM, 28 CARDURA, 27 carisoprodol, 61 CARMOL, 44 CARMOL-HC, 44 CARNITOR, 64 carteolol, 55 carvedilol, 28 CASODEX, 25 caspofungin, 66 CATAFLAM, 62 CATAPRES, 29 CECLOR, 23 CEDAX, 23 CEENU, 25 cefaclor, 23 cefadroxil, 22, 23 cefdinir, 23 cefditoren, 23 cefixime, 23 cefpodoxime, 23 cefprozil, 23 ceftibuten, 23 CEFTIN, 23 ceftriaxone, 23 cefuroxime, 23 CEFZIL, 23 CELEBREX, 62 celecoxib, 62 CELESTONE, 45 CELEXA, 37 CELLCEPT, 26 CELONTIN, 34 CENESTIN, 52 cephalexin, 23 CEPHALEXIN, 23 CEREZYME, 67 cetirizine, 56, 57 CETIRIZINE, 84 Cetirizine/D-OTC, 82 Cetirizine-OTC, 82

Ch

CHEMET, 64 CHERATUSSIN, 59 chloral, 33 chlorambucil, 25 chlordiazepoxide, 33, 40 chlorhexidine, 44 chloroquine, 20 chlorothiazide, 30 chlorphen, 56, 57 chlorpheniramine, 56 chlorphen-pe-

methscopolamine, 57 chlorpromazine, 39

chlorpropamide, 47 chlorthalidone, 30 CHLORTHALIDONE, 30 chlorzoxazone, 61 cholestyramine, 26 choline, 26, 61

C

CIALIS, 63 ciclopirox, 41 cilastatin, 23 cilostazol, 64 CILOXAN, 54 cimetidine, 49 cinacalcet, 63 CIPRO, 25, 45 CIPRODEX, 45 ciprofloxacin, 25, 45, 54 citalopram, 37 CITROLITH, 63 CLARAVIS, 43 CLARINEX, 57 CLARINEX-D, 56 clarithromycin, 23 CLARITIN, 57, 84 Claritin Eye OTC, 82 Claritin/D-OTC, 82 CLARITIN-D, 56 Claritin-OTC, 82 clemastine, 57 CLEMASTINE, 57 CLEOCIN, 23, 40, 53 clidinium, 49 CLIMARA, 52, 53 clindamycin, 23, 40, 53 CLINORIL, 62 clioquinol, 41 clobetasol, 43 CLODERM, 42 clomipramine, 38 clonazepam, 34 clonidine, 29 clopidogrel, 64 clorazepate, 33 clorcortolone, 42 CLORPRES, 29 clotrimazole, 20, 41 clozapine, 38 CLOZARIL, 38 coagulation, 70 COARTEM, 20 codeine, 32, 57 CODEINE, 32 COGENTIN, 35 COLAZAL, 51 colchicine, 61

COLCHICINE/PROBENECID, 61

COLCRYS, 61 colesevelam, 27 COLESTID, 27 colestipol, 27 colistin, 45 collagenase, 44 COMBIGAN, 55 COMBIPATCH, 53 COMBIVENT/, 59 COMBIVIR, 22 COMPAZINE, 36 COMPLERA, 22 COMTAN, 35 CONCERTA, 39 CONDYLOX, 44 COPAXONE, 67 COPEGUS/, 66 CORDARONE, 26 CORDRAN, 42 COREG, 28 CORGARD, 28 CORTANE-B, 45 CORTEF, 46 CORTENEMA, 51 CORTIFOAM, 51 cortisone, 45 CORTISPORIN, 41, 45, 54 CORTISPORIN-TC, 45 CORTONE, 45 CORZIDE, 30 COSOPT, 55 COUMADIN, 64 COVERA-HS, 28 COZAAR, 27 CREON, 50 CRESTOR, 27 cresyl, 45 CRESYLATE, 45 CRINONE, 53 CRIXIVAN, 22 crizotinib, 68 CROLOM, 53 cromolyn, 51, 53, 60 CUPRIMINE, 61 CUTIVATE, 43 cyanocobalamin, 65 CYANOCOBALAMIN, 65 cyclobenzaprine, 61 CYCLOCORT, 42 CYCLOGYL, 55 cyclopentolate, 55 cyclophosphamide, 25 cycloserine, 21 cyclosporine, 55 CYMBALTA, 37 cyproheptadine, 57

2013-2014 | 96

CYPROHEPTADINE, 57 CYSTADANE, 66 CYSTAGON, 66 cysteamine, 66 CYSTOSPAZ, 62 CYTOMEL, 48 CYTOTEC, 50 CYTOVENE, 22 CYTOXAN, 25

D

D.H.E., 36 dabigatran, 64 dalfampridine, 67 DALLERGY, 56, 57 DALMANE, 34 dalteparin, 64 danazol, 48, 52 DANOCRINE, 48, 52 DANTRIUM, 61 dantrolene, 61 dapsone, 23 DAPSONE, 23 DARAPRIM, 20 darbepoetin, 67 darunavir, 22 dasatinib, 68 DAYPRO, 62 DDAVP, 48 DECADRON, 54 DECLOMYCIN, 25 DECON-A, 56 DECON-G, 58 deferasirox, 64 deferiprone, 69 delavirdine, 21 DELZICOL, 51 DEMADEX, 30 demeclocycline, 25 DEMEROL, 33 DENAVIR, 42 denosumab, 69 DEPACON, 35 DEPAKENE, 35, 40 DEPAKOTE, 34, 36, 40 DEPO-MEDROL, 46 DEPO-TESTOSTERONE, 48 DERMA-SMOOTHE, 42 DERMATOP, 43 DERMOTIC, 45 desipramine, 38 desloratadine, 56, 57 desmopressin, 48, 69 DESMOPRESSIN, 48 desonide, 42 DESOWEN, 42 desoximetasone, 42

DESOXYN, 39 DESPEC, 58 DESPEC-EXP, 59 DESPEC-PD, 58 DESQUAM, 7 DESYREL, 37 DETROL, 63 dexamethasone, 45, 54 DEXAMETHASONE, 45 dexchlorpheniramine, 56 DEXCHLORPHENIRAMINE, 56 DEXEDRINE, 39 dexmethylphenidate, 39 dextroamphetamine, 39 dextromethorphan, 57, 58 dextrose, 64 DEXTROSE/SODIUM, 64 DEXTROSTAT, 39 DIABETA, 47 DIABINESE, 47 DIAMOX, 30 DIASTAT, 34 diazepam, 33, 34 diazoxide, 48 diclofenac, 55, 62 dicloxacillin, 24 DICLOXACILLIN, 24 dicyclomine, 49 didanosine, 21 DIDRONEL, 48 DIFFERIN, 7, 40 diflorasone, 42 DIFLUCAN, 20, 66 diflunisal, 62 DIFLUNISAL, 62 digestive, 50 digoxin, 31 DIGOXIN, 31 dihydroergotamine, 36 DILANTIN, 35 DILATRATE, 31 DILAUDID, 33 diltiazem, 28 Diovan, 83 DIOVAN, 28, 30 DIPENTUM, 51 diphenhydramine, 56, 57 DIPHENHYDRAMINE, 57 diphenoxylate, 49 DIPROLENE, 42 DIPROSONE, 42 dipyridamole, 64 DISALCID, 62 disopyramide, 26 DITROPAN, 62 DIURIL, 30 divalproex, 34, 36, 40 dolasetron, 36

DOLOGESIC, 61 DOMEBORO, 45 DONATUSSIN, 58 donepezil, 31 DONNATAL, 49 DORAL, 34 dornase, 69 DORYX, 25 dorzolamide, 55 DOSTINEX, 48 DOVONEX, 43 doxazosin, 27 doxepin, 38, 41 doxercalciferol, 63 doxycycline, 25 DOXYCYCLINE, 25 DRISDOL, 65 DRITHO-SCALP, 43 dronabinol, 36 DROXIA, 26 DRYSOL, 43 DUETACT, 46 DULERA, 60 duloxetine, 37 DURAGESIC, 32 DURICEF, 22, 23 dutasteride, 62 DYAZIDE/MAXZIDE, 30 DYLIX, 60 DYNACIN, 25 DYNACIRC, 28 DYNACIRC-CR, 28 dyphylline, 60 dyphylline-guaifenesin, 60 DYRENIUM, 30

E

E.E.S., 23 E.E.S./ERYPED, 23 EAR-GESIC, 45 EC-NAPROSYN, 62 econazole, 41 ED, 56 ED-A-HIST, 58 EDECRIN, 30 EDURANT, 21 efavirenz, 21 EFFEXOR, 37 EFFIENT, 64 EFUDEX, 43 ELAVIL, 38 ELDEPRYL, 35 ELELYSO, 67 eletriptan, 36 Elidel, 82 ELIMITE, 44 ELIQUIS, 64

2013-2014 | 97

ELIXOPHYLLIN, 60 ELMIRON, 63 ELOCON, 43 elvitegravir, 22 EMADINE, 53 EMCYT, 26 emedastine, 53 EMEND, 36 EMLA, 44 emollient, 43 emtricitabine, 22 EMTRIVA, 22 enalapril, 27, 29 ENBREL, 69 enfuvirtide, 66 ENJUVIA, 52 enoxaparin, 64 entacapone, 35 entecavir, 66 ENTOCORT, 51 ENULOSE, 50 enzalutamide, 25 EPIDUO, 40 EPIFOAM, 44 EPIVIR, 22, 66 eplerenone, 30 epoetin, 67 EPOGEN, 67 epoprostenol, 68 eprosartan, 27, 29 EPZICOM, 21 EQUAGESIC, 32 EQUANIL, 34 ERAXIS, 66 ergocalciferol, 65 ergoloid, 37 ERGOMAR, 36 ergotamine, 36, 37 ERIVEDGE, 68 erlotinib, 68 ERYGEL, 40 ERY-TAB, 23 ERYTHROCIN, 23 erythromycin, 23, 40, 54 ERYTHROMYCIN, 23, 40 escitalopram, 38 estazolam, 33 esterified, 51 ESTRACE, 52, 53 estradiol, 51, 52, 53 estramustine, 26 ESTRASORB, 52 ESTRATEST, 51 estrogens,, 51, 52, 53 estropipate, 52 ESTROPIPATE, 52 etanercept, 69 ethacrynic, 30

ethambutol, 21 ethinyl, 52 ethionamide, 21 ethosuximide, 34 ethotoin, 34 etidronate, 48 etodolac, 62 etoposide, 26 etravirine, 21 EULEXIN, 25 everolimus, 68 EVISTA, 52 EXELDERM, 42 EXELON, 31 exemestane, 26 exenatide, 47 EXFORGE, 29 EXJADE, 64 EXPECTUSS, 57 EXTAVIA, 67 ezetimibe, 27 Ezetimibe-Simvastatin, 82 ezogabine, 34

F

factor, 70 famciclovir, 21 famotidine, 49 FAMVIR, 21 FARESTON, 25 FEIBA, 70 felbamate, 34 FELBATOL, 34 FELDENE, 62 felodipine, 28 FEMARA, 26 Femecal, 53 FEMHRT, 52 FEMTRACE, 52 fenofibrate, 27 fenoprofen, 62 fentanyl, 32 FENTANYL, 32 FENTORA, 32 ferric, 65 FERRIPROX, 69 fexofenadine, 56, 57 FEXOFENADINE, 84 Fexofenadine-OTC, 82 filgrastim, 67 FINACEA, 44 finasteride, 62 fingolimod, 67 FIORICET, 32, 36 FIORICET/CODEINE, 31, 36 FIORINAL, 32, 36 FIORINAL/CODEINE, 32, 36

FLAGYL, 24 FLAREX, 54 flavoxate, 62 flecainide, 26 FLEXERIL, 61 FLOLAN, 68 FLOMAX, 63 FLONASE, 60 FLORINEF, 45 FLOVENT, 60 FLOXIN, 25, 45 fluconazole, 20, 66 flucytosine, 20 fludarabine, 67 fludrocortisone, 45 FLUMADINE, 22 flumazenil, 64 flunisolide, 60 Flunisolide, 82 fluocinolone, 42, 45 fluocinonide, 42 fluorometholone, 54 fluorouracil, 43 fluoxetine, 38 fluoxymesterone, 25, 48 fluphenazine, 39 FLUPHENAZINE, 39 flurandrenolide, 42 flurazepam, 34 flurbiprofen, 55, 62 flutamide, 25 fluticasone, 43, 60 Fluticasone, 82 fluvastatin, 27 fluvoxamine, 38 FML, 54 FOCALIN, 39 folic, 65 FOLIC, 65 FOLVITE, 65 fondaparinux, 64 FORADIL, 59 formoterol, 59 FORTEO, 69 Fosamax, 83 FOSAMAX, 52 fosamprenavir, 22 fosfomycin, 23 fosinopril, 27, 29 FOSRENOL, 63 FRAGMIN, 64 FRENADOL, 61 FROVA, 37 frovatriptan, 37 FURADANTIN, 24 furosemide, 30 FUZEON, 66

2013-2014 | 98

G

gabapentin, 34 GABITRIL, 35 galantamine, 31 ganciclovir, 22 GANI-TUSS, 58 GARAMYCIN, 41, 54 GASTRINEX, 50 GASTROCROM, 51 GEL-KAM, 45 gemfibrozil, 27 GENEXA, 58 GENOTROPIN, 68 gentamicin, 24, 41, 54 GENTAMICIN, 24 GEODON, 38 GILENYA, 67 GILTUSS, 58 glatiramer, 67 GLEEVEC, 68 glimepiride, 47 glipizide, 46, 47 glucagon, 48 GLUCAGON, 48 GLUCOPHAGE, 46 GLUCOTROL, 47 GLUCOVANCE, 46 glyburide, 46, 47 GLYCOLAX, 50 glycopyrrolate, 49 GLYCRON, 47 GLYNASE, 47 GLYSET, 46 GOLYTELY, 50 GORDON'S, 44 granisetron, 36 GRIFULVIN, 20 griseofulvin, 20 GRIS-PEG, 20 guanabenz, 29 guanfacine, 29 guanidine, 37 GUANIDINE, 37

H

halcinonide, 42 HALCION, 34 HALDOL, 38, 39 halobetasol, 43 HALOG, 42 haloperidol, 38, 39 haloprogin, 41 HALOTIN, 41 HECTOROL, 63 HELIDAC, 50 HEMOFIL, 69, 70

heparin, 64 HEPARIN, 64 HEPSERA, 66 hexachlorophene, 44 HEXALEN, 25 HIPREX/UREX, 63 HISTEX, 56 HUMALOG, 47 HUMATE-P, 70 HUMATROPE, 69 HUMIRA, 69 HUMULIN, 47 HYCODAN, 58 HYDERGINE, 37 hydralazine, 31 HYDREA, 26 hydrochlorothiazide, 31 HYDROCHLOROTHIAZIDE, 31 hydrocod, 58 hydrocodone, 32, 58 hydrocortisone, 41, 42, 43, 45,

46, 51 HYDRODIURIL, 31 hydromorphone, 33 hydroxocobalamin, 65 HYDROXOCOBALAMIN, 65 hydroxychloroquine, 20 hydroxyurea, 26 hydroxyzine, 34, 57 HYDROXYZINE, 57 hyoscyamine, 49, 62 HYTONE, 42 HYTRIN, 27 HYZAAR, 29

I

ibandronate, 52, 69 IBUDONE, 32 ibuprofen, 62 icosapent, 27 iloprost, 68 ILOTYCIN, 54 imatinib, 68 IMDUR, 31 imiglucerase, 67 imipramine, 38 imiquimod, 43 IMITREX, 37 IMODIUM, 49 IMURAN, 26, 61 indapamide, 30 INDERAL, 28 INDERIDE, 30 indinavir, 22 INDOCIN, 62 indomethacin, 62 INFED, 65

INFERGEN, 66 INFLAMASE, 55 infliximab, 69 inj, 66 INLYTA, 68 INNOHEP, 64 INSPRA, 30 insulin, 47 insulin-(pen), 47 insulin--(pen), 47 insulin-(vial), 47 insulin--(vial), 47 INTAL, 60 INTELENCE, 21 interferon, 66, 67 INTRON-A, 66 INVIRASE, 22 iodoquinol, 20, 41 IOPIDINE, 55 ipratropium, 59 irbesartan, 27, 29 Irbesartan, 83 iron, 65 IRRIGATION, 44 ISENTRESS, 21 ISMO, 31 isocarboxazid, 37 isoniazid, 21 ISONIAZID, 21 ISOPTO, 55 ISORDIL, 31 isosorbide, 31 isotretinoin, 43 isoxsuprine, 31 isradipine, 28 itraconazole, 20 ivermectin, 20

J

JANUMET, 46 Januvia, 81 JANUVIA, 48 JENTADUETO, 48 J-TAN, 56 Juvisync, 82 JUVISYNC, 46

K

KADIAN, 33 KALETRA, 22 KAON, 65 KAYEXALATE, 64 K-DUR, 65 KEFLEX, 23 KENALOG, 43, 45, 46 KEPPRA, 34

2013-2014 | 99

KERLONE, 28 ketoconazole, 20, 41 ketoprofen, 62 KETOPROFEN, 62 ketorolac, 56, 62 KETOROLAC, 62 ketotifen, 53 KETOTIFEN, 53 KLARON, 40 KLONOPIN, 34 KLOR-CON, 65 K-LYTE, 64, 65 KOATE-DVI, 70 KOMBIGLYZE, 46 KORLYM, 49 K-PHOS, 65 KRISTALOSE, 50 KYTRIL, 36

L

labetalol, 28 LAC-HYDRIN, 43 lacosamide, 34 lactic, 43 Lactic acid, 82 lactulose, 50 LAMICTAL, 34 LAMISIL, 20, 42 lamivudine, 22, 66 lamotrigine, 34 LANOXIN, 31 lanreotide, 69 lansoprazole, 50 Lansoprazole, 83 LANSOPRAZOLE OTC, 84 lanthanum, 63 LANTUS, 47 lapatinib, 68 LARIAM, 20 LARTUS, 58 LASIX, 30 latanoprost, 55 leflunomide, 61 lenalidomide, 68 LESCOL, 27 LETAIRIS, 68 letrozole, 26 leucovorin, 65 LEUCOVORIN, 65 LEUKERAN, 25 LEUKINE, 67 leuprolide, 26 levalbuterol, 59 LEVAQUIN, 25 LEVATOL, 28 LEVEMIR, 47 levetiracetam, 34

LEVITRA, 63 levobunolol, 55 levocarnitine, 64 Levocetirizine, 82 levofloxacin, 25 levorphanol, 33 LEVORPHANOL, 33 levothyroxine, 48 LEVOTHYROXINE, 48 LEVSIN, 49 LEVSINEX, 49 LEXAPRO, 38 LEXIVA, 22 LIALDA, 51 LIBRAX, 49 LIBRIUM, 33 LIDAMANTLE, 44 LIDEX, 42 lidocaine, 20, 44, 51 LIDODERM, 44 LIMBITROL, 40 linaclotide, 51 linagliptin, 47, 48 LINCOCIN, 24 lincomycin, 24 lindane, 44 LINDANE, 44 LINZESS, 51 LIORESAL, 61 liothyronine, 48 LIPITOR, 26 liraglutide, 48 lisdexamfetamine, 39 lisinopril, 27, 29 lithium, 40 LITHIUM, 40 LITHOBID, 40 LITHOSTAT, 63 LOBAC, 61 LOCOID, 43 LODINE, 62 LODOSYN, 35 lodoxamide, 53 LODRANE, 56 LOFIBRA, 27 LOMOTIL, 49 lomustine, 25 LONITEN, 31 loperamide, 49 LOPID, 27 lopinavir, 22 LOPRESSOR, 28, 30 LOPROX, 41 loratadine, 56, 57 LORATADINE, 84 Loratadine/D-OTC, 82 Loratadine-OTC, 82 lorazepam, 34

LORTAB/VICODIN, 32 losartan, 27, 29 Losartan, 83 LOTENSIN, 27, 29 loteprednol, 54 LOTREL, 29 LOTRIMIN, 41 LOTRISONE, 41 LOTRONEX, 51 lovastatin, 27 LOVAZA, 27 LOVENOX, 64 loxapine, 39 LOXITANE, 39 LOZI-FLUR, 65 LOZOL, 30 lubiprostone, 51 LUDIOMIL, 37 LUFYLLIN-GG, 60 LUMIGAN, 55 LUPRON, 26 LURIDE, 65 LUSAIR, 58 LUVOX, 38 LUXIQ, 42 LYRICA, 35 LYSODREN, 26

M

M.V.I., 65 MACROBID, 24 MACRODANTIN, 24 mafenide, 43 magnesium, 61 MALARONE, 20 maprotiline, 37 maraviroc, 21 MARINOL, 36 MARPLAN, 37 MATERNA, 53 MATULANE, 26 MAVIK, 27 MAXAIR, 59 MAXALT, 37 MAXIDEX, 54 MAXITROL, 54 mebendazole, 21 meclizine, 36 meclofenamate, 62 MECLOFENAMATE, 62 MEDROL, 46 medroxyprogesterone, 52 mefenamic, 62 mefloquine, 20 MEGACE, 26 megestrol, 26 MELLARIL, 39

2013-2014 | 100

meloxicam, 62 melphalan, 25 memantine, 31 MENEST, 52 MENTAX, 41 meperidine, 33 meprobamate, 34 MEPRON, 23 mercaptopurine, 26 mesalamine, 51 MESTINON, 37 METADATE, 39 METAGLIP, 46 metaproterenol, 59 METAPROTERENOL, 59 metaxalone, 61 metformin, 46 methadone, 33 METHADONE, 33 methamphetamine, 39 methazolamide, 30 methenamine, 63 METHERGINE, 48 methimazole, 48 METHITEST, 25, 48 methocarbamol, 61 methotrexate, 26, 61 METHOTREXATE, 26, 61 methoxsalen, 43 methscopolamine, 49 methsuximide, 34 methyclothiazide, 31 METHYCLOTHIAZIDE, 31 methyldopa, 29 methylergonovine, 48 methylnaltrexone, 51 methylphenidate, 39 methylprednisolone, 46 methyltestosterone, 25, 48 metipranolol, 55 metoclopramide, 51 metolazone, 31 metoprolol, 28, 30 METROCREAM, 44 METROGEL, 53 METROGEL/, 44 metronidazole, 24, 44, 53 MEVACOR, 27 mexiletine, 26 MEXILETINE, 26 MIACALCIN, 48, 52 micafungin, 66 Micardis, 83 MICARDIS, 28, 30 miconazole, 53 MICONAZOLE, 53 MICRO-K/SLOW-K, 65 MICRONASE, 47

MIDAMOR, 30 midazolam, 34 midodrine, 29 MIDRIN, 36 mifepristone, 49 miglitol, 46 miglustat, 67 MIGRALAM, 36 MIGRANAL, 36 MIMYX, 43 MINIPRESS, 27 MINOCIN, 25 minocycline, 25 minoxidil, 31 mirabegron, 62 MIRAPEX, 35 mirtazapine, 37 misoprostol, 50 mitotane, 26 mitoxantrone, 68 MOBIC, 62 modafinil, 39 MODURETIC, 30 moexipril, 27, 30 mometasone, 43, 60 MONOCLATE-P, 70 MONODOX, 25 MONONINE, 70 MONOPRIL, 27, 29 montelukast, 60 MONUROL, 23 morphine, 33 MORPHINE, 33 MOTOFEN, 49 MOTRIN, 62 MOXEZA, 54 moxifloxacin, 25, 54 MS, 33 MST, 61 MUCINEX, 58 multiple, 65 mupirocin, 41 MYAMBUTOL, 21 MYCAMINE, 66 MYCELEX, 20 MYCOBUTIN, 21 MYCOLOG, 41 mycophenolate, 26 MYCOSTATIN, 41 MYDRIACYL, 55 MYLERAN, 25 MYRBETRIQ, 62 MYSOLINE, 35 MYTELASE, 61

N

nabumetone, 62

nadolol, 28, 30 nafarelin, 48 nafcillin, 24 NAFCILLIN, 24 NAFRINSE, 45 naftifine, 41 NAFTIN, 41 NALFON, 62 naloxone, 64 NALOXONE, 64 naltrexone, 64 NAMENDA, 31 naphazoline, 55 NAPRELAN, 62 NAPROSYN, 62 naproxen, 62 naratriptan, 37 NARDIL, 37 NASACORT, 60 NASAREL, 60 NASONEX, 60 NATACYN, 54 natalizumab, 67 natamycin, 54 NAVANE, 39 NEBUPENT, 24 nedocromil, 53 nefazodone, 37 nelfinavir, 22 neomycin, 24, 54 NEOMYCIN, 24 NEOSPORIN, 54 neostigmine, 37 NEOTUSS-D, 59 nepafenac, 56 NEPTAZANE, 30 NEULASTA, 67 NEUMEGA, 67 NEUPOGEN, 67 NEUPRO, 35 NEURONTIN, 34 NEVANAC, 56 nevirapine, 21 NEXAVAR, 68 niacin, 27 NIASPAN, 27 nicardipine, 28 nifedipine, 28 NILANDRON, 25 nilotinib, 68 nilutamide, 25 nimodipine, 28 NIMOTOP, 28 nisoldipine, 28 nitazoxanide, 21 NITRO-BID, 31 NITRO-DUR, 31 nitrofurantoin, 24

2013-2014 | 101

nitroglycerin, 31 NITROLINGUAL, 31 NITROSTAT, 31 NITRO-TIME, 31 nizatidine, 49 NIZORAL, 20, 41 NOHIST-LQ, 56 NOLVADEX, 25 NORDITROPIN, 69 norethindrone, 52 NORFLEX, 61 norfloxacin, 25 NORMODYNE, 28 NOROXIN, 25 NORPACE, 26 NORPRAMIN, 38 nortriptyline, 38 NORTUSS-EX, 57 NORVASC, 28 NORVIR, 22 NOVANTRONE, 68 NOVASTART, 53 NOVOLIN, 47 NOVOLOG, 47 NOVOSEVEN, 70 NOXAFIL, 20 NULYTELY, 50 NUTROPIN, 69 nystatin, 20, 41, 53 NYSTATIN, 20, 41, 53

O

OBTREX, 53 octreotide, 69 OCUFEN, 55 OCUFLOX, 54 OCUPRESS, 55 ofloxacin, 25, 45, 54 OFORTA, 67 OGEN, 52 olanzapine, 38 olmesartan, 28, 30 olopatadine, 53, 60 olsalazine, 51 OLUX, 43 omega-3-acid, 27 omeprazole, 50 OMEPRAZOLE OTC, 84 Omeprazole-OTC, 83 omeprazole-sodium, 50 OMNICEF, 23 OMNITROPE, 69 ondansetron, 36 Onglyza, 81 ONGLYZA, 48 OPANA, 33 oprelvekin, 67

OPTIPRANOLOL, 55 OPTIVAR, 53 ORACIT, 63 ORAP, 37 ORAPRED/PEDIAPRED, 46 ORASEP, 44 ORAXYL, 25 ORENCIA, 69 orphenadrine, 61 ORPHENADRINE/ASA/CAFFE

INE, 61 ORUDIS, 62 oseltamivir, 22 OTICIN, 45 oxaprozin, 62 oxazepam, 34 oxcarbazepine, 34 oxiconazole, 41 OXISTAT, 41 oxybutynin, 62 oxycodone, 33 OXYCODONE, 33 OXYCONTIN, 33 oxymorphone, 33

P

PACERONE, 26 PALGIC, 57 PAMELOR, 38 pamidronate, 69 PAMINE, 49 pancrelipase, 50 PANDEL, 43 PANLOR, 31 PANOXYL-8, 40 pantoprazole, 50 Pantoprazole, 83 papaverine, 31 PAPAVERINE, 31 PARAFON, 61 paregoric, 49 PAREGORIC, 49 paricalcitol, 63 PARLODEL, 35 PARNATE, 37 paroxetine, 38 PASER, 21 PATADAY/, 53 PATANASE, 60 Patanol, 82 PAXIL, 38 pazopanib, 68 PCE, 23 PEDIAZOLE, 23 pegademase, 67 PEGANONE, 34 PEGASYS, 66

pegfilgrastim, 67 peginterferon, 66, 68 PEG-INTRON, 66 penbutolol, 28 penciclovir, 42 penicillamine, 61 penicillin, 24 PENICILLIN, 24 PENLAC, 41 PENTAM, 24 pentamidine, 24 PENTASA, 51 pentosan, 63 pentoxifylline, 64 PEPCID, 49 PERCOCET, 32 PERFOROMIST, 59 PERIDEX, 44 perindopril, 27 permethrin, 44 perphenazine, 39 PERPHENAZINE/AMITRIPTYL

INE, 39 PERSANTINE, 64 phenazopyridine, 62 phenelzine, 37 PHENERGAN, 36 phenobarbital, 35 PHENOBARBITAL, 35 phenyleph, 58 phenyleph-chlorphen, 58 phenyleph-dm-pyril-pot, 58 phenyleph-ephed-cpm, 58 phenylephrine, 57, 58 phenylephrine-

brompheniramine-guaifenesin, 58

phenylephrine-chlorphen-dihydrocodeine, 58

phenylephrine-chlorphen-dm, 58

phenyltoloxamine, 61 phenytoin, 35 PHISOHEX, 44 PHOSLO, 63 PHRENILIN, 32, 36 physiological, 44 PHYSIOLYTE, 44 phytonadione, 65 pilocarpine, 45, 55 PILOPINE, 55 pimozide, 37 pindolol, 28 pioglitazone, 46, 47 pirbuterol, 59 piroxicam, 62 PLAQUENIL, 20 PLAVIX, 64 PLENDIL, 28

2013-2014 | 102

PLETAL, 64 PLEXION, 40 podofilox, 44 POLYCITRA, 63 polyethylene, 50 polymyxin, 54 POLYSPORIN, 54 POLYTRIM, 54 PONSTEL, 62 posaconazole, 20 pot, 63, 64, 65 POTABA, 65 potassium, 63, 65 POTASSIUM, 63 POTIGA, 34 PRADAXA, 64 pramipexole, 35 PRAMOSONE, 44 pramoxine, 44, 45 PRANDIN, 47 prasugrel, 64 PRAVACHOL, 27 pravastatin, 27 Pravastatin, 82 praziquantel, 21 prazosin, 27 PRECOSE, 46 PRED, 55 PRED-G, 54 prednicarbate, 43 prednisolone, 46, 55 prednisone, 46 PREDNISONE, 46 PREFEST, 51 pregabalin, 35 PRELONE, 46 PREMARIN, 52, 53 PREMPRO/, 51 prenatal, 53 PREVACID, 50 PREVACID 24H, 84 Prevacid 24HR OTC, 83 PREVIDENT, 45 PREVPAC, 50 PREZISTA, 22 PRIFTIN, 21 PRILOSEC, 50 PRILOSEC OTC, 84 Prilosec-OTC, 83 primaquine, 20 PRIMAQUINE, 20 PRIMAXIN, 23 primidone, 35 PRINCIPEN, 24 PRINIVIL, 27 PRINZIDE, 29 PROAIR, 59 PROAMATINE, 29

probenecid, 61 procarbazine, 26 PROCARDIA, 28 prochlorperazine, 36 PROCRIT, 67 PROCTOCORT, 42, 51 PROCTOFOAM, 51 PROFILNINE, 70 progesterone, 52, 53 PROGLYCEM, 48 PROLASTIN, 67 PROLIA, 69 PROLIXIN, 39 PROLOPRIM, 24 promethazine, 36, 58 PROMETHAZINE, 57, 58 PROMETHAZINE/CODEINE,

58 PROMETHAZINE/DEXTROME

THORPHAN, 58 PROMETRIUM, 52 propafenone, 26 propantheline, 49 PROPANTHINE, 49 Propionate-Nasal, 82 propranolol, 28, 30 propylthiouracil, 48 PROPYLTHIOURACIL, 48 PROSCAR, 62 PROSOM, 33 PROSTIGMIN, 37 proteinase, 67 PROTONIX, 50 Protopic, 82 protriptyline, 38 PROVENTIL, 59 PROVERA, 52 PROVIGIL, 39 PROZAC, 38 pseudoephed-bromphen-dm,

59 pseudoephed-chlorphen, 59 pseudoephedrine, 59 pseudoephedrine-

dihydrocodeine-gg, 59 PSEUDOEPHEDRINE-

GUAIFENESIN, 59 PSORCON, 42 PULMICORT, 60 PULMOZYME, 69 PURINETHOL, 26 pyrazinamide, 21 PYRAZINAMIDE, 21 PYRIDIUM, 62 pyridostigmine, 37 pyridoxine, 65 PYRIDOXINE, 65 pyrilamine, 57 pyrimethamine, 20

Q

QUALAQUIN, 20 quazepam, 34 QUESTRAN, 26 quetiapine, 38 QUINAGLUTE, 26 quinapril, 27, 30 quinidine, 26 QUINIDINE, 26 quinine, 20 QVAR, 60

R

rabeprazole, 50 raloxifene, 52 raltegravir, 21 ramipril, 27 RANEXA, 31 ranitidine, 49, 50 ranolazine, 31 RAZADYNE, 31 REBIF, 67 RECLAST, 69 RECOMBINATE, 70 REFACTO, 70 REGLAN, 51 regorafenib, 68 REGRANEX, 44 RELAFEN, 62 RELAGARD, 53 RELAGESIC, 61 RELENZA, 22 RELISTOR, 51 RELPAX, 36 REMERON, 37 REMICADE, 69 REMODULIN, 68 RENAGEL, 63 RENVELA, 63 repaglinide, 47 REQUIP, 35 RESCRIPTOR, 21 reserpine, 29 RESERPINE, 29 RESTASIS, 55 RESTORIL, 34 RETIN-A, 41 RETROVIR, 22 REVATIO, 68 REVIA, 64 REVLIMID, 68 REYATAZ, 22 RHINOCORT, 60 RIBAPAK, 66 RIBASPHERE, 66 ribavirin, 66

2013-2014 | 103

RIDAURA, 61 rifabutin, 21 RIFADIN, 21 RIFAMATE, 21 rifampin, 21 rifapentine, 21 RIFATER, 21 rifaximin, 24 rilpivirine, 21 RILUTEK, 37 riluzole, 37 rimantadine, 22 rimexolone, 55 ringer's, 44 RINGER'S, 44 risedronate, 52 RISPERDAL, 38 risperidone, 38 RITALIN, 39 ritonavir, 22 rivaroxaban, 64 rivastigmine, 31 rizatriptan, 37 ROBAXIN, 61 ROBINUL, 49 ROCALTROL, 65 ROCEPHIN, 23 ROMAZICON, 64 RONDEC, 56 ropinirole, 35 ROSAC, 41 rosiglitazone, 46, 47 ROSULA, 41 rosuvastatin, 27 rotigotine, 35 ROWASA/, 51 ROXICET, 32 ROXICODONE, 33 rufinamide, 35 RYNA-12, 57 RYNA-12X, 58 RYNATAN, 56 RYNATUSS, 58 RYTHMOL, 26

S

SAIZEN, 68 SALAGEN, 45 SALEX, 44 salicylic, 44 salmeterol, 59 salsalate, 62 SAL-TROPINE, 49 SANDOSTATIN, 69 SANTYL, 44 saquinavir, 22 sargramostim, 67

saxagliptin, 48 saxagliptin&metfomin, 46 scopolamine, 36 SECTRAL, 28 selegiline, 35 SELZENTRY, 21 SEMPREX-D, 56 SENSIPAR, 63 SEPTRA, 25 SERAX, 34 SEREVENT, 59 SEROMYCIN, 21 SEROQUEL, 38 SEROSTIM, 69 sertraline, 38 SERZONE, 37 sevelamer, 63 sildenafil, 63, 68 SILVADENE, 41 silver, 41 SIMCOR, 27 SIMETYL, 49 SIMUC-GP, 58 simvastatin, 27 SINEMET, 35 SINEQUAN, 38 SINGULAIR, 60 sitagliptin, 46, 48 SKELAXIN, 61 SKELID, 52 sodium, 42, 45, 51, 59, 63, 64,

65, 67, 68 SODIUM, 59, 63, 65 SOLU-CORTEF, 46 SOLU-MEDROL, 46 SOMA, 61 somatropin, 68 somatropin., 69 somatropin-., 68 somatropin-.-, 69 somatropin.-, 69 somatropin.., 69 somatropin--.., 68 somatropin..-, 69 somatropin..., 69 SOMATULINE, 69 SOMNOTE, 33 SONATA, 34 sorafenib, 68 SORIATANE, 43 sotalol, 26 SPECTAZOLE, 41 SPECTRACEF, 23 SPIRIVA, 59 spironolactone, 30 SPORANOX, 20 SPRYCEL, 68 STALEVO, 35

stannous, 45 stavudine, 22 STAXYN, 63 STELAZINE, 39 STIMATE, 69 STIVARGA, 68 STRATTERA, 39 streptomycin, 24 STREPTOMYCIN, 24 STRIBILD, 22 STROMECTOL, 20 SUBOXONE, 20, 77 SUBUTEX, 20, 77 succimer, 64 sucralfate, 50 SULAR, 28 sulconazole, 42 sulfacetamide, 40, 41, 54 sulfadiazine, 25 SULFADIAZINE, 25 sulfamethoxazole, 25 SULFAMYLON, 43 sulfanilamide, 53 sulfasalazine, 51 sulindac, 62 sumatriptan, 37 sunitinib, 68 SUPRAX, 23 SURMONTIL, 38 SUSTIVA, 21 SUTENT, 68 SYLATRON, 68 SYMBICORT, 60 SYMMETREL, 22, 35 SYNALAR, 42 SYNAREL, 48 SYNTHROID, 48

T

tadalafil, 63 tafluprost, 55 TAGAMET, 49 taliglucerase, 67 TAMBOCOR, 26 TAMIFLU, 22 tamoxifen, 25 tamsulosin, 63 TAPAZOLE, 48 TARCEVA, 68 TARGRETIN, 26, 43 TARKA, 30 TASIGNA, 68 tazarotene, 44 TAZORAC, 44 TEGRETOL, 34 telbivudine, 66 telmisartan, 28, 30

2013-2014 | 104

temazepam, 34 TEMODAR, 67 TEMOVATE, 43 temozolomide, 67 TENEX, 29 tenofovir, 22 TENORETIC, 29 TENORMIN, 28 TERAZOL, 53 terazosin, 27 terbinafine, 20, 42 terbutaline, 59 terconazole, 53 teriflunomide, 67 teriparatide, 69 TESSALON, 57 testosterone, 48 TESTOSTERONE, 48 tetracycline, 25 tetrahydrozoline, 57 Teveten, 83 TEVETEN, 27, 29 TEV-TROPIN, 69 TEXACORT, 42 thalidomide, 68 THALITONE, 30 THALOMID, 68 THEO-24, 60 THEO-DUR, 60 theophylline, 60 thiamine, 65 THIAMINE, 65 THIOLA, 63 thioridazine, 39 thiothixene, 39 THORAZINE, 39 thyroid, 48 tiagabine, 35 TIAZAC, 28 TICLID, 64 ticlopidine, 64 TIGAN, 36 tiludronate, 52 timolol, 28, 55 TIMOPTIC, 55 TINVER, 42 tinzaparin, 64 tiopronin, 63 tiotropium, 59 tipranavir, 22 tizanidine, 61 TOBI, 66 TOBRADEX, 54 tobramycin, 54, 66 TOBRAMYCIN, 66 TOBREX, 54 tocilizumab, 69 tofacitinib, 69

TOFRANIL, 38 TOFRANIL-PM, 38 tolazamide, 47 TOLAZAMIDE, 47 tolbutamide, 47 TOLBUTAMIDE, 47 TOLECTIN, 62 TOLINASE, 47 tolmetin, 62 TOLMETIN, 62 tolterodine, 63 TOPAMAX, 35 TOPICORT, 42 topiramate, 35 TOPROL, 28 toremifene, 25 torsemide, 30 TRACLEER, 68 Tradjenta, 81 TRADJENTA, 47 tramadol, 33 trandolapril, 27, 30 TRANSDERM-SCOP, 36 TRANXENE, 33 tranylcypromine, 37 TRAVATAN, 55 travoprost, 55 trazodone, 37 TRECATOR, 21 TRENTAL, 64 treprostinil, 68 tretinoin, 26, 41 TREXALL, 26, 61 triamcinolone, 43, 45, 46, 60 TRIAMCINOLONE, 43 triamterene, 30 triazolam, 34 TRICOR, 27 trifluoperazine, 39 trifluridine, 54 TRIGLIDE, 27 trihexyphenidyl, 35 TRILAFON, 39 TRILEPTAL, 34 TRILIPIX, 26 TRILISATE, 61 trimethobenzamide, 36 trimethoprim, 24 trimipramine, 38 TRIZIVIR, 21 tropicamide, 55 TRUSOPT, 55 TRUVADA, 22 TUDORZA, 59 TUSNEL, 57, 59 TUSSAFED, 58 TUSSI-12, 57 TUSSI-12D, 58

TUSSIONEX, 58 TUSSI-ORGANIDIN, 57 TUSSI-ORGANIDIN-S, 57 TUSSI-PRES, 58 TUSSIZONE-12, 57 TUSSO-C, 57 TYKERB, 68 TYLENOL/CODEINE, 32 TYSABRI, 67 TYZEKA, 66 TYZINE, 57

U

ULTRACET, 32 ULTRAM, 33 ULTRAVATE, 43 UNIRETIC, 30 UNIVASC, 27 urea, 44 URECHOLINE, 63 URETRON, 63 URIN, 63 URISPAS, 62 UROGESIC, 63 URSO, 51 ursodiol, 51

V

VAGIFEM, 53 valacyclovir, 21 VALISONE, 42 VALIUM, 33 valproate, 35, 40 valproic, 35, 40 valsartan, 28, 30 Valsartan, 83 VALTREX, 21 VANCOCIN, 24 vancomycin, 24 VANTIN, 23 vardenafil, 63 VASCEPA, 27 VASERETIC, 29 VASOCIDIN, 54 VASODILAN, 31 VASOTEC, 27 VAZOL-D, 56 VECTICAL, 43 VEETIDS, 24 velaglucerase, 67 vemurafenib, 68 venlafaxine, 37 VENTAVIS, 68 VENTOLIN, 59 VEPESID, 26 Veramyst, 82

2013-2014 | 105

VERAMYST, 60 verapamil, 28, 29 VERELAN, 28, 29 VERMOX, 21 VERSED, 34 VERTIN-32, 36 VESANOID, 26 VEXOL, 55 VFEND, 20, 66 VIAGRA, 63 VIBRAMYCIN, 25 VIBRAMYCIN/VIBRATAB, 25 VICOPROFEN, 32 VICTOZA, 48 VIDEX, 21 VIGAMOX, 54 VIMPAT, 34 VIRACEPT, 22 VIRAMUNE, 21 VIRAMUNE/, 21 VIRAZOLE, 66 VIREAD, 22 VIROPTIC, 54 VISICOL, 51 VISKEN, 28 vismodegib, 68 VISTARIL, 34 vitamin, 65 VITAMIN, 65 VIVACTIL, 38 VIVELLE-DOT, 53 VOLTAREN, 55, 62 VOLTAREN-XR, 62 VOPAC, 32 voriconazole, 20, 66 vorinostat, 68 VOSOL, 45 VOSOL-HC, 45 VOSPIRE, 59 VOTRIENT, 68 VPRIV, 67 VYTONE, 41

VYTORIN, 27 VYVANSE, 39

W

warfarin, 64 water, 44 WELCHOLl, 27 WELLBUTRIN, 37 WESTCORT, 43 WYTENSIN, 29

X

XALATAN, 55 XALKORI, 68 XANAX, 33 XARELTO, 64 XELJANZ, 69 XELODA, 67 XERAC-AC, 43 XIFAXAN, 24 XOPENEX, 59 XTANDI, 25 XYLOCAINE, 20, 44 XYNTHA, 70 XYREM, 68

Y

YODOXIN, 20

Z

Zaditor OTC, 82 ZADITOR OTC, 84 zafirlukast, 60 zaleplon, 34 ZANAFLEX, 61 zanamivir, 22 ZANTAC, 49, 50 ZARONTIN, 34

ZAROXOLYN, 31 ZAVESCA, 67 ZEBETA, 28 ZEGERID, 50 Zegerid OTC, 83 ZEGERID® OTC, 84 ZELBORAF, 68 ZEMPLAR, 63 ZERIT, 22 ZETIA, 27 ZIAC, 29 ZIAGEN, 21 zidovudine, 22 zileuton, 60 ZIOPTAN, 55 ziprasidone, 38 ZITHROMAX, 23 ZMAX, 23 ZOCOR, 27 ZODERM, 40 ZOFRAN, 36 zoledronic, 69 ZOLINZA, 68 zolmitriptan, 37 ZOLOFT, 38 zolpidem, 34 ZOMIG, 37 ZONALON, 41 ZONEGRAN, 35 zonisamide, 35 ZORBTIVE, 68 ZOVIRAX, 21, 42 ZYDONE, 32 ZYFLO, 60 ZYLOPRIM, 61 ZYPREXA, 38 ZYRTEC, 57, 84 Zyrtec Itchy OTC, 82 Zyrtec/D-OTC, 82 ZYRTEC-D, 56 Zyrtec-OTC, 82

lista de medicamentos asegurados y encargados de grupo ......se ofrece también como una alternativa...

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