Appendix XI <strong>ADAP</strong> Formularies by State/Territory
Alabama <strong>ADAP</strong> FORMULARIES ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx), lamivudine (Epivir, 3TC), lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, HIVID), zidovudine (AZT, Retrovir). PIs- amprenavir (Agenerase), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Fortovase, Invirase). NnRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), fluconazol (Difulcan), ganciclovir (Cytovene), lecovorin, sulfatrim DS (Bactrim, Septra). Other OIs- epoetin alfa (Procrit), dapsone, valganciclovir (Valcyte). Hepatitis C- none. Alaska ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx, Videx EC), lamivudine (Epivir, 3TC), lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, HIVID), zidovudine (AZT, Retrovir). PIs- amprenavir (Agenerase), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Fortovase, Invirase). NnRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune). Other- hydroxyurea (Hydrea). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), cidofovir (Vistide), clarithromycin (Biaxin), famciclovir (Famvir), fluconazole (Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), isoniazid (INH), itraconazole (Sporonox), leucovorin, pyrazinamide, pyrimethamine (Daraprim, Fansidar), rifampim, sulfadiazine, TMP/SMX (Bactrim) Other OIs- amphotericin B, atovaquone, ciprofloxacin, clindamycin, clotrimazole (Mycelex), dapsone, ethambutol, fomivirsen, ketoconazole, nystatin, pentamidine (aerolsolized), pyridoxine, rifabutin. Hepatitis C- none. TREATMENTS FOR METABOLIC DISORDERS Hyperlipidemia- atorvastatin calcium (Lipitor), gemfibrozil (Lopid), pravastatin sodium (Pravachol). Wasting- testosterone (depotest, patches and gel, oxandrin, deca-durabolin, or delatestry). ALL OTHERS diphenox/atr sulf (Lomotil), gabapentin (Neurontin), hepatitis A Vaccine (2 doses), hepatitis B Vaccine (3 doses), influenza (annually), loperamide (Imodium), pneumococcal Vaccine, prochlorperazine (Compazine), varicella zoster immune globulin. Arizona ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx, Videx EC), lamivudine (Epivir, 3TC), lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, HIVID), zidovudine (AZT, Retrovir). PIs- amprenavir (Agenerase), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Fortovase). NnRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune). Other- hydroxyurea (Hydrea). OI DRUGS PHS “A1 OI”s- acyclovir, azithromycin (Zithromax), clarithromycin (Biaxin), pyrimethamine (Daraprim), TMP/SMX (Bactrim). Other OIs- dapsone, pentamidine (NebuPent), rifabutin (Mycobutin), trimethoprim. Hepatitis C- none. Arkansas New drugs added since June 2000 indicated in bold. ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx), lamivudine (Epivir, 3TC), lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, HIVID), zidovudine (AZT, Retrovir). PIs- amprenavir (Agenerase), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Fortovase, Invirase). NnRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), clarithromycin (Biaxin), famciclovir (Famvir), fluconazole (Diflucan), itraconazole (Sporonox), leucovorin, pyrimethamine (Daraprim), sulfadiazine, TMP/SMX (Bactrim, Septra). Other OIs- amoxicillin/clavulanate (Augmentin), atovaquone (Mepron), cephalexin (Keflex), ciprofloxacin (Cipro), clindamycin (Cleocin), clofazimine (Lamprene), clotrimazole (Mycelex), dapsone, doxycycline, erythromycin, ethambutol (Myambutol), griseofulvin (Fulvicin), ketoconazole (Nizoral), metronidazole, nystatin, ofloxacin (Floxin), paromomycin (Humatin), terbenafine (Lamisil), valacyclovir (Valtrex). Hepatitis C- none.