reachout 2018 formulary - daytonreachout.org · reachout 2018 formulary - alpha list drug name...

REACHOUT 2018 FORMULARY - Alpha List

DRUG NAME

DOSAGE

FORM DRUG TYPE ALT NAME

Acetaminophen 325 mg (MaPap, Q-Pap) Tablet Analgesic Tylenol

Acyclovir 400 mg Tablet Antiviral Zovirax

Advair Diskus 500mcg/50mcg *sample* Inhaler Respiratory

Fluticasone/

salmeterol

Alcaine 0.5% ophthalmic *sample* Solution Ophthalmic, anestheticProparacaine

Albuterol Soln for Nebulizer 0.083% Solution Respiratory

Allopurinol 300 mg Tablet Anti-Gout Zyloprim

Amitriptyline 10mg Tablet Antidepressant Elavil

Amitriptyline 25 mg Tablet Antidepressant Elavil

Amitriptyline 50mg Tablet Antidepressant Elavil

Amitriptyline 150 mg Tablet Antidepressant Elavil

Amlodipine 2.5 mg Tablet Antihypertensive Norvasc

Amlodipine 5 mg Tablet Antihypertensive Norvasc

Amlodipine 10 mg Tablet Antihypertensive Norvasc

Amitiza 8mcg *sample* Capsule GI Agents Lubiprostone

Amitiza 24mcg *sample* Capsule GI Agents Lubiprostone

Amoxicillin 125 mg/5mL Suspension Anti-Infective Amoxil

Amoxicillin 250 mg Capsules Anti-infective Amoxil

Amoxicillin 250 mg/5mL Suspension Anti-Infective Amoxil

Amoxicillin 400mg/5mL Suspension Anti-infective Amoxil

Amoxicillin 500 mg Capsules Anti-Infective Amoxil

Amoxicillin 875 mg Tablet Anti-Infective Amoxil

Amoxicillin/Clavulanate 400mg/57mg /5ml Suspension Anti-Infective Augmentin

Amoxicillin/Clavulanate 500mg/125mg Tablet Anti-Infective Augmentin

Amoxicilin/Clavulanate 600mg/42.9mg/5ml Suspension Anti-infective Augmentin

Amoxicillin/Clavulanate 875mg/125mg Tablet Anti-Infective Augmentin

Anoro Ellipta *sample* Inhaler Respiratory

umeclindimium

/vilanterol

Antibiotic Ointment (Bacitracin) Ointment Anti-Infective, Topical (Bacitracin)

Antifungal Cream (Clotrimazole 1%) Cream Antifungal, topical Lotrimin

Apidra *sample* Vials Insulin Glulisine

Aricept 10 mg *sample* Tablet Anti-dementia Donepezil

Aripiprazole 2mg *sample* Tablet Antipsychotic Abilify

rev 2/20/2018


DRUG NAME

DOSAGE


Aripiprazole 5mg *sample* Tablet Antipsychotic Abilify

Artificial Tears ophth ointment Ointment OTC

Artificial Tears solution Solution OTC

Asmanex HFA 100 mcg *sample* Inhaler Respiratory Mometasone

Asmanex HFA 200mcg *sample* Inhaler Respiratory Mometasone

Aspirin 325mg Tablet Analgesic

Aspirin 81mg chewable - clinic use only Tablet Analgesic

Aspirin 81mg Tablet Analgesic

Atenolol 25 mg Tablet Antihypertensive Tenormin

Atorvastatin 20 mg *sample* Tablet Cholesterol inhibitorLipitor

Atorvastatin 80mg Tablet Cholesterol inhibitorLipitor

Ayr saline nasal gel *sample* Gel Respiratory

Ayr saline nasal mist *sample* Mist Respiratory

Ayr saline nasal rinse kit *sample* Rinse Respiratory

Azithromycin 100mg/5ml Suspension Anti-infective Zithromax

Azithromycin 200mg/5ml Suspension Anti-infective Zithromax

Azithromycin 250mg Zpack Dose pack Anti-infective Zithromax

Azithromycin 250mg Tablet Anti-infective Zithromax

Azithromycin 500mg Tablet Anti-infective Zithromax

Baclofen 10mg *sample* Tablet Muscle relaxant Lioresal

Benzonatate 100 mg Capsules Cough Suppressants Tessalon Perles

Betamethasone valerate 0.1% *sample* Ointment Steroid, Topical Diprolene

Bisacodyl 5mg Tablet Laxative Ducolax

Boniva 150 mg *sample* Tablet Osteoporosis Ibandronate

Brilinta 60mg *sample* Tablet Antiplatelet agent Ticagrelor

Brilinta 90mg *sample* Tablet Antiplatelet agent Ticagrelor

Bumetanide 1mg Tablet Anti-infective Bumex

Bumetanide 2 mg Tablet Anti-infective Bumex

Bupropion SR 150mg *sample* Tablet Antidepressant Wellbutrin SR

Buspirone 10 mg Tablet Anxiolytics Buspar

Bydureon 2mg pen Pens Antidiabetic, GLP-1 agonistExenatide

Bystolic 20 mg *sample* Tablet Beta Blocker Nebivolol


rev 2/20/2018


DRUG NAME

DOSAGE



Calamine Lotion Lotion Topical

Carbamazeprine 200 mg Tablet Anticonvulsant Tegretol

Carvedilol 3.125mg *sample* Tablet Beta Blocker Coreg

Carvedilol 6.25 mg Tablet Beta Blocker Coreg

Carvedilol 12.5 mg Tablet Beta Blocker Coreg

Carvedilol 25 mg Tablet Beta Blocker Coreg

Cefdinir 125mg/5ml Suspension Anti-infective Omnicef

Cefdinir 250mg/5ml Suspension Anti-infective Omnicef

Ceftriaxone 250mg injectable Injectable Anti-infective Rocephin

Ceftriaxone 500mg injectable Injectable Anti-infective Rocephin

Celebrex 100mg Capsule NSAID Celecoxib

Celecoxib 200mg Capsule NSAID Celebrex

Cephalexin 250 mg Capsules Anti-infective Keflex

Cephalexin 500 mg Capsules Anti-infective Keflex

Cetirizine 10mg (All Day Allergy) Tablet Antihistimane Zyrtec

Chlorthalidone 25 mg Tablet Diuretic Hygroton

Ciprofloxacin 0.3% opth solution Solution Anti-Infective, TopicalCiloxan

Ciprofloxacin 250 mg Tablet Anti-infective Cipro

Ciprofloxacin 500 mg Tablet Anti-infective Cipro

Citalopram 20 mg Tablet Anti-depressant Celexa

Citalopram 40 mg Tablet Anti-depressant Celexa

Clindamycin 150 mg Capsules Anti-infective Cleocin

Clindamycin/tretinoin 1.2%/0.025% *sample* Gel Topical Ziana

Clonidine 0.1 mg Tablet Antihypertensive Catapres

Clonidine 0.2 mg Tablet Antihypertensive Catapres

Clopidogrel 75mg Tablet Antiplatelet Plavix

Clotrimazole 1% Cream Antifungal, Topical Lotrimin

Clotrimazole & Betamethasone *samp* Cream Antifungal, Topical Lotrisone

Combivent Respimat *sample* Inhaler Respiratory Iprat/Alb

Cyclobenzaprine 5 mg Tablet Muscle relaxant Flexeril

Cyclobenzaprine 10 mg Tablet Muscle relaxant Flexeril

Crestor 40 mg *sample* Tablet Cholesterol inhibitorRosuvastatin

rev 2/20/2018


DRUG NAME

DOSAGE


Depo-Medrol 80mg/mL *sample* Injectable Steroid

Methylprednisol

one

Depo-Provera Injectable Contraceptive

Medroxy-

progesterone

Diclofenac Gel 1% Gel Nsaid, Topical Voltaren

Dicyclomine 10 mg Capsules GI Agents Bentyl

Dicyclomine 20 mg Capsules GI Agents Bentyl

Digoxin 0.125 mg Tablet Cardiovascular Digox

Diltiazem 180 mg Capsules Calcium Channel BlockerCardizem

Diphenhydramine (Banophen) 12.5mg/5mL Syrup Antihistamine

Benadryl/

Banophen

Diphenhydramine (Banophen) 25 mg Tablet Antihistamine Benadryl

Dipyridamole 50 mg Tablet Antiplatelet Persantine

Divalproex DR 250mg Capsules Anti-Convulsant Depakote

Divalproex DR 500mg Capsules Anti-Convulsant Depakote

Docusate Sodium 100 mg Capsules Stool Softener Colace

Dulera 100mcg/5mcg *sample* Inhaler Respiratory

Mometasone/

formoterol

Dulera 200mcg/5mcg *sample* Inhaler Respiratory

Mometasone/

formoterol

Doxycycline 100 mg Capsules Anti-Infective Vibramycin

Duloxetine 30mg Capsules Anti-Depressant Cymbalta

Duloxetine 60mg Capsules Anti-Depressant Cymbalta

Dutasteride 0.5mg *sample* Capsules BPH Avodart

Earwax Drops (Debrox) Solution OTC Debrox

Edarbi 80 mg *sample* Tablet Antihypertensive Azilsartan

Eliquis 2.5mg *sample* Tablet Anticoagulant Apixaban

Eliquis 5mg *sample* Tablet Anticoagulant Apixaban

Enalapril 10 mg Tablet Ace Inhibitor Vasotec

Enoxaparin 40mg/0.4 ml Injectable Anticoagulant Lovenox

Enoxaparin 80 mg/0.8 ml Injectable Anticoagulant Lovenox

Enoxaparin 100mg/1 ml Injectable Anticoagulant Lovenox

Enoxaparin 150mg/1 ml Injectable Anticoagulant Lovenox

rev 2/20/2018


DRUG NAME

DOSAGE


Epi-Pen 0.15mg (pediatric) - clinic use only Syringe Antidote Epinephrine

Epi-Pen 0.3mg - clinic use only Syringe Antidote Epinephrine

Erythromycin Ophth 0.5% Ointment Anti-Infective, TopicalIlotycin

Escitalopram 10 mg *sample* Tablet Anti-depressant Lexapro

Escitalopram 20mg *sample* Tablet Anti-depressant Lexapro

Famotidine 20 mg Tablet GI Agents Pepcid

Farxiga 5mg *sample* Tablet Oral diabetic Agent Dapagliflozin

Farxiga 10mg *sample* Tablet Oral diabetic Agent Dapagliflozin

Fenofibrate 160mg Tablet Lipid Lowering AgentsTricor

Ferrous Sulfate 325 mg Tablet Vitamins/Minerals Iron

Flovent HFA 110mcg Inhaler Respiratory Fluticasone

Fluconazole 150 mg Tablet Antifungal Diflucan

Fluconazole 200 mg Tablet Antifungal Diflucan

Fluoxetine 10mg Capsules Anti-Depressant Prozac

Fluoxetine 20 mg Capsules Anti-Depressant Prozac

Fluticasone Propionate 50 mcg Nasal Spray Respiratory Flonase

Folic Acid 1 mg Tablet Vitamins/Minerals Vitamin B

Furosemide 20 mg Tablet Diuretic Lasix

Furosemide 40 mg Tablet Diuretic Lasix

Gemfibrozil 600 mg Tablet Lipid Lowering AgentsLopid

Gentamicin Sulfate Ophth 0.3% Solution Anti-Infective, TopicalGentak

Glimepiride 4mg Tablet Oral Diabetic AgentsAmaryl

Glipizide 10 mg Tablet Oral Diabetic AgentsGlucotrol

Glipizide 5 mg Tablet Oral Diabetic AgentsGlucotrol

Glyburide 5 mg Tablet Oral Diabetic AgentsMicronase

Griseofulvin 125mg/5ml Suspension Anti-Infective Gris-Peg

Hemorrhoidal Ointment Ointment OTC Prep-H

Humalog Vials Insulin Lispro

Humalog KwikPens 100units/ml Pens Insulin Lispro

Humalog KwikPens 200units/ml *samp* Pens Insulin Lispro

Humalog Mix 75/25 Vials Insulin Lispro

Humulin 70/30 Vials Insulin NPH/Regular

Humulin N Vials Insulin Insulin NPH

rev 2/20/2018


DRUG NAME

DOSAGE


Humulin R Vials Insulin Insulin Regular

Hydralazine 10 mg Tablet Cardiovascular Apresoline




Hydrochlorothiazide 12.5 mg Tablet Diuretic Microzide

Hydrochlorothiazide 25 mg Tablet Diuretic Microzide

Hydrocortisone 1% Ointment Ointment Steroid, Topical Cortizone

Hydrocortisone 1% Cream Cream Steroid, Topical Cortizone

Hydrocortisone 1% Lotion Lotion Steroid, Topical Cortizone

Hydrocortisone 2.5 % Ointment Ointment Steroid, Topical Cortizone

Hydrocortisone 2.5% Cream Cream Steroid, Topical Cortizone

Hydrocortisone 2.5% Lotion Lotion Steroid, Topical Cortizone

Hydroxychloroquine 200mg Tablet Anti-malaria Plaquenil

Hydroxyzine HCL 25 mg Tablet Antihistamine Atarax

Hydroxyzine Pamoate 25 mg Capsules Antihistamine Vistaril

Hydroxyzine Pamoate 50 mg Capsules Antihistamine Vistaril

Ibuprofen Children's Oral Susp 100/5 *sam Suspension NSAID Motrin

Ibuprofen 200 mg Tablet NSAID Motrin




Indomethacin 25 mg Capsules Anti-Gout Indocin

Indomethacin 50mg Capsules Anti-Gout Indocin

Invokamet XR 50/500 mg *sample* Tablet Oral-Diabetic AgentsCana+Met




Ipratropium & Albuterol Soln Nebulizer Vials Respiratory Duo-Neb

Ipratropium 0.02% Soln Nebulizer Vials Respiratory

Isoniazid 300mg Tablets Anti-Tubercular AgentLaniazid

Isosorbide Mononitrate ER 30 mg Tablet Cardiovascular Imdur

rev 2/20/2018


DRUG NAME

DOSAGE


Janumet 50/500 *sample* Tablet Oral Diabetic AgentsSit+ Metformin

Janumet 50/1000 *sample* Tablet Oral Diabetic AgentsSit+ Metformin

Janumet XR 50/1000 *sample* Tablet Oral Diabetic AgentsSit+ Metformin

Janumet XR 100/1000 *sample* Tablet Oral Diabetic AgentsSit+ Metformin

Januvia 100 mg *sample* Tablet Oral Diabetic AgentsSitagliptin

Jentadueto 2.5/1000 mg *sample* Tablet Oral-Diabetic AgentsLin+Metformin

Jentadueto 5/1000 XR mg tab *sample* Tablet Oral-Diabetic AgentsLin+Metformin

Ketoconazole 2% Cream Cream Antifungal, Topical Xolegel

Ketoconazole 2% Shampoo Solution Antifungal, Topical

Ketotifen 2% ophthalmic (Eye itch relief) Solution Topical Zaditor

Lactulose Soln Syrup GI Agents Enulose

Lamotrigine 25mg *sample* Tablet Anti-Convulsant Lamictal



Lantus Vials Insulin Glargine

Lantus Solostar Pens Insulin Glargine

Latuda 20mg *sample* Tablet Antipsychotic

Levemir *sample* Vials Insulin

Levemir Flextouch *sample* Pens Insulin

Levetiracetam 500mg (Keppra) Tablets Anti-Convulsant Keppra

Levofloxacin 500 Tablet Anti-infective Levaquin

Levofloxacin 750 Tablet Anti-infective Levaquin

Levothyroxine 100 mcg Tablet Thyroid Synthroid

Lice Killing Shampoo Kit Solution Anti-parasitic

Lidocaine Patches 5% Patches Analgesic Lidoderm

Lidocaine 20mg/2 mL inj Injectable Analgesic

Lidocaine/prilocaine 2.5%/2.5% - clinic use only Cream Analgesic

Linezolid 600mg Tablet Anti-infective Zyvox

Linzess 72mcg *sample* Capsule GI Agents



Lisinopril 2.5 mg Tablet ACE Inhibitor Zestril

Lisinopril 5 mg Tablet ACE Inhibitor Zestril

rev 2/20/2018


DRUG NAME

DOSAGE





Loperamide 2mg Tablet AntiDiarrheal Imodium

Loratadine 10 mg Tablet Antihistamine Claritin

Loratadine Children's Liquid Syrup Antihistamine Claritin

Losartan K 50 mg Tablet Antihypertensive Cozaar

Losartan K 100 mg Tablet Antihypertensive Cozaar

Lovastatin 20 mg Tablet Cholesterol inhibitorMevacor

Lovastatin 40 mg Tablet Cholesterol inhibitorMevacor

Magnesium Citrate 296 Ml Solution Laxative

Maztim LA 420mg *sample* Tablet Calcium Channel BlockerDiltiazem ER

Meclizine 12.5 mg Tablet Antihistamine Antivert

Meclizine 25mg tablet Antihistamine Antivert

Medroxyprogesterone 10 mg Tablet Hormone Provera

Meloxicam 7.5mg Tablet Nsaid Mobic

Metformin 500 mg Tablet Oral Diabetic AgentsGlucophage

Metformin 850 mg *sample* Tablet Oral Diabetic AgentsGlucophage

Metformin 1000 mg Tablet Oral Diabetic AgentsGlucophage

Methimazole 10mg Tablet Thyroid Tapazole

Methocarbamol 500mg Tablet muscle relaxant Robaxin

Methylprednisolone 4 mg Dose Pak Steroid Medrol

Metoclopramide 10 mg Tablet GI Agents Reglan

Metoprolol succinate 50mg*sample* Tablet Beta Blocker Toprol XL

Metoprolol succinate 100mg *sample* Tablet Beta Blocker Toprol XL

Metoprolol Tartrate 25 mg Tablet Beta Blocker Lopressor

Metoprolol Tartrate 50 mg Tablet Beta Blocker Lopressor

Metoprolol Tartrate 100mg Tablet Beta Blocker Lopressor

Metronidazole 250 mg Tablet Anti-Infective Flagyl

Metronidazole 500 mg Tablet Anti-Infective Flagyl

Minocycline 50mg Tablet Anti-Infective Solodyn

Minocycline 100mg Tablet Anti-Infective Solodyn

Minoxidil 10 mg Tablet Antihypertensive

rev 2/20/2018


DRUG NAME

DOSAGE


Mobisyl pain relieving cream Cream OTC Trolamine

Montelukast 10mg Tablet Respiratory Singulair

Mucinex ER 600mg Tablet OTC Guaifenesin

Mucus Relief DM Tablet OTC

Guaifenesin/

dextromethorph

an

Thera M multivitamin Tablet Vitamins/Minerals Multivitamins

Mupirocin 2% topical Ointment Anti-Infective, TopicalBactroban

Naproxen 500 mg Tablet NSAID Naprosyn

Narcan 4mg - clinic use only Nasal Spray Opioid antagonist

Neomycin & Polymyxin B Sulfate Otic Solution Anti-Infective, TopicalCortisporin

Neomycin & Polymyxin B Sulfate Otic Suspension Anti-Infective, TopicalCortisporin

Nesina 25mg *sample* Tablet Oral Diabetic AgentsAlogliptin

Nifedipine XL 30 mg Tablet Calcium Channel BlockerProcardia

Nitrofurantoin 100 mg (Macrobid) Capsules Anti-Infective Macrobid

Nitroglycerin 0.4 mg SL Tablet Cardiovascular Nitroglycerin

Nix Lice Killing Crème Rinse Suspension Anti-parasitic Permethrin

Norethindrone (Heather) Tablet Contraceptive Nora-Be

Novolin N -see Humulin N Vials Insulin NPH

Novolog * sample* or see Humalog Insulin Aspart

Nystatin Cream 100,000 units Cream Antifungal, topical Nyamyc

Nystatin Ointment 100,000 units Ointment Antifungal, topical Nyamyc

Nystatin Oral Susp Suspension Antifungal, oral Mycostatin

Nystatin Powder 100,000 units Powder Antifungal, topical Nyamyc

Omeprazole 20mg Capsules GI Agents Prilosec

Ondansetron 4mg Tablet anti-emetic Zofran

Ondansetron 4mg odt Tablet anti-emetic Zofran

Oxybutynin CL 5 mg Tablet Urinary Tract DisorderDitropan

Pantoprazole 20mg Tablet GI Agents Protonix

Pantoprazole 40mg Tablet GI Agents Protonix

Penicillin VK 250 mg Tablet Anti-infective

Penicillin VK 500 mg Tablet Anti-infective

Penicillin VK 125mg/5mL Solution Anti-infective

rev 2/20/2018


DRUG NAME

DOSAGE


Penicillin VK 250mg/5mL Solution Anti-infective

Permethrin 5% Cream Anti-parasitic Elimite

Phenazopyridine 100 mg Tablet Urinary Tract DisorderPyridium

Phenazopyridine 200 mg Tablet Urinary Tract DisorderPyridium

Phenytoin Sodium ER 100 mg Capsules Anti-Convulsant Dilantin

Polymixin B & Trimethoprim Ophth Solution Anti-Infective, Topical

Polyethylene Glycol 3350 Powder Powder Laxative Miralax

Potassium Chloride ER 10 mEQ Tablet Cardiovascular

Potassium Chloride ER 20 mEQ Tablet Cardiovascular

Prazosin 1mg *sample* Capsule Antihypertensive Minipress

Prednisolone Oral Solution 15 mg / 5 ml Suspension Steroid Prelone

Prednisone Oral Solution 5mg/5ML Suspension Steroid

Prednisone

Intensol

Prednisone 5 mg Tablet Steroid Deltasone



Proctozone HC Rectal Cream Cream Steroid, Topical Hydrocortisone

Promethazine 25 mg Tablet anti-emetic Phenergan

Promethazine 6.25 Syrup Syrup anti-emetic Phenergan

Propranolol 10 mg Tablet Beta Blocker Inderal

Propranolol 20 mg Tablet Beta Blocker Inderal

Propranolol 80mg Tablet Beta Blocker Inderal

Propranolol ER 60 mg Capsules Beta Blocker Inderal

Quetiapine Fumarate 25mg *sample* Tablet Antipsychotic Seroquel



Ranitidine 150 mg Tablet GI Agents Zantac

Ranitidine 300 mg Tablet GI Agents Zantac

Rhinocort Allergy Spray *sample* Nasal Spray Respiratory Budesonide

Risendronate 150 mg *sample* Tablet Osteoporosis Actonel

Risperidone 1 mg *sample* Tablet Antipsychotic Risperdal

Risperidone 2 mg *sample* Tablet Antipsychotic Risperdal

Risperidone 4 mg *sample* Tablet Antispychotic Risperdal

rev 2/20/2018


DRUG NAME

DOSAGE


Robitussin DM Syrup Syrup Cough Suppressants Robafen DM

Robitussin Plain Syrup Syrup Cough Suppressants Robafen

Rosuvastatin 10mg Tablet Cholesterol inhibitorCrestor

Saxenda Injectable Antidiabetic, GLP-1 agonistLiraglutide

Senexon-S tablet Laxative Senokot-S

Senna Laxative Tabs tablet Laxative Senokot

Seroquel XR 50mg *sample* Tablet Antipsychotic

Quetiapine

fumarate

Sertraline 100mg Tablet Anti-Depressant Zoloft

Sertraline 50 mg Tablet Anti-Depressant Zoloft

Silver Sulfadiazine 1% cream Cream Topical Agent

Simvastatin 10 mg Tablet Cholesterol inhibitorZocar

Simvastatin 20 mg Tablet Cholesterol inhibitorZocar

Simvastatin 40mg Tablet Cholesterol inhibitorZocar

Soliqua 100/33 *sample* Injectable Insulin/GLP-1

Glargine/

lixisenatide

Solu Medrol 40mg/mL Injectable Steroid

Methylprednisol

one

Solu Medrol 125mg/mL Injectable Steroid

Methylprednisol

one

Spiriva Respimat 1.25mcg Inhaler Respiratory

Tiotropium

bromide

Spironolactone 25 mg Tablet Diuretic Aldactone

Spironolactone 100 mg Tablet Diuretic Aldactone

Sprintec Tablet Oral Contraceptive

Ethinyl estradiol/

norgestimate

Stiolto Respimat 2.5mcg *sample* Inhaler Respiratory

Tiotropium/

olodaterol

Sucralfate 1gm Tablet GI Agents Carafate

Sulfacetamide Sodium Ophth Solution Anti-Infective, TopicalKlaron

Sulfamethoxazole & Trimeth 200/40/5ml Suspension Anti-infective Bactrim

Sulfamethoxazole/Trimeth DS 800/160 Tablet Anti-Infective Bactrim

rev 2/20/2018


DRUG NAME

DOSAGE


Sulfasalazine DR 500mg *sample* Tablet GI Agents Azulfidine

Sumatriptan 25mg Tablet Antimigraine Imitrex

Sumatriptan 100mg Tablet Antimigraine Imitrex

Symbicort 80mcg/4.5mcg Inhaler Respiratory

Budesonide/

formoterol

Symbicort 160mcg/4.5mcg Inhaler Respiratory

Budesonide/

formoterol

Synjardy XR 5/1000mg *sample* Tablet Antidiabetic, SGLT2

Empagliflozin/m

etformin

Synjardy XR 10/1000mg *sample* Tablet Antidiabetic, SGLT2

Empagliflozin/m

etformin

Synjardy XR 12.5/1000mg *sample* Tablet Antidiabetic, SGLT2

Empagliflozin/m

etformin

Synjardy XR 25/1000mg Tablet Antidiabetic, SGLT2

Empagliflozin/m

etformin

Tamsulosin 0.4 mg Tablet Urinary Tract DisorderFlomax

Taztia XT 120mg *sample* Capsule Calcium Channel BlockerDiltiazem ER



Telmisartan 40mg Tablet Antihypertensive Micardis

Telmisartan 80mg Tablet Antihypertensive Micardis

Terazosin 2 mg Capsules Alpha 1 Blocker Hytrin

Terazosin 5 mg Capsules Alpha 1 Blocker Hytrin

Terbinafine 250 mg Tablet Antifungal Lamisil

Topiramate 25mg *sample* Tablet Anticonvulsant Topamax



Toprol XL 50mg *sample* Tablet Antihypertensive

Metoprolol

Succinate

Toujeo (glargine) *sample* Pens Insulin Glargine

Tradjenta 5 mg *sample* Tablet Oral Diabetic AgentsLinagliptin

Trazodone 50 mg Tablet Anti-Depressant Oleptro

Trazodone 100mg Tablet Anti-Depressant Oleptro

rev 2/20/2018


DRUG NAME

DOSAGE


Trazodone 150 mg Tablet Anti-Depressant Oleptro

Tresiba Flextouch *sample* Pens Insulin Degludec

Triamcinolone Acetonide 0.025% Cream Steroid, Topical Kenalog


Triamcinolone Acetonide 0.1% Ointment Steroid, Topical Kenalog


Triamterene/HCTZ 37.5 mg - 25 mg Tablet Diuretic Maxzide

Triamterene/HCTZ 75 mg/ 50 mg Tablet Diuretic Maxzide

Tri- Sprintec Tablet Oral Contraceptive

Ethinyl estradiol/

norgestimate

Triple Antibiotic Ointment 28grams Ointment Anti-Infective, Topical

Bacitracin,

Neomycin,

Polymxin B

Trulicity 0.75mg/0.5mL *sample* Injectable Antidiabetic, GLP-1 agonistDulaglutide

Trulicity 1.5mg/0.5mL *sample* Injectable Antidiabetic, GLP-1 agonistDulaglutide

Uloric 40 mg *sample* Tablet Anti-gout Febuxostat

Uloric 80 mg *sample* Tablet Anti-gout Febuxostat

Valacyclovir 500mg Tablet Antiviral Valtrex

Valacyclovir 1000mg Tablet Antiviral Valtrex

Venlafaxine 75mg Tablet Antidepressant Effexor

Venlafaxine 100mg Tablet Antidepressant Effexor

Venlafaxine ER 37.5mg *sample* Tablet Antidepressant Effexor XR

Venlafaxine ER 75mg *sample* Tablet Antidepressant Effexor XR

Venlafaxine ER 150mg *sample* Tablet Antidepressant Effexor XR

Ventolin HFA Inhaler Respiratory Albuterol

Verapamil ER 240 mg Tablet Calcium Channel BlockerCalan

Vitamin B 100 Capsules Vitamins/Minerals Thiamine

Vitamin D (ergocalciferol) 50,000 units Tablet Vitamins/Minerals

Warfarin Sodium 1 mg Tablet Anticoagulants Coumadin

Warfarin Sodium 5 mg Tablet Anticoagulants Coumadin

Xarelto 15mg *sample* Tablet Anticoagulants Rivaroxaban

Xarelto 20mg Tablet Anticoagulants Rivaroxaban

rev 2/20/2018


DRUG NAME

DOSAGE


Xigduo XR 5/1000 *sample* Tablet Oral Diabetic AgentsDap+Met

Xigduo XR 10/1000 *sample* Tablet Oral Diabetic AgentsDap+Met

rev 2/20/2018

reachout 2018 formulary - daytonreachout.org · reachout 2018 formulary - alpha list drug name...

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