Montana <strong>ADAP</strong> FORMULARIES 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 (Zovirax), azithromycin (Zithromax), clarithromycin (Biaxin), fluconazole (Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), isoniazid (INH), itraconazole (Sporonox), leucovorin (floinic acid), pyrazinamide (Rifater), pyrimethamine (Daraprim, Fansidar), rifampim (If not covered by County Health), sulfadiazine, TMP/SMX (Bactrim). Other OIs- amphotericin B (standard formulation only), atovaquone (Mepron), dapsone, ethambutol hydrochloride (Myambutol), rifabutin (Mycobutin), clotrimazole oral (Mycolex Troches), nystatin (Mycostatin), pentamidine (NebuPent/Pentam), Valacyclovir (Valtrex ). Hepatitis C- none. Nebraska 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 (Zovirax), azithromycin (Zithromax), clarithromycin (Biaxin), famciclovir (Famvir), fluconazole (Diflucan), isoniazid (Laniazid), itraconazole (Sporonox), pyrazinamide, rifampim (Rifadin), TMP/SMX (Bactrim, Septra). Other OIs- atovaquone (Mepron), ciprofloxacin (Cipro), clindamycin (Cleocin), clofazimine (Lamprene), clotrimazole (Mycelex), dapsone, ethambutol (Myambutol), ketoconazole (Nizoral), nystatin (Mycostatin), metronidazole (Flagyl), pentamidine (Pentam), rifabutin (Mycobutin), valacyclovir (Valtrex). Hepatitis C- none. TREATMENTS FOR METABOLIC DISORDERS Wasting- megestroll acetate (Megace). ALL OTHERS alprazolam (Xanax), amitriptyline (Elavil), buspirone (BuSpar), bupropion (Weflbutrin), carbamazepine (Tegretol), chlordiazepoxide (Librium), chlorpromazine (Thorazine), citalopram (Celexa), clomipramine (Anafrabil), clonazepam (Klonopin), clorazepate (Tranxene), clozapine (Clozaril), desipramine (Norpramin), diazepam (Valium), doxepin (Sinequan), droperidol (Inapsine), estazolam (Prosom), fluoxetine (Prozac), fluphenazine (Prolixin), flurazepam (Dalmane), fluvoxamine (Luvox), halazepam (Paxipam), haloperidol (Haldol), hydroxyzine (Atarax, Vistaril), imipramine (Tofranil), lithium (Lithobid), lorazepam (Ativan), loxapine (Loxitane), mesoridazine (Serentil), mirtazipine (Remeron), molindone (Moban), nefazodone (Serzone), nortriptyline (Pamelor), olanzapine (Zyprexa), oxazepam (Serax), paroxetine (Paxil), perphanazine (Trilafon), pimozide (Orap), prazepam (Centrax), prochlorperazine (Compazine), quetiapine (Seroquel), risperidone (Risperdal), sertraline (Zoloft), temazepam (Restoril), thioridazine (Mellaril), thiothixene (Navane), trazodone (Desyrel), triazolam (Halcion), trifluoperazine (Stelazine), trimipramine (Surmontil), venlaxafine (Effexor), zolpidem (Ambien). Nevada 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). Other- hydroxyurea (Hydrea). OI DRUGS PHS “A1 OI”s- acyclovir, azithromycin (Zithromax), clarithromycin (Biaxin), fluconazole (Diflucan), ganciclovir (Cytovene), itraconazole (Sporonox), leucovorin, pyrimethamine, sulfadiazine, TMP/SMX (Septra). Other OIs- ciprofloxacin (Cipro), clindamycin (Cleocin), clotrimazole (Mycelex), dapsone, erythropoietin, ethambutol (Myambutol), GCSF (Neupogen), nystatin (Nilstat), paromomycin (Humatin). Hepatitis C- none. TREATMENTS FOR METABOLIC DISORDERS Hyperlipidemia- pravastatin (Pravachol). Wasting- dronabinol (Marinol), megestrol acetate (Megace), oxandrolone (Oxandrin), testosterone. ALL OTHERS amitriptyline (Elavil), diphenoxylate/atropine (Lomotil), gabapentin (Neurontin), loperamide (Imodium), ondansetron (Zofran), pancreatic enzymes (Ultrase), prochlorperazine (Compazine), trazadone (Desyrel).
New Hampshire <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). Other- hydroxyurea (Hydrea). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), clarithromycin (Biaxin), famciclovir (Famvir), fluconazole (Diflucan), ganciclovir (Cytovene), isoniazid (Rifater), itraconazole (Sporonox), leucovorin (Wellcovorin), pyrazinamide, pyrimethamine (Daraprim), rifampim (Rimactane, Rifadin), TMP/SMX (Bactrim, Septra). Other OIs- atovaquone (Mepron), ciprofloxacin (Cipro), clindamycin (Cleocin), clotrimazole (Lotrimin, Mycelex), dapsone, ethambutol (Myambutol), ketoconazole (Nizoral), metronidazole (Flagyl), nystatin (Mycostatin), pentamidine (Pentam), primaquine, rifabutin (Mycobutin), trimethoprim (Proloprim, Trimpex), valacyclovir (Valtrex), valganciclovir (Valcyte). Hepatitis C- none. TREATMENTS FOR METABOLIC DISORDERS Hyperlipidemia- atorvastatin (Lipitor), fenofibrate (Tricor), gemfibrozil (Lopid), pravastatin (Pravachol), simvastatin (Zocor). Wasting- dronabinol (Marinol), megestrol acetate (Megace), oxandrolone (Oxandrin), testosterone (Testoderm). ALL OTHERS bupropion (Wellbutrin, Zyban), cephalexin (Keflex), cefuroxime (Ceftin), chloroquine (Aralen), citalopram (Celexa), clonazepam (Klonopin), dicloxacillin, diphenoxylate/atropine (Lomotil AD), divalproex (Depakote), famotidine (Pepcid), fluoxetine (Prozac), gabapentin (Neurontin), granisetron (Kytril), lansoprazole (Prevacid), levofloxacin (Levaquin), lorazepam (Ativan), mirtazapine (Remeron), nefazodone (Serazone), olanzapine (Zyprexa), omeprazole (Prilosec), ondansetron (Zofran), oxazepam (Serax), panrelipaxe (Ultrase), paroxetine (Paxil), penicillin (V-Cillin K), ranitidine (Zantac), risperidone (Risperdal), sertraline (Zoloft), terbinafine (Lamisil), venlafaxine (Effexor). New Jersey 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). Hepatitis C- all FDA approved drugs. ALL OTHERS Open Formulary. all FDA approved drugs are covered. Specific exclusions: cosmetics, fertility drugs, less than effective drugs, over the counter mediations. impotence treatments limited to four times a year.
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